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We were thrilled to have the opportunity to talk to PEN America's Jeremy Young about what a second Trump administration holds in store for higher education. It was an informative—and sobering—conversation. Over the next four years, we should be prepared for a tsunami of ideologically-driven threats to academic freedom, campus free expression and the basic integrity of higher education. If you would rather read than listen, there is a transcript attached below. Show NotesPEN America's *Educational Censorship* page is a terrific resourceOn Christopher Rufo, see Benjamin Wallace-Wells, “How a Conservative Activist Invented the Conflict Over Critical Race Theory,” New Yorker, June 18, 2021 and Michael Kruse, “DeSantis' Culture Warrior: ‘We Are Now Over the Walls,'” Politico, March 24, 2023. For Rufo's take on critical race theory, in his own words, see this YouTube video. Here is the full text of Executive Order 13950, which became the template for most of the anti-CRT (or “divisive concepts”) laws passed in red states. On the Stop WOKE Act, the marquee anti-CRT law signed into law by Florida Governor Ron DeSantis in 2022, check out these two Banished episodes:The Sunshine State Descends into Darkness (Again)Will Florida's "Stop WOKE Act" Hold Up in Court?Jeffrey Sachs and Jeremy Young predict the future: “For Federal Censorship of Higher Ed, Here's What Could Happen in 2025” (PEN America, January 2, 2025)For more on the phenomenon of “jawboning,” see this page from FIRE and this page from the Knight First Amendment Institute On “anticipatory obedience,” see this excerpt from Timothy Snyder's 2017 book, On Tyranny On legislative challenges to campus DEI, see the Chronicle of Higher Education DEI Legislation Tracker. (We are quite skeptical of many conventional DEI efforts but state bans are a cure that is far worse than the disease )For a deeper dive on accreditation, see Eric Kelderman, “Trump's Vision for College Accreditation Could Shake Up the Sector” (Chronicle of Higher Education, November 26, 2024)On Title VI investigations by the Office of Civil Rights, see Zach Montague, “Campus Protest Investigations Hang Over Schools as New Academic Year Begins” (New York Times, October 5, 2024)Here is the International Holocaust Remembrance Alliance definition of antisemitism. Kenneth Stern, one of the definition's main authors, explains why he is concerned it is being used to promote campus censorshipOn the prospect of a much heftier endowment tax for the country's wealthiest institutions, see Phillip Levine, “How Trump Could Devastate Our Top Colleges' Finances” (Chronicle of Higher Education, January 13, 2025). Levine addresses the normative question—should college endowments be taxed?—here. TranscriptJeff: So, we're looking forward to a second Trump administration.Jeremy: Are we looking forward to a second Trump administration?Amna: No…towards.Jeff: We are anticipating…I personally am dreading a second Trump administration.Amna: This is Banished and I'm Amna Khalid, along with my colleague Jeff Snyder. Jeff and I were delighted to have the chance to catch up with PEN America's Jeremy Young at the recent American Historical Association conference in New York City. He's one of the most informed and astute analysts of government driven censorship in higher education today. We started by asking him to tell us a little about PEN America.Jeremy: PEN America is a 102 year old organization that exists at the intersection of literature and human rights. It is one of 140 PEN centers around the world which are in a loose network of PEN Centers governed by PEN International. PEN America's mission is to celebrate literature and defend the freedoms that make it possible, of which two of the foremost are academic freedom and freedom of expression.Amna: And what's your specific role?Jeremy: I am the Director of State and Higher Education Policy at PEN America, which means that I oversee our Freedom to Learn program, which leads actions and responses to educational censorship legislation, largely from the state governments, but also from the federal government. Things like DEI bans, critical race theory restrictions, and various other types of restrictions on faculty governance and university autonomy.Amna: We're eager to hear your predictions on what the higher ed sector should be bracing for with the second Trump administration. But first, Jeremy, could you please remind us of the nature of the attacks against higher education during Trump 1.0?Jeremy: In the summer and fall of 2020, this really happened late in the first Trump administration, there was a national panic around critical race theory, and this was created by Chris Rufo and some others really as a response, a backlash, if you will, against the George Floyd protests, the Black Lives Matter movement, the popularity of the 1619 Project, and so on, this sort of moment of racial reckoning. And so Rufo and others (Rufo is a fellow at the Manhattan Institute) decided to use this term critical race theory, which of course is an academic term with a particular set of meanings but to, as he put it, decodify and recodify it, essentially weaponize it to mean things that weren't all that connected to the actual theory of critical race theory and were really just a sort of catchall for criticisms of DEI and other race-based pedagogies and ideas. And so Rufo was able to convince president Trump to issue an executive order 13950 called Race and Sex Stereotyping that laid out a list of nine divisive concepts which bore some passing resemblance to critical race theory, but really were vague, and general, and banned all sorts of practices related to race, gender, and identity, and ideas related to race, gender, and identity that were unclear and difficult to interpret. Originally, this was a restriction aimed solely at trainings in government agencies…the executive order never went into effect. It was stayed by a court and repealed on the first day of the Biden administration. But that language of the divisive concepts then began to appear in state legislatures aimed now squarely at education. At first, at K-12 institutions primarily, and over time, higher education became more and more of the target.In 2023, we started to see a shift toward sort of broad spectrum attacks on higher education, moving away from some of the direct speech restrictions of the critical race theory bans, in part because of court cases that had gone adversely for those restrictions, and instead restricting broad swaths of university governance, including DEI offices, the ability of a university to manage diversity work on its own as a sort of shared governance function, tenure restrictions on faculty governance, restrictions on curriculum, which I think are going to be very prominent in 2025.Amna: You mentioned backlash to the 2020 racial reckoning as a key factor driving the anti-CRT movement. Can you say something more about where this opposition to CRT and now DEI is coming from?Jeremy: I think that there are several causes that are inseparable from one another. I think there are people who actually do want to restrict those particular ideas on campus, who want to advance a sort of triumphalist Western canon narrative of America as the victor, and they're just very opposed to any discussions that paint the United States in any way that is not hyper-patriotic and perfect. There's absolutely some racism, some sexism, some, some discrimination, discriminatory bias that's involved.I also think that there is a real desire to simply crush university power that I think comes out of the educational realignment that we have seen over the last 10 years. Kamala Harris won college educated Americans by 14 points, and four years ago, Joe Biden won them by four, and prior to the 2016 election, there was essentially no difference between the parties, really, at any time in American history on the axis of college education. There is now a sense I think among some conservative forces that instead of the long-time conservative project of reforming universities, having more viewpoint diversity, think of the Koch Centers in various institutions. Instead they're a place where liberals go to get educated, so we should just crush them, right? So I think that's part of it. It's just the goal of taking away universities' autonomy on everything is a key component.And the third component is political gain. And that is the one that has fluctuated the most over this period. Glenn Youngkin won a come from behind victory running on criticizing critical race theory in K-12 schools. And Steve Bannon said in 2021, I think about critical race theory and I see 50 new House seats in the midterm elections. Now, when that didn't happen, I think it began to become clear that these attacks are not as salient as they were thought to be. I think in 2023 and 2024, there was a real move away from that, especially with, also with the collapse of the DeSantis presidential campaign, which was built entirely around this idea of him being, fighting the war on woke. There was a sense that, maybe you still want to do these things, but now it's going to be quiet, it's going to be stealth mode, because there's no political gain to be gotten from having a big press release around this, around the Stop WOKE Act. But the other two motivations, the motivation of restricting certain ideas about race; and the motivation of smashing the power of higher education, those have remained constant.Jeff: Very succinct and helpful. Thank you. You and your colleague Jeffrey Sachs recently wrote an informative and sobering piece about Trump's plans for higher ed in 2025 and beyond. Maybe you could tell us a little about your key predictions. The first one you mention is jawboning. What is jawboning and why should we be worried about it?Jeremy: Jawboning, put simply, is when government officials, instead of passing a law requiring someone who isn't a government official to do something, they simply browbeat or bully or threaten them into doing it. In some ways you can look at the congressional hearings as a form of jawbonings or making threats against presidents at Columbia and Harvard and so on. But the classic example is actually what we're seeing at the state level where lawmakers are simply going to university presidents and say, saying, okay, we're not going to pass a DEI ban or a curriculum restriction. We're going to simply request that you make one on your own or we'll cut your funding. Or we'll pass one next year that's worse than anything you could imagine. It's a very intimate form of censorship, right? It takes restrictions out of the legislative process where they can be challenged at a hearing; out of the judicial process where they can be challenged on constitutional grounds; and every single one of these bills has at least some constitutional infirmities. And instead makes it just a threat, right? We're gonna cut your budget. What are you gonna do about that? It's a very difficult position for presidents to be in because they don't have a lot of leverage.Jeff: I think it was Yale historian Timothy Snyder who coined the term anticipatory obedience. He said it was a dynamic that's often seen under conditions of rising authoritarianism. So you've got individuals and groups that start to make concessions they think will appease the powers that be. Is there a connection here to jawboning?Jeremy: Yes, so we talk about over compliance and pre-compliance. We're not going to comply with the letter of the law, we're going to comply with the spirit of the law. There is a law in Alabama that passed in 2024 that restricts some elements of DEI, but does not actually ban outright the DEI offices. And every university in Alabama has treated it as though it is an outright ban. And that's significant, in particular, because of the nature of these laws. You know, you go look at a set of statutes in a state legislature or the federal government, what you'll notice is that most laws are very precise. Think about traffic laws. What are you allowed to do on the road? It's very specific. You can drive this many miles an hour this particular way. There's no room for interpretation. There's no room for judgment because the goal is to make you comply with the law. These laws are intentionally vague. They ban broad swaths of ideas which are never defined in the laws.What does it mean to say, for instance, one of the divisive concepts, to say that you're not allowed to say that the United States is fundamentally racist. What does that mean? It doesn't say in the law what that means. It's left up to your interpretation, which means whoever is going to enforce that law gets to decide whether you violate it. That is actually a constitutional violation. It's against the 14th Amendment. And while the courts have found all sorts of infirmities with these laws, that's the one they've found the most consistency. Not freedom of speech, not racial discrimination but vagueness. So over-complying with a vague law is, it's difficult to avoid because these laws lend themselves to over-compliance because they're so vague. But it's also vitally important to avoid doing that.The other thing that we see is pre-compliance, which is just imagining that the legislature is going to pass a law but then whether or not they do it. We intervened with the Western Association of Schools and Colleges, one of the seven accrediting bodies because they were basically enacting what a restriction in Project 2025 that would have forbidden them to have a DEI standard for universities they accredit. And just doing it preemptively.It's not clear whether the education department is able to pass that restriction without legislation. And it's not clear whether legislation or the regulation would survive a court challenge. And they're just saying we'll just take it out. That's pre-compliance. You don't want to do that. And what we argued successfully, is that, again, even if you don't think an accreditor should have a DEI standard, we don't take a position on that. The worst time to get rid of your DEI standard is one month before a new administration that's promised to ban it tells you to. That's the moment when you put up your back and say, no, we're not going to comply with this.Jeff: Jeremy, tell us a little bit more about the new Trump administration's plans to disrupt the conventional work of accreditors.Jeremy: So higher education institutions are accredited by one of seven accrediting bodies, six of which have historically served certain regions, but now under new federal regulations the university can work with any of the seven accreditors. But they still tend to be concentrated in regions.Accreditation is really the only thing that separates a real substantive university from a diploma mill; and the way that accreditation is enforced, is that the Department of Education will only provide federal student financial aid, which 55 percent of all students receive, to schools that it recognizes as legitimate accreditors, which currently is those seven institutional accreditors. They are private or nonprofit organizations. They're run by academics. They have their pluses and minuses, but they are pretty much the guarantor of institutional quality in higher education. And if you look at Project 2025, everything that they say they want to do to higher education is focused on accreditation. They have identified these accreditors as the soft underbelly of higher education. And the simplest thing that they want to do and that they probably will at least try to do is to ban accreditors from having DEI standards, of which six of the seven currently do.But they really want to go further. What they really want to do is to undermine the system of accreditation itself by allowing any jurisdiction, any state, to either charter its own accreditor or serve as its own accreditor. So Ron DeSantis could become the accreditor for all universities in Florida. And now instead of those universities having DEI offices, he can say you cannot be accredited in the state of Florida unless you've banned DEI and basically instituted a classical curriculum, a Hillsdale style classical curriculum. It's a little more complicated than project 2025 makes it sound. Our analysis is that while they may attempt to do it through regulatory action, the process of negotiated rulemaking in the Department of Education is sufficiently complex that it would probably stop them from doing it and so that probably means that they need legislation to change the Higher Education Act, which would be subject to a filibuster.So this is something that we will be watching to see if they try to do it administratively. It may not be possible. And we'll also be watching if they try to slip it into one of those reconciliation bills that are being proposed that would be able to go through without a filibuster.Jeff: So that's how the accreditation system might be weaponized. You and Sacks also identify Title VI enforcement by the Office of Civil Rights as a key area of concern. Maybe we can break this down into its component parts. What is the Office of Civil Rights and what's Title VI?Jeremy: Sure. So the Office of Civil Rights is an office within the Department of Education that ensures that educational institutions meet the requirements of the various civil rights laws. It covers Title VI funding, which is funding that is tied to financial aid for universities, and it makes sure that institutions that are receiving federal financial aid are following these civil rights protections. It is an office does good work and we have a good relationship with the office.We have some concerns about the way that the Biden administration has been investigating and enforcing agreements with universities around antisemitism. We expect things to get far worse in the new administration. We expect that any university that has any sort of protest or any faculty member who expresses pro-Palestinian views is going to be investigated and sanctioned by the Office of Civil Rights. We expect they're going to launch lawsuits. They're going to really go after universities. So it is an office that is going to be used in some really aggressive ways to restrict speech on campus.Jeff: In terms of restricting speech, you and Sachs are especially worried about the trend on the part of colleges and universities, not to mention states and the federal government, to adopt the International Holocaust Remembrance Alliance definition of antisemitism. Why is this so concerning to you both?Jeremy: So the International Holocaust Remembrance Alliance definition of antisemitism is a very interesting document. It starts with a description that is quite thoughtful and then it gives a list of examples of things that could be forms of antisemitism or could accompany antisemitism, and that list includes things like singling out the state of Israel for special criticism that other states are not singled out for that do engage in the same actions or just you know criticizing Zionism, things like that. Which in the context of what that definition was designed for yes, sometimes when you see those statements, it's worth perking your ears up and asking, is this accompanying antisemitism or not?What the laws are doing, and this comes from a model bill that the Goldwater Institute wrote in 2016, and it's now being suffused into all these federal and state policies, is to take those examples of possible antisemitism and change it from possible to definite antisemitism. So anytime you criticize the state of Israel, it's antisemitism. And then writing that into law, saying that universities have to treat this as any instance of this broad definition of antisemitism as hate speech or as a form of harassment. The author of that definition, Kenneth Stern has repeatedly said that it is not designed to be used in that way. In fact, he said it's unconstitutional to use it in that way. And yet that's what we're seeing. So that's the concern. It's not that you shouldn't have a definition of anti Semitism, although I will say our statutes tend not to define particular types of hate speech because it's too subjective, right? This is the reason that we have definitions like severe, pervasive, and targeted for harassment. You're looking at a pattern of behavior because each individual case is protected by free expression.Jeff: I understand that the Office of Civil Rights is currently conducting dozens of Title VI investigations stemming from campus protests over the war in Gaza. There are widespread allegations of antisemitism, many of which are accompanied by competing charges of Islamophobia. How do you think we should make sense of this?Jeremy: These are complex situations. Lots of universities are getting them wrong. Some universities are being overly censorious, some not enforcing harassment protections. And it's right and proper for OCR to investigate these things. The problem is that they are not always coming up with the right findings. That they're not always protecting free expression, balancing free expression adequately with the need to protect students from harassment. We're seeing universities implement draconian time, place and manner restrictions on speech. So just the fact that OCR and the Congress are making all these threatening noises about restricting speech leads a lot of universities to do the censor's work for them.Amna: Jeremy mentioned one other thing the new Trump administration has made ramblings about, which is ramping up the endowment tax on the country's wealthiest institutions. Please see an informative Chronicle of Higher Education article by Philip Levine, linked in the show notes.What all these attacks or interventions, depending on your point of view, have in common, is that they seek to undermine the autonomy of colleges and universities. Here's Jeremy.Jeremy: University autonomy is not a principle that is very widely understood in the United States. It's much more common in Europe where there's an autonomy index and all sorts of things as a way of protecting academic freedom. But it's a vital component of academic freedom. We think about academic freedom in the U.S. primarily as being the freedom of an individual faculty member to speak their mind or to engage in their research or teaching. But, in reality, that freedom can only be protected so long as the people overseeing it, the university administration, are free from the ideological control of the government. The key here is ideological control. We aren't saying that the government doesn't have a budgetary responsibility to oversee the university, or that there isn't a role for the government in community relations, or student success, or access and completion, or any of these things. But when it comes to ideas, what ideas can be present on a campus, whether it's in the classroom, whether it's in a DEI office, anywhere on campus, that is not the government's business, and it cannot be the government's business, or ultimately everyone on campus is simply going to be currying favor with whatever political party is in charge.Amna: Jeremy, this has been wonderful and you've been so kind to give us so much time. Thank you.Jeff: Thank you. It's an absolute pleasure.Amna: That was our conversation with Jeremy Young of PEN America on what Trump 2.0 portends for higher education. As of yesterday, Trump's second term has officially begun. Keep your eyes peeled and ears tuned for what's to come next. If you liked what you heard today, be sure to help us spread the word about Banished, and don't forget to comment and rate this show.Once again, this is Banished, and I'm Amna Khalid, along with Jeff Snyder. Until next time. This is a public episode. 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In this special episode of the Oracle University Podcast, Lois Houston and Nikita Abraham, along with Principal HCM Instructor Jeff Schuster, delve into the intersection of HCM and AI, exploring the practical applications and implications of this technology in human resources. Jeff shares his insights on bias and fairness, the importance of human involvement, and the need for explainability and transparency in AI systems. The discussion also covers the various AI features embedded in HCM and their impact on talent acquisition, performance management, and succession planning. Oracle AI in Fusion Cloud Human Capital Management: https://mylearn.oracle.com/ou/learning-path/oracle-ai-in-fusion-cloud-human-capital-management-hcm/136722 Oracle Fusion Cloud HCM: Dynamic Skills: https://mylearn.oracle.com/ou/course/oracle-fusion-cloud-hcm-dynamic-skills/116654/ Oracle University Learning Community: https://education.oracle.com/ou-community LinkedIn: https://www.linkedin.com/showcase/oracle-university/ Twitter: https://twitter.com/Oracle_Edu Special thanks to Arijit Ghosh, David Wright, and the OU Studio Team for helping us create this episode. -------------------------------------------------------- 00:00 Welcome to the Oracle University Podcast, the first stop on your cloud journey. During this series of informative podcasts, we'll bring you foundational training on the most popular Oracle technologies. Let's get started! 00:26 Lois: Hello and welcome to the Oracle University Podcast! I'm Lois Houston, Director of Innovation Programs here at Oracle University, and with me, is Nikita Abraham, Team Lead of Editorial Services. Nikita: Hi everyone! Last week's conversation was all about Oracle Database 23ai backup and recovery, where we dove into instance recovery and effective recovery strategies. Today's episode is a really special one, isn't it, Lois? 00:53 Lois: It is, indeed, Niki. Of course, all of our AI episodes are special. But today, we have our friend and colleague Jeff Schuster with us. I think our listeners are really going to enjoy what Jeff has to share with us. Nikita: Yeah definitely! Jeff is a Principal HCM Instructor at Oracle University. He recently put together this really fantastic course on MyLearn, all about the intersection of HCM and AI, and that's what we want to pick his brain about today. Hi Jeff! We're so excited to have you here. 01:22 Jeff: Hey Niki! Hi Lois! I feel special already. Thanks you guys so much for having me. Nikita: You've had a couple of busy months, haven't you? 01:29 Jeff: I have! It's been a busy couple of months with live classes. I try and do one on AI in HCM at least once a month or so so that we can keep up with the latest/greatest stuff in that area. And I also got to spend a few days at Cloud World teaching a few live classes (about artificial intelligence in HCM, as a matter of fact) and meeting our customers and partners. So yeah, absolutely great week. A good time was had by me. 01:55 Lois: I'm sure. Cloud World is such a great experience. And just to clarify, do you think our customers and partners also had a good time, Jeff? It wasn't just you, right? Jeff: Haha! I don't think it was just me, Lois. But, you know, HCM is always a big deal, and now with all the embedded AI functionality, it really wasn't hard to find people who wanted to spend a little extra time talking about AI in the context of our HCM apps. So, there are more than 30 separate AI-powered features in HCM. AI features for candidates to find the right jobs; for hiring managers to find the right candidates; skills, talent, performance management, succession planning— all of it is there and it really covers everything across the Attract/Grow/Keep buckets of the things that HR professionals do for a living. So, anyway, yeah, lots to talk about with a lot of people! There's the functional part that people want to know about—what are these features and how do they work? But obviously, AI carries with it all this cultural significance these days. There's so much uncertainty that comes from this pace of development in that area. So in fact, my Cloud World talk always starts with this really silly intro that we put in place just to knock down that anxiety and get to the more practical, functional stuff. 03:11 Nikita: Ok, we're going to need to discuss the functional stuff, but I feel like we're getting a raw deal if we don't also get that silly intro. Lois: She makes a really good point. Jeff: Hahaha! Alright, fair enough. Ok, but you guys are gonna have to imagine I've got a microphone and a big room and a lot of echo. AI is everywhere. In your home. In your office. In your homie's home office. 03:39 Lois: I feel like I just watched the intro of a sci-fi movie. Jeff: Yeah. I'm not sure it's one I'd watch, but I think more importantly it's a good way to get into discussing some of the overarching things we need to know about AI and Oracle's approach before we dive into the specific features, so you know, those features will make more sense when we get there? 03:59 Nikita: What are these “overarching” things? Jeff: Well, the things we work on anytime we're touching AI at Oracle. So, you know, it starts with things like Bias and Fairness. We usually end up in a pretty great conversation about things like how we avoid bias on the front end by making sure we don't ingest things like bias-generating content, which is to say data that doesn't necessarily represent bias by itself, but could be misused. And that pretty naturally leads us into a talk about guardrails. Nikita: Guardrails? Jeff: Yeah, you can think of those as checkpoints. So, we've got rules about ingestion and bias. And if we check the output coming out of the LLM to ensure it complied with the bias and fairness rules, that's a guardrail. So, we do that. And we do it again on the apps side. And so that's to say, even though it's already been checked on the AI side, before we bring the output into the HCM app, it's checked again. So another guardrail. 04:58 Lois: How effective is that? The guardrails, and not taking in data that's flagged as bias-generating? Jeff: Well, I'll say this: It's both surprisingly good, and also nowhere near good enough. Lois: Ok, that's as clear as mud. You want to elaborate on that? Jeff: Haha! I think all it means is that approach does a great job, but our second point in the whole “standards” discussion is about the significance of having a human in the loop. Sometimes more than one, but the point here is that, particularly in HCM, where we're handling some really important and sensitive data, and we're introducing really powerful technology, the H in HCM gets even more important. So, throughout the HCM AI course, we talk about opportunities to have a human in the loop. And it's not just for reviewing things. It's about having the AI make suggestions, and not decisions, for example. And that's something we always have a human in the loop for all the time. In fact, when I started teaching AI for HCM, I always said that I like to think of it is as a great big brain, without any hands. 06:00 Nikita: So, we're not talking about replacing humans in HCM with AI. Jeff: No, but we're definitely talking about changing what the humans do and why it's more important than ever what the humans do. So, think of it this way, we can have our embedded AI generate this amazing content, or create really useful predictions, whatever it is that we need. We can use whatever tools we want to get there, but we can still expect people to ask us, “Where did that come from?” or “Does this account for [whatever]?”. So we still have to be able to answer that. So that's another thing we talk about as kind of an overarching important concept: Explainability and Transparency. 06:41 Nikita: I'm assuming that's the part about showing our work, right? Explaining what's being considered, how it's being processed, and what it is that you're getting back. Jeff: That's exactly it. So we like to have that discussion up front, even before we get to things like Gen and Non-Gen AI, because it's great context to have in mind when you start thinking about the technology. Whenever we're looking at the tech or the features, we're always thinking about whether people are appropriately involved, and whether people can understand the AI product as well as they need to. 07:11 Lois: You mentioned Gen and Non-Gen AI. I've also heard people use the term “Classic AI.” And lately, a lot more about RAG and Agents. When you're teaching the course, does everybody manage to keep all the terminology straight? Jeff: Yeah, people usually do a great job with this. I think the trick is, you have to know that you need to know it, if that makes sense. Lois: I think so, but why don't you spell it out for us. Jeff: Well, the temptation is sometimes to leave that stuff to the implementers or product developers, who we know need to have a deep understanding of all of that. But I think what we've learned is, especially because of all the functional implications, practitioners, product owners, everybody needs to know it too. If for no other reason so they can have more productive conversations with their implementers. You need to know that Classic or Non-Generative AI leverages machine learning, and that that's all you need in order to do some incredibly powerful things like predictions and matching. So in HCM, we're talking about things like predicting time to hire, identifying suggested candidates for job openings, finding candidates similar to ones you already like, suggesting career paths for employees, and finding recommended successors. All really powerful matching stuff. And all of that stuff uses machine learning and it's certainly AI, but none of that uses Generative AI to do that because it doesn't need to. 08:38 Nikita: So how does that fit in with all the hype we've been hearing for a long time now about Gen AI and how it's such a transformative technology that's going to be more impactful than anything else? Jeff: Yeah, and that can be true too. And this is what we really lean into when we do the AI in HCM course live. It's much more of a “right AI for the right job” kind of proposition. Lois: So, just like you wouldn't use a shovel to mix a cake. Use the right tool for the job. I think I've got it. So, the Classic AI is what's driving those kinds of features in HCM? The matching and recommendations? Jeff: Exactly right. And where we need generative content, that's where we add on the large language model capability. With LLMs, we get the ability to do natural language processing. So it makes sense that that's the technology we'd use for tasks like “write me a job description” or “write me performance development tips for my employee”. 09:33 Nikita: Ok, so how does that fit in with what Lois was asking about RAG and Agents? Is that something people care about, or need to? Jeff: I think it's easiest to think about those as the “what's next” pieces, at least as it relates to the embedded AI. They kind of deal with the inherent limitations of Gen and Non-Gen components. So, RAG, for example - I know you guys know, but your listeners might not...so what's RAG stand for? Lois & Nikita: Retrieval. Augmented. Generation. Jeff: Hahaha! Exactly. Obviously. But I think everything an HCM person needs to know about that is in the name. So for me, it's easiest to read that one backwards. Retrieval Augmented Generation. Well, the Generation just means it's more generative AI. Augmented means it's supplementing the existing AI. And Retrieval just tells you that that's how it's doing it. It's going out and fetching something it didn't already have in order to complete the operation. 10:31 Lois: And this helps with those limitations you mentioned? Nikita: Yeah, and what are they anyway? Jeff: I think an example most people are familiar with is that large language models are trained on this huge set of information. To a certain point. So that model is trained right up to the point where it stopped getting trained. So if you're talking about interacting with ChatGPT, as an example, it'll blow your doors off right up until you get to about October of 2023 and then, it just hasn't been trained on things after that. So, if you wanted to have a conversation about something that happened after that, it would need to go out and retrieve the information that it needed. For us in HCM, what that means is taking the large language model that you get with Oracle, and using retrieval to augment the AI generation for the things that the large language model wouldn't have had. 11:22 Nikita: So, things that happened after the model was trained? Company-specific data? What kind of augmenting are you talking about? Jeff: It's all of that. All those things happen and it's anything that might be useful, but it's outside the LLM's existing scope. So, let's do an example. Let's say you and Lois are in the market to hire someone. You're looking for a Junior Podcast Assistant. We'd like the AI in HCM to help, and in order to do that, it would be great if it could not just generate a generic job description for the posting, but it could really make it specific to Oracle. Even better, to Oracle University. So, you'd need the AI to know a few more things in order to make that happen. If it knows the job level, and the department, and the organization—already the job posting description gets a lot better. So what other things do you think it might need to know? 12:13 Lois: Umm I'm thinking…does it need to account for our previous hiring decisions? Can it inform that at all? Jeff: Yes! That's actually a key one. If the AI is aware not only of all the vacancies and all of the transactional stuff that goes along with it (like you know who posted it, what's its metadata, what business group it was in, and all that stuff)...but it also knows who we hired, that's huge. So if we put all that together, we can start doing the really cool stuff—like suggesting candidates based not only on their apparent match on skills and qualifications, but also based on folks that we've hired for similar positions. We know how long it took to make those hires from requisition open to the employee's first start date. So we can also do things like predicting time to hire for each vacancy we have with a lot more accuracy. So now all of a sudden, we're not just doing recruiting, but we have a system that accounts for “how we do it around here,” if that makes any sense. But the point is, it's the augmented data, it's that kind of training that we do throughout ingestion, going out to other sources for newer or better information, whatever it is we need. The ability to include it alongside everything that's already in the LLM, that's a huge deal. 13:31 Nikita: Ok, so I think the only one we didn't get to was Agents. Jeff: Yeah, so this one is maybe a little less relevant in HCM—for now anyway. But it's something to keep an eye on. Because remember earlier when I described our AI as having a great big brain but no hands? Lois: Yeah... Jeff: Well, agents are a way of giving it hands. At least for a very well-defined, limited set of purposes. So routine and repetitive tasks. And for obvious reasons, in the HCM space, that causes some concerns. You don't want, for example, your AI moving people forward in the recruiting process or changing their status to “not considered” all by itself. So going forward, this is going to be a balancing act. When we ask the same thing of the AI over and over again, there comes a point where it makes sense to kind of “save” that ask. When, for example, we get the “compare a candidate profile to a job vacancy” results and we got it working just right, we can create an agent. And just that one AI call that specializes in getting that analysis right. It does the analysis, it hands it back to the LLM, and when the human has had what they need to make sure they get what they need to make a decision out of it, you've got automation on one hand and human hands on the other...hand. 14:56 Have you mastered the basics of AI? Are you ready to take your skills to the next level? Unlock the potential of advanced AI with our OCI Generative AI Professional course and certification that covers topics like large language models, the OCI Generative AI Service, and building Q&A chatbots for real-world applications. Head over to mylearn.oracle.com to find out more. 15:26 Nikita: Welcome back! Jeff, you've mentioned the “Time to Hire” feature a few times? Is that a favorite with people who take your classes? Jeff: The recruiting folks definitely seem to enjoy it, but I think it's just a great example for a couple of reasons. First, it's really powerful non-generative AI. So it helps emphasize the point around the right AI for the right job. And if we're talking about things in chronological order, it's something that shows up really early in the hire-to-retire cycle. And, you know, just between us learning nerds, I like to use Time to Hire as an early example because it gets folks in the habit of working through some use cases. You don't really know if a feature is going to get you what you need until you've done some of that. So, for example, if I tell you that Time to Hire produces an estimated number of days to your first hire. And you're still Lois, and you're still Niki, and you're hiring for a Junior Podcast Assistant. So why do you care about time to hire? And I'm asking you for real—What would you do with that prediction if you had it? 16:29 Nikita: I guess I'd know how long it is before I can expect help to arrive, and I could plan my work accordingly. Jeff: Absolutely. What else. What could you do with a prediction for Time to Hire? Lois: Think about coverage? Jeff: Yeah! Exactly the word I was looking for. Say more about that. Lois: Well, if I know it's gonna be three months before our new assistant starts, I might be able to plan for some temporary coverage for that work. But if I had a prediction that said it's only going to be two weeks before a new hire could start, it probably wouldn't be worth arranging temporary coverage. Niki can hold things down for a couple of weeks. Jeff: See, I'm positive she could! That's absolutely perfect! And I think that's all you really need to have in terms of prerequisites to understand any of the AI features in HCM. When you know what you might want to do with it, like predicting the need for temp cover, and you've got everything we talked about in the foundation part of the course—the Gen and the Classic, all that stuff, you can look at a feature like Time to Hire and then you can probably pick that up in 30 seconds. 17:29 Nikita: Can we try it? Jeff: Sure! I mean, you know, we're not looking at screens for this conversation, but we can absolutely try it. You're a recruiter. If I tell you that Time to Hire is a feature that you run into on the job requisition and it shows you just a few editable fields, and then of course, the prediction of the number of days to hire—tell me how you think that feature is going to work when you get there. Lois: So, what are the fields? And does it matter? Jeff: Probably not really, but of course you can ask. So, let me tell you. Ready? The fields—they are these. Requisition Title, Location, and Education Level. Nikita: Ok, well, I have to assume that as I change those things… like from a Junior Podcast Assistant to a Senior Podcast Assistant, or change the location from Redwood Shores to Detroit, or change the required education, the time to hire is going to change, right? Jeff: 100%, exactly. And it does it in real time as you make those changes to those values. So when you pick a new location, you immediately get a new number of days, so it really is a useful tool. But how does it work? Well, we know it's using a few fields from the job requisition, but that's not enough. Besides those fields, what else would you need in order to make this prediction work? 18:43 Lois: The part where it translates to a number of days. So, this is based on our historic hiring data? How long it took us to hire a podcast assistant the last time? Jeff: Yep! And now you have everything you need. We call that “historic data from our company” bit “ingestion,” by the way. And there's always a really interesting discussion around that when it comes up in the course. But it's the process we use to bring in the HCM data to the AI so it can be considered or predictions exactly like this. Lois: So it's the HCM data making the AI smarter and more powerful. Nikita: And tailored. Jeff: Exactly, it's all of that. And obviously, the HCM is better because we've given it the AI. But the AI is also better because it has the HCM in it. But look, I was able to give you a quick description of Time to Hire, and you were able to tell me what it does, which data it uses, and how it works in just a few seconds. So, that's kind of the goal when we teach this stuff. It's getting everybody ready to be productive from moment #1 because what is it and how does it work stuff is already out of the way, you know? 19:52 Lois: I do know! Nikita: Can we try it with another one? Jeff: Sure! How about we do...Suggested Candidates. Lois: And you're going to tell us what we get on the screen, and we have to tell you how it works, right? Jeff: Yeah, yeah, exactly. Ok—Suggested Candidates. You're a recruiter or a hiring manager. You guys are still looking for your Junior Podcast Assistant. On the requisition, you've got a section called Suggested Candidates. And you see the candidate's name and some scores. Those scores are for profile match, skills match, experience match. And there's also an overall match score, and the highest rated people you notice are sorted to the top of the list. So, you with me so far? Lois: Yes! Jeff: So you already know that it's suggesting candidates. But if you care about explainability and transparency like we talked about at the start, then you also care about where these suggested candidates came from. So let's see if we can make progress against that. Let's think about those match scores. What would you need in order to come up with match scores like that? 20:54 Nikita: Tell me if I'm oversimplifying this, but everything about the job on the requisition, and everything about the candidate? Their skills and experience? Jeff: Yeah, that's actually simplified pretty perfectly. So in HCM, the candidate profile has their skills and experience, and the req profile has the req requirements. Lois: So we're comparing the elements of the job profile and the person/candidate profile. And they're weighted, I assume? Jeff: That's exactly how it works. See, 30 seconds and you guys are nailing these! In fairness, when we discuss these things in the course, we go into more detail. And I think it's helpful for HCM practitioners to know which data from the person and the job profiles is being considered (and sometimes just as important, which is not being considered). And don't forget we're also considering our ingested data. Our previously selected candidates. 21:45 Lois: Jeff, can I change the weighting? If I care more about skills than experience or education, can I adjust the weighting and have it re-sort the candidates? Jeff: Super important question. So let me give you the answer first, which is “no.” But because it's important, I want to tell you more. This is a discussion we have in the class around Oracle's Embedded vs. Custom AI. And they're both really important offerings. With Embedded, what we're talking about are the features that come in HCM like any other feature. They might have some enablement steps like profile options, and there's an activation panel. But essentially, that's it. There's no inspection panel for you to open up and start sticking your screwdriver in there and making changes. Believe it or not, that's a big advantage with Embedded AI, if you ask me anyway. Nikita: It's an advantage to not be able to configure it? Jeff: In this context, I think you can say that it is. You know, we talk about the advantages about the baked-in, Embedded AI in this course, but one of the key things is that it's pre-built and pre-tested. And the big one: that it's ready to use on day one. But one little change in a prompt can have a pretty big butterfly effect across all of your results. So, Oracle provides the Embedded AI because we know it works because we've already tested it, and it's, therefore, ready on day one. And I think that story maybe changes a little bit when you open up the inspection panel and bust out that screwdriver. Now you're signing up to be a test pilot. And that's just fundamentally different than “pre-built and ready on day one.” Not that it's bad to want configuration. 23:24 Lois: That's what the Custom AI path and OCI are about though, right? For when customers have hyper-specific needs outside of Oracle's business processes within the apps, or for when that kind of tuning is really required. And your AI for HCM course—that focuses on the Embedded AI instead of Custom, yes? Jeff: That is exactly it, yes. Nikita: You said there are about 30 of these AI features across HCM. So, when you teach the course, do you go through all of them or are there favorites? Ones that people want to spend more time on so you focus on those? Jeff: The professional part of me wants to tell you that we do try to cover all of them, because that explainability and transparency business we talked about at the beginning. That's for real, so I want our customers to have that for the whole scope. 24:12 Nikita: The professional part? What's the other part? Jeff: I guess that's the part that says sure, we need to hit all of them. But some of them are just inherently more fun to work on. So, it's usually the learners who drive that in the live classes when they get into something, that's where we spend the most time. So, I have my favorites too. The learners have their favorites. And we spend time where it's everybody's favorite. Lois: Like where? Jeff: Ok, so one is far from the most complex one, but I think it's really elegant in its simplicity. And it's the Celebrate feature, where we do employee recognition. There's an AI Assist available there. So when it's time to recognize a colleague, you just need to enter the headline or the title, and the AI takes it from there and just writes up the recognition. 24:56 Lois: What about that makes it a good example, Jeff? You said it's elegant. What do you mean? Jeff: I think it's a few things. So, start with the prompt. It's just the one line—just the headline. And that's your one input. So, type in the headline, get the recognition below. It's a great demonstration of not just the simplicity, but the power we get out of that simplicity. I always ask it to recognize my employees for implementing AI features in Oracle HCM, just to see what it comes up with. When it tells the employee that they're helping the company by automating routine tasks, bringing efficiency to the HR department, and then launches into specific examples of how AI features help in HCM, it really is pretty incredible. So, it's a simple demo, but it explains a lot about how the Gen AI works. Lois: That's really cool. 25:45 Nikita: So this one is generative AI. It's using the large language model to create the recognition based on the prompt, which is basically just whatever you entered in the headline. But how does that help explain how Gen AI works in HCM? Jeff: Well, let's take our simple prompt for example. There's a lot happening behind the scenes. It's taking our prompt, it's doing its LLM thing, but before it's done, it's creating the results in a very specific way. An employee recognition reads really differently than a job description. So, I usually describe this as the hidden part of our prompt. The visible part is what we typed. But it needs to know things like our desired output format. Make sure to use the person's name, summarize the benefits, and be sure to thank them for their contribution, that kind of stuff. So, those things are essentially hard-coded into the page. And that's to say, this is another area where we don't get an inspection panel that lets us go in and tweak the prompt. 26:42 Nikita: And that's generally how generative AI works? Jeff: Pretty much. Wherever you see an AI Assist button in HCM, that's more or less what's going on. And so when you get to some of the other more complex features, it's helpful to know that that is what's going on. Lois: Like where? Jeff: Well, it works that way for the About Me part of your employee profile, for goal creation in performance, and I think a really great example is in performance, where managers are providing the competency development tips. So the prompt there is a little more complex there because it involves the employee's proficiency rating instead of free text. But still, pretty straightforward. You're gonna click AI Assist and it's gonna generate all the development tips for any specific competency listed for that employee. Good development tips. Five of them. Nicely formatted with bullet points. And these aren't random words assembled by an AI. So they conform to best practices in the development of competencies. So, something is telling the LLM to give us results that are that good, in that particular way. So, it's just another good example of the work AI is doing while protected behind the inspection panel that doesn't exist. So, the coding of that page, in combination with what the LLM generates and the agent that it uses, is what produces the result. That's generally the approach. In the class, we always have a good time digging into what must be going on behind that inspection panel. Generally speaking, the better feel we have for what's going on on these pages, the better we're able to get the results we want, even without having that screwdriver out. 28:21 Nikita: So it's time well-spent, looking at all the individual features? Jeff: I think so, especially if you're anticipating really using any of them. So, the good news is, once you learn a few of them and how they work, and what they're best at, you stop being surprised after a while. But there are always tips and tricks. And like we talked about at the top, explainability and transparency are absolutely key. So, as much as I'm not a fan of the phrase, I do think this is kind of a “knowledge is power” kind of situation. 28:51 Nikita: Sadly, we're just about out of time for this episode. Lois: That's too bad, I was really enjoying this. Jeff, you were just talking about knowledge—where can we get more? Jeff: Well, like you mentioned at the start, check out the AI in HCM course on MyLearn. It's about an hour and a half, but it really is time well spent. And we get into detail on everything the three of us discussed here today, and then we have demoscussions of every feature where we show them and how they work and which data they're using and a whole bunch more. So, there's that. Plus, I hear the instructor is excellent. Lois: I can vouch for that! Jeff: Well, then you should definitely look into Dynamic Skills. Different instructor. But we have another course, and again I think about an hour and a half, but when you're done with the AI course, I always feel like Dynamic Skills is where you really wanna go next to really flesh out all the Talent Management ideas that got stirred up while you were having a great time in the AI course. And then finally, the live classes. It's always really fun to take live questions while we talk about AI in HCM. 29:54 Nikita: Thanks, Jeff! This has been really interesting. Lois: Yeah, thanks for being here, Jeff. We've loved having you on. Jeff: Thank you guys so much for having me. It's been a pleasure. Lois: If you want to learn more about what we discussed, go to the show notes for today's episode. You'll find links to the AI for Human Capital Management and Dynamic Skills courses that Jeff mentioned so you can check them out. You can also head over to mylearn.oracle.com to find the live sessions for MyLearn subscribers that Jeff conducts. Nikita: Join us next week as we kick off our “Best of 2024” season, where we'll be revisiting some of our most popular episodes of the year. Until then, this is Nikita Abraham… Lois: And Lois Houston, signing off! 30:35 That's all for this episode of the Oracle University Podcast. If you enjoyed listening, please click Subscribe to get all the latest episodes. We'd also love it if you would take a moment to rate and review us on your podcast app. See you again on the next episode of the Oracle University Podcast.
Jeff Morris, VP of Product & Solutions Marketing at Couchbase, joins Corey on Screaming in the Cloud to discuss Couchbase's new columnar data store functionality, specific use cases for columnar data stores, and why AI gets better when it communicates with a cleaner pool of data. Jeff shares how more responsive databases could allow businesses like Dominos and United Airlines to create hyper-personalized experiences for their customers by utilizing more responsive databases. Jeff dives into the linked future of AI and data, and Corey learns about Couchbase's plans for the re:Invent conference. If you're attending re:Invent, you can visit Couchbase at booth 1095.About JeffJeff Morris is VP Product & Solutions Marketing at Couchbase (NASDAQ: BASE), a cloud database platform company that 30% of the Fortune 100 depend on.Links Referenced:Couchbase: https://www.couchbase.com/TranscriptAnnouncer: Hello, and welcome to Screaming in the Cloud with your host, Chief Cloud Economist at The Duckbill Group, Corey Quinn. This weekly show features conversations with people doing interesting work in the world of cloud, thoughtful commentary on the state of the technical world, and ridiculous titles for which Corey refuses to apologize. This is Screaming in the Cloud.Corey: Welcome to Screaming in the Cloud. I'm Corey Quinn. This promoted guest episode of Screaming in the Cloud is brought to us by our friends at Couchbase. Also brought to us by Couchbase is today's victim, for lack of a better term. Jeff Morris is their VP of Product and Solutions Marketing. Jeff, thank you for joining me.Jeff: Thanks for having me, Corey, even though I guess I paid for it.Corey: Exactly. It's always great to say thank you when people give you things. I learned this from a very early age, and the only people who didn't were rude children and turned into worse adults.Jeff: Exactly.Corey: So, you are effectively announcing something new today, and I always get worried when a database company says that because sometimes it's a license that is going to upset people, sometimes it's dyed so deep in the wool of generative AI that, “Oh, we're now supporting vectors or whatnot.” Well, most of us don't know what that means.Jeff: Right.Corey: Fortunately, I don't believe that's what you're doing today. What have you got for us?Jeff: So, you're right. It's—well, what I'm doing is, we're announcing new stuff inside of Couchbase and helping Couchbase expand its market footprint, but we're not really moving away from our sweet spot, either, right? We like building—or being the database platform underneath applications. So, push us on the operational side of the operational versus analytic, kind of, database divide. But we are announcing a columnar data store inside of the Couchbase platform so that we can build bigger, better, stronger analytic functionality to feed the applications that we're supporting with our customers.Corey: Now, I feel like I should ask a question around what a columnar data store is because my first encounter with the term was when I had a very early client for AWS bill optimization when I was doing this independently, and I was asking them the… polite question of, “Why do you have 283 billion objects in a single S3 bucket? That is atypical and kind of terrifying.” And their answer was, “Oh, we built our own columnar data store on top of S3. This might not have been the best approach.” It's like, “I'm going to stop you there. With no further information, I can almost guarantee you that it was not.” But what is a columnar data store?Jeff: Well, let's start with the, everybody loves more data and everybody loves to count more things, right, but a columnar data store allows you to expedite the kind of question that you ask of the data itself by not having to look at every single row of the data while you go through it. You can say, if you know you're only looking for data that's inside of California, you just look at the column value of find me everything in California and then I'll pick all of those records to analyze. So, it gives you a faster way to go through the data while you're trying to gather it up and perform aggregations against it.Corey: It seems like it's one of those, “Well, that doesn't sound hard,” type of things, when you're thinking about it the way that I do, in terms of a database being more or less a medium to large size Excel spreadsheet. But I have it on good faith from all the customer environments. I've worked with that no, no, there are data stores that span even larger than that, which is, you know, one of those sad realities of the world. And everything at scale begins to be a heck of a lot harder. I've seen some of the value that this stuff offers and I can definitely understand a few different workloads in which case that's going to be super handy. What are you targeting specifically? Or is this one of those areas where you're going to learn from your customers?Jeff: Well, we've had analytic functionality inside the platform. It just, at the size and scale customers actually wanted to roam through the data, we weren't supporting that that much. So, we'll expand that particular footprint, it'll give us better integration capabilities with external systems, or better access to things in your bucket. But the use case problem is, I think, going to be driven by what new modern application requirements are going to be. You're going to need, we call it hyper-personalization because we tend to cater to B2C-style applications, things with a lot of account profiles built into them.So, you look at account profile, and you're like, “Oh, well Jeff likes blue, so sell him blue stuff.” And that's a great current level personalization, but with a new analytic engine against this, you can maybe start aggregating all the inventory information that you might have of all the blue stuff that you want to sell me and do that in real-time, so I'm getting better recommendations, better offers as I'm shopping on your site or looking at my phone and, you know, looking for the next thing I want to buy.Corey: I'm sure there's massive amounts of work that goes into these hyper-personalization stories. The problem is that the only time they really rise to our notice is when they fail hilariously. Like, you just bought a TV, would you like to buy another? Now statistically, you are likelier to buy a second TV right after you buy one, but for someone who just, “Well, I'm replacing my living room TV after ten years,” it feels ridiculous. Or when you buy a whole bunch of nails and they don't suggest, “Would you like to also perhaps buy a hammer?”It's one of those areas where it just seems like a human putting thought into this could make some sense. But I've seen some of the stuff that can come out of systems like this and it can be incredible. I also personally tend to bias towards use cases that are less, here's how to convince you to buy more things and start aiming in a bunch of other different directions where it starts meeting emerging use cases or changing situations rapidly, more rapidly than a human can in some cases. The world has, for better or worse, gotten an awful lot faster over the last few decades.Jeff: Yeah. And think of it in terms of how responsive can I be at any given moment. And so, let's pick on one of the more recent interesting failures that has popped up. I'm a Giants fan, San Francisco Giants fan, so I'll pick on the Dodgers. The Dodgers during the baseball playoffs, Clayton Kershaw—three-time MVP, Cy Young Award winner, great, great pitcher—had a first-inning meltdown of colossal magnitude: gave up 11 runs in the first inning to the Diamondbacks.Well, my customer Domino's Pizza could end up—well, let's shift the focus of our marketing. We—you know, the Dodgers are the best team in baseball this year in the National League—let's focus our attention there, but with that meltdown, let's pivot to Arizona and focus on our market in Phoenix. And they could do that within minutes or seconds, even, with the kinds of capabilities that we're coming up with here so that they can make better offers to that new environment and also do the decision intelligence behind it. Like, do I have enough dough to make a bigger offer in that big market? Do I have enough drivers or do I have to go and spin out and get one of the other food delivery folks—UberEats, or something like that—to jump on board with me and partner up on this kind of system?It's that responsiveness in real, real-time, right, that's always been kind of the conundrum between applications and analytics. You get an analytic insight, but it takes you an hour or a day to incorporate that into what the application is doing. This is intended to make all of that stuff go faster. And of course, when we start to talk about things in AI, right, AI is going to expect real-time responsiveness as best you can make it.Corey: I figure we have to talk about AI. That is a technology that has absolutely sprung to the absolute peak of the hype curve over the past year. OpenAI released Chat-Gippity, either late last year or early this year and suddenly every company seems to be falling all over itself to rebrand itself as an AI company, where, “We've been working on this for decades,” they say, right before they announce something that very clearly was crash-developed in six months. And every company is trying to drape themselves in the mantle of AI. And I don't want to sound like I'm a doubter here. I'm like most fans; I see an awful lot of value here. But I am curious to get your take on what do you think is real and what do you think is not in the current hype environment.Jeff: So yeah, I love that. I think there's a number of things that are, you know, are real is, it's not going away. It is going to continue to evolve and get better and better and better. One of my analyst friends came up with the notion that the exercise of generative AI, it's imprecise, so it gives you similarity things, and that's actually an improvement, in many cases, over the precision of a database. Databases, a transaction either works or it doesn't. It has failover or it doesn't, when—Corey: It's ideally deterministic when you ask it a question—Jeff: Yes.Corey: —the same question a second time, assuming it's not time-bound—Jeff: Gives you the right answer.Corey: Yeah, the sa—or at least the same answer.Jeff: The same answer. And your gen AI may not. So, that's a part of the oddity of the hype. But then it also helps me kind of feed our storyline of if you're going to try and make Gen AI closer and more accurate, you need a clean pool of data that you're dealing with, even though you've got probably—your previous design was such that you would use a relational database for transactions, a document database for your user profiles, you'd probably attach your website to a caching database because you needed speed and a lot of concurrency. Well, now you got three different databases there that you're operating.And if you're feeding data from each of those databases back to AI, one of them might be wrong or one of them might confuse the AI, yet how are you going to know? The complexity level is going to become, like, exponential. So, our premise is, because we're a multi-modal database that incorporates in-memory speed and documents and search and transactions and the like, if you start with a cleaner pool of data, you'll have less complexity that you're offering to your AI system and therefore you can steer it into becoming more accurate in its response. And then, of course, all the data that we're dealing with is on mobile, right? Data is created there for, let's say, your account profile, and then it's also consumed there because that's what people are using as their application interface of choice.So, you also want to have mobile interactivity and synchronization and local storage, kind of, capabilities built in there. So, those are kind of, you know, a couple of the principles that we're looking at of, you know, JSON is going to be a great format for it regardless of what happens; complexity is kind of the enemy of AI, so you don't want to go there; and mobility is going to be an absolute requirement. And then related to this particular announcement, large-scale aggregation is going to be a requirement to help feed the application. There's always going to be some other bigger calculation that you're going to want to do relatively in real time and feed it back to your users or the AI system that's helping them out.Corey: I think that that is a much more nuanced use case than a lot of the stuff that's grabbing customer attentions where you effectively have the Chat-Gippity story of it being an incredible parrot. Where I have run into trouble with the generative story has been people putting the thing that the robot that's magic and from the future has come up with off the cuff and just hurling that out into the universe under their own name without any human review, and that's fine sometimes sure, but it does get it hilariously wrong at some points. And the idea of sending something out under my name that has not been at least reviewed by me if not actually authored by me, is abhorrent. I mean, I review even the transactional, “Yes, you have successfully subscribed,” or, “Sorry to see you go,” email confirmations on stuff because there's an implicit, “Hugs and puppies, love Corey,” at the end of everything that goes out under my name.Jeff: Right.Corey: But I've gotten a barrage of terrible sales emails and companies that are trying to put the cart before the horse where either the, “Support rep,” quote-unquote, that I'm speaking to in the chat is an AI system or else needs immediate medical attention because there's something going on that needs assistance.Jeff: Yeah, they just don't understand.Corey: Right. And most big enterprise stories that I've heard so far that have come to light have been around the form of, “We get to fire most of our customer service staff,” an outcome that basically no one sensible wants. That is less compelling than a lot of the individualized consumer use cases. I love asking it, “Here's a blog post I wrote. Give me ten title options.” And I'll usually take one of them—one of them is usually not half bad and then I can modify it slightly.Jeff: And you'll change four words in it. Yeah.Corey: Yeah, exactly. That's a bit of a different use case.Jeff: It's been an interesting—even as we've all become familiar—or at least junior prompt engineers, right—is, your information is only going to be as good as you feed the AI system—the return is only going to be as good—so you're going to want to refine that kind of conversation. Now, we're not trying to end up replacing the content that gets produced or the writing of all kinds of pros, other than we do have a code generator that works inside of our environment called Capella iQ that talks to ChatGPT, but we try and put guardrails on that too, right, as always make sure that it's talking in terms of the context of Couchbase rather than, “Where's Taylor Swift this week,” which I don't want it to answer because I don't want to spend GPT money to answer that question for you.Corey: And it might not know the right answer, but it might very well spit out something that sounds plausible.Jeff: Exactly. But I think the kinds of applications that we're steering ourselves toward can be helped along by the Gen AI systems, but I don't expect all my customers are going to be writing automatic blog post generation kinds of applications. I think what we're ultimately trying to do is facilitate interactions in a way that we haven't dreamt of yet, right? One of them might be if I've opted into to loyalty programs, like my United account and my American Express account—Corey: That feels very targeted at my lifestyle as well, so please, continue.Jeff: Exactly, right? And so, what I really want the system to do is for Amex to reward me when I hit 1k status on United while I'm on the flight and you know, have the flight attendant come up and be like, “Hey, you did it. Either, here's a free upgrade from American Express”—that would be hyper-personalization because you booked your plane ticket with it, but they also happen to know or they cross-consumed information that I've opted into.Corey: I've seen them congratulate people for hitting a million miles flown mid-flight, but that's clearly something that they've been tracking and happens a heck of a lot less frequently. This is how you start scaling that experience.Jeff: Yes. But that happened because American Airlines was always watching because that was an American Airlines ad ages ago, right, but the same principle holds true. But I think there's going to be a lot more of these: how much information am I actually allowing to be shared amongst the, call it loyalty programs, but the data sources that I've opted into. And my God, there's hundreds of them that I've personally opted into, whether I like it or not because everybody needs my email address, kind of like what you were describing earlier.Corey: A point that I have that I think agrees largely with your point is that few things to me are more frustrating than what I'm signing up, for example, oh, I don't know, an AWS even—gee, I can't imagine there's anything like that going on this week—and I have to fill out an entire form that always asked me the same questions: how big my company is, whether we have multiple workloads on, what industry we're in. And no matter what I put into that, first, it never remembers me for the next time, which is frustrating in its own right, but two, no matter what I put in to fill that thing out, the email I get does not change as a result. At one point, I said, all right—I'm picking randomly—“I am a venture capitalist based in Sweden,” and I got nothing that is differentiated from the other normal stuff I get tied to my account because I use a special email address for those things, sometimes just to see what happens. And no, if you're going to make me jump through the hoops to give you the data, at least use it to make my experience better. It feels like I'm asking for the moon here, but I shouldn't be.Jeff: Yes. [we need 00:16:19] to make your experience better and say, you know, “Here's four companies in Malmo that you ought to be talking to. And they happen to be here at the AWS event and you can go find them because their booth is here, here, and here.” That kind of immediate responsiveness could be facilitated, and to our point, ought to be facilitated. It's exactly like that kind of thing is, use the data in real-time.I was talking to somebody else today that was discussing that most data, right, becomes stale and unvaluable, like, 50% of the data, its value goes to zero after about a day. And some of it is stale after about an hour. So, if you can end up closing that responsiveness gap that we were describing—and this is kind of what this columnar service inside of Capella is going to be like—is react in real-time with real-time calculation and real-time look-up and real-time—find out how you might apply that new piece of information right now and then give it back to the consumer or the user right now.Corey: So, Couchbase takes a few different forms. I should probably, at least for those who are not steeped in the world of exotic forms of database, I always like making these conversations more accessible to folks who are not necessarily up to speed. Personally, I tend to misuse anything as a database, if I can hold it just the wrong way.Jeff: The wrong way. I've caught that about you.Corey: Yeah, it's—everything is a database if you hold it wrong. But you folks have a few different options: you have a self-managed commercial offering; you're an open-source project, so I can go ahead and run it on my own infrastructure however I want; and you have Capella, which is Couchbase as a service. And all of those are useful and have their points, and I'm sure I'm missing at least one or two along the way. But do you find that the columnar use case is going to disproportionately benefit folks using Capella in ways that the self-hosted version would not be as useful for, or is this functionality already available in other expressions of Couchbase?Jeff: It's not already available in other expressions, although there is analytic functionality in the self-managed version of Couchbase. But it's, as I've mentioned I think earlier, it's just not as scalable or as really real-time as far as we're thinking. So, it's going to—yes, it's going to benefit the database as a service deployments of Couchbase available on your favorite three clouds, and still interoperable with environments that you might self-manage and self-host. So, there could be even use cases where our development team or your development team builds in AWS using the cloud-oriented features, but is still ultimately deploying and hosting and managing a self-managed environment. You could still do all of that. So, there's still a great interplay and interoperability amongst our different deployment options.But the fun part, I think, about this is not only is it going to help the Capella user, there's a lot of other things inside Couchbase that help address the developers' penchant for trading zero-cost for degrees of complexity that you're willing to accept because you want everything to be free and open-source. And Couchbase is my fifth open-source company in my background, so I'm well, well versed in the nuances of what open-source developers are seeking. But what makes Couchbase—you know, its origin story really cool too, though, is it's the peanut butter and chocolate marriage of memcached and the people behind that and membase and CouchDB from [Couch One 00:19:54]. So, I can't think of that many—maybe Red Hat—project and companies that formed up by merging two complementary open-source projects. So, we took the scale and—Corey: You have OpenTelemetry, I think, that did that once, but that—you see occasional mergers, but it's very far from common.Jeff: But it's very, very infrequent. But what that made the Couchbase people end up doing is make a platform that will scale, make a data design that you can auto partition anywhere, anytime, and then build independently scalable services on top of that, one for SQL++, the query language. Anyone who knows SQL will be able to write something in Couchbase immediately. And I've got this AI Automator, iQ, that makes it even easier; you just say, “Write me a SQL++ query that does this,” and it'll do that. But then we added full-text search, we added eventing so you can stream data, we added the analytics capability originally and now we're enhancing it, and use JSON as our kind of universal data format so that we can trade data with applications really easily.So, it's a cool design to start with, and then in the cloud, we're steering towards things like making your entry point and using our database as a service—Capella—really, really, really inexpensive so that you get that same robustness of functionality, as well as the easy cost of entry that today's developers want. And it's my analyst friends that keep telling me the cloud is where the markets going to go, so we're steering ourselves towards that hockey puck location.Corey: I frequently remark that the role of the DBA might not be vanishing, but it's definitely changing, especially since the last time I counted, if you hold them and use as directed, AWS has something on the order of 14 distinct managed database offerings. Some are general purpose, some are purpose-built, and if this trend keeps up, in a decade, the DBA role is going to be determining which of its 40 databases is going to be the right fit for a given workload. That seems to be the counter-approach to a general-purpose database that works across the board. Clearly you folks have opinions on this. Where do you land?Jeff: Oh, so absolutely. There's the product that is a suite of capabilities—or that are individual capabilities—and then there's ones that are, in my case, kind of multi-model and do lots of things at once. I think historically, you'll recognize—because this is—let's pick on your phone—the same holds true for, you know, your phone used to be a watch, used to be a Palm Pilot, used to be a StarTAC telephone, and your calendar application, your day planner all at the same time. Well, it's not anymore. Technology converges upon itself; it's kind of a historical truism.And the database technologies are going to end up doing that—or continue to do that, even right now. So, that notion that—it's a ten-year-old notion of use a purpose-built database for that particular workload. Maybe sometimes in extreme cases that is the appropriate thing, but in more cases than not right now, if you need transactions when you need them, that's fine, I can do that. You don't necessarily need Aurora or RDS or Postgres to do that. But when you need search and geolocation, I support that too, so you don't need Elastic. And then when you need caching and everything, you don't need ElastiCache; it's all built-in.So, that multi-model notion of operate on the same pool of data, it's a lot less complex for your developers, they can code faster and better and more cleanly, debugging is significantly easier. As I mentioned, SQL++ is our language. It's basically SQL syntax for JSON. We're a reference implementation of this language, along with—[AsteriskDB 00:23:42] is one of them, and actually, the original author of that language also wrote DynamoDB's PartiQL.So, it's a common language that you wouldn't necessarily imagine, but the ease of entry in all of this, I think, is still going to be a driving goal for people. The old people like me and you are running around worrying about, am I going to get a particular, really specific feature out of the full-text search environment, or the other one that I pick on now is, “Am I going to need a vector database, too?” And the answer to me is no, right? There's going—you know, the database vendors like ourselves—and like Mongo has announced and a whole bunch of other NoSQL vendors—we're going to support that. It's going to be just another mode, and you get better bang for your buck when you've got more modes than a single one at a time.Corey: The consensus opinion that's emerging is very much across the board that vector is a feature, not a database type.Jeff: Not a category, yeah. Me too. And yeah, we're well on board with that notion, as well. And then like I said earlier, the JSON as a vehicle to give you all of that versatility is great, right? You can have vector information inside a JSON document, you can have time series information in the document, you could have graph node locations and ID numbers in a JSON array, so you don't need index-free adjacency or some of the other cleverness that some of my former employers have done. It really is all converging upon itself and hopefully everybody starts to realize that you can clean up and simplify your architectures as you look ahead, so that you do—if you're going to build AI-powered applications—feed it clean data, right? You're going to be better off.Corey: So, this episode is being recorded in advance, thankfully, but it's going to release the first day of re:Invent. What are you folks doing at the show, for those who are either there and for some reason, listening to a podcast rather than going to getting marketed to by a variety of different pitches that all mention AI or might even be watching from home and trying to figure out what to make of it?Jeff: Right. So, of course we have a booth, and my notes don't have in front of me what our booth number is, but you'll see it on the signs in the airport. So, we'll have a presence there, we'll have an executive briefing room available, so we can schedule time with anyone who wants to come talk to us. We'll be showing not only the capabilities that we're offering here, we'll show off Capella iQ, our coding assistant, okay—so yeah, we're on the AI hype band—but we'll also be showing things like our mobile sync capability where my phone and your phone can synchronize data amongst themselves without having to actually have a live connection to the internet. So, long as we're on the same network locally within the Venetian's network, we have an app that we have people download from the Apple Store and then it's a color synchronization app or picture synchronization app.So, you tap it, and it changes on my screen and I tap it and it changes on your screen, and we'll have, I don't know, as many people who are around standing there, synchronizing, what, maybe 50 phones at a time. It's actually a pretty slick demonstration of why you might want a database that's not only in the cloud but operates around the cloud, operates mobile-ly, operates—you know, can connect and disconnect to your networks. It's a pretty neat scenario. So, we'll be showing a bunch of cool technical stuff as well as talking about the things that we're discussing right now.Corey: I will say you're putting an awful lot of faith in conductivity working at re:Invent, be it WiFi or the cellular network. I know that both of those have bitten me in various ways over the years. But I wish you the best on it. I think it's going to be an interesting show based upon everything I've heard in the run-up to it. I'm just glad it's here.Jeff: Now, this is the cool part about what I'm talking about, though. The cool part about what I'm talking about is we can set up our own wireless network in our booth, and we still—you'd have to go to the app store to get this application, but once there, I can have you switch over to my local network and play around on it and I can sync the stuff right there and have confidence that in my local network that's in my booth, the system's working. I think that's going to be ultimately our design there because oh my gosh, yes, I have a hundred stories about connectivity and someone blowing a demo because they're yanking on a cable behind the pulpit, right?Corey: I always build in a—and assuming there's no connectivity, how can I fake my demos, just because it's—I've only had to do it once, but you wind up planning in advance when you start doing a talk to a large enough or influential enough audience where you want things to go right.Jeff: There's a delightful acceptance right now of recorded videos and demonstrations that people sort of accept that way because of exactly all this. And I'm sure we'll be showing that in our booth there too.Corey: Given the non-deterministic nature of generative AI, I'm sort of surprised whenever someone hasn't mocked the demo in advance, just because yeah, gives the right answer in the rehearsal, but every once in a while, it gets completely unglued.Jeff: Yes, and we see it pretty regularly. So, the emergence of clever and good prompt engineering is going to be a big skill for people. And hopefully, you know, everybody's going to figure out how to pass it along to their peers.Corey: Excellent. We'll put links to all this in the show notes, and I look forward to seeing how well this works out for you. Best of luck at the show and thanks for speaking with me. I appreciate it.Jeff: Yeah, Corey. We appreciate the support, and I think the show is going to be very strong for us as well. And thanks for having me here.Corey: Always a pleasure. Jeff Morris, VP of Product and Solutions Marketing at Couchbase. This episode has been brought to us by our friends at Couchbase. And I'm Cloud Economist Corey Quinn. If you've enjoyed this podcast, please leave a five-star review on your podcast platform of choice, whereas if you've hated this podcast, please leave a five-star review on your podcast platform of choice along with an angry comment, but if you want to remain happy, I wouldn't ask that podcast platform what database they're using. No one likes the answer to those things.Corey: If your AWS bill keeps rising and your blood pressure is doing the same, then you need The Duckbill Group. We help companies fix their AWS bill by making it smaller and less horrifying. The Duckbill Group works for you, not AWS. We tailor recommendations to your business and we get to the point. Visit duckbillgroup.com to get started.
Working with amazing, hard-working property management entrepreneurs is what makes being a coach worth it. Join property management growth expert Jason Hull in today's episode as he interviews DoorGrow client Jeff Garner. Jeff went from 150 to 420 doors in 4 months! Learn how he did it. You'll Learn [02:35] Why would anyone get into property management? [12:40] Fixing the foundation of a property management business [15:14] Importance of culture in a business [25:05] Why you need a coach [27:34] Navigating operational issues Tweetables “No matter what market we're in, it's good. If we're going to the moon, management's great. If we're crashing, it's even better because people can't sell their properties and they go, ‘Oh shoot, we'll turn them into rentals.'” "Go where they won't go and do what they won't do. That's where the money's at," “It all starts with your mindset.” “Weekly commitments, and you'll start to see the momentum build big time when the team are all visible and can be seen and there's accountability and they get recognized because you have that system installed, performance sometimes goes up.” Resources DoorGrow and Scale Mastermind DoorGrow Academy DoorGrow on YouTube DoorGrowClub DoorGrowLive TalkRoute Referral Link Transcript [00:00:00] Jeff: I have 420 doors and I have more peace of mind, more direction and I know where I'm going to be and where I'm going and how to get there. [00:00:12] Jason: Welcome DoorGrow Hackers to the DoorGrowShow. If you are a property management entrepreneur that wants to add doors, make a difference, increase revenue, help others, impact lives, and you are interested in growing in business and life, and you're open to doing things a bit differently, then you are a DoorGrow Hacker. DoorGrow Hackers love the opportunities, daily variety, unique challenges, and freedom that property management brings. Many in real estate think you're crazy for doing it. You think they're crazy for not [00:00:38] because you realize that property management is the ultimate, high trust gateway to real estate deals, relationships, and residual income. At DoorGrow, we are on a mission to transform property management business owners and their businesses. We want to transform the industry, eliminate the bss, build awareness, change perception, expand the market, and help the best property management entrepreneurs win. I'm your host, property management growth expert Jason Hull the founder and CEO of DoorGrow. Now let's get into the show. [00:01:08] And today's guest is Jeff Garner. Jeff, welcome. [00:01:14] Jeff: Thanks man. Glad to be here. [00:01:17] Jason: So Jeff, what's the name of your property management business? [00:01:19] Jeff: Homes Stretch Property Management [00:01:21] Jason: Homes Stretch. All right, cool. And why'd you pick that name? [00:01:26] Jeff: I feel like real estate investing it's a long-term play. It builds wealth over the long haul. And for our home stretch of our life, whether you decide your home stretch starts at 40 because you retire early, or whether it's 60 or 70, if you are buying real estate, really it, you know, It's about letting the tenants pay down, you know, principal balance, pay down, depreciation, tax, write-offs, appreciation. Sure cash flow's nice every month, but you can make millions over, you know, 20 year period, 25 year period. And so I see the real value in real estate is being that, so we want to get our owners to the home stretch and, you know, that's kind of how we look at it. So we want to improve and maintain your property so that someday you can either sell or refi and it's in great shape and it's an easy process. Or you just want to keep it in cashflow forever. So our job's to give you freedom and peace of mind knowing that your properties are being taken care of better than you can or anyone else so. [00:02:29] Jason: Nice. Love the brand. So Jeff. Why don't you give people a little bit of background on you. How did you start getting into real estate and what made you decide to do the crazy thing of starting a property management company? How did this all happen? [00:02:43] Jeff: Yeah, it was the crazy thing because-- so I'll tell you a little bit about me. Real estate's the only business I've ever been in. I got my real estate license when I was 22. I was going to be a real estate agent. Found a niche working with investors because when you're 22, you know, growing up doesn't come overnight. And so when you're got all your, "oh shoot, I'm showing property today," and you have to crunch the beer cans and put them under your seat. because you just turned 21 a year before, you know, it can be a little awkward putting the 40 year old mom and dad and their kids in the car to go show them property. [00:03:18] Right. Which I did okay at. I did fine. But I found a niche in working with investors because you could sell them one house and most of the time they don't even want to get in your car. Half the time, once you get know what you're doing, you just give them a lockbox code and tell them to call you back and tell you what you think, and they give you a number and you write it and put it in. You could sell them 10 or 20 houses. So I developed a niche at that. I got really good at finding deals and I would send them to my guys. Shortly after that, I decided that I was on the wrong side of the table, you know, three or four years of that. I go to closing, I collect my $2,500 commission check, and he gets a check for $20,000 because he flipped it, right? And I just thought, wait a minute, I'm finding the deal. I'm calling him up, I'm telling him what number to put it in at and he's making all this money. What am I doing wrong? So I got into that side of the business, you know. So, 08 hit crashed. All of us really put me in a position to where I to make a decision on what I wanted to do because all my investors were gone. Right? [00:04:17] They were trying to stay alive. Yeah. You know, in 08 for the people that didn't go through it, was like If you worked in Walmart and all of a sudden the next morning you woke up and no one will shop at Walmart again. [00:04:31] Jason: Right? [00:04:31] Jeff: Yeah. Never walks through the door. [00:04:34] Jason: Yeah. So must have been scary. [00:04:37] Jeff: Yeah. And so, I thought, "well, this investment thing's really what I want to do. So I'm going all in. It's time to restart. So that's what I'm going to go all in at." So I really looked at what happened and I realized that history, you know, tells the story and that everyone was riding this wave and had no idea it was a wave because no one does the research to, you know, see what the cycles are. I didn't know there was a cycle. I was young. Yeah. And so the common sense thought came, well, we were at a high. If I was a real investor and I was really good at what I did, I would've been taking vacations, waiting for this crash to happen, and then I'd go out and buy everything I could find and hold it. Yeah, so I did that. I bought 110 rentals over a three year period, all at, you know, probably 20% of what the market is today. And outsourced the management a couple times. Horrific. Cost me more money than you know, one, when I was at 110 properties, I had to take them back overnight because I realized that I had 16 vacants and they didn't even know about half of them. [00:05:42] Really? Yeah. It was horrible. They just they got overwhelmed and so I built a management company overnight to manage my own properties and had zero desire. It was the last thing on the absolute planet I wanted to deal with was tenants and toilets. I did not get into rentals to deal with tenants or maintenance. It didn't, yeah. So I put together a makeshift management company and decided I'd never take on another property of anyone else's. I'd only do my own, because I was going to do this, it was going to be for myself. There certainly wasn't going to make a hundred dollars a month on a property and do all this for somebody else. Right. That's, that was my thought on being real. And a few years went by '16, '17, realized that I'd gotten tons of equity and I had properties sitting there with 50, 60,000 in equity and I'm making 200 or 300 a month. And I thought, this math doesn't make sense anymore, right? So I sold off over a two or three year period, about 50 of them. But everyone apparently, everyone knew management is a tough gig and there's not a lot of good management companies out there. Why? Right? There was no DoorGrow then that I'm aware of at least. Right? So everyone in the management business just thought, "this looks like we can make some money, let's do this." [00:06:57] But they had no idea. The machine, it has to be to run well. Yeah. And so they said, "well, I'll buy that property. I'll even give you retail for it, but you have to keep the management." So to this day, I still manage all 110 of those properties, even though I only own 60 of them. Right. So to get the money I wanted, I had to keep the management. And then I just kind of started looking at it is in the last couple years when I realized that we could potentially be getting to another place. If you look at the charts and you look at history that we're you know, we're at a high now, will it last four years longer? Probably. So I had to kind of reevaluate what I wanted to do and I looked at all my businesses, flip business, wholesale, you know, my rental portfolios and my management company, I went, wait a minute, what am I doing? I'm focusing all this energy and chasing down deals and having all these, you know, taking all the risk on everything I buy and just grinding away constantly. For over 20 years now. And I got this management company, although it's not sexy, everyone tells me it's the worst thing in the world to do. Yeah. You know, I realize it was the one thing that was repeatable, scalable, and I could predict. And no matter what market we're in, it's good. If we're going to the moon, management's great. If we're crashing, it's even better because people can't sell their properties and they go, oh shoot, we'll turn them into rentals. I thought, "wait, what am I doing? I'm looking at this all wrong." I just started to look at it and so I started working on getting really good at it and filling all the holes on my own, right, with my own. And it's, you know, and I realized that with the right team in place and the right mindset, you know, which is we want to help landlords, right? I want to take 20 something years of resources and try to convert over this management company and give them to everyone else-- that it could be a great business. And then I realized, like I preach, because I did some coaching in the real estate space throughout the years "go where they won't go and do what they won't do. That's where the money's at," right? So if everyone's going after retail flips and a really nice b and b areas, then go look in the C areas because they're being neglected. If everyone's after all the C properties because the cash flows, so well then go up to your A or B areas and start doing flips because those are being neglected. Nice. Certain town everyone's afraid of? Good. Let them be all fighting in one place and you go there. And so I realized that was what was going on in the real estate market for the management business. So I decided that's what I wanted to focus my energies on. So I literally burned all the other boats, man. No marketing, no wholesaling, no flipping. [00:09:40] Jason: Wow. You went all in on property management? [00:09:42] Jeff: All in on property management, period. I got online, I did what I did 15 years before, after 08 happened, and I thought, "I'm going to redo myself. How do I do this?" And so I just got online and I started digging around and trying to teach myself things and I got coaches back then, and even though I knew 90% of what they were trying to teach me, because I got coaches in the flipping side, right? I knew you know, 80, 90% of what they were teaching me was that 10 or 20% where I knew would bring me all my money, right? So I did the same thing here and that's how I came to DoorGrow is I found you guys really were the only real system oriented, you know, nuts and bolts teach the how and not just the why. You know, a lot of people want to tell you why you do. Oh, well, you know why? They want to give you the why on, you know, but they don't want to give you the nuts and bolts of the how and tell you connect A to B to C to D and you'll get your results, right? And so, I found you guys, and I knew that's all I was missing to having success because the rest of the management companies all had bad raps. You couldn't talk to a landlord that really loved their management company. Yeah. So I knew I could fix, put those pieces together and really treat it like a business based off of giving people their freedom and peace of mind, knowing that their properties are being taken care of better than theirs. [00:11:10] If you can do that, anyone listening to this, if you can wrap your mind around being of service. No one else is doing that in the management business. Right? Yeah. You will dominate, it's like I used to say when I had lots of rehab crews going, if someone shows up and does what they say and has half of the talent that I need them to have, they could be rich. That's all they have to do. Just not be the best, but do what you say and show up so it's predictable and we can communicate well and get stuff done. So if you did that, and you can do that with a mindset of, "I want to be of service to the industry." Be the best. You'll dominate, end the story, but you have to wrap that around your mind, you know, and it'll come out in your calls. It'll come out in your conversations at the grocery store. It'll come out everywhere. [00:12:00] Hell, I pulled 16 doors out of my gym in the first 30 days after joining DoorGrow because I just got the structure when we went through mindset and and some sales stuff of. Really taking what was in my mind and putting it in paper and going through the process of splitting the page into four spots and right. You know, going through everything. I got to dial it in and then boom, that was it. There's nothing else to talk about, but what I came up with there, you know, home stretch was the name of the business because it fits what I'm trying to do. I know what our mindset is, the culture for my company and you know, we started just plugging in systems and processes. [00:12:40] Jason: So let's talk a little bit about it. because you said nuts and bolts, but to most property managers, they're like, "nuts and bolts means how do you like do maintenance and how do you plunger a toilet?" you know, like it's like the practical stuff where you know how to manage properties. Yeah. You know how to deal with tenants, you know how to like do all that. What challenge were you dealing with that brought you to DoorGrow and how did that help? [00:13:04] Jeff: It's really hard to explain that. What I really had was is I had a business and it functioned and I did okay, but I did not feel at 150 properties, I did not feel I could bring on 10 more doors. I felt like it would all crumble and break because I had no idea what I was doing really. Right. I had nothing to model. I had just said I got maintenance, my maintenance was horrible. I had all these guys that that was one of the hardest parts to find. But I had all these just subcontractors and every once in a while we'd find someone to come on full time, but you'd have to trust them to be out there all day doing what they said they were doing. And I didn't know how to run that. I didn't know how to manage that. I didn't know how to systematize that where I knew what was going on at all times. And I didn't feel comfortable going any bigger because, I felt like I could see why other management companies had problems, and I don't think they want to suck, right? No, I don't think so. But they just don't want to say no to the money. [00:14:06] "Hey, I got 20 doors." oh, we're going to do a great job for you. Let's bring it on. And they're already struggling with what they have. Yeah, right. Just think it's magically you're going to work, or, you know what? It'll give me more money in that way. More money will mean I can do more things. And no it doesn't. It creates more problems that cost more money. So I needed the systems, I needed the processes. Those are the nuts and bolts I'm talking about. Got it. Who to hire to do what and to, because that's it. [00:14:34] Jason: I mean, so what's changed then? Like you had 150 doors, you came to DoorGrow and we started helping you change a lot of stuff, right? Yeah, absolutely. So, what things have you changed since joining DoorGrow? Yeah. What are some of the first things we start working on with you? [00:14:51] Jeff: Okay, well, really it was just getting my mindset right was the biggest one because once my mindset was correct and I knew and I had our, what we were trying to do, where we could be of service, that opened my mind up to, " how do we do that then?" Right. So that's sort of answering questions for me, you know. [00:15:14] Jason: So with mindset, what you're saying is I believe you're talking about all the culture stuff that we took you through stuff. Just the culture stuff and just kind of, I mean, that's the core foundation of the business. Like if we want to make this business built around you, we've got to figure that piece out, right? So we started with that and that probably had a significant ripple through everything. [00:15:33] Jeff: Imagine like this, you have children, you all of a sudden you, "I'm going to be the best dad ever and I'm going to have kids." Next thing you know, you got two or three of them, they're under five. You have no, literally imagine your parents weren't good. I don't know. They didn't model worth a crap. Okay. Like, how do I do this? Like, I can feed them, I can put them to bed and I can keep them from killing themselves, but do I really know how to raise them to have commitment, how to be honest, how can I make a five year old a strong member of society at 28 years old, right? But if you have a culture and a mindset, you know, "I want my children to be like this. I want them to have this belief system," and how do we give them that belief system? Okay, "well, let me look into that. Okay. Well, if we go to this school, it'll give them these values and then I can back them up at home. And then with bedtime and, oh, I did a little research here. If I put them to bed at this time, get them up at this time. Oh wait, the sugars and dyes are bad. It makes them spastic and oh, well I'll take that out." And you start learning, right? But it all starts with your mindset. Right. And so my mindset changed and it started making me go down the rabbit holes that are all in DoorGrow of, "Okay. Leasing-- my leasing person that we're just winging it and working out of this software that we really were just doing all workarounds and spreadsheets because we really didn't know how to use it. Watch this. Watch these videos on leasing, watch these videos on placing tenants." And then I would watch them and then we would meet and put together a process and a system on how it's going to go instead of just winging every call we got. [00:17:17] So I started building it out position by position. I went and I found a new property manager that had the capacity to be a really good property manager and grow from some of the-- I'm still new inDoorGrow. I'm only six months in. Right? And honestly over the last month I've had a two months, I've had a really hard time getting into DoorGrow because I. [00:17:42] I'm up 420 in doors. Right. [00:17:45] Jason: So, yeah. So, and let's get to that. That's interesting. But so the children, in your analogy here, this is your team you're talking about, and this is my team. Yeah. And you were in it for what, maybe a couple months and then you started replacing the entire team? [00:18:00] Jeff: The entire team is gone except for two people. And one of the two was almost gone. Because of just be all of a sudden having this parent mindset, I kind of coached him, or you know, raised him in a way in this little short period of time to where he's changed. Nice. And he is just, and the reality of it is, what I found out is he was so unhappy because of how screwed up systems were that everything rolled down to him that once I realized that I got to take things away, put them create and find out what was broken on his role. And he was a main construction manager that we created a different systems and now he's probably one of my strongest pieces. So everyone knew the whole team is new. [00:18:50] Jason: So new team, you installed a good culture, you're then able to work with us on the hiring piece and getting good team members in place. Absolutely. You've leveled up some team members because you have culture and you know, like what you deserve and want as a business owner and what have the type of team and we want to build around you. Absolutely. Most business owners build teams around the business, and that's probably what you did before. [00:19:15] Jeff: Absolutely a pure necessity. And I, I didn't but hire people that fit the culture or what I was looking for. I just hired a warm body that seemed like they would work, and I thought, we'll just teach them what we need them to know. Yeah. And their mindset or what they did in their off time or their goals didn't mean they were their business. [00:19:36] Jason: Right. Yeah it's amazing. Some simple frameworks like just understanding the three fits to hiring. Yeah. Like culture fit, skill fit, personality fit can shift hiring significantly. So then you started working pretty quickly with one of our coaches on acquisitions. You went out and found a deal. And in four months you were at 420 units. [00:19:59] Jeff: Yeah. Yep. 420. And I've got probably we're I'm just, we might be at four 40 or four 50 because we have 20 or 30 vacants that Okay. That are under, that are kind of on make ready that we took over that we haven't been able to fill yet because we have this construction backlog, not on our end, but on his backend. The guy that I bought the management from, which was part of the deal, and one of the reasons he sold was because he had done exactly what everyone else did. He got too big and wasn't saying no, and got backlogged and yeah, he was starting to provide really horrible service, so I went in, bought it from him at a really good price for me, but I think it was still a good price for him because if you're at a point to where you're going to, it's stressing you out, you can't get it all done. [00:20:46] It's affecting anything, all your other revenue streams and people are getting ready to start leaving you. Someone walks in "wait, you can take this off my hands and give me money? Okay. Where do I sign?" You know? [00:20:59] Jason: So what are the things did you do with our team? Have we done a website for you? [00:21:03] Jeff: You did a website. [00:21:05] Jason: What about your branding? Did you change your brand at all? [00:21:08] Jeff: Yeah. Hell, hell yeah. I was starting point property management. I changed my brand. We rebranded a week before this acquisition, which I was like, I'm going to put this rebranding thing off because that's another, and then we sat down and I was talking to the team and I don't think they loved it, but they agreed that doing it before we transition all these new owners and tenants over was going to be the way to go because then we would have to change it all up in a couple months anyway when we rebranded and had them in a new website and portal and such so. [00:21:38] Jason: How about pricing? Did you change your pricing? [00:21:41] Jeff: I'm on the hybrid pricing. Okay. The three plans. The three plans now, which is exactly from you guys. Which was another thing that really helped me because with changing the pricing and doing the hybrid plan and going through that training, and it was, once again, it was all the why's we're doing it. I got to design the plans that fit our culture and provide the service we wanted to provide. It gave me more confidence, honestly, in what we were doing, even though I was going to be charging more now. So yeah, we're on the three tier pricing, hybrid pricing. [00:22:19] Jason: So you've changed your team, you changed your branding, you changed your website, you changed your pricing model. You've probably made some adjustments to your pitch. Do you do the Golden Bridge stuff? [00:22:31] Jeff: I didn't have a pitch before. You didn't have a pitch? I didn't have a pitch. I'd just say, "Hey, we do management. Can we manage your properties?" And I just like, that's what I'm saying, when I didn't know, like I couldn't wrap my mind around, because I'd been flipping houses and wholesaling. I had that down to a science. I am a fricking ninja in that. Yeah. But the management side, it was just, "Hey, we manage properties." Yeah. This is what we charge if you want to come over. Cool. If not, I got to go. I got other calls with me, you know, and to have a pitch. So it was literally everything and the pitch made it. That's what I'm saying. I pulled 16 doors out of the gym. Yeah. Just "what are you doing now? Oh, I'm doing management and it's--" 'boop,' just going into my pitch casually, just real casual because we're at the gym. "Do you know anybody that manages any properties? Yeah, I do. I got this buddy. Cool. Could I talk to him? That was it. [00:23:23] Jason: So I love clients like you, Jeff. because you implement, like you went through the rapid revamp and you did it rapid, like you got that stuff done. Yeah. Pretty quick. And then you start working on acquisition because you saw that opportunity with our acquisitions coach and you're like, "I'm going to do that." and you're just doing stuff and I think that's a testament to you. You know, this is part, I think when we work out more often at the gym, and I think our brains work better. I think that's science, like that's been proven. Like there's something released in our muscles. And you're a big dude. I got to get to your point. I'm trying to work out to catch up to you. [00:23:59] Jeff: I'm going to be pitching you on coaching you in that area. [00:24:02] Jason: But I think I appreciate that you've been implementing this stuff rapidly and I asked you at DoorGrow Live, I was like, "where do you see yourself, you know, do you think you could get to a thousand doors?" And you were like, "yeah, probably a year and a half." Like it's nothing. Like it's nothing. And you're like, "well, maybe two years." And I was like, "do you know how ridiculous that sounds to most people?" Yeah. So, but I believe it. I believe it for you. I believe it's possible for you. And I believe any of our clients could do it if they just. Take action and implement. And in order to do that, they've got to trust us. And I appreciate you putting your faith in us and trusting us and just putting your head down and doing the work. [00:24:41] So what would you say to other property managers that are maybe like the company that you bought or maybe like the way you were before if they've just been watching DoorGrow on the sidelines and they think they know what we're about and they think we're just marketers or something that like have a decent sales pitch, but they don't know if they can trust us? You're behind the paywall. What would you say to them? [00:25:04] Jeff: Well, I mean, besides being behind the paywall and doing it and having experience with it, I know coaching and I know that space, and so I recognized DoorGrow immediately from watching your marketing and just digging in a little that you guys taught the business. It wasn't a marketing ploy to get people to sign up to you. Actually, it wasn't like I was just going to get a bunch of motivation, "go out there and do it!" right, right. Because I motivated it was, like I said, it was the whys and the hows and and the all the processes and systems. And so man, it's all there for you to just do it. You would just do it. You would literally just go, "okay, I'll start at one and work to 10." I had a management company already. If I had to redo it all when I got real life processes and systems, and then I saw that there was people in it that had a hundred doors, 500 doors, a thousand doors, and I'm like, "that's what I need." I need to be surrounded by people that are at a higher level of success and have been where I am and now are where I want to go. And so if you are watching and you have management already and you are struggling, and it sucks. Whether it's for you or your customers, or both? I have 420 doors and I have more peace of mind, more direction and I know where I'm going to be and where I'm going and how to get there. And more time to myself if I wanted to take it. I don't take it because I still have big goals and so I'm working a lot. But then I did with 150 doors. That's awesome. I had more certainty with 3x almost than I did where I started. I got the team in place. I watched them problem solve all day long on the chat and working systems and the processes and everything happens the same over and over again. [00:27:01] So it's really a business in a box, but you have to do it. You can't question yourself. You can't make excuses. You just have to do it. It'll be really easy if you just one foot in front of the other and take the steps. It's all there. And I had to stop because I can't wrap my mind around everything until I get to another place. Right. Yeah. Like I can only do so much and it's growing and working and so like, I've got to pause and then I'm going to dive back in and I don't know I'm still in DoorGrow obviously regularly. [00:27:34] Jason: Well, let's do some co coaching live on air. Let's figure out what's your next step? Ready? Okay. Yeah. You open? Okay, cool. So you're at 420 units right now. Yeah. Yeah. You've finally got a good team, you've got good culture. Yeah. So the next level to get to, you know, to break past that next kind of major barrier, which maybe is 600 doors, you have to have a great team, but you got to get three major systems installed. Those three major systems are going to be, you have to really get a good process system installed. Not just process documentation, but a system to where they're running the processes each time. So we've got DoorGrow flow. You can use that, lead simple, process street, something, but you need a good process system. That's one piece. The other piece you need is you need a really good people system. So you've started to create the culture, you've started to install that system. Then we want to make sure-- and did you use DoorGrow hiring and do grow ATS and work with Sarah on some of that stuff? [00:28:32] Jeff: I watched the coaching and implemented some of the things I learned just like I did with Clint. So yeah. [00:28:38] Jason: So we want to make sure we have a solid system so that as you scale, you can get the right people and get those people quickly. So it sounds like you've done some work on that. And then we want to make sure you have a really good planning system. So once you have a team of people you trust to execute, your executive team, then we want to install a planning system. Now these three systems should not be run by you because as a visionary and an entrepreneur, it's not fun for you to do this. So the key person, the most important hire you will have on the team will be an operator. Somebody that runs the operations. Do you feel like you have that key person right now? [00:29:15] Jeff: I do, but she is one of the people I brought on the most valuable hire I've made after I came to DoorGrow. And it was to have that operator, but she's a CFO. Okay. And she's grown another insurance company to probably where we're at now from scratch, which, you know, I think I'm blowing her mind a little on where we want to go, how fast we're going. But yeah, my goal is to make her the operator. She's the CFO. And so you know management's an accounting business, really at the end of the day, and so we are doing so many changes to our software and our accounting to make sure that all those processes and automations are in place that she is buried every day, but she helps with the team. She helped on the hiring. And she's going to be the operator to try to shorten that. We're working her into that role because as she figures pieces out, we hand them off. So it frees her time up and she's not doing the 15- $20 an hour work because they're paying her more than that. Handing it off and it's freeing up her time and she's. Then we're putting in place some of that more operation stuff, so in process. [00:30:23] Jason: Nice. Yeah. Cool. Awesome. So when she's ready, one of the things we'll want to do is start to get her to show up on the Friday coaching call, which is operations, and to do that super system breakout and work with her and you to get DoorGrow OS installed. Once you get DoorGrow OS installed, the planning system is that next level system. This is going to allow you to have your team start to function like a visionary, like the entrepreneur, they're going to start to innovate and move goals forward without you having to, you know, push them. And she will run that system. She'll run the meetings, and then you'll be able to set goals and break them down from quarterly to monthly to weekly commitments, and you'll start to see the momentum build big time when the team are all visible and can be seen and there's accountability and they get recognized because you have that system installed, performance sometimes goes up. When I first install a system like that, we grew 300% in a year. And so that is kind of the next level I think for you guys is when she's ready for that, we start to get DoorGrow OS installed and get that planning system and cadence. Because cadence in a business is the communication, cadence is the culture, cadence creates all of this, and it gets everyone rowing the boat in the same direction. So instead of you saying, "Hey, let's do this to everybody, watch this video at DoorGrow," et cetera. They will start to innovate and move outcomes forward because they're given goals and deadlines and then support instead of tasks. And that's where you'll start to see your team really perform. This is where you get like three times the output from your team members. This is where your operational costs drop significantly in relation to the number of people you have per door. And so that's what I see next level for you guys. And once you have that system installed, 600 doors is going to be a piece of cake. [00:32:17] Jeff: Yeah. The other thing too is that I know we need a sales funnel. The funnel right now is this mouth, that's it right now. [00:32:27] Jason: We got to get you out of that. So what'll be next is either we get you, if you don't have this already, we get you an assistant, a setter, or a sales assistant. And that person will then help you double your capacity currently. because they'll be doing all of the follow up, getting you on calls to close and you can use tactics like the double barrel close and some of these things we talk about. That's maybe, that's like level one, baby step. Level two, we just get you out of doing that all together. We get you a full-time BDM. Just like James Wachob 's team installed Brad, he's been showing up to each of our Wednesday calls where we support the BDMs or the people working on growth and I think he's helped him add like 250, something like that. They've added 400 doors organically in less than a year. [00:33:18] Jeff: Is that Brian Bouler guy? [00:33:20] Jason: Yeah, Brian Bouler's their operator. And he's, he actually just, yeah, he's a stud. He just became the director of the property management. So he's running all property management and he just hired an operator to replace himself from a Fortune 50 company. Right? So this is like once you have your operator fully functioning as an operator, you get her out of CFO role and you get her into being an operator, then we can start to install DoorGrow OS, get that team to the next level. And part of that plan, I think for your 90 days would be to start to focus on that sales side. If you're ready to ramp up lead gen and growth, then we get you maybe a setter initially, and then we get you a full-time BDM or you can jump straight to getting a BDM and we help you find somebody that can just crush it at sales. We identify the right personality type, they're great at this, and they will go out and just make it rain and create business for you. [00:34:13] Jeff: I got the hiccups all of a sudden, so I'm like, this is going to look great in the podcast. [00:34:17] Jason: You're just so excited about the future. Excited. Yeah. And you know, and that BDM could also, and then I think what you would do, if you want to focus on the growth side, if that's still fun for you, you just go out and find more acquisition deals. Yeah. Yeah. Yeah, that's fine. You can even get your BDM to start hunting for acquisition deals as well and feed them to you, and then you do double barrel close that way. They're feeding you to close it. Right? So, anyway, I think that's going to be the next level for you and, you know, maybe what I would maybe have your CFO do is do a time study and maybe you do a time study if you haven't done one for a while, so that you can see where can you support her even more and more quickly to get things off of her plate. What are you doing? Which things do you love the most? Which things don't you? And start to take some things off of her plate and give them to other team members as quick as possible. So, and then you'll know like, this is what she spent her time doing over the last two weeks. You're like, cool, we, these are minus signs. These are things that are lower level dollar an hour work. Let's define these processes and we make that a goal and all that. When you have a cadence and a planning system, you can plug all that into your goals. Like one of your quarterly goals would be transition CFO to operator, for example. Yeah. So we could start to build out those systems even right now with her, we just need to get you and her on board with that. And then you'll see things start to go even faster because you're already working a plan. When we put the plan in a way that everyone else can see it and everyone can contribute, the whole business starts to go faster. Otherwise, it's you pushing her and her pushing everybody else, and it's very top down. When you create a bottom up system, you'll start to feel a lot of momentum. Okay. It's a weird feeling when you start to feel the team pulling you forward instead of you pushing them forward. [00:36:10] Jeff: So, when you say that, what does that, what do you call that then? Like when you're saying bottom up, you know? When you, everything you just said, like, what is that? Like, what do I call that? [00:36:21] Jason: So I call that the planning system or DoorGrow OS, the operating system. The operating. So we want to get this operating system installed so that there's this planning cadence and communication. So I'd start with by doing a six core functions assessment with your team brainstorming session. That'll be quarterly planning and it'll take like an hour and a half or two hours. First time you do this as a team. [00:36:44] Jeff: That's all in os. That whole process is an OS. The step-by-step on that. That was my direction. I need OS, and I need Flow, and I'm like, oh, another thing I got to plan. [00:36:53] Jason: Yeah that's DoorGrow OS. The planning system. What's cool about it and, if you do the math on this, right? Let's say you do in your annual planning, you spend maybe an hour, a half. Your quarterly planning, you do four times a year. You spend maybe an hour, a half, two hours, right? Each of your monthly planning meetings, which you have 12, that adds up to 12 hours, maybe an hour each, right? Then you're doing your weekly commitments meetings every week. Maybe you'll do about 50 of those a year. Maybe those take an hour, sometimes even just 30 minutes, depending on the size of your team and the aggressiveness of your goals. And the goal on a weekly basis is to hit 80% of your weekly commitments. That's a lot of goals getting achieved. This is outside of the tactical work, outside of the day-to-day work. This is innovating and moving the business forward towards your core functions and what the business needs most and what you need most. [00:37:49] If you stack and add all this up, maybe even add a culture meeting here or there, and you add your daily huddles with your teams that are like maybe 15, 20 minutes, all that combined adds up to, you can run the entire business on 300 hours a year, and it eliminates a massive amount of 'got a minute?'s, sneaker net communication, interruptions, and it makes the business far more efficient. [00:38:14] Jeff: And that's all lined out in OS. Like I start OS, it's like everything step by step. I can do this. How? [00:38:22] Jason: Yes. However, my disclaimer is, this is not stuff that you're going to want to do. This is stuff that your operator will probably enjoy doing. Okay, but not you. Okay. Like me, I hear a bunch of meetings. My initial gut reaction is like, "oh gosh, shoot me now." Right? Yeah. Like that sounds like a cumbersome and a waste of my time. It actually speeds you up and speeds up the business and gives you more time, but you don't want to run it. You need somebody else to run it because otherwise you end up as the emperor with no clothes because everybody's going to agree to you, say "whatever Jeff says," you need somebody else to run it. And you're last to speak in all these meetings. Yeah. Then you'll start to see the magic and the genius of your team. because some of them are more closely connected to some of the things that need to shift or move or be innovated or move forward than you are, right? Your maintenance coordinator can see what's going on in maintenance and they probably have ideas. And so this will allow them to start to, you know, bubble up some of these ideas and it'll allow them to innovate. When team members don't get deadlines and outcomes that they're given to achieve. And then they can see that there's need for improvement, instead of innovating, they go and try and spend more of your money. Yeah, exactly. And so the team gets more expensive. And then you, if you give them a blank check, they'll just spend like, "let's go buy this new thing and let's buy that. And that might do this," right? When you give your team a deadline and some constraints and an outcome, they will start to get creative and innovate, and you want your team members to start to think like that. That turns them into intrapreneurs. So getting this system installed, I think will be the big next level thing, and we can start getting that installed right away so Sarah can help you get that set up. And set up a call with you and your operator and you're already working on some goals. So let's just get those goals into a system where everyone can see and make sure you start to move the plan forward, create the plan, work the plan, and you'll start to see the team move forward way faster. [00:40:16] So I'm excited for you man. [00:40:19] Jeff: Can you believe I got the hiccups? I get hiccups like once every 10 years. I get in the middle of the podcast. Yeah, I'm very excited about that because here's the truth is you're right, like you get to this place at, you know, 150 doors on my own right, that's capacity really no capacity would've been much higher. But doing it well, capacity was 150 doors. Now I'm at 400 something and we're going, well, yeah. I think I could add another a hundred doors before anything breaks, but I know we're there. We're 50 to a hundred doors away from having to do new stuff again. Yeah. I can feel it. And so that's exciting, but dreadful to think, to have to implement myself. [00:40:59] I think that's why I've kind of like, "let's just wait till we get everything we're doing dialed it perfectly before I get into that," but I need to just suck it up. I got to call with Sarah coming up the next couple days and I just need to tell her, okay, let's do OS, whatever. Tell me what to do next. Let's go. [00:41:14] Jason: Yeah. And really we're just going to start working on creating a plan. Then we'll put in the software and you'll start to see when you start having these weekly meetings with your team, you're going to start to see stuff move forward. Like our goal, we sometimes have like 40 things in a single week that we're working on as a team outside of our daily work, like 40 tasks that are assigned to different team members. [00:41:38] And my team members do not want to show up with a red 'no.' Yeah. And this increases their performance level, like you would not believe. They want green yeses when they show up on Monday for our weekly commitments meeting. And that means we are really likely to get all of our 30 day goals done, which means we're really likely to get all of our quarterly goals done because they're all connected. [00:41:59] Yeah. You'll start to see your business move forward really quickly. This is a next level thing. So I'm excited for you to get that installed. because first, you got to have an operator. because I've tried to do it on my own without an operator and I really, I get lazy because I just don't like it. Like, I don't like running the meetings. I'm like, "all right, anyone's stuck on anything? Let's move forward faster." And I just skip steps and I tell people, do things, but when the team starts to run this, your operator will start to run the business. The business will start to run itself. Things will start to move forward without you, and then instead of you feeling like you're the entrepreneur pulling your entire team up the hill in a wagon, which is what it feels like until you get a system like this, you're going to start to see them moving forward ahead of you, and you're going to be the one that is in the wagon and they're pulling you up the hill. You're just going to be there like giving some feedback, coaching them, supporting them, but you'll start to see the business move forward. I'm the biggest constraint on my team. Sarah and the team are using DoorGrow OS, and they're moving the whole business forward constantly. And they're like, "Jason, keep up. We need more from you." And so they're keeping me accountable now. I don't need to keep them accountable because I've got A players and I've got a system that brings that out in them. So that's the next level. Cool, man. Awesome. Well, hey, thanks for coming on the podcast and being vulnerable and sharing some of your struggles and your wins. [00:43:23] Really appreciate you as a client. [00:43:25] Jeff: Yeah. Appreciate you too, man. It's been a huge life changer. So cool. Well, keep pushing me. [00:43:32] Jason: Yeah, we'll keep going. We'll get you to that next level as well. So, thousand doors, here we come! [00:43:37] Jeff: Here we come. All right. [00:43:39] Jason: All right, thanks. See you. All right, so if you are a property management entrepreneur and you're wanting to get some coaching, you're tired of not having anyone in your corner, maybe nobody's believing in you, maybe not even your spouse is believing in you right now, and you need some hope, you want to have some results like Jeff, you're wanting to move your business forward. We would love to coach and help and support you. Join our mastermind. You can check us out at doorgrow.com. If you're looking like to get nurtured and warmed up a little bit more and you're not really sure about those DoorGrow people, then go to doorgrowclub.com. Join our free Facebook group. We give out better free stuff than most coaches in this industry give out that's paid, and you're going to get access to our master classes and some really cool stuff in there. Join that and you're going to see that we care and we want to see you succeed. And that will hopefully be a nice pathway into you becoming a client and working with DoorGrow and taking your business to that next level. And finally getting what you deserve, getting paid what you deserve, and having the business that you dream of having. [00:44:47] Until next time everybody, to our mutual growth. Bye everyone. [00:44:51] Jason Hull: You just listened to the #DoorGrowShow. We are building a community of the savviest property management entrepreneurs on the planet in the DoorGrowClub. Join your fellow DoorGrow Hackers at doorgrowclub.com. Listen, everyone is doing the same stuff. SEO, PPC, pay-per-lead content, social direct mail, and they still struggle to grow! [00:45:18] At DoorGrow, we solve your biggest challenge: getting deals and growing your business. Find out more at doorgrow.com. Find any show notes or links from today's episode on our blog doorgrow.com, and to get notified of future events and news subscribe to our newsletter at doorgrow.com/subscribe. Until next time, take what you learn and start DoorGrow Hacking your business and your life.
Summary: Tristan and Jeff are back with strategies and insights about 3 of the currently hottest Social Media platforms - X, Threads, and Facebook! Twitter has officially rebranded to ‘X', while Threads continues to ride the hype train. Facebook, too, has surprisingly improved in standing over the last few months. All of these developments could mean huge impacts for your current approach, so best to stay updated and ahead of the trends! Highlights: Intro T&J have 3 things to discuss. Let's talk about ‘X' (Tristan) Parallel success on X and Threads. Find logically connective posts. Jeff is on Threads more. Commercial time! A Tristan story time. Meta's diverse channels. What Jeff likes about Threads. Jumping to Facebook. A quick note on post-suppression. Why people stick with the classics. Jeff has a sound plan. Outro Summary: Tristan is back after a long while! Welcome back to the podcast champ! We're taking things a bit easy this episode, so Tristan and Jeff will walk you through the latest happenings and developments within the Social Media space. There has been a resurgence in the popularity of text-based online interaction; tune in to this episode to get an idea of what you can get out of Threads and the newly renamed Twitter - ‘X.com'. Highlights: Intro Let's talk about the next Social Media era. Monochrome is back! The secret to getting real engagement on X. The key to Threads… Jeff shares interesting ‘Big News'. Let's cut to commercial. Tristan dives into X. Jeff: So about Linda Yaccarino… Tristan on the real opportunity for X. Text-posting on TikTok. Engagement is key. What Tristan is excited about. Outro Resources: Threads https://www.threads.net/ X https://twitter.com/ Tags DrunkOnSocial, SocialGenius, TristanAhumada, JeffPfitzer, Socialmediaupdates, Socialmediastrategy, Socialmediatrends, socialmediasimpactonyourbusiness, socialmediaplatforms, socialmediainfluencers, Socialmedia, Socialmediamarketing, Socialmediacoach, Socialmedianews, Socialnetwork,
Summary: Tristan is back after a long while! Welcome back to the podcast champ! We're taking things a bit easy this episode, so Tristan and Jeff will walk you through the latest happenings and developments within the Social Media space. There has been a resurgence in the popularity of text-based online interaction; tune in to this episode to get an idea of what you can get out of Threads and the newly renamed Twitter - ‘X.com'. Highlights: Intro Let's talk about the next Social Media era. Monochrome is back! The secret to getting real engagement on X. The key to Threads… Jeff shares interesting ‘Big News'. Let's cut to commercial. Tristan dives into X. Jeff: So about Linda Yaccarino… Tristan on the real opportunity for X. Text-posting on TikTok. Engagement is key. What Tristan is excited about. Outro Resources: Threads https://www.threads.net/ X https://twitter.com/ Tags DrunkOnSocial, SocialGenius, TristanAhumada, JeffPfitzer, Socialmediaupdates, Socialmediastrategy, Socialmediatrends, socialmediasimpactonyourbusiness, socialmediaplatforms, socialmediainfluencers, Socialmedia, Socialmediamarketing, Socialmediacoach, Socialmedianews, Socialnetwork,
Throughout this Portals adventure, we have explored in many ways how to create the inner and outer space that would allow the next phase of universal and human evolution – the future – to appear. It's time to embrace the bold proposition that evolution has moved forward, and is still doing so, and the future has arrived. Homo sapiens, welcome Homo Universalis, the whole person. The evidence of individual and collective transformation is turning up in many places around the world. Homo Universalis is not meant to be characterized by physical changes but by changed lives and communities; the liberation of remarkable new intelligence, new capabilities, the elevation of thinking and behavior, and healing at many levels. Part of the human species updating represented by Homo Universalis is that each one of us can take steps to activate the new elevation and consciousness in ourselves. This conversation takes a deeper look at some of those steps. Join Aviv Shahar and Jeff Vander Clute for Homo Universalis Activates. KEY TAKEAWAYS 02:51 – Aviv welcomes back to the show, Jeff Vander Clute, to engage in a rich discussion on today's topic: Homo Universalis Activates14:46 – Aviv reflects on creating ecologies where people discover knowledge and release their inner intelligence and brilliance for themselves22:10 – The building of resilience, endurance, and mental toughness for growth opportunities29:03 – Explaining the concept of Homo Universalis and Shadow Work37:59 – The cleansing, sublimation, self-absolvement and forgiveness work41:32 – The continual updating of our own personal sense-making maps46:35 – Self-authoring, alignment & inquiry-based perception seeking55:27 – Why pursue shadow work?1:01:27 – Aviv provides some personal examples of how he's practiced shadow work in the past1:09:32 – Healing power1:14:31 – Closing thoughts and insights from Aviv and Jeff TWEETABLE QUOTES “There is always a consideration in me of how do you no longer do teaching in the old way of teaching, which is the transference of knowledge, but really create an ecology and an experience where individuals and groups can come into the ecology and that experience such that the knowledge, the discovery, the insight is self-arising.” (14:50) (Aviv)“I never completely resolve the pattern if it's in the world, but it's not present anymore personally; it's present transpersonal. And so now, because I've done the work, life says, ‘Fantastic, here's somebody who knows what to do so let's give him now a dump truck full from the USA's energy field' as an example. So, I get to do it again for the collective but with tools and with resources. And so my sense is that this could be world work. And we could each potentially do world work.” (20:29) (Jeff)“So, there's a great wisdom in life when immaturity is actually an asset for rapid growth. And then with wisdom I've become more discerning.” (25:47) (Jeff)“Let's just be aware and let's name the other fields such that the great fascination with shadow work does not become an end to itself but is rather recognized and appreciated and embraced inside a bigger context, which is this idea of human development in the evolutionary context from the homo sapiens or the sapien sapiens into the homo universalis.” (34:59) (Aviv)“Regarding alignment practices, as I experience alignment it is about aligning with life - the flow of life, the direction and movement of life. And that's a capacity that can be built over time - the capacity to sense in subtle ways how life is moving and then flow with life. And what I have found is life will then show me where there is shadow work, where there are opportunities to cleanse, or forgive, or release blockages, or improve my energy management. I'll be the first one to say right now that I'm a work in progress.” (52:07) (Jeff)“What you're offering, through these investigations, is a clear understanding of some of the ways that we can participate. And as we participate consciously in the flow of life and the unfolding of these empowered, nonlinear solutions, they have more power because they have our power.” (1:17:58) (Jeff) RESOURCES MENTIONED Portals of Perception WebsiteAviv's LinkedIn Aviv's TwitterAviv's WebsiteJeff's LinkedIn
About JeffJeff Smith has been in the technology industry for over 20 years, oscillating between management and individual contributor. Jeff currently serves as the Director of Production Operations for Basis Technologies (formerly Centro), an advertising software company headquartered in Chicago, Illinois. Before that he served as the Manager of Site Reliability Engineering at Grubhub.Jeff is passionate about DevOps transformations in organizations large and small, with a particular interest in the psychological aspects of problems in companies. He lives in Chicago with his wife Stephanie and their two kids Ella and Xander.Jeff is also the author of Operations Anti-Patterns, DevOps Solutions with Manning publishing. (https://www.manning.com/books/operations-anti-patterns-devops-solutions) Links Referenced: Basis Technologies: https://basis.net/ Operations Anti-Patterns: https://attainabledevops.com/book Personal Site: https://attainabledevops.com LinkedIn: https://www.linkedin.com/in/jeffery-smith-devops/ Twitter: https://twitter.com/DarkAndNerdy Medium: https://medium.com/@jefferysmith duckbillgroup.com: https://duckbillgroup.com TranscriptAnnouncer: Hello, and welcome to Screaming in the Cloud with your host, Chief Cloud Economist at The Duckbill Group, Corey Quinn. This weekly show features conversations with people doing interesting work in the world of cloud, thoughtful commentary on the state of the technical world, and ridiculous titles for which Corey refuses to apologize. This is Screaming in the Cloud.Corey: This episode is sponsored by our friends at Fortinet. Fortinet's partnership with AWS is a better-together combination that ensures your workloads on AWS are protected by best-in-class security solutions powered by comprehensive threat intelligence and more than 20 years of cybersecurity experience. Integrations with key AWS services simplify security management, ensure full visibility across environments, and provide broad protection across your workloads and applications. Visit them at AWS re:Inforce to see the latest trends in cybersecurity on July 25-26 at the Boston Convention Center. Just go over to the Fortinet booth and tell them Corey Quinn sent you and watch for the flinch. My thanks again to my friends at Fortinet.Corey: Let's face it, on-call firefighting at 2am is stressful! So there's good news and there's bad news. The bad news is that you probably can't prevent incidents from happening, but the good news is that incident.io makes incidents less stressful and a lot more valuable. incident.io is a Slack-native incident management platform that allows you to automate incident processes, focus on fixing the issues and learn from incident insights to improve site reliability and fix your vulnerabilities. Try incident.io, recover faster and sleep more.Corey: Welcome to Screaming in the Cloud. I'm Corey Quinn. One of the fun things about doing this show for long enough is that you eventually get to catch up with people and follow up on previous conversations that you've had. Many years ago—which sounds like I'm being sarcastic, but is increasingly actually true—Jeff Smith was on the show talking about a book that was about to release. Well, time has passed and things have changed. And Jeff Smith is back once again. He's the Director of Product Operations at Basis Technologies, and the author of DevOps Anti-Patterns? Or what was the actual title of the book it was—Jeff: Operations Anti-Patterns.Corey: I got hung up in the anti-patterns part because it's amazing. I love the title.Jeff: Yeah, Operations Anti-Patterns, DevOps Solutions.Corey: Got you. Usually in my experience, alway been operations anti-patterns, and here I am to make them worse, probably by doing something like using DNS as a database or some godforsaken thing. But you were talking about the book aspirationally a few years ago, and now it's published and it has been sent out to the world. And it went well enough that they translated it to Japanese, I believe, and it has seen significant uptick. What was your experience of it? How did it go?Jeff: You know, it was a great experience. This is definitely the first book that I've written. And the Manning process was extremely smooth. You know, they sort of hold your hand through the entire process. But even after launch, just getting feedback from readers and hearing how it resonated with folks was extremely powerful.I was surprised to find out that they turned it into an audiobook as well. So, everyone reaches out and says, “Did you read the audiobook? I was going to buy it, but I wasn't sure.” I was like, “No, unfortunately, I don't read it.” But you know, still cool to have it out there.Corey: My theory has been for a while now that no one wants to actually write a book; they want to have written a book. Now that you're on the other side, how accurate is that? Are you in a position of, “Wow, sure glad that's done?” Or are you, “That was fun. Let's do it again because I like being sad all the time.” I mean, you do work Kubernetes for God's sake. I mean, there's a bit of masochism inherent to all of us in this space.Jeff: Yeah. Kubernetes makes me cry a little bit more than the writing process. But it's one of the things when you look back on it, you're like, “Wow, that was fun,” but not in the heat of the moment, right? So, I totally agree with the sentiment that people want to have written a book but not actually gone through the process. And that's evident by the fact that how many people try to start a book on their own without a publisher behind them, and they end up writing it for 15 years. The process is pretty grueling. The feedback is intense at first, but you start to get into a groove and you—I could see, you know, in a little while wanting to write another book. So, I can see the appeal.Corey: And the last time you were on the show, I didn't really bother to go in a particular topical direction because, what's the point? It didn't really seem like it was a top-of-mind issue to really bring up because what's it matter; it's a small percentage of the workforce. Now I feel like talking about remote work is suddenly taking on a bit of a different sheen than it was before the dark times arrived. Where do you land on the broad spectrum of opinions around the idea of remote work, given that you have specialized in anti-patterns, and well, as sarcastic as I am, I tend to look at almost every place I've ever worked is expressing different anti-patterns from time to time. So, where do you land on the topic?Jeff: So, it's funny, I started as a staunch office supporter, right? I like being in the office. I like collaborating in person; I thought we were way more productive. Since the pandemic, all of us are forced into remote work, I've hired almost half of my team now as remote. And I am somewhat of a convert, but I'm not on the bandwagon of remote work is just as good or is better as in person work.I've firmly landed in the camp of remote work is good. It's got its shortcomings, but it's worth the trade off. And I think acknowledging what those trade-offs are important to keeping the team afloat. We just recently had a conversation with the team where we were discussing, like, you know, there's definitely been a drop in productivity over the past six months to a year. And in that conversation, a lot of the things that came up were things that are different remote that were better in person, right, Slack etiquette—which is something, you know, I could talk a little bit about as well—but, you know, Slack etiquette in terms of getting feedback quickly, just the sort of camaraderie and the lack of building that camaraderie with new team members as they come on board and not having those rituals to replace the in-person rituals. But through all that, oddly enough, no one suggested going back into the office. [laugh].Corey: For some strange reason, yeah. I need to be careful what I say here, I want to disclaim the position that I'm in. There is a power imbalance and nothing I say is going to be able to necessarily address that because I own the company and if my team members are listening to this, they're going to read a lot into what I say that I might not necessarily intend. But The Duckbill Group, since its founding, has been a fully distributed company. My business partner lives in a different state than I do so there's never been the crappy version of remote, which is, well, we're all going to be in the same city, except for Theodore. Theodore is going to be timezones away and then wonder why he doesn't get to participate in some of the conversations where the real decisions get made.Like that's crappy. I don't like that striated approach to things. We don't have many people who are co-located in any real sense, nor have we for the majority of the company's life. But there are times when I am able to work on a project in a room with one of my colleagues, and things go a lot more smoothly. As much as we want to pretend that video is the same, it quite simply isn't.It is a somewhat poor substitute for the very high bandwidth of a face-to-face interaction. And yes, I understand this is also a somewhat neurotypical perspective, let's be clear with that as well, and it's not for everyone. But I think that for the base case, a lot of the remote work advocates are not being fully, I guess, honest with themselves about some of the shortcomings remote has. That is where I've mostly landed on this. Does that generally land with where you are?Jeff: Yeah, that's exactly where I'm at. I completely agree. And when we take work out of the equation, I think the shortcomings lay themselves bare, right? Like I was having a conversation with a friend and we were like, well, if you had a major breakup, right, I would never be like, “Oh, man. Grab a beer and hop on Zoom,” right? [laugh]. “Let's talk it out.”No, you're like, hey, let's get in person and let's talk, right? We can do all of that conversation over Zoom, but the magic of being in person and having that personal connection, you know, can't be replaced. So, you know, if it's not going to work, commiserating over beers, right? I can't imagine it's going to work, diagramming some complex workflows and trying to come to an answer or a solution on that. So again, not to say that, you know, remote work is not valuable, it's just different.And I think organizations are really going to have to figure out, like, okay, if I want to entice people back into the office, what are the things that I need to do to make this realistic? We've opened the floodgates on remote hiring, right, so now it's like, okay, everyone's janky office setup needs to get fixed, right? So, I can't have a scenario where it's like, “Oh, just point your laptop at the whiteboard, right?” [laugh]. Like that can't exist, we have to have office spaces that are first-class citizens for our remote counterparts as well.Corey: Right because otherwise, the alternative is, “Great, I expect you to take the home that you pay for and turn it into an area fit for office use. Of course, we're not going to compensate you for that, despite the fact that, let's be realistic, rent is often larger than the AWS bill.” Which I know, gasp, I'm as shocked as anyone affected by that, but it's true. “But oh, you want to work from home? Great. That just means you can work more hours.”I am not of the school of thought where I consider time in the office to be an indicator of anything meaningful. I care if the work gets done and at small-scale, this works. Let me also be clear, we're an 11-person company. A lot of what I'm talking about simply will not scale to companies that are orders of magnitude larger than this. And from where I sit, that's okay. It doesn't need to.Jeff: Right. And I think a lot of the things that you talk about will scale, right? Because in most scenarios, you're not scaling it organizationally so much as you are with a handful of teams, right? Because when I think about all the different teams I interact with, I never really interact with the organization as a whole, I interact with my little neighborhood in the organization. So, it is definitely something that scales.But again, when it comes to companies, like, enticing people back into the office, now that I'm talking about working from home five days a week, I've invested in my home setup. I've got the monitor I want, I've got the chair that I want, I've got the mouse and keyboard that I want. So, you're going to bring me back to the office so I can have some standard Dell keyboard and mouse with some janky, you know—maybe—21-inch monitor or something like that, right? Like, you really have to decide, like, okay, we're going to make the office a destination, we're going to make it where people want to go there where it's not just even about the collaboration aspect, but people can still work and be effective.And on top of that, I think how we look at what the office delivers is going to change, right? Because now when I go to the office now, I do very little work. It's connections, right? It's like, you know, “Oh, I haven't seen you in forever. Let's catch up.” And a lot of that stuff is valuable. You know, there's these hallway conversations that exist that just weren't happening previously because how do I accidentally bump into you on Slack? [laugh]. Right, it has to be much more it of a—Corey: Right. It takes some contrivance to wind up making that happen. I remember back in the days of working in offices, I remember here in San Francisco where we had unlimited sick time and unlimited PTO, I would often fake a sick day, but just stay home and get work done. Because I knew if I was in the office, I'd be constantly subjected to drive-bys the entire time of just drive-by requests, people stopping by to ask, “Oh, can you just help me with this one thing,” that completely derails my train of thought. Then at the end of the day, they'd tell me, “You seem distractible and you didn't get a lot of work done.”It's, “Well, no kidding. Of course not. Are you surprised?” And one of the nice things about starting your own company—because there are a lot of downsides, let me be very clear—one of the nice things is you get to decide how you want to work. And that was a study in, first, amazement, and then frustration.It was, “All right, I just landed a big customer. I'm off to the races and going to take this seriously for a good six to twelve months. Great sky's the limit, I'm going to do up my home office.” And then you see how little money it takes to have a nice chair, a good standing desk, a monitor that makes sense and you remember fighting tooth-and-nail for nothing that even approached this quality at companies and they acted like it was going to cost them 20-grand. And here, it's two grand at most, when I decorated this place the first time.And it was… “What the hell?” Like, it feels like the scales fall away from your eyes, and you start seeing things that you didn't realize were a thing. Now I worry that five years in, there's no way in the world I'm ever fit to be an employee again, so this is probably the last job I'll ever have. Just because I've basically made myself completely unemployable across six different axes.Jeff: [laugh]. And I think one of the things when it comes to, like, furniture, keyboard, stuff like that, I feel like part of it was just, like, this sort of enforced conformity, right, that the office provided us the ability to do. We can make sure everyone's got the same monitor, the same keyboard that way, when it breaks, we can replace it easily. In a lot of organizations that I've been in, you know, that sort of like, you know, even if it was the same amount or ordering a custom keyboard was a big exception process, right? Like, “Oh, we've got to do a whole thing.” And it's just like, “Well, it doesn't have to be that complicated.”And like you said, it doesn't cost much to allow someone to get the tools that they want and prefer and they're going to be more productive with. But to your point really quickly about work in the office, until the pandemic, I personally didn't recognize how difficult it actually was to get work done in the office. I don't think I appreciated it. And now that I'm remote, I'm like, wow, it is so much easier for me to close this door, put my headphones on, mute Slack and go heads down. You know, the only drive-by I've got is my wife wondering if I want to go for a walk, and that's usually a text message that I can ignore and come back to later.Corey: The thing that just continues to be strange for me and breaks in some of the weirdest ways has just been the growing awareness of how much of office life is unnecessary and ridiculous. When you're in the office every day, you have to find a way to make it work and be productive and you have this passive-aggressive story of this open office, it's for collaboration purposes. Yeah, I can definitively say that is not true. I had a boss who once told me that there was such benefits to working in an open plan office that if magically it were less expensive to give people individual offices, he would spare the extra expense for open plan. That was the day I learned he would lie to me while looking me in the eye. Because of course you wouldn't.And it's for collaboration. Yeah, it means two loud people—often me—are collaborating and everyone else wears noise-canceling headphones trying desperately to get work done, coming in early, hours before everyone else to get things done before people show up and distracted me. What the hell kind of day-to-day work environment is that?Jeff: What's interesting about that, though, is those same distractions are the things that get cited as being missed from the perspective of the person doing the distracting. So, everyone universally hates that sort of drive-by distractions, but everyone sort of universally misses the ability to say like, “Hey, can I just pull on your ear for a second and get your feedback on this?” Or, “Can we just walk through this really quickly?” That's the thing that people miss, and I don't think that they ever connect it to the idea that if you're not the interruptee, you're the interruptor, [laugh] and what that might do to someone else's productivity. So, you would think something like Slack would help with that, but in reality, what ends up happening is if you don't have proper Slack etiquette, there's a lot of signals that go out that get misconstrued, misinterpreted, internalized, and then it ends up impacting morale.Corey: And that's the most painful part of a lot of that too. Is that yeah, I want to go ahead and spend some time doing some nonsense—as one does; imagine that—and I know that if I'm going to go into an office or meet up with my colleagues, okay, that afternoon or that day, yeah, I'm planning that I'm probably not going to get a whole lot of deep coding done. Okay, great. But when that becomes 40 hours a week, well, that's a challenge. I feel like being full remote doesn't work out, but also being in the office 40 hours a week also feels a little sadistic, more than almost anything else.I don't know what the future looks like and I am privileged enough that I don't have to because we have been full remote the entire time. But what we don't spend on office space we spend on plane tickets back and forth so people can have meetings. In the before times, we were very good about that. Now it's, we're hesitant to do it just because it's we don't want people traveling before the feel that it's safe to do so. We've also learned, for example, when dealing with our clients, that we can get an awful lot done without being on site with them and be extraordinarily effective.It was always weird have traveled to some faraway city to meet with the client, and then you're on a Zoom call from their office with the rest of the team. It's… I could have done this from my living room.Jeff: Yeah. I find those sorts of hybrid meetings are often worse than if we were all just remote, right? It's just so much easier because now it's like, all right, three of us are going to crowd around one person's laptop, and then all of the things that we want to do to take advantage of being in person are excluding the people that are remote, so you got to do this careful dance. The way we've been sort of tackling it so far—and we're still experimenting—is we're not requiring anyone to come back into the office, but some people find it useful to go to the office as a change of scenery, to sort of, like break things up from their typical routine, and they like the break and the change. But it's something that they do sort of ad hoc.So, we've got a small group that meets, like, every Thursday, just as a day to sort of go into the office and switch things up. I think the idea of saying everyone has to come into the office two or three days a week is probably broken when there's no purpose behind it. So, my wife technically should go into the office twice a week, but her entire team is in Europe. [laugh]. So, what point does that make other than I am a body in a chair? So, I think companies are going to have to get flexible with this sort of hybrid environment.But then it makes you wonder, like, is it worth the office space and how many people are actually taking advantage of it when it's not mandated? We find that our office time centers around some event, right? And that event might be someone in town that's typically remote. That might be a particular project that we're working on where we want to get ideas and collaborate and have a workshop. But the idea of just, like, you know, we're going to systematically require people to be in the office x many days, I don't see that in our future.Corey: No, and I hope you're right. But it also feels like a lot of folks are also doing some weird things around the idea of remote such as, “Oh, we're full remote but we're going to pay you based upon where you happen to be sitting geographically.” And we find that the way that we've done this—and again, I'm not saying there's a right answer for everyone—but we wind up paying what the value of the work is for us. In many cases, that means that we would be hard-pressed to hire someone in the Bay Area, for example. On the other hand, it means that when we hire people who are in places with relatively low cost of living, they feel like they've just hit the lottery, on some level.And yeah, some of them, I guess it does sort of cause a weird imbalance if you're a large Amazon-scale company where you want to start not disrupting local economies. We're not hiring that many people, I promise. So, there's this idea of figuring out how that works out. And then where does the headquarters live? And well, what state laws do we wind up following on what we're doing? Just seems odd.Jeff: Yeah. So, you know, one thing I wanted to comment on that you'd mentioned earlier, too, was the weird things that people are doing, and organizations are doing with this, sort of, remote work thing, especially the geographic base pay. And you know, a lot of it is, how can we manipulate the situation to better us in a way that sounds good on paper, right? So, it sounds perfectly reasonable. Like, oh, you live in New York, I'm going to pay you in New York rates, right?But, like, you live in Des Moines, so I'm going to pay you Des Moines rates. And on the surface, when you just go you're like, oh, yeah, that makes sense, but then you think about it, you're like, “Wait, why does that matter?” Right? And then, like, how do I, as a manager, you know, level that across my employees, right? It's like, “Oh, so and so is getting paid 30 grand less. Oh, but they live in a cheaper area, right?” I don't know what your personal situation is, and how much that actually resonates or matters.Corey: Does the value that they provide to your company materially change based upon where they happen to be sitting that week?Jeff: Right, exactly. But it's a good story that you can tell, it sounds fair at first examination. But then when you start to scratch the surface, you're like, “Wait a second, this is BS.” So, that's one thing.Corey: It's like tipping on some level. If you can't afford the tip, you can't afford to eat out. Same story here. If you can't afford to compensate people the value that they're worth, you can't afford to employ people. And figure that out before you wind up disappointing people and possibly becoming today's Twitter main character.Jeff: Right. And then the state law thing is interesting. You know, when you see states like California adopting laws similar to, like, GDPR. And it's like, do you have to start planning for the most stringent possibility across every hire just to be safe and to avoid having to have this sort of patchwork of rules and policies based on where someone lives? You might say like, “Okay, Delaware has the most stringent employer law, so we're going to apply Delaware's laws across the board.” So, it'll be interesting to see how that sort of plays out in the long run. Luckily, that's not a problem I have to solve, but it'll be interesting to see how it shakes out.Corey: It is something we had to solve. We have an HR consultancy that helps out with a lot of these things, but the short answer is that we make sure that we obey with local laws, but the way that we operate is as if everyone were a San Francisco employee because that is—so far—the locale that, one, I live here, but also of every jurisdiction we've looked at in the United States, it tends to have the most advantageous to the employee restrictions and requirements. Like one thing we do is kind of ridiculous—and we have to do for me and one other person, but almost no one else, but we do it for everyone—is we have to provide stipends every month for electricity, for cellphone usage, for internet. They have to be broken out for each one of those categories, so we do 20 bucks a month for each of those. It adds up to 100 bucks, as I recall, and we call it good. And employees say, “Okay. Do we just send you receipts? Please don't.”I don't want to look at your cell phone bill. It's not my business. I don't want to know. We're doing this to comply with the law. I mean, if it were up to me, it would be this is ridiculous. Can we just give everyone $100 a month raise and call it good? Nope. The forms must be obeyed. So, all right.We do the same thing with PTO accrual. If you've acquired time off and you leave the company, we pay it out. Not every state requires that. But paying for cell phone access and internet access as well, is something Amazon is currently facing a class action about because they didn't do that for a number of their California employees. And even talking to Amazonians, like, “Well, they did, but you had to jump through a bunch of hoops.”We have the apparatus administratively to handle that in a way that employees don't. Why on earth would we make them do it unless we didn't want to pay them? Oh, I think I figured out this sneaky, sneaky plan. I'm not here to build a business by exploiting people. If that's the only way to succeed, and the business doesn't deserve to exist. That's my hot take of the day on that topic.Jeff: No, I totally agree. And what's interesting is these insidious costs that sneak up that employees tend to discount, like, one thing I always talk about with my team is all that time you're thinking about a problem at work, right, like when you're in the shower, when you're at dinner, when you're talking it over with your spouse, right? That's work. That's work. And it's work that you're doing on your time.But we don't account for it that way because we're not typing; we're not writing code. But, like, think about how much more effective as people, as employees, we would be if we had time dedicated to just sit and think, right? If I could just sit and think about a problem without needing to type but just critically think about it. But then it's like, well, what does that look like in the office, right? If I'm just sitting there in my chair like this, it doesn't look like I'm doing anything.But that's so important to be able to, like, break down and digest some of the complex problems that we're dealing with. And we just sort of write it off, right? So, I'm like, you know, you got to think about how that bleeds into your personal time and take that into account. So yeah, maybe you leave three hours early today, but I guarantee you, you're going to spend three hours throughout the week thinking about work. It's the same thing with these cellphone costs that you're talking about, right? “Oh, I've got a cell phone anyways; I've got internet anyways.” But still, that's something that you're contributing to the business that they're not on the hook for, so it seems fair that you get compensated for that.Corey: I just think about that stuff all the time from that perspective, and now that I you know, own the place, it's one of those which pocket of mine does it come out of? But I hold myself to a far higher standard about that stuff than I do the staff, where it's, for example, I could theoretically justify paying my internet bill here because we have business-class internet and an insane WiFi system because of all of the ridiculous video production I do. Now. It's like, like, if anyone else on the team was doing this, yes, I will insist we pay it, but for me, it just it feels a little close to the edge. So, it's one of those areas where I'm very conservative around things like that.The thing that also continues to just vex me, on some level, is this idea that time in a seat is somehow considered work. I'll never forget one of the last jobs I had before I started this place. My boss walked past me and saw that I was on Reddit. And, “Is that really the best use of your time right now?” May I use the bathroom when I'm done with this, sir?Yeah, of course it is. It sounds ridiculous, but one of the most valuable things I can do for The Duckbill Group now is go on the internet and start shit posting on Twitter, which sounds ridiculous, but it's also true. There's a brand awareness story there, on some level. And that's just wild to me. It's weird, we start treating people like adults, they start behaving that way. And if you start micromanaging them, they live up or down to the expectations you tend to hold. I'm a big believer in if I have to micromanage someone, I should just do the job myself.Jeff: Yeah. The Reddit story makes me think of, like, how few organizations have systematic ways of getting vital information. So, the first thing I think about is, like, security and security vulnerabilities, right? So, how does Basis Technologies, as an organization, know about these things? Right now, it's like, well, my team knows because we're plugged into Reddit and Twitter, right, but if we were gone Basis, right, may not necessarily get that information.So, that's something we're trying to correct, but it just sort of highlights the importance of freedom for these employees, right? Because yeah, I'm on Reddit, but I'm on /r/sysadmin. I'm on /r/AWS, right, I'm on /r/Atlassian. Now I'm finding out about this zero-day vulnerability and it's like, “Oh, guys, we got to act. I just heard about this thing.” And people are like, “Oh, where did this come from?” And it's like it came from my network, right? And my network—Corey: Mm-hm.Jeff: Is on Twitter, LinkedIn, Reddit. So, the idea that someone browsing the internet on any site, really, is somehow not a productive use of their time, you better be ready to itemize exactly what that means and what that looks like. “Oh, you can do this on Reddit but you can't do that on Reddit.”Corey: I have no boss now, I have no oversight, but somehow I still show up with a work ethic and get things done.Jeff: Right. [laugh].Corey: Wow, I guess I didn't need someone over my shoulder the whole time. Who knew?Jeff: Right. That's all that matters, right? And if you do it in 30 hours or 40 hours, that doesn't really matter to me, you know? You want to do it at night because you're more productive there, right, like, let's figure out a way to make that happen. And remote work is actually empowering us ways to really retain people that wasn't possible before I had an employee that was like, you know, I really want to travel. I'm like, “Dude, go to Europe. Work from Europe. Just do it. Work from Europe,” right? We've got senior leaders on the C-suite that are doing it. One of the chief—Corey: I'm told they have the internet, even there. Imagine that?Jeff: Yeah. [laugh]. So, our chief program officer, she was in Greece for four weeks. And it worked. It worked great. They had a process. You know, she would spent one week on and then one week off on vacation. But you know, she was able to have this incredible, long experience, and still deliver. And it's like, you know, we can use that as a model to say, like—Corey: And somehow the work got done. Wow, she must be amazing. No, that's the baseline expectation that people can be self-managing in that respect.Jeff: Right.Corey: They aren't toddlers.Jeff: So, if she can do that, I'm sure you can figure out how to code in China or wherever you want to visit. So, it's a great way to stay ahead of some of these companies that have a bit more lethargic policies around that stuff, where it's like, you know, all right, I'm not getting that insane salary, but guess what, I'm going to spend three weeks in New Zealand hanging out and not using any time off or anything like that, and you know, being able to enjoy life. I wish this pandemic had happened pre-kids because—Corey: Yeah. [laugh].Jeff: —you know, we would really take advantage of this.Corey: You and me both. It would have very different experience.Jeff: Yeah. [laugh]. Absolutely, right? But with kids in school, and all that stuff, we've been tethered down. But man, I you know, I want to encourage the young people or the single people on my team to just, like, hey, really, really embrace this time and take advantage of it.Corey: I come bearing ill tidings. Developers are responsible for more than ever these days. Not just the code that they write, but also the containers and the cloud infrastructure that their apps run on. Because serverless means it's still somebody's problem. And a big part of that responsibility is app security from code to cloud. And that's where our friend Snyk comes in. Snyk is a frictionless security platform that meets developers where they are - Finding and fixing vulnerabilities right from the CLI, IDEs, Repos, and Pipelines. Snyk integrates seamlessly with AWS offerings like code pipeline, EKS, ECR, and more! As well as things you're actually likely to be using. Deploy on AWS, secure with Snyk. Learn more at Snyk.co/scream That's S-N-Y-K.co/screamCorey: One last topic I want to get into before we call it an episode is, I admit, I read an awful lot of books, it's a guilty pleasure. And it's easy to fall into the trap, especially when you know the author, of assuming that snapshot of their state of mind at a very fixed point in time is somehow who they are, like a fly frozen in amber, and it's never true. So, my question for you is, quite simply, what have you learned since your book came out?Jeff: Oh, man, great question. So, when I was writing the book, I was really nervous about if my audience was as big as I thought it was, the people that I was targeting with the book.Corey: Okay, that keeps me up at night, too. I have no argument there.Jeff: Yeah. You know what I mean?Corey: Please, continue.Jeff: I'm surrounded, you know, by—Corey: Is anyone actually listening to this? Yeah.Jeff: Right. [laugh]. So, after the book got finished and it got published, I would get tons of feedback from people that so thoroughly enjoyed the book, they would say things like, you know, “It feels like you were in our office like a fly on the wall.” And that was exciting, one, because I felt like these were experiences that sort of resonated, but, two, it sort of proved this thesis that sometimes you don't have to do something revolutionary to be a positive contribution to other people, right? So, like, when I lay out the tips and things that I do in the book, it's nothing earth-shattering that I expect Google to adopt. Like, oh, my God, this is the most unique view ever.But being able to talk to an audience in a way that resonates with them, that connects with them, that shows that I understand their problem and have been there, it was really humbling and enlightening to just see that there are people out there that they're not on the bleeding edge, but they just need someone to talk to them in a language that they understand and resonate with. So, I think the biggest thing that I learned was this idea that your voice is important, your voice matters, and how you tell your story may be the difference between someone understanding a concept and someone not understanding a concept. So, there's always an audience for you out there as you're writing, whether it be your blog post, the videos that you produce, the podcasts that you make, somewhere there's someone that needs to hear what you have to say, and the unique way that you can say it. So, that was extremely powerful.Corey: Part of the challenge that I found is when I start talking to other people, back in the before times, trying to push them into conference talks and these days, write blog posts, the biggest objection I get sometimes is, “Well, I don't have anything worth saying.” That is provably not true. One of my favorite parts about writing Last Week in AWS is as I troll the internet looking for topics about AWS that I find interesting, I keep coming across people who are very involved in one area or another of this ecosystem and have stories they want to tell. And I love, “Hey, would you like to write a guest post for Last Week in AWS?” It's always invite only and every single one of them has been paid because people die of exposure and I'm not about that exploitation lifestyle.A couple have said, “Oh, I can't accept payment for a variety of reasons.” Great. Pick a charity that you would like it to go to instead because we do not accept volunteer work, we are a for-profit entity. That is the way it works here. And that has been just one of the absolute favorite parts about what I do just because you get to sort of discover new voices.And what I find really neat is that for a lot of these folks, this is their start to writing and telling the story, but they don't stop there, they start telling their story in other areas, too. It leads to interesting career opportunities for them, it leads to interesting exposure that they wouldn't have necessarily had—again, not that they're getting paid in exposure, but the fact that they are able to be exposed to different methodologies, different ways of thinking—I love that. It's one of my favorite parts about doing what I do. And it seems to scale a hell of a lot better than me sitting down with someone for two hours to help them build a CFP that they wind up not getting accepted or whatnot.Jeff: Right. It's a great opportunity that you provide folks, too, because of, like, an instant audience, I think that's one of the things that has made Medium so successful as, like, a blogging platform is, you know, everyone wants to go out and build their own WordPress site and launch it, but then it like, you write your blog post and it's crickets. So, the ability for you to, you know, use your platform to also expose those voices is great and extremely powerful. But you're right, once they do it, it lights a fire in a way that is admirable to watch. I have a person that I'm mentoring and that was my biggest piece of advice I can give. It was like, you know, write. Just write.It's the one thing that you can do without anyone else. And you can reinforce your own knowledge of a thing. If you just say, you know, I'm going to teach this thing that I just learned, just the writing process helps you solidify, like, okay, I know this stuff. I'm demonstrating that I know it and then four years from now, when you're applying for a job, someone's like, “Oh, I found your blog post and I see that you actually do know how to set up a Kubernetes cluster,” or whatever. It's just extremely great and it—Corey: It's always fun. You're googling for how to do something and you find something you wrote five years ago.Jeff: Right, yeah. [laugh]. And it's like code where you're like, “Oh, man, I would do that so much differently now.”Corey: Since we last spoke, one of the things I've been doing is I have been on the hook to write between a one to two-thousand-word blog post every week, and I've done that like clockwork, for about a year-and-a-half now. And I was no slouch at storytelling before I started doing that. I've given a few hundred conference talks in the before times. And I do obviously long Twitter threads in the past and I write reports a lot. But forcing me to go through that process every week and then sit with an editor and go ahead and get it improved, has made me a far better writer, it's made me a better storyteller, I am far better at articulating my point of view.It is absolutely just unlocking a host of benefits that I would have thought I was, oh, I passed all this. I'm already good at these things. And I was, but I'm better now. I think that writing is one of those things that people need to do a lot more of.Jeff: Absolutely. And it's funny that you mentioned that because I just recently, back in April, started to do the same thing I said, I'm going to write a blog post every week, right? I'm going to get three or four in the can, so that if life comes up and I miss a beat, right, I'm not actually missing the production schedule, so I have a steady—and you're right. Even after writing a book, I'm still learning stuff through the writing process, articulating my point of view.It's just something that carries over, and it carries over into the workforce, too. Like, if you've ever read a bad piece of documentation, right, that comes from—Corey: No.Jeff: Right? [laugh]. That comes from an inability to write. Like, you know, you end up asking these questions like who's the audience for this? What is ‘it' in this sentence? [laugh].Corey: Part of it too, is that people writing these things are so close to the problem themselves that the fact that, “Well, I'm not an expert in this.” That's why you should write about it. Talk about your experience. You're afraid everyone's going to say, “Oh, you're a fool. You didn't understand how this works.”Yeah, my lived experiences instead—and admittedly, I have the winds of privilege of my back on this—but it's also yeah, I didn't understand that either. It turns out that you're never the only person who has trouble with a concept. And by calling it out, you're normalizing it and doing a tremendous service for others in your shoes.Jeff: Especially when you're not an expert because I wrote some documentation about the SSL process and it didn't occur to me that these people don't use the AWS command line, right? Like, you know, in our organization, we sort of mask that from them through a bunch of in-house automation. Now we're starting to expose it to them and simple things like oh, you need to preface the AWS command with a profile name. So, then when we're going through the setup, we're like, “Oh. What if they already have an existing profile, right?” Like, we don't want to clobber that.SSo, it just changed the way you write the documentation. But like, that's not something that initially came to mind for me. It wasn't until someone went through the docs, and they're like, “Uh, this is blowing up in a weird way.” And I was like, “Oh, right. You know, like, I need to also teach you about profile management.”Corey: Also, everyone has a slightly different workflow for the way they interact with AWS accounts, and their shell prompts, and the way they set up local dev environments.Jeff: Yeah, absolutely. So, not being an expert on a thing is key because you're coming to it with virgin eyes, right, and you're able to look at it from a fresh perspective.Corey: So, much documentation out there is always coming from the perspective of someone who is intimately familiar with the problem space. Some of the more interesting episodes that I have, from a challenge perspective, are people who are deep technologists in a particular area and they love they fallen in love with the thing that they are building. Great. Can you explain it to the rest of us mere mortals so that we can actually we can share your excitement on this? And it's very hard to get them to come down to a level where it's coherent to folks who haven't spent years thinking deeply about that particular problem space.Jeff: Man, the number one culprit for that is, like, the AWS blogs where they have, like, a how-to article. You follow that thing and you're like, “None of this is working.” [laugh]. Right? And then you realize, oh, they made an assumption that I knew this, but I didn't right?So, it's like, you know, I didn't realize this was supposed to be, like, a handwritten JSON document just jammed into the value field. Because I didn't know that, I'm not pulling those values out as JSON. I'm expecting that just to be, like, a straight string value. And that has happened more and more times on the AWS blog than I can count. [laugh].Corey: Oh, yeah, very often. And then there's other problems, too. “Oh, yeah. Set up your IAM permissions properly.” That's left as an exercise for the reader. And then you wonder why everything's full of stars. Okay.Jeff: Right. Yep, exactly, exactly.Corey: Ugh. It's so great to catch up with you and see what you've been working on. If people want to learn more, where's the best place to find you?Jeff: So, the best place is probably my website, attainabledevops.com. That's a place where you can find me on all the other places. I don't really update that site much, but you can find me on LinkedIn, Twitter, from that jumping off point, links to the book are there if anyone's interested in that. Perfect stocking stuffers. Mom would love it, grandma would love it, so definitely, definitely buy multiple copies of that.Corey: Yeah, it's going to be one of my two-year-old's learning to read books, it'd be great.Jeff: Yeah, it's perfect. You know, you just throw it in the crib and walk away, right? They're asleep at no time. Like I said, I've also been taking to, you know, blogging on Medium, so you can catch me there, the links will be there on Attainable DevOps as well.Corey: Excellent. And that link will of course, be in the show notes. Thank you so much for being so generous with your time. I really do appreciate it. And it's great to talk to you again.Jeff: It was great to catch up.Corey: Really was. Jeff Smith, Director of Product Operations at Basis Technologies. I'm Cloud Economist Corey Quinn, and this is Screaming in the Cloud. If you've enjoyed this podcast, please leave a five-star review on your podcast platform of choice or smash the like and subscribe buttons on the YouTubes, whereas if you've hated this podcast, do the exact same thing—five-star review, smash the buttons—but also leave an angry, incoherent comment that you're then going to have edited and every week you're going to come back and write another incoherent comment that you get edited. And in the fullness of time, you'll get much better at writing angry, incoherent comments.Corey: If your AWS bill keeps rising and your blood pressure is doing the same, then you need The Duckbill Group. We help companies fix their AWS bill by making it smaller and less horrifying. The Duckbill Group works for you, not AWS. We tailor recommendations to your business and we get to the point. Visit duckbillgroup.com to get started.Announcer: This has been a HumblePod production. Stay humble.
Sean: We have a question. How do you map out a plan for your employees' growth and promotion? Jeff: You have to probably first identify where do you want to bring the company in the first place? Again, growth in a company happens when your people are also growing. See, I've seen many companies in the past that, as you know, they grew too fast, too soon, and forgot the people that are in the company, and they didn't grow them together with the organization. What happens is that they kept on growing. They hired people from the outside to sustain the growth. But unfortunately, you know, when you put in new blood, it's a good thing once in a while to eventually put in new blood so that it would challenge the organization. But if you keep on pouring in new people from the outside and you're not growing internal, it will eventually disrupt your momentum, your culture, and so on. Jeff: So how do you map it out? First again, identify the company's objective or your company's roadmap, and eventually translate it to the structure that you have. By the way, Sean. I like this framework. It's called McKinsey's Seven S. So, whenever we have start planning, we would usually use McKinsey sevens to eventually help us what to do with the strategy that we've come up with. So, in that seven S, you have the strategy, the structure, the system, the skill sets, the style of the leader and the shared values, and also the staffing in terms of putting it together. So part of that is your system which you would eventually review and revise in relation to the new structure, in relation to the new types of staff or the number of staff, and in terms of the skill sets that are needed to eventually achieve the strategy that you've set for the organization. So it's something that you would first identify the goals and from that goal, the strategy, identify the structure, what kind of staff, what are the skill sets, and then eventually what are the systems you'll have to put in place. And I think this is one of them, we call it in some companies as the comprehensive talent development program. As you mentioned it is a bit complex, but to put it in simple terms, once you know the organization's goals, strategy, structure, the staff, the system will eventually follow. You'll have to map it out based on how you want the company to grow in relation to the employees that you've hired or you will hire in the future. - - - Youtube: https://www.youtube.com/leadershipstack Join our community and ask questions here: from.sean.si/discord Facebook: https://www.facebook.com/leadershipstack
A Florida Native and graduate of University of South Florida, Jeff Wills is an accomplished Tampa Bay Area agent who brings a strategic yet personable approach to the home buying and home selling process. Drawing from years of experience as an agent in the Tampa market, he has built a solid reputation for himself as an industry leader with a solid track record that specializes in attention to detail in commercial and residential transactions. Investors are buying homes in Tampa at a record rate. Between July and September 2021, one in four homes that sold had an investor as the buyer. According to a report from the Tampa Bay Times, Tampa Bay ranks as the 7th hottest metro area for investors nationwide. Today, Jeff talks about the Tampa Bay market: neighborhoods, price to rent ratios, economic drivers, geographic considerations, and more insights that investors will want to know before making moves there. Episode Links: https://sefair-inv.com/ --- Transcript Before we jump into the episode, here's a quick disclaimer about our content. The Remote Real Estate Investor podcast is for informational purposes only and is not intended as investment advice. The views, opinions and strategies of both the hosts and the guests are their own and should not be considered as guidance from Roofstock. Make sure to always run your own numbers, make your own independent decisions and seek investment advice from licensed professionals. Michael: Hey, everyone, welcome to another episode of the Remote Real Estate Investor. I'm Michael Albaum and joining me today is Jeff Wills, our certified agent out in Tampa Bay, Florida and Jeff's gonna be talking to us today about all the things we as investors need to know and should be aware of, if we're investing in that market. So let's get into it. Really quickly, before we get into the episode today, I want to encourage everyone to go check out roofstockacademy.com. Roofstock Academy is our one stop shop for real estate education, independent of whether you're just getting started or a seasoned investor looking to scale up or get involved in a different asset class. We've got lectures, we've got coaching, we've got one on one slack access forum and a plethora of other financial benefits, as well as money back on your marketplace fee credits. If you're transacting on Roofstock. So come check us out at rootstockacademy.com look forward to seeing you in there. Jeff wills thanks so much for taking the time to hang out with me today, man really appreciate you coming on. Jeff: Absolutely, man. Love to do it and thank you for having me. Yeah, of course. So Michael: Yeah, of course. So we're just gonna like jump right into it and we're talking today about Tampa Bay, Florida. I want you to give all of our listeners why Tampa why now. Jeff: So why Tampa why now honestly, I've been hearing that a lot. However, it has been very, very popular as of late. A lot of the big things that people are hearing, actually, just yesterday, Goldman Sachs bought 305 units in downtown Tampa for 168 million, setting another record price per unit and a crazy valuation for cap rates right now and so there's just there's a lot of synergy. The biggest thing behind it has been Water Street water streets about halfway through its 10 year growth plan. They've got phase one out of the way, phase two starting, and that has really brought a lot of life and vibrance to Tampa that was kind of growing and burgeoning there prior to COVID prior to all the popularity we have now, but I think it's really hit its peak and honestly, it's probably got a good you know, 10-20 30.50 years stride to soon looking like Miami, although personally I hope not. I'd like there to be a little bit less people and, and keep the enjoyment that we have here and honestly, you know, Tampa is a big town, it's a big population. But it really does have an extremely small town feel with the micro communities inside the neighborhoods inside the certain you know, sectors and where we are on the map and near the water and so I think Tampa has a lot to offer, both from an investment standpoint, from a long term hold appreciation standpoint, and especially, especially a rent gross. I don't know what that's gonna look like now, just because you know, kind of has hit a very, very high mark. However, we're not seeing any vacancies. We're not seeing, you know, any kind of rent concessions. I was just talking to a very big property manager yesterday for a different reason. But they were saying, yeah, we're barely giving written concessions. We're hitting full market rent. Everything's at 95% occupancy or above and there's no signs of stopping. So I love it, I I've always thought Tampa was a hidden gem before COVID and before things got crazy, but you know, kind of very lucky to be here now and enjoying every minute of it. Michael: Right on, Jeff, that is that's super interesting. So I'm wondering, what was that cap rate that they got for the Goldman Sachs purchase, do you recall? Jeff: Honestly, I don't have that in front of me, I can almost guarantee it was probably sub four. Even after tax adjustment, it's crazy. I actually lived in that building. When it first opened, I got a I snuck in with some written concessions and realtor bonuses and stuff like that. So I kind of skated in a bit but I mean, it went through a lot of challenges. I mean, management was horrible. Two years, they had the same management then fired that one and then fired another one and they've had problems left, right and center what that building just knowing because I've got friends that live there and stuff still and it's still selling for that price given I mean there's a bar across the street that has so much drama tied to it. It's insane, that the publicity from that sale has anything to do and so backing up from that Goldman Sachs has long been rumored to be taking a very, very big piece of the pie in the Waterstreet office space and so while that hasn't been announced Goldman Sachs buying that building to me just sounds like corporate housing instead of them having to go and give all their employees stimulus, oh, we'll give you a 5000 monthly allowance. They'll say hey here, we've got a block of rooms, pick one enjoy yourself. It's paid for and I think that might be how they're skating that market rent because some of the stuff and water St. Tampa is going up. Actually, I just talked to my friend yesterday 966 square feet with a big balcony 5000 a month and it's it was exactly what I did you have 550 a square foot. Yeah, um, it's, it's insane and I mean, once you set that, once you set that standard, I mean, they do. I mean, okay, the Heron is the best multifamily building I've ever seen. But I mean, setting that precedent, all people have to do is just be nearby and just enjoy the overflows, people who can live there and by the way, they have zero vacancy, and they have a weightless for that unit. That's coming up down hole, it's crazy. Michael: Holy smokes. So Jeff, you clearly an expert on the area, give people a little bit background, who you are, where is it that you come from and what is it you do in real estate today? Jeff: Absolutely, so I grew up about an hour north of Tampa and a county called Pasco, a very small town and to me growing up, Tampa was a big city, a really big city, I had been there three, four times the aquarium a couple of times, and I just every time staring at the top of the skyscrapers and that was just the biggest thing to me and growing up, went to college, didn't really know what I was doing there. When for finance, I was like, yeah, let me kind of figure stuff out. My dad one day was like, hey, why don't you just, you know, pop into real estate, see what's going on? I'm like, yeah, sounds fun, should be pretty flexible. I like people, like, give it a go. Seven years later, here I am and it's just been, you know, from top to bottom, you get to help people with something that's extremely difficult, extremely stressful, and very nuanced and I mean, you know, from deal to deal, there's always something different. There's always a different backstory a different why and even growing up prior to all that I've always kind of felt that I was a good listener. You know, I, of course, I have my own, you know, opinions and desires and stuff. But I was always able to kind of peel back, what is somebody looking for? What does somebody want to do? You know, what they're, they're telling me one thing, but what do they actually mean and I've always, you know, of course, ask them, hey, you know, you're saying this, but what do you want this, and it's just been very enjoyable and, you know, the client feedback is the same, I've got a ton of referrals, a ton of repeat customers, and it's just, it's very, very enjoyable for me to be able to, you know, simmer it down to its the parts that they can control and make sense of, and then I just handle all the other legal mumbo jumbo stuff on the back end and it's just been very, very enjoyable. The first three years, I was very retail focused, you know, end user not very investor friendly, and kind of got bored with that and I was like, you know, I, I've always enjoyed numbers always been pretty good at numbers, like, why can't I get to the investor side of things and that's when I joined my current brokerage see fair investments and from there, it just kind of skyrocketed. Our offices set up extremely streamlined and efficient, to the point where in the past 13 months, just me and my broker together have done about 137 million in business, and 98% of that was investors and we're just, we're just masterfully efficient, fine-tuned and, you know, we know how to strike valuations from, you know, Jacksonville down to Fort Myers, it's, you know, it's a few things we know how the appraisers operate, we know what a tenant is going to do to it as far as evaluation what people are paying, because we've got 30 under contract that we can look at and say, oh, you know, hey, a cap rate is this based on this or like, we just have a ton of insight and ability to help our investors and you know, even just last week, you know, we have, you know, I guess it's kind of our, our secret sauce, but it's very simple. Every Friday, all of our clients get an update, regardless of status did nothing happen, hey, nothing happened today, you know, that just wanted to let you know, have a great day and yet again, I had another client last week said, hey, you know, honestly, we haven't even spoke on the phone. Once. It's been all email. I just wanted to say thank you. You were exemplary and you know, he even brought up the Friday things like every Friday, I had an update, I didn't need an update. I didn't you know, I didn't ever had a question about what you were doing, how the property was going and so while those compliments don't always come, I mean, it's always 9 to 10 with that, we haven't had very many upset people at all and they always bring us their next listing or, hey, I'm trying to buy in here and buying has been very challenging right now. So a lot of the investors are on hold being patient, seeing what rates are doing. But all in all, it's been really, really great, especially on the sales side, and we're just, you know, happy to help people while we can while the market is doing great. Michael: Right on. Well, it sounds like if you ever transition careers whenever you're done to be ready to be done with real estate, you'd be a great therapist. good listener. Jeff: Oh my gosh, I joke about that all the time. I tell people sometimes like, man, I've done so much marriage counseling, I'm good to go. We need to like do one deal. You'll know you'll get one and I'm saying, oh, that's pretty, it's, it's a lot, but it's just very easy. You know, I mean, the end of the day, people want a couple of things. They want to be comforted, they want to be, you know, they want to know that you're honest, and they want someone reliable and if you can fit those buckets, while being a joy to talk to and to interact with, I think that's really all I needed to do. Michael: Love it, love it, love it. Well, Jeff, let's dig into the kind of meat and potatoes of the Tampa market a little bit and give listeners some insights into other than this Goldman Sachs transaction, which set new record highs and the buying being a little bit difficult. Let's educate people about the Tampa market. So who are some of the major employers in the market and are you seeing people moving to the area or maybe moving out of Tampa? Jeff: Definitely a massive influx, I'm not sure the exact daily rates, but I know Florida, pre COVID was about 1200 people per day. After COVID, we're at about 2400 to 2600 people per day from out of state moving to Florida and while that's not always Tampa, that really is the only place that has had affordable housing, affordable rents, especially compared to Miami. Compared to Orlando, Orlando is a relatively higher price than us just because it was more pocketed it was hard to find an actual community over there. While there are a handful. It's very spread out and sprawling, and Tampa is extremely concentrated. Some of the larger employers in Tampa are, I wouldn't say there's one or two, the majority are a lot of health care providers, hospitals, doctors, stuff of that nature, a very big presence with attorneys and then honestly Tampa is becoming a very, very big tech hub. Reliaquest is a very big cybersecurity firm, they signed in Waterstreet for the top of their class, a class A office tower and so it's been rumored I've seen a couple articles that Tampa is the next Austin as far as a tech hub and you know, we're tax friendly. We don't have any state income tax, we have homestead, there's a lot of things that were already here and then now as other states like California are being, you know, more tax even more stricter on a lot of things. It's just it's increased that flow and I don't think that stops for a long, long time. Because Florida has so much land, we have so much room for stuff and while you know, even though you might not be right in the heart of Tampa, a 3540 minute drive is no big deal and you are close to a million different things inside that span. So just you know all of those things and then one underlying factor too, that I like to tell that nearly no one knows that I mentioned is pre COVID. I haven't checked these numbers after the Port of Tampa. Probably Never heard of it does 3 billion in revenue every year, if not more and so that has been a very silent provider. Actually, one of the biggest companies in Tampa is mosaic. They own right over 400,000 acres, and they're a fertilizer company. So they are huge in Tampa, as you know, from ground all the way up to politics and everything else. So they are very big employer and advocate for the port and everything else that's going on there. Michael: Right on and Jeff, you give folks a sense of like, what is a traditional typical three, two, single family home cost and what would the rent look like and maybe you can give people an idea of some of the different neighborhoods in which they could be considering? Jeff: The median home price now is right around 335,000 today, and we have about less than two months of inventory, scroll back to 2019, we had about six and a half months of inventory. So we've reduced that by about 300% and days on market, three to five days max, if it's even close to move in ready and that that median price. I mean, I'm looking at the chart now it's almost it's very, very close to 350,000 as of today, and it's just it's very, very challenging, but some of the better neighborhoods. So if you're in Tampa, South Tampa is really where you want to be, but those price points are honestly million dollar homes for a three two and so those rents and cap rates just won't sweat. They won't crack the code for what we're looking for and what honestly any investors should be looking for. So that's not really where we want to be. But I would say that Brandon is a great area. It's just outside of Tampa. It's about 30 minutes east, very sprawling tons of land, tons of nature, tons of trees and that area is a great neighborhood. Same very roughly same median price per square foot, you'll probably be able to get rents around anywhere from 1900 to 2200 for that size home depending on the condition and that's honestly a pretty savory return. Of course, you're now seeing foreign 450 be the norm there too but the rents are following. You know, I mean rents for those are 26 to 2800, all day long and sometimes that makes the cap rate, it maybe the cap rates a little more compressed and the overall return, but the cash flow is higher, and you know, the appreciation is going to be there. Another and it's really hard to find a great cap rate neighborhood right now, because it's just, it's getting nipped up so much. If you go west of Tampa, north to the west Chase Oldsmar area, that's a great little area to that has very, very, very, very quickly start to price up as everybody's moved there, to where they couldn't afford South Tampa to where they couldn't afford north of Kennedy and West Tampa and so that's an excellent little pocket there great schools, great golf courses, you've got all ages that enjoy that area, which is, in my mind, for somebody that's looking for a renter, always, that's a good market to be in and then if you go north of Tampa, you've got Carolwood up there and greater Northdale. So all that area, there is also a great pocket of Tampa, the price points are going to be pretty high on average as well. But you can still find that starter entry level home and if you can get it at a good cap rate buy it, the every growth that I've seen is coming north of Tampa, in waves and this cheval Lutz area all the way over to Keystone in an East Lake. This actually has the highest concentration of wealth in the Hillsborough County so it's actually not in South Tampa. It's not in downtown, it's not on Davis Islands, which is a phenomenal honestly the best part of Tampa but a home there's you know, 4 million for 1500 square feet so those prices are crazy, but this area is excellent very equestrian, tons of lakes, tons of lake homes, tons of golf courses, nature trails preserves, an excellent up and coming area to be in and then one last area I'd like to highlight is the Ybor City and Seminole Heights area. So this area is directly north of downtown Tampa and if anybody on here is familiar with St. Pete and fourth Ave, fourth Ave, stretches out of downtown St. Pete and goes north and that stretch is probably a 10 mile stretch of the most golden real estate I've ever seen retail shopping centers, storage homes, but that's been there for 20-30 years and then north and east where you see that Columbia restaurant is Ybor City, historic Ybor ton of culture there a ton of background ton of history, an excellent place to be but it is very, very pocketed and very hard to find land there, but would be an absolute killer. The next best spot is going to be Tampa heights and Seminole heights. If we see the Hillsborough River here, that's kind of the cutoff point for Seminole heights and then everything south of the Hillsborough River to about 15 Street is both terminal, Tampa heights and Seminole heights. Those areas are fantastic. People love to be there. There's a whole bunch of you know, farmers markets and pop up shops and just cool boutique II stuff that is not you know, another McDonald's and Taco Bell that people are bored with. So this that's another great neighborhood, and that also sprawls out into a sea wells wood, and then West Ham over here by the airport. Michael: That's a super great overview. Jeff, thank you so much. Jeff: Absolutely. Michael: I'm so curious if you can give people an idea of how property taxes work, because I think that can often be and I'm sure as you see, one of the biggest maker breaks of a real estate deal. So give folks a walkthrough in the Greater Tampa area. Of course, it varies county by county, but how should they be thinking about property taxes? Jeff: Excellent questions. So obviously, we all know taxes based on a millage rate, every county, like you said is different county by county. But based on that, I mean, there's really not much else we can do to kind of guesstimate and or further understand it besides going to the Property Appraiser website. But plugging in the property and estimating the taxes. A good rule of thumb with that though, is that I found is anywhere between 85 and 90% of the purchase price, and then take the millage rate, then we can kind of skip the step of you know going in there and directly estimating it but that is that will get you within 99% accuracy of the taxes when they become reassessed after closing and so again, that's 8085 to 90% of the purchase price. So if it's 400 it's gonna be about you know, 375 380 and then take the millage and then that'll be your that'll be your new annual tax roll. And that is very, very, very, very important to take into account because I've seen a lot of investors in the past, go into a property and just pull the current taxes without any idea that they're gonna go. If that person's owned the home for 30 years tax you're going to have Got 1000 a month on a $400,000 home after you close, they're going to be closer to about, you know, five to 6000. So that that alone can easily skew a deal. So you always want to make sure that the taxes are, you know, properly at least estimated going in and then double checked while you're going through the process. Michael: Jeff, you said 1000 a month for that 30 year old 30 year old hold, but I think he made 1000 a year, right? Jeff: Correct. Yeah, absolutely, 1000 a year for sure. Michael: Okay, okay. So is there like a good rule of thumb, if someone doesn't know the millage rate like 1% of the sale price, or one and a half percent of the sale price, Jeff: I would I would inch to one and a half percent of the sales price because I'm seeing more and more than a $400,000 home is any anywhere between 5500 to 7500, depending on their tax district and while it is county by county, there are some overlays in some certain neighborhoods and CBDs that we'll have some effect on that. So I would I would definitely lean to one and a half percent and then if you want to be real conservative, just go 2% and then it'll always be below that. Michael: Okay, right on. Now, anyone who's ever listened to the news ever, or who follows any kind of climate or weather has heard about that Florida has hurricanes. Talk to us a little bit about some of the weather and climate, things that are unique to Tampa that someone from California might not be aware of. Jeff: Right, well, I will say anything that you've seen from not being in one, it's always way crazier, that are way less crazy than what they say it is obviously… Michael: People hanging on the palm trees, you know, getting strung out. Jeff: Oh, yeah. All, all extremely oversaturated. In my opinion, the biggest thing with Tampa Bay is flooding. And that really only happens in South Tampa and waterfront properties. So honestly, I would say any investor in Florida should really avoid waterfront properties because of hurricane insurance and flood insurance. They're just too high and they're gonna kill your returns not on not including any liability insurance you have. For the tenant that's there, I would say waterfront would work excellent in a short term rental, because that's kind of a hotel experience. But a long term tenant really is not going to do great there. I would certainly avoid it. Overall, if you're in the mainland and not in the low lying area, hurricanes aren't gonna do just about anything to you. As long as the home is up to code and you have a you know, Hurricane Preparedness step do you have the metal covers for the windows and just, you know, it's simple Google search will show you how to get hurricane ready, but it's really, it's really way more than they hype it up to be. Michael: Okay, awesome and that's a really good point that you bring up. If the house is up to code, you expect it to withstand a hurricane or not became a drone? How should people be thinking about older housing stock or does Tampa even have older housing stock, like in California, we've got a lot of 1950s built ranch style homes. That's just a lot of the bulk of the inventory, what are you seeing there in Tampa? Jeff: Exactly the same, the bulk of the inventory is probably going to fall in the 1970 range, a ton of homes and that 1950 to 1980 and then honestly, in Ybor you'll see a whole bunch of homes in 1912, 1915, where the area is very, very old, and has a ton of homes with crawl spaces. So what you want to avoid is homes on a crawlspace. If it doesn't have a slab Foundation, honestly, just avoid it. Can you get around it? Can you figure it out, can you have a foundation inspection? Absolutely but those are all things they're going to tack on to the cost and your whole period. If you're a five year holder, maybe it's not a big deal. But if you're at 1015 20, you are going to be dealing with foundation issues, at least at some point and it is not cheap. So that is one thing I would avoid with the age of the inventory and then one other special thing that kind of gets talked about a lot in Florida is sinkholes and so sinkholes are extremely common. They're not as bad as again, as you see on the news 99% of the time. But what happened back in, I would say 95 205 a couple people had a sinkhole that was relatively bad, you know, the home was falling in and unsafe living conditions and then insurance companies and engineers that were working with them came into the entire neighborhood and said, oh, you've got settlement cracks. This looks like a sinkhole and so you'll see 85% of homes maybe even higher than that that have had a sinkhole remediation done with no significant repairs or need for that at all and once the sinkhole home has been remediated with either a chemical grounding a underpinning or a another. They actually insert concrete under the home once you do either of those three things. Your risk for a sinkhole after that is slim to none because once you solidify all the Lime Rock and silt that's under the home you're done, there's nothing to worry about, just check for warranties, and make sure that engineering report gets to your insurance provider and I believe there's still only two insurance providers in the state of Florida, that will insure a single home. So it's going to be a little bit more expensive as well. So just keep that in mind. Michael: Okay, good to know and, Jeff, I just want to go back to the foundation, you said that to avoid slabs or avoid crawl spaces? Jeff: Avoid crawl spaces. I mean, you don't have to avoid them at all costs. But if the house looks a little wonky, even on the photos, just go on to the next one. I've seen 95% of every home that I've been that has a crawlspace has some sort of issue, you can drop a marble in the kitchen, and it ends up in the living room every time. It's just Florida. I mean, Florida with sinkholes, and still homes horrible mixture and there's not a ton of those. But you'll see him a lot in Ybor City a lot around some of the older areas of Tampa, but just stick to the easy stuff, you know, slab on frame or slab on block and you'll 9 times out of 10 you'll be good to go. Michael: Okay, right on and from a kind of hurricane perspective, what are your thoughts and what should people be looking out for in terms of roofs? Jeff: You want as long of a life expectancy on the roof as possible, um, shingle roofs are great, every roof made in the past, I think from 2010, or maybe even earlier, since we had that one bad hurricane that came through all of the code is updated. The majority of the roofs have roof strapping that straps the trusses down to the block and that helps tremendously during hurricanes and just about every home has that and when you get an inspection, you do your wind mitigation and that is a very, very, very big piece of the pie to save you money on insurance, especially if you're considering hurricane coverage. So I would say maybe one out of every 100 to 200 clients gets hurricane protection. But it's available and honestly, you really just want to make sure that it has up to code roofing and those standards and it'll be just fine. Michael: Right on and kind of in the same vein as insurance. What are you seeing or do you have a good kind of ballpark estimate for clients and listeners about what insurance costs are in Florida? Jeff: Absolutely, to keep it simple, like we did with the taxes, I would probably say that's very close to the 1% rule and probably even a little bit below that, a $400,000 home. I've seen quotes anywhere from 2800 to 3800. So if you use the 1%, it's going to be less but you know, as long as you're not in a flood zone and don't you know don't have any hazard or wind additional add ones, then that should be a perfect, perfect metric to keep track on. Michael: Right on. Jeff, this has been super awesome, man. Any final thoughts, things tips tricks that folks should be aware of as they're investigating the Tampa market? Jeff: Absolutely don't wait, don't sleep if you want something, get it now get it while it's hot, because it's only going up. I think we've been undervalued for a very long time. I think we're at market value now. But I think the you know, honestly, the 10 to 30 year window and long range gross of Tampa I think is going to pay massive dividends for whoever can get in there. Michael: Right on and I guess my last question you, are you seeing stuff go over asking or are you still seeing things come under list price or how are you seeing that? Jeff: The market right now is very weird. Only because I've been used to just stuff flying for 18 months now. With the rates kind of adjusting the way that they have been everything has slowed to a tolerable level instead of 20 offers on a home we have three to five, so it's still chaos, but it's controlled chaos and something we can all deal with a little bit. But yet if you're not offering asking, you're not getting the house, if you're not offering 10 grand 15-20 above the house, you're probably still not getting it if somebody else's cash. So it's, it's extremely competitive. You have to be willing to push that cap rate on your own and be ready for the appreciation and the rent growth next year to kind of float you to where you want to be. Michael: Okay, so good to know, Jeff, our certified agent out in Tampa, and folks have questions for you want to get a hold up? Where's the best place for them to do that? Jeff: Absolutely. Um, you can visit our website at any time https://sefair-inv.com or feel free to reach out to me directly. My cell phone and email will be left in the podcast notes and I'll be happy to do whatever you like. Michael: Right on. Thanks so much Jeff, can't wait to hear from you to chat soon. Jeff: Absolutely, buddy. Have a great day, thank you! Michael: Thanks, take care. All right, everyone. That was our episode A big thank you to Jeff for coming on and hanging out with me. It was a lot of fun, super interesting and clearly he is jazz about the market. I think a lot of us should be too. As always, if you've liked the episode I would love, love, love to hear from you all check out some ratings or reviews from you all and just hear what you have to say about the show. We look forward to seeing on the next one and happy investing!
No matter what may be happening in the world, it is always a time of opportunity. Old ways are ending. New possibilities are appearing. And what can emerge in these times we are in seems, in a sense, infinite. In this far-reaching conversation, Aviv invites Jeff Vander Clute to reflect on where we've been, where we are, how we can ask the right questions, and how we can thrive as we unfold, consciously, into the next chapter. Join us for Thriving Now with Jeff Vander Clute. KEY TAKEAWAYS 02:13 – Jeff Vander Clute joins the show to share keys for thriving in the new pattern he's observed 14:07 – Aviv presents Five Threads to express a unique experience he had at a recent weekend workshop 27:57 – The two different energy centers of love 34:06 – The importance of self-alignment practices 48:43 – Enlightened living and Aviv's personal transformation 1:04:35 – Aviv speaks to the history and influence of religion 1:16:44 – Different evolutionary cycles 1:20:26 – Aviv ends with one final thought-provoking inquiry TWEETABLE QUOTES “We can let go of the idea of the starving artist, we can let go of the ideas that you can't be spiritual and prosperous. This really is a new time. And I would say that the new economy that's also emerging, and we can't see it fully yet - although if you look at the grassroots, you see it more clearly - is an economy of many to many connections. Is an economy that is distributed, decentralized, radically inclusive.” (06:37) (Jeff)“So in the business world, I would encourage people that ‘How' leads you to tactic, ‘What' leads you to strategy, and ‘Why' leads you to purpose.” (37:24) (Aviv)“I wanted to cede, maybe for future conversation, the word infinitization because I've noticed that what's happening is, pretty much wherever I look and am having conversations with other people who are looking closely and inquiring deeply into the real nature of things, what we thought was finite is infinite. So money is actually infinite curiously enough because our economies are based on the notion of scarcity, either real or artificially imposed. So, when we look at the twenty-one ways we are trained to take big things and make them small, I think in terms of all the ways in which we try to take the infinite, all, and turn it into something bite-sized and somehow separate so that we can analyze and distinguish one thing from another as if they're two things.” (50:30) (Jeff)“When we look at the headlines we might think the world is going to hell in a handbasket, but maybe we're just entering into the next cycle. But the beginning of the cycle is a cycle - or a sub cycle - of conflict and working it out, hopefully with much less tumultuousness and violence compared to the past.” (1:17:38) (Jeff)“If the new emerging operating system is to be true, it will have to include all of it. If it cannot include all of it, it simply is a flawed operating system. How do we include all of it and remain safe for ourselves and for each other and give permission for an ecosystem that is not just sustainable, but is regenerative and will bring to light the new possibilities of tomorrow?” (1:20:26) (Aviv) RESOURCES MENTIONED Portals of Perception WebsiteAviv's LinkedIn Aviv's TwitterAviv's WebsiteJeff's LinkedIn
Enjoy another round of questions and answers during a recent Marketing Secrets Live episode. Register for the next Marketing Secrets Live episode at ClubHouseWithRussell.com Hit me up on IG! @russellbrunson Text Me! 208-231-3797 Join my newsletter at marketingsecrets.com ClubHouseWithRussell.com ---Transcript--- Russell Brunson: What's up, everybody? This is Russell Brunson. Welcome back to The Marketing Secrets Show. During this episode, you're going to have a chance to listen to some of the live Q and A. And this one got really fun. We had some really cool directions and angles that we went on. I think there's something for everybody through this Q and A, so hopefully you enjoy it. On top of that, don't forget: If you want to get your question answered live, make sure you subscribe at clubhousewithrussell.com. It's clubhousewithrussell.com. Go there. Subscribe to the room. And that way, you'll be notified the next time I decide to go live, and you can jump on and get your questions answered. These questions this week were really fun. A lot of different directions. I think you guys will get a lot of value from it. So that said, we'll cue the theme song. When we get back, we'll jump directly into the questions and answers. Yhennifer: Awesome. So our first guest here is Tracy. Tracy is guiding you with tax reduction strategies! All right, Tracy. Thank you so much for being here. What question do you have for Russell? Tracy: Hi, Russell! This is Tracy Lo, and I am so inspired by your stories all the time. I've learned so much from both you from afar, and also Myron. So my question is: How do you keep all your parts moving? Do you have a strategy for keeping your mental state as well as your philanthropy and your business together? What is your strategy? Russell: Oh, that's a great question! I would say I've been lucky, because when I first started this business, it was me trying to figure things out. And I was more chaotic than I am now. Anyone on my team is laughing, because they know that it's still kind of chaos. I think from the outside, things look organized, and things like that. But it's really surrounding myself with a good team of people. People who have a similar mission, who are trying to do the same things that we're doing together. It's having a good team of people. And then a lot of it is just figuring out how to build the things into your routines that'll get you the success you're looking for. Right? So for me, I know that for the first... ah, man... seven to eight years of my entrepreneur journey, I wasn't into health. And so I gained a ton of weight. And I had a... You know? I was more lethargic. I didn't even know I was unhealthy until I decided to start getting in shape and getting back in. And all of a sudden, by getting back in shape, it increased my energy. I felt better. And I was like, "Oh, my gosh! I need to weave this, now, into my routine to make sure I don't lose it again." So it became part of my routine where these things are all tied into it. Right? And so now it's easy, because it's just part of what I do. Mentally: "Okay. How do I stay sharp?" Well, if I'm going to be successful, I get paid to think for a lot of people. So if I'm going to be successful, my mind has got to be sharp. So I got to go listen to podcasts, and read books. And putting myself in situations where I can keep sharp and keep figuring out, "What's working today? What are the things that are working the best?" And so I figure out what all those things are, and then I put them into my schedule. I say, "Okay. I need to build this into my routine where I have time to listen to podcasts, or read books, or go to things that are going to help stimulate my mind so I can stay high there." And then charities. Right? When we decided... It's funny, because I get hit. I'm sure all of you guys here, you're hit by a million people wanting to... "I want to start donating money, maybe, to charities!" And for me, it's like, "I don't want to be the person that just gives money and then forgets about it." I want to make sure the things that I'm passionate about, so... Like Village Impact, we're very passionate about that. So it was like, "Okay. How do we make this part of what we do?" And so it wasn't just like... Give them a check, and then a year later, figure it out. It was like, "Okay. If we're going to do this with them, let's be very strategic about that." So I said, "Okay. Let's..." Todd and I, when we started ClickFunnels, we said, "Okay. Let's set up where every time somebody creates a funnel inside of ClickFunnels and it gets at least 100 visitors..." So it's a live funnel. "We'll donate a dollar to Village Impact." And so we started that seven years ago. And the first year, I think our check we gave them was... I don't know, $15 grand. And then the next year, it was $30 grand. And then $60 grand. And then $100 grand. So it gets bigger and bigger, but it's now part of the mission. So I don't have to think about it, because it's built into what we're doing. And now every year at Funnel Hacking Live, I'm like, "Stu and Amy, come on stage!" And we have a big old check. You know? Now, it's six-figure checks. And they get bigger. And it's eventually going to be seven-figure checks. But it's built into what we're doing, and so I don't have to think about it again. You know? O.U.R. is the same thing. We did the big launch where we launched with the documentary, and it did well, but then it wasn't consistent. So we're building a whole platform now that'll be a consistency thing, where it's now that... This mission is always being worked on, because there's a platform, and there's someone in charge of it. There's a team member who... that becomes their sole focus. And now it's weaved into it. So it's figuring out the things that are important to you that help you achieve the goals you want, and then figuring out... How do you weave those things into your routine, or your business model, or your whatever, so that it just happens and you don't have to think about it? Because it's too hard. We have so many things we're all doing. If you have to have the mental power to think about it every time, then nothing ever happens. So that's kind of how I do it. And I hope that helps. And it's also surrounding yourself by amazing humans who help fulfill those missions as well. Tracy: Thanks so much, Russell. This is Tracy Lo, CPA, passing the mic. Thank you. Russell: Awesome! Thank you, Tracy. Appreciate it. Yhennifer: All right. Thank you for being here, Tracy. Now we're going to go on to Jermaine. Jermaine is in the real estate industry. Jermaine, what question do you have for Russell? Jermaine: Hey, Russell! Hey, everyone! I just had a quick question. I was wondering... Well, I got two questions. The first one: I didn't quite catch that book that you recommended? Russell: Was it Atlas Shrugged? Jermaine: What was that again? Russell: Atlas Shrugged. Jermaine: Yep. That's it. Russell: It's a really big book, so it takes commitment. It's insanely big. But as an entrepreneur and producer, you will love it. Especially in the real estate market. Jermaine: Okay. And I also wanted to know... while I have you... I wanted to know: Throughout all your time that you've changed the world and inspired people, what was your biggest business challenge that you had to overcome? And how did you overcome it? Russell: Oh, that's a great question! You know what's interesting, is that at every level, there's a new challenge. And so it changes. And every time when you're going through it, it seems like the biggest thing in the world. And when you look back, it's like, "Oh, that was actually really simple." But in the heat of the moment, it's hard. For the beginning part, it was just me believing that I was worth it. Right? I was the kid who struggled in school. I was never that smart. The only thing I was ever good at was wrestling. And I'm trying to start a business, and then I had a million doubts of, "I'm not worthy. I don't know how to do this. I'm not smart enough. I don't..." At the time, I didn't like to read! You know? First, it's that mental battle. I think for most entrepreneurs when they start their journey, it's the mental battle of just believing that you're worth it, that you can actually do it. And so for me, that one took a while. And then when I finally was like, "Oh, my gosh. I'm not..." I always thought I was a dumb kid growing up, because I struggled in school. So I remember having the realization after I started having success. I was like, "Oh, my gosh. I'm not dumb! I can learn things! If I'm interested in the book, I can actually read it and enjoy it!" So that was the first big hurdle for me. Right? The next one was... As I got to a point in my business that was like... It was just me, and I was juggling a million things. I was like, "Okay. How do I... I can't keep doing this. I'm going to drown eventually." So I was bringing on employees to the team. And man, I can't tell you how bad I was at that! I hired all my friends. All my friends, I just hired initially, because I was like, "Oh. They're cool. I'll hang out with them!" So I hired all my friends. It turns out my friends are morons... No, I'm just kidding! Well, kind of. Some of them were... But no, I love them all. But it was like I hired all my friends, and they didn't know what to do. And I didn't know how to teach them. So I was like... Dude, I was working while they were all goofing off in the other room. And they wanted help, but I couldn't teach them, because I was too busy trying to make money to pay them. And so it took me years to figure out, "How do you get a team and get the right people in place?" And that was the next big challenge. Right? Then it was like, "How do you actually create something that's not just an offer?" Right? That could be a long-standing business. We tried for years to figure that out. And eventually, ClickFunnels was the business that became more than just an offer for me where it was like, "Oh, my gosh. This is a platform, something that can grow bigger." And then inside of that, there has been so many challenges. How do you scale a company like that? You know? How do you scale the support? How do you go from five employees to 500 employees? There's just different challenges to every step. And so I think that there's been a lot of them. But the biggest thing I would say is that the key that I find at every tier, the thing... It took me a while to figure this out initially. And now, I've gotten better at realizing, "Oh, the pattern to solve these is always the same." It is... You can call it "funnel hacking," call it, "modeling," whatever it is... is I try to always connect to the people that are a tier above me or two tiers above me. Right? So right now, we're trying to... I literally am paying somebody who's gone here, done this. And we do a one-hour call every other week with him. He's built multiple companies, software companies, to the billion-dollar mark. And so he's been down the path. And so we get on a call. I'm like, "Okay. Here's where we're stuck. What am I going to do? What would you do?" And I'm asking questions and modeling, like, "Hey. Show me three businesses that have done what you're talking about." And he'll show me. We'll find it. And we look at it, and we reverse-engineer it. We come back and apply it. And so the key is just really figuring out... It's modeling. It's figuring out who's already done the thing you're doing. Find that person. Pay them money. Get to know them. Join their coaching. But whatever it is, get around the people who have already done the thing you're trying to do. Because for them, it's simple. Right? For us, as we're going through it, it's really, really difficult. But the person who's already done it, looking back, it's simple. For me, now, the mindset and belief of, "I can do this," is simple now. I get it. I can help somebody with that really, really easily. Whereas in the moment, it was impossible. It felt impossible. Right? Launching a software company felt like an impossible moment, and now it's super easy. So it's finding people who... The thing you're struggling with now is super easy, because they've already done it multiple times. Getting around them. Hiring them. Paying them. And learning how to think like them. Right? It's always a shift in thinking and belief. And so it's coming back and saying, "Okay. I've got to think like them. I've got to believe like them." I think a lot of times, many of us... and I see this a lot with people who hire me... they hire me, or they hire a coach, and then they try to get the coach to believe or think like they do. And I'm the opposite: I'm not coming to you to try to influence your beliefs. I'm coming to you to change my beliefs. And that's a hard thing to do. Right? Our ego gets in the way a lot of times. So it's coming and saying, "Okay. I'm a blank slate. I'm going to do whatever you say." In fact, it's funny, because inside our community, we have the... Kaelin Poulin started it with the whole hashtag, #dowhatrussellsays. And at first, I was really embarrassed by it. But now, it's so cool! Because it's like, "Yeah. If you're hiring me to be your coach, just do what I say!" If I hire a coach, I just do what they say. I literally just... In fact, I'm working on my fourth book right now. And I have a quote. One of my friends wrote this in a blog post. He was talking about his morning routine, and why he does this really weird thing. And he says in the thing, he said, "People ask me why I do this." He said, "Because Tony Robbins told me so, and I obey all giants who fly helicopters and have stage presence." And so for me, it's always been this joke: Now, when I hire a coach, whatever they say, I say, "I obey all giants who fly helicopters and have stage presence." Right? If I hire someone, I just believe them inherently, because I did the work ahead of time to see if I'm going to believe them. If I believe them, I give them my money. And I do whatever they say, and I don't deviate from that. Right? So people in my world say hashtag, "#dowhatrussellsays." For me, it's hashtag, "#dowhatstevencollinssays." That's the guy who I hired right now who is mentoring me. Whatever he says, I just do it. I don't fight. I don't question. He's been there a million times. And so I just do what all giant... You know? I obey all giants with helicopters and stage presence. I obey whoever I pay to teach me something, because they know what I don't know. And so for me, that's kind of the process: Find the hurdle. Find out who's already done it. Get that person. And then obey them, and just follow what they say to a T. So I hope that helps. Jermaine: That made perfect sense. So you basically trust yourself, and then you do what your coaches say? Russell: 100 percent. Yep! I do the work ahead of time. Before I hire the coach, I got to make sure I believe this coach is right. But if I believe they're right, then yes, I just do whatever they say. And so I see people, sometimes, blindly will sign up for coaching, or they'll hire a mentor, or whatever. And then they just kind of blindly follow the person. The person might not be right for them. But I do the homework ahead of time. And then when I know, "Okay. I'm committed. This is the person." Then I go all in, and I just put on blinders and follow them. Jermaine: Got you. I appreciate that. What was that book again? I'm going to have to write that down. Russell: Atlas Shrugged. So the way to remember it is Atlas is the god that's holding the weight of the world on his shoulders. And the premise of the book is: The producers, the entrepreneurs, people like us who are trying to... We're literally holding the weight of the world on our shoulders. Right? We're creating companies. We're creating jobs, and doing all these things. What would happen if Atlas just shrugged and walked away from his responsibilities? So the book is about that. What happens when the producers get so much pressure from government and society where it's no longer worth it to them, so they shrug, and they walk away from their responsibilities? And so that's the premise of the book, which is so fascinating. I'm actually listening to it again right now, which is fun. But it's a 1500-page book. It's intense. If you listen to the audiobook, it's eight audiobooks. That's how big it is. But man, it's worth it! Jermaine: I'm going to grab both of them right now. I've got all of your books. I've been following you for a while. My favorite one is the DotCom Secrets. Russell: Oh, very cool! Thanks, man! I appreciate that. Yhennifer: Awesome! Thank you. Jermaine: You're welcome. Yhennifer: ... Jermaine. Thank you for being here today. I'm going to reset the room really quickly. We are, right now, listening to the Marketing Secrets Live podcast. This room is actually being recorded. Make sure you follow the house at the top so that you can get a notification when Russell goes live again here. Now, we are going to give the mic to Jeff. Welcome, Jeff! He is a product launch expert, has made over $8 million from 22 launches in three years. What question do you have for Russell, Jeff? Russell: What's up, Jeff? Jeff: Hey, Russell! What's going on, buddy? Russell: Good to hear from you. Jeff: So hey, being in your inner circle for the last five years, I've had the awesome pleasure of watching all the big house marketing initiatives that you've incorporated into the funnels that you and the rest of the ClickFunnels community launched, and also at your annual Funnel Hacking Live event with Village Impact and O.U.R., as you mentioned. So what's been cool to see is the more funnels and events you launch, the more you're able to give back, which is awesome. So how are you thinking about incorporating that live launch strategy that you've been doing with, perhaps, more of an evergreen launch strategy now? With things like OFA, your quarterly Two Comma Club Live virtual event, and now the DotCom Secrets Summit that you just launched, with some of these... trying to also bring in these new live launches. I know you have Funnel Hacking Live coming up in a few months. Can you just talk about... Each month, what are you looking at in terms of evergreen versus live? Russell: Yeah. That's a good question. That's something we could talk about for a long time. You know? I think it's interesting. I watch somebody like Tony Robbins, who... He does UPW four times a year. He does Date with Destiny twice a year. And he does these things. And he's been doing it live for decades now. Three or four decades, he's been doing these events. If you go to them, they're very similar every single time. And for me, it's tough, because if I go back and I teach the same thing twice, I want to pull my hair out! You know? And I'm like, "I don't know how Tony has been so consistent for so long." And so for me, it's like there's this blend. Right? There's things that... The DotCom Secrets book came from me from a decade of me teaching these principles. I was doing events, and speaking at other people's events, and teaching these principles. And finally, I was like, "If I have to tell this story about the value ladder one more time, I'm going to kill myself." Right? So that's when I finally was like, "I'm going to write a book." So I wrote a book. And it was like, "Here it is. It's now evergreen. I can give it to people. And I don't want to talk about this thing again." Right? A similar thing happened with Expert Secrets. And you were in the inner circle, and I was... We spent three years geeking out on webinars, and conversions, and psychology, and all this kind of stuff. And I was like, "I don't ever want to talk about this again." So I turned it into a book. And I was like, "Hey, there's the blueprint!" And so I look at the online stuff through a very similar way. Right? We did the Two Comma Club Live event that first time, and then my energy was there. I was excited. It was fun. We created it. We launched it. It was amazing! But then, I was like... For me, it's like art. I didn't want to just be like, "Hey, it's done!" And walk away from it. But I didn't want to teach it again. So it's like, "Okay. How do I turn this experience into something that's now evergreen?" That we can keep the message going on. Right? So that when I'm dead and gone, my kids can keep running the ads, and keep running the event, and it'll keep producing. Because for me, all the stuff we do is art. And so I want to sustain it. So I'm always looking: Is there something I can do that I can create it, but then it'll last? It'll live beyond myself. Right? If you've read Ryan Holiday's book, The Perennial Seller... In fact, he spoke last year at Funnel Hacking Live about that book. I was like, "I want you to talk about Perennial Seller!" He was like, "I've written eight books since then!" I was like, "I know, but that's my favorite one! You've got to talk about that." But in Perennial Seller, he talks about the difference between art that lasts forever versus stuff that happens and is gone. Right? A good example is in movies. Right? Avatar, for a long time, was the greatest selling movie of all time. But if you ask someone to quote an Avatar line, there's not a person on this Earth who can remember anything from that movie. Right? It was a great seller, but then it died. Right? And so many people in our industry do a big sell, and then it dies. And it disappears. Versus you create a movie like Star Wars, where it lives beyond itself... It has legacy. It's a perennial seller. It'll continue to do well for a million years from now. Or you have TV shows. Right? You look at Seinfeld versus Friends: Friends was very much successful in the moment, but then it hasn't lived on as well as something like Seinfeld, which has lived on in perpetuity for so long. Much more of a perennial seller. And so I was always trying to create things that could be perennial sellers. And so when I do do something like that where I think it can last beyond itself, where things are strategic enough that they're not tactical, and they're going to change. Where they're strategic and we can do it, I want those things to live forever. So again, that's the Summits. That's the Two Comma Club Live, and things like that. But then we have our big hits. Right? Funnel Hacking Live, it's a big show. It's what's working now. You know? We put all this energy and this effort into it, but we know it's a one-time show. Right? And it happens. It's done. It's over. And then next year, we're going to plan a new one. And we can't evergreen Funnel Hacking Live. Right? It's a little bit different. And so it's just looking at those kind of things. You know? Sometimes, you're going to have an Avatar hit. And you should totally go and take the 100 billion dollars it makes and cash it, because that's awesome. But other things you create, you want the longevity. And so for me, that's how I'm looking at things. It's just like, "Okay. What things have longevity? What things do I want to be a perennial seller? What things do I think can last just beyond a product launch or beyond a thing?" And as soon as it's done, then it's like, "Okay. How do we morph that into something now that can last beyond the moment?" So that's kind of how I look at things in my head, how I figure things out. And then on top of that, it's just... You know? We're still kind of figuring it out. So some things, we're finding that we launch and we make the perennial version, they don't last long. They're still there. So people can find them, but they're not... The longevity is not there. We can't continue to buy ads to it. Whereas One Funnel Way, it's crazy! To this day, One Funnel Way has been running almost three years now. We fill up 1500 every two weeks to a 100 dollar, paid challenge. And it continues to convert. It continues to work. It continues to... That one is, of all the things we've done, the most perennial, and just continues to work. And I wouldn't have guessed that going into it until we tried to make the evergreen version. And it kept working. And it's like, "Oh, my gosh! This is amazing!" So yeah. I don't know if that answers the question. But kind of... That's how I think through things, and how I'm looking at stuff. Myron: Can I ask you a question about that, Russell? Russell: Yeah, Myron! I'd love to. Myron: What advertising methodologies are you using to put 1500 people in a challenge every two weeks? Because that sounds phenomenal! Russell: Yeah! A couple things: Number one is we pay 100 percent affiliate commission. So the only people who go through it refer people, and it's 100 bucks, and they get 100 percent of that 100 bucks. Number two is that I can spend 100... I can lose money. So I can spend 150, 200 dollars to sell a challenge. So I can spend a lot of money to do it, because again, 100 percent of the money goes directly back into advertising. We're not trying to make money on the challenge. As you know, all the money is in the back. And amateurs focus on the front end. So we liquidate it. 100 percent of our money goes into the ad spin. And number three, I think, is just... The message is right. For some reason, that message, it lives long. Right? The people, if it's their very first time... You look at the headline. It's like, "If you want to launch your first or your next funnel." So if it's their first one, it's like, "Oh, this is going to help me." Number two, it's like if you've launched a funnel but, "I need to go back and do this again," it gives you a chance to review it and go back through it. And I'd say the last thing is we weave that theme into all of our offers now. If you look at everything, every offer leads back to OFA. You buy all my books? OFA is in that sales flow. You do one of our challenges, it leads back to OFA. So it's weaved into everything now. So it's plugged into the back end of everything we're doing. And so no matter what somebody buys, all roads lead to the One Funnel Way challenge eventually, which is pretty cool. Myron: Wow! Russell: Yeah. And we're working on, now- Myron: Great stuff. Russell: We're working on a One Funnel Away e-commerce version of the OFA challenge next, which I'm really excited for as well. So anyway- Dan: And you do that live every two weeks? Russell: So I don't. I recorded it live once. And we have a team, now, though. So we have a team of... One person runs it, and three or four coaches. And so every week, they reset a new Facebook group. And then they're in there full-time answering questions. And then they stream. The trades that were live at one time, they stream them into the Facebook group. And all the interaction happens there. So it feels very alive. People know it's not alive, but it feels very live. It's executed live. It's not like logging the members in and watch... Day-one videos. We try to replicate the experience as close as possible. And again, it's not just like, "Go watch this video and hope for the best." Literally, they watch the video, and then there's coaches in there who are answering questions, who are getting them to do the homework, who are... Full-time, their job is in there, now. Because it's been so profitable for us, man, we left... I always tell people: One of the biggest problems that us entrepreneurs have is we create something and then we move on to the next thing. And OFA was the first thing that our group created it, and were like, "There's something magic here." And we left somebody behind. So Shane on our team, we left him behind and said, "Your job is to continue to make this better and to run it." And then he hired three or four coaches, and now there's a team of people who, full-time, all they do is make sure OFA is happening, and it's consistent, and it works. And because we left somebody behind, that's why the fulfillment continues to improve week after week, although I'm not creating new content week after week. Dan: And it converts similar with the streaming replay as it did with you doing it live? Russell: Yeah. Yeah. Dan: That's- Russell: It was easier to sell people in initially: "Yeah, go sign up for it! Go to onefunnelway.com and watch the process!" But yes- Dan: That's what I'm going to do right now. Russell: 100 percent. 100 percent. And like I said, three years, we've been running that thing. We launched initially, and then we did it live again four or five months ago just to kind of refresh the whole thing. But other than that, it's the same thing. And it runs on autopilot. Dan: And the affiliate aspect is really important, because everybody that comes in, you then say, "Hey. Do you want to make money? Did you love this challenge? Bring somebody in." And they get a commission. Can I just ask one question about that? Russell: Yeah. Let me give one clarity, and then ask the question. So the clarity is- Dan: Yeah. Russell: also right when they first come in. It's like, "You paid 100 bucks for this. Do you want this to be free? Invite a friend." It's right when they sign up. It's like, "Bring by a friend," and now it's free for them, because they just get one person to sign up, and now it's free. Dan: Okay. That... Okay. So that's my question, is: You guys have really, truly went just deep in the affiliate game. And I almost feel like, sometimes, going all-in on the affiliate game is like... I'd rather pay my customers and my clients than pay Zuckerberg. Do you know what I mean? Honestly! And so my question to you, on that, is: How do you train somebody who is a normal customer, who is not an affiliate or a traditional super affiliate, to actually refer people to you? Obviously, you have to tell them, "Hey, here's how you refer people." What's your best tip for that? Russell: Yeah. The best tip is you have to think about it differently. A lot of people are thinking about, "I'm going to make him an affiliate, and teach him about affiliate marketing!" And the average customer, they're not going to be an affiliate. Right? You look at... The people in e-com space do this really well, a lot of times, and other places, where it's... The position is not how to make a bunch of money as an affiliate. The position is, "How do you get this product for free?" Right? It's like, "Hey. You get three people to sign up for this, or..." You know? Whatever. For me, it's like, "You get one person to sign up, and now it's free." That's how you position it. And they're like, "Oh, my gosh! I can tell my brother!" And then, "I'm doing this challenge, too! I'm going to invite my friend, and I actually get paid for it?" And so you get them passing it around. They're not looking at it as a business opportunity as much as, "How do you get the thing you just bought for free? How do you get your money back very, very, quickly?" That's the shift. Right? Because they're not going to go sign up 100 people, but they are going to get one or two. Right? And if every person brings in one or two, it becomes this self-fulfilling machine that just keeps growing, and things like that. And so it's just looking at it differently, and just showing... That's the positioning. Right? It's not how to be affiliates. It's, "Get this thing for free by telling three people to-" Dan: So you're not giving them any sort of extensive training? You're just pretty much hoping that one customer will refer, maybe, a couple... few... people. But it's a consistent thing, rather than, "Hey. Here's this training on how to refer more people." And you... But- Russell: Yeah. Because they're not going to buy ads. They're not going to... They don't have an email list. But they're going through this. They believe in it now, and they don't want to feel dumb. And it's like, "If I can get my friends in this and do it together, now it's a fun thing. And we can study together." And that's the- Dan: Oh, the accountability! Oh, my gosh! That's so good! Okay. All right. That was awesome. That was gold. Russell: Awesome. Yhennifer: Light bulbs are going off here! I love it! I hope everyone is taking notes. I want to add one more thing to the OFA stuff, Russell, if it's okay with you? Russell: Yeah. Yhennifer: Because I see what goes on in the Facebook community, and I just wanted to add that people sometimes buy the OFA more than once just because they want the accountability of the coaches. They come back. They see that it has so much value that they're like, "100 dollars? I'm in!" So we also see that as well. Russell: Yeah. The OFA lifers, it's almost a continuity program. They re-sign up every single month, because they don't want to lose the connection with the team! Yhennifer: Yes! Yes. It's amazing. So if you have not done the One Funnel Way, go to onefunnelway.com. It's an awesome, awesome offer. Yhennifer: Okay. We have one more guest here, Michael Hoffman. He's a digital marketer and an owner of a digital media agency. So Michael, what question do you have for Russell? Michael: Hi, everyone! Thanks so much for having me up here. Russell, thanks so much for providing all the value. You mentioned something before, that there was this hashtag, "#dowhatrussellsays." And earlier this year, I read Traffic Secrets, started my podcast. The other day, I finished your new Expert Secrets. I'm going to work on my weekly webinar now. So doing what Russell says actually works! So my question is a little different, and more mindset-related. You have an extensive past in... almost professional sports. You were a wrestler for many, many years. And you made that transition into entrepreneurship. And I have a past as a professional basketball player, and also transitioned into... first, to a full-time job, and then entrepreneurship. And for me, it was a very difficult time to shift my identity. And I just wanted to get your... yeah, basically... experiences on how you experienced that phase, to transition from full-time sports to entrepreneurship, and what helped you to complete this identity shift? Russell: Oh, very cool! It's interesting. I think... Not always, but I feel like athletes often do really good in entrepreneurship. And I think the reason why... I've thought about this a lot... It's because for me, with wrestling... I'm sure it's the same for you with basketball... Every day, for me, I'd step out on the mat. And there was the guy I'm going against. And we'd wrestle. And a lot of times, I lost. A lot of times, I won. But I got used to failure, and it didn't destroy my identity when I failed. Right? I feel like a lot of people get into entrepreneurship, and they're so scared that if they try something and it fails, that it means that they're a failure. Versus in wrestling, I'd fail, and I'm like, "Cool! Now I know how to beat this guy!" Watch the film, figure it out next time I go back, and I try to beat him again. Right? And it's a different mindset where failure meant I could learn something, versus failure meant I was a failure. And I see that so many times in entrepreneurs, where they'll sit in club house rooms, or podcasts, or read books for years, and years, and years, and never do anything, because they're so scared of that failure. Whereas athletes have experienced it. You know? I lost tons of matches! You know? So I'm used to that failure, and I'm okay with it, and I don't label myself as a "failure." So I think that's why athletes do well, just because they have had that experience. But on the other question, that identity shift: So it was interesting. So my wrestling career, that was my life, as you know. It was probably similar to you. I was a wrestler. If you asked me, "Russell, what are you?" I'd go, "I'm a wrestler." And so I was. And I wrestled all the way through college. And I remember at the end of college is when I started learning some of the internet business and figured things out. And my senior year, I ended up losing the Pac-10 Tournament. I thought I was going to go to Nationals and place. And I had... My entire life, I was focused on this goal. And I ended up losing the Pac-10s and not qualifying for the National Tournament my senior year, which was horrible for me. Right? My entire everything just stopped. I remember sitting there on the side of the mat crying, and just... "It's done. I can't even achieve my goal if I wanted to. It's gone! There's no..." It was weird not being able to achieve a goal. And I remember, luckily for me, I had this entrepreneurship thing happening at the time that I was learning about. Because if I didn't have something, I think I would have gone into this downward spiral of depression just knowing that the thing I'd been dreaming about for 20 years, I know longer... It's physically impossible for me to do, now. It's out of... It's impossible. And so for me, luckily, I had this business. And I started focusing my time and energy there. And it gave me something to do, to focus on a new goal. And that was the big goal, the big thing. And so, because I was able to transition pretty easily... Because I had just... I was trying to avoid the pain of my old identity dying, and so I had to shift over here. And so I think, for people who are making that transition, it's... I mean, you used the word "identity shift," which was the right word. Right? It's like you have to shift that identity. And I don't know how to... I mean, in fact, we have Anthony Trucks, who is going to be speaking at Funnel Hacking Live specifically on identity shifting yourself, which I'm excited for. He's geeked out on this at a level that I don't think anyone else really has, and so it's going to be fun to have him go into it on the process. Because I don't know exactly what the process was, other than that I knew that I shifted. And then I started looking at it like a sport. I said, "Okay. What's the goal? What am I going to win?" You know? "Who are my teammates? Who do I got to get to know? Who are the competitors? Who do I have to beat?" And I just used the same mindset. And I think that a lot of people come into business, and they look at it different than a sport, which is interesting when you look at it. It's like, "Oh, I'm here to..." You know? I don't know. I did a podcast three or four years ago. I still remember where I was at when I recorded it, because when we came out with ClickFunnels, for me, it was... It's a combat sport. I'm looking: "Okay, who are the competitors? Who are the people out there?" And at first, it was like, "Leepages! That's who I have to beat!" Because in wrestling, that's what I did: "All right. Who is the guy that I got to beat?" I looked at him. We studied film. We figured it out, and we got to the point where I could beat that person. And we found the next person in the next tier up. We found the person, identified the target, reverse-engineered their style, and learned how to beat them. And so for me, it was the same thing. Leepages was the first person on our hit list. Right? So we came out. And those who were around when we launched ClickFunnels, it was very aggressive. It was not... You know? I was like, "This is our competitors. We're going after them." And we went after them. Then we got to the point where we beat Leepages, and we passed them. After we passed them, it was like, "Hey, who is the next competitor?" For us, it was Infusionsoft. And I was like, "There's no way we can beat Infusionsoft. They're huge!" But I'm like, "That's the goal!" And so we figured out who they were. We reverse-engineered it. You know? Went after them, and ended up far surpassing them. And it was interesting, because I remember the CEO and me... He's a really nice guy. But he messaged me one time, and he asked me... He was like, "Why do you hate Infusionsoft so much?" And I'm like, "I don't hate you! I'm grateful for you! You're the person..." I needed somebody to get me motivated. Otherwise, as a competitor, if I'm just... I'm not here just to make money. That was what inspired. It inspired me. It was the victory, trying to figure out the next person who we're going after. Right? And I told... It's kind of like that scene in Batman, The Dark Knight, where Joker asks Batman, "Why do you hate me?" And he's like, "I don't hate you! You fulfill me! I need you! Without you, there's no me!" Right? And so for me, that was the transition. It was like... I didn't take the competitiveness out of me. I kept it. Everything I did that drove me in wrestling, I kept that. But I focused it over here in business. And so the identity shift wasn't huge. It was just a different game. Right? Same athlete. Same competitive nature. Same everything. But the game was different, and so I had to figure out the game, figure out the rules, figure out the players, figure out the competition, and then make it fun for me. And so for me, that's kind of, I think, how I was able to make that transition. Yeah. I don't know if that answers the question. But that's kind of the mindset behind, for me, how I was going to make that transition. And at Funnel Hacking Live, Anthony Trucks will show us the actual process to shift identity, which I'm so excited for! Michael: Awesome! Thank you so much! That was really helpful, just listening to your experience and hearing it from someone else. And I like the competitive aspect, and the perseverance that we have as athletes to transition that into entrepreneurship. Russell: Yeah. Well, very cool, man. Thanks for jumping on the show. I appreciate it! Yhennifer: Awesome! Thank you, Michael, for being here. And Russell, I think that wraps up our Marketing Secrets podcast today! Russell: How fun! Well, thanks, you guys, all for jumping on and hanging out. We're going to continue to do these. I'm having fun with it so far. So hopefully, you guys are as well. For those who are listening to the recording: If you want to make sure you get on the next live one and maybe get your question answered live, go to clubhousewithrussell.com. That'll redirect you to our clubhouse page. Go follow the room, and we'll do this again soon. Thank you for all of our guest speakers who jumped on: Keenya, Dan, and Myron. I appreciate you guys jumping on and sharing your thoughts, as well. Hopefully, some of the conversations we had were stimulating and helped you think about yourself, think about your charity, think about your funnels, all this stuff. Hopefully, you guys enjoyed it. If you did, let us know! And if you want to hear the recording of this, make sure you subscribe to the Marketing Secrets podcast on any of the platforms. We're there. Probably in the next week or so, it'll go up live there, and you can go and re-listen to all the stuff we talked about. So thank you Yhennifer for all the time and effort you put into it, and everybody else here on the clubhouse team. I'm grateful for everybody. And with that said, I guess we'll see you guys all on the next episode!
Now that the country is opening back up again, many people are excited to see their loved ones, eat at restaurants, go to shows, and live their lives in a more pre-pandemic way. But as excited as we all are, sadly, many of our favorite places to visit no longer exist. They shut down during the COVID-19 recession and couldn't survive. So today I am absolutely thrilled to welcome back my guest to the show. While others weren't so lucky, today's guest is excited to give us an update. I'm Hilary Topper and you are listening to Hilary Topper on Air. Joining me today on this episode is Jeff Jaffe. He's the founder and owner of Pop International Galleries. They are an art gallery on the Bowery at the junction of Spring Street in New York City. Welcome to the show, Jeff. Jeff - Thanks for having me. It's a pleasure to be here, given what we've all gone through this last year and a half or so. Hilary - Gosh, it's been, it's been crazy. Um, well, I'm very happy to have you back on the show and I'm so glad that Pop International Galleries, which is one of my favorite in New York City, is still open and doing well. Can you remind our listeners about who you are and what Pop International Galleries is all about? Jeff - Sure, The Pop Gallery started back, believe it or not, it's hard to even comprehend back in 1997 when I sort of came to realize that there was a need for an art gallery to focus on specific things. And in those days it happened to be pop art, which was Andy Warhol and Keith Haring and big names, John Michel, Basquiat, and Roy Lichtenstein and so on and so forth. And we did really well with that. But as things began to progress, it dawned on me that Pop International really meant focusing on pop culture more than pop art per se, that pop art fits into the realm and genre of, uh, what we're sort of interested in, but there were more things too, we were missing out on. And so we began to focus on sports, photography and rock and roll photography, and, more recently, street art and graffiti, and, as a consequence of which, Pop International Galleries has become this sort of iconic little center for focusing on anything that has to do with pop art and popular culture. Hilary - So, as we were talking at the beginning of the show, I said that this year had been like no other, how was the gallery doing? And how did you fare during all of this? And how did you survive? Jeff - It's funny. I was just going to say before you said the word survive that we dived into survival mode. There were choices that had to be made. And then there were decisions that were made for us that we had no power to overcome or resist or embrace. We just had to sort of take them on. And as a consequence of which, we sort of began to look at what the virtual world was going to offer us. What technology was going to offer us and help us with, that goes past the questions of having conversations with landlords and dealing with those kinds of things. And we were fortunate enough to have a lovely landlord who was willing to help work things out and help us through so that we could really remain in business. And then the other thing is I made a very, very strong decision. Some people questioned me why, but I decided not to let a single staff person go. I was just sort of, of that mind where I felt a certain amount of responsibility. And so I took steps to enable remote working and remote selling, which was very difficult because selling art remotely is not something that we would ever have thought we would ever encounter. People like to come to an art gallery, they like to look at the art and smell it and touch it and look at the frame and we really had to come up with different sort of means and strategies to get people comfortable with the notion that they could buy a lot this way. Hilary - So during this pandemic, you told me that you developed even stronger client relationships. Can you talk about that a little bit? Jeff - Absolutely we, well, again, it sort of goes back to this notion of virtual business and sort of doing things with Zoom and Skype and all kinds of things. And what we discovered was that by actually picking up the telephone as opposed to sending emails, reaching out to people individually and touching base with people, especially regular collectors about us. And we have, we have a huge collectors base and I mean, people have been buying from us for 25 years. We have thousands of people that we've sold out to and we decided that one of the things that we would do is reach out to people individually. And so it began. And emails became phone calls, emails became texts, messages, and text messages, became phone calls. And then it sort of blossomed into this ongoing dialogue between our consultants and our collective base and which led into larger events using a Zoom to have virtual openings and that kind of thing, which had been very successful. Hilary - So, can you tell us, or, share with us some of the interesting artists that you represent in your gallery today and why you represent them? Jeff - Well, we represent roughly about 25 artists or so from around the world. And again, it goes back to what I said a little bit earlier in terms of representing art is certainly pop related, but it has much more to do with the notion of what popular culture is. And subsequently, we still do represent Andy Warhol and Keith Haring and John Michelle Buskey out and so on. But we've edged out into other realms, which focus on things. Like, for example, we did a very, very special event with the godfather of street art, Ron English. And Ron was thrilled at the concept of making a type of work that he had never made before, which is paintings on paper in the manner he had never made them before. And so running this book has become a very important aspect of the pop gallery. We represent a Danish artist whose name is Ola Olberg and Ola has taken the cartoon character Tintin, who many people know lots of American people don't know about Tintin, but put Tintin into different scenarios, sort of naughty sort of sexual scenarios, which is something that most people don't associate Tintin with. But the idea of Tintin and popular culture and cartoons and things, that many people and I grew up with Tintin comics. So, that's been truly successful. We represent an artist by the name of Tony Ray Negro, who did all the backstage passes for the grateful dead. When, you know, from the age of 20 back in the eighties and nineties and so on. So the whole concept of rock and roll and music fits perfectly into this notion of pop culture. And then of course we represent two other artists that really fit into this concept so beautifully that I couldn't have even imagined it. It was just a natural thing. We represent the art of Dr.Seuss, which besides all this sort of nonsense and drama that occurred with the audit Dr. Seuss recently, we represent the estate of. Dr. Seuss, which means all the illustration drawings and things that he made limited additions of and the estate represents and a very special what we call the secret audit Dr. Seuss, which has stuff that he made in his spare time or the midnight audit Dr. Seuss, along with what he called the unorthodox taxidermy, which are these really beautiful, funny sort of taxidermy heads, which are just hilarious. And then we represent Tom Everhart, who was the protégé, if you will, of Charles Schultz of Peanuts and Snoopy fame. Tom was a young guy who saw Schultz Sparky as a mentor. And they had a really wonderful father, son type relationship. They and Tom started to interpret all the Snoopy characters and Schulz gave him permission before he died to be the only artist in the world to be able to make art using Snoopy and peanuts characters without a license. He has a lifetime license. They had a show together in the loop a number of years ago. So again, this whole notion of popular culture and pop, all these, The Seuss, the Tintin, the Snoopy Eberhardt pieces that all fit in really, really well. And then of course we move into street art and graffiti. And I have some lovely stories to tell you about that when you're ready. Hilary - Tell us we'd love to hear. So the very first sort of graffiti street art experience happened with pop and about 12 years ago, actually I got a phone call from a collector, a good friend collector. They said Jeff, these two boys who live in Bushwick in Brooklyn, I've started to collect their art quite, quite seriously. And I think you should go and visit them in their studio. And I said, Mike, if you are sure that's what you suggest, I trust you and happy to do it. So Mike set up this little meeting and I drove out to Bushwick 12 years ago. Bushwick wasn't what it is today, 12 years ago or so. And I arrived in this sort of funny little loft odd building where these two guys lived and worked. They had a studio together. Their names were, Mike Buck, Michael Bucca and, Fernando Romero, their street names, graffiti names were 2ESAE and Ski. So Fernando is Ski and Mike is a 2esae and I arrived at this place sort of not expecting a whole lot, but it was kind of exciting. And the first thing of course was they had a big pile of donuts and coffee for me on the table. And on the other side, they had a big bottle of Hennessy. They had no clue who I was going to be, and they were wondering what I was going to choose. It was really hilarious. And I meant, I went for the coffee and donuts just for the record, but, I'd forgotten to mention that they went by the name of a group that painted and work together. They went by the name of UR New York. And I saw their work around, you know, they used to sell this stuff on the street for a hundred bucks. And here I had this opportunity and as I went through the space studio, whatever you'd like to call it, I knew instantly that they belonged in the gallery. So I pulled him aside and I said, Fernando, Mike, we're definitely going to do something, but there are a few things that we have to deal with first. And they said, yeah, sure. I mean, they were really, really excited. And I looked at them and I said, you know, the 37 indictments that you have against you and the five years probation that you're on. I mean, these guys were like, looking, how do you know? How do you know all this? I said, how do I know it? Mike told me, you know, Mike referred me to you. He told me all of this stuff, they said. Yeah, yeah, yeah. But how does Mike know? And I had to sort of at that moment in time, decide, should I say how Mike and I figured out what the heck? I said, well, I hate to break it to you but Mike is the undercover cop who arrested you guys. It was always the uniform guys who took you in, but Mike was undercover. So you never knew who he was. And he developed a relationship with your love, of art and started collecting your art. Hilary - That's so funny. That's a great story. Jeff - There's a documentary in there somewhere. I'm sure. Mike, I'm telling you, they went bananas. These two guys jumping up and down hooting and hollering. It was just hilarious. And I said, and based on what. In order for me to put you in the gallery, we have to get rid of those issues that we just discussed and the way we're going to do it is by doing community work and getting involved with children in need and homelessness and whatnot. My attorney is a former judge. Mike, the undercover cop eventually became a DA. We're going to write letters. We're going to do all kinds of things that are going to sort of help mitigate this. And so the first thing we did was a big project in Chelsea in that there's a public housing center in Chelsea, on the west side of New York City. And we arranged for the boys to do a big mural and to work with all the children, helping them draw and paint and do all that kind of stuff. Got a fair amount of press and coverage. And one thing led to another. And the boys started working with children everywhere working with charities and organizations that we were able to connect them with. They went overseas, they went to Australia to work with Aboriginal children. When they went to South Africa to work with children in need, they went to Israel to work with Palestinian and Israeli children to show them how we're all the same. They really did some beautiful things and, as a consequence of all of this, all of those charges and probations were dropped and they have gone on to become two of the most important artists that we represent here. And my relationship with them is incredible. I mean, we are talking about a father-son relationship, and we've sold hundreds and hundreds of thousands of dollars worth of their art since then. Hilary - Two boys selling their art for 50 bucks on the street, wonderful story. That's awesome, that's awesome. Thank you for sharing those stories with me. So let's take this a step back. Someone walks into your gallery and they're looking to start a collection. How does that process work? Jeff - So the one thing about Pop International Galleries, which I believe was a game-changer and for many reasons, was that we decided to break down that whole barrier. You often walk into these galleries where someone's sitting behind a desk and you can barely see them. It's a high sort of desk and it's just white walls and maybe three pieces of art on the wall and nobody even talks to you. And then they look at you and they want to know what shoes you're wearing or what handbag you're carrying or how big the diamond is, or the watch on your hand. You know, that kind of stuff. We broke that completely. We have a much more open, friendly, inviting, environment. And as a consequence of which people absolutely love coming into the gallery. And so we focus on people who have never bought a piece of art before and on people who have big collections. And so we don't differentiate. We just help people find all that they love. We've always had a policy not to sell art on the basis of investment, when people say to me, well, if I buy this print, you know, it's 3,000 bucks, what's it going to be worth in 10 years? And I say, well, I have a really good stockbroker who has an office down the road. If you'd like, I could send you there, but we try not to. If you came to me with 5 million bucks and said, hey, could you help me invest in art? That might be a different story, but we break down all those barriers. Hilary - That's awesome. Let me ask you something. Do you have any exciting exhibits coming up that you want to share with us? Jeff - I do. Actually. There are a few things that we're working on. I'll just tell you about two that we had that sort of part of what this conversation was about. Where these virtual exhibitions, the first one we did was with Ron English and it was a big test for us to see if we could sell art while the gallery was shut down, or while we have contracted hours or while there were rules and regulations about social distancing and so on and so forth. So we did a test actually with two artists, Ron English, and McKenzie Papa, British artists who I'd been working with for many, many years. And they were amazing, absolutely amazing. They were RSVP events only. So you couldn't come to the Zoom call if you didn't get, if you didn't RSVP, couldn't join the thing. The idea was to show some videos, moderate with questions. My team here had questions for Oscar, the artists, and then, we opened up some of the questions to collectors and again, moderated things well enough so that it didn't get drawn out in long, sort of like into a sort of drawn out thing. And we sold a whole bunch of art. And so it opened up this idea for us. To do some more of them. And, we're now going to be working on a curated show of street art, that Ski from that team that I was just telling you about Fernando Romero is going to curate, that's going to be absolutely amazing, it's going to be a smash hit, no questions about it because he's going to, he has a lot of connections, obviously in the street art world and graffiti world. And he's going to bring in people who we've never represented, um, and curated in a way that will sort of open up art that had never been shown before in this manner. So we're very, very excited about that one. The other one that I'm working on is an Australian couple, the names are Gillie and Mark a husband and wife team who make art together. And, they're actually very well known in New York City for their outdoor monumental bronze works. And, before the pandemic, they did this beautiful, beautiful exhibition of women of valor. They had come to realize that women bronze, sculptures and statues of women, we're sadly lacking female sculptures, and monumental sculptures of women. There were less of them than there were men and they were going to change that. So they did this really beautiful collection of sculptures of some fantastic women, from Ruth Bader Ginsburg and so on and so forth, it was just really beautiful. And then they've done these large outdoor installations. People may have seen it up at Astor Place in Brooklyn, the big rhinos stacked on top of one another. Monumental pieces and part of what they do besides them tease and make fun of themselves. Gillie and Mark, Gillie is a bunny rabbit and Mark as a dog in their paintings and they sit on Vespas and bicycles and do all kinds of sweet, lovely things. We're going to do an event with them online and sort of tied in with the time zone with Australia. Those are two really great things that are coming up. Hilary- So cool. How could our listeners get in touch and actually sign up for any of these events? Jeff - Really easy. All you need to do is shoot us either an email, to, you could send it to me, jeff@popinternational.com or just art@popinternational.com. And just say, Hey, I heard the podcast, or you could, um, just call the gallery. And the number is (212) 533-4262. And we'll put you on the list and, and sort of begin to develop a relationship with you the way we have with our many, many thousands of collectors that we have over the years, we look so forward to it. Hilary - This was really informative and congratulations on your successes. I really appreciate you being on the show. I want to also thank our sponsors, the Russo law group, The Profit Express with Tim Healey, Pop international galleries. Thank you. Gold Benes LLP, and the Pegalis Law Group. And last but not least, I want to thank you our listeners for tuning in. If you want more information on this show or any other show you could visit our website at hillarytopperonair.com or you can find us on Spotify, iTunes, Google Play, apple podcasts, even Amazon Alexa, where out there you'll find you can find us have a great week and we'll see you next time.
Todd: OK. Jeff, you have your own website?Jeff: Yes, I do.Todd: OK.Jeff: Very nice site!Todd: OK, can you just talk about your website?Jeff: Yes. The address, I'll give you my address first to the website.Todd: OK.Jeff: So, you can have a look at it.Todd: OK.Jeff: www.eagarbros.com. E-A-G-A-R-B-R-O-S dot C-O-M and it's eagerbros.com because my last name is Eagar, Jeff Eagar. And "Bros" is short for brothers and I have three brothers but I have two brothers that I travel with around the world, different countries with and so it's sort of like a video diary of some of the things we've seen and done on our travels with people and places. Yeah, it's interesting. It's got video, stories, and audio. It's all about people and poverty and wealth and their serenity..of the world. It's pretty good. It's pretty interesting I think.Todd: Wow! Thanks.
Todd: OK. Jeff, you have your own website?Jeff: Yes, I do.Todd: OK.Jeff: Very nice site!Todd: OK, can you just talk about your website?Jeff: Yes. The address, I'll give you my address first to the website.Todd: OK.Jeff: So, you can have a look at it.Todd: OK.Jeff: www.eagarbros.com. E-A-G-A-R-B-R-O-S dot C-O-M and it's eagerbros.com because my last name is Eagar, Jeff Eagar. And "Bros" is short for brothers and I have three brothers but I have two brothers that I travel with around the world, different countries with and so it's sort of like a video diary of some of the things we've seen and done on our travels with people and places. Yeah, it's interesting. It's got video, stories, and audio. It's all about people and poverty and wealth and their serenity..of the world. It's pretty good. It's pretty interesting I think.Todd: Wow! Thanks.
Max: Hello and welcome back to The Recruitment Hackers Podcast, I am your host Max and today I am delighted to welcome Jeff Wald. Jeff Wald is the author of two books including The end of jobs, The rise of on demand workers and agile corporations hot topics, kicking off into 2021, Jeff, welcome to the show.Jeff: Max, thank you so much for having me.Max: It's a pleasure. And we're at opposite sides of the planet Jeff is logging in from Florida, I'm in Hong Kong. But I think the world is smaller than it has ever been. With so many of the so many of those jobs being kind of remote, being advertised as it doesn't matter where you're, where you're hiring you know it's anywhere in the world as long as you've got the skills. So, it must have been a busy year for you, promoting the cause of the remote worker and the on demand worker. I'm even more excited about the international dimension of that, as opposed to, let's say, the creation of a new job category. I just like the fact that now the talent pool is universal and global.Jeff: I agree, I will say this man. Let's not gloss over this small little fact that you're sitting in Hong Kong, I'm sitting in Florida. This is mind blowing to me if your mind's not freakin blown by this anyone that's listening to the fact that the two of us are sitting on literally opposite sides of the planet. That is amazing. You know pre pandemic I'd said a bunch of times in the book down the hall, on another floor, down the block, or halfway around the world. You don't need to be in the same place to be on the same team. And that has become all the more true during the pandemic or I should say all the more true, it's always been true. Over the last few years it has been all the more aware than people become of that. And this is exemplified here I mean we had a wonderful conversation, prior to you know hitting record here, as if we were colleagues on a project, just working and it to me there was no difference the conversation we had then are having now than you, me sitting in your office.Max: Yes, yes, Well all the mess in my office is outside of camera view. It looks a lot better. Actually, I control this environment better. Jeff: I'd probably be wearing pants. Those are all things that are slightly different than if I were in your office. But still, it's all amazing to me.Max: That's great. So far listeners out there. Jeff is pantless.Jeff: Allegedly, allegedly!Max: Well. So Jeff, maybe you start by telling us a little bit about yourself, before you became an author on the topic of employment. It's probably not what you grew up, dreaming to become a kind of happened with life. Can you walk us through the main steps in your career. Jeff: Sure, I started my career in finance with JP Morgan,moved to venture capital, which was just an amazing, amazing experience working with entrepreneurs, and getting to see men and women that were just trying to change the world. So exhilarating that I left and started my first company, that failed miserably and basically bankrupted me. But that's the thing with entrepreneurship, pick yourself up dust yourself off and keep going. Second company we built up, and eventually got sold to Salesforce and that was a good outcome not a great outcome. And then this last company Work Market, founded 10 years ago. Work Market is enterprise software that enables companies to organize manage and pay their freelance population, raised about 70 million from Union Square ventures SoftBank and a few others sold the company to ADP almost three years ago. So it's been a great, great journey and the sale to ADP specifically gave me the space, Max to finally sit down and finish this book because I've been working on it for like four years prior to the purchase of ADP. Max: Okay. Well, congrats on that entrepreneurial journey. I haven't read that. After you sell your business, there was a moment. It's a moment where most entrepreneurs kind of struggle with depression. Suddenly a drop, drop in activity and energy. But apparently, you made the most of that sort of drop.Jeff: That's super super interesting. I guess I understand it conceptually. It's one of the silliest reasons to be depressed, not that I wish to ever make fun of depression. I will tell you having your business fail and going bankrupt. I'd say bankrupt as bankruptcy is a technical term. Have your business fail and virtually going bankrupt. That is something that did in general did a lot of depression in me. And, you know, having not leaving my apartment for some time. As I was super bummed out by that, but I had no experience like that with the sale of joy upon joy and gratitude and fortune. Max: Yeah. Good, I am really happy to hear that because you know who knows maybe one day I'll have to sell some of my shares. And I'd like it to be a happy moments as well. Jeff: God will. God will.Max: So, your new book, The end of jobs, The rise of on demand workers, I'm excited about this topic, because it is all of our, our mission in the corporate world and the enterprise world, to, to create a performance driven culture, and an output driven culture where people are measured on, you know what they produce, as opposed to you know how why they smile. And I think that the transition towards task base job assignment, as opposed to job descriptions, is one for the best because it actually gives more freedom to be able to just get the job done in as much in as little time as possible, which is giving people more freedom to run their lives the way they want. I mean it could be looked at. It could be looked in that way it could be looked at on the opposite side of the spectrum as like a cold market driven approach to employment. Instead of where many employers to position themselves as we are family. But I think the 'we our family' message is a bit outdated personally. How do you feel about that transition? Do you think that we're moving towards a world which is, is that what's covered in your book?Jeff: So there are a number of things that are ever covered in the book about the future of work. The first and the most important is to look at the history of work. I wrote the book because I get very frustrated with people that make predictions about the future of really anything quite frankly without evidence, specifically in the world of work. We have the history of work and how companies workers have come together to produce goods and services throughout different societal changes different technological changes. So let's study those. And the second body of evidence is data. What does the data, tell us how to data trends and patterns, play out. Currently, and obviously through history as well. The third is how companies actually engage workers. You know a lot of people think the labor resource planning meeting goes like this, CEO walks in and says, 'All right, what are we gonna do ot her workers. Let's hire the cheapest ones, meeting adjourned'. That is actually not how those meetings go, there's a lot of variables that go into that equation. And so understanding how companies actually engage workers, understanding the data and the data trends and understanding history, and how society has coped with some of these struggles before. That to me is a very thoughtful way to think about, or start to make predictions about the future of work and that's what we endeavour to do with the book.Max: So the book has a historical component that goes back to the the history of work. I was excited when I read about the time of Abraham Lincoln when they were talking about what's it called wage slaves, or where it was considered that every man should be his own employee, there was a vision that was articulated at the time that you know you were to be on a regular wage is somehow less envious, that everybody should be self employed as kind of coming back a little bit right from one or two years ago.Jeff: It certainly is coming back to the whole idea behind freelancing is the idea that you get to have flexibility and choose your own path that is a very very powerful thing it's something very encoded in our DNA to want to have control of our own destiny, of course, and all the things that the freelancer faces are starting to permeate the full time workforce. So, like called the book The end of jobs the rise of on demand workers. That is not to say I think everyone's going to be a freelancer, that is to say that all the things that the freelancer deals with task based labor, personal responsibility, algorithms, allocating work data driven HR all of those things Max are permeating the full time workforce and all workers are dealing with kind of things.Max: Okay, so, everybody who's looking at Uber drivers thinking, I'm glad I don't have an algorithm, looking over me. Time is coming up. Yeah,Jeff: it is coming. No question. It is coming.Max: Okay. From a talent acquisition perspective which is really my focus. How does this affect recruitment How does the rise of the on demand worker affect recruitment? Do you think that. Are you noticing that they're, they're being hired in a different manner than the permanent staff?Jeff: Well I think there are a few ways that all of these changes impact recruiting. The first is the recruiting is that tip of the spear right your listeners are the first people out there that are dealing with the changes and how companies are structuring their workforces. We need more of X we need less of Y. We need more people in this geography, fewer in that geography. And so recruiting is seeing in real time, the shifts in labor resource management, and that is super super interesting in and of itself. And we can spend some time talking about the types of recruiting they're gonna be more important as we get into skills based labor, and more remote work, and more on demand work and how robots and AI are going to impact the workforce with large. That's one conversation set that is a very interesting conversation to be had. The other part is how does that specific function change, given all of these things is more recruiting going to be done in an on demand capacity? is more recruiting going to be done via robots or AI systems going to be doing more recruiting? And that's another very big impact that quite frankly we don't know how that's going to play out yet. You know there are just way too many variables and it's way too early in the game, but we certainly have seen some trends around on demand recruiting. And we've certainly seen some trends around some of the tasks inherent recruiting starting to be done by machines.Max: With the start of the new year. Are you talking to companies who are setting targets around. I'd like to move, you know, 10, or 20% of my workforce to on demand, does that come down from the board to the operational level?Jeff: Short answer is, look from the board down the answer to that is usually No, that is. You'd hope, but boards, I don't think, sitting on a few public boards myself boards don't get involved that tactically even though I would argue it is strategic and they should be having that type of conversation. Those conversations are very nuanced very complex, and so I've never seen somebody come down and see any point out. When I was running Work Market because if you wanted to increase your usage of freelancers there weren't any really other places to go, if you wanted to manage a large freelance workforce and Work Market. So, I would usually get that call. And I will tell you we very very very rarely got the labor force transformation call. The call of a we're getting into the change how we're doing things we need to bring in, and we're frankly, what I would get those calls, I kind of was like this is going to be a two year conversation, this sucks, but it usually, the call will come from real big companies so you take it and start having obviously if we could work with fortune 50 company we're going to do it. What the call, we would get Max, the calls that we would get all the time is we currently manage a freelance workforce. It is a very large part of our labor force strategy and it has been for years or decades, in some cases, but it's a mess. We don't know who's where who sent what legal Raymond who is working on what is good and what we need a piece of software to help us efficiently and compliantly manage this workforce, that call, I would get all the time. But the idea that, whether it's on demand work or robots and AI, that there's going to be some huge shifts that data doesn't support it. History doesn't support it, and how companies actually engage workers does not support an argument that oh my gosh all those jobs are gonna go next year, 10% of those jobs are gonna go. Labor force statistics and labor resource planning happens very slowly and very methodically and that's that's just the reality. So it's that reality that people should be mindful of when thinking about the future of work.Max: And there's a huge regulatory component where a change in the law, and how easy it is to hire and fire will immediately impact the percentage of the staff, which is on demand right because it drives a lot of the demand.Jeff: It is a incredibly powerful maybe the most powerful, powerful variable and what I call the labor equation, very complex equations series have a system of equations, I should say that guide how companies actually engage workers, and the regulatory environment, especially when it comes to freelance workers, I would argue is the biggest variable in that equation. And the problem with that variable is that that variable itself is all over the map. It's very different how you engage worker in California than what you do in Louisiana. Workers comp board in Wisconsin has an entirely different point of view than the Labor Department in Portugal. So you got to be super super mindful of how complex it is and that's why most companies go, oh my god it's too complicated just keep everybody employed. Obviously that's a bit glib of an interpretation, but it's not that far from accuracy.Max: Yeah. Yeah, I believe it for sure. For me, I experienced it the other way I was like oh my god it's so complicated I have all these full time employees and be better I'd just have contractors, but either way. Either way, the decision towards a simpler way of doing things. I mean, I imagined that it's a little bit easier to decentralize, the compliancy, meaning. Instead of putting the onus on the employer to be in charge of everybody's, you know, being compliance is to say to the on demand worker, it's your responsibility. And by the way, here's a little bit of money to help you file your taxes or, you know, manager, your stuff.Jeff: That is a really good point there. A increasing number of companies out there that are helping the freelancer set up a corporate structure, which really makes it a vendor relationship, and that stuff certainly helps shield the company, but in no way can the company. And I would not pretend to understand laws in China, or anywhere else. But in the United States, you can't pass that liability down to the worker. So when the State Department of Labor comes, you can't say well I, you know, they all signed these legal agreements indemnify me the department labor's we go okay I don't care. There, we view them as your employees, where is our back payroll tax? Where's Social Security payments? Where's unemployment insurance? let's go gimmy gimmy gimmy. They couldn't care less. But there are ways to your point, that companies can certainly mitigate their risk.Max: Great. Well, what else can corporations think about your talking to you know it was in your title the Agile Corporation. What are some of the trends Do you foresee in 2021 for companies who want to become more agile, Besides that, besides work market. What other what other tools or methodologies do you recommend?Jeff: Well I don't anticipate a huge increase in the size of the on demand workforce. But the on demand workforce as a number shrank. So there were over 240 million workers in the on demand workforce now there are high 30 million workers in the workforce, but the labor force as a whole film. And so we're still trying to parse together, did the percent of the on demand workforce shrink grow or stay the same? My guess is that it probably that stayed about the same. So I don't anticipate in 21, a huge movement back. I think it will stay about the same. percent of the labor force, because companies are just focused elsewhere, right now, right they're trying to make sure their teams are safe they're trying to make sure that their supply chains are safe and trying to make sure that their employees are being productive and they're not thinking about labor force transformation and 21. 22 might be a very different scenario. And as we discussed earlier regulation I think it's going to be the biggest variable in that equation. But when we talk about agile Max there there are a host of different ways in which a company can be agile. The best way is managing an army of freelancers. They are completely agile. The next you know you can move into temps and the vendors to other types of relationships. The biggest change that we saw in the labor market unquestionably in terms of how work gets done, I think the biggest change was unemployment and obviously horrific impacts on labor because of the pandemic. But the biggest change in how work actually gets done was clearly remote. It was moving to remote work and does that make a company more agile? of course it does. Allow your workers to be able to work where they want how they want is a very important step in kind of breaking that bone of the one office one manager 9-5 job. And that's the job by the way that is referenced in the title the end of jobs. Robots are taking all of our jobs, far from it, they are not, that is a very clear conclusion from the book. But this idea that you have one office, one manager, you work 9-5 that job is dying and it gets replaced by people being nomadic people having flexible work arrangements, people working in different contexts so that certainly on demand. Temps of freelancers and all that jazz. Those are the kinds of changes that were sped up by the pandemic as companies had to become more agile, there was no everyone's got to come to the office from 9-5, that wouldn't happen in almost anywhere in the world, in April of 2020. So, that is a huge step forward in the Agile corporations.Max: Actually, to your last points on, I've noticed the same trends and of course but the 9-5 aspects, there are still a bunch of companies that still look at the nine to five hour. And, and there's a strong case to be made for for the work life balance to say, yeah, starts at nine five so you don't invade people's lives, but on the other hand, it does remove you know to do so because you, you say we want to create boundaries and we want to create overlap or people working at the same time. It does also mean you're removing a little bit of freedom from your employees, from your staff, let's say, to decide when they work. Jeff: Of course.Max: It's not that great right, like. I would argue like work whenever, and we try to minimize the number of conference calls if we can.Jeff: That is a fine way to think about it, but when we're thinking about 164 million people in the US labor force actually 154 million now, 164 at the beginning of the pandemic. That is not the way all of them are gonna work. If you have a shift at H&M. That's when your shift is, there's no hey I want to work from Barcelona this weekend no no your shift is here in the store and that's when your shift is, if you're working on the line at Volkswagen your shift is nine to five, or maybe, whatever it is, there is no a I'm going to you know come in late. And I'll stay later, I don't know, that's when the shift starts like you have to be there. So it's important to think about the full context of the labor force. When we have conversations about the future of work it's easy to slip into this idea that everybody works in these remote first type jobs that are very enabled by remote work and digital work and all these other things. The reality is most people don't, that's just not the reality for most workers in any labor force.Max: Agreed. Agreed. And I work in these industries where people do have to physically come a lot of the time, so I know that's the case, but I guess, for the knowledge worker. I still see, I still see people trying to cling on to this office. You know way of work, sure where, whereas all communication, eventually, as much communication as possible should be moved to the asynchronous. So because we can read faster than we can sit through a meeting.Jeff: I completely agree. But to your point, some people do enjoy it. And there are tremendous benefits to it. I saw a study that 93% of remote workers still live within a commutable distance of the office. Because going remote doesn't mean you never go to the office, there are benefits to having everybody come together and have brainstorming sessions and do small talk. Those serendipitous encounters at the watercooler, they're actually incredibly good for productivity, do they need to be every day? Of course not. Can we allow people to flexible work arrangements, those that want it and those that can do it. Sure. But here's another important thing 42% of the US workforce can work remotely. That's it. Max: yeah.Jeff: And the US by the way is the highest percentage of any workforce on the planet that can work remotely. But another way to say that is 58% of workers, cannot do this digital lifestyle, cannot work remotely their jobs won't allow it. So we need to be mindful of that when having these types of conversations.Max: Alright, so it was a bubble 2020 bubble and the narrative, to a certain degree that was not really supported by hard data. In fact, most people will still be coming into the office and, and the on demand worker or while it's an ongoing transition. We haven't seen a huge rise in the percentage of the workforce that goes on demand. And the robots will now take our jobs. I'm sure that there's a lot more depth to this book, than my cliff notes here. How do people find your book, I'm gonna put a link to where do you want to sell, are we selling through Amazon or is there another place?Jeff: There are tons of other places but 98% of the books that have been sold have been bought on Amazon and, you know, certainly when the book came out in June, there was almost no other place to buy the book. That's not true actually was on barnesandnoble.com, a few other web sellers but it's funny I'm down here in Florida now and Florida's COVID restrictions are much looser than my normal home in New York, and I passed the Barnes and Noble today. As I was going school, get my office set up down here. Home Office, and I'm super excited to go tomorrow and see if my book is there, so hopefully it is in bookstores where it's supposed to be but it'd be the first time I get a chance to go into an old school Barnes noble I'm super excited. Max: All right. Don't forget to put on your protective gear for that Barnes and Noble experience.Jeff: No question. No question.Max: And, well, how do people get a hold of you? What's the best way to reach you?Jeff: Well, you can certainly follow me on twitter at @Jeffreywald, that's the only place that I go by Jeffrey for wells I go by Jeff, but I couldn't couldn't get Jeff Wald, and LinkedIn, I'm always I will always accept connections on LinkedIn and Amazon is certainly the best place to find the book.Max: Wonderful. Well thanks Jeff for sharing your insights and coming on the show and. Well, I look forward to my FREE copy in the mail. No, I'll go and get myself a copy I've got a bunch of books,I am a little bit behind on my reading, and I'll go get myself a copy right now.Jeff: I appreciate it thank you so much. It was so great to chat and I look forward to listening to many more episodes of this podcast.Max: Thanks, Jeff. Jeff: Thank you.
更多英语知识，请关注微信公众号: VOA英语每日一听Mike: OK, so Jeff, we've been talking a little bit about your travel kind of experiences and stuff, and one other question I wanted to ask you, is there a time where you experienced something really weird, or something strange that happened in your travels around the world? Is there something that stands out in your memory?Jeff: Many weird things happen when you're traveling. I think that's the beauty about traveling is it's an emotional roller coaster but I remember one time, again it was in India because it's a country full of surprises, but I was driving on an old rickety[快要散架的；摇摇晃晃的；不结实的] bus. We were going down the road and we stopped, and I was sitting by the window, and a bus is full of action and noise and everything so I was paying attention inside the bus, and when the bus came to a stop at the intersection I turned around and looked out the window and there was an elephant staring right about me. The big eye of an elephant at the same level as the bus window looking right at me, and it was such a shock to me that, you know, you're in the middle of a big city in India and you're one a crowded bus and you turn around and look outside, and there's this big elephant looking at you. Well, you expect to see that in the zoo, but not out in the streets so I must say it was a very weird and wonderful experience.Mike: Did you strike up a conversation with the elephant?Jeff: Actually, there was a man sitting on top of the elephant, so I had a quick chat with him and then the bus went on and we left the elephant and that was it.And you have --- India you have cows in the streets, and you have donkeys, and you have dogs and cats. It's a very animal-friendly place, and I knew that they had elephants, but I hadn't seen one at that point in the street, so, and I expected to see one my first time from a distance. I didn't expect to be eye-to-eye with one the first time I saw one, and elephants have quite big eyes.Mike: I heard that.Jeff: So, but it was very good and elephants are lovely animals.Mike: You didn't poke him in the eye?Jeff: I didn't poke him in the eyeMike: That's a good thing. Fantastic.
更多英语知识，请关注微信公众号: VOA英语每日一听Mike: OK, so Jeff, we've been talking a little bit about your travel kind of experiences and stuff, and one other question I wanted to ask you, is there a time where you experienced something really weird, or something strange that happened in your travels around the world? Is there something that stands out in your memory?Jeff: Many weird things happen when you're traveling. I think that's the beauty about traveling is it's an emotional roller coaster but I remember one time, again it was in India because it's a country full of surprises, but I was driving on an old rickety[快要散架的；摇摇晃晃的；不结实的] bus. We were going down the road and we stopped, and I was sitting by the window, and a bus is full of action and noise and everything so I was paying attention inside the bus, and when the bus came to a stop at the intersection I turned around and looked out the window and there was an elephant staring right about me. The big eye of an elephant at the same level as the bus window looking right at me, and it was such a shock to me that, you know, you're in the middle of a big city in India and you're one a crowded bus and you turn around and look outside, and there's this big elephant looking at you. Well, you expect to see that in the zoo, but not out in the streets so I must say it was a very weird and wonderful experience.Mike: Did you strike up a conversation with the elephant?Jeff: Actually, there was a man sitting on top of the elephant, so I had a quick chat with him and then the bus went on and we left the elephant and that was it.And you have --- India you have cows in the streets, and you have donkeys, and you have dogs and cats. It's a very animal-friendly place, and I knew that they had elephants, but I hadn't seen one at that point in the street, so, and I expected to see one my first time from a distance. I didn't expect to be eye-to-eye with one the first time I saw one, and elephants have quite big eyes.Mike: I heard that.Jeff: So, but it was very good and elephants are lovely animals.Mike: You didn't poke him in the eye?Jeff: I didn't poke him in the eyeMike: That's a good thing. Fantastic.
How important is content marketing strategy to your e-commerce business? Crafting valuable content helps build brand trust with both existing and potential customers, allowing you to successfully grow your brand. Today we're talking all about content and smart ways to ramp up your strategy. Jeff Coyle is co-Founder and Chief Product Officer of MarketMuse. Coming from twenty years in the SEO and content strategy arena, Jeff's products use AI to accelerate content planning, creation, and optimization. With their spokes-of-a-wheel keyword approach, MarketMuse's content marketing strategy connects ideas, allowing clients to demonstrate product expertise. Episode Highlights: How content relates to growth and where to start assessing the need for your business. Strategies that help tell the story that you are trying to tell. How to gauge the success rate. Where the news dynamic fits into your content campaign. The breadth and depth of your content. Figuring out where the gaps are. When to hire an expert. How the Marketmuse suite of services help the writer. Using smart content to illustrate expertise. Why search volume is not the only strategy for content valuation. Some quick win strategies – aka one-page plans. Packages MM offers for different sized audiences. Tools and hacks Jeff recommends. Transcription: Mark: So there was a time early on in Quiet Light Brokerage when I was doing all of the Content Marketing for the firm and I was writing on average eight blog posts or articles per week averaging about 18,200 words in length. And I underestimated when I started on this kind of venture of can I do these eight to 10 per month; I underestimated how much work it was going to be and it was a lot of work because it's not just writing down your thoughts it's writing for the web and writing for SEO and understanding what do you write about next. It's amazing how quick the writer's block comes in. I know that you had a conversation with Jeff Coyle a mutual friend of ours from Rhodium and one of the founders of MarketMuse which is an awesome company; a great tool from an SEO and content marketing standpoint. You guys talked about everything content which is relevant to buyers, anyone looking to acquire a web-based business and grow it. I know it's been a huge part of our marketing plan. What are some of the things that you and Jeff talked about in this conversation? Chuck: It's quite great. I had a great conversation with Jeff and we're talking about if you've got a dollar spend where to spend it. Most people they're doing basic keyword research, they're looking for what's the keyword that's getting the most searches versus the keyword difficulty. And he takes it like way beyond that and they're looking at not just the specific keywords but what keywords are actually tied to other keywords that show that you're an expert in the topic. If I'm talking about like a specific thing but I fail to mention other words Google then thinks that I'm not an expert because anybody who's an expert would be using these other words or when you're just looking at keyword tools to look at the ones they're getting the most traffic you often miss the additional keywords that are in there. Mark: Right. And I know full disclosure I use MarketMuse with Quiet Light Brokerage and actually with my other company as well. I use their service and the general sales pitch is pretty simple. It's this idea of setting up pillar pages and having this kind of spokes on a wheel branch now so the example that they use I think in some of the marketing materials is if you're going to have a website on craft beer you should have a blog post on craft beer but you should also have an entire section on hops and an entire section on barley and malts and then even from there if you want to be all about hops and afford it to do a page on hops you should also have some satellite pages on imperial hops or these other types of varieties of hops and being able to have this kind of wheel with different spokes coming out. And you know what a bunch of SEO tools use this. Like I've been using Sight Bulb recently; a really cool software that diagrams out your site and the sort of hub sort of format. What MarketMuse does is they take a blog post and had topics so you say I want to focus on craft beer and they say okay if you want to really be known as an expert, make sure that you're talking about hops at least 10 or 15 times in this blog post. And make sure that you're also talking about different types of barley. And then you can use that and say well okay I'll talk about this in this blog post but what do I write on other blog post? It's made for me and I don't do a lot of the writing anymore but it makes the content creation process super easy; like the ideation part, I mean that's the hard part about all of this. How do you come up with new ideas on what you should write about? But I don't want people to think this is just a sales pitch for MarketMuse. It's a great piece of software, obviously, I believe in it from that standpoint. But I think from a buyer standpoint also from a seller standpoint having a solid content strategy is really really key. If you were to spend money; Chuck you've had a bunch of businesses in the past and I know you've used content, if you're going to spend your money somewhere for long term marketing dollar I'm kind of leading you to the answer here, where would you spend it? Would it be in the content marketing world or would it be PPC or what are the advantages in your opinion of this content marketing versus other types of marketing? Chuck: Yeah I mean it really depends I think on the type of business you have. Obviously, if you have a content-related business then you want to hop out as much quality content as you can. If you've got an e-commerce business there's different funnels and then buckets may be that you need to put your money in but you definitely need to be investing in content. Even on Amazon when you're thinking about like selling something on Amazon you go to some people's pages and the content is just horrible and it's so important. One of the things we didn't talk about but like when you're looking at Amazon you'll look at the questions people are asking and then answer those questions. So content is definitely important. We talked just a lot about what you should be writing about next. When you're looking at competitors sometimes you can actually see the direction they're going and then beat them and write a bunch of content. Actually, get in front of them because you look at their keyword list and you know the direction they're headed and you can actually get in front of them. Mark: Yeah for my money I think the two areas that are the most important for a marketing strategy at least long term return will be content marketing and CRO, conversion rate optimization. Those two things alone have such staying power where you invest now and you're going to benefit for years to come as opposed to PPC which is great because you can throttle PPCC; that's the reason people love it. You can throttle up and down. You can really find some gems and it's very immediate. But long term success I think is predicated on this content strategy frank that's something we've even bought a little bit at Quiet Light. I just got to give you a quick shot out Chuck because you are wearing a Quiet Light shirt. So for all those people that are watching on YouTube and I know it's not a ton of you that are watching on YouTube but those that are you can see that Chuck actually has a really cool shirt. I don't even have that shirt. Did you give me one? Chuck: I think I kind of bought Joe one but I didn't get you one so maybe I'll have to get you one as well. Mark: Okay, I think Brad gave me one and it was like enormous. I was swimming on the thing. Chuck: I think that's the one I have with Joe when I bought his it was too big for him so I have to get your size. Mark: Make sure you size it down and hey if we get a few extras of these maybe we can set up a contest for people that actually want a Quiet Light; I don't care what you do with it but it's kind of fun to give that away as a prize. Let's get into the episode. Content marketing is where I cut my teeth early in the Internet world. I love this topic. I think Jeff is one of the smartest people in the industry when it comes to content marketing [inaudible 00:07:02.0] good market views and this is definitely one to learn from. Chuck: Yeah absolutely and two things before we dive right into it; one they're giving a special discount. Again we're not trying to promote it. It's just a good product if you want it great but in the show notes, there's going to be a discount code to get a nice percentage off. And stay tuned to till the end of the video because I also asked Jeff for some additional tools that he likes to use. I always think it's fun to ask entrepreneurs what are some various tools that are unrelated to our discussion from what you're using so. Chuck: All right hi everybody Chuck Mullins here from Quiet Light Brokerage and today on the call we have Jeff Coyle the co-founder of MarketMuse and chief is it, product officer? Jeff: Yeah, Chief Product Officer, I manage the product data science and engineering teams as well as the marketing team at Marketing News. Chuck: Awesome. So I've known Jeff for a couple of years, we run in the same circles. I've been on the Internet world for quite a while. Jeff do you want to tell us a little bit about yourself? Jeff: Sure. I am as you mentioned the co-founder and chief product officer for MarketMuse. Prior to this, I've been in this space as Chuck mentioned for quite a long time; about 20 years as scary as that might sound in the search engine optimization content strategy game. I have generated like 50 million leads and not as an exaggeration for B2B technology primarily companies in the early part of my career. I worked as an early employee at a company called Knowledge Storm which sold to Tech Target which is also a great B2B publisher and an intent data and ABM platform for enterprise and mid-market B2B companies. I worked for them through their in-house team and in-house capabilities while I was there really focused on driving engaged users through content and content strategy. When I left Tech Target having already spoken with my co-founder about ways that we could grow MarketMuse I came on as a bit of a late co-founder and we've since grown the company to almost 50 people; really, really an amazing story about growth, building a new category about content strategy, what should you write next, what should you update or optimize next that's going to have the biggest impact on your business and everything that goes along with that from how do I assess my own authority, how do I understand where my gaps are, how do I know where my strengths are. And that's been the mission of our business is really to tell the story of I could spend a dollar on content; creating, optimizing, blah, blah, blah, tomorrow what should it be? And that's what MarketMuse is for; to tell that story. Chuck: Alright so kind of you alluded to it but today we'll get you on a call to talk about SEO and maybe more so how content is applicable to SEO. So maybe starting at the base when somebody either acquires a new site or maybe is looking at a site trying to think of how do I grow this site like where's my opportunity, what kind of analysis do you think somebody should start off with? Jeff: Well I think that traditionally the way that people have assessed sites for their strengths sometimes is only by looking at their current and existing rankings or their historical rankings. So it's a bit of you know kind of a tail wagging the dog assessment of where you're at, where you have been, but that as a starting point does provide some value as to where you are. It just doesn't tell typically the entire story about what it means to be about something. So when I'm looking at assessing a site for the merits of its; the collection of its content or its inventory of content, when I'm looking at is to say yes certainly I want to see performance. I want to look at also things that I might get out of my analytics package engagement. I have to understand the goals of the company the key performance indicators of the business. Am I driving those things? Can I peddle out of them? But divorcing those concepts for this point in discussion about conversion rate optimization and such from a search engine optimization or authority perspective I want to see where I've written great content so how much content have I created on core topics that I care about. When I do cover those topics how in-depth do I get and how successful does that; what kind of success does that yield when I write about a concept I care about when I get deep when I write high-quality content on concepts that I care about. Those two things really tell the story of your existing momentum on a concept. And so that when I'm assessing a site that's one thing I want to want to figure out is where do I have momentum? What concepts can I write about and I expect to be successful. And that's Stage 1. Chuck: Before we move on from that one how do we gauge that success rate; what do we think is successful, what are the indicators that say hey I'm already doing well here or I'm not doing well here? Jeff: Absolutely and that's the hardest part. And to run an effective content marketing team and a content production team for any company you've got to start at what are the key performance indicators? If I'm an e-commerce site the key metrics that I have is my average order size, it's my conversion rate close to a closed cart, it's my cart abandons, it's my total revenue. If I'm an affiliate site it might be an RPM metric and I have to be agnostic of and when I have agnostic a reference of affiliate and then I want specific combinations of affiliates because sometimes you can actually fake your books accidentally if you've got great affiliates on one page and not great affiliates on another. So it's really about I think engagement with affiliate opportunities in addition to revenue. You get a look at both of those things. If you are a publisher it's going to be RPM but also it's engagement with those pages. Because again how your ad server validates is do you have paid ads? So if you have a bunch of house ads and those have a different rate you want to always account for that because you might have great content this shooting off impressions engaged users clicks and such. So I always like to look at my current value per visit and then by the way from a B2B tech or something PI attorney; all these places are where MarketMuse does business so I like to kind of list a full fledge. I'm looking at my conversion to lead. I'm also looking at as far down the funnel as I can track and attribute. Every deal no matter what every situation you're looking at you always want to get it back to current value per visit and aspirational value per visit from a channel. In this case, let's say organic. So if I'm in a scenario I want to always be able to back that up. That's the only way I can truly define quantified value. And for MarketMuse obviously, that's the only way we can truly walk in the door and be confident in that ROI analysis. And that's why we've had to do this hundreds of times. When we talk to somebody it's to say how much do you really value each one of these visits? And if you can't answer that question it's okay, let's back into it, let's figure it out. How much is that truly about? Because then if you grow your traffic 20% you can say okay well that's worth this much to me. How much am I willing to invest in that? And that's how I define. So that's a long way of answering a short question that was actually really duped question. But the answer then is my quantified value metric. How much did I publish? How much did I update? How much do those act motions cost or those actions cost? And what was the efficiency rate on the content achieving some sort of baseline goal? I like to use recurring traffic from organic search as my goal. So I might get a boost from other channels and then it dies off. So I want recurring traffic at or above a particular baseline. So if I wrote 100 articles and 10 of them achieved my baseline of ongoing recurring traffic when I have 10 percent efficiency rate in that zone. If I updated 100 articles and 40 of them grew in traffic at or above a particular level. Then I've got a 40% efficiency rate on optimization. So when I talk about effectiveness of content I want to see how much should I publish, how much should I update and how often did that achieve my goals? I see ranges by the way just it scares the crap out of me sometimes, 1 to 2% of efficiency. Like I write 100 articles and only 2 get rankings. Quite often 40 and 45% at best practice that it's so wide. So you need to take stock today whomever you are and say how often did I write, how often did that yield recurring traffic; that's my efficiency rate. Am I in that 10 percent zone? I got some work to do. Am I above 20, 30, 40? I'm kicking butt. Now how do I take advantage of that? What do I do? No matter where you are there's always steps you can take to really maximize your earn. But it's a great question because so many people talk about ROI and they can't explain how they calculated. Chuck: Right. And it sounds like what you're saying is maybe like diving into your analytics but not looking at like how much traffic this page is doing but what is the segmented traffic; how much is coming from Google or Bing or whatever you're targeting. Maybe you're targeting link acquisition with an article then you got to figure out what's the value of a link that's coming in, how many did I get on this piece of content, and then maybe kind of summing up the value of all the different components. Like knowing what your KPIs are for the specific content. Jeff: Absolutely. And so the ways that I do that so it's manageable; there are ways where you can do that so it's manageable because [inaudible 00:16:38.2] I have thousands of pages or I published hundreds of pages how could I possibly do that? It's do it for the site level. Do it by site section; it's the way Google thinks about your site anyway. Do it by site section and then take your marquee pages and do a more thorough analysis of them. And marquee could mean your best pages that you feel are the best but they punch below their weight class, stuff that does really well, stuff that you invested a lot of money in. So build your plat; this is the stuff I'm going to do with deep dive but I'm also going to get my section level and sight levels metrics. An example might be that when Chuck writes an article he's on a 20% conversion rate to my effectiveness metric. But when Ron I don't know who Ron is but well just say Ron, when Ron writes an article he's 5%. So you're to get; you could do person level, you could do section level. You really want to get that slice and dice to know what's the thing that is causing success to happen or is it luck. A lot of sites a lot of B2B companies they rely on all of their authority for 5, 10 pages and they've got hundreds. Not only is it completely scary and unhealthy from a competitive space situation but if you're a Quiet Light listener it's an opportunity. I mean it's an opportunity to see a site that has a risk of ruin. It's an opportunity to see a site that has huge opportunity if they just publish the right content. So all of those things are what we're typically looking at. It's when I publish about Chevrolets it does real well when I publish about smart cars it doesn't. So when I get that site I'm shooting off about Ford and about gosh as my adjacent so I'm talking about; so it's really getting into when I get in how can I write about tangential or semantically related concepts, really expand my inventory in ways I know we'll have more success, and if I do want to cover other things. I think a reasonable expectation about investment need because I can't just go right kitty cats and crush it. But I know that if I cover what hubcaps should be on the PT Cruiser I can. And so those are the types of conceptual analysis, editorial content strategies I have been doing with years. Now you have data to support it. And that's where I think that the next phase of great Search Engine Optimization outcomes comes from this type of content strategy analysis for sure. Chuck: And one of the things I was reading the other day was just and I think everybody already knows this but they were talking about news websites and why don't news websites rank for everything. Like a news website gets all the links because everybody's linking to articles but yet they don't have the ability to rank for all topics, right? Certain news agencies actually get a lot more traffic for specific topics because that is maybe their topical relevance of their business. Jeff: Yeah. Oh, I mean news is so unique. The news algorithm has so many components and so from a Google news perspective and Google top stories there's components of real-time boosting. There's the concept of the fact that news articles appear in organic search. And they're coming from different channels of information. So they cross the chasm from just being news to being appropriate in search results. So then there's the dynamic of some of those items stay forever. Some of them are temporal and they're going to bounce out when that thing becomes less of a temporal story. We actually have a solution for that. MarketMuse allows you to analyze both serps and overlay analysis and it's called newsroom but that's neither here nor there. But the point of the message is what if you write news articles about this topic you care about but there's four to five aggressive publishers also publishing in that that have authority for news and you're just picking up the scraps. You can see that with solutions that are out there now. You're going to just see what those things are and then tracking that back to assessing performance. If I'm looking at my content items and I write 80 articles about some topic I get no news referrals and I get trickles in of organic and I'm writing it for the purposes of news, is that great? Let's say they get other KPIs, let's say they do gather links and they become powerful. But I'm not winning news, I'm not getting the organic search value that I think I should, how do I use that? How do I use the power that those pages are acquiring to my benefit? And most of the time when I see problematic content strategy; document the content strategy at a company they're not looking at their existing power pages. What content are they publishing that is gaining some value and how do we use that? Because I've got something that's a link magnet that every SEO in the world will go we need to do something with that but they don't necessarily know what that is. And a lot of times you see these link magnets and they're out there. They got a little bit of traffic upfront. They're not valuable enough to get recurrent traffic or it's not; it was a temporal staged story so they don't know what to do. And so weaving that article; weaving that item into some real good content strategy, that's the win. That's building my thought leadership, building my clusters of content, and hey this powerful battery. Plug the battery in here, plug the battery in here, and weave it in with internal link, weave it in with appropriate content, upgrade opportunities for conversions, there's so many things you can do to repurpose but when you get a winner use the winner. And we see that older people are scared to touch them because they're like it might break up. So these are the main dynamics that we run into with kind of the Assessment Authority and news as a special case. But it's so misunderstood what to do when you get a news winner. Because if you can predict that every time you publish a news story on Linux you're in the top three of Google top stories. Like, open that wallet every darn day. And I have clients that are in that scenario and we're like you must write about this every day and they cringe at first and I'm like here's the value that this produces; it's not just traffic. It's all the good stuff that comes as a result of that. It's also a long answer to a short question but I think that's usually a theme with me. Chuck: Alright, so number two you're about to say before I ask you a question? Jeff: Oh gosh I don't even remember what it was now. No, I'm just kidding. So it's kind of breadth and depth and then is the things that you see as being really high quality that you've written. These pillar pieces, the centers of the universe, the things that have acquired the KPI. How are those KPIs; they've acquired some metric that gives you that sense. So we've talked about how your existing momentum, well what are these cornerstone pieces, what are the center of the cluster pieces that exist and how are you using them today? Are you weaving them in? Are you using them to write then support pieces, etcetera? And how do you combine that with analysis of your target readership or user or buyer intent? So what's their purchase cycle; do you have coverage in the information phase, do you have coverage in the middle of funnel, do you have coverage late in the funnel, do you have post-purchase troubleshooting and adherence in ownership? So when you have a beacon of power really that's the time your mirror needs to be the most clear. I always say this. Like, stop tilting the mirror your way because you think you have success. The garbage in the game right now as I call it is people looking at search results and saying I need to write articles just like that search result item regardless of whether you want to argue differentiation it doesn't work. It only works if you have existing power to start to do things like that. What you have to do is just say with my site that I'm assessing, do I have coverage at all phases of the cycle that people would care about who are in this motion; I mean research, intent, decision, conversion, adherence, troubleshooting, whatever the metrics of the buy spying journey would be. And that comes to the why I say this way because the pragmatic approach is to say does this site truly represent my business as an authority and as an expert? What about this collection of pages or this content inventory tells a story that I actually am an expert? And so when you're looking at coverage, you're looking at momentum and what's been validated that I am an authority. But then it's also going to be like aspirationally if I truly were an expert what would I have covered? I can do that by doing competitive analysis or I can do that by doing semantic analysis and manual research. And so when you cross-reference; the punch line here is cross-reference the aspirational model against what you have and that's your gap analysis. So think about the outcomes there. I have gaps in this part of the bio journey. I have gaps, I have blind spots I don't ever cover these topics. I have blind spots here blah, blah, blah. I also have ranking gaps where I have striking distance keywords like I'm on page two that's that the SEO trick, right? Go tell them to update the pages where you're on page two and they'll go up a little and hey you did your job. So but if you weave that into this type of semantic analysis; this gap analysis, your content strategy becomes 2, 3, 10x more impactful overnight. And so compare that to keyword gap analysis, think about the outcomes. You get a word out of it. You get a word where you're ranking 12th and you think you should rank 5th. Well, now you know why. And then you know what you need to do. And that's the secret here. It's get yourself out of just keywords; get yourself into the content that's needed to plug the holes. Chuck: So we don't know what we don't know so how do we figure out what the gaps are? Are there tools you can recommend? How do we figure this out? Jeff: Yeah. Well I think that they're certainly on it and they're obviously not just the ones I present with MarketMuse but there are ways if you want to see. You want to be able to look at using your analytics, using any off the shelf Search Engine Optimization suite whether you are a higher-end person in a more enterprise or kind of using an [inaudible 00:27:29.2]. Looking at those pages; again all of your pages trying to organize them or you're looking at you don't want to buy those things, you've got analytics and you look at something that can crawl and analyze the structure of your site like a screening frog or a [inaudible 00:27:45.5] or a solution like that. Get a true understanding about your site and what it's about. What are the things where every time you publish it it's a winner or more of the time versus what's the stuff where you've been tilting at; aspirational goals. So looking at that or even looking at just traffic and revenue versions by section or by page type or by publish state because last year this was under this person's management this year this is under this person's management. Just a combination of this basic information from analytics and page-level data from a [inaudible 00:28:23.7] can get you at least started. And just to start thinking critically about your content inventory. A solution like the MarketMuse obviously is going to give you the sniper rifle to say go write this page, go fill this gap. But even if you if you're just looking to get kind of a basic understanding it can be easily put together to say gosh Chuck I don't know if we should publish any more articles about backgammon we're a chess site, it just hasn't extended. But when I write about you know particular defenses, we crush. Why don't we just lean into that? So you can make those types of decisions but then how do you get where we want to be a backgammon site. What are the ways that we can bridge the gap between chess and backgammon? How can we become more of an authority on strategic board games in general? So those are the types of questions that are out of this type of analysis, if you're real with yourself you stop publishing stuff that's not going to succeed. Try to figure out why it's not succeeding. That's where a person like a business like ours operates. But there's many out of an agency that knows the answer to these questions that can do that introspection that can do that analysis. But if you're analyzing your site I think it's truly to step back and say am I putting myself out there as an expert? Am I really showing it or was I chasing keywords? And it's always that oh man I haven't even thought about; I've just been looking up keywords, building lists, writing articles, keywords, lists, articles, keywords, lists, articles especially in the affiliate side not knocking always [inaudible 00:29:58.8] so much. It clearly comes out of a keyword list. And then I wrote the article some of them get linked together. Some of them don't. It's not leaving the web of somebody who actually knows their stuff. A great example of this; I've got uprise for every product in the world prices or reviews combination; bottom of funnel. That encompasses my contact strategy against this topic. It could have helped with that and then people wonder why they get hit when there's a quality change in the algorithm. It's because they're looking for that thing. They're looking for that stuff. You haven't told the story about buying that thing. Why are you the expert on pricing it? It doesn't make sense. And so that's the thing that; think about; get out of these search engine optimization shoes get into an editorial shoe. Hire an expert to say hey if you were writing an inventory of content about sound bafflers what would you cover; what are the things you need to know? And then cross-reference that against your stuff. Obviously, there's ways of doing both of those things taking technology like what we do. Chuck: So let's talk about that I know we don't want to like hardcore pitch your product but you have a great product that I think is a lot of value to a lot of people. So let's talk about like how your product can help and maybe even hit it as like these are the things that my product can do and some of the stuff people can do without the product so they could do it on their own but you're offering a service that makes it a lot easier. So let's talk about that. Jeff: So if I'm going to assess the value of a site; for example, if I want to see where there's areas of opportunity to create content or update content and be more successful. If I can get that hit list immediately and go execute on those plans; really move the needle quickly, that's a direct value of what one of the components of MarketMuse Suite. So MarketMuse Suite is a collection of; a combination of an automated content inventory and content auditing solution. We'll also take it to the next level and say after you build; after you say I want to create this page or update this page we'll build a comprehensive content brief for your writer. So it acts as a blueprint or an outline or a brief if you're familiar with what a brief looks like. And it tells a story so that the writer can be creative. So that the writer can research imagery; so the writer can research their sources and doesn't have to worry about is this thing going to have success after I hit publish. So many writers the anxiety they have; this is a huge pain point in the writing space is am I doing my keyword research correctly. Ask them. I mean that's the part I don't know. That's the part I really don't care about. I'm speaking from their standpoint. So take that mystery out of it. Take the SEO mystery out of it. Here's the outline we need you to follow. Be super creative. So we answer that question with that side of MarketMuse. We also have some point applications for doing competitive analysis so I can look at any search engine result page and understand who's got great content; high quality, who's got weak content, what are the gaps. And if I were going to put out true best in Class content on this specific intent, this specific topic what would it look like getting into the gritty details. Chuck: So what are some of those details? Jeff: Yeah. So what are the concepts that need to be included, what are the variants to consider, what are the questions to ask, what are the questions to answer, what are the internal linking; things you should do to internally link to other pages to tell the story that this isn't an orphan page on left field that actually weaves into your existing inventory and then grading your existing coverage and understanding how to interweave and to weave those things together. I have this great page; the one that you talked about, the news one, I want to make sure that it's linked. So all of those things we have point solutions so you can do a one-page analysis and get recommendations to improve it. You can get that one-page analysis and recommendations to make it equal to or better than your competitors every time and go head to head or against the whole field; questions and answers analysis, internal and external linking recommendations, and then we have for premium; one of our premium offerings is the newsroom solution specifically for Google News optimization. So basically the story is what should I write next, can you give me details as to how I would execute that so that you're getting me as close as you can to publishing? And then for all of my adjunct workflows; this specific analysis, this one-page analysis, we have applications to solve those specific goals to say okay why is Quiet Light Brokerage beating me for this topic? Is it because of quality; MarketMuse will tell you. Is it because of links and they have a worst page? Darn, they're more authoritative than me; what do I need to do? I need to go write a package of content. Tell me more of the story that I'm the expert because I don't have that off-page authority. So no matter where you sit it's giving you the advice as to what those next steps should be. And that's kind of the spirit of what we do. Chuck: So one of the examples I've heard you say before is like you're writing about a specific topic blue fuzzy widgets, everybody who writes about blue fuzzy widgets also includes pink monkeys and if you're not writing about pink monkeys then you clearly don't know about blue fuzzy widgets. You're not an expert. So maybe can you talk about that a little bit? Jeff: Sure. So our core technology is built on it. It's a topic modeling technology and it tells the story of what it means to be an expert on a concept. So it tells me by analyzing in some cases hundreds of thousands or millions of content items that people who know a lot about blue fuzzy widgets also know a lot about pink monkeys and so if you write about blue fuzzy widgets and you don't include pink monkeys you're not telling the story that you're an expert. So often in the market people have just looked at like the top 10 results to do this assessment. For so many reasons that I could get into there's a great article online called TFIDF is not the answer to your content and SEO problems and it goes into detail of each one of these logic challenges that exist. It's great for information retrieval. It's been around for 30 something years. Obviously, it's still being used. The challenge though is don't base your business content strategy and thousands of dollars of investment on that. And so what we were able to do is to say that but we're also then because we're analyzing so much data we're able to say that well guess what the top competitors aren't talking about orange donkeys and it's very relevant. That's a way for you to differentiate yourself. So you're covering the blue fuzzy widgets, your covering the pink monkeys but then you're going to differentiate yourself by also illustrating that you know all about those orange donkeys and that's what makes you special. And how does that drive back to true expertise? In this, we see constantly being successful with the best content strategies. They're writing about the table stakes content but they're also illustrating that they really know this stuff. And I always use more detailed examples but a cool one I always use for content marketing is a lot of people that write about content strategy don't talk about buyer personas. They don't talk about target audience. They don't talk about the roles on a content strategy team. Do you know why? Because they're chasing keywords. And if you can look at a search engine results page and go ooh, they're chasing keywords, there's my opportunity. Even if they're 9,000-word articles by HubSpot if you can find gaps in their game you can really take advantage of that and you can punch above your weight. And if you can pop a page that doesn't have as much traditional off-page authority link profile to build that beautiful cluster you can start ranking with undersized off-page pages and sections. And that's niche hunting. That's what the niche hunters talk about. That's what the UN fencers of the world; that's what they're really focusing on. How can I punch above my weight with undervalued off page sites? That's the way you get there; great content illustrates that you're an expert every time. Chuck: So we're thinking; traditional people when they're thinking about articles they're doing keyword research they're finding those low difficulty versus high search volume relative and then they're just going after that but what they're missing is just because people aren't searching for a specific word doesn't mean that it's not important. Jeff: You shouldn't have it in there. Chuck: Right. Jeff: Oh yeah. Chuck: Or specific words within content that you need to have to show you're in authority even though people; the average Joe may not be searching for that. Jeff: Exactly right. And that is the funniest thing about to watch the evolution in this market. When we first launched four years ago everyone when they would see a list of topics; this is the most interesting thing I'll say today, four years ago they used to look at that list and go why isn't it sorted by search point? And I said because that's irrelevant to what we're trying to do here. We're trying to tell you what it means to write that golden article to be an expert. Why does it matter what search volume is because you're so ingrained to use volume and PPC competition which that's another story for another day; crazy. Why don't do it? By the way, I'm not correlative to organic competition. I can get into that in a second but they're so ingrained; heavily so ingrained to use search volume as their North Star. They want everything to have search volume next to it so they can sort by it. So if we sort by that and then you discredit the stuff on the bottom, that's bananas. You're thinking about this from a content strategy perspective or from an expertise perspective. And that's what we see time and time again. Fun fact and I think you've heard me speak about this; it's totally exploitable. If you see competitors who clearly take topic lists and sorted by search volume you can; we usually call it chopping down a tree, you can chop down the tree. Every time it works because they have this strategy gap. You can predict what they're going to do. You can also chop down the tree in areas where they have blind spots. They will never fill them because they're using search point as a North Star. And so another way to say it is stop using that four square; that volume competition, you've all seen it. Alright, let's try to find those low competition high volume words. Sure those are great. Lean into those but that's not the whole picture of how you should write your content. Because the last thing I'll say about this is if you have no content at one stage of the purchase cycle and you think that you're not at risk with having content at another stage you've got another thing coming. It's going to catch up to you. Someone is going to fill that. Somebody is going to fill those intent gaps and crush you. It's just common. And we see it with publishers that have been resting on the laurels of their powerful content. They're just getting their tail handed to them by real content strategies every day. Chuck: So what are some quick wins you think people can have? Like okay, I have a let's say a site about; I don't know, let's just say a general content site, you pick the topic. What are some real quick wins I can get? Jeff: I like to call them one-page plans. So I'm going to find a page of interest. So something that's special about my site and maybe it's a small collection of pages. This is my page that's for some reason it's special. It's really long form, it's beautiful, it converts very well. Chuck: Are we defining special meaning like it's already getting traffic or I just think it's pretty? Jeff: I like it and it gets me some KPI that I think is legitimate and is giving me value. So it could be traffic already. It could be rankings that I am already getting; it ranks for lots of words. So that's a signal of comprehensiveness. A quick win could be to look at what that page is ranking for and pick out the words; this is using SEM Rush; using that to pick out the words in that list that the page doesn't actually satisfy the user intent for rewrite those pages; quickest win ever. So that one-page plan I rank this; I'll use a great example. Content Marketing Institute; I love that site, they have a wonderful page on LinkedIn profiles. It dominates LinkedIn profile marketing. They also rank for marketing profiles, not very good. And the site; the page just covers LinkedIn profiles. It doesn't cover generally marketing profiles. So they could beam their other zoom higher and now cover marketing profiles in general and write about other marketing profile presences as a cluster. All boats are going to rise. So you do that exercise, a quick win every time. You can find it. We call them content mismatches or unaddressed intent plants; always a win. You can always find one on your site because you've probably got pages that rank for hundreds of things. No one page can answer a hundred things beautifully. So when you go write that page people are like won't that cannibalize? No. I mean [inaudible 00:43:23.2]. Do I have to explain myself no? Chuck: So the key there is again you've got that one page; it's linking for a lot of words, you've got tons of words, you'll pick out the few that it's not ranking well for and then you'll link through that keyword to a new article that is specifically about that content? Jeff: Or expand it if it's a fit. If it's not a fit writing new but the key is it's not just that it's not ranking. I mean if it's not ranking for that's important but it could be ranking reasonably but not satisfying like user searches for that on Google and then they land on that page and like this sucks this isn't what I wanted. So if that intent mismatched so can you correct that and improve the page or do you need to do that in a new creation motion? So that is a tried and true technique. That's a recycle, recycle, recycle. Inside MarketMuse you just press a button and it tells you those plans which make life a lot easier obviously but you can do it. It's just that manual labor to use that one technique. And if you ask me for a quick one it's always a quick one. Look for that hundred word or more ranking page, find the word that this; read the page. You'd be surprised how many content strategists and CEOs don't actually read their sites; it's amazing. Read the page, know what value it has, and does this page get people to achieve that value. It can also be done on the back end. Andy Crestodina who works at Orbit Media; he is an expert in Google Analytics and content strategy. He wrote a book called Content Chemistry. Inside his analytics book; parts of the book, it shows you how to do this in Google Analytics by looking at exit rate and engagement gaps. So you can do it there or you can do it from keywords or any other ways but those are some quick ones. Look at your worst exit rates. So many people don't break those down by; they don't cross-reference those two things. So they've got a page, this thing is broken it's 90% in exit rate. Go back to the words that are driving the users to that page. What if all of them are out of alignment? You can just flash the content double engagement overnight. So there's so many wins that you can do with just a quick one-page plan analysis. I like to say pick one you like, get started, put few wins on the board, prove it out, and then decide is this something I want to get serious with and invest in technology that can support it. Chuck: I got you. Now when I started first looking at your product a couple of years ago and seeing kind of the wonderful amazing things you were doing, it was at a price point where I actually kind of like when high price points because it keeps; on really good things it keeps other people from being able to do it. But I guess you just launched a new price point for a self-service. Jeff: Yes. It's actually something we've been looking forward to doing. And we are a mid-market enterprise large publisher; people who have really invested in content that's traditionally been our target market. Chuck: Could you give an example of some big players that you work with? Jeff: Yeah sure. I'm trying to think of who's on this site. G2 Crowd is a customer and they're on there; we work with divisions of the Walmart Corporation, Home Depot, large e-commerce but also just great publishers. Business.com; love them so there's a lot of people who are publishing content. A lot of people I can't name and I wish I could. But if you type in MarketMuse case studies you can find a cool example from Tomorrow's Sleep on that one and how their site grew from 4,000 to 400,000 in a year with their agency that works with us. So that was always a big focus of ours. It was make sure that they can write content. Make sure that they can update content, that they've committed; they actually believe content can get them there because then life's going to be a lot easier for everybody. But we then also said let's look at the mirror. I'm always about looking in the mirror and look at the demand that we have. And so we really looked at who's coming in the front door saying we want to be MarketMuse customers. And right now having made that case internally or I just I'm not a profile of a customer that can spend tens or in some cases hundreds of thousands of dollars on software. And so what we did was we right-sized for a specific target market, we right-sized a self-serve offering. And there is also a trial experience that everyone who's listening can go to the site. Go to MarketMuse trial. Go to MarketMuse, see the trial and you'll get an experience with your data; we've actually set this up so you can use your site, optimize a page, create a content brief, update some existing content like I mentioned, get that content brief and then there's also a special workflow baked in there that'll amaze you that I'm not allowed to explain but you'll see it when you get there. But you can do a competitive analysis, you can update a page, you get a content brief; by the way, take that with you it's free and make that decision of whether you want to become a MarketMuse Pro customer which is our self-serve offering at 499 a month. Quiet Light Brokerage Podcast listeners have a promo which Chuck will include in his notes which gets you a discount there. Or if you're a larger team, if you have four writers, if you write 10, 15 articles a month it's going to make more sense for you to be in one of our other packages; a bronze, a silver, or a gold, or a higher offering. So it gives you an understanding about the value that we provide, the opportunity to buy, to see if that's a fit, or to immediately recognize oh gosh this is what I need for all of my content items. I need one of the larger offerings. So the experience we typically is that people find the right car on the lot. Or they begin using and saying oh wow I need more of this. I was successful with the first thing I did. I know this makes sense. Making your content higher quality, that's the fun part about being in Market Muse; it's you never look at it and you're like oh man I wish I hadn't made that page better. You're always on this ongoing quest to do a better job, write better content that resonates more with your audience. And that's what we do every day. Chuck: Awesome. So to wrap this up I always like to ask people could you give us a few random tools not really related to what we're talking about but just things you like to use in your daily work or just regular life. What are some of the hacks you may have? Jeff: Man, there's so many. I love this. So a couple that I use, when I had some personal time management issues I tried everything. I tried boards with; con bomb boards and everything. And one thing that helped me analyze where I was spending my time was called Tomecular and it looks like an eight-sided dice and you put stuff on it. And as you're working on stuff you move the dice around and it seems so; maybe it's because I like touching things like that but it really gave me an understanding about where I was spending my time and I fixed some stuff within MarketMuse like the business organizationally just from that information. So that's cool. I love Boomerang. I think it's a beautiful solution for making sure you don't forget stuff if you get a lot of e-mails. It's a really good productivity tool. Chuck: Before you move on from Boomerang I think Google now have something similar built-in where they have the… Jeff: They have don't let me forget this. Chuck: Yeah. It's like a little reminder you can set for different dates and it comes back in. Jeff: Yeah. Boomerang has some features that I'm so used to being able to set and forget things pause so I don't know if Google's ever going to pause Google so that's something that, but I like Boomerang. It's not that expensive. You do need to watch your SaaS subscriptions though. That's another story. Another one I love, love, love, love is Full Story. Full Story isn't; they keep going a little bit a little more expensive each time you look at them. Good for them. It's like having a DVR on every user that ever comes to your site. You can watch the experiences; obviously anonymized but you can watch their experiences, build pattern matching, look at segments, and really get an understanding about why people are doing things. I mean I think that that's really valuable. Chuck: It's kind of like what is it Crazy Egg? Jeff: It's similar to a Crazy Egg but it's more of like a heat map reporting. They've got this capability and a handful of other solutions that are out. I just think Full Story has this like really robust like I can go in and I can find users that went through this specific sequence and just watch all the sessions. I mean so many times. Just learn from that to really tell a story and it really is powerful when you are already doing a new multivariate testing to really catapult that into the next level. I mean if I told you what conversion rates we have you'd blow up. But yeah I mean you really have to think critically and fly the flag of your customers so that when you do get these solutions they don't just sit on the shelf. I mean my goal every day is to make sure that the next article that every one of my clients publish is more successful than it could have been without us. And I think that comes through in our online messaging. It's not just that we're this secret weapon of the elite agencies which I know for a while that's what we were. It's that if you use MarketMuse your stuff will do better more consistently and then I will be happy. And if it does not happen then I and our entire team will not be happy. And we hope that our messaging comes through and we couldn't do it without these other solutions that we work with Full Story, like Pendo; Pendo is a beautiful thing, and some other metrics, some other things we use to really dive deep into our customer experience. Chuck: Awesome well I appreciate you taking the time to talk with everybody today. Is there a way that people can reach out to you or the company? Jeff: Yeah, absolutely. So MarketMuse.com, Chuck's going to post a promo code that's for the MarketMuse Pro self-serve offering as a discount. You can email me directly Jeff@MarketMuse.com, Jeffrey_Coyle on Twitter. I'm pretty active. LinkedIn, please. I typically don't say no unless you've sent me a weirdo request that tells me in an unreal way that you like my profile and you'd love to connect. If it's clear that you bought or sold a website before in your life I'm probably going to connect with you and want to talk in any light. So yeah please reach out and go check it out. We have a lot of content. I have a lot of; this conversation is like this throughout the web that I think can really level up your game and give you the ability to assess deals quickly without just hunches. You got to go with your hunches but it's nice to have hunches and data. Chuck: Yeah for sure. And a quick pro tip from me, if you're trying to get somebody to accept your LinkedIn profile and they don't know who you are, write a message. Don't just send the like later. Personally, I feel like if I've LinkedIn with somebody and I'm connected then I'm somewhat vouching for them so I don't just accept random LinkedIns. Like, everybody, I've accepted for the most part are people I've actually met in person. But then we go to these conferences and somebody sent me a request and I don't remember them so it's like just send a little message with them, take the two seconds to write. Jeff: Yeah, and make it from the heart. We can smell of that. Come on. I think MarketMuse is cool. Oh really do you? I do too. So I guess we are connected I love the thing but you know. Chuck: There you go. All right well I appreciate your time and thank you, everybody, for taking the time to listen and see you soon. Links and Resources: MarketMuse MarketMuse coupon code (mentioned in the podcast): QLBMM Email Jeff Twitter LinkedIn
Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum and I'm back with Nachi Gupta. Nachi: For our regular listeners, you probably noticed a lapse in recent episodes as we pulled away from our usual monthly releases. Jeff: With both of us having increasing demands on our time -- myself with business school and the busiest 21 month old in the world and Nachi with yet another entrepreneurial endeavor on the horizon -- we decided that it would be best to pass the podcast on to another host, so EMplify can continue to create and deliver the high quality materials that you deserve. Nachi: We have obviously really enjoyed creating this podcast and working closely with EB Medicine to produce it. We are deeply appreciative of you, our listeners, and your wonderful feedback and comments over the years. Without you, there would be no point in us working so hard on this. Jeff: And keep the feedback coming as we hand the reins to Dr. Sam Ashoo as the new host of EMplify. Dr. Ashoo is an Emergency Physician based out of Tallahassee Florida with a keen interest in informatics who has been featured on several other podcasts you may have heard. We can't think of a better person to take over for EMplify. I'm sure you'll really like him and the content he produces. Well, with that, let's get started on our final scheduled episode of EMplify! Nachi: As we are just about to see one of the busiest travel days of the year, that would be the Wednesday before Thanksgiving, we thought there would be no better time to discuss the September 2019 issue of EMP: Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls. Jeff: This was a fantastic issue, thanks to the hard work by Drs. DeLaney and Greene, both of the University of Alabama Birmingham School of Medicine. Thanks as well to the peer editors, Dr. Knight, and Dr. Hill of the University of Cincinnati. Nachi: And I think you have a bit of a disclosure for this month... Show More v Jeff: Well, this is a first! Finally at the point in my career where I can announce a disclosure, though it's more of a potential conflict of interest than an actual disclosure, but certainly still worth noting. I currently spend some of my time working for STAT-MD - which is an airline consultation service run by the Center for Emergency Medicine and UPMC. Though I'm certainly a junior member of the team, in some sense, I've responded nearly 500 inflight emergencies over the last two years. Nachi: And this definitely places you are in a particularly nice position to share some information with our listeners this month, and I'll have some questions scattered throughout the episode for you too. Jeff: Sounds great, so let's dive in, starting with what I think is the most important point - qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal concerns. Nachi: I couldn't agree more, so let me reiterate, please trust the evidence. And volunteer to help should you hear the call. We'll get to this in a bit but there is little medicolegal concern and you owe it to the sick passenger to help. Jeff: So what are the chances you are called - well, they are not particularly high, but certainly not negligible either. In 2019, of the 4 billion passengers expected to fly, there will be an estimated 60,000 medical emergencies. That means there will be about 1 emergency per every 604 flights. Nachi: So, I fly about 4 times a month for work. At 4 times per month, over the next 12 years I can expect about one medical emergency. Already excited! Let's start with some physiology. Cabin pressurization varies, but is typically equivalent to an altitude of 8000 feet. Jeff: And this has a huge effect, in one study of healthy volunteers, this change in pressure resulted in a 4-10 point decrease in oxygen saturation and a 35 point d...
Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta. Nachi: For our regular listeners, you probably noticed a lapse in recent episodes as we pulled away from our usual monthly releases. Jeff: With both of us having increasing demands on our time -- myself with business school and the busiest 21 month old in the world and Nachi with yet another entrepreneurial endeavor on the horizon -- we decided that it would be best to pass the podcast on to another host, so EMplify can continue to create and deliver the high quality materials that you deserve. Nachi: We have obviously really enjoyed creating this podcast and working closely with EB Medicine to produce it. We are deeply appreciative of you, our listeners, and your wonderful feedback and comments over the years. Without you, there would be no point in us working so hard on this. Jeff: And keep the feedback coming as we hand the reins to Dr. Sam Ashoo as the new host of EMplify. Dr. Ashoo is an Emergency Physician based out of Tallahassee Florida with a keen interest in informatics who has been featured on several other podcasts you may have heard. We can’t think of a better person to take over for EMplify. I’m sure you’ll really like him and the content he produces. Well, with that, let’s get started on our final scheduled episode of EMplify! Nachi: As we are just about to see one of the busiest travel days of the year, that would be the Wednesday before Thanksgiving, we thought there would be no better time to discuss the September 2019 issue of EMP: Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls. Jeff: This was a fantastic issue, thanks to the hard work by Drs. DeLaney and Greene, both of the University of Alabama Birmingham School of Medicine. Thanks as well to the peer editors, Dr. Knight, and Dr. Hill of the University of Cincinnati. Nachi: And I think you have a bit of a disclosure for this month... Show More v Jeff: Well, this is a first! Finally at the point in my career where I can announce a disclosure, though it’s more of a potential conflict of interest than an actual disclosure, but certainly still worth noting. I currently spend some of my time working for STAT-MD - which is an airline consultation service run by the Center for Emergency Medicine and UPMC. Though I’m certainly a junior member of the team, in some sense, I’ve responded nearly 500 inflight emergencies over the last two years. Nachi: And this definitely places you are in a particularly nice position to share some information with our listeners this month, and I’ll have some questions scattered throughout the episode for you too. Jeff: Sounds great, so let’s dive in, starting with what I think is the most important point - qualified, active, licensed, and sober providers should volunteer to assist in the event of a medical emergency rather than decline out of fear of medicolegal concerns. Nachi: I couldn’t agree more, so let me reiterate, please trust the evidence. And volunteer to help should you hear the call. We’ll get to this in a bit but there is little medicolegal concern and you owe it to the sick passenger to help. Jeff: So what are the chances you are called - well, they are not particularly high, but certainly not negligible either. In 2019, of the 4 billion passengers expected to fly, there will be an estimated 60,000 medical emergencies. That means there will be about 1 emergency per every 604 flights. Nachi: So, I fly about 4 times a month for work. At 4 times per month, over the next 12 years I can expect about one medical emergency. Already excited! Let’s start with some physiology. Cabin pressurization varies, but is typically equivalent to an altitude of 8000 feet. Jeff: And this has a huge effect, in one study of healthy volunteers, this change in pressure resulted in a 4-10 point decrease in oxygen saturation and a 35 point drop in arterial oxygen partial pressure from 95 mm Hg to 60. Nachi: In another study of healthy volunteers on a long haul flight, this change caused 7% of passengers to report symptoms consistent with acute altitude illness. Jeff: Due to the principles of Boyle’s law, decreased cabin pressure also causes expansion of gases within anatomical spaces in the body such as the eye, GI tract, sinuses, middle ear, etc. This expansion can potentially threaten surrounding structures. Nachi: So there must be guidelines for those recent post-op for flying - right? Jeff: There certainly are, but I don’t think we need to get into the weeds on this one since nobody listening will likely be doing pre-flight screenings. I think one thing to remember here, is that though cabins are pressurized to several thousand feet, they CAN be pressurized even further if necessary. The airlines don’t do this because it takes a tremendous quantity of fuel to do so, but if pressurization will defer a diversion, this option may peak their interest. Though an anecdote, the only time I’ve ever suggested it is on a flight from someone recent post-op eye surgery who went blind midflight. We pressurized the cabin from 8000 to 4000 and then finally to sea level and his vision returned. Pretty cool stuff. But getting back to the text, next we have air quality. Only 50% of inflight air is recirculated, all of the flow is compartmentalized between sections of rows, and all the air is run through a HEPA filter. The authors note that the air is actually comparable to that of an operating room. Nachi: Then why are people always getting sick after flying…? Jeff: Well it’s hard to prove, but experts believe that most post flight respiratory illnesses are likely caused by exposure to fomites on high-risk surfaces of airplanes and in airports - like the trays on the seat back. Nachi: Interesting. Jeff: It’s also worth noting that the air is quite dry, though this is unlikely to produce any clinically significant events. Most of the dehydration that occurs is more likely due to inadequate water intake and excess caffeine and alcohol consumption depending on the time of day. Nachi: Don’t judge. Even though it may be 8 am, some of our night shift locums friends may prefer an airport cocktail after a long week away. Jeff: Oh I’m definitely not judging, facts only over here. Anyway, let’s move on to a little epidemiology. Nachi: Syncope and cardiac events account for a large proportion of in-flight emergencies, with cardiac events accounting for the largest percentage of diversions. Jeff: Gi, endocrine and respiratory emergencies follow syncope and cardiac events, with specific percentages varying based on which study you look at. Nachi: Thankfully obstetric emergencies are relatively rare, accounting for less than 0.1% of all emergencies. Jeff: Trauma and substance abuse related complaints have also been reported, but represent only a small percentage of inflight emergencies. Nachi: I think that covers the main pathologies you may encounter. Next we should touch upon the actual responders. Physicians reportedly respond 44% of the time, followed by nurses at 20% and EMS providers at about 4%. Interestingly, despite physicians being there only 44% of the time, they were involved in the care for over 70% of diversions. Jeff: It might seem crazy, but that’s definitely my experience. Many physicians, especially non-ED physicians are not familiar with caring for the acutely ill. Additionally, most physicians are very uncomfortable actually witnessing someone syncopize and then immediately checking vitals and finding the passenger to be bradycardic and hypotensive as is the case with many patients immediately after a vasovagal syncopal episode. I cannot tell you how many times we get called by pilots considering diversion based on a physician’s request only to have the symptoms completely resolve in just 10 minutes. Be patient, this is a common in flight pathology. Nachi: Your experience has not failed you - data from your own group showed that 31% of cases resolved before arrival. Even in cases where EMS was requested, patients were only transported 37% of the time and of those, only 8% were actually admitted for further work up. Death is also a very rare phenomenon, occurring in only 0.3% of cases. Jeff: Alright, so let’s move onto the actual logistics of responding. Each airline has its own protocols and policies with respect to medical responders - some will require credentials, others may not. In some instances, you may be the first responder, in others, the flight crew may have already been in contact with their ground based medical control. Nachi: In terms of supplies, the FAA requires an emergency medical kit and an AED on all commercial flights. These kits cannot be opened without direction from a medical professional on the ground or on board. Jeff: And while airlines may add additional drugs at their discretion, the FAA mandates certain supplies. You can remember these supplies by thinking of the 5 A’s - asthma, allergy, altered mental status, ACS, and ACLS. The 5 As should help you remember the bronchodilators, epinephrine, antihistamine, dextrose, nitroglycerine, aspirin, and lidocaine as the one antiarrhythmic available. Of course, there are also gloves, an IV start kit, and a few other basic supplies. Nachi: AEDs are also required and have been since 2001 and amazingly when a shock was delivered in flight, 40% survived to hospital discharge with a good outcome. Jeff: Just as on the ground, shockable rhythms do well with good BLS care. And lastly, airlines also have a portable oxygen tank in addition to the emergency oxygen that is stored in the event of cabin depressurization. The exact quantity varies, but portable cylinders are certainly available. Nachi: So next we have to talk about a topic that I’m sure many of you have wondered about - what are the medico-legal risks of intervening? Jeff: As with most incidents of concern over medico-legal risk, we really just shouldn’t be too concerned over the potential legal ramifications. Though we’ll get into specifics, the short answer is that you should definitely volunteer your services - there are lots of protections in place with a paucity of case reports of legal actions against medical volunteers who volunteers in flight. Nachi: Perhaps most importantly, remember that ultimately the captain is in charge and you are functioning in a strict advisory capacity. Remember that most airlines can handle most emergencies with their ground based medical control, their typical staff, and predefined protocols - you are an added bonus. Jeff: For many ED providers, functioning as a consultant will be unfamiliar. Nachi: If I’m a consultant, I’m going to demand a WBC before seeing the patient, as I’m fairly certain that’s rule number 1 in consultant school... Jeff: It’s actually rule #12, now get out of your seat and come see the patient…. But back to medicolegal issues. In the US, health care professions are protected by the good Samaritan law and the 1998 federal aviation medical assistance act. Nachi: The Good Samaritan law provides legal protection to medical providers who perform their services in response to medical emergencies outside of the hospital. The exact verbiage of the law differs from state to state, but all 50 states have some version of it in their legislation. Jeff: Similarly the aviation medical assistance act applies to “medically qualified individuals and offers broad medico-legal protection to the airlines in the event that a medical volunteer is accused of malpractice as well as to medical providers who respond to an in-flight emergency.” Nachi: More specifically, the act states that “...an individual shall not be liable for damages arising out of the acts or omissions of the individual in providing or attempting to provide assistance in the case of an in-flight medical emergency unless the individual, while rendering such assistance, is guilty of gross negligence or willful misconduct.” Jeff: That’s a bit of a mouth full to get out. But basically, you need to remember that the AMAA protects you from everything shy of gross negligence. Because of this, there have been no reports to date of a medical professional falling below that standard. Nachi: There is one caveat to all of this though: don’t forget about your own mental status - for example if you have taken any sleeping aids or had any alcoholic drinks. Though this may not preclude you completely from rendering care, do so only with extreme caution. Jeff: And I don’t think we were clear enough about this up front. Up until this point we have mostly talked about US based flights. Flights run by International airlines are a somewhat different ball game for a number of reasons. First, medication kits will vary widely. Many will carry medications similar to those mandated by the FDA, but there certainly is no international standard. Next, the availability of ground based medical consultation is similarly widely variable, with many in the middle east contracting for this service and almost no airlines in Africa offering such services. Nachi: And lastly, with respect to legal risk - the international laws also vary widely. According to French law, for example, a French physician who does not volunteer may be committing willful negligence. Similar laws exist in Germany, Australia, and Canada. However proving you were there and refused to provide care would be quite difficult. And lastly, it’s unclear how to determine which countries’ laws apply when - for example, is it the sending country’s laws, the receiving country’s laws, or the country whose airspace you are currently in? Jeff: All excellent points. Next, we are moving to my favorite topic of the article - diversion. This is a tremendously complicated topic and I think the authors handled it quite well. Remember, the decision to divert is multifactorial and you are only there to communicate your medical opinion about the passenger - leave the decision for diversion up to the flight crew. I cannot stress this enough. Getting on the radio with the pilot and ground based medical control and demanding a diversion is often very unhelpful and simply not the right approach and can really be quite costly. Nachi: All of this is so interesting. I can’t believe you do this and divert planes.... Can you go into a bit more detail about everything the pilot considers when they are deciding to divert? Jeff: So there’s quite a bit, but I can touch on some of the main considerations. First, you have to consider the medical needs of the passenger - can he or she be temporized to get to the destination? Is there a suitable airport for diversion with an accessible local hospital with the required resources? Logistically, you need to find an airport that can not only safely accommodate the plane you are on but also one in which the airline can refuel and guarantee that the passengers and crew are safe. Remember, if you are on an A380, there are only so many airports with runways long enough for a safe landing. Fun fact: planes also take off heavy - with tons of fuel that will be burned prior to landing. Say you were to take off from London, bound for the US. To turn around and land back at London Heathrow, you may have to literally dump thousands of gallons of fuel to get the plane to a safe weight for landing. Alternatively, you may have to fly in circles for some time to burn fuel off in planes that cannot dump. A heavy landing necessitates a thorough maintenance overhaul of the landing gear and can cost the airlines not only money but significant time, which is equally as valuable. Nachi: Speaking of cost - while exact costs are unknown, one airline estimates that the cost can be as high as $600,000 - we are not dealing with small numbers here... Jeff: No definitely not. That’s why it’s so frustrating when medical volunteers demand the plane divert without talking through the medical scenario with the crew and ground based control - often temporizing measures are adequate. Nachi: And we alluded to this earlier - Physicians advise diversion more frequently at 9% of the time followed by EMS providers and nurses. When the airlines are left to their own means, they divert at rates roughly half that - just 5% of the time. At half a million dollars for some diversions, and an overall very low level of morbidity and mortality, a 50% reduction amounts to massive savings for possibly no clinical difference. Jeff: I can’t stress this enough - you are a consultant, helping the captain and the ground based medical control to come to most appropriate plan of action. When your advice causes the airlines to deviate from their standard protocols, that’s where they potentially run into trouble. Nachi: There are just two controversies to discuss this month and I actually think they are extremely pertinent. The first one relates to using personal medication or medications from other passengers. Given the relative paucity of medications in most airline medical kits, it may occur to you that someone else may have a helpful medication on board. While there is no strict rule against this, it could result in an increased level of scrutiny if there is an adverse event. So consider this a last resort. Jeff: The next controversy to discuss is the issue of gifts. There is a widespread belief that accepting gifts from the airlines would void legal protections. To date, there is ample airline-based data to suggest that medical providers’ legal protections are not negated in the event that the airlines wanted to reward a medical volunteer. Additionally, there are no reported cases of providers losing legal protection for receiving compensation for their services in flight. Nachi: Interestingly, some international carriers even offer points or other bonuses for registering as a medical volunteer. While I’m hesitant to call this controversy a myth, it seems like there isn’t much evidence to support it. Jeff: Agreed, don’t expect a gift, but if you do receive one, you can keep it and enjoy it without concern for your legal protections. Nachi: Alright so that wraps up the new material for this special edition of EMplify - let’s close out with some key points and clinical pearls. Jeff: Aircraft cabins are typically pressurized to about 8000 ft, resulting in a 4-10 point drop in oxygen saturation in healthy adults as well myalgias, fatigue, and generalized discomfort on long haul flights. Nachi: Only 50% of the cabin air is recirculated. When recirculated, it is subjected to HEPA filtration, which is adequate to prevent infection by airborne pathogens but not the infectious respiratory viruses, which are spread by droplets. Jeff: Dehydration on long flights is likely due to inadequate water intake and the increased use of diuretics such as caffeine and alcohol. Nachi: There is about 1 in-flight emergency per 11,000 passengers or 1 in 604 flights. Syncope and cardiac events are most common followed by GI, respiratory, and neurologic events. Jeff: Most in-flight emergencies are minor. When EMS is requested upon arrival, roughly 1/3rd are transported and less than 10% are admitted, with mortality estimated at 0.3% of cases. Nachi: AEDs are required on all US-based flights. Jeff: Airlines have a limited supply of supplemental oxygen for use in medical emergencies in addition to that provided to the entire plane in the event the cabin becomes depressurized Nachi: All US airlines have some form of ground-based medical assistance. Ultimately any decisions are the responsibility of the pilot in command – medical volunteers function in a strictly advisory capacity. Jeff: Medical volunteers are protected by both the Good Samaritan law and the 1998 Aviation Medical Assistance Act. Nachi: The Aviation Medical Assistance Act protects medically qualified individuals, unless they are guilty of gross negligence or willful misconduct. Jeff: International laws and protections vary widely. In some European countries, for a physician to not offer their services during an in-flight emergency may constitute willful negligence. Nachi: The decision to divert is multifactorial and can cost as much as $600,000 in some circumstances. Jeff: When physicians and EMS providers respond to in-flight emergencies, diversion rates are nearly double that of when the airlines work solely with their ground based support, increasing diversion events from 5% to 9%. Nachi: It is largely a myth that accepting any gift or payment after responding to an in-flight emergency would void your legal protections; the AMAA has no language regarding compensation and to date there are no such reported cases of lost legal protection. Jeff: And that’s the end of this months episode of EMplify: Assisting With Air Travel Medical Emergencies. This also marks the end of our run as your hosts. Over the past 3 years, we’ve thoroughly enjoyed hosting EMplify and having the unique opportunity to share high quality evidence based medicine with you all. As health care continues to move towards a quality over quantity paradigm, understanding evidence based practice will be increasingly more important. Nachi: We thank you all for giving us your ears and your time to help hone your clinical practice. Naturally, a big thanks also goes out to all of the contrubutors to Emergency Medicine Practice -- authors, peer reviewers, and of course the kind and thoughtful staff at EB Medicine. Jeff: We have no doubt that Dr. Ashoo, who will be taking over, will keep you on the edge of your seat as he brings new material to you. Couldn’t be more excited to have him as our successor. Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: The [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net.
Special Presentation on Agile Methodology Joshua: I am Joshua from Dorks Delivered. So, cool stuff I've done in the past are columns for an online entrepreneur magazine so that's something that's happened more recently. Published a book, a couple ago which I'm pretty excited about. Some of the different stuff and ways that we do business has been featured on news.com.au I've got a YouTube channel and a podcast as I already sort of pointed out there. Which you guys will all be podcast famous in a few weeks so, it's pretty exciting. Woo! In one way or another I've been a business owner for 19 years, with Dorks Delivered for 12 years. And I'm pretty keen on automating things. So my home, my lifestyle, and everything is automated wherever possible. Learn more about Agile Methodology at dorksdelivered.com.au A business owner needs to be able to automate everything. Not just when they're in their business and trying to get their processes and their staff all accounted and right, they need to make sure they're doing that in their home lifestyle as well, because if you're sitting at home and you're vacuuming, well you're not vacuuming if you're sitting are you? But if you're at home and you're vacuuming then you're wasting time a lot of the time. You need make sure that you're looking at every single process. That's the fish pond that I've automated, which goes through, uses the fertiliser coming from the, or the excrement from the fish is fertiliser across all the gardens, and does it all automatically. Looks at the amount of evaporation and goes nuts. Any questions? I can see a few confused faces. Speaker 5: It looks like a spa. Joshua: It does look like a spa! It's actually a dual tank fish, so you can have two different breeds of fish, sit out there in a little pond and have a look and they've got a little putt putt area up the top there. That I build around, so, just, fun stuff. You've got to automate your life. So with Dorks Delivered as I said, I'm an automation specialist through south-east Queensland. And what we do for business is remove poor time, time-poor, we bring time back to business owners by improving efficiencies and removing repetitious tasks. So I also help with sales and marketing to an extent through some of their social media aspects, but mostly all just as a holistic view, and point you in the right direction of how to get to the right person. So, what is agile development? As we sort of discussed, there's a waterfall methodology which is where you're producing something and then you're saying "okay now it's working, but it might have broken", and then you're going through a very, very, a process that's in series. There's a clear start and there's a clear end, but there's nothing in the, necessarily in the middle that isn't defined. It has a start, has an end and then the product is created. The problem with that is it's incredibly, tell me if I'm talking to quickly, because I say it and I just get excited. But the problem with it is, agile development, has a start, has an end, but costs a lot of money and doesn't make money most of the time throughout the process. And so the whole process of agile development costs a lot of money, needs a lot of capital and there's no money coming in from it. So, as I said, in a nutshell, it's creating the smallest most basic item that's scalable, that you can have sent off to your clients or sent out to market. So a good example would be Uber. Whoop I've gone too far. So Uber created their app on their phone so that you can rideshare and so on and so forth. Their intention is, and was, was and still is, to create autonomous vehicles but they needed to have acceleration, data and any other points of black spots and what-not... Of what's going around the area. So, Uber's intention is to create an autonomous vehicle, but they created an app that allowed for ridesharing, and used people, the meat in a seat, to achieve their objectives until they were able to have AI to a spot where they were able to then have it work. Because AI was going to be way too expensive, so they created a small product and then continued to develop the product, but had a known ending, but had a profitable product to start off with. So, any questions on how that all works? Any participation you get a prize. Speaker 4: Josh, it's just a, yes a question. So you said like, with agile development, there's like, you'd don't really get any sort of like, the potential return on investment until the end. So what you're saying now is with Uber, if you look at their agile development, you know, the intention was at the end was to have the AI intelligence that will make them, you know, self-automated. But what, so, they have got a return now, by implementing the first basic part of it. Joshua: So agile development gives you a return straight away. Or very, very close to straight away. Traditional models, or the waterfall model, means that you, they would have said, "we're going to make an autonomous vehicle" and they're going to say "okay, it's going to cost us billions of dollars but we have a clear defined outcome". Instead they've said "let's break this down into profitable steps, where we can then, use that". So although Uber appears as if they're in competition with DiDi and Ola and Lyft overseas, they're not really in competition with them and that's why Uber's balance sheets look like they're running at a loss. Joshua: Significantly. That's right. And then you look at others and you go "wow they're doing exactly the same thing, how are they running at such a loss?". So, and that's where their money is going, is- Speaker 4: But you generally find that people who are first, are the ones who end up losing all the money and then the others jump on it and like, like the DiDis and the Olas, et cetera, now they're using the same, but Uber paved it. Joshua: It depends, like McDonald's and Hungry Jack's could have the same argument. McDonald's and Hungry Jack's are pretty much exactly the same, but you've got McDonald's and it's definitely first, and it's still out there and I'd, it's definitely larger. It all depends. Uber's definitely got the name. No one says "I'm going to catch an Ola", they're going to go catch an Uber. They've changed the market. They've made it a level playing ground. From my house into Brisbane, it was a 20 dollar Uber, now it's a 46 dollar Uber, to get to the airport was 28 dollars and now it's something like 55 dollars. So all DiDi's done is they've just levelled the playing field. What Uber did is they said "let's crush", they did what Netflix did to Blockbuster, "let's crush the taxi drivers, once we've crushed taxi drivers, increase our profits". But you have the early adopters, and then you have the latecomers, and the early adopters and their... I'm not sure if I'm, that makes sense? The curve of where everyone sits in the adoption cycle. They would've known that someone was going to come along and copy the idea. But they would have had such a deep footing and grounding in what they've done, that it wouldn't have mattered, it doesn't matter a whole bunch because their end goal isn't to be competing with DiDi or Ola, it's just to be using their, the points of data. So for us, it looks like the same app, but what they're actually gaining, and the intelligence they're gaining from the app is far greater than what DiDi or Ola has does that make sense? For the questions, I'm going to give, you get a pair of fun, where is it? Green glasses! All right we can match. So has anyone heard of Beyond Meat? So Beyond Meat is this meat that has more protein than steak, more protein than most hamburgers, takes up 99 percent less landmass, has nearly all the health benefits of consuming meat, burns and cooks like meat, has haem in it the same as you have haemoglobin in meat, and to anyone that has not tried one of these, it tastes exactly like you've had meat. Has anyone tried any of these before? Grill'd, yeah they have them at Grill'd. They've only just recently come in there. And they're absolutely amazing. I tried when I went, you can't tell, if I gave that to a vegetarian, they would have sent it back to the kitchen they said "oh no this is terrible, this is meat". It, yeah, it flame grills a whole lot exactly the same. Anyway so, they created one product. Which is the Beyond Meat patty. And the Beyond Meat patty is absolutely revolutionary with the way that it works, and it means that it'll be a sustainable product that still gives you all the same benefits as meat into the future. Regardless of health and life choices and stuff, their intention was to have a huge range of products. But they obviously can't do that and be profitable if they're working on all these products at once. So they developed the easiest product that was able to sneak into the market as easy as possible. So, if you have a look at the predominant meat eaters, it'd definitely be America ever ever else, obviously India and Asia are significantly more vegetarian than they are anything else, even though they have a huge population. Jeff: So why does agile make a difference? Surely [crosstalk 00:11:24] the traditional project methodology, your goal was to produce the simplest product into the market as quickly as possible, why does agile make a difference? Joshua: It's about improving upon the original product, with a bigger end goal than just the initial project. Joshua: So the idea is testing the waters without getting your feet wet. You can use the agile methodology for anything, even marketing. So, as I said here, you can slowly develop your business without having huge cost outlay, is one of the big things. So from a marketing perspective, there are different ways that people use the agile methodology. So Dad and I, we've started a craft brewery. We've got ten different products that we've got on tap. We haven't got the licensing to sell it or anything like that, and the licensing to sell it and what not is quite expensive, when you don't know if it's going to work and people are actually going to enjoy the taste of your brew. So what we've done is we've created a survey, where when people fill out the survey, because we can give the beers away for free, when people fill out the survey and they try they beers and they go "yes this is fantastic", we pay a pre-order to buy a six pack for instance, when we have 6000 people on that list we then know that there's enough of a test there that we know that people would be interested in buying it, without having to then fork out the money for larger infrastructure and any of the licensing costs and so on and so forth. Speaker 4: So what will it cost you though, to give those 6000 beers for free? Joshua: Well the beers for free to start off with, the 6000 beers are quite cheap. Maybe 30 cents a beer or something like that. Speaker 4: Oh, okay. Joshua: Yeah, so it's very, very cheap. And in scale, cheaper than that. So that's why my wallet, it's better to be producing something that you can test the waters with. So if you need any help with the agile development process or anything in your business we can jump in and have a look at some of the projects that you're doing and make sure that you are doing them in the most efficient and effective way. So, what Steve Jobs did, is he has six different iPhones in front of his stand. On the six different iPhones one of them played videos, one of them received SMSs and calls, one of them played music and so on and so forth. So one of them had different apps that showed maps, and all these different things. Not a single iPhone could do all the things at once without crashing. Additionally, if you tried to, and you accidentally did it, it may start working and then crash mid presentation. So to save face, while he was showing everyone this revolutionary new technology, each different person with agile methodology was able to create the certain function working on each device, but not all of them together. He went up and said, "this is world-changing, this is revolutionary, everyone's going to have one of these in their pocket". And he's not half wrong. What he did there it was just fancy video editing, as he put the phone down and then picked it up, he already knew that it was going to be exactly the spot where it needed to be. Additionally to that, they had a tower that was put there by Verizon that, that was only paired to their phones that were on the stand, to make sure that they had absolutely lightning-fast speed, that had no congestion with everyone else that was in the audience. So, that is, that bit isn't really agile, that's just tricky. But having the different phones, knowing that you can do it somewhat, but you don't have the capital to continue producing a single device, and you don't know how well it's going to be received, this allowed for a world audience to see, pre-order the devices, continue to have the money to then build it out. Does that make sense? Does that kind of answer your question before on the, how it can be varied with the approach for agile development as opposed to just creating a full device from start to finish? Jeff: I'd be interested to know what your thoughts are on the difference between lean, agile and scrum, as delivering outcomes for small business owners like us. Joshua: With communication and branding you'd say that a lot of that would come to their marketing, and how well they're being shown on the web, making sure that everything's consistent. Yeah? Jeff: Oh, well I'm thinking about story-telling, so, if Steve Jobs you just gave is the best example of, any marketing story-telling, best businesses telling their stories. Joshua: That's correct. But if you went to a small business and you said "you need to make sure that your story resonates with your ideal client, and you need to make sure this you do that and this", and you said that the marketing budget is going to be $200,000 to make sure that we get your message our the appropriate people. Most business owners are going to be like "I can't afford that, I know that that's what I need to do, but I can't afford that". So let's test the water, use a long tail key word, sniper marketing, target a very test small audience, because you can't afford the $200,000 even thought you know that's going to work. You test a smaller audience, a subset niche of their target market, and then from that go "okay, that has worked, that is now bringing in an income", especially for startup business or something like, even if the income's not huge, it's bringing in then an income to then afford to then push the money towards the $200,000. So it's about, that would still be testing the waters, as opposed to knowing that you've got from start to finish the full solution. Speaker 4: Isn't that just the normal way that you would start a business? [crosstalk 00:29:17] don't startups just do that? Joshua: Do what, sorry? Speaker 4: Exactly what you're saying. You start with a smaller part of the market, make some money. Joshua: You should. That's exactly right. But even if you know that you need to have the larger portion of the market, or you're not necessarily a larger portion, but you need to market and brand in a certain way. Like I know that for instance, YouTube, cost the business a lot of money to produce a channel, it doesn't necessarily have a whole bunch of views, but the views that are does have, convert, and work towards our end goal in our business. So it's a functional platform, but most businesses when they start out they know, "if I have a YouTube channel I'll be able to get my message across more easily, be able to tell the story about what we do", but you won't necessarily be able to afford to be able to tell your story to the audience that needs to hear it. So, does that, am I explaining that right? I don't know, does that sound fair? So, sometimes you don't know how to go about finishing creating a product to service, and that's where we've sort of just said: "agile developmental design is your answer". That's what Steve Jobs did to make sure that they had a product, although they would have had the money and the market research that said "this product is going to work", they may not have wanted to spend the capital on something that might have flopped because there already was the Nokia phone that could do nearly everything, but it just didn't have the right story-telling and the right approach to it. So, security is another big objective towards agile development. If you don't have good security in your business, if you don't have good security practices, it will delay and push things out. One of the things that a lot of businesses, has everyone seen the HTTPS at the start of their website? So like, up until a couple of years ago, there was this thing, a vulnerability in it, that had been there for decades, for about a decade. Called heart bleed. Apple was aware of it. Apple had protected all their systems. Apple didn't let everyone else know about that. Apple was able to snoop and see any details that were deemed encrypted on everyone else's system. That's terrible. The OpenSSL protocol was able to be broken into. Certain people knew about it and other people didn't. The person that developed that was in their garage, just a home business that developed this and gave it away for free for everyone to use, and then everyone abused that, and that then opened up to mass hysteria when that came out of, the security problem came out about a year ago. So that's where you need to make sure you keep your eyes on the process and your security around all of the processes. Because if you don't, you, you'll have delays in the way that your product's going to be released.
更多英语知识，请关注微信公众号:VOA英语每日一听Jonathan: Have you ever heard about speed dating?Jeff: Speed dating? No. I have no idea. Fast....?Jonathan: This is a kind of thing that started up in the last number of years, and what happens is it there's an organizer and you go to some dates in a two hour period.Jeff: So this is organized... it's organized and it's... what do you do? Like what do you do?Jonathan: Well, you'll have a number and a little name tag and maybe you'll be Jeff number 7 and you'll meet and talk to these ladies. Those five minutes are yours to talk about whatever you like. Perhaps you're interested in finding out what the girls enjoy doing in their free time, their hobbies, what their background is. I'm sure they'll have questions for you, as well, and if for example out of those twenty dates, there are four or five that you would be interested in seeing again, you put a little check next to their name on your check-list. If any of those same ladies put a check next to your name, then you have a match, and you're able to contact those ladies. You are given their e-mail addresses and you can continue to be in contact with them and find out if someone might be right for you.Jeff: So that sounds great. Have you ever done it before?Jonathan: Yes, I have.Jeff: And any luck?Jonathan: A little bit of luck. You know hard it is. People are looking for sorts of different things, so maybe my lifestyle isn't really suitable for a lot of people I meet and vice-versa.Jeff: Well, sounds good. I'm in.Jonathan: OK, I'll sign you up.
更多英语知识，请关注微信公众号:VOA英语每日一听Jonathan: Have you ever heard about speed dating?Jeff: Speed dating? No. I have no idea. Fast....?Jonathan: This is a kind of thing that started up in the last number of years, and what happens is it there's an organizer and you go to some dates in a two hour period.Jeff: So this is organized... it's organized and it's... what do you do? Like what do you do?Jonathan: Well, you'll have a number and a little name tag and maybe you'll be Jeff number 7 and you'll meet and talk to these ladies. Those five minutes are yours to talk about whatever you like. Perhaps you're interested in finding out what the girls enjoy doing in their free time, their hobbies, what their background is. I'm sure they'll have questions for you, as well, and if for example out of those twenty dates, there are four or five that you would be interested in seeing again, you put a little check next to their name on your check-list. If any of those same ladies put a check next to your name, then you have a match, and you're able to contact those ladies. You are given their e-mail addresses and you can continue to be in contact with them and find out if someone might be right for you.Jeff: So that sounds great. Have you ever done it before?Jonathan: Yes, I have.Jeff: And any luck?Jonathan: A little bit of luck. You know hard it is. People are looking for sorts of different things, so maybe my lifestyle isn't really suitable for a lot of people I meet and vice-versa.Jeff: Well, sounds good. I'm in.Jonathan: OK, I'll sign you up.
更多英语知识，请关注微信公众号:VOA英语每日一听Jonathan: So, Jeff, you know, I don't know if I want to go out to the pub again on Saturday. LIke the music is a little bit too loud. It's hard to meet people and so on. I don't know. I've been thinking, we should do like some online dating. You know, try to meet some women that way.Jeff: What do you mean? We just sit at home and through the computer. Or how do you do that?Jonathan: No, you don't have a date through the computer. That would be awful. But, you know, in the modern world people are rushed. They always don't have time to go out and meet people. If you only go to bars, to try to meet people, you're only meeting a small percentage of the population: the people who do like to go out and drink and have fun, and so on. You're cutting yourself off from a lot of people.Jeff: So how does this work, this online dating? Do I have to pay to use this site?Jonathan: Oh, there are some sites where you pay and somewhere you don't. You can put up a profile of yourself, you know, with a picture if you like, or perhaps you would like to stay more anonymous and not put your picture up. You can see a lot of basic information about people even before you're ever in contact with them.Jeff: So, if I'm living in a city, do I look for dates or women only in that city?Jonathan: Well, most of them have search criteria. You can choose within say twenty kilometers or a hundred kilometers. Anyway where in the world if you like? You don't always find love just around the corner. You might find you have a heck of a lot in common with somebody on the other side of the world. But with online dating, people put up some information that they are comfortable sharing, so you can see what somebody does in their free time, what somebody's beliefs are, what somebody is interested in finding, so you may find by doing the search that you meet someone that really matches up with you that you would be interested in contacting without ever going out to the bar, or if you just go out and hit the bar, you may feel a one in a million shot to meet the right person, whereas online, maybe you can search a million people and you find that right one.Jeff: Online dating. That sounds great. I'm gonna give it a go.
更多英语知识，请关注微信公众号:VOA英语每日一听Jonathan: So, Jeff, you know, I don't know if I want to go out to the pub again on Saturday. LIke the music is a little bit too loud. It's hard to meet people and so on. I don't know. I've been thinking, we should do like some online dating. You know, try to meet some women that way.Jeff: What do you mean? We just sit at home and through the computer. Or how do you do that?Jonathan: No, you don't have a date through the computer. That would be awful. But, you know, in the modern world people are rushed. They always don't have time to go out and meet people. If you only go to bars, to try to meet people, you're only meeting a small percentage of the population: the people who do like to go out and drink and have fun, and so on. You're cutting yourself off from a lot of people.Jeff: So how does this work, this online dating? Do I have to pay to use this site?Jonathan: Oh, there are some sites where you pay and somewhere you don't. You can put up a profile of yourself, you know, with a picture if you like, or perhaps you would like to stay more anonymous and not put your picture up. You can see a lot of basic information about people even before you're ever in contact with them.Jeff: So, if I'm living in a city, do I look for dates or women only in that city?Jonathan: Well, most of them have search criteria. You can choose within say twenty kilometers or a hundred kilometers. Anyway where in the world if you like? You don't always find love just around the corner. You might find you have a heck of a lot in common with somebody on the other side of the world. But with online dating, people put up some information that they are comfortable sharing, so you can see what somebody does in their free time, what somebody's beliefs are, what somebody is interested in finding, so you may find by doing the search that you meet someone that really matches up with you that you would be interested in contacting without ever going out to the bar, or if you just go out and hit the bar, you may feel a one in a million shot to meet the right person, whereas online, maybe you can search a million people and you find that right one.Jeff: Online dating. That sounds great. I'm gonna give it a go.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: So, Jonathan, you are the... maybe the most prolific traveler I have ever met, and your home is a suitcase, so how do you live out of a suitcase like that?Jonathan: I wouldn't really say my home is a suitcase, but I think that people really hold onto their possessions a little bit too much, and people think that they need to have their favorite books nearby when they probably will never even read it again. I really don't think it's necessary to have all of those things there, so I don't need to have a lot of nice clothes with me all the time. I don't need to carry around all of these souvenirs of days gone by. I'm perfectly comfortable having just a minimal amount of things with me. I have changes of clothes so it's not like I'm in any way suffering from a lack of personal hygiene and such things.Jeff: So, but... so what do you do? How do you clean your clothes? What do you do when you want to buy something new?Jonathan: Well, I find that in fact I don't often buy some many things when I travel. I buy the necessities, but I try to keep everything small in size so for example I have one small little pack that has shampoo, conditioner and body soap, and I can in fact, fill it up from a lot of hotels which offer those things to their guests. I can have a little bar of soap. I have a small towel to travel with. I can take my clothes to a coin laundry. At worst, I put on a pair of shorts while I'm washing my two pairs of jeans. If it's a cold weather country perhaps people look at me a little bit funny, but being Canadian and descended from cold weather countries, I don't have a difficulty with it.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: So, Jonathan, you are the... maybe the most prolific traveler I have ever met, and your home is a suitcase, so how do you live out of a suitcase like that?Jonathan: I wouldn't really say my home is a suitcase, but I think that people really hold onto their possessions a little bit too much, and people think that they need to have their favorite books nearby when they probably will never even read it again. I really don't think it's necessary to have all of those things there, so I don't need to have a lot of nice clothes with me all the time. I don't need to carry around all of these souvenirs of days gone by. I'm perfectly comfortable having just a minimal amount of things with me. I have changes of clothes so it's not like I'm in any way suffering from a lack of personal hygiene and such things.Jeff: So, but... so what do you do? How do you clean your clothes? What do you do when you want to buy something new?Jonathan: Well, I find that in fact I don't often buy some many things when I travel. I buy the necessities, but I try to keep everything small in size so for example I have one small little pack that has shampoo, conditioner and body soap, and I can in fact, fill it up from a lot of hotels which offer those things to their guests. I can have a little bar of soap. I have a small towel to travel with. I can take my clothes to a coin laundry. At worst, I put on a pair of shorts while I'm washing my two pairs of jeans. If it's a cold weather country perhaps people look at me a little bit funny, but being Canadian and descended from cold weather countries, I don't have a difficulty with it.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: So, Jonathan, what is home for you? Where is home for you?Jonathan: Where is home for me? Actually, I would have to say that I'm homeless.Jeff: Homeless! What do you mean homeless?Jonathan: Well, I don't call one particular place home. I pretty much live out of a suitcase. I don't have roots holding me to one particular place. I was born and raised in Toronto but from a very young age I was traveling for different purposes: some for the work that I was doing, some for just pleasure travel and even now when I go back to Toronto, it doesn't really feel like home. In fact people comment about my accent, and they say, "Oh, that's an interesting accent. Where you are from?" and I say, "Well, I'm from here."Jeff: So where do you split most of the majority of your time? Where's your base?Jonathan: Well, I don't really have a base. That's the thing. I spend about four, sometimes a little more, sometimes a little less, months in Japan and I usually visit my parents for about a month a year, sometimes in Canada where they spend spring, summer and early autumn, and sometimes in this small little town in Mexico that they like to go to avoid the harsh Canadian winter.Jeff: So, you and... in between those times, in between Mexico, in between Canada, in between Japan, where are you?Jonathan: Wherever I sort of feel like going. Now I don't draw the kind of salary that allows me to live a glamorous lifestyle and travel around the world with the jet set, but I can certainly go and spend several months a year in different destinations, living a very basic existence but having enough time to be able to travel around and stay in simple accommodation, go out and hit the bars at night, talk to the people I meet in those different areas. At different times I have different interests.Jeff: So that sounds like a pretty exciting, pretty fun life. Do you ever get tired of it?Jonathan: I think that it's the kind of life that doesn't appeal to everyone and some people think I have this wonderful, fantastic life all the time. Sometimes, I would like to work a little bit more. Sometimes, I think, "Oh, no! I have nothing to do for the next three months."Jeff: Except for travel.Jonathan: Yes. And as of now, this work that I'm about to do finishes in a couple of days and people have asked me, where am I going afterward and my honest answer is I don't know. I literally have no idea where I'm going to be four or five days from now, and I have no idea what I'll be doing for the next three months until I need to be back in Japan for work three months from now.Jeff: Well, good luck on your next trip.Jonathan: Thank you.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: So, Jonathan, what is home for you? Where is home for you?Jonathan: Where is home for me? Actually, I would have to say that I'm homeless.Jeff: Homeless! What do you mean homeless?Jonathan: Well, I don't call one particular place home. I pretty much live out of a suitcase. I don't have roots holding me to one particular place. I was born and raised in Toronto but from a very young age I was traveling for different purposes: some for the work that I was doing, some for just pleasure travel and even now when I go back to Toronto, it doesn't really feel like home. In fact people comment about my accent, and they say, "Oh, that's an interesting accent. Where you are from?" and I say, "Well, I'm from here."Jeff: So where do you split most of the majority of your time? Where's your base?Jonathan: Well, I don't really have a base. That's the thing. I spend about four, sometimes a little more, sometimes a little less, months in Japan and I usually visit my parents for about a month a year, sometimes in Canada where they spend spring, summer and early autumn, and sometimes in this small little town in Mexico that they like to go to avoid the harsh Canadian winter.Jeff: So, you and... in between those times, in between Mexico, in between Canada, in between Japan, where are you?Jonathan: Wherever I sort of feel like going. Now I don't draw the kind of salary that allows me to live a glamorous lifestyle and travel around the world with the jet set, but I can certainly go and spend several months a year in different destinations, living a very basic existence but having enough time to be able to travel around and stay in simple accommodation, go out and hit the bars at night, talk to the people I meet in those different areas. At different times I have different interests.Jeff: So that sounds like a pretty exciting, pretty fun life. Do you ever get tired of it?Jonathan: I think that it's the kind of life that doesn't appeal to everyone and some people think I have this wonderful, fantastic life all the time. Sometimes, I would like to work a little bit more. Sometimes, I think, "Oh, no! I have nothing to do for the next three months."Jeff: Except for travel.Jonathan: Yes. And as of now, this work that I'm about to do finishes in a couple of days and people have asked me, where am I going afterward and my honest answer is I don't know. I literally have no idea where I'm going to be four or five days from now, and I have no idea what I'll be doing for the next three months until I need to be back in Japan for work three months from now.Jeff: Well, good luck on your next trip.Jonathan: Thank you.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: Now the world is small and there's this type of people who are called backpackers, and you've been a backpacker, or you are a backpacker. What's a backpacker and what do you think of them?Jonathan: I don't know if I'd go so far as to say I'm a backpacker. I actually have a bag that rolls on wheels, so I don't know if I fit that category. When I was younger, then I certainly did go around with the backpack and considered myself to be a little bit a part of that community. I wouldn't say I really would consider myself one anymore because a lot of people that I meet who consider themselves to be backpackers, they almost have a little bit of an unusual perception of what they are, and they think somehow they're different from say tourists, and I meet people who say these things, like, I'm not a tourist, I'm a traveler, or "I'm not a tourist, I'm a backpacker" in some way suggesting that they are above being a tourist in some way, but in the same hand, I'll meet people who are in some area like say Khao San Road in Bangkok, which is famous as being a backpacker street, and I meet people who stay there for two weeks and only talk to other backpackers, and they end up at the end of their holiday saying how much they love Thailand, whereas the realty was they never really went anywhere except perhaps to a little bit to a temple or something.Jeff: So, are backpackers boys and girls, old people and young people, Indians and Canadians. Is there any, like, are all backpackers Americans for example?Jonathan: Oh, no, actually, I meet very few Americans when I travel surprisingly. It seems that certain nationalities have a greater predisposition to travel. I meet as many Canadians as I do Americans despite the population of the United States being ten times larger than that of Canada's. I meet a lot of New Zealander's, whereas their population is comparatively tiny, but they can come from any place. I've met backpackers from all kinds of different walks of life, different age groups, different nationalities, but you do find that the majority of them are young people. Perhaps they're taking a year off before or after college. Maybe they just want to see a little bit of the world before they know they're going to be rooted in one place because perhaps from their field of study they think that their future is going to be more or less planned out and they want to get a bit of travel in before they embark on their career.Jeff: So you have a wheely case, and you're not really a backpacker so is it OK if I call you a wheely-packer?Jonathan: I suppose you could call me that, but I'm not sure whether other people would know that term, and if you don't mind, I'm not going to refer to myself as a wheely-packer.Jeff: OK. Good luck on your next trip.Jonathan: Thank you.
更多英语知识，请关注微信公众号:VOA英语每日一听Jeff: Now the world is small and there's this type of people who are called backpackers, and you've been a backpacker, or you are a backpacker. What's a backpacker and what do you think of them?Jonathan: I don't know if I'd go so far as to say I'm a backpacker. I actually have a bag that rolls on wheels, so I don't know if I fit that category. When I was younger, then I certainly did go around with the backpack and considered myself to be a little bit a part of that community. I wouldn't say I really would consider myself one anymore because a lot of people that I meet who consider themselves to be backpackers, they almost have a little bit of an unusual perception of what they are, and they think somehow they're different from say tourists, and I meet people who say these things, like, I'm not a tourist, I'm a traveler, or "I'm not a tourist, I'm a backpacker" in some way suggesting that they are above being a tourist in some way, but in the same hand, I'll meet people who are in some area like say Khao San Road in Bangkok, which is famous as being a backpacker street, and I meet people who stay there for two weeks and only talk to other backpackers, and they end up at the end of their holiday saying how much they love Thailand, whereas the realty was they never really went anywhere except perhaps to a little bit to a temple or something.Jeff: So, are backpackers boys and girls, old people and young people, Indians and Canadians. Is there any, like, are all backpackers Americans for example?Jonathan: Oh, no, actually, I meet very few Americans when I travel surprisingly. It seems that certain nationalities have a greater predisposition to travel. I meet as many Canadians as I do Americans despite the population of the United States being ten times larger than that of Canada's. I meet a lot of New Zealander's, whereas their population is comparatively tiny, but they can come from any place. I've met backpackers from all kinds of different walks of life, different age groups, different nationalities, but you do find that the majority of them are young people. Perhaps they're taking a year off before or after college. Maybe they just want to see a little bit of the world before they know they're going to be rooted in one place because perhaps from their field of study they think that their future is going to be more or less planned out and they want to get a bit of travel in before they embark on their career.Jeff: So you have a wheely case, and you're not really a backpacker so is it OK if I call you a wheely-packer?Jonathan: I suppose you could call me that, but I'm not sure whether other people would know that term, and if you don't mind, I'm not going to refer to myself as a wheely-packer.Jeff: OK. Good luck on your next trip.Jonathan: Thank you.
Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta. This month, we are tackling a topic for which the literature continues to rapidly change - we’re talking about the ED management of patients taking direct oral anticoagulants or DOACs, previously called novel oral anticoagulants or NOACs. Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: This month’s article was authored by Dr. Patrick Maher and Dr. Emily Taub of the Icahn School of Medicine at Mount Sinai, and it was peer reviewed by Dr. Dowin Boatright from Yale, Dr. Natalie Kreitzer from the University of Cincinnati, and Dr. Isaac Tawil from the University of New Mexico. Nachi: In their quest to update the last Emergency Medicine Practice issue on this topic which was published in 2013, they reviewed over 200 articles from 2000 to present in addition to 5 systematic reviews in the cochrane database, as well as guidelines from the American Heart Association, European society of cardiology, and the american college of cardiology. Jeff: Thanks to a strong literature base, Dr’s Maher and Taub found good quality evidence regarding safety and efficacy of the DOACs in relation to warfarin and the heparin-based anticoagulants. Nachi: But do note that the literature directly comparing the DOACs is far more limited and mostly of poor quality. Show More v Jeff: Fair enough, we’ll take what we can get. Nachi: Well, I’m sure more of those studies are still coming. Jeff: Agree. Let’s get started with some basics. Not surprisingly, DOACs now account for a similar proportion of office visits for anticoagulant use as warfarin. Nachi: With huge benefits including reduced need for monitoring and a potential for reduced bleeding complications, this certainly isn’t surprising. Jeff: Though those benefits are not without challenges - most notably the lack of an effective reversal agent and the risk of unintentional overdose in patients with altered drug metabolism. Nachi: Like all things in medicine, it’s about balancing and finding an acceptable risk/benefit profile. Jeff: True. Let’s talk pathophysiology for a minute - the control of coagulation in the human body is a balance between hemorrhage and thrombosis, mediated by an extensive number of procoagulant and anticoagulant proteins. Nachi: Before the development of the DOACs, vitamin K antagonists controlled the brunt of the market. As their name suggests, they work by inhibiting the action of vitamin K, and thus reducing the production of clotting factors 2, 7, 9, and 10, and the anticoagulant proteins C and S. Jeff: Unfortunately, these agents have a narrow therapeutic window and many drug-drug interactions, and they require frequent monitoring - making them less desirable to many. Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. The DOACs currently on the market work by one of two mechanisms - direct thrombin inhibition or factor Xa inhibition. Jeff: DOACs are currently approved for stroke prevention in nonvalvular afib, treatment of VTE, VTE prophylaxis, and reduction of major cardiovascular events in stable cardiovascular disease. Studies are underway to test their safety and efficacy in arterial and venous thromboembolism, prevention of embolic stroke in afib, ACS, cancer-associated thrombosis, upper extremity DVT, and mesenteric thrombosis. Nachi: Direct thrombin inhibitors like Dabigatran, tradename Pradaxa, was the first FDA approved DOAC. It works by directly inhibiting thrombin, or factor IIa, which is a serine protease that converts soluble fibrinogen into fibrin for clot formation. Jeff: Dabigatran comes in doses of 75 and 150 mg. The dose depends on your renal function, and, with a half-life of 12-15 hours, is taken twice daily. Note the drastically reduced half-life as compared to warfarin, which has a half-life of up to 60 hours. Nachi: The RE-LY trial for afib found that taking 150 mg of Dabigatran BID had a lower rate of stroke and systemic embolism than warfarin with a similar rate of major hemorrhage. Dabigatran also had lower rates of fatal and traumatic intracerebral hemorrhage than warfarin. Jeff: A separate RCT found similar efficacy in treating acute VTE and preventing recurrence compared with warfarin, with reduced rates of hemorrhage! Nachi: Less monitoring, less hemorrhage, similar efficacy, I’m sold!!! Jeff: Slow down, there’s lots of other great agents out there, let’s get through them all first... Nachi: Ok, so next up we have the Factor Xa inhibitors, Rivaroxaban, apixaban, edoxaban, and betrixaban.As the name suggests, these medications work by directly inhibiting the clotting of factor Xa, which works in the clotting cascade to convert prothrombin to thrombin. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment. After taking 15 mg BID for the first 21 days, rivaroxaban is typically dosed at 20 mg daily with adjustments for reduced renal function. Nachi: The Rocket AF trial found that rivaroxaban is noninferior to warfarin for stroke and systemic embolism prevention without a significant difference in risk of major bleeding. Interestingly, GI bleeding may be higher in the rivaroxaban group, though the overall incidence was very low in both groups at about 0.4% of patients per year. Jeff: In the Einstein trial, patients with VTE were randomized to rivaroxaban or standard therapy. In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Continuing therapy beyond the acute period resulted in similar rates of VTE recurrence and bleeding episodes to treatment with aspirin alone. Nachi: Next we have apixaban, tradename Eliquis. Apixaban is approved for afib and the treatment of venous thromboembolism. It’s typically dosed as 10 mg BID for 7 days followed by 5 mg BID with dose reductions for the elderly and those with renal failure. Jeff: In the Aristotle trial, when compared to warfarin, apixaban was superior in preventing stroke and systemic embolism with lower mortality and bleeding. Rates of major hemorrhage-related mortality were also nearly cut in half at 30 days when compared to warfarin. Nachi: For the treatment of venous thromboembolism, the literature shows that apixaban has a similar efficacy to warfarin in preventing recurrence with less bleeding complications. Jeff: Unfortunately, with polypharmacy, there is increased risk of thromboembolic and hemorrhage risks, but this risk is similar to what is seen with warfarin. Nachi: And as compared to low molecular weight heparin, apixaban had higher bleeding rates without reducing venous thromboembolism events when used for thromboprophylaxis. It’s also been studied in acute ACS, with increased bleeding and no decrease in ischemic events. Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. It’s recommended that edoxaban be given parenterally for 5-10 days prior to starting oral treatment for VTE, which is actually similar to dabigatran. It has similar levels of VTE recurrence with fewer major bleeding episodes compared to warfarin. It has also been used with similar effects and less major bleeding for stroke prevention in afib. In the setting of cancer related DVTs specifically, as compared to low molecular weight heparin, one RCT showed lower rates of VTE but higher rates of major bleeding when compared to dalteparin. Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Because it’s utility is limited to venous thromboembolism prophylaxis in mostly medically ill inpatients, it’s unlikely to be encountered by emergency physicians very frequently. Jeff: As a one sentence FYI though - note that in recent trials, betrixaban reduced the rate of VTE with equivalent rates of bleeding and reduced the rate of stroke with an increased rate of major and clinically relevant non-major bleeding as compared to enoxaparin. Nachi: Well that was a ton of information and background on the DOACs. Let’s move on to your favorite section - prehospital medicine. Jeff: Not a ton to add here this month. Perhaps, most importantly, prehospital providers should specifically ask about DOAC usage, especially in trauma, given increased rates of complications and potential need for surgery. This can help with destination selection when relevant. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Nachi: Extremely important to identify DOAC use early. Once the patient arrives in the ED, you can begin your focused history and physical. Make sure to get the name, dose, and time of last administration of any DOAC. Pay particular attention to the med list and the presence of CKD which could point to altered DOAC metabolism. Jeff: In terms of the physical and initial work up - let the sites of bleeding or potential sites of bleeding guide your work up. And don’t forget about the rectal exam, which potentially has some added value here - since DOACs increase the risk of GI bleeding. Nachi: Pretty straight forward history and physical, let’s talk diagnostic studies. Jeff: First up is CT. There are no clear cut guidelines here, so Drs. Maher and Taub had to rely on observational studies and expert opinion. Remember, most standard guidelines and tools, like the canadian and nexus criteria, are less accurate in anticoagulated patients, so they shouldn’t be applied. Instead, most studies recommend a low threshold for head imaging, even with minor trauma, in the setting of DOAC use. Nachi: That is so important that it’s worth repeating. Definitely have a low threshold to CT the head for even minor head trauma patients on DOACs. Basically, if you’re on anticoagulation, and you made it to the ED for anything remotely related to your head, you probably win a spin. Jeff: I suspect you are not alone with that stance... There is, however, much more debate about the utility of follow up imaging and admission after a NEGATIVE scan. Nachi: Wait, is that a thing I should routinely be doing? Jeff: Well there’s not great data here, but in one observational study of 1180 patients on either antiplatelet or anticoagulant therapy, a half a percent of them had positive findings 12 hours later, and importantly none required surgical intervention. Nachi: Certainly reassuring. And for those with positive initial imaging, the authors recommend repeat imaging within 4-6 hours in consultation with neurosurgical services or even earlier in cases of unexpected clinical decline. Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9% vs 20.8% in those on DOACs vs warfarin with traumatic intracranial hemorrhage. Nachi: Hmm that actually surprises me a bit with the ease of reversibility of warfarin. Jeff: And we’ll get to that in a few minutes. But next we should talk about ultrasound. As always with trauma, guidelines recommend a FAST exam in the setting of blunt abdominal trauma. The only thing to be aware of here is that you should have an increased index of suspicion for bleeding, especially in hidden sites like the retroperitoneum. Nachi: And just as with traumatic head bleeds, a small observational study of those with blunt abdominal trauma found 8% vs 30% mortality for those on DOACs vs warfarin, respectively. Jeff: That is simply shocking! Let’s also talk lab studies. Hemoglobin and platelet counts should be obtained as part of the standard trauma work up. Assessing renal function via creatinine is also important, especially for those on agents which are renally excreted. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. DOAC levels may be indicated in certain specific situations, such as while treating life-threatening bleeding, development of venous thromboembolism despite compliance with DOAC therapy, and treating patients at risk for bleeding because of an overdose. Jeff: In terms of those who require surgery while on a DOAC - if urgent or emergent, the DOAC will need to be empirically reversed. For all others, the recommendation is to wait a half life or even multiple half-lives, if possible, in lieu of level testing. Nachi: Coagulation tests are up next. Routine PT and PTT levels do not help assess DOACs, as abnormalities on either test can suggest the presence of a DOAC, but the values should not be interpreted as reliable measures of either therapeutic or supratherapeutic clinical anticoagulant effect. Jeff: Dabigatran may cause prolongation of both the PT and the PTT, but the overall correlation is poor. In addition, FXa inhibitors may elevate PT in a weakly concentration dependent manner, but this may only be helpful if anti-fXa levels are unavailable. Nachi: Which is a perfect segway into our next test - anti-factor Xa level activity. Direct measurements of the anti-Fxa effect demonstrates a strong linear correlation with plasma concentrations of these agents, but the anticoagulant effect does not necessarily follow the same linear fashion. Jeff: Some labs may even have an anti-FXa effect measurement calibrated specifically to the factor 10a inhibitors. Nachi: While measuring thrombin time is not routinely recommended, the result of thrombin time or dilute thrombin time does correlate well with dabigatran concentrations across normal ranges. Jeff: And lastly, we have the Ecarin clotting time. Ecarin is an enzyme that cleaves prothrombin to an active intermediate that can be inhibited by dabigatran in the same way as thrombin. The ECT is useful for measuring dabigatran concentration - it’s not useful for testing for FXa inhibitors. A normal ECT value could be used to exclude the presence of dabigatran. Nachi: So I think that rounds out testing. Let’s move into the treatment section. Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Tourniquet application, direct pressure, endoscopy for GI bleeds, etc... should all be used as needed. And most importantly, for airway bleeding, pericardial bleeding, CNS bleeding, and those with hemodynamic instability or overt bleeding, those with a 2 point drop in their hemoglobin, and those requiring 2 or more units of pRBC - they all should be considered to have serious, life threatening bleeds. This patient population definitely requires reversal agents, which we’re getting to in a minute. Nachi: A type and screen should also be sent with the plan to follow standard transfusion guidelines, with the goal of a hemoglobin level of 7, understanding that in the setting of an active bleed, the hemoglobin level will not truly be representative. Jeff: Interestingly, in the overdose literature that’s out there, bleeding episodes appear to be rare - occurring in just 5% of DOAC overdose cases. Nachi: Finally, onto the section we’ve all been waiting for. Let’s talk specific reversal agents. Praxbind is up first. Jeff: Idarucizumab or Praxbind, is the reversal agent of choice for dabigatran (which is also called pradaxa). According to data from the RE-LY trial, it reverses dabigatran up to the 99th percentile of levels measured in the trial. Nachi: And praxbind should be given in two 2.5 g IV boluses 15 minutes apart to completely reverse the effects of dabigatran. Jeff: As you would expect given this data, guidelines for DOAC reversal recommend it in major life-threatening bleeding events for patients on dabigatran. Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. This recombinant factor has a decoy receptor for the FXa agents, thus eliminating their anticoagulant effects. Jeff: Recombinant factor Xa is given in either high or low dose infusions. High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration. Low dose infusions should be used for those with smaller doses within the last 8 hours or for last doses taken beyond 8 hours. Nachi: In one trial of 352 patients, recombinant factor Xa given as an IV bolus and 2 hour infusion was highly effective at normalizing anti-FXa levels. 82% of the assessed patients at 12 hours achieved hemostasis, but there were also thrombotic events in 10% of the patients at 30 days. Jeff: And reported thrombotic events aren’t the only downside. Though the literature isn’t clear, there may be limited use of recombinant factor Xa outside of the time of the continuous infusion, and even worse, there may be rebound of anti-Fxa levels and anticoagulant effect. And lastly, the cost is SUBSTANTIAL. Nachi: Is there really a cost threshold for stopping life threatening bleeding…? Jeff: Touche, but that means we need to save it for specific times and consider other options out there. Since this has only been around for a year or so, let’s let the literature play out on this too... Nachi: And that perfectly takes us into our next topic, which is nonspecific reversal agents, starting with prothrombin complex concentrate, also called PCC. Jeff: PCC is FDA approved for rapid reversal of vitamin K antagonist-related hemorrhagic events and is now being used off label for DOAC reversal. Nachi: PCC comes in 3 and 4 factor varieties. 3-factor PCC contains factors 2, 9, 10 and trace amounts of factor 7. 4 factor PCC contains factors 2, 9 10, as well as purified factor 7 and proteins C and S. Jeff: Both also contain trace amounts of heparin so can’t be given to someone with a history of HIT. Nachi: PCC works by overwhelming the inhibitor agent by increasing the concentration of upstream clotting factors. It has been shown, in healthy volunteers, to normalize PT abnormalities and bleeding times, and to achieve effective bleeding control in patients on rivaroxaban, apixaban, and edoxaban with major bleeding events. Jeff: In small studies looking at various end points, 4 factor PCC has been shown to be superior to 3 factor PCC. Nachi: Currently it’s given via weight-based dosing, but there is interest in studying a fixed-dose to decrease both time to medication administration and cost of reversal. Jeff: Guidelines currently recommend 4F PCC over 3F PCC, if available, for the management of factor Xa inhibitor induced bleeding, with studies showing an effectiveness of nearly 70%. As a result, 4F PCC has become an agent of choice for rapid reversal of FXa inhibitors during major bleeding events. Nachi: Next we have activated PCC (trade name FEIBA). This is essentially 4Factor PCC with a modified factor 7. Though traditionally saved for bleeding reversal in hemophiliacs, aPCC is now being studied in DOAC induced bleeding. Though early studies are promising, aPCC should not be used over 4factor PCC routinely as of now but may be used if 4Factor PCC is not available. Jeff: Next we have recombinant factor 7a (trade name novoseven). This works by activating factors 9 and 10 resulting in rapid increase in thrombin. Studies have shown that it may reverse the effect of dabigatran, at the expense of increased risk of thrombosis. As such, it should not be used as long as other agents are available. Nachi: Fresh Frozen Plasma is the last agent to discuss in this section. Not a lot to say here - FFP is not recommended for reversal of any of the DOACs. It may be given as a part of of a balanced massive transfusion resuscitation, but otherwise, at this time, there doesn’t seem to be a clear role. Jeff: Let’s move on to adjunct therapies, of which we have 3 to discuss. Nachi: First is activated charcoal. Only weak evidence exists here - but, according to expert recommendations, there may be a role for DOAC ingestions within 2 hours of presentations. Jeff: Perhaps more useful than charcoal is our next adjunct - tranexamic acid or TXA. TXA is a synthetic lysine analogue with antifibrinolytic activity through reversible binding of plasmin. CRASH-2 is the main trial to know here. CRASH-2 demonstrated reduced mortality if given within 3 hours in trauma patients. There is very limited data with respect to TXA and DOACs specifically, so continue to administer TXA as part of your standard trauma protocol without modification if the patient is on a DOAC, as it’s likely helpful based on what data we have. Nachi: Next is vitamin K - there is no data to support routine use of vitamin K in those taking DOACs - save that for those on vitamin K antagonists. Jeff: Also, worth mentioning here is the importance of hematology input in developing hospital-wide protocols for reversal agents, especially if availability of certain agents is limited. Nachi: Let’s talk about some special circumstances and populations as they relate to DOACs. Patients with mechanical heart valves were excluded from the major DOAC trials. And of note, a trial of dabigatran in mechanical valve patients was stopped early because of bleeding and thromboembolic events. As such, the American College of Cardiology state that DOACs are reasonable for afib with native valve disease. Jeff: DOACs should be used with caution for pregnant, breastfeeding, and pediatric patients. A case series of 233 pregnancies that occurred among patients on a DOAC reported high rates of miscarriage. Nachi: Patients with renal impairment are particularly concerning as all DOACs are dependent to some degree on renal elimination. Current guidelines from the Anticoagulation Forum recommend avoiding dabigatran and rivaroxaban for patients with CrCL < 30 and avoiding edoxaban and betrixaban for patients with CrCl < 15. Jeff: A 2017 Cochrane review noted similar efficacy without increased risk of major bleeding when using DOACs in those with egfr > 30 (that’s ckd3b or better) when compared to patients with normal renal function and limited evidence for safety below this estimated GFR. Nachi: Of course, dosing with renal impairment will be different. We won’t go into the details of that here as you will probably discuss this directly with your pharmacist. Jeff: We should mention, however, that reversal of the anticoagulant in the setting of renal impairment for your major bleeding patient is exactly the same as we already outlined. Nachi: Let’s move on to some controversies and cutting-edge topics. The first one is a pretty big topic and that is treatment for ischemic stroke patients taking DOACs. Jeff: Safety and efficacy of tPA or endovascular therapy for patients on DOACs continues to be debated. Current guidelines do not recommend tPA if the last DOAC dose was within the past 48 hours, unless lab testing specific to these agents shows normal results. Nachi: Specifically, the American Heart Association suggests that INR and PTT be normal in all cases. ECT and TT should be tested for dabigatran. And calibrated anti-FXa level testing be normal for FXa inhibitors. Jeff: The AHA registry actually included 251 patients who received tpa while on DOACs, which along with cohort analysis of 26 ROCKET-AF trial patients, suggest the risk of intracranial hemorrhage is similar to patients on warfarin with INR < 1.7 and to patients not on any anticoagulation who received tpa. However, given the retrospective nature of this data, we cannot exclude the possibility of increased risk of adverse events with tpa given to patients on DOACs. Nachi: Endovascular thrombectomy also has not been studied in large numbers for patients on DOACs. Current recommendations are to discuss with your stroke team. IV lysis or endovascular thrombectomy may be considered for select patients on DOACs. Always include the patient and family in shared decision making here. Jeff: There are also some scoring systems for bleeding risk to discuss briefly. The HAS-BLED has been used to determine bleeding risk in afib patients taking warfarin. The ORBIT score was validated in a cohort that included patients on DOACs and is similarly easy to use, and notably does not require INR values. Nachi: There is also the ABC score which has demonstrated slightly better prediction characteristics for bleeding risk, but it requires high-sensitivity troponin, limiting its practical use. Jeff: We won’t say more about the scoring tools here, but would recommend that you head over to MD Calc, where you can find them and use them in your practice. Nachi: Let’s also comment on the practicality of hemodialysis for removal of the DOACs. Multiple small case series have shown successful removal of dabigatran, given its small size and low protein binding. On the other hand, the FXa inhibitors are less amenable to removal in this way because of their higher protein binding. Jeff: Worth mentioning here also - dialysis catheters if placed should be in compressible areas in case bleeding occurs. The role of hemodialysis for overdose may be limited now that the specific reversal agent, praxbind, exists. Nachi: In terms of cutting-edge tests, we have viscoelastic testing like thromboelastography and rotational thromboelastometry. Several studies have examined the utility of viscoelastic testing to detect presence of DOACs with varying results. Prolongation of clotting times here does appear to correlate with concentration, but these tests haven’t emerged as a gold standard yet. Jeff: Also, for cutting edge, we should mention ciraparantag. And if you’ve been listening patiently and just thinking to yourself why can’t there be one reversal agent to reverse everything, this may be the solution. Ciraparantag (or aripazine) is a universal anticoagulant reversal agent that may have a role in all DOACs and heparins. It binds and inactivates all of these agents and it doesn’t appear to have a procoagulant effect. Nachi: Clinical trials for ciraparantag have shown rapid and durable reversal of edoxaban, but further trials and FDA approval are still needed. Jeff: We’ve covered a ton of material so far. As we near the end of this episode, let’s talk disposition. Nachi: First, we have those already on DOACs - I think it goes without saying that any patient who receives pharmacological reversal of coagulopathy for major bleeding needs to be admitted, likely to the ICU. Jeff: Next we have those that we are considering starting a DOAC, for example in someone with newly diagnosed VTE, or patients with an appropriate CHADS-VASC with newly diagnosed non-valvular afib. Nachi: With respect to venous thromboembolism, both dabigatran and edoxaban require a 5 day bridge with heparin, whereas apixaban and rivaroxaban do not. The latter is not only easier on the patient but also offers potential cost savings with low risk of hemorrhagic complications. Jeff: For patients with newly diagnosed DVT / PE, both the American and British Thoracic Society, as well as ACEP, recommend using either the pulmonary embolism severity index, aka PESI, or the simplified PESI or the Hestia criteria to risk stratify patients with PE. The low risk group is potentially appropriate for discharge home on anticoagulation. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around. Nachi: Definitely a great opportunity for some shared decision making since data here is fairly sparse. This is also a great place to have institutional policies, which could support this practice and also ensure rapid outpatient follow up. Jeff: If you are going to consider ED discharge after starting a DOAC - there isn’t great data supporting one over another. You’ll have to consider patient insurance, cost, dosing schedules, and patient / caregiver preferences. Vitamin K antagonists should also be discussed as there is lots of data to support their safety outcomes, not to mention that they are often far cheaper…. As an interesting aside - I recently diagnosed a DVT/PE in an Amish gentleman who came to the ED by horse - that was some complicated decision making with respect to balancing the potentially prohibitive cost of DOACs with the massive inconvenience of frequently checking INRs after a 5 mile horseback ride into town... Nachi: Nice opportunity for shared decision making… Jeff: Lastly, we have those patients who are higher risk for bleeding. Though I’d personally be quite uneasy in this population, if you are to start a DOAC, consider apixaban or edoxaban, which likely have lower risk of major bleeding. Nachi: So that’s it for the new material for this month’s issue. Certainly, an important topic as the frequency of DOAC use continues to rise given their clear advantages for both patients and providers. However, despite their outpatient ease of use, it definitely complicates our lives in the ED with no easy way to evaluate their anticoagulant effect and costly reversal options. Hopefully all our hospitals have developed or will soon develop guidelines for both managing ongoing bleeding with reversal agents and for collaborative discharges with appropriate follow up resources for those we send home on a DOAC. Jeff: Absolutely. Let’s wrap up with some the highest yield points and clinical pearls Nachi: Dabigatran works by direct thrombin inhibition, whereas rivaroxaban, apixaban, edoxaban, and betrixaban all work by Factor Xa inhibition. Jeff: The DOACs have a much shorter half-life than warfarin. Nachi: Prehospital care providers should ask all patients about their use of anticoagulants. Jeff: Have a low threshold to order a head CT in patients with mild head trauma if they are on DOACs. Nachi: For positive head CT findings or high suspicion of significant injury, order a repeat head CT in 4 to 6 hours and discuss with neurosurgery. Jeff: Have a lower threshold to conduct a FAST exam for blunt abdominal trauma patients on DOACs. Nachi: Assessment of renal function is important with regards to all DOACs. Jeff: While actual plasma concentrations of DOACs can be measured, these do not correspond to bleeding outcomes and should not be ordered routinely. Nachi: The DOACs may cause mild prolongation of PT and PTT. Jeff: Idarucizumab (Praxbind®) is an antibody to dabigatran. For dabigatran reversal, administer two 2.5g IV boluses 15 minutes apart. Reversal is rapid and does not cause prothrombotic effects. Nachi: Recombinant FXa can be used to reverse the FXa inhibitors. This works as a decoy receptor for the FXa agents. Jeff: Vitamin K and FFP are not recommended for reversal of DOACs. Nachi: Consider activated charcoal to remove DOACs ingested within the last two hours in the setting of life-threatening hemorrhages in patient’s on DOACs. Jeff: Hemodialysis can effectively remove dabigatran, but this is not true for the FXa inhibitors. Nachi: 4F-PCC has been shown to be effective in reversing the effects of the FXa inhibitors. This is thought to be due to overwhelming the inhibitor agent by increased concentrations of upstream clotting factors. Jeff: tPA is contraindicated in acute ischemic stroke if a DOAC dose was administered within the last 48 hours, unless certain laboratory testing criteria are met. Nachi: Emergency clinicians should consider initiating DOACs in the ED for patients with new onset nonvalvular atrial fibrillation, DVT, or PE that is in a low-risk group. Jeff: So that wraps up Episode 31! Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: And the address for this month’s cme credit is www.ebmedicine.net/E0819, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month!
My guest today is IT consultant and author Jeff Sussna. Jeff's liberal arts background has given him a unique perspective on digital transformation. In this episode, we explore the relevance of cybernetics to today's complex design and DevOps challenges. Listen to the full conversation https://theinformeddotlife.files.wordpress.com/2019/08/the-informed-life-episode-15-jeff-sussna.mp3 Show notes Sussna Associates @jeffsussna on Twitter Change by Design: How Design Thinking Transforms Organizations and Inspires Innovation by Tim Brown Norbert Wiener Dark Hero of the Information Age: In Search of Norbert Wiener, The Father of Cybernetics by Flo Conway and Jim Siegelman Cybernetics: or Control and Communication in the Animal and the Machine by Norbert Wiener The Human Use of Human Beings: Cybernetics and Society by Norbert Wiener Lean startup Agile software development Mutual Causality in Buddhism and General Systems Theory: The Dharma of Natural Systems, by Joanna Macy Claude Shannon The Net of Indra Ranulph Glanville Designing Delivery: Rethinking IT in the Digital Service Economy by Jeff Sussna Read the full transcript Jorge: So Jeff, welcome to the show. Jeff: Thanks for having me. It's great to be here. Jorge: For folks who are not familiar with you and your work, how do you describe what you do? Jeff: Well on a basic mechanical level, I founded and lead a consulting agency in Minneapolis. Our focus is helping organizations learn how to move fast without breaking things, and we do that through the entire digital product lifecycle from design through product management all the way to development and operations. It's about bringing together agile and devops and design thinking. We do coaching. We do workshops. A lot of it is about helping people understand: what are we really trying to accomplish when we do things like agile? I go into a lot of organizations where they do scrum for example, and they may do it reasonably well, and they have a bunch of agile activities going on but they're not necessarily really getting where they want to go. And typically that's because they don't fully understand where are they supposed to be going and how is agile supposed to actually help them get there. And it's interesting because the way I got there was actually a somewhat unusual path and I think that that path and how it's gone along really informs my work and my approach to my work. Jorge: I am not familiar with your backstory, so you've said that and now I'm completely curious. Jeff: That was intentional. I figured I'd give you a chance rather than just rambling on for 20 minutes give you a chance to say, “Now would you like to ramble on for 20 minutes and tell us about your background?” Sure, so my background is actually liberal arts. I studied visual arts, anthropology, and political science in college and one day my advisor suggested that I should take a class that had absolutely nothing to do with what I was studying. And so I took an artificial intelligence programming class. This was back in the early 80s, the sort of first or maybe second golden age of AI. And I became captivated both by that but more so programming and and system programming. And I graduated from college and managed to worm my way into the software industry. I've been there for the last 30 years. I've built systems. I've led organizations across the entire development, QA, and operation spectrum. But I always had this background of being in artsy liberal arts person. And I found myself thinking about things a little bit differently and I can never put my finger on it until I read Tim Brown's Change by Design book, which is a popular introduction to design thinking and went, “Oh, that's it! That's me. That's how I naturally think about things.” At the same time, cloud computing was starting to come about. And when I put those two things together what I realized is that service — because we were talking about it as a service and software as a service and things like that — service and the human-centered design that's part of service is really at the heart of everything we do. And so that's really been behind my approach to my work ever since then. And one of the things that happened when I was in college and I was reading about artificial intelligence and playing with it was I read someone, some little paragraph somewhere, about some guy named Norbert Wiener who back in the '40s had invented something called control theory that was peripherally related to AI. And I kind of went okay, that's interesting and didn't make much of it and went about my business. And then about five or six years ago, I happened to be in the library one day and I saw a book called Dark Hero of the Information Age, which was a biography of Norbert Wiener. I thought, “Oh, I remember that guy, you know, I should check that out. I should find out more about him.” So I read it and I was instantly captivated. And I was introduced to this world of cybernetics, which was the thing that he was really responsible for. And cybernetics is really interesting because it was a very big deal in the '40s, '50s, and into the '60s. Wiener wrote a book about cybernetics, which is about 50% post grad level math, you literally can't read it unless you're unless you're a math major. But from what I've read apparently in the '50s every single college student in America was walking around with a copy of that book under their arm. So it was a very big deal and then for a variety of reasons it fell out of favor and disappeared and was completely forgotten. The irony is that anytime that you say a word that begins with cyber — you know cyber-terrorism, cyber-security, cyberspace — the cyber comes from cybernetics. And cybernetics is really at the heart and the origin of computing and actually the heart in the origin of information. When we talk about information architecture, information theory, we have to talk about cybernetics. And it gives kind of a different flavor to what information is and how we work with it. So what is cybernetics? Cybernetics is the idea that in complex systems — particularly the kinds of systems we find in the natural world and in the social world, whether it be cities or economies or companies or markets — that control has to be adaptive. It has to be based on listening and responding as well as just telling people or things what to do. If you think about the most basic cybernetic device, it's a thermostat. A thermostat doesn't actually control the temperature of the air in the room directly. What it does is it, you could say that it listens: it detects what the temperature is, and it detects the fact that the temperature isn't what it's supposed to be, and then it tells the furnace to do something about it. And so the furnace pumps warm air into the room the room warms up, the second law of thermodynamics kicks in the room starts to cool down again. The stat goes. “Uh oh, things aren't as they're supposed to be! We better do something about it.” So you could say that the thermostat in the furnace have actually no control whatsoever over the temperature of the air in the room. Only the second law of thermodynamics does that. But they're continually having a relationship where they're adjusting things. And the way that works is based on a principle that Wiener developed or identified called feedback. And we use that word all the time. But feedback has a very specific meaning which is information about the gap between actual and expected. So if the thermostat is set to 72 degrees and the temperature in the room is actually 71 degrees the thermostat gets some information that says well, it's one degree colder than its supposed to be. So we have a tendency to think about information as the thing, right? We architect it, we store it in databases, we pass it back and forth. But from a cybernetic perspective, information doesn't have any real meaning aside from the context in which it's happening. And its purpose is not just to be a thing its purpose is to help you understand what it is you need to do. One of the things that I learned from studying art and also to some degree from my own just kind of life is that mistakes happen. Things don't always go the way we expect them to. And that's perfectly fine. That doesn't prevent us from getting to a good place if we can have kind of a dance, and to some degree give up the idea that we're fully in control, and instead have a relationship with our world of, “What is it that you're telling me and what do I need to do based on that?” So it's much more relational. I think that companies are beginning to discover that. The reason they're reaching out for things like agile is that they're realizing that they can't control the markets anymore the way they used to, so they have to have the ability to understand and respond to situations — environments — over which they have less and less control and ability to predict. Jorge: You talked about Wiener's book and how fifty percent of it is college level math, and that brings to mind the the idea that some of this stuff can be complicated for folks. And hearing you describe it in this way, it sounds more accessible than other introductions I've heard before to the subject — and more relevant. I'm hearing you say that and thinking, “Yeah, definitely.” I mean that maps to my experience of reality; the fact that if you're going to act you have to get a read on your surroundings and then you must have some kind of model where there's an objective that you're going towards and you need to somehow compute at some level the difference between where you are and where you want to be and adjust your direction. So the question is, when presented at that level it is kind of obvious. Why do you think it fell out of favor? Jeff: Well, part of it was Wiener's fault. He was a very eccentric person. And well, let me take a step back first and say that that Wiener's first book was called Cybernetics: Communication and Control in the Machine and the Animal. That's the one that's full of math. He wrote another book called The Human Use of Humans, which is much more accessible and it presents the concepts of cybernetics in a much less technical way. The amazing thing about it is it also predicts many of the trends that we're seeing now in terms of the dangers of computer-centric society. It's quite an amazing book given that it was written something like 60 years ago. But aside from that, I think the reason it fell out of favor was to some degree because it's too simple and too elegant on a very simple level. I think that part of it is that basically what it's talking about is circular causality. If you really kind of go beyond the surface of just well, we have a thermostat, we want to control the air if we talked about your example of I have an objective and I need to make sure I get to my objective, the real implication of cybernetics is that you're also adjusting your objective. Right? If you look at things like Lean Startup and the whole idea of a pivot, right? Step one of Lean Startup is let's make sure that we're accurately getting where we want to go. But Step 2 of Lean Startup is let's make sure we're trying to get to the right place. That is not exactly a 20th century Western approach to thinking about things. There's been interesting things written about the relationship between cybernetics and systems thinking and more kind of Eastern philosophical approaches. So I think, to be honest to some degree, it just blew people's minds and the world wasn't ready for it. And what I'm seeing now is that maybe the world is starting to get ready for it. It is beginning to be sort of culturally resuscitated again and people are starting to become interested in it again and going, “Oh, maybe there's actually something here.” Jorge: I am very intrigued by this notion of the relationship between systems thinking and Eastern philosophy. You have written very compellingly about this, and I'm wondering if you can delve a bit more on that connection. Jeff: Well, that's a big one. Well, there's… I'll actually refer to a very interesting book by Joanna Macy called General Systems Theory. Now I'm not remembering the name; it's something like Buddhism and General Systems Theory. And she is a system thinking practitioner. She's also a Buddhist teacher and practitioner. And she talks a lot about the Buddhist view of interdependence, which on one level means that the reason that you and I are here now is because of a whole set of things that happen that brought us to this place. You know if if Wiener hadn't thought about feedback systems and if Claude Shannon hadn't figured out how do you transmit feedback reliably in a noisy channel there would be no such thing as information Theory there would be no such thing as computers. There were no such thing as binary logic there would be no such thing as Zoom you and I wouldn't be sitting in different cities talking to each other. So on one level it means that the causality behind what you and I are doing right now is much richer and much larger and much more complex and intertwined and tangled. So to some degree your karma and my karma and Norbert Wiener's and Claude Shannon's karma are all intertwined with each other. On another level and a deeper level what it means is that when I think about myself and who I am that is defined as much by my relationship to you and my relationship to Apple Computer who made the computer that I'm using as it is my idea of who I am internally separate from the world. That this whole idea of you and I and the other things that we see around us is being fundamentally separate from each other is according to Buddhism A) an illusion and B) the cause of suffering — because it is an illusion. So you could say that you caused my experience and I caused your experience as much as each of us causing our own experience. So there is a circularity to how and why things happen, which is a very Buddhist view which comes very much out of an Indian tradition and very compatible with a cybernetic view. Particularly when you go beyond this idea that cybernetics is just about, “How do I control things out there?” and the notion that what it's really about more fundamentally is, “How is it that I dance with this relationship that I have with the world where myself and my environment are creating and driving each other?” Jorge: The image that comes to my mind hearing you describe this, which is an image that I believe comes from the Buddhist tradition, is this notion of the Net of Indra, where there are jewels that are all interconnected and all the jewels reflect the other jewels and you can't intervene in one of them without impacting the others. And in this notion of systems thinking, one of the distinctions I make between that worldview and other approaches is that you're taking in a holistic perspective — as holistic a perspective of the situation as possible — whereas if you contrast it in a more reductionist approach, where we try to divide so we can control. It is a completely different approach, and I'm wondering — just because this subject can get fairly abstract fairly quickly — if there are ways that that impacts your approach both to how you do your work and perhaps the work that you do for clients? Jeff: Very much so. And it actually has very practical down-to-earth ramifications both for IT and also I think for design. One of the things that we've begun to learn in IT is that as we go to the cloud, the systems we manage become more complex. Which means that the parts become more and more intertwined with each other and I think actually the Net of Indra is a wonderful metaphor for that, where it's no longer possible to say, “Well there's a database over here, and there's a network over here, and we have an ERP application over here, and a website over there, and they're all independent from each other, and we can manage them separately.” It doesn't really work anymore; they all impact each other. And one of the practical ramifications of that is that when things break, what we typically try to do is to find the “root cause.” What is the one thing that was the original source of the problem? And in complex systems, you can't actually do that. What you find are contributing causes. That the problem happened because of A and B and C and D coming together. And if any one of them had not happened or happened differently or happened a little slowly or happened at a different time of day either the outage wouldn't have happened or it would have been more or less severe. And this perspective is actually really influenced by work that people have done in industrial safety systems, people who work on things like looking at airplane accidents, nuclear power plant meltdowns, that kind of thing. And they've been discovered for they've come to realization seems like this whole idea of identifying human error — the train conductor, the train driver fell asleep, that's why the train crashed therefore we need to automate the train and get rid of the drivers — that that doesn't actually work. That you need to take a much more holistic perspective on how all of the pieces fit together. Why did the train conductor fall asleep? Well, there are lots of technical reasons, there are political reasons, there are bureaucratic, financial, so on and so forth. And you have to look at them as a whole, and you have to understand that when you fix one thing, you cannot fully predict what changes will ripple through the system. So you might fix one thing a break another, and you there is no way to guarantee that you won't do that. I also think that has very profound implications for design right now, because design is going through this process of grappling with ethics. That we thought Facebook and Twitter would be the most wonderful thing in the world, and what's happening instead or in addition, perhaps, is that they are enabling manipulation of democratic processes and online hate and bullying and so on and so forth. And there's an idea that as designers, you have a responsibility to design systems that don't cause harm. The problem is that what you're trying to design are very, very complex systems and on some level, while it's important to think in terms of doing good and not doing harm, I think you also need to confront the inevitability that you will do harm on some level that there will be unintended consequences. And what's more interesting — and to me where the cybernetic approach comes in — is you could say that doing harm is is a very compelling version of there being a gap between actual and desired, right? We wanted to build a system that would help people collaborate better and instead we built a system that's starting to help people dislike each other more.Let's assume that's going to happen and let's look for it and let's design for it in a much more continuous way. Jorge: We're recording this in the second week of July. And I bring up that that time stamp because next week, we will be celebrating the 50th anniversary of the lunar landing, which in my mind is kind of the apex of big pre-planned projects. People refer to things that are hard to do as moonshots. Hard to do but achievable, right? And because this is happening next week I've been watching documentaries and reading books and listening to podcasts on the subject — I'm just fascinated by it. And one of the things that's come up over and over again is that the people who are a part of that project, many of them have expressed the belief that they would not have been able to successfully land people on the moon if Apollo 1 hadn't catastrophically burned in the launch pad. That accident was kind of a jolt that the program needed to bring up all these flaws that they had not accounted for. And they completely redesigned the command vehicle as a result of that happening. And unfortunately if three astronauts hadn't died in that accident, they probably wouldn't have had the shock to the system that the system needed in order to — pardon my French, to get their asses in gear, basically. Jeff: Well, that's a pretty provocative statement. Jorge: It's not mine. It's… I was very surprised to hear that, but it's a feeling that I've heard expressed several times by these folks that the accident is what actually got them to the Moon. Jeff: So that's a very interesting… It is a provocative statement, whether it's yours or not, and I'll give you a couple of responses to it. The first one is that one of the things that I think is mostly healthy — there is a little misunderstanding — is the whole idea of moving fast and breaking things is being met with new skepticism. Right? My business is predicated on the idea that it's possible to move fast without breaking things. And I teach people how to do that. I think the way that you do that is that you break things in much smaller units and much earlier in the process when it's safer to do it. I am certainly not recommending that doing things where people die as a learning mechanism is a good thing. However, I will go out on a limb. I had some things happen in my life when I was younger, which, looking back, felt like potentially large failures at the time. And when I look at what happened as a result, my life got tremendously better as a result. One of which was that I had cancer when I was 20 years old. I was at college, I'd been having my first year in college was sort of a mess. I'd gotten my act together; I was doing very well. I was very happy. I got very sick. I left college. I went home. I went through chemotherapy treatments — this was back in the early '80s when chemotherapy was really awful — I spent time in the oncology wing of the University of Pennsylvania hospital, watched a lot of people die from leukemia, face the prospect of my own death. It was the best thing that ever happened to me. It gave me a level of sort of resiliency in my life. And it's funny because you know at some point they said, “Okay, you're done with your treatment, you're in remission. Now, you can go on with your life.” Two weeks later, I was back in school. People were kind of freaked out like, “Who is this guy?” And, “He was gone and now he's back. And what does that mean?” But it was a it was a very positive thing for me and one of the things I've learned is that, you know, we have this idea of well, “Fail early, fail fast.” Is it really good? What we really want to do is learn. And it is true that what we really want to do is learn, but I think we have to deal with the fact that one of the ways we learn is by failing. By getting it wrong. Jorge: I hope my comment about the astronauts didn't come across as callous. I don't think that anyone involved in that program, from what I've heard them say, I don't think any of them wished for that to happen, much as what you are relating is an experience that fortunately, I've not had myself but I've read of folks saying, “You know, I almost died and it was the best thing that happened to me.” Because somehow it forces the… It's like a focusing force, right? And you're talking about learning, which as I understand it, an important part of systems thinking and cybernetics, right? This idea that you're adjusting based on feedback. There is implicit in that the idea that the system is somehow modified as a result of of the adjustment. And I'm wondering, just to bring this home to folks, if there are any mechanisms that you yourself use to either formalize that learning or to capture it or to integrate it into your life in a kind of a structured way? Jeff: I think it's a couple of things. One is I like to joke that I should offer a fixed fee consulting service where all I do is walk around your organization and say the same sentence over and over again, which is, “Make your work smaller.” Give yourself more opportunities to get feedback, to learn, to find out that you're wrong in smaller and safer ways. I think the other part of it — and this is one that I think that organizations that are trying to adopt agile and design thinking and DevOps and Lean Startup and so on and so forth really struggle with — is it requires a certain level of trust. Ranulph Glanville, who was a designer and a cyberneticist made a really fascinating comment when he said that the controller is controlled by the control. In other words, if you think you're in charge, if you think you're in control at whatever level, you're really not. And I think that the more that we can let go of thinking that we are and also thinking that we need to be, the more we can discover that we can actually get where we want to go in a way that feels sloppy but can be very efficient. I'll give you a straightforward example from my experience. The first time I worked with an offshore and group doing development, I was told by the US representative as I started the project, he said you have to give them a really good requirements. I said yeah, I'm good at that. I know I'm a good writer blah blah blah. And of course, I was way too busy, so I gave him really lousy requirements. Kind of poetic. And the initial version of the software they gave me was about 70 degrees off from what I wanted and I got really annoyed for about five minutes and then I realized you know, it's my own fault. You know, if you look at the requirements I gave them, you could imagine how they would get the result. So I sent them this long laundry list of everything that was wrong. And 48 hours, they came back with something that was 20 degrees off from what I wanted. So I sent another laundry list, 24 hours later it was about 3 degrees off. In other words, it was really good. And afterwards, I sat back and I thought, “Okay, well, how long did the process take? How much work did it take? And how good was the output?”” And I realized it was really good and it was really fast and it was really efficient. It felt very sloppy at the time but it actually was very precise. And I realized that this was a very powerful way of working and it was really at the heart of what agile was actually about: that you can get where you want to go if you have uncertainty about that in a way that feels very bumpy, but if you can relax into it, it can be extremely effective. I think the relaxing into it is really hard for all of us. Jorge: I agree … Jeff: So if you wanted to say it in a nutshell what cybernetics is about at its deepest heart. I think it's about working in smaller units and relaxing into it. Jorge: I love that Jeff. That's that's actually a great place to to wrap it up. We didn't get to your book, but I do want to call it out: you wrote a fantastic book for O'Reilly called Designing Delivery, which is about these subjects. And I am going to link it in the in the show notes. Where can folks follow up with you? What's the best place to send them to? Jeff: They can find me on Twitter at Jeff Sussna or they can find me on my company website at sussna-associates.com Jorge: Fantastic, so I'm going to include those in the show notes as well. I am thrilled that we had the opportunity to have this conversation. I think it's a very important subject and I hope it's not the last time that you and I get to catch up on this Jeff: Agreed, this has been great. It's been really enjoyable. Thanks a lot. Appreciate it.
Jeff & Will talk about their upcoming trip to New York City for the Romance Writers of America national conference and reveal the news that they will be among the presenters at the RITA Awards ceremony on Friday, July 26. Will reviews The Masterpiece by Bonnie Dee while Jeff reviews a book Bonnie co-wrote with Summer Devon called The Nobleman and the Spy. Jeff interviews Michael Vance Gurley about his new YA steampunk novel Absolute Heart (Infernal Instruments of the Dragon #1). Michael discusses the inspiration behind the story, what he did to build the world it takes place in and what he hopes for the trilogy. He also talks about what's coming up next for him. Complete shownotes for episode 198 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript - Michael Vance Gurley This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Welcome Michael to the podcast, or back to the podcast I should say. Michael: I'm super excited. Thanks for having me Jeff. Jeff: Yeah. We were talking before I hit the record button that we last had you on in Episode 42 and now we are at 198, it's kind of crazy. So like you did the first time we had you on, you've come up with a book that I didn't even know I needed to read when I first got to read it. So you've got this YA book called 'Absolute Heart'. It's the first book in the 'Infernal Instruments of the Dragon' series. Tell everybody what this is about, both the book and the series behind it. Michael: 'Absolute Heart' is above all else a steampunk book. It's an adventure set in a world where clockwork powered England - in 1880s Victorian era England - is at war, a sort of Cold War, when we first pick up the series, against the Magically Powered Ireland who's been kind of besieged by the Brotherhood of the mage. It's a clock. It's a warlock group that is sort of made the queen subservient to them in ways you have to find out when you read it. And it's really the story about two boys. Gavin the high councilman's son from England and his friends, following him when he has these terrible secrets - he thinks they're terrible - and when they're found out he could be executed for them, for at least one of them. So he does what all teenagers do when they have something awful happen and they think they're gonna get trouble, he runs away and his friend, his best friend Landa who's an art officer, which is a mechanic, a computer engineer and she's a powerful female character that I'm really proud of. And she has his back and challenges him and calls him foolish when he's foolish and she goes with him and some other people who have their own agendas on this quest. Then the other side, the Brotherhood, sends Orion of Oberon who is a young warlock of immense power because he's the nephew of the ailing Irish Queen. They send him off to get the most powerful weapon in the world - the dragon stones and there's a lot of mystery and history about the dragon stones and what they are and what they can actually do, but they want them to end this war in their favor. So of course they have a meet cute, or at least I hope people think it's a meet cute. They have to decide like, are they going to get together? Will they/won't they? Of course, there's the will they/won't they thing. I'm really excited about the steampunk adventure and it sets off and is set to be a trilogy so I'm really excited about that, and hopefully people will like it - the inclusion of fairies and the air steamships and all the wonder that is steampunk. Jeff: Steampunk it's so not really anything I read... I dabble in it periodically, but something about Gavin and Orion and the bad ass friend you gave Gavin. Full disclosure to the listeners, I read a very early draft of this. You have a lot going on in book one, what you've parroted back now, into a more condensed story, but how did all this coalesce and come together and what was the inspiration? Michael: You really should pat yourself on the back because your viewers should know that you read an early ARC and gave me notes, and edited, and really kind of dissected it for me - like, wherever it was messy you, like a good editor said, "That's messy." The research starts with reading steam punk books and reading a lots of YA, which is of course a terrible addiction of mine. In reading all of that steampunk and finding those characters that you like, and you want to write about - because I use Scrivener, you have the photo option to put your vision of the characters, the places, the ships - you put photos in there and I work with a split screen so I can always reference that, so I never really lose track of it. But yeah, it was great looking into all that steampunk stuff and going into like Cassandra Claire's 'Clockwork Angels' series or Scott Westerfield's 'Leviathan' series. And if I can get even a little bit of that spirit I'll be really happy. But it starts with loving steampunk. You really should write what you know and write what you love. I've never been an airship captain but I love reading about them and I love that whole idea. And you know, thinking about like 'Leviathan', that series has a powerful gender bending quality to it, with the girl because she has to, dresses like a boy and acts like a boy in order to have a career - and I love that. I hope I've engendered Landa with that a little bit as well. Jeff: What went into creating your world of magic in Ireland and steam power and clockwork in England, because there's so much that you can pull from to create the steampunk universe. What was your decision to make these things your universe? Michael: Steampunk is - one of the amazing things about it is, an amazing thing about worldbuilding as well, is you can go with historical fiction. You know, like my first book and it's wonderfully creative but you're also stuck with... you can't lie. It's historical fiction, you can make up characters and you can make up some things, but really if you get too far away from reality, people stop believing in what you're writing about with historical fiction. At least I think so. I stuck with the roaring 20s pretty well and that kind of thing. Steampunk is like a little bit to where you're in the 1880s Victorian era. But then you have these advances and you can get creative and wild and all of that. A lot of that came from traveling for me too, like I've traveled to Ireland and I kissed the Blarney Stone, which of course means I'm full of B.S. I guess, the gift gab you know. And then I went to England and I went to Stonehenge and I played around amongst all of the hinges there, because that's where they keep them, and how a lot of fun. And the idea of the magic stones and power and Irish magic and castles - and then of course the troubles with the war between Northern Ireland and England - and I just rolled that back 40 years or so, and brought all that magic and the Stones and the power, I brought all that together and that's really where the idea came from. I also wrote a comic book like 20 years ago that had a lot of the fantasy stuff in it and it never got published but I tweaked it and changed it throughout the years. You can almost say that this part of this book- the backstory, the fantasy magic side - is about 20 years in the making, which I guess makes this a labor of love. Jeff: That's very cool that it goes back quite that far. Michael: Makes me feel old saying it out loud. Jeff: You could have had the idea when you were 5 or 6. What do we have to look forward to as the as the trilogy progresses - without obviously spoiling anything necessarily - but what can you kind of hint at about the story arc? Michael: Well, you know I'm a big fan of sci-fi, and Steampunk is really an offshoot of sci-fi in a way, or vice versa I guess. But, you know 'Star Wars' originally was 'Star Wars' and then they added 'A New Hope' to the title when they were like, "Well, you know Darth Vader is still out there." I mean, you know they gave Luke and Han Solo some medals. But, you know, then you get Darth Vader out there. So I love that idea of there's always more. If you look for it, if you see the little bits, like there's actually Darth Vader and an emperor... we're still at war guys, so come back for 'Empire', and guess what, it's going to get darker and worse and that's really kind of what's happening here - the book sort of gives you an ending but - and I think so does every book [in the series]. It has an ending, but it really isn't. If you're reading it, you know there's a lot more that's about to come down, and we might lose some people along the way, and maybe find some new people that you love, who's together might not always be together. Jeff: So with everything, between the magic and the clockwork and the steam and everything, your story, your book bible for this must be huge. Michael: I used this great British author named Ellen Gregory who did some high seas adventure, and she read an early Edit 2 and gave me some criticisms - which I kept calling British-isms - and gave me some pointers in that, and we were joking about that too, that I have one hundred pages on the parts of a ship... hundreds of pages and you could just bore people to death writing about that. It's like giving that little bit to make it believable, and make it feel fantastic or whatever, and then let it go. And then I just use that incredible knowledge about mid ships and jibs at parties. I can talk about all that stuff at a party now, but you don't put too much worldbuilding in, but it is fun. I do have lots of stuff, like when I'm writing, there's fairies in the book and I did so much research about Oberon, the king of the fairies and all that history. And then my amazing editor Dawn Johnson at Dreamspinner/Harmony Ink - I mean the whole team has been amazing, and each person has challenged me. Which is really part of the deal, you have to kill your darlings right? You have to allow some of your characters to change with some of the professional feedback. And so, anyway, I was able to use that research and pull it in and I still miss stuff, and some of those editors were like, "Hey, you know the name of that person? Shouldn't it be this, for this reason historically?" I'm like, "Yep, I don't know what I was thinking." You know, And so it really takes a village, you know. Jeff: What do you hope people get out of this book? Michael: What I'm hoping to get out of it is enough people interested to get a whole trilogy out of it and to get an audio book. I really want to hear this story come alive - the swashbuckling adventure come alive. I hope people get entertainment out of it. I hope they feel empowered and maybe challenged on their beliefs a little bit, which is, you know, a lofty goal. And it sounds like hubris to say it, but I hope people read it and see the LGBTQ+ world is just like everything else. It's steeped in mystery, and history, and great characters with amazing depth, capable of heroic acts and terrible evils, and everything in between. You know, some people will write a character and be afraid to make the gay character or the trans character do something horrible, but that's wrong. They have to do everything that everyone else does in order to make it real. And so I'm hoping people will forgive me if I do something horrible to a character, or make them do something terribly wicked... you know, mustache twirling - and not, of course, hate the straight characters that do bad things as well. Jeff: Right. Now, you kept a lot of this book in your family, in some ways too, because your husband Jason Buren did the cover and interior art - and the cover is gorgeous. Michael: Thank you. I love the art. Jeff: How did he come to get involved in it an what was it like collaborating with him on those elements? Michael: Well, Jason's an amazing artist and graphic designer. We actually worked on the first one together and we worked on comic books together and what I realized through it - honestly working with Dawn and the great editors, kind of makes you realize some things - you have to back up and state your vision. Say what you want. Show covers of things you like, and things you don't like, and then not micromanage it. Because then what you're going to get is my artistry, which I'm a writer you know, not technically a graphic artist. So you really get your best work if you let the artist kind of figure it out and that's what happened. I let go of the reins of both books and I think that the covers are amazing, if I do say so myself. I think this cover is so exactly what I wanted to be, and I was unable to say it out loud. And that's what a good artist should do in the interiors too. I wanted so badly to have chapter art and I know that people don't have to let you do stuff like that, but [my publisher] Dreamspinner was so amazing. I pitched this idea of clockwork meets fantasy with the Dragon Wing and the clockwork gears together So I'm so excited to show some of that together with the dragon wings with the mixture. Anyway I'm so excited and geek about it. I even got a little gears as text breaks in the art, in the books, it's really fun. It's really gorgeous. But you, know let go and see what happens. That's the idea. Jeff: When you were here in Episode 42, we were talking about a historical m/m hockey romance called 'The Long Season'. This is a total departure. Unless you can talk about the fact that you're dealing with historical times. Had you always seen in your career switching genres so completely? Michael: You know that's a great question. I want to challenge myself to do something completely different every time. And so, like being a new writer, writing historical fiction was crazy. That's too much to take on. I said, "Well, whatever. It's a labor of love, you know?" So then for my second novel, a trilogy? Themed like science fiction? Like, "Oh you're crazy, that's too much. You're not going to handle it." And who knows what we'll see. The first one got picked up, thank you Dreamspinner and I'm super excited about it. I want to challenge myself and I love that genre. So I say, let's do something completely different. People ask me about doing a sequel of 'The Long Season'. We're doing another hockey book. You know, I'm really proud of the fact that I wrote a character, Maggie in 'The Long Season' who was Brett's best friend. Turns out Bret's best friend started off with John Paul, which I'm really proud that people want a Maggie story and I think that's amazing. Who knows when that might happen. I might do that. My grandmother certainly, when she read it before she passed away, she said it can't end here and she's right... another story. And I did all that roaring 20s research... who knows, I might go back, but I want to challenge myself to do something different. I could write another hockey book because I love it and I love the whole romance side of it and who knows. Jeff: I was thinking you need to find a way to introduce hockey into the Infernal Instruments universe. Michael: I mean, there might be some sports related in there a little bit, but like medieval hockey? That would be fun. I mean the 1880s isn't too far away from Lord Stanley, so they could theoretically run into Lord Stanley somewhere. You know that can happen. Good idea. Jeff: Do you foresee more in this universe, potentially if the if the trilogy works out and is successful? Michael: Yeah. I mean, you know, I think it's set up perfectly for a TV show. That's huge right. But I've even thought about - I have a friend who's a game designer and I even thought about... man, that would be amazing. That whole steampunk idea is a huge world and you'll see in book two, the world's even bigger than you see in book one because it's a world at war. It's a world half conquered by clockwork powered England and half conquered by magic powered Ireland. So everywhere you go France, and Germany, and Africa, and potentially the United States. Are they even the United States? It's a huge world, so the stories could go anywhere. You know I think of like, Gideon Smith books. 'Gideon Smith and the Mechanical Girl' I think the first is called. They, at some point, they end up in an airship going to the United States, and the Wild West, and Egypt, and all kinds of things. Steampunk is open. Jeff: I hope that just keeps going and expanding. So what's coming up next for you? Are you done with book two or are still writing on the trilogy ,and can you look beyond this first trilogy? What's next? Michael: Well, interestingly enough, it goes back to your last question. Books two and three, the trilogy, has a beginning, middle, and end in my head. Of course there could be more after that, much like 'The Long Season', but in my mind I've already started about halfway through writing a third completely different genre book, challenging myself with something completely different, which is a contemporary YA book built on my travels to Antarctica. So it's a YA, two young people who meet and fall in love on a cruise to Antarctica. Sort of a travelog and what happens, and the interesting things, and people, and penguins that they see. I won't give away too much, meaning - that's what I'm in the middle of now. Jeff: That's exciting. A little something new there. Again, totally disparate, but you mentioned what you want to keep mixing it up. Michael: So yeah. And we'll see how that works out. I'm working with a gender nonconforming character, which is really new for me, it's taken lots of research to get intersectionality in the forefront of the book, you know not as a ploy, but as a reality of the world that we live in, and people that need representation. So I'm really excited about that. Jeff: Hurry up and write that please. Michael: All right. Hopefully, if you're willing, you'll probably see it before anybody else as a proofreader. Jeff: What's the best way for folks to keep up with you online, to keep up is as 'Infernal Instruments' continues and this new contemporary book starts to take shape? Michael: If they go to my full name - MichaelVanceGurley.com. Go on there and there'll be links to my two book sites and to my Instagram, they can go to Captain Rhetoric on Instagram and find me, that's where I write self-involved book reviews where hopefully people care about what I think about these amazing books that I read, and travel pictures, and just little bits like that, not too much of me, just sort of what I see about the world. I like to do that on Instagram and that's the best way to keep up with me. Jeff: Well I wish you the best of success with 'Absolute Heart'. It's been great to talk to you a little bit about it. And when that contemporary is done you'll have to come on back. Book Reviews Here's the text of this week's book reviews: The Masterpiece by Bonnie Dee. Reviewed by Will.The Masterpiece by Bonnie Dee is a makeover story with Pygmalionthemes in a historical setting. Essentially, an irresistible gay version of My Fair Lady. The story centers on a guy named Arthur. He is the well-to-do gentleman in this particular scenario and, one day, he's out enjoying the good life with his bestie, a guy named Granville. Occasionally Arthur calls Granville, “Granny” and it totally cracked me up. Granville believes very heavily in the British class system. Arthur is a little more modern in views. He feels that if a man has the wherewithal and can pull himself up by his bootstraps, he can achieve anything with his life, no matter where he was born on the ladder of social hierarchy. In order to prove their different theories, they set a wager, and that bet involves Joe the shoeshine boy. Arthur must make Joe a gentleman in six weeks. It is there that he will make his debut at the biggest party of the social season. Joe moves in with Arthur who is very glad that to realize that Joe is not only very smart and very kind, he is hardworking and interested in bettering himself. Joe is undertaking this particular makeover because he has dreams of owning his own men's shop one day - with a focus on finely crafted shoes. They get down to work and, after spending several days studying and learning which fork to use, they decide to get some fresh air. So they go for a constitutional in the park where they unfortunately run into Granville, who's like escorting some demure young ladies. Joe does very in his first unexpected like test. Arthur and Joe now realize that they have definite feelings for one another. Their next test comes during an evening at the theater where they unfortunately run into Granville yet again (this dude's everywhere). Granville has befriended a professor of linguistics, and Arthur knows that Granville is only befriending this schlub because he plans on bringing the linguist to the party to expose Joe as some sort of lower-class fraud. Joe handles the situation admirably. He's proving himself time and time again, but Granny is not going to give up. He makes sure that Arthur's family is invited to the big soiree, and his family comes to stay, making it nearly impossible to have any alone time with Joe. Finally, the big evening arrives and everything goes swimmingly. Joe is tested but everyone is really charmed and quite taken by him. When it comes to Pygmalionstories there is usually a point in the narrative where the Eliza Doolittle character has to wonder if the professor is in love with her, or the person that she's pretending to be. We kind of skip over that in this particular story because it's really obvious that Arthur and Joe are like completely into one another. What ends up happening is that Joe feels guilty, his conscious getting the better of him. All these lords and ladies and debutantes are remarkably kind to him, and he feels genuinely bad that he's pulling the wool over their eyes. That guilt eventually leads him to leave Arthur's house sooner, rather than later. Arthur and Joe try to figure out how can they make their relationship work, but they can’t. Even though they've essentially won the bet and they've proven their point, the fact is that the class system is still very much a thing and the two of them are from two different worlds. Joe packs his bags and leaves and Arthur ends up going to India. He has been convinced by his brother and his father that he has to finally grow up and take part in the family business. While he's away, Joe uses the money that he earns from the bet and opens his own shop. When Arthur finally arrives back in England, there's a big declaration of love scene because they realize they are both utterly and completely miserable without one another. And they both vow to find some way that they're going to make it work. I really, really loved this book an awful lot. I loved these two characters that Bonnie Dee created I was rooting for them the entire time. The Nobleman and the Spy by Bonnie Dee & Summer Devon. Reviewed by Jeff & Will.Jeff: Bonnie and Summer are both new to me authors. The Nobleman and the Spy, which I would call a second-chance romantic suspense historical, was a complete delight full of intrigue and some steaming hot sex. Solider-turned-British spy Jonathan Reese is assigned to keep watch over German Karl von Binder. Jonathan knows Karl all too well because during the war Karl spared Jonathan’s life. It doesn’t take much for Jonathan to lose focus on his mission and pay attention to the man who has come back into his life. He’s also aware that he cares too much for Karl to allow anything to happen to him, despite the fact that his orders as the mission begins are a bit mixed if he should allow the man to be killed or not. Karl, despite the forbidden attraction to Jonathan, tries to keep the spy at length, sure that he can protect himself. As evidence piles up though that there’s someone on Karl’s trail, the two end up working together trying to figure out who’s behind it. It’s a tangled web that I didn’t quite believe even as it was all falling into place. The resolution was certainly something I’d never anticipated as I tried to solve it as I read along. It was quite a thrill. I loved the feel of this book. In often reminded me of a childhood favorite TV show, Wild Wild West, which was set in the same time period of the mid 1860s. While this isn’t set in the American west with some strange characters as villains, the time period comes through loud and clear in a rich setting and how the characters carry themselves. I also liked how Karl and Jonathan recognized that they couldn't give in to their attraction but the more they couldn't give into it the more they really want to. And then when they got together it was so intense. Narrator Todd Scott I have to say does a terrific job with the entire story but the sex scenes…off the charts! Will: What really struck me and what I enjoyed the most is that it's essentially a bodyguard trope and it has all the different things that go along with that but in a historical setting. So it was sexy and it was fun and there's lots of adventure and action. I really enjoyed this one as well. Jeff: Calling out the bodyguard trope is really appropriate. But what makes it a little different, at least to me, is that Karl doesn't really want to be guarded. But Jonathan certainly takes that role because he keeps reinserting himself even where he's taken off the case. He wants to keep Karl safe at all costs. So, yes, we both highly recommend The Nobleman and the Spy by Bonnie Dee and Summer Devon.
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So, you are pretty in tune with global warming. You are pretty in tune with the environment - conscious, environmentally conscious. What do you do to do your part for help protecting the environment?Tim: Yeah, well, I think I do quite a bit. I grew up in an area that's really environmentally conscious. Oregon is pretty environmentally conscious, so I recycle. It's pretty easy to recycle in Oregon. They just pick it right up at your house. You don't have to separate it. They separate it for you, so I recycle as much as I possibly can.Jeff: But maybe those are traditional things. Do you do anything sort of more advanced or more modern than just recycling? Is there anything in your life that's more modern?Tim: Well, one thing: I recently bought a hybrid car.Jeff: A hybrid car.Tim: Yeah.Jeff: What's a hybrid car?Tim: So it is a car that basically gets better gas mileage cause what my car does is I have to put gas in it. I have to put gas in it but when I break it takes the energy created by the heat from the breaking and it charges the battery, and then the battery can help power the car, so it's half gasoline, half - just electric energy from the battery.Jeff: Really. Electric and gas.Tim: Yeah.Jeff: Really interesting. So do you have to charge the car at night? Do you have to plug it in or anything like that?Tim: No, my car just by breaking it charges the battery completely. Occasionally, I've heard of some people that if they leave their car for like a year or something they have to go back and they'll have to plug in the battery and it will charge up, but for the most part, I don't have to do very much at all.Jeff: So that is a fancy watch you're wearing as well. Is that environmentally friendly at all?Tim: Oh, yeah. This watch actually doesn't take batteries. It's solar powered and so it just gets energy from the sun.Jeff: Wow. So you pretty environmentally conscious dude.Tim: I try.
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So you do winter camping and the place you live, do you get a lot of snow there?Tim: We get quite a bit of snow but it's mostly just up in the mountains.Jeff: So, lately there's been a lot of talk about global warming. So where you live, do you find that you can see the effects global warming, say with less snow?Tim: I think you can. I think there's been less snow. That is not quite as noticeable as the glaciers that are on the mountains have gotten smaller and smaller, so I think there has been less snow although it's not really noticeable cause ski resorts are still open and there's still snow out there but to snowshoe but every summer the glaciers seem to be getting smaller and smaller.Jeff: So you are about - what - 35 now?Tim: Ah, younger than that actually.Jeff: Really. So in your thirties, but when you were a boy, when you were young like 5 or 6 and you were playing in the snow, was there more snow back then?Tim: I think there probably was. One thing is - I told you the snow is in the mountain - and there used to be a lot more snow in the valley where I live and I can't remember the last time we got snow in the valley.Jeff: Really! So global warming, you think maybe is getting worse?Tim: I would say so. I think one of the biggest effects is we seem to be getting more rain actually. The weather patterns have switched a little bit and it seems like it's been dumping rain. There's been more flooding, so we're actually getting more rain and less snow.Jeff: Oh, really. OK. Interesting.
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So, you do winter sports?Tim: Ah, yeah, really, I just do snowshoeing and cross-country skiing.Jeff: Snowshoeing!Tim: Yeah.Jeff: That sounds interesting. What snowshoe? Is that like a boot?Tim: Well, it's kind of hard to explain but it's kind of like a big - I don't know how you would say it - kind of like a big paddle that you strap on to your boot. You have a regular boot, your good boots and then you put a big flat kind of round thing on the bottom of your shoe.Jeff: What's it made of?Tim: Well, it is made out of kind of webbing. It's made out of webbing and basically, it spreads out your weight so that you can walk on snow, cause if you don't have them and you just have your regular boots you're gonna fall into the snow, so it distributes your weight out onto the snow.Jeff: So are they heavy?Tim: They can be, but like a long time ago they used to have huge ones that were made out of like skins and stuff like that from seals but now they're pretty light. They're made out of metals and good materials so they are pretty light now.Jeff: Are they expensive?Tim: They can be, but not too bad and you can rent them probably almost anywhere.Jeff: And how deep is the snow when you're walking with snowshoes? How deep is the snow?Tim: Well, it depends on how much it snowed really. You know it can be really really deep: something that is going to cover up a car, or it can be barely deep at all. Like I've taken snowshoes out on my pack - I was hiking Yosemite and we hiked up and there wasn't any snow at first as we got, there was more and more and then it got to the point where we were sinking in the snow and it was time to put on the snowshoes.Jeff: So, they're not heavy. Do your legs get very tired when you are walking in snowshoes?Tim: Not too bad really unless sometimes the snow isn't really dry. It's really wet snow and sometimes it will kind of clump on the snowshoes and then the snow will make it really, really heavy, so you got to knock them off and that can get really heavy and your legs can get tired.Jeff: And how do you put them on? How do you attach them to your boots or?Tim: Well, you just lay them down and they're some straps on them and you just put the straps on pull them tight. It's a lot like snowboarding really except you don't have click on boots. They're some straps you just pull on.Jeff: Cool. It sounds pretty cool.Tim: Yeah, it is not bad.
Jeff talks about going to the reading and Q&A for Frederick Smith and Chaz Lamar's In Case You Forgot. The guys also talk about their recent trip to see the musical The Drowsy Chaperone starring Bruce Vilanch. It's a Heidi Cullinan double feature this week as Will reviews Nowhere Ranch and Jeff reviews The Doctor's Secret. Jeff talks with Jacqui Greig, the creator and editor of Blush magazine. Jacqui talks about why she created the magazine and what sparked her love of all things romance. We also find out about the books that she writes and how she encourages anyone who is interested to start an online magazine. Complete shownotes for episode 197 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript – Jacqui Greig This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Thanks for coming to the podcast Jacqui it is so great to have you here. Jacqui: My absolute pleasure. Jeff: So Will and I have loved “Blush” since the first issue came out and. Jacqui: Thank you. Jeff: I love what one of the things on the website that talks about you where it says “I may or may not have started this publication and in order to fangirl my favorite authors without getting slapped with a restraining order.” Jacqui: Pretty much. Jeff: Which sounds so awesome. It’s like a mission statement. Jacqui: But it’s so true. I used to finish reading a book and then I just I loved it so much that I wanted to be best friends with the author. I wanted to know everything about them. I just you know wanted to delve into their heads I guess. And that’s kind of what “Blush” lets me do. Yeah without getting hit with a restraining order. Jeff: We feel the same way about the podcast it’s so great to just dive in with these folks. Jacqui: Yeah absolutely. Jeff: Tell us a little bit for our listeners who may not have discovered blush yet. What is the magazine kind of all about besides obviously of course romance books? Jacqui: So essentially, it’s an online magazine for romance readers. So I just wanted something that was specific for people who read romance and there’s already so many amazing blogs and podcasts that I just thought a magazine would be a fun way of getting that information across. And yeah. So it’s kind of interviewing authors, looking at the different books that are coming out at the moment, the different trends in the industry. I’m calling it an online digital platform. There’s even things like I imagine what a particular heroine in a book would wear. And I based a fashion page on that. So it’s just kind of interpreting the romance genre in different ways. Jeff: It really is because you go so much further than a Book Review blog or like what we do on the podcast because you do have, as you mentioned, the fashion thing or I believe in June it was the ‘book crush’ with Jamie Frazier which everybody can have that crush, right? Jacqui: Right? Jeff: There are elements of reviews that work their way in, but then you do some dives on the industry too, or talking about tropes and such. Jacqui: Yeah. I think that’s probably my background in journalism as well. I used to work on magazine in Sydney. I worked in a travel magazine and on a hair magazine of all things. And then I started my own magazine, a women’s lifestyle magazine, which was print – that was more than 10 years ago now. So the industry has evolved so much since then and it’s so much easier to do a digital magazine than it is a print magazine. Yes. So I just thought I’d give it a go. Jeff: How do you decide what goes in to each issue. Because there’s so many things to pick from. Jacqui: I know there’s so many things to pick from and it’s actually been a little – it’s getting easier every month because the magazine is getting more widely known and people are actually messaging me, emailing me, then giving me content ideas, which is fantastic, but it’s just whatever I like. Yeah. I don’t know. Whatever I’ve been reading or what I’ve seen or I am quite big on Instagram I get a lot of inspiration there. Jeff: Yeah. And I enjoy watching your Instagram just because it’s so creative. Jacqui: I’m a graphic designer as well so I see lots of cheeky quotes and things like that and I just redesigned them for my own purposes which is fun. Jeff: Your July issue will have been out a short time by the time this episode airs. What can readers find in July? Jacqui: So I’m super excited. In July I have three authors that I definitely fangirl over. So I’ve got Eve Dangerfield. I’ve got an interview with her. I have an interview with Sarah MacLean and an interview with Abbi Glines. Jeff: Wow. Three of them are all in the same issue. Jacqui: Yeah, well in my very first issue I had Beverly Jenkins and Kylie Scott and I thought, “Right, I’m happy to finish this right now. I’ve reached my peak.” That was epic for me. I think romance authors are so generous with their time and knowledge and it’s just such a beautiful, interesting industry to be in. Jeff: Yeah, it really is because there’s so many warm people who are just happy to tell their story and tell everybody about their books. What are the regular sections that readers look for each month? Jacqui: So I generally start with a ‘Lust-Haves’, which is just kind of products/bookish things that basically I would like to be spending my money on. I think in one issue I had a pair of cashmere socks that were like one hundred and ten dollars and I had a girlfriend calling me, she said, “You didn’t buy those, did you?” I didn’t. I’d like to. So yeah, we did ‘Lust-Haves’, we do an IG profile. I pick an Instagram account that’s really inspiring and has gorgeous images and profile them. We’ve got our author interviews. I generally have a couple of features. So for example, in the current issue we did one on the rise of rural romance. So it’s basically Australian authors writing romance set in rural settings… on farms which is really lovely. I live in a small country town myself, so I can really identify with that. We do a ‘Book Crush’ every issue. So that’s just a hero that we’ve got a bit of a crush on at the time and it’s really fun to contact the author and find out what they had in mind when they were writing that character. I get them to share their Pinterest pages with inspiration that they drew when writing, which I love. And there’s a bookshelf at the back, which features a lot of books, and it’s a really great showcase for indie authors I think. So yeah, that’s kind of it. Jeff: You say that’s kind of it, but that’s a lot. I mean, there’s a lot of stuff that goes into these issues. What kind of overall timing and process goes into creating a single issue? Jacqui: Well, having done in my previous life the print lifestyle magazine that was a whole circus. So I had staff and we had an office and because that I was spending forty thousand dollars an issue just to print it. So it was big. Right. So because [Blush] is digital – it’s online – my overheads are tiny, it’s literally me sitting at my kitchen table and, I have I don’t have it here, but I literally designed up on an A3 bit of paper for weeks and split it into the days and split the jobs across it and I laminated it so that I can write over the top of it – every issue. And it’s actually not too involved I think because I know what I’m doing. And I love what I’m doing. And I think as a working mother you become… I just have to get shit done. Like I just, I’ve got no windows in between kids being at school or ballet lessons or you know all of that kind of jazz. I just have to really, really be productive with my time and bang it out. Jeff: And I think the online magazine in a lot of ways gives you a much broader design to work with than if you were locked in to any kind of website format. Jacqui: Yeah, I think it’s fun because you can flip through the pages. It kind of it feels interactive and you can, you know, I can put gifs onto the pages so there’s movement, there’s different animations that you can use. And it’s just readers really like the tactile experience of a physical magazine. And because I can’t do that, I think a digital magazine – it is still something different from a blog post and not to say that, you know, there’s some fantastic blogs out there, but this is just a different format. Jeff: Yeah, it’s a different medium, but it’s going to be interesting, I think to see if other people move in that direction. I think we’re all so used to seeing blogs that this is another similar but different way to go. Jacqui: Yeah, it’s just a bit fun, little bit different. Jeff: July is also kind of a milestone for you because it’s six months old for the magazine – issue number six. What’s your favorite thing to write about so far in those six months? Jacqui: I think the interview with Beverly Jenkins, that was kind of amazing. She’s an icon in the industry and she’s so generous and I couldn’t believe that she’s giving me the time of the day, especially because I hadn’t published a magazine by that stage. I literally had nothing to show her. She just kind of said, “Yeah sure.” So that was really incredible. I do freelance digital marketing, which I’ve just stopped, and I’m focusing all my energy on ‘Blush’ because I really want to give it a go. I felt like I was building other people’s dreams, helping them build their dreams and I wasn’t really putting any time into my own. So yeah, I’m kind of all in with this. I got skin in the game now. Jeff: That’s awesome. It’s a good feeling. Jacqui: Yeah, it really is. And I do need to say my husband is super supportive and I’m very lucky. But yeah, like this is my gig now. Jeff: What’s surprised you over the six months. Jacqui: I don’t know if it was surprise. It was probably just reinforced how wide and how deep this romance genre is and how amazing it is. I mean, if Alexa Riley can beat Michelle Obama in the rankings on Amazon, that’s huge. Jeff: And you’re right about the romance genre being so big. I have found, so far, that you try to cover seemingly all of it. You’ve featured all kinds of romance including LGBTQ romance. Jacqui: Well, that’s a that’s a big sector and it’s valid and I know that, especially in the states, you’ve been having a lot of diversity talk at the moment – and so you should. ‘Blush’ is a vehicle for the romance industry and I want it to encompass all aspects of that. Jeff: And we talked a little bit before we started recording that it was ‘Blush’ that first put ‘Red, White & Royal Blue’ on our radar as the thing we needed to watch out for in the spring. Jacqui: Well, I’m sure you hadn’t seen it with me, you would have seen it very soon because it has been so well received and validly So like she’s amazing, Casey’s [McQuiston] she’s going places. Jeff: Yeah, absolutely. What got you into romance? Jacqui: So my parents owned a newsagent when I was younger. And romance novels were distributed by magazine companies, which meant that if they didn’t sell, it was cheaper to rip the cover off and throw it out than it was to send it back to the company. So I used to scavenge through the back bin and I just fell into it. I read to my heart’s content. The only problem was, that because it didn’t have a cover, I knew the title, but without that image on the top on the cover and the title, I can’t remember any of them. And probably I was reading so many of them, I was just kind of consuming them. But yes, so that’s how I got into it – scavenging. Jeff: That is awesome. What a great way to get books. Jacqui: I know right. I mean it’s so demoralizing and awful for an author to think about – that’s how some of your books may end up. I don’t know if that’s still the practice – I would hope not. But yeah, that’s back when I was 12 or 13. That’s how we did it. Jeff: On the other hand, I mean how terrific that it must be – Yes, they didn’t get paid for – but they inspired somebody to go out and create something like this later in life. Jacqui: Well that’s true. That’s a really nice way of looking at it. Oh, thank you. Jeff: You can’t remember some of the titles and authors obviously, but do you remember what tropes and what sort of elements of the story fueled your interest in the genre? Jacqui: I read a lot of the historicals, which I loved. But I kind of stopped reading for a while – going through high school and then university – and got back into it with Kylie Scott, who’s an Australian author who wrote a romance in a zombie apocalypse, which is very far removed from historical romance, but freaking awesome. She wrote two books and a novella and then found mainstream success with her Rockstar romances. But she kind of got me back into reading romance, her and Amy Andrews who is another Australian author. She’s got a ‘Sydney Smoke’ rugby series, which is a series of books set around a rugby team in Sydney and she just has the dialogue down pat, like she is so dynamic with her writing. Yeah, she is really, really incredible. I think those two got the ball rolling to get me back into it and now I don’t really have a favorite trope or a favorite genre. I will literally read anything you put in front of me. I will read it. Jeff: That’s awesome. I’m kind of the same way. Will has is his thing where he likes contemporary/low angst – may take a few diversions off that path… But if I like the blurb, I’m at least game to see where it goes. Jacqui: Exactly. Yep. I’m with you. Jeff: Now, since we are an LGBTQ romance podcast, what are some of your recent reads, kind of in that genre. Jacqui: So what I’ve really loved is that some of my favorite authors are diversifying. I guess they’re going into that queer space. So Kate Canterbury, she wrote The Walsh series – which I devoured I loved – and then it’s an offshoot. There’s a lobster fisherman who marries Aaron and Nick in book 6. And So the lobster fisherman he gets his own book and he falls in love with a tech tycoon. And honestly it was one of the hottest romances I’ve ever read. Like it was. She nailed it. And that was her first male/male book. And I just went, “Oh wow, you’ve done such a good job.” Also Tessa Bailey she wrote a male/male. What’s it called… I wrote it down. ‘Heat Stroke’. She wrote ‘Heat Stroke’ which is just really sweet. And the relationship between the two men, it was so believable and she’s really good at characterization. She’s fantastic, but my absolute favorite of mine is Sierra Simone, who wrote the ‘Camelot’ series. So it starts with ‘American Queen’ goes to ‘American Prince’ and I actually haven’t read the third one because I got a spoiler and I don’t have the emotional fortitude at the moment. Jeff: I understand how that it goes. Jacqui: But she just writes… So it’s a male/female/male, but the two guys, they’ve been in love for so long before Greer, the woman, actually comes into it and just the depth of their love for each other. And she’s, I mean, it’s kind of filthy – the writing, but awesome. It’s emotional and it’s just, yes, she’s fantastic. Jeff: Since you look at romance really from around the world for ‘Blush’, because you’re in Australia and have read so many Australian authors, do you see a difference of what romance is around the world – what gets written into the books from the native authors? Jacqui: I think that a lot of Australian authors are actually setting their books in the US. I don’t know if that’s a marketing thing or if that’s just what they read and that’s what they want to write, but then there’s a whole crop of Australian authors who are writing rural romance, which is set on an Australian farm as opposed to an American ranch. So you know there are differences in words I guess. I don’t know. Apart from that though, I kind of think everyone’s just writing their own happily ever after. And it’s and in different ways, using different tropes, different locations. I do wish that there were more Indigenous Australians writing romance novels. I think that would be amazing. There are some amazing Indigenous authors, just not so many writing romance, so that that would be really incredible to see. I actually am writing as well. I’m sure everyone who reads is trying to write as well. So I’ve just published my second book, but I would like to co-author a book with… I grew up in a small country town with a high indigenous Aboriginal population. So I went to school with all of these Aboriginal girls and I need to make contact with them and see if one of them will sit down with me and co-write a book, a romance from their point of view. I think that would be amazing. I don’t think that I would have the guts, I guess, to write from that point of view, even if I had a sensitivity reader come in and read it afterwards. I really do think that their issues and their worldviews and, you know, they have their differences and you’ve got to do justice to that. Jeff: So what do you write? Tell us a little bit about your books. Jacqui: Well my full name is Jacqueline, and my maiden name is Hayley, so they’ve written under Jacqueline Hayley. And second, which literally I published yesterday, it’s ‘Getting Under Her Skin’, and it’s set in Sydney. So they’re contemporary romances that are a little bit sexy, I don’t think I really want my mum reading them. Jeff: Yeah that’s awesome. Any chance of a male/male book in your future? Jacqui: Yeah, I think So but I think that, again, I would want to team up with a gay male author to help me do that. Like, I just I don’t want to presume that I would know their life experiences. So I think that would be super fun. Jeff: I hope you get to do that. We’d have to have you back on the show to talk about that when it comes out. Jacqui: Absolutely. Jeff: What can you tell us about upcoming issues [of ‘Blush’] for the rest of this year? Jacqui: Oh, the rest of this year. So I’m actually heading to the Australian Romance Writers Association, their annual conference is in Melbourne, and I have lined up some authors that I’m going to do video interviews with as bonus content for my readers. So we’re just finalizing the details of that, but I do think that video, which can be embedded into the magazine – in the magazine we also find YouTube clips and things as well, the digital magazine format allows for that, which I think is really fun. The video will start to become a little bit more of a thing with the magazine, as much as I don’t really want to see myself on video, I think that it would be really fun for authors, who are normally behind the pen – behind the computer – and you don’t see their faces or hear them. I think that that would be a really fun thing to do. Jeff: Very much looking forward to that. It’s great seeing how the video gets in there to really make this interactive magazine. What’s the best way for people to keep up with ‘Blush’ online and how do they get the subscription? Tell us all about that. Jacqui: So at the moment, to be able to read the magazine, you have to head to the website which is blushmagazine.com and sign up with your email address. So it’s free. And then the magazine gets emailed to you, well a link to the magazine gets sent to you, so that you can view the magazine. Previous issues are available on the website, so you can you can click through there, but probably I’ most prolific on Instagram. That’s kind of where that’s my jam. That’s what I like doing. So you know, for cheeky quotes and books that are coming up, all the behind the scenes of what I’m doing here, that’s Instagram, is where it’s at. Jeff: Very cool, and can readers of the magazine get in touch and suggest ideas? Jacqui: Absolutely. I love it. The interaction is one of the best things that I love about what I’m doing, so I get DMs on Facebook, Instagram, and my email is hello.BlushMagazine@gmail.com. Jeff: And what would you say to anybody who is like, “Gosh, I really like that. Maybe I should start my own.” Jacqui: Yeah. So I guess have a look at the different platforms that are out there to do a magazine on. I use readymag which I really love. But there’s also issu, which I’m kind of looking at as I get bigger. That might be where I go just because you can get more stats on what particular pages people are staying on longer. That kind of thing. So I guess just have a really clear view of what you want to put in your magazine, you’ve got to structure it like a real magazine. So go and get a physical magazine, you need a contents page and an editor’s letter and kind of build it from there, but just know that readers like continuity, so if you’re going to start a section, you’ve got to kind of continue it. So have a really clear idea of what kind of content you want to do. I haven’t done this and I probably should have build up content so that you’re an issue ahead of yourself so that, you know, just to for timing I guess, that would make life easier. I like making things hard for myself. Give it a go, like why not? Compared to the money that I used to put into print publishing, digital publishing… there’s barely any any cost. So yeah, give it a go. Jeff: Cool. Hopefully somebody will take up the inspiration because – at least the way we feel concerning podcasts, the more podcasts the better, the more magazines the better, the more blogs the better. Jacqui: Built this industry! Jeff: Yes absolutely. Well Jacqui, thank you so much for telling us about ‘Blush’, we’re going to link up to everything we talked about- the authors and the magazine – in the show notes, and we look forward to see what comes out in future issues. Jacqui: Thank you so much for having me. It was just the highlight of my week. Thank you so much. Book Reviews Here’s the text of this week’s book reviews: Nowhere Ranch by Heidi Cullinan. Reviewed by Will. Admittedly, I’m a little late to the party when It comes to this book. When I posted online that I’d finished reading Nowhere Ranch, I got a slew of responses, “Isn’t it the best?”, “That’s my favorite Heidi book.” So, for the few that haven’t yet experienced the sexy wonder of this cowboy romance, Nowhere Ranch is about a young guy named Monroe, Roe for short. He’s the prototypical lone cowboy who’s just landed a job at Nowhere Ranch. On one of his free nights, Roe travels several hours away to the nearest gay bar. To his surprise he runs into his boss, Travis Loving. After some flirty banter and surmising that they are both definitely into each other, they spend one wild night together in Travis’s hotel room. Roe tries to keep things professional with his boss, but Travis is just too damn irresistible. After a trip to the rodeo, he gives into his desire yet again. His hook-ups with Travis are so amazing that he begins to reconsider his ‘no relationships’ policy. When it comes to the bedroom, Roe likes things a little kinky. Travis is more than willing to give him everything he wants. After a rough and raunchy tumble in a horse stall on his birthday, Roe is so turned on and turned around, that he just doesn’t know what to do. Guys, this book is incendiary. I’m no expert when it comes to Heidi Cullinan’s books, but the few that I have read, have ridden that delicious line between sweetly romantic and utterly filthy. The kink explored in Nowhere Ranch isn’t your mommas 50 Shades style slap ‘n tickle. This is hardcore stuff in the best possible way. Back to the story. Hailey, the daughter of the ranch foreman, becomes fast friends with Roe and it becomes her personal mission to tutor Roe so he can get his GED. After learning some English composition basics, Roe writes an essay especially for his boss entitled, “Why Travis Loving Should Fuck Me”. What’s wonderful is that the entire text of the essay is included as part of the story. It’s sweet, it’s funny, and it leads to some more smoking hot sex for our two heroes. Unfortunately, the course of true love never did run smooth. A letter from the family that rejected Roe years earlier, forces him to examine what “home” really means. Home is definitely Nowhere Ranch. Some drama eventually forces Roe to make an unwanted trip to deal with the backwards, judgmental people he once called his family. With Travis and Hailey by his side, he sets things to rights and accepts that he is, in fact, worthy of his very own happily-ever-after. There’s a brief time jump at the end of the story to show us just how happy the happily-ever-after is for Roe and Travis. It’s wonderfully schmoopy and surprisingly sweet for a story that is so dang filthy. It just goes to show, that in the hands of a skilled author, kink doesn’t have to equal dark or angsty. The story of two hot and horny cowboys can be just as swoon-worthy as the lightest of rom-coms. The Doctor’s Secret by Heidi Cullinan. Reviewed by Jeff. This book had me at its cover with its clean design, heartbeat along the top and the handsome doctor. And I snatched the audiobook out from under Will because Iggy Toma was doing the narration. As with my other experiences with Heidi and Iggy, this one was above and beyond. The Doctor’s Secret brings Dr Hong-Wei Wu, or Jack as he tells the staff to call him, to Copper Point, Wisconsin. Hong-Wei’s left a high powered residency and his family in Texas to re-locate to this tiny town that needs a surgeon. He also hopes to lead a quiet life here. That’s derailed almost as soon as he steps off the plane because he meets Simon Lane, the hospital’s surgical nurse and the person who was dispatched to pick him up. Simon wasn’t quite ready for the attraction either. He’s in Copper Point working alongside his two best friends who all wanted to stay and give back to their home town–a place so small Simon’s sure he’ll never find a man for him. Hong-Wei is torn from the beginning because he came to Copper Point to get away from complications, but he can’t deny the immediate attraction to Simon. He tends to put himself under a tremendous amount of pressure to always do the right thing, even if that means saying yes to things he doesn’t want. As Simon learns more about Hong-Wei–from his love of classical music as well as his dislike for most pop music, his love of Taiwanese food and even the meticulous way he wants his operating room set up–only made him fall for the man more. Simon’s incredible from the get go. Instead of using “Jack,” Simon wants to use Hong-Wei’s given name and takes the time to learn how to pronounce it. It’s super adorable too how Simon can’t believe Hong-Wei might be flirting with him–their interactions at the hospital are super cute as they both easily get flustered. Their potential relationship comes with great risk. Copper Point is a small town with small town drama and shenanigans. St. Ann’s Hospital has a stranglehold on its employees with a hospital board that attempts to rule with an iron fist. This includes a no-dating policy. As they grow closer though, Hong-Wei’s having none of it, insisting he’ll protect Simon. Simon’s friends Owen and Nick, also doctors at the hospital, help the two get together in secret. As you can imagine neither men want to live in secret, and the more they fall for each other it becomes more difficult to keep it. Beyond Simon catching Hong-Wei’s attention, he starts to fall for the entire town of Copper Point. From the owners of his favorite restaurant to his co-workers to the local orchestra. It’s far more than he ever planned for and he’s not quite sure how to manage all the feelings of peace and happiness he has here. When a medical emergency forces Hong-Wei to reveal more of himself than he planned, the major power struggle begins around the dating policy and the future of St. Ann’s. Heidi does a tremendous job about making us care not only for Hong-Wei and Simon, but for everything that’s at stake for the town. There’s so much to love in this book between Simon and Hong-Wei, their friends, the citizens of Copper Point. The book also has one of the best grand gestures ever. It gave me all the feels. Kudos to Iggy Toma for a brilliant performance, infusing everyone with strong emotions and rich personalities. The tender moments between Simon and Hong-Wei are perfection. I’m looking forward to Owen and Nick’s books in the series. Owen’s is already out but I’m hanging tight for the audio and Nick’s book releases in August.
The guys talk about the television they’ve been watching so far this summer, including American Ninja Warrior on NBC, FX’s Pose, American Masters: Terrence McNally: Every Act of Life on PBS, Grand Hotel on ABC, Good Trouble on Freeform and What/If on Netflix. Jeff reviews In Case You Forgot by Frederick Smith & Chaz Lamar. Jeff interviews Roan Parrish about Raze, the latest book in the Riven series. They talk about the research she did for the series, including going on tour with a band, as well as the eclectic music she enjoys. The origin of Roan’s collaboration with Avon Gale is also discussed along with what got Roan started with writing gay romance. Complete shownotes for episode 196 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript - Roan Parrish This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Welcome, Roan, to the podcast. It is so great to finally have you here. Roan: Thank you. I'm so happy to be here. Jeff: And it's a perfect opportunity because just last week, you released raise "Raze," just the third book in the "Riven" series. And for those who don't know, tell us about the series and, of course, this latest installment. Roan: Sure. So "Riven" starts out with the book, "Riven," also the series title. And it's kind of an anti-rock star romance. It's about Theo, who's the lead singer of the band, Riven. And they've suddenly hit it big and are super famous. And everyone in the band loves being famous and their success. And Theo hates it. He hates being famous. He hates being the center of attention. He hates, like, people knowing things about him or looking at him when he leaves the house. So he loves the music, but he finds fame, like, the worst thing ever. And so he's about to go off on a new leg of the tour and is sort of, like, wandering the streets of New York, feeling a little bit sorry for himself. When he hears this song coming from a bar, like, someone just strumming guitar, and it's one of the most beautiful things he's ever heard. So he goes in the bar to see who's playing this or what the song is. And he meets Caleb, who is the one playing the music. And Caleb, we learn later, has been a musician for a long time, a working musician, but has sort of gone away from the scene and hidden himself away in his uncle's house out of town because he's had some addiction issues, and he's trying to stay clean by staying away from everything that reminded him of the scene, including music. So they start to talk to each other and they bond over music. And then little by little, they fall in love. The problem being, of course, that for Theo being in the scene and being public is kind of part of his thing. And for Caleb, everything about that just brings back a lot of bad memories. So they have to sort of work together to figure out how that's gonna impact their relationship and if they can get through it. And then it kind of takes a hard left, I feel like this is the thing that I should say for people who haven't read the series, is that the series really does hang together. It has the same secondary characters. It deals with a lot of the same themes, like, the themes of ending up someplace that you never thought you would be. But then in book two, we met Reese, or we've met Reese in book one, but we have a book about Reese who was Caleb's best friend and Reese's husband, Matt. And Matt has nothing to do with the music scene. And the book is told from his perspective. So for people who go in expecting that the whole series is about music, it is in some ways, like, music as a through line. And certainly, this idea of fame and this idea of struggling with fame is a through line. But book one is sort of anti-rock star. And then book two is like working musician and person who's not involved with music at all. So I feel like that's the thing I should say. Jeff: Well, they it does hang together because you've got the working musician. Roan: Yeah, totally. And Reese, who is the working musician is someone who toured with Caleb when Caleb was still playing music. So the characters all hang together and the series hangs together, but it's not a kind of musician book, if that make sense. Jeff: Yeah, that makes sense. Roan: And then "Raze," which is book three, it also hangs together. "Raze," it's similarly about characters ending up someplace that they never thought they would be. And in this book we meet Huey, who was in the first two books, and has been a sort of a little bit of a shadowy figure who we never knew his backstory, we didn't know who he is, he just pops in and dispenses wisdom, and pops out again, he doesn't say much else. And so he was Caleb's sponsor in Narcotics Anonymous. And he's still been working as a sponsor. And he is so used to taking care of everyone else being a sponsor, helping people work through their own addiction issues, dealing with his own, that he doesn't really ever focus on his own life. He's built up this kind of wall of focusing on everyone else, so he never has to think about himself. And we meet Felix, who is doing the same thing, taking care of everyone else but him himself, but through his family instead of through NA. So he grew up and help take care of his younger brothers and sisters, and always helped his sister get whatever she wanted, and has now found himself as his sister goes off to do her music thing, found himself kind of like, "What the hell am I doing with my life? Who am I? I kind of forgot to ever notice what I wanted." And so the two of them come together. And two people who are so used to looking out for everyone except themselves, as you can imagine, when it comes down to trying to make a relationship, they kind of don't know how to do it. They don't know how to ask for what they want. They don't even know what they want from each other. And so feelings kinda bubble up and nobody knows what to do with them. And then it ends really happily. Jeff: As all romance must. Roan: That's a must. And there's even a kitten. So, yeah. Jeff: What attracted you to writing this series? Roan: I think that there's themes that go together. I love music. And I've always been a huge music fan. And one of the things that I've always thought was interesting is that music is so personal, to me, anyway. And I know for many other people, like, each of us, listens to music and feels something - has associations that are deeply personal. And something about the weirdness of something so personal, experienced on a large scale of fame has always struck me as really odd. So you can be at a concert with the band and have thousands and thousands of people there. And each person has been hit with his music in a really personal way. And yet, we're all there together in a super public space, having kind of a personal experience, like, smooshed up together with each other. And I've just always found that really strange. And I know for people who make music, the process of making music is really personal. And it's really different than the process of performing music. And so I think I was interested in what would it feel like to do something really personal in front of a lot of people and then watch as this thing that you've made gets loose on the world, and you no longer have any control over it or what people think of it. And to me being famous seems like absolutely the worst thing I can imagine outside of, like, actual torture. And I know that for some people, that's not the case. But, yeah. So I was interested in writing, like, the genre of rock star romance is a thing. And I was interested in looking at it from the perspective of what would a rock star romance look like, if instead of rock star being a desirable thing, it was a terrible thing or a thing that caused a lot of problems for the rock star. Jeff: What was the process around some of the research, because, like, you talk about this very personal thing. How do you research that? And then how do you try to read and put it in a book so everybody else gets it? Roan: You know, I mean, I don't know. I can't really claim that I did it correctly. I've never been a musician. I like singing karaoke to Paula Abdul once with five other people very drunk in college. And that's about my performance level. But my sister-in-law, my sister's wife is a musician. And she's very personal and writes very personal music and then performs it. And, you know, I've been to many of her shows, obviously. And I went on tour with her in Europe once, like, carrying her stuff and hanging on for the ride. And one thing that struck me was, like, people would come up to her after the show and tell her like, "Your music has meant so much to me. I was going through such a hard time and your music spoke to me in these really hard moments." And so I would see that and I know that people are having these personal responses and have personal relationships with the music. And I know that my sister-in-law does as well. And then, like, the moment that the two of them would be having together would be personal. But there was still this whole performance element that I kinda…yeah, just seems like a very strange crucible of the personal and the public smooshed together, and maybe the performativity of that, in some way, like, hides the personalness…or not hides necessarily, but, like, you need a little bit of distance, like, the lights and the smoke machine, and the darkness, and the space between the stage and the crowd to insulate you a little bit in order to take something that's so personal and project it out in public. Jeff: I love how you kinda had the personal research going on there that you actually went on this tour and got to see all of it kinda go down about as close to it as you could without being the actual performer. Roan: Yeah, yeah, which is awesome. And I mean, like, I've had many friends who do music. So I knew that if I had, like, specific questions, you know, I had some questions about, like, the studio stuff and how you laid out tracks that I was able to ask friends about. But I really do think it's, like, the feeling of performing that I was trying to capture and the sense of what it felt like to have something that was yours, like, the music, and then watch other people make it theirs. And although I've never been a performer in any way, I mean, that's a little bit, like, what happens with books is that I sit at home in my pajamas, like, with cat hair all over me, and I write these books. And then when they're published, it's not mine anymore, it belongs to the people who read it. And I don't really have any control over it. So that part was easy to kind of understand. Jeff: Of course, you mentioned your love of music. And your bio actually mentioned that you listen to torch songs and melodic death metal. Now, I get eccentricity because my playlists are, like, wildly, you know, strangely hooked together in some way. But these two seem very different. What attracts you to these two individual styles? Roan: I think I was trying to write my bio in a way that was, you know, like on dating sites, you wanna say the two things that seem most opposed. So you can be like, "Listen, this is what you're getting as a human being who is essentially at odds with himself," maybe that's just me. Anyway, yeah, I love both of those genres. I think they're both simultaneously really raw and really beautiful. Like, torch songs, I love because they are heartbroken, and tender, and they tell a story, and they're so vulnerable, and beautiful. And melodic death metal is like, doing the same thing, only it can't be vulnerable, or, like, it needs a really harsh bass riff, and loud guitar, and loud drums in order to do something that's that tender and that personal. And I find not like screamy death metal, but yeah, melodic death metal. I find it like one of those puppies that growls at you until you get a little bit closer, and then little by little it sorta lets you pet it. And then by the time you're petting it, it's like, "Oh, no, I really do love this. Please don't ever stop petting me," but then, like, someone else walks in the room and they're all growly again. Jeff: I love that analogy. So awesome. Jeff: Now, speaking of music, with the "Riven" series seems such an obvious thing to perhaps you write to music if you're a writer who does that. Was there a particular playlist that sort of pushed you along in the writing of the series? Roan: You know, I actually didn't listen to music at all writing the series, which is sort of strange when you say it like that. I go through phases of whether I like to write with music on or not. And there have been books that I've written where I listened to the same music over and over. Like, when I wrote...what book was it? Oh, "Out of Nowhere," which is the second book "In the Middle of Somewhere" series, I listened like obsessively to "The Civil Wars" just over, and over, and over. And for some reason, the mood of those albums was, like, exactly the mood that I needed to be in to write that book. But with the "Riven" series, I didn't listen to music at all. Jeff: Interesting. Okay. Roan: Yeah. And none of the music in the books is real. Like, I made up all the band names and all of the music. And I wonder if maybe part of it was like, I didn't want real music in my head because I was making it up. Jeff: That would make sense. Yeah. If you're having to write any kind of song lyrics or anything inside the book, I could see where you would wanna, like, accidentally just pick up something. Roan: Right. Well, it was super adorable actually because one of my best friends who reads all my stuff first is, like, she likes music a lot, but she's like a top 40 radio kind of tastes music person. And so she thought that all of the musical references in my books in the "Riven" series were real, because she knows that I like lots of different kinds of music, and she just didn't know that they were fake at all, which is totally adorable. Jeff: Oh, that's awesome. So you could have an extra career then as a songwriter if you're writing lyrics. Roan: Maybe a band-namer. I like the band names more. Jeff: So I have to ask for the audio book then that you've got song lyrics - does that mean your narrator is actually singing the lyrics? Did you make Iggy sing and Chris sing? Roan: No. And, you know, I don't think that I have a chunk of lyrics long enough to be sung. They're like a couple snippets. But I didn't even think about the fact that I could have written a song of it for the audio book. That would have been awesome. Too late. Jeff: Something to think about maybe for a future book or another installment in the series. Roan: Yeah, yeah. I could do it as like an extra or something, I guess. Jeff: And speaking of the series, is there more to come in this series? Roan: There's not. Like, The Good Place that we were talking about earlier, I have decided that book three is the end. Jeff: Okay. Time to wrap up that universe. Roan: Yeah. And, you know, I say that and obviously maybe I would go back in the future and write another one. But I think the fact that the last book is about a character whose story we've kinda been wondering about for the whole series, it felt like a good place to stop because it's sort of the wrap up of, like, solving the last interpersonal mystery. So that felt like the right place to stop. And there are definitely tendrils. Like, people who've read a bunch of my books will notice that Riven, the band, is mentioned in another book, and that some characters from the "Middle of Somewhere" series are briefly alluded to in "Riven." So there's, like, little Easter eggs for people who have read all the books because I sort of think of everything as being connected in that way. So it'll pop back up, I'm sure. Jeff: I love that. I love the broad interconnected universe thing. Roan: Yeah, yeah. Secretly in my head, all of the books are connected in lots of ways that I don't necessarily put on the page. But, like, I like to get a couple in there. Jeff: Nice. Now, you also co-write with Avon Gale. What got that collaboration going? Roan: You know, that collaboration happened completely by accident, or on a whim, I should say. And I'm so glad it did. So I was living in New Orleans a couple years ago. And Avon and I were friends on the internet. And she offered when I was moving back from New Orleans to Philadelphia, she was like, "I love a road trip. What if I fly to New Orleans and drive with you," because it's a many day drive and you have a cat. I had like my truck and then I had my car hitched to the back of the truck, and it was a whole big thing. So I was like, "Oh, great. This will be fun." So we started driving from Louisiana to Pennsylvania. And it was, like, a torrential downpour. And we couldn't hear the radio. We couldn't do anything. And so Avon was like, "Okay. Well, I'll just tell you about this book that I've been working on. And I am really stuck on it. I can't get the plot right." So I was like, "Okay." And I'm pretty introverted and Avon is very extroverted. And we going in... Jeff: And it's very true, she is. Roan: Yes. And, you know, I really just love a clear communicator, so I loved it. She was like, "Basically, I talk constantly. And if you want me to stop, you have to tell me to stop." And I was like, "Oh, that's amazing. I run out of steam socially in approximately two-and-a-half hours, and I'm still listening to you, but I won't respond." And she was like, "Okay, great." And thus, it was. And so she basically narrated to me the entire plot of this book that she was trying to write, and she was having trouble with it. And I kept doing this probably obnoxious thing where I was like, "Oh, what if you did this?" Or, "What if you did that?" Or, "Oh, my gosh, it's so funny, because if that were me, I would totally do this." And she, instead of being annoyed, was like, "Well, you should obviously write this book with me." And that book was what it turned into "Heart of the Steal," which is the first book we wrote together. And it was so fun because then as we were driving, we just plotted the whole book. And she had her little, like, computer that she was typing on while we drove. And I drove the truck the whole way. And so I would like yammer at her and she would take notes, and then in the hotel rooms at night, we would kinda hash it out. And so it happened on a total whim, and then turned out to be really fun. And so we planned it on that trip. And then I went and visited her months later, I guess. Yeah, some months later, and we actually wrote "Thrall," which was the second book that we co-wrote together, like, in the same place. So we wrote it, like, together, even though we don't live in the same place. So it was two very different writing experiences, but both equally awesome. Jeff: That's fantastic. And I have to imagine it's a nice way to kill the time in a road trip to just write a book. Roan: Oh, yeah, totally. And it's really fun because I don't know about you or about other writers in general, but, like, I find that traveling is one of the best, like, brain, what do you call it? Like, catalyzers, brain catalyzers, something about moving through space constantly, whether it's, like, on a train or just walking or whatever. It's, like, the rhythm of moving through space makes my brain also work in a forward rhythm. And I find myself, excuse me, getting so many ideas when I'm just, like, walking a long distance, or on a train, or on a bus, or something. And so something about driving and plotting the thing together was, like, super, some word… Jeff: Awesome. Roan: Yeah, awesome. Jeff: Probably better than awesome, but awesome was the first thing that popped into my head. Roan: Yeah, yeah. Jeff: And then I totally get what you're talking about there, too, because I've done a lot of plotting and some writing on planes. Because it's like, yeah, there's something about just that that just you've got the time, and, like, the brain is working, so use it. Roan: Yeah. And it's, like, looking out the window of something moving through that kinda space with everything passing so quickly, it almost feels like it changes the rhythm of thoughts or something. Jeff: Yeah. And kudos to Avon for being able to type in a moving vehicle because I don't know that I could do that. Roan: Oh, my God, she has, like, motion sickness proof. I swear to God. Jeff: That's just crazy. Roan: Oh, I know. Jeff: But we definitely got to talk a little bit about "Thrall." I reviewed it back in Episode 157. I was just blown away by it. For folks who don't know, tell us about what that book is and what in fact does make it so special? Roan: So "Thrall" is our modern "Dracula" retelling, basically. And for anyone who's read "Dracula," you'll remember that "Dracula," it's an epistolary novel, so it's told through letters, and diary entries, and, like, newspaper clippings, telegram, stuff like that. And so we did "Thrall" in the same way, we made it an epistolary novel. But since ours was modern, and that one was 19th century, instead of letters and journal entries, and stuff like that, we have emails, and g-chats, and tweets, and podcast descriptions, and stuff like that. So the whole thing is written in that way, this combination of different print media. So we have the main characters that people will recognize from "Dracula." And Mina, and Lucy, who are the two characters that people will know from "Dracula," in our version, have a podcast, a true crime podcast in New Orleans. And they get caught up in basically trying to solve the mystery of Lucy's brother who seems to have disappeared. And so in getting caught up in that mystery, they stumble upon this a role-playing game kind of thing, where they use an app, and they go to different places, and they try to solve clues, hoping that it will take them to Lucy's brother. And so in addition to it being an epistolary form in general for the whole book, then kind of within that epistolary form, there's this mystery that they're trying to solve on a computer, I mean, on a phone app. So it's like a game inside an epistolary novel that's an adaptation of another epistolary novel. Jeff: And epistolary just not something you see very much. At least I don't, especially in the romance genre that I tend to read in general. What was it like as a writer, and just plotting to take on such a different narrative format? Roan: Yeah, it was awesome. It was really, really cool. I love form, like, I'm super interested in what different things you can do with form. And one of the things that, like, when I'm reading other things I'm always interested in is what form did this author choose, whether it's something simple, like, short chapters, or long chapters, or, like, flashbacks versus telling everything in order, all of that stuff, I think, has such an impact on the way the story gets delivered. And so I was really excited to play with the form. And I think that with the genre of romance, one of the reasons why we don't see epistolary stuff so often is that it's, like, an additional level of remove between the two characters. And romance seems, to me, to be all about intimacy and connection. And sure, it can be really romantic or sexy to write a love letter or love email, I guess, in 2019. But there's still something where you're not in the moment. There's no, like, tracking a touch as it happens, or a kiss, or whatever it is. And so I think that going into "Thrall," we were like, "How the hell do we make a romance happen when the characters essentially are never in the same scene?" Like, in order to be texting each other, they probably aren't together. In order to be chatting each other, they're probably not together. And so any evidence of an encounter, which is all we could show, also demonstrated their distance. So that was a challenge. And we got around it in a couple of different ways, including characters literally writing out sex scenes that they wished would happen like fantasies, having chats that were more intimate. But yeah, the romance part, I think, was actually the hardest to portray via the epistolary form because it introduces that necessary distance, which is sort of the anti-romance. It was much easier, for example, for the mystery, or the suspense parts because those things can be portrayed that way no problem. But, yeah, the romance part was tricky. Jeff: Well, as I said the review, I think you guys pulled it off so amazingly. If people have not read "Thrall," they should really pick it up and give it a try. Roan: Oh, thanks. Jeff: Because maybe a little much to call it a breath of fresh air, but it's certainly gonna be something very different than what I think most people tend to read. Roan: Yeah, it definitely is different. And it's one of those books that Avon and I knew going in, but it's not everyone's cup of tea. It's an adaptation. It's an adaptation of "Dracula." It's an adaptation of "Dracula" without vampires. It's a romance where you don't ever see the characters touch necessarily. But like, I feel, like, for people who are interested in form for people who are interested in Dracula or interested in suspense, and all that stuff, we were really excited to just do something totally new for us. Jeff: Yeah. It was super cool. Please do more of that sometime. Roan: I would love too. Jeff: So laying a little bit of your origin story, how did you get involved in writing M/M romance? Roan: You know, at the risk of making, it sound completely accidental, it was kind of accidental. My good friend from graduate school, got a job in Phoenix, and didn't know very many people. She didn't have many friends. And she and I both started reading both young adult and M/M mysteries in grad school. And so I went to go visit her and she was having a hard time. Like, I said she didn't know very many people, didn't have any friends, and she just wanted like, escape reading. And we were, like, in the kitchen cooking dinner or something, and she was saying that she just wished that there was, like, a romance novel that she could read about someone who was in her situation. So someone who was a new professor in a new place, didn't know very many people and was kind of struggling to fit in. And because she's my friend and I wanted to make it all better, I was like, "Oh, no worries, I'll write you a story. Everything is gonna be okay." So on the plane home from Arizona, I wrote the first chapter of what would eventually be "In the Middle of Somewhere," my first book, thinking that, like, I would send it to my friend, and she would read it and be like, "You are such a nerd. I can't believe you actually wrote me this story. I was just complaining. You're weird." But instead, she read it and wrote back and was like, "Oh, a story. Oh, my gosh. What happens next?" And, of course, I didn't know what happened next because there was no next. I thought that it was going to be a little one-off thing. But then I wrote the next chapter and I emailed it to her, and she wrote back and was like, "What happens next?" And I actually wrote the whole first half of the book that way just chunking out a chapter, emailing it to my friend, and I was really writing it for her. I never thought I would show it to anyone. I never intended to send it to a publisher. I didn't even have a plot, I just was writing these little sections. And around halfway through the book, I suddenly realized that, like, it was getting kinda long, and I should probably figure out how it was gonna end. Otherwise, I would just end up writing this, like, email missive to my friend forever, which was really fun. But also, I thought she would get sick of it eventually. And then when I finished the book, I thought that was gonna be the end of it. And it was my friend who was like, "No, you should totally try to publish it." And I owe it all to her, I never occurred to me to send it to anyone. And I would never have done it if she hadn't made me. Jeff: Well, kudos to her for making that happen. And that's the best accident story ever. I mean, just amazing. Were you writing before that at all? Or was this just really like, "Hey, I could write. I'll write you something. No worries." Roan: Well, you know, I've always written different things. I was a poetry major in college of all the super useful things to pursue. And so I wrote poetry or some short fiction. And then I did my PhD in literature. So, you know, I wrote a dissertation, I wrote nonfiction for years, and years, and years. But I've always loved to write. And I love reading novels. And so sitting down to write a novel, I think it actually helps that I wasn't thinking of it as writing a novel. I just thought of it as writing the story for my friend. So I didn't have any of the self-consciousness or like that internal editorial voice that I'm sure if I had planned to send it out, would have like, killed me as I was trying to start. And in terms of, like, as we get back to your original question, which I don't know that I actually answered in terms of, like, why M/M romance specifically. I hate misogyny, and sexism, and can't deal with stories where I read female characters and feel intensely alienated from them. And I find often in romance, not all by any means, there are some amazing, amazing, like, revolutionary really amazing people writing romance with women, but I've often found that reading romance novels that are, like, heterosexual romance stories make me feel alienated, and angry, and the opposite of anything that I associate with romantic. And so, yeah. Jeff: Who are sort of your author influences? Roan: Oh, man. Well, you know, growing up, I read everything. I'm a real, like, moody reader. So I go through phases. And when I'm in that phase, that's all I read. So, like, when I was in elementary school, I was obsessed with S. E. Hinton Hinton, "The Outsiders" and "Rumble Fish," those books. And she writes with this very kind of, like, spare style, but lots of sensory detail. And I think that that's definitely something that I've always really admired was the ability to evoke feeling even while being very spare. And then when I was in middle school, I was obsessed with Anne Rice, obviously, because middle school. And I read her books over, and over, and over. And I think that she is like the master of the kind of Baroque sentence structure that when you're deep in, reading one of her books, you don't notice that she's, like, in a strange Yoda way, like, flipping a subject and predicate to make things sound, more flourishy and purple prosy. You don't notice it because you're so deep in it that, like, of course, that character would talk that way. But if you go and you read another author or another book, you realize suddenly what she was doing. And so I think from her, I got just, like, I really respected this immersive detail-rich all the senses engaged kind of writing. Also, I really love long books, and the ability to sustain a story over 800 pages, and keep going with this level of detail. I mean, I know it's not everyone's bag, like, some people really like a short one and done, but I mean, I will read a series that goes on forever if I'm still engaged. And I just think that she does that incredibly well. Then, oh, gosh, I'm taking you on a tour. I don't know if this is actually answering your question, but I do think... Jeff: It is actually. Yeah. Roan: Oh, okay, good. The real answer is, like, I learned things from every single author I read. And sometimes, it's things that I don't ever wanna do. And sometimes, it's things that my mind is blown because I'm like, "Holy crap, I didn't even know you could do that." Sometimes it's like I feel like I'm weak in one area at a moment. And so I wanna go read someone who I think does something really well and try to learn it. Oh, Francesca Lia Block was a huge influence when I was a teenager. She writes this kind of magical realism that is, like, very urban set - in LA, deals with real world problems, but has this, like, pink fog over the entire thing. And I was really, really taken by that. That way of combining urbanity with fantasy, and so that's definitely something that I took from her. I went through a really deep, like, epic historical fiction kick, which maybe is that same kind of, like, very immersive detail, huge cast of characters, all that stuff. And, oh, gosh, I'm totally blanking on her. Oh, Sharon Kay Penman is her name. Okay. Sorry, this is maybe a tangent. But this story blows my mind and is, like, one of the more impressive things I've ever heard in my life, if you'll indulge me for a moment. Jeff: Of course. Roan: So Sharon Kay Penman writes these, like, hugely epic, 1,000-page long, British Isles historical fiction. And she wrote this book called "The Sunne in Splendour," in, like, I wanna say the early 80s, maybe mid-80s. And the book is epically long, and just detail, and hundreds and hundreds of characters, and like tons of things translated into Welsh. It's about Welsh civil wars, or wars with England. Anyway, she wrote the book and, like, on a typewriter, and had it in one of those, you know, the boxes that reams of paper come in…you would put your manuscript in this box. So she was going to drive her book to her publisher. And she stopped at the bank to, like, deposit a check or something. And when she came back out, her car had been stolen with the copy of the book inside, the only copy of the book, which I don't even know how that happens. So the car stolen, she's just sure she's never gonna get it back. And whereas, like, I don't know, I would probably immediately go home and, like, order seven pizzas, and you wouldn't see me for a month. She drove home and started writing the book again. Jeff: Wow. I would have done the seven-pizza thing and then walked away for, like, at least a week. Roan: Yeah. Like, I would have told every single person who would listen that my life's work had been ripped from me. And it was the worst thing that ever happened to me and which, you know, I think that's actually speaking pretty well of my life that that would be the worst thing. But, yeah, I just, like, that level of tenacity and dedication to a project, it just blows my mind. Anyway, she's amazing. Jeff: Yeah, that's awesome. And just, like, I can't even imagine, it speaks so well to these days where we're like, "Did you back that up on Dropbox?" Roan: Yeah, at least someone's like, "Oh, man, I just spent, like, 20 minutes writing that email and it got wiped." And I'm like, "Sharon Kay Penman." Jeff: So what's coming up next for you? What's yet to come this year? Roan: Well, do wanna be the first person to know because I actually just found out yesterday? Jeff: Oh, breaking news. Roan: Breaking News. Yeah, I just sold a new book, which I'm pretty excited about. Okay. The concept is, there is a guy who has a bunch of animals. He's like, kind of antisocial, kind of pissed off at the world for reasons that I will not divulge yet. And he likes animals better than people. So he has all these rescue dogs and a bunch of cats that hang around. And basically, all he wants to do is take his dogs on these long rambling walks and think about how fucked up his life has gotten. It's the only thing keeping him sane, it's just, like, rambling walks with these dogs. And one night he is walking with the dogs and one of them starts chasing something. And he starts chasing the dog and falls down a hill and breaks his ankle. So all of a sudden, he can't do the one thing that he's liked, which is walk his dogs. So he goes online, and he finds this app that, like, match makes pet owners with people who wanna hang out with animals, but can't have pets of their own, because he's looking for someone who could help him walk his dogs, since he can't do it anymore. Then you have this other character, who's super shy lives with his grandma is, like, husband saving up to try to, like, get a new apartment so that he could have a dog. And then his grandfather dies, he has to move in with his grandmother, and he can't have an animal because she's desperately allergic. So he goes on the matchmaker app, and gets matched with this dude who needs someone to walk his dogs. And so the Meet Cute is a dog walking app, and a grouchy meets a shy guy, and lots of animals, and love. Jeff: Well, this sounds awesome. When do we get to see this? I'm guessing 2020 sometime? Roan: I think so. I don't have a date on it. I'll start working on it soon. But, yeah, I think it's gonna be, like, cute-ish in tone. And I don't know, I keep, like, accidentally writing animals into every single one of my books. And I don't even mean too. And this time. I was like, "Well, I mean, I keep doing it by accident. Maybe this time, I'll just, like, actually do it on purpose." Jeff: And what's the best way people can keep up with you online and find out when this next thing comes out? Roan: Well, they can check out my website, roanparrish.com, where I post all things that exist. And then in terms of social media, I've been very active on Instagram stories lately. I just bought a house, my first house, like the first non-one-bedroom apartment that I've been living in. And I've been doing all these, like, garden planting, and baking, and projects, and stuff. So I've been really liking Instagram stories. So people should follow me there and tell me all the things that I'm doing wrong in my garden. Jeff: They may not think you're doing wrong. Roan: I mean, it's my first time and I feel, like, I'm doing everything wrong. But we'll see, it might grow. Jeff: I bet it does. And congratulations on the first house. That's such a huge thing. Roan: Oh, thank you. I really went, like, in the space of one month from a person who thought that they would always live in one-bedroom apartments to a person who bought a house. And so it was very shocking for me. I keep wandering to the extra room and being, like, "What's gonna go in here? I don't know." Jeff: It's part of the fun of home-ownership. Roan: Yeah. Mostly, it's like my cat goes in there. And that's what happened. So I mean, I'm on all the social media things. I'm everywhere as Roan Parrish and people can find me. But Instagram stories is totally the most fun. And for people who, like, wanna know about when books are coming out, but don't dig the social media vibe, BookBub is a great place to find me because they'll just get emails when I have books coming out or on sale. Jeff: Fantastic. Well, we will link up to everything we talked about in the show notes. We wish you the best of luck with the release of "Raze." And thanks so much for hanging out with us. Roan: Oh, thanks so much. It was a blast. Book Reviews Here's the text of this week's book reviews: In Case You Forgot by Frederick Smith and Chaz Lamar. Reviewed by Jeff Frederick Smith and Chaz Lamar are new to me authors and I loved reading their first collaboration, In Case You Forgot. Frederic and Chaz are two black gay men writing about two black gay men living in West Hollywood. This year in the life story left me wanting sequels because I want to read even more about these two interesting characters. Zaire James and Kenny Kane are in similar positions. Coming up on his 30th birthday, Zaire decided it was time to separate from his husband, even though a lot of his family and his friends thought Mario was perfect for him. Kenny, approaching 40, was dumped by Brandon-Malik via text as he was en route to his mother’s funeral. Both of these guys need a reboot. For Zaire that means moving into WeHo--it happens that he moves in across the street from Kenny. He’s got a new job at a social media firm and he’s looking for what comes next. He’s got a family that wants him to find it too--the James Gang siblings--brother Harlem and sisters Langston and Savannah--are always on him to get his life together and find his happy. Kenny, on the other hand, is working on getting his consulting business off the ground since he’s recently finished his doctorate. He’s trying to mostly focus on the business, but he also wants to find Mr. Right. Kenny also carries the weight of having watched his first boyfriend, Jeremy, die after a stabbing. He’s working on his life with some therapy. So what happens in this book? Life. Kenny and Zaire, at times together and at others separate, look for a good date that may lead to more, celebrate birthdays, experience success and failures. The last line of the book’s description captures this perfectly: “...they hope new opportunities, energy, mindsets, and connection will reinvigorate what is missing in their lives--drama and all.” That’s exactly what I liked about In Cast Your Forgot, the slice of life feel. It’s happy, sad, angry, messy and full of great triumph and really bad mistakes. It takes a lot to make this kind of loose plot work, especially since the two lead characters aren’t always together as the year progresses. Frederick and Chaz made it work though. One of the reasons it works is the cast of supporting characters from family, friends, roommates and co-workers. Among my favorite parts of the book was the use of social media to plan their lives and sometimes even to stalk their exes, at times to the chagrin of the friends trying to help them move on. There’s also a Labor Day trip to Palm Springs that was one of my favorite parts of the book because of the realness of how it unfolded and how it tweaked Kenny and Zaire’s relationships. The characters reminded me of Noah’s Arc, a show I loved that ran on Logo in 2005 and then was a movie in 2008. The show focused on queer men of color in various states of life and relationships. Kenny and Zaire would fit right in there. I do want to set some expectations around this book. As you may have figured out, it’s not a romance. It’s categorized that way on the Bold Strokes Books site as well as at retailers. I think that’s wrong. It doesn’t have any of the typical romantic story beats and, most importantly while Kenny and Zaire date for a bit in the middle of the book they don’t get an HEA or HFN as a couple….although the book does end with both characters in good places. If you want a great look at a year-in-the-life of some terrific characters who are trying to get their lives together, I highly recommend In Case You Forgot. And I’d love to see sequels to this book. Frederick, Chaz, please write romances for these guys...
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So, Tim, you live in a nice natural spot.Tim: Yeah, that's true.Jeff: Lots of nature around where you live?Tim: Yeah, I'm from Oregon. There's lots of nature. There's not a lot of towns really.Jeff: And do you take advantage of it by doing any outdoor sports or activities or anything?Tim: Yeah, I try to, like me and my friends, we go hiking. We camp. We backpack. Snow camp. Snowshoe. All kinds of stuff.Jeff: Really. You snow camp?Tim: Yeah, we snow camped before, yeah.Jeff: So do you stay out or do you stay in a cabin or?Tim: No, usually we go out. A lot of times it's snowshoeing and cross-country skiing. We go out and we build a little hut basically by digging down and go underneath and stay there for the night and come out. It's really cold.Jeff: So, do you pull a sled behind you or do you carry your stuff?Tim: Usually, we just put a pack on your back. Yeah.Jeff: I want to try that.Tim: Yeah, it's a lot of fun, but it's cold and usually, you don't enjoy a lot of it until you done, and when you're done you think, "Ah, that was a great experience."Jeff: Yeah, yeah. I think it would be good but, so is it very different from summer camping?Tim: I think that the biggest thing is that when you go out there it's really, really silent. You don't see a lot of things out and about because it's cold. So it's just really quiet and it's really, really peaceful.Jeff: Is it safe? Can you die?Tim: Yeah, it is relatively safe. People do die doing it. For the most part, it's really safe. One time we were caught in a pretty bad storm and we were coming back. The biggest thing is we came out and our car was covered in snow and we couldn't get out so that was a pretty big deal. Luckily the cellphone worked through and we were able to eventually get out but we had to dig the car out and call some people to come out and help us.Jeff: So do you follow a trail?Tim: Sometimes. It just depends. Sometimes we just use navigation systems and just go out and go and pick points and go for it and sometimes we follow like ski trails that have like little diamonds on trees and you can point towards them and look for them and find them.Jeff: So do you recommend winter camping to people?Tim: Not unless you've had some outdoor experience. Not somebody who's just gonna go out there because you really got to look at the weather. You gotta have the right gear. If you don't have the right gear you'll freeze to death.Jeff: So city people, don't winter camp.Tim: Mostly yeah. I'd say city people better not winter camp unless you've got somebody who's really experienced with you. I've taken my girlfriend out there and so you can do it as long as you're with somebody that knows what they are doing and you have the right gear cause if you don't have something that's waterproof and things that are going to keep water out you can't do it.Jeff: Great.
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So where are you from?Tim: I'm from Oregon. It's right above California. It's on the West Coast of America.Jeff: So the State of Oregon.Tim: It's on the West Coast between California and Washington.Jeff: So you're neighbor states, say California in the south, do you guys get along? Are you good neighbors?Tim: Well, we get along a little bit with Northern California. They have similar thinking. But Southern California, they kind of have different thinking. They think a bit more about money. And also, they are moving a lot up into Oregon, and they have different thinking and they are moving into Oregon and they are kind of changing things.Jeff: So do you get a lot.... are you patriotic towards your own state of Oregon?Tim: A little bit. We just like to keep things the way they are just a little bit. Californians move up because they can sell their homes in California for a lot of money. They move up there and then they tend to be more conservative.Jeff: So, if I was to meet you and call you a Californian, would you get mad at me?Tim: I wouldn't get mad at you, no. I would think that he must think I was from Northern California.Jeff: So do the Californians feel the same way about the people from Oregon? Is that a mutual emotion to dislike the Oregon people as well?Tim: I don't think so because there's been a lot of them moving up. You know they move up there to retire and they move their kids up there, so I think they life Oregon and Oregonians tend to be pretty friendly.Jeff: And how about the North, your northern neighbor? Washington?Tim: Washington and Oregon are pretty similar as far a culturally.Jeff: So if I call you a Washington - if I say you are from Washington you don't mind as much as being called Californian?Tim: Ah, that's true. Yeah, that's for sure.
更多英语知识，请关注微信公众号: VOA英语每日一听Jeff: So where are you from?Tim: I'm from Oregon.Jeff: Oregon.Tim: Yeah. It's on the West Coast of America, above California and below Washington. It has the coast. It has the mountains and a lot of different regions really.Jeff: Really, so which is your favorite of those for regions, which do you like the best?Tim: Well, that's difficult. I like the coast a lot. The coast of Oregon is really, really rocky. It's really natural. In Washington, it's really, really developed and in California as well, but in Oregon, it's really, really natural - really rocky. There's beaches and you go out there and it's just nature.Jeff: Swimming? Fishing?Tim: It's cold so there's not a lot of swimming. There's surfing. There's really good fishing. People fish. They take boats out. It's really nice, but...Jeff: Sounds good. So you have the ocean and then you can move inland to the woods.Tim: Yeah, from the ocean you move inland and you've got a real green area. In fact, it gets some of the most rain in all of America really.Jeff: So it is a rain forest.Tim: Well, there are areas that are considered a rain forest. One of the biggest rain forests in America is there, but it's real wet, real green and really mossy. There's moss hanging off the trees. It's beautiful. The greenest place you've ever seen.Jeff: And then, so you had the beach, the ocean. You had the woodland. Is there any other types of regions or landscapes?Tim: Well, you got the real green area I talked about and then from there you go to the mountains, and the mountain kind of traps all the rain. On the other side, it's really dry. It's called kind of a desert region. Lots of cattle ranchers. Real dry. It gets snow. It's good for outdoor sports, but hardly any rain really.Jeff: And that is mostly, you say farmland?Tim: Yes. It's farmland. Ranching land.Jeff: Are there any cowboys?Tim: There's lots of cowboys, actually. Lots of cowboys. Lots of people think of Oregon as a real liberal area but on the other side of the mountains, it's real conservative. So really two types of people.Jeff: So, you have those three regions. Do you have any big cities?Tim: We have Portland Oregon. It's a pretty big city. It's got a basketball team. It is a real nice city. It's got good public transportation.Jeff: So would you like to live in Portland?Tim: I'd like to live in Portland. It's be OK, but there's two college towns that I think would be really good: Corvallis, Oregon, and Eugene, Oregon. Real liberal college towns. They've got really good places to eat and friendly people. A little more liberal and laid-back, so it's my type of place.Jeff: So that sounds like a pretty good place to live. It has a little bit of everything.Tim: Yeah, I think so.Jeff: Maybe I'll move there.
It's the final week of Pride Month 2019. The guys wish everyone celebrating World Pride in NYC a wonderful time. Jeff talks about being homesick for New York and missing playing hockey. Pose's early season 3 renewal is praised. Will talks about the special Masterwork Experiment happening on The Story Grid Podcast where they are breaking down and analyzing the story structure of Annie Proulx's Brokeback Mountain. Jeff and author/blogger Lee Wind have an extended interview in which Lee discusses his debut YA novel, Queer as a Five Dollar Bill and how he's become engaged in discovering queer history. They also talk about the YA book blog I'm Here. I'm Queer. What the Hell Do I Read? that Lee began over a decade ago. Lee also recommends a couple of his favorite YA books and the queer history project he's trying to jump start on Instagram. Complete shownotes for episode 194 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript - Lee Wind This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Lee, welcome to the podcast. It is so great to have you here. Lee: Thank you so much. I'm really excited to be here, Jeff. Jeff: Now, I recently read your debut novel, "Queer as a Five-Dollar Bill". In fact, I reviewed it back in Episode 189. And absolutely love it. Now, tell people in your own words what this YA novel is about. Lee: So it's all about the fact that I don't have a time machine. When I went...in 2011, I went to a game in summer camp kind of weekend. And there was a guy talking about the letters that Abraham Lincoln wrote Joshua Fry Speed that convinced him that Abraham was in love with Joshua. And I just thought he was full of it. Like how could that have been possibly been true? It's the first time I heard about it. And I went to the library, and I got the letters and I read them and because the emotions Lincoln speaks about are the same emotions I experienced when I was closeted in dating girls and sort of judging it the right thing to do, but not feeling it, I had this moment of sort of goosebumps, and I was like, "Oh my gosh, I think maybe Lincoln was in love with speed." And I thought, "Oh, if I had a time machine and go back and tell my 15-year-old self that the guy on Mount Rushmore, the guy on the $5 bill, the guy on the penny, was maybe in love with another guy, I think it would have changed my whole life. I don't think it would have taken me until I was 25 years old to fully come out. I think it would have been a game changer. But I don't have a time machine. So "Queer as a Five-Dollar Bill" is my paying it forward. I'm a writer, I wanted to write the story about a 15-year-old who's closeted and bullied and dating a girl because he kind of judges it's the right thing to do, but he doesn't feel it. And then he's assigned a book report on Lincoln and he gets the same book that I got from the library, he reads the actual letter, where Lincoln is asking his best friend, after the best friend has gotten married to a woman, "Are you now, in feeling as well as judgment, glad you're married as you are? From anybody but me, this would be an impudent question not to be tolerated, but I know you'll tolerate it for me." And he ends the letter saying, "Please tell me quickly, I feel very impatient to know." And we don't have Joshua's answer, because Mary Todd burned all the letters on that side of the correspondence. But we do know it was only four weeks later that Abraham had married Mary. So to me, it felt like wow, that, like what would happen if a kid today found that out and decided that he wants the world to know? Because everyone loves Abraham Lincoln in our country. And he thought, "Well, okay, so if he tells - the main character, Wyatt - if he tells the whole world that Abraham Lincoln was in love with another guy, he thinks it's going to change how everyone feels about gay people, cue the songbirds and the rainbow and happy ending." I do think if in our culture today if someone was to go really viral with the information that Abraham Lincoln was, wrote these letters and was in love with Joshua Fry Speed, I think there would be a huge conservative backlash and media firestorm. And that's really that what I wanted to show in the novel, how this Wyatt, how Wyatt, this main character makes his way through this incredible maelstrom of fury that he's ignited by just sharing what actually is part of American history. And then to kind of ratchet the stakes up even further, I wanted to make it, like, how was it important for a teenager today? Why is Abraham Lincoln important? So I kind of situated him in Lincolnville, Oregon, a town I kind of made up. His parents own the Lincoln Slept Here Bed & Breakfast. And when the economy of the town kind of starts to tank and they're threatened with losing their business, they bring in a civil rights attorney to help and she has an openly gay son and sparks fly between the two teens. But the main character Wyatt can't do anything about it. Because gay kids saying Lincoln is gay is really different than a straight kid saying Lincoln is gay. And he's faced with his choice, does he follow his heart and see if something might be happening with this guy, Martin? But the cost of that is letting this secret fade back into history, and nothing will ever change in our world. Or does he sort of sacrifice himself and his own happiness, and persist with the story that Lincoln was indeed in love with another guy and see if he can change the world a little bit, even though it won't change for him? So that's the story of "Queer as a Five-Dollar Bill". Jeff: And I feel like even before I read this book that I had heard, you know, some of the rumblings that Lincoln may have had a relationship, may have been gay. So I think it kind of dances around the edge of what some people know, because I can't even begin to tell you where I heard it or anything else, just that it had been kind of back there somewhere in the memory of I don't know, something. Does that even make sense? Lee: Well, it's been a big thing on "Will & Grace", the revived series. They've been doing a whole run on jokes about Jack doing a one-man play called Gaybraham Lincoln, which is sort of all about Lincoln being gay, which I think has been good on the one hand, because it's letting more people know that this is something that people are talking about, but it's also doing so as if it's a farce, as if it's not true at all, and completely made up in a complete flight of fancy on the part of this bigger than life character. When in fact, if you read the letters, it is remarkable how to me it feels so clear that Lincoln was in love with Joshua. Jeff: What was your process for researching the history? Because there's more in here than just the letters themselves. There's a lot of Lincoln history, there's comparisons drawn between Lincoln and Martin Luther King Jr. In my review, you know, I kind of likened it a little bit, you know, you go see "Hamilton" and you get this big infusion of history, while you're wildly entertained. What was kind of your process around gathering all the pieces you needed? Lee: Well, first of all, thank you for comparing it to "Hamilton." That is like the best compliment ever. I need to embroider that on a pillow or something. I did a lot of research. I started out with the letters and then I realized that I just didn't know enough. I looked around and I live in Southern California. And it turns out in Redlands, California, there is an Abraham Lincoln Memorial shrine and museum. And it's like a three-room edifice that has display cases and a gift shop. And so many of the things that ended up being part of the bed and breakfast that Wyatt's parents own were kind of taken from that real-world experience of going to this place and seeing that they actually had, you know, civil war chess sets. And they had, you know, little teddy bears that were gray or blue. And they had, you know, Confederate Flag and a Union Flag. And that was hugely helpful. And then just starting to dig in deeper to some of the things I discovered there, there's a whole sort of subplot about how Wyatt feels that there's no one he can actually talk to. And so he's developed this strange internal dialogue with this image of a soldier in the background of one of their display cases. And I actually have a photo of it from when I went to this Lincoln shrine. And it was there, it was behind all these ammunitions. And I don't know that my gaydar works 150 some years later, but definitely, there's somebody in that, they're one of the soldiers in that photo does look like he could be gay. And I thought, "Wow, what if this was the only way that Wyatt felt that he could have somebody that recognized who he was, and how sad that was that he didn't really have a friend?" And that was why I was excited to create the character of Martin so he had somebody. Jeff: Were you a history buff all along? Lee: No, I hated history. And I'm sure that they're all these teachers that are like hitting their foreheads in shame right now. But like, honestly, I never had a history teacher that kind of got me excited about the stories of history, because I really feel like the way we teach history today, and my daughter's in 10th grade right now and her history textbook could have been my history textbook from the 1980s, where basically, it's the stories of rich, white, straight, cis-gendered, able-bodied men from Europe. And, you know, history is more than that. There are the stories of disabled people and people of color and women and men who loved men and women who loved women and people who looked outside gender boundaries in history. And I kind of feel like, we have to crack that facade of that false facade of history and let people know that that there's all this amazing light and you can see yourself in history. And, you know, Lincoln and Joshua are just sort of like the tip of the iceberg. There's, you know, Eleanor Roosevelt and Lorena Hickok, there's Mahatma Gandhi and his love for this German Jewish architect, Hermann Kallenbach. There's the pharaoh Hatshepsut in Egypt, there is Safa, there's so many stories that impact us today. But we don't really know them because they don't get taught, or when they are taught, they're not taught in a sort of, queer inclusive or respectful manner. So I kind of feel like now I love history. And in fact, I wrote this novel, but as I was writing the novel, there was so much history, there was so many things that came up, so many more pieces of evidence, so many more pieces of the pie, things that made me surprised, like, I didn't really know that Lincoln was sort of a racist, even though he's credited with freeing all the slaves, he had this whole plan that he signed off on with Congress at that time to sort of, you know, explore shipping all black people back to Africa. And I didn't know that. And the deeper I dug, when I found a piece of information that kind of contradicted what I knew, I really wanted to find a way to include it in the story. Because I feel like that's what we should be doing when we find things that show that history is complex, and that people are not black and white, that it just makes it all so much more real and so much more relatable. And if we can see reflections of ourselves in the past, like if we know that there were men who love men in the past, then we can believe that we have a place at the table today. And if we know that we have a place at the table today, we can envision a future that is sort of limitless. And I want that for everyone that doesn't feel like their history is included. I want it for all the women and all the people of color and the disabled people and the women who love women and the people who lived outside gender boundaries, too. Because that's, you know, we call it LGBTQAI+ or QUILTBAG or whatever. But really, the job is about being an ally to other people. And me as a gay man, I have to think, "Well, how can I be an ally to everybody else?" And hopefully, they're thinking the same thing. And that's how we start to create societal change. Jeff:: That is wildly profound. And especially, given that this episode of the podcast is dropping in the last week of June, as you know, the queer community celebrates Stonewall 50. Lee: Oh, yeah. Well, you know, I love that we're celebrating Stonewall, I love that the gender non-conforming people that were there, the transgender people, the drag queens are getting some respect now that they were part of that and they were in fact, the leaders of standing up to the police finally. But for many, many years, Stonewall had a banner, the Stonewall Inn had a banner outside that read "Where Pride Began". And I think that's really misleading. And we talk in the queer community in America as if that's where pride began, right. Like, pride, "Hey, we're celebrating 50 years of Stonewall, Hooray." But wait a minute, Karl-Maria Kertbeny came up with the word homosexual 100 years before Stonewall. Right? Like Lincoln and Speed were writing these letters to each other 20 years before that. You know, you can go back thousands and thousands of years and there's this beautiful story from China before China was unified, where the State of Wey that the guy that ruled it, his name was Duke Ling and he had a guy he loved his name is Mizi Xia. And they were walking through the orchard one day and Mizi Xia picks a peach off a tree and starts to eat it. And halfway through, he stops because it's so delicious. He wants to share it and he gives the half eaten peach to the Duke and the Duke makes a really big deal out of it. Like, "I can't believe your love for me is so profound that you would sacrifice your own happiness to give me the peach." And something about that moment captured the imagination of people in that pre-unified China. And for over 1,000 years, the way in Chinese that they said gay love was love of the half-eaten peach. Like we have this amazing, amazing history. And we just need to kind of breakthrough that facade and let all this amazing rainbow light shine through. So that's kind of what I feel my mission is to kind of let people know that we have all this amazing history, and we can start to dive into it. Jeff: Is this all history? Because you mentioned earlier that you're not, you weren't a history buff and you hated history. Have you gathered up all of this new knowledge since you were researching to write "Queer as Five-Dollar Bill"? Lee: Yeah. So while I was writing "Queer as a Five-Dollar Bill," like I mentioned, there was just so much stuff that came up, so much evidence that I was like, "I can't really cram all this into a novel, because at the end of the day, the novel is really about a kid today." And I didn't want it to feel like a historical novel. I wanted it to be this page-turner. So I realized that maybe it was two books, maybe there was the novel. But what if there's a nonfiction book as well that presents the primary source materials, like a popup video thing on MTV or VH1, whatever it was, helps interpret, or at least how I interpret the thing? So like, there's all this talk about Shakespeare's Sonnets, and how, while they're very rarely taught, over 100 of the sonnets, Shakespeare wrote to another guy. And these are love sonnets that include really, really famous lines that we all recognize, like, "Shall I compare thee to a summer's day. Thou art more worthy, yet more temperate." That's a line that Shakespeare wrote to another guy. For hundreds of years, they had changed the pronouns of that in one of the folios. So it ended up being that for hundreds of years, people thought that Shakespeare wrote all those poems to a woman, to the Dark Lady. But when "The Riverside Shakespeare" came out, the editor of that section, he talked about how, "Well, we've restored the sonnets to their original, you know, pronouns, but you shouldn't mistake that, you know, the affection men felt for each other in the 1500s was nothing like the homosexual attraction today." He wrote this in 1970s. And I'm like, "Really? Really?" Because, you know, "A man in hue all hues in his controlling, Which steals men's eyes and women's souls amazeth," it sounds pretty romantic to me. So what I realized what I wanted to do is to create a book that wouldn't be just a book about Lincoln and Speed, but it would be a book about the broader thing, about men who love men and women who love women and people who lived outside gender boundaries. So there's 15 chapters. One is about Lincoln and Speed, one is about Shakespeare. And then there's, like, you know, a bunch of other amazing people in history, and it really presents the primary source material. And I'm really excited because today - that we're recording this - is the day that I'm signing the contract for that book with a publisher. Jeff: Oh, that is exciting. Congratulations. Lee: Thank you. It's been a long journey, long and crazy journey. Because the book originally was set up at one of the big five publishers, and I worked on it for a year and a half with them. It was approved, we were talking cover design. And then two weeks after our current president was elected, they canceled the book. I think they were concerned that it was going to be too controversial. They just didn't have the courage to proceed. And that was really devastating. And it took a long time to find a new home for it. There were a lot of shenanigans, a lot of plot twists. The agent I had had at the time turned out to be a criminal who, well, she was telling all her clients she was submitting things and that they were having all these pending book deals. She was lying. And the book was never submitted anywhere. Even after it was returned, the rights were returned to me. And the novel, "Queer as a Five-Dollar Bill" ended up getting crowdfunded because I thought that I was being, well, stonewalled by the children's book industry and they didn't want word to get out about Lincoln and Speed so much so that no one would even respond to the submissions. So I crowdfunded it. I have a blog, I think we're talking about that a little bit later. But I have a bunch of people that know who I am and what I was trying to do, and they all supported me to not just publish the book professionally, but also, what I wanted to do is raise enough money to donate at least 400 copies of the novel to LGBTQ and allied teens, and the Kickstarter funded in six days, it was amazing. And then it went on for another 24 days. So we ultimately raised enough money to give away 910 copies. So that's been really, really gratifying. Jeff: That's incredible. I mean, it's really one of the great things about publishing today is that there's really no more gatekeepers out there. Anybody can publish, get it on Amazon, get an audiobook done, etc, and get their messages out there. Lee: There still is the thing, though, that being with a traditional publisher, you generally can reach more, especially when we're talking about like middle grade, you know, or books, where you go into libraries, which I think that this nonfiction book really is a, you know, hopefully, it'll sell like hotcakes. But also, I do think that to get it adopted more broadly into schools and into libraries, I think that coming from an established publisher is really useful and really helpful. So I'm excited about that. I do think that yeah, that there are many, many fewer boundaries than there used to be - or barriers than there used to be. But at the same time, we have the additional challenge that while access to the marketplace has never been easier, the marketplace has never been bigger. So getting noticed in a marketplace, where there's over a million books that are published every year now in the U.S., is a challenge. And that's why it's so important to have safe places to find out about these things, like your podcast, and my blog. Jeff: Yes, absolutely. To spin back on "Five-Dollar Bill" a little bit and talk a little bit more about it. What were your inspirations for both Wyatt and Martin and the type of teenagers they would be? Lee: When I was growing up, or when I was coming out, I think it felt like you couldn't be gay if you lived anywhere except for one of the big cities like San Francisco or New York. And I really wanted to have a character that felt connected to nature. And that one of the thematic subplots would be, 'Could he be himself where he was? Could he be himself in small town America, in a rural community, was there a way through for him to be successfully himself and authentic?' I feel like I spent so much of my life being inauthentic, that I want to do everything I can to help teens be authentic now. So on the one hand, Wyatt was the study of a kid that was on a journey to be authentic and Martin was the flip side of that. Martin was the character that already was authentic, and was already reaping the benefits of that level of confidence. And you know, as soon as you, for me, when I came out, it was like this huge burden off of me. And suddenly, I realized the weight of it was on everyone else, right? Like, if they had a problem with it, that was their problem. But it wasn't me hiding or holding back, or pretending or acting, which I did for so long. My husband and I have a joke, where when you go to a Starbucks or something, they're always like, "What's your name?" And every time my husband changes his name. Like he just makes up different names every single time. And they ask me and I'm always Lee because it took me 25 years to even start to like myself and to accept myself. And I finally got here. And I'm like, "Yeah, I'm not anybody else. I am me. I am Lee." It's funny. I take a spin class and as a motivational thing the spin instructor does, "Who do you want to be today?" I'm always like, "Me, I want to be me." I spent so long being other people. And then also, it was really cool when I was creating Martin's character, to think about him being African American. And that being an opportunity for me to talk about the complexity of Abraham Lincoln and him not being so perfect and explore those themes a little more. And it's funny because I hear from a lot of people how much they love Martin. And yeah, he's pretty lovable. Jeff: Yeah, I really liked them both in their individual ways. For sure Wyatt...I grew up, I spent like middle school, high school, college in Alabama. So I could totally relate to where Wyatt was in his journey like he knows, but there's no way he's telling anybody. And I didn't have a Martin for a best friend. So I also loved Martin, because he was the ideal friend to have for Wyatt in the moment to show him what could be. Lee: Yeah, exactly. Jeff: What do you hope the audience takes away from this kind of history/fiction mashup? Lee: So I think a lot about words, you know, being a writer, and I think that the word homosexual isn't helping us. I think that if we, because we're so reactive and weird in our culture, in America about sex, and we are obsessed with it, and we don't want to acknowledge it. And especially we don't want to talk about it to teens. So when we talk about homosexual rights and homosexual history, all straight people are hearing, you know, to paint with a broad brush, is they're thinking about sex and that we have sex differently than they do and how do we have sex. And I just don't think that's particularly helpful. And I think that if we talked about love as sort of the binding element that makes me and my husband and our teenage daughter a family, or the love between you and your husband, if we talked about HomoLOVEual rights and HomoLOVEual history, I think we'd have a very different cultural conversation. So what the tagline of my book is, "What if you knew a secret from history that could change the world?" And I love this because it gets a little meta. But it's the challenge that Wyatt faces, right? He finds out the secret about Abraham Lincoln writing these letters and maybe being in love with Joshua Fry Speed. And he decides that he's going to tell the world because it could change the world. And then it's the same challenge that I faced because I knew the secret from history and I thought this drumming sense of responsibility, like I had to share it, I had to get it out in the world. And because I wasn't getting anywhere with traditional publishing, I thought, "Okay, well, I'm going to crowdfund it, I'm going to get it out in the world, myself." And then what I am really excited about is that it's also the challenge that the reader faces. Because when you've read the book, or you even heard me talk about the book, you know that there is something more to the story of Abraham Lincoln that has been taught to you. And it's that first crack in that facade of history. And it makes you think, "Well, wait a minute, when you see the picture of Mount Rushmore, or when you pick your kid up at the Lincoln middle school, or you're driving on Lincoln Boulevard, you know, does it occur to you that, you know, our culture has not shared that part of who Lincoln is? And does it make you feel a little more pride about the fact that you know what, we do have history, queer people, and we need to lean into it? And we have the opportunity to because there are hundreds of years of historians that are going to argue with us and that are going to say, "Yeah, yeah, it's not true. It was very typical for men to share beds on the frontier." Not that Springfield, Illinois was the frontier. But for four years, you know, Abraham and Joshua shared a bed long after Abraham could afford his own bed. "Well, it was cold." Okay, yeah. But they shared a bed for four years. It's not proof. But it's interesting. And I think that as all those things add up, we can all make our own determination of what we think, you know. Is it important for me that I convince the world that Abraham Lincoln was in love with Joshua Fry Speed? No. I think a lot about Anne Lamott, she's a writer, and she writes about writing. She has a beautiful book called "Bird by Bird". And in that book, she talks about lighthouses, and how they don't run all over an island looking for boats to save, they just sort of stand there and they shine. And I think a lot about that. Like, I need to be a lighthouse. Like I found out this amazing, cool stuff about history, and how it relates to today, and how empowering it is. And I just want to shine. And if people are interested, they can come closer to the light. And if they're not interested, no worries, you know, watch out, there's some rocks over there. Jeff: Any chance of a sequel? Because I know I would love to see more of Wyatt and Martin at some point Lee: I haven't really come up with a good angle on a sequel, I had this funny idea for...one of the other pieces of history that really struck me was Mahatma Gandhi and the story of his love for Hermann Kallenbach. And we talk a lot about Gandhi having this sort of breakthrough where he talked about it doesn't matter whether you pray facing left and I pray facing right - I may have that reversed. We're all praying to the same God. Like he had this huge breakthrough, not just in terms of, you know, a peaceful protest, Satyagraha. He changed our world in such profound ways. And at the same time, he was in love with this German Jewish architect named Hermann Kallenbach. And if he was in love with a Jewish guy, like that's actually really interesting and really germane. Like maybe that's why he had that inspiration, that insight about it doesn't matter who you're praying to, because it's, we're all sort of bonded by this sense of spiritual connection. Like, that's really exciting. And I feel like there's so many stories like that, like Eleanor Roosevelt and Lorena Hickok. Eleanor Roosevelt was the woman that after, you know, her husband died, she went to the UN and became this advocate for the Universal Declaration of Human Rights. And would she had done that if she didn't have this experience of being in love with another woman, and feeling that sort of outsider status, while at the same time being this empowered woman in our world? History starts to open up like a flower. So I don't have an exact idea for a sequel for Wyatt and Martin, but I will put it in the hopper as ideas. Reason I brought up Hermann Kallenbach and Mahatma Gandhi was that I thought, that would be an interesting thing to talk about a kid finding out about that, and how that would have changed their life. And then about, "Wait, that's the exact same story over again, I don't need to do that. I already wrote that." So for now, I'm going to focus on the nonfiction piece and some other fiction writing that I want to get to that, actually, I'm very inspired by your book too, by the "Codename: Winger" series, because I love the idea of mashing up a gay teen with a sort of spy thriller. Jeff: And I can't wait to read what you might do with that. So please, bring that to the marketplace. Lee: Thank you. I keep thinking, "Is there a way I can get gay history in here somehow?" I haven't figured that either yet. But, you know, I'll work on it. Jeff: You'd mentioned earlier that you've got your blog, which I was so excited to find right around the same time as finding the book. You've been a YA blogger for more than a decade now. I believe you said it'll be 12 years in September. And the blog is called "I'm Here. I'm Queer. What the Hell do I Read?" What led you to starting that? Lee: Thanks. Yeah, there was no safe space to find out what were the books with queer characters for kids and teens. And I remember, there was a review on Amazon for a really sweet picture book called "The Family Book" by Todd Parr. And it's sort of a cartoon-y book. And there's like one page, it says, "Some families look alike." And it's a bunch of dogs that they all have similar features. "Some families look different." And it's a tree with all these different kind of animals in it. "Some families adopt children." And it's a bunch of ducks. And on the back of one duck is a penguin. And then you turn the page and it's, "Some families have two moms or two dads." And it's a picture of two women and two men. And then it continues, and there was a review, pretty high up that said, "If you tear out the page with the two moms and dads, then this is a lovely book on diversity." And I thought, "Wow, way to miss the entire point of what diversity is." And I got so upset and so hurt, you know, because I'm a gay dad. And I thought this was an amazing book for my daughter, but also for all of my daughter's classmates to see and recognize, "Yeah, yeah, you know, some families do have two moms and two dads." And to Amazon, that wasn't hate speech, it didn't violate their terms of service, it was just somebody's opinion. Albeit kind of, you know, nasty, or at least I interpreted as nasty. And it got me thinking about how there really needed to be a safe place online, where a kid could go and find out what are the books that were out there. And when I started, there were maybe 30 books total that were inclusive of LGBTQ characters and themes for kids and teens. And what's happened over the years is that by keeping this curated safe space, where I'm not vetting all the books, but I'm making sure that no nastiness is happening on the site. We have over 500 books now in many, many categories. And it's been really exciting to see that sort of explosion of content. And yet, it's that sort of similar problem again. Like now, suddenly, there's so much content, how do you make your way through it? How do you find the things that you want? So the idea behind it was to post about the books, what's queer about the books, and then let readers add their own reviews. There hasn't been a lot of review, there's just too many places for people to leave reviews these days. So I don't see a lot of that. But I also didn't want to make it, you know, "Lee's favorite book site" because I think that that has a limited value, I thought that there was more value in it being a site that felt really comprehensive. And that's what I aim for. And then it just became a place where I could talk about the stuff that I really care about, that I want queer and allied teens to know about. And over the years, what I've discovered is that the readership is split into thirds. There's about a third, queer teens and queer and allied teens on it. There about a third of librarians and teachers and people that work with LGBTQ teens. And then there's a whole bunch of adults that are sort of reading the books for themselves and sort of healing their inner teen. And I think that there is a healing that happens. Every time I read a queer book that has a happy or even a hopeful ending, there's a healing that happens. And I think maybe that's part of why romance as a genre is so popular. I know Will was saying in a previous episode that people get on his case for like ruining the ending, but it's all romance, you know it's going to be a good ending. And I think maybe that's why people turn to it. So I know how empowering it is for me when I read something where I see a reflection of myself, and it's a positive thing. Because when I was growing up, there was nothing to read, nothing positive. The only queer characters were like evil pedophile villains, it wasn't particularly helpful. Jeff: Yeah, that's, unfortunately, the case in the history that you and I have from that era when we were growing up. In the decade-plus that you've been running the site, other than just more YA, how have you seen it all evolve? Lee: There's more, and there's better and there's deeper, and there's less preachy and there's room for it all. It's funny, there was a kind of push a few years back for...well, maybe we're beyond the coming out story. And I kind of got my dander up a little bit on that. And I felt like, "Well, we're never going to be beyond the first love story when it's, you know, a straight romance. So, Andrew Solomon has this great book that he wrote called "Far From the Tree" and it's a nonfiction piece. And he talks about how, you know, when your identity is...where you're the apple that does fall far from the tree, or falls from the tree and rolls across the, you know, down the hill and across the orchard, when you're queer, most likely your parents were not. And so you have this moment where you have to find your sense of community outside of the family that you grew up in. A lot of other identities, you share that. Like, usually, like me, I was raised Jewish and so I would, you know, my parents were Jewish. So I sort of shared that identity. For all of our identities, we sort of are either sort of close to the tree or far from the tree. And when you're far from the tree, there's more work involved. So coming out, I think is going to continue to be this universal thing. Because just like, you know, my daughter has two dads, but she's straight. So in a funny way, she's going to have to, you know, she had a bit of a coming out where she had to tell us, sort of, you know, abashed, hoping that we'd be okay with it, that she was straight. And we had a good laugh about it. Because it's not that big a deal for us. We just want her to be her authentic self and to be happy. So we do want to have coming out books, and we also want to have books where being gay, like your character Winger, Theo, where it's the least interesting thing about him. I loved when you said that in your interview. Because yeah, we want those stories, too. It's like in acting, right? In improv, the rule is yes/and. So we want these books, and we want those books. We want the fantasy, we want the romance, we want the science fiction, we want all of it because truly, if you look at the numbers of books that are published - traditionally there about 5,000 books published a year for kids and teens. And then, if you look at the world of self-publishing, let's say that 5,000 are doing it really beautifully. And the books are indistinguishable with the quality of that from traditional publishing. That's 10,000 books a year, a year. And you have all those years going back too. So what we want is the opportunity to sort of have all of those books and right now we still only have like 500. So we have a long way to go. We need lots more books, we need lots more voices, we need people writing their own voices, stories, we need more diversity included in everybody's stories because truly, you're not going to have a classroom today that doesn't include someone that's LGBTQ, we need it all. Jeff: That's very true. Given that you had the blog, did you always see yourself eventually writing the YA novel that you did? Or did that just kind of manifest itself because you have the story to tell? Lee: I've always been a writer. I've written...I remember one summer when I was like between 9th and 10th Grade in high school, I was like, "I'm going to write a novel." I sometimes think of those poor characters still trapped in the broken space station that was orbiting the Earth. And I'm like, "Oh man, I have to do something with that someday." I don't think I will. I've always written. I think that for the last 14 years, I've really focused on writing for kids and teens. I also write picture books and middle grade. And when I found out this thing about Lincoln and Speed, it really inspired me to focus on writing that as a novel. I think that the blog has been a way to have my voice heard in a more direct way, and not wait for somebody to tap me on the shoulder and say, "Okay Lee, we're ready for what you have to share." So that's been really empowering. I remember, when I started the blog, there were very few people reading it, and I would get all excited, I'd be like, and I'd tell my husband, "Hey, 15, people went to my blog today." And I was so, so excited. And now, all these years later, we passed 2.6 million page loads. I get between, you know, 15,000 to 25,000 page views a month. It's remarkable, and humbling, and also a really cool responsibility to continue to maintain this safe place. And at the same time, I'm trying to keep writing and work on the new stuff, which has been really a good thing, because balancing the day job and the blogging, there's a lot but I have stories I want to tell. And I'm going to keep trying to tell them. Jeff: Good. Yeah, keep putting it out there. Because we always need more, to be sure. For people who haven't seen the site yet, and we're certainly going to link to it in the show notes. It has an amazing hero image across the top of the superhero. Where did that come from? And where did the name come from? For folks who might question the name too, because I have a pretty good idea where the name came from. But let's hear it from you. Lee: Sure. So "I'm Here. I'm Queer. What the Hell do I read?" is a play on words of something we chanted in Act Up in the '80s and '90s. The chant was "We're here. We're queer. Get used to it." And I thought, well, my issue is a little more "What the hell do I read?" Because I felt so starved for any books that included somebody like me. I mean, you know, I grew up and I really and truly thought I was the only person in the world that felt the way I felt about other guys. And which was super ironic, because I have an older brother, who's five and a half years older, and he's gay too, but we never spoke about it. We are the children of immigrants and when my parents came from Israel, they sort of brought all their homophobia with them. And the American culture at the time was super homophobic, especially where we lived outside Philadelphia. It was not a safe place. And it's so amazing to think that you can grow up and feel like you're the only person and everything I read, I was obsessed with the series by Anne McCaffrey called the Dragonrider series. And there was this super between the lines, sort of thematic thing that you could maybe interpret that there was gay stuff happening in that world, but you had to really stretch for it. And looking back, I think, well, maybe that's why I was so obsessed with that book, with that series, because there was some faint, not even mirror reflection, but like the gleam of a tarnished piece of silverware. I was like, "Wait, wait, maybe that's me." So that's where "I'm Here. I'm Queer. What the Hell do I read?" came from. The image happened a few years later. I had been running the site for about two years, it had been doing really well. And I realized I wanted to have a customized image. And yet, it's a pretty wordy title. So I realized I needed an image that didn't have any additional words to it. So I contacted someone I knew, an artist I knew, Jim DeBartolo. And, I said, "Look, I need an image that says empowerment." And he came up with this sort of superhero moment of like ripping the denim shirt off. And there's this sort of T-shirt underneath with the sort of superhero logo, which is the website, which is leewind.org. And it was funny. We tried to play with the sort of partial face that you see, we tried to, you know, could we make it a person of color? Could we do some things with you, know, the physique? But ultimately, it was sort of an avatar of me, and it took me years to admit it that's sort of what of course it is, it's an avatar of me, but I don't have that good a jawline. But at least in my mind, I think that it's been this sort of symbol of empowerment. And that's really what I hope that people get from visiting the site, from reading anything I write. I want them to feel empowered. Jeff: I like that. That's a great story behind that. Lee: Thanks. Jeff: So relying on your...I'm going to call it a YA expertise because of the site that you run. What are three or four titles of current YA that you would recommend our audience to take a stab at? Lee: Sure. So I have to start with "Carry On" by Rainbow Rowell. I know it's not super recent. But this is the gay Harry Potter book that I wanted so badly. And I was so frustrated that JK Rowling didn't include Dumbledore as being gay in the canon. It sort of was outside the books that that revelation happened and you can go back and sort of, you know, read subtexts and stuff. But I really was hoping that there would be some sort of, you know, on the page, queer love or something, and it didn't happen, there was really nothing. And, you know, Rainbow Rowell, she wrote two books, one about the girl that writes the fan fiction, which is called "Fangirl", which is really good. And then there was this book, which was the fan fiction, that ended up being a huge success on its own, called "Carry On". And I don't want to say too much, but it is absolutely brilliant. And if you are queer, or love queer stories, and you had any connection to Harry Potter, and that sort of world of magic, you've got to go read this. It's just wonderful. Jeff: Excellent. Her books have been on my TBR forever. And I actually need to take the leap and read them. Lee: Read this one first. It's just you will be so happy you did. Jeff: So you mentioned the nonfiction that you've just signed the contract on and other stuff noodling around in your head... anything else you want to shout out that's coming up soon for you? Lee: So there are a bunch of things percolating. But nothing has come to full boil yet. So I will let you all know when it does. Jeff: That is fair. I can't wait to hear what they are. Because I think that, yeah, having read the one book from you, I'm looking forward to reading so much more. So where can people keep up with you? There's leewind.org as we talked about, which is the "I'm Here. I'm Queer. What the Hell do I read?" site. Anyplace else people should be looking for updates? Lee: Yeah. I mean, I'm playing around with Instagram. I'm trying to do this thing. I had the idea that we could do a #queerhistoryiseverywhere. And I wanted people to upload photos of Abraham Lincoln or the word Lincoln wherever they saw it and just start posting it on Instagram. It hasn't exactly caught on yet. But I still like that idea. Jeff: Maybe our podcast listeners will play along with that. Lee: Oh, yeah, that would be really fun. And also, I mean, as, you know, more queer history happens. I was speaking at the Bay Area Book Festival recently and someone came up after my panel and they said, "Did you know that Bābur from the Bāburnāma when he was a teen he was in love with another boy?" I was like, "Really?" Totally, I have sitting on my desk right next to me right now the "Bāburnāma" and indeed, when he was 18, he was in love with this other boy. And it's so exciting to find out this stuff. So I feel like because it's been hidden, the more we can crowdsource this information and share it and then all amplify each other. I think it's very, very exciting. Jeff: Very cool. So we will link to all that stuff, the books we talked about - everything else - in our show notes. And Lee, I'm so glad we got the opportunity to talk, spread the word a little bit more about this book and the website and thank you for all you're doing to get more out there about YA literature too. Lee: Thank you, Jeff. I really want to say thank you to you and to Will. I'm really a fan of the podcast and getting to be on it as a real thrill. So thanks.
Jeff opens the show talking about the work he's doing on the manuscript for the Hat Trick re-release. New patron Lucy is welcomed. The guys talk about Tales of the City on Netflix and the new season of Pose on FX. Will reviews Anticipating Disaster by Silvia Violet while Jeff reviews Prince of Killers (Fog City #1) by Layla Reyne. Jeff interviews Layla Reyne about the new Fog City series as well as how it felt wrapping up the Trouble Brewing series earlier this year. They also talk about Layla's RITA nominated book, Relay, and the upcoming fall release, Dine with Me. Complete shownotes for episode 193 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript – Layla Reyne This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Welcome Layla back to the podcast. It’s great to have you here. Layla: Thank you for having me back. Jeff: I had to have you back to talk about this new series, “Prince Of Killers,” as listeners will have heard right before this interview, blew my mind to pieces and back. Layla: That’s what I wanna hear. Jeff: Tell everybody what this new series is and in particular what they have to look forward to in “Prince Of Killers.” Layla: Sure. So the series is “Fog City.” It’s set here in San Francisco. It’s a new romance suspense series. You don’t need to have read any of my series before that. I won’t say that there aren’t some Easter eggs for those that have, because we are all existing in the same place and time. But, this is a little different because this is following a family of assassins. So in books one to three of the “Fog City” trilogy, starting with “Prince of killers,” you’ve got Hawes Madigan, who runs a cold storage business by day, a very successful family kind of business in the city. And then by night, the families, they’re assassins. And he and his two siblings, Helena and Holt, are kind of the triumvirate that is currently the heir apparent. He’s the heir apparent and they kind of all run it together. His grandfather is ailing and so that’s kind of the setup and fairly successfully he is making some changes in the organization. And so in comes…in the first scene, which is actually set at one of my favorite restaurants in the city, Gary Danko, walks Dante Perry who kind of has this strut about him, you know, long hair, looks like a rock God. But he’s carrying a gun, which he immediately notices, Hawes does, and Perry tells him, “There is someone trying to kill you.” And Hawes kind of laughs it off to start with because, dude, he runs an organization of assassins. That’s what they’re paid for. But then as Hawes and the family come to learn, it does look like someone is trying to stage a palace coup, so to speak. And so “Prince Of Killers” involves sort of the first stages of that and them trying to figure out who it is. And Dante has his own motivations as well. You know, he is trying to find the killer of someone who was close to him and Hawes doesn’t want him to find out who that is either. So I will leave it at that without spoiling too much. Jeff: Let’s talk about the elephant in the room a little bit, and that is the fact that while you have left, for example, the books of the Whiskeyverse on some subtle cliff hangers, this one’s bigger than normal for you. Layla: Yeah, I’m not hiding anything, guys. This one’s got a cliffhanger. I wouldn’t say anyone’s life is in jeopardy, but it’s definitely a cliffhanger. I have made no bones about that “The Usual Suspect” is one of my favorite movies. So hello. And, you know, I grew up in TV land and so I love cliffhangers and I kind of embrace it with this. And, you know, the good thing is the plan is for all the books to be out this year. All the covers are done. By the time this airs, book two will be in the hands of editors and I should be working on book three by then. So, they will all come this year and it’s in the blurb. So you know, everybody, fair warning. I’m not trying to hide it here. So… Jeff: Yeah. And I love how you make the analogy to TV because I would put the cliffhanger that you did on the level of like the mid-season break. Not quite the end of season break, but that mid-season, it’s Christmastime, we’re gonna go away for a while and we’ll have a big thing when we come back. Layla: That’s right. It’s the end of November sweeps. Jeff: Exactly. Layla: That’s where we’re at, not gonna lie. And then book two picks up right where it ended and goes on in there. Jeff: Yeah. Which I’m super looking forward to. Layla: I’m writing. It’s been a…It’s fun and, you know, I can’t…yeah, I can’t spoil anything. Jeff: Yeah. Don’t say anything else. I don’t wanna know. I don’t want the listeners to know. Layla: Okay. Okay. Jeff: What was the inspiration for “Fog City” overall? Because since you’ve gone with this family of assassins, it’s certainly different from what we’re used to in the Whiskeyverse where you’ve got all the, you know, FBI agents and other kinds of, you know, law enforcement as your main characters. Layla: So ironically, I was wandering through Wander Aguiar’s photography website looking for covers for a different project and I saw this picture of what will be the book three cover. And I had to know what the hell is their story. I mean it just jumped at me and I was like, I have to know the story. And then one of my good writer friends, Allison Temple said, “You can’t buy the pictures until you have a story.” She’s like, “Do not spend the money.” So by the end of the weekend, I had the story. I had all three of them and then I was like, “Okay, so let me piece together the three covers.” And so that’s kind of how it, in its original, came about, you know, thinking about doing it. So art really did inspire art in this case because the photos were just amazing. I wanted to branch out and do a little bit of something different. There have been hints of the people in the gray area, you know, Jamie, good guy, but some of that hacking is not exactly on the up and up. Mel, I think we saw go more and more, you know, in her bounty hunter business and be a little bit more flexible once she left the FBI. And so kind of going from there and wanting to play more in that gray area and having read books too, L.J. Hayward’s “Death And The Devil” series, in particular, you know, it’s fun and it’s to some extent pretty liberating. I don’t think it was…it wasn’t harder. There are less rules. Right? I don’t have to check the FBI’s hierarchy chart every day to make sure I’m naming someone the right position. So in that regard, it’s actually been a bit easier. Jeff: Your shades of gray is 100% right because it’s not a spoiler to say that Hawes, not only did he have the legit business on the side, but he’s even trying to modify the ways that the family does the assassin business to make it, I guess, less bad maybe. Layla: Yeah. So, there’s an event that happened three years ago that kind of drives a lot of the series and when you read you’ll find out what that is and to the extent it drives Hawes’ three rules, which are in the blurb, which is no indiscriminate killing, no collateral damage, and no unvetted targets. So, if they’re not…He is turning the organization away from kind of the killing machine that his grandfather, Papa Cal, was. And his parents were very methodical, very efficient, not a whole lot of emotion in it. And so, he’s trying to find the balance between those two of it being, you know, I don’t wanna say the killer with a heart of gold, but he is a killer with a conscience. And so he doesn’t even like the moniker Prince of Killers and what that stands and how it came about, which you’ll read about in the book as well. So, he’s definitely a great character. And then when you look at the broader picture of everyone in the series, Holt is, you know, this…he has a kid and he is, first and foremost, a father, right? And he is a hacker and he, because of where he’s at in his life, has pulled back to being kind of the digital assassin of the bunch. And then Helena, who is the sister, who is my typical female complete badass, love her, she works for…she does a criminal defense work in her day job where she is actually working for people who are wrongfully accused. And so there’s some shades of gray in her as well. And then even one of the other side characters is the chief of police who has an interesting relationship with the Madigans and he knows that there is some benefit to what they do and you’re gonna find out there’s some backstory with him as well as to where he is. So, there’s a reference to him in…If you’ve read “Trouble Brewing,” there’s a reference to him in “Noble Hops.” It’s the same chief, for those who are watching, that read that. So… Jeff: That was one of the Easter eggs that I missed. Because you and I have talked about the Easter eggs and there was some that I caught it and some was like, “Dang it.” Layla: So that’s one of…he’s the new chief, you know, that’s a little bit more flexible in the way things are done. And so everybody…and then Dante is also, you know, playing in his shades of gray as a PI and how far he’s willing to go and what he’s doing personally and professionally. Like where’s that line for him? Jeff: Helena is the one that I found the most interesting in her shades of gray because here’s an officer of the court who occasionally does some, you know, very illegal things, which isn’t to say that, you know, all lawyers are, you know, on the right side of the law. But for her, it seemed like really… Layla: Right. And she makes a line about balancing out her karma, right? That’s kind of how she approaches it to some extent of, you know, part of what they’re doing and why he…particularly Helena and Hawes are so well aligned like that, you know, Hawes wants the contracts of the people the law can’t reach or that escape the law, you know, who get around it, let’s just say, because of who they know or who they pay. And that’s kind of who their targets…that’s the targets he wants. People that have, you know, skirted justice for nefarious reasons. And her day job is the people who justice has wrongfully done. And so they kind of work hand in hand and her feeling on it plays to both of her careers. Jeff: You mentioned in this book you had less rules, so like, you’re not looking upon the FBI flow chart and things. Were there challenges to coming at these characters who had these shades of gray or was it…”free for all” is a little bit much, but certainly more freeing I guess. Layla: Yeah, certainly challenges. Though, I mean, you still have to balance the fact that, “Hey, they’re killing people.” Right? And how you balance that with their conscience, with the people around them, particularly Kane, who was the police chief, has a lot to deal with and going on kind of. So yeah, I mean it is definitely there. There were different challenges for me, I kind of liked it because I got to go a little bit more, even though it’s a shorter book than usual, I think going into their heads more than I typically would because there’s a lot more internal conflict – while still having tons of external conflict. I felt like there was more internal conflict about what they’re actually doing than, you know, being an FBI agent and knowing you’re on the right side of the law. So this was more…they had to kind of walk that line, particularly Hawes. Jeff: One of the things I like most about the book that is…in a lot of ways, it’s separate from the romance and it’s separate from the suspense element a lot is the family unit. And it’s a recurring theme, at least in the books that I’ve read of yours from, you know, Irish And Whiskey and their families. And then what we see of the families in “Trouble Brewing” of the main characters. And here I really feel like maybe it’s because we’re so much closer to the family that we really, even in the shorter book, get a lot about Hawes and Holt and Helena and their interaction with each other. What was your plan as you like populated this family and the characters that you wanted to put on the page? Layla: So, it kind of, I would say, came about organically to an extent. The first scene I wrote like that weekend when I saw the pictures, I wrote it and then I posted it in my little reader group’s like, “I hate you.” And in that first scene, actually there’s a reference to the siblings, but you actually don’t see them, but then they pop up. And part of it too was I had already found their pictures as well. I kind of knew who they all were, but, I also knew who we needed to do X, Y, and Z from a plot standpoint. I also didn’t want Hawes to be an island to himself. Right? And to some extent, giving the life that he lives. And, you know, the two aspects of his life, that family is gonna be the only…like they can’t really let anyone else get close. Right? And so, they’re so tight with the family. That’s the only people they trust. And so, that’s, I think, particularly why, you know, that’s who he debriefs with. That’s who they’re planning with and everything because that’s kind of it. And then, sort of, you have in that expanded family, you also have Holt’s wife, Amilia, and you have the grandmother, Papa Cal’s wife, and like that’s the tight-knit crew. And it has been that way for that family for three generations. And that’s kind of what you find out is that, this is what they do. And because of that, they have to keep it close to the vest and the families who they trust. Jeff: But even through that, you’ve got Helena pushing on Hawes to make the connection to find somebody. Which I love because even as all hell’s breaking loose, it’s like think about doing that because you could have what Holt has. Layla: Yeah. They both…you know, Holt’s happily married with a kid. And I think for both, for Hawes and Helena, you know, that’s the ideal. Their parents were happily married, right? Papa Cal and Rose were. So you can have happiness, right, in this. You just have to find the person who accepts it and where’s that line? And Dante is someone who could be that person, right? He comes in and he seems to know what they do. He seems to be okay with it. And it’s got a hint of insta-lust for sure. Like they’re immediately attracted to each other, but it’s not until later where Hawes kind of starts to think, “Huh, here’s this person who maybe gets it and is okay with it,” the way that Holt and Amelia ended up working out. And Amelia is part of the group, she actually has her own specialty with pressure points and being kind of a perfect Trojan horse for the group because she’s not as out there as the rest of the Madigans are with the business. So yeah. So, he starts to see that. And Helena is kind of also walking a thin line of, “I wanna be happy, but do we know who this dude is?” Right. “Hey, Buddy. Okay, go have fun. But be careful.” So, he’s trying to be the rational one in that scenario. Jeff: So, we know that this is a trilogy. How far does “Fog City” go overall? Do you have a grand plan? Layla: I do, I do. Hawes and Dante will have a trilogy. So they’re the main characters through books one to three. And then Helena will have a book and then there’s another fifth book, but I’m not gonna say who that is because that’ll spoil things. But everybody will get their HEAs by the end of it. I’m looking at five and then I’ve got some ideas for spin-offs and I may already have some cover photos bought for them. I would say I like building big verses, right? I mean, I grew up…I mean my intro to really reading a lot of romances, Kristen Ashley, and I love that big verse concept. And so I like building them too. Jeff: And if you, you know, put it back on TV, I mean, you look at things like the Arrowverse and all of its characters or all of the Chicago shows on NBC, you can have all of your one big, huge comboverse. Layla: Yeah. No, and that’s kind of like that. I grew up in all that too. I was a TV person first. I come from that world where it is all intertwined like that. I like doing that. I like cameos and seeing characters and it’s fun. And you know, Mel runs everything, just remember that. That’s all you need to know. Jeff: Even if the characters don’t know that, she’s really in charge. Layla: Everything. Yeah. Jeff: Now, we gotta give you a congrats too because in the midst of you getting this ready, it was announced you’re a finalist for the Romance Writers of America RITA Award, for the book, “Relay.” Layla: Yes. Yes. Jeff: Which is awesome. For those who don’t know, tell us what “Relay” is about. Layla: “Relay” is book one and the “Changing Lanes” duology, which is “Relay” and “Medley.” So, two books. The duology follows the four men who are on the U.S. men’s medley relay team, swim team. And so, the first book, “Relay,” which was nominated, is about Alex Cantu and Dane Ellis, who had a little summer love affair at a training camp 10 years ago and didn’t go well because Dane is the son of an evangelical minister and very closeted. And so he ends up on the same Olympic team with Alex, who is the team captain, who’s worked his tail off basically to get where he’s at and he is…you know, it’s enemies to lovers to start. Obviously, there’s a lot of friction there from what happened in the past. And then they end up on the relay team together, have to work together. And so then you’ve got a bit of a second chance love story. That’s what it rolls into. And so you see up through the first two legs of training camp and Olympic training in the first book. So you see the two domestic sites. And then in the second book, “Medley,” which follows the other two characters, Boss and Jacob, that’s a mentor-mentee. A little bit of an age gap, like 26 to 19, I think. And Jacob’s this lovely like pirate-quoting cinnamon roll. I love him. He’s so much fun. And two bi characters. Jeff: Pirate-quoting cinnamon roll? Layla: Yeah, he’s a cinnamon roll character, like, he’s a total dork. Jeff: I love that description of him. Layla: And so, then you see international training in the Olympics in that book. So they go hand in hand. And I’m really…you know, there are definite problems with the RITA awards has been brought up with getting better representation. I am happy this book got through. Alex is a character of color. And, you know, when I wrote this, I wanted to say, you know, “This is the U.S. Olympic team, a representation that I would like to see,” right, that’s diverse in sexuality and race and, you know, I’m glad that it did get to the finalists because that’s at least out there. Jeff: And again, congrats for that. That’s cool. I’ll have to go pick that up now because I have not picked up your sports books and I’m certainly like a sports romance lover anyway, so… Layla: One of my good friends was a competitive swimmer up through college and so I talked to him a lot and then one of my other friends swam up through high school and then a little bit in college too. So, it was something different, you know, and I think it was right about the Olympics time where we started talking about that idea and then it just rolled. Jeff: As I mentioned, there was some research involved there too, just to know what the training program was like and where it happened. Layla: And then some of it was my own, like, but too, they go to Vienna for training and I studied abroad there. And I’ve kinda always wanted to put it in a book. And so that was a lot of fun – everywhere there is somewhere that I went and even the fight that happens up in the wine country kind of happened to a friend. And so it was interesting like to see kind of, it was a different source of the fight, but you know, I was traipsing through this little village in the middle of the night going, “Where’d you go?” Jeff: That’s awesome. Drawing from real life events. You’ve got a bit of a con schedule going on this year. You’re headed to BLC so you’ll be at the first incarnation of Book Lovers Con in New Orleans, but you’re also making your very first trip to GayRomLit this year. Layla: I know, I can’t wait. It’s finally back out here, relatively close to us on the West Coast. I’m so looking forward to that. You know, I loved…I’ve been to an RW International and then I went to RT last year and I love the reader interaction like that. I like that part of it so much. And so that’s why I’m going back to Book Lovers Con to get more of that, but then I really want to go to GRL because those are particularly our readers, right, and my favorite authors, so I can’t, you know, wait to meet some folks. See folks that I met last year, meet others, and then like… two of my closest writing friends I’ve never met in person, they’re both going to be there. So I can’t wait for that. Jeff: So name drop a little bit. Who are these people you’re meeting in person for the first time? Layla: Well, what’s cool at Book Lovers Con is that I’ll get to meet Annabeth Albert, who’s been a sprint partner, publishes with the same…with Carina Press too. So that’ll be awesome. But then, yeah, at GRL, it’ll be Erin McLellan, who you actually reviewed “Clean Break,” and Allison Temple. So we’re looking forward to that. Jeff: Very cool. Now, of course, “Fog City” continues through this year. I know you’ve got at least one other book sneaking it’s way out there. What else is coming up this year? Layla: So there’ll be the three “Fog City” books and then “Dine With Me” comes out in September and it’s very different from everything else. So, well, I guess not, you know, if you read my books, and even in “Fog City,” there’s food, there’re restaurants because I am a complete and total foodie. And so “Dine With Me” is kind of my love letter to restaurants that I’ve loved, to food experiences that I’ve loved. And it follows Miller Sykes who is an award-winning chef who gets a diagnosis, a medical diagnosis, and basically if he gets treatment, he will lose his sense of taste. It’s a high likelihood that the treatment and surgery will compromise the sense of taste. And as a chef, dude, how? Like even as a foodie, you know, God, I can’t imagine and I can’t even…as a chef, wow. And so rather than get treatment, he decides to go on the last tour of his favorite meals. And it’s not just high end, you know, it’s dive bars and, you know, there are high-end restaurants also all across the spectrum for everything a different place offers. And that’s partially my experiences too, everywhere there is based on somewhere I’ve been. And then Clancy Rhodes who is the financial backer for this effort is kind of along for the ride. He’s a total foodie, experiencing it, and how he starts to piece together what’s going on and also starts to realize they have a lot in common. Despite, you know, a bit of an age gap and coming from different places in different worlds, they are both kinda facing these great expectations and how to handle that. And he has to convince him that, you know, life is more than just your taste buds, right, and that love’s worth it. And so it’s the book of my heart. It’s been in my head for years. I’ve sat on the first chapter since 2015, 2016 it was on the initial list of blurbs I gave my agent, and we finally found a place to make it happen. So I’m super excited about it. Jeff: That’s awesome because it’s always good to get the book of your heart out there. Layla: Yes. Yeah. Like I said, it’s different. You know, there is a ticking clock aspect to it given the diagnosis and what’s going on but, there’s not a car chase, which is unusual. But it’s a much more internal book and a lot of food gushing. So, you know, I generally say have snacks and tissues, just FYI. Jeff: That’s not really a bad thing for any book to have the snacks and the tissues nearby. Layla: You’ll really need it. So, I’m excited. That comes out September 16 and that’ll be from Carina, that one will. Jeff: Cool. And I have to ask before we wrap up, how was it to wrap up the Whiskeyverse for now – as “Trouble Brewing” wrapped up earlier this year? Layla: Yeah. I mean, good. Right. I like where everybody got to. I loved writing that last scene in “Trouble Brewing” and “Noble Hops.” You know, it was just kind of a nice – everybody’s where they should be. Right. I was glad to give everybody their happily ever after there. I did see some things, which are in the pipeline. And so, things may happen in the future depending on time and whatnot. But I’m excited for it and I’m glad Nick and Cam and Mel and Danny and Aiden and Jamie all got their happy. They definitely deserved it. Jeff: Yeah. Yes, they did. They worked for it. Layla: They worked for it. Jeff: Yeah. It was such a satisfying read. If anybody hasn’t picked those books up, they need to for sure. Layla: Thank you. Jeff: So what is the best way for folks to keep up with you online so they can keep track of all the “Fog City” releases and the upcoming “Dine With Me” and everything else? Layla: Yeah, so probably my Facebook group, Layla’s Lushes is where I’m at the most. And you can find a link to that on my Facebook page too, which is just Layla Reyne. So, that’s me on pretty much all the platforms on Twitter, Facebook, and Instagram. I’m on Instagram a fair bit. There’s a lot of food and my pugs there, so just FYI. I would say the reader group and the newsletter too, which is on my website, there’s a banner, so it’s laylareyne.com and you can follow and find it there. Jeff: Yup. We will link to all that in the show notes along with all the books. The reader group is the place to be because it’s where you find out about like, oh, the first chapter of “Fog City” well before anybody else does. Layla: Yeah. I kind of like…I have a hard time sitting on stuff. I ran one of the big “X-Files” spoiler sites back in the day, so if that tells you anything, I’m a bit of a spoiler junkie and have a tendency to spoil things though, just FYI. Jeff: Yeah. Everybody should go join up with that if you’re into Layla’s books in any shape, form, or fashion. Layla: Yes. Jeff: All right. Well, Layla, it’s been so good talking to you. Thank you so much for the great read that is “Prince of Killers” and I look forward to keeping track of “Fog City” as the year progresses. Layla: Excellent. Thank you so much for having me again. It’s been fun. Book Reviews Here’s the text of this week’s book reviews: Anticipating Disaster by Silvia Violet. Reviewed by Will Nice-guy Oliver enjoys his quiet bookish life – so he’s less than thrilled to be attending a family reunion at a ski resort. He braves the frigid temperatures and disapproving attitudes of his extended family to please his grandmother, who he adores. Irresistibly sexy bisexual outdoorsman David is in town to help his friend mend a broken heart. While his bestie distracts himself with a pair of slope bunnies, David sets his sights on klutzy Oliver, offering to give him private ski lessons. Flirtation leads to friendship and to David accompanying Oliver to some of the planned reunion activities. When certain family members mock Oliver’s nerdish tendencies, David fiercely defends him. Can’t they see how smart and sweet and kind he is? To give Oliver a vacation from his relatives, David takes Oliver to Anticipation, the picture-perfect mountain town that he calls home. The more time that our heroes spend together, the more they think this might just be the real deal. The problem is that neither one of them does casual relationships. David has his life in Anticipation and Oliver has his life back in Florida with his grandmother. A long-distance arrangement doesn’t seem particularly practical and they sadly part ways. Oliver returns to his real life and, after some time apart from David, he realizes (with some help from grandma) that his quiet existence might be more about hiding from life than truly living it. He decides that David is well-worth the risk and heads back to Anticipation to start a new adventurous chapter in his life story. I really enjoyed Anticipating Disaster. The author takes some familiar character types and story tropes and crafts a really compelling story, while at the same time giving the romance her own twist. The set-up might be pure category romance, but let’s be real, this is a Silvia Violet book, so you know that the heat level is going to be cranked up to 11. Oliver has a penchant for lacy undergarments and, over the course of the story, David discovers he likes cute guys with a penchant for lacy undergarments – like, A LOT. Also, in the bedroom, David has a talent for turning some particularly filthy turns-of phrase. So the time our that heroes spend together do not disappoint – these aren’t the kinds of sex scenes you’ll skim over. This book is the first in a series with the quaint town of Anticipation serving as the backdrop for future installments. A few side characters are introduced in Anticipating Disaster and I look forward to the new romances that will unfold in upcoming books. Prince of Killers (Fog City #1) by Layla Reyne. Reviewed by Jeff. Anyone who’s been listening to the show over the past year knows that I’ve fallen hard for romantic suspense, and in particular the stories that Layla Reyne writes. As soon as I offered the chance to read an advanced copy of Prince of Killers I jumped on it and devoured it in just a few days. Not only is the suspense tight but the budding romance had great sizzle. I’ve never read romantic suspense where someone in law enforcement wasn’t at least one, if not both, of the central characters in the love story. In this book, our main character is on the flipside of the law as the leader of a family of assassins. This provided an interesting twist and I loved the ride. The titular prince of killers is Hawes Madigan who has recently come into leading his family’s business because his grandfather is on his deathbed. One evening, just before a job, Hawes gets information that someone inside the organization is looking to take him out and possibly targeting others inside his family. The bombshell is dropped by the mysterious Dante Perry. The news of betrayal from the inside throws Hawes for a loop. He figured some associates might take issue with the new rules he’s put into place, which include no indiscriminate killing, no collateral damage and no unvetted targets. He introduces these rules because of past incidents that haunt him. The introduction of the Madigan family and how they approach their line of work fascinated me as much as the suspense of the internal sabotage and the romance that blooms between Hawes and Dante. Hawes has a twin sister, Helena, and younger brother, Holt who has a wife and baby daughter. Holt’s the tech wizard for the organization and Helena has another career as an attorney helping those who are wrongfully accused. Hawes’s life revolves solely around the family businesses–both the legit refrigeration business and the not-so-legit assassin game. The interplay of the family members as they try to sort out the traitor in their midst while dealing with their dying grandfather is so sharply written. There’s barely time for them to process any one thing that happens and yet the do make time to support and care for one another. Helena even pushes Hawes toward Dante as a potential partner because she wants her brother to have someone. Hawes taking the leap to trust and fall for Dante is one of things I love most about the book as he finds the strength to overcome the fear of putting his family at risk. Even though Holt has made a family for himself and his parents and grandparents had a successful family life, Hawes feels that he needs to be cautious since he’s the family leader now. Dante also goes out of his way to get Hawes and the family to trust him with not only their brother’s heart but aspects of the business as well. Hawes using Dante as his rock as the plot against the family unfolds, exposed his vulnerabilities perfectly. Meanwhile, the bombs that dropped in the final quarter of this book were ones I hadn’t seen coming and got my heart thumping. This is book one of a trilogy and as was the case with Layla’s other books I can’t wait to see where she takes this story. Similar to the Irish and Whiskey and Trouble Brewing trilogies, the Hawes and Dante’s story doesn’t fully wrap up at the end of the book. Of particular note, Prince of Killers ends with a significant cliffhanger. I don’t mind cliffhangers but if you are averse to that kind of ending you might want to wait until book two’s out so you won’t be waiting long to see what happens next. For me Layla’s redefined what a family of assassins looks like with this book. Fog City kicks off with some mind-blowing twists and I can’t wait to see what happens next.
Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta for your regularly scheduled monthly dose of evidence based medicine. This month, we are tackling an incredibly important topic – Assessing abdominal pain in adults, a rational, cost effective, and evidence-based strategy. Nachi: This incredibly important topic was chosen to mark the 20th anniversary of Emergency Medicine Practice. It is actually a revision of the first issue of Emergency Medicine Practice in 1999, now with updated evidence and recommendations. Thanks Robert Williford and Dr. Colucciello for getting this all started 2 decades ago! Jeff: Wow – 20 years – that’s amazing considering Emergency Medicine as a specialty hadn’t even been around all that long at the time and as Dr. Jagoda writes in his intro “evidence based education was still finding its footing.” Nachi: As a tribute to the man who started it all, EB Medicine again turned to Dr. Colucciello, who is no longer wearing his editor in chief hat, but instead is a professor at the University of North Carolina School of Medicine, to update his original article with the latest evidence. Jeff: Before we dive into the meat and potatoes of this month’s issue, let me also recognize Drs. Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Show More v Nachi: For a number of reasons, this month is going to be a little different. You will notice that we will focus more on safe disposition instead of on diagnosis. Which is reasonable, as that is the crux of our job as emergency physicians. Jeff: Indeed. So for those of you who can’t wait, here’s a quick spoiler, The CBC isn’t all that useful. CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: All valid points, but let’s dive in too some actual detail. Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. Nachi: With respect to the elderly, statistically speaking, 20% presenting with abdominal pain will undergo surgery, and 5% will die. Jeff: Often the etiology of the abdominal pain is never determined. This happens up to 40% of the time by the end of the ED visit. Nachi: I feel like that needs to be restated for emphasis – nearly half of patients who present to the ED with abdominal pain will have no determined etiology for their pain. Clearly, that doesn’t mean you are a bad ED physician – it’s just the way it goes. Jeff: Definitely still a win to be told you aren’t having an intra-abdominal catastrophe at the end of your visit! Nachi: Moving on to pathophysiology. Visceral pain results from distention or inflammation of the hollow organs or from ischemia from any internal organ, while the more localized, somatic pain is typically from irritation of the adjacent peritoneum. Jeff: And don’t forget about referred pain. Due to the movement of organs and stretching of nerve pathways during fetal development, pain may be referred to distant sites, like diaphragmatic irritation presenting as shoulder pain. Nachi: Let’s talk differential diagnosis. The differential for abdominal pain is tremendously broad and includes both intra-abdominal and extra abdominal pathologies. Check out table 2 for a very thorough list. Jeff: Table 1 is also worth reviewing while you’re on page 3 as it lists a few of the common dangerous mimics that often lead to misdiagnosis on initial presentation. To highlight a few – a AAA can masquerade as renal colic, diverticulitis, or a lumbar strain; an ectopic may present similar to PID, a UTI, or a corpus luteum cyst, and mesenteric ischemia may present shockingly similar to gastroenteritis, constipation, ileus, or an SBO. Nachi: Though misdiagnosis is certainly possible at any age, one must be particularly cautious with the elderly. Abdominal pain in the elderly is complicated by a number of factors, they often have no fever, no leukocytosis, or no localized tenderness despite surgical disease, surgical problems progress more rapidly, and lastly, they are at risk for vascular catastrophes, which don’t typically afflict the younger population Jeff: Dr. Colucciello closes the section on the elderly with a really thought-provoking point – we routinely admit 75 year old with chest pain and benign exams, yet we readily discharge a 75 year old with abdominal pain and a benign exam even though the morbidity and mortality of abdominal pain in this group exceeds that of the chest pain group. Nachi: That’s an interesting perspective, but we still have to think about this in the context of what an admission would offer in either of these cases. Most of the testing for abdominal pain can be done in the ED, CT being the workhorse. This point certainly merits more thought though. Jeff: Most clinicians have a low threshold to scan their elderly patients with abdominal pain, and the data behind this practice is quite compelling. In one study, CT altered the admission decision in 26%, need for surgery in 12%, the need for antibiotics in 21%, and changed the suspected diagnosis in 45%. Nachi: That latter figure, 45% change in suspected diagnosis, that was also confirmed in another study in which CT revealed a clinically unsuspected diagnosis in 43% of the elderly. Jeff: And it’s worth mentioning, that even though CT may be the go-to-tool - biliary tract disease, which we know is best visualized on ultrasound, is actually the most common cause of abdominal pain, especially sudden onset abdominal pain in the elderly. Nachi: The next higher risk group to discuss are patients with HIV. While anti retroviral therapy has certainly decreased the burden of opportunistic infections, don’t forget to keep a broader differential in this group including bacterial enterocolitis, drug-induced pancreatitis, or AIDS related cholangiopathy Jeff: Definitely make sure to check to see if the patient has a recent CD4 count to give you a sense of their disease and what they may be at risk for. At less than 200, cryptosporidium, isospora, cyclospora, and microsporidium all make their way onto the differential in addition to the standard players. Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice, which covered this and more in depth. Jeff: The next high risk population we are going to discuss are women of childbearing age. Step one is always the same - diagnose pregnancy! Always get a pregnancy test for women between menarche and menopause. Nachi: The pregnancy test is important not only for diagnosing an intrauterine pregnancy, but it’s also a reminder, that we need to consider and rule out an ectopic. Jeff: Along similar lines, you also need to consider torsion, especially in your pregnant population, as 20% of cases of ovarian torsion occur during pregnancy. Nachi: Unfortunately, you cannot rely on the physical exam alone in this age group, as the pelvic exam may be misleading. Up to a quarter of women with appendicitis can exhibit cervical motion tenderness -- a finding typically associated with PID. Sadly, errors are common and ⅓ of women of childbearing age who ultimately were found to have appendicitis were initially misdiagnosed. Jeff: To help reduce your risk in the pregnant population, consider imaging, particularly with radiation reduction strategies, including using ultrasound and MRI, which is gaining favor in the diagnosis of appendicitis in pregnancy. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Sounds familiar. Didn’t we just talk about this in Episode 24 back in January? Jeff: We sure did! Take another listen if that doesn’t ring a bell. Nachi: That was focused on first trimester only, but while we’re talking about appendicitis in pregnancy - keep in mind that during the second half of pregnancy, the appendix has moved out of the RLQ and is more likely to be found in the RUQ. Jeff: As yes, the classic RUQ appendix. As if our jobs weren’t hard enough, now anatomy is changing… Anyway, the last high risk group we are going to discuss here are those patients with prior abdominal surgery. Make sure to ALWAYS examine the patient's exposed skin to look for scars. Adhesions are the leading cause of SBOs in the industrialized world, followed by malignancy, IBS, and internal or external hernias. Nachi: Also keep a high index of suspicion for patients who have undergone bariatric surgery. They are especially prone to surgical causes of abdominal pain including skin infections and surgical leaks. Jeff: For this reason, CT imaging should be done with IV and oral contrast, with those having undergone a Roux-en-Y receiving oral contrast on the CT table. Nachi: Perfect. Let’s move on to evaluation once in the ED! Jeff: As we mentioned a few times already - diagnosis is difficult, a comparison of initial and final diagnosis only has about 50-65% accuracy. For this reason, Dr. C suggests taking a ‘worst first’ approach to forming your differential and guiding your workup. Nachi: And as a brief aside, before we continue… Missed appendicitis is one of the three most common causes of emergency medicine malpractice lawsuits - with MI and fractures being the other two. That being said, you, as a clinician, have either missed appendicitis or likely will in the future. In a study of cases of misdiagnosed appendicitis brought to litigation, several themes recurred. For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. Also, note that in addition to imaging and the physical exam, history is often the key to uncovering the cause of abdominal pain. Nachi: Not to harp on litigation, but in malpractice cases brought up for failure to diagnose abdominal conditions, deficiencies in data gathering and charting were often to blame rather than misinterpretation of data. Jeff: As no shocker here, getting a complete history remains tremendously important in your practice as an emergency clinician. A recurring theme of EMplify for sure. Nachi: In order to really nail this down, consider using a standardized history form -- or memorizing one. An example is shown in Table 1. Standardized forms have been shown to improve patient satisfaction and diagnostic accuracy. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. Experiencing pain going over a speed bump has been shown to be about 97% sensitive and 30% specific for appendicitis. So fairly sensitive, but not too specific. Nachi: That’s interesting and may help guide you, but it’s certainly no replacement for CT. And remember that you can have stump appendicitis. This can occur in the appendiceal remnant after an appendectomy and is found in about 0.15% of all appendectomies. Jeff: Alright, so on to the physical exam. Like always, let’s start with vital signs. An elevated temp can be associated with intra abdominal infection, but sensitivity and specificity vary greatly here. Always consider a rectal temp, as these are generally more reliable. Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. Jeff: Elevated respiratory rate can be due to pain or subdiaphragmatic irritation. However, it can also be due to hypoxia, sepsis, anemia, PE, or metabolic acidosis, so consider all of those also in your differential. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. You can also use the shock index, which as a reminder is simply the HR/SBP. In one study, a SI > 0.7 was sensitive for 28-day mortality in sepsis. Jeff: Speaking of HR, tachycardia can be a response to pain, anxiety, fever, blood loss, or sepsis. An irregularly irregular rhythm -- or a fib -- is an important risk factor for mesenteric ischemia in elderly patients. This is important to consider in your differential early as it may guide your imaging modality. Nachi: With vitals done, we can move on to the abdominal exam - it is rare that a serious abdominal condition will present without tenderness in a young adult patient, but remember that the elderly patient may not present with much tenderness at all due decreased peritoneal sensitivity. Abdominal tenderness that is greatest when the abdominal muscles are contracted is likely due to abdominal wall pain. This can be elicited by having the patient lift their head or let their legs off the bed. This finding is known as Carnett sign and is about 95% accurate for distinguishing abdominal wall pain from visceral abdominal pain. Jeff: Though tenderness itself is helpful, the location of tenderness can be misleading. Note that while 80% of patients with appendicitis have RLQ tenderness, 20% don’t. The old 80-20 rule! So definitely don’t let RLQ tenderness be your sole guide! Nachi: Voluntary guarding is due to fear, anxiety, or even a reaction to a clinician’s cold hands. Involuntary guarding (also called rigidity) is more likely to occur with surgical disease. Remember that rigidity may be a less common finding in the elderly despite surgical disease. Jeff: Peritoneal signs are the true hallmark of surgical disease. These include rebound pain, pain with coughing, pain with shaking the stretcher or pain with striking the patient’s heel. Rebound historically has been thought to be pathognomonic for surgical disease, but recent literature hasn’t found it to be all that useful, with one study claiming it has no predictive value. Nachi: As an alternative, consider the “cough test”. Look for evidence of posttussive abd pain (like grimacing, flinching, or grabbing the belly). Studies have found the cough sign to be 80-95% sensitive for peritonitis. Jeff: In terms of other sings elicited during the abdominal exam: The murphy sign, ruq palpation that causes the patient to stop a deep inspiration -- in one study had a sensitivity of 97%, but a specificity of just under 50%. The psoas sign, pain elicited by extending the RLE towards the back while the patient lies on their left side -- in one study had a specificity of 95%, but only had a sensitivity of 16%. Nachi: Neither the obturator sign (pain with internal rotation of the flexed hip) nor the rosving sign (pain in the RLQ by palpating the LLQ) have been rigorously studied. Jeff: Moving a bit further south, from the abdomen to the pelvis - let’s talk about the pelvic exam. Most EM training programs certainly emphasize the importance of the the pelvic exam for women with lower abdominal pain, but some recent papers have questioned its role. A 2018 study involving 288 women 14-20 years old found that the pelvic didn’t increase sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomoniasis when compared with history alone. Another study questioned whether the pelvic exam can be omitted in these patients with an early intrauterine pregnancy confirmed on ultrasound, but it was unable to reach a conclusion, possibly due to insufficient power. Nachi: While Jeff and I do find it valuable to elicit as much as information from the history as possible and take value in the possibility of omitting the pelvic in certain cases in the future, given the current evidence based medicine, we both agree with the author here. Don’t abandon the pelvic for these patients just yet! Jeff: While on this topic, we should also briefly mention a reminder about fitz-hugh-curtis syndrome, perihepatic inflammation associated with PID. Nachi: As for the digital rectal exam, this can certainly be of use when considering and diagnosing prostatitis, perirectal disease, stool impactions, rectal foreign bodies, and gi bleeds. Jeff: And let’s not forget the often overlooked scrotal and testicular exam. In men with abdominal or flank pain, this should always be considered. Testicular torsion often presents with isolated abdominal or flank pain. The scrotal exam will help diagnose inguinal and scrotal hernias. Nachi: Getting back to malpractice case reviews for a minute --- in a 2018 review involving testicular torsion, almost ⅓ of the patients with missed torsion had presented with abdominal pain --- not scrotal pain! In ⅕ of the cases, no testicular exam was performed at all. Also, most cases of missed torsion occured in patients under 25 years old. Jeff: Speaking of torsion, about 6% occur over the age of 31, so have an increased concern for this in the young. Of course, if concerned for torsion, consult urology immediately and consider manual detorsion. Nachi: And if you, like me, were taught to manually detorse by rotating in the lateral or open book direction, keep in mind that in a study of 200 males with torsion, ⅓ had rotated laterally, not medially. Jeff: Great point. And one last quick point here. Especially if you are unsure about the diagnosis, make sure to perform serial exams both in the ED and also in the next few days at their PCP’s office. In one study, a 30 hour later repeat exam for patients discharged with nonspecific abdominal pain resulted in a clinically relevant change in diagnosis and therapy in almost 25% of patients. Nachi: So that wraps up the physical. Let’s get into diagnostic studies, starting with lab work and everybody’s favorite topic... the cbc. Jeff: Yup, just the other day I was asked by a consultant “what’s the white count.” in a patient with CT proven appendicitis. Man, a small part of my soul dies every time this happens. Nachi: It appears you must have an evidenced based soul then. According to a few studies, anywhere from 10-60% of patients with surgically proven appendicitis have an initially normal WBC. So in some studies, it’s even worse than a coin flip. Jeff: Even worse, in children the CBC is less helpful. In children, an elevated WBC detects a mere 53% of severe abdominal pathology - so again not all that helpful. Nachi: That being said, at the other end of the spectrum, in the elderly, an elevated WBC may imply serious disease. Jeff: So let’s make this perfectly clear. A normal WBC should not be reassuring, but an elevated WBC, especially in the elderly, should be very concerning. Nachi: The CRP is up next. Though not used frequently, it’s still worth mentioning, as there is a host of data on it in the setting of abdominal pain. In one meta analysis, CRP was approximately 62% sensitive and 66% specific for appendicitis. Jeff: And while lower levels of CRP do not rule out positive findings, increasing levels of CRP do predict, with increasing likelihood, the chances of positive findings. Nachi: Next we have lipase and amylase. The serum lipase is the best test for suspected pancreatitis. The amylase adds limited value and should not be routinely ordered. Jeff: As for the lactate. The greatest value of a lactate level is to detect occult shock and sepsis. It is also useful to screen for visceral ischemia. Nachi: And the last lab test we’ll discuss is the UA. The urinalysis is a potentially misleading test. In two studies, 20-30% of patients with appendicitis also had hematuria with leukocytes and bacteria on their UA. In a separate study of those with a AAA, there was an 87% incidence of hematuria. Jeff: That’s pretty troubling. Definitely not great to diagnosis someone with hematuria and a primary GU problem, when their aorta is actually exploding. Nachi: And that’s a great reminder to always avoid premature diagnostic closure. Jeff: Also worth mentioning is that not all ureteral stones present with hematuria. At least 6% have no hematuria on microscopy. Nachi: Alright, so that brings us to imaging. First up: plain films. I’m going to quote this directly from the article since I think it's so important, ‘never rely on plain films to exclude surgical disease.” Jeff: This statement is certainly evidence based as in one study 40% of x-ray findings were inconsistent with the final diagnosis. In another study, 43% of patients with major surgical disorders had either normal or misleading plain film results. So again, the take home here is that XR cannot rule out surgical disease, and should not be routinely ordered except for in specific settings. Nachi: And perhaps the most important of all those settings is in the setting of possible free air under the diaphragm. In this case, an upright chest visualizing the area under the diaphragm would be the test of choice. But again, even this doesn’t rule out surgical disease as free air may be absent on plain films in ⅓ to ½ of patients who have already perfed. Jeff: Next we have everybody’s favorite, the ultrasound. Because of it’s low cost and ease of use, bedside ultrasound is gaining traction. And we’ve cited this and other similar studies in other issues, this is a skill emergency medicine physicians must have in this day and age and it’s a skill they can learn quickly. Nachi: Ultrasound can visualize most solid organs, but it is best suited for the Right upper quadrant and pelvis. In the RUQ, we are looking for wall thickening, pericholecystic fluid, ductal dilatation, and sonographic murphys sign. Jeff: In the pelvis, there is a role for both transabdominal and transvaginal to rule out ectopic and potentially rule in intrauterine pregnancy. I know the thought of performing your own transvaginal ultrasound may sound crazy to some, but we both trained in places where ED TVUS was the norm and certainly wasn’t that hard to learn. Nachi: Ah, the good old days of residency. I’m certainly grateful for the US tech where I am now though! Next up we have CT. CT scans are ordered in just under 30% of patients with abdominal pain. Jeff: It’s worth noting, that while many used to scan with triple contrast - oral, rectal and IV, recent literature has shown that IV contrast alone is adequate for the diagnosis of most surgical conditions, including appendicitis. Nachi: If you’re still working in a shop that scans for RLQ pain with oral or rectal contrast, definitely check out the 2018 american college of radiology appropriateness criteria that states that IV contrast is generally appropriate for assessing the RL. Jeff: And while we are on the topic of contrast, let’s dive a bit deeper into the, perhaps myth, that contrast leads to contrast induced nephropathy. Nachi: This is another really important point. Current data show that being ill enough to be admitted to the hospital is a risk factor for acute kidney injury and that IV contrast for CT does not add to that risk. In 2015, the american college of radiology noted in their manual on contrast media that the concern for the development of contrast induced nephropathy is not an absolute contraindication for using IV contrast. IV contrast may be necessary regardless of the risk of nephrotoxicity in certain clinical situations. Jeff: Ok, so contrast induced nephropathy may be real, but more studies and a definitive statement are still needed. Regardless, if the patient is sick and they need the scan with contrast, don’t hold back. Nachi: I think that’s a fair take home. As another note about the elderly, CT should be almost routine in the elderly patient with acute abdominal pain as it improves accuracy, optimizes appropriate hospitalization, and boosts ED management decision making confidence for this patient group. Jeff: If they are over 65, make sure you chart very carefully why they don’t need a scan. Nachi: Speaking of not needing a scan, two quick caveats on CT before moving to MRI. Unstable patients do not belong in a radiology suite - they belong in the ED resus bay to be resuscitated first. Prompt surgical consultation and bedside ultrasound if indicated are both a must in unstable patients. Jeff: The second caveat is on the other end of the spectrum - not all CT scanning is created equally - the interpretation depends on the scanner, the quality of the scan, and the experience and training of the reading radiologist. In one study, nearly 13% of abdominal CT scans may initially be misread. Nachi: So if you’re concerned, consider consultation or an extended ED observation to monitor for any changes in the patient’s status. Jeff: Next up is MRI - MRI has an ever expanding role in the ED. The accuracy of MRI to diagnose appendicitis is very similar to CT, so consider it in all pregnant patients, though ultrasound is still considered first line. Nachi: And finally let’s touch upon the ekg and ACS. In patients over 40 with upper abdominal pain, an EKG and troponin should always be considered. Jeff: Don’t be reassured by a response to a GI cocktail either - this does not exclude myocardial ischemia. Nachi: Next, let’s talk the role of analgesia in treating the undifferentiated abdominal pain patient. Jeff: While there was formerly a concern of ‘masking the pain’ with opiates, the evidence says otherwise. Pain medicine may even aid in the diagnosis, so definitely don’t withhold it in the setting of acute abdominal pain. Nachi: Wait I get that masking the pain is no longer considered a concern, but how would it aid in the diagnosis? Jeff: Good question. Analgesics might facilitate the gathering of history and allow a more complete physical exam by relaxing the abdominal musculature. Nachi: Ahh that makes sense. So certainly treat pain! Both morphine at 0.1 mg/kg and fentanyl at 1 mic/kg are appropriate analgesics for acute abdominal pain. In those that are a difficult stick, a recent study showed that 2 micrograms/kg of fentanyl via a nebulizer was a safe alternative. Remember, fentanyl is quick on, quick off, which may make it desirable in certain situations. It actually has the shortest time of onset of any opioid. It’s also safer in patients with a “marginal” blood pressure. Jeff: And just like the GI cocktail - response to opiate analgesics does not exclude serious pathology. These patients need serial exams and likely labs and imaging if their pain is so severe. Nachi: Few things are more important prior to discharge of an abdominal pain patient than documenting repeat exams and a PO trial. Jeff: True. You should also consider haloperidol for patients with gastroparesis and cannabinoid hyperemesis as a growing body of literature supports its use in such settings. Check out the August 2018 EMP or EMplify for more details if you’re curious. Nachi: The last analgesic to discuss is our good friend ketamine. Low dose ketamine at 0.3 mg/kg over 15 minutes is gaining traction as the analgesic of choice in many ED’s. Jeff: The key there, is that it must be given over 15 minutes. Ketamine has a great safety profile, but you make it so much safer and a much better experience if you give it slowly. Nachi: Before we get to disposition, let’s talk controversies and cutting edge - and there is just one this month - and that’s the use of the Alvarado score. Jeff: In the Alvarado score, you get two points for RLQ tenderness and 2 points for a leukocytosis over 10,000. You get an additional point for all of the following; rebound, temp over 99.1, migration of pain to the RLQ, anorexia, n/v, and a left shift. The max score is therefore 10. A score of 3 or less make appendicitis unlikely, 4-6 warrants CT imaging, and 7 or more a surgical consultation. Nachi: A 2007 study suggests that using the Alvarado score along with bedside ultrasound might allow for rapid and inexpensive diagnosis of appendicitis. Jeff: I don’t think we should change practice based on this just yet, but more ultrasound diagnosis may be on the horizon. If you want to start using the Alvarado score in your practice, MDcalc has a great easy to use calculator. Nachi: Let’s get to the final section. Disposition! Jeff: As we mentioned at the beginning of this episode, the diagnosis is less important than proper disposition. For patients with suspected ruptured AAA, torsion, or mesenteric ischemia - the disposition is easy - they need immediate surgical consultation and likely operative intervention. Nachi: For others, use the tools we outlined above - ct, us, labs, etc, to help support your decision. Keep in mind, that serial exams are a great tool and of little expense - so make sure to lay your hands on the patient's abdomen frequently, especially when the diagnosis is unclear. Jeff: For those that look well after a work up, with no clear diagnosis, it may be reasonable to discharge them home with prompt follow up, assuming prompt follow up is plausible. The key here is that these patients need good discharge instructions. Check out figure 2 on page 20 for a sample discharge template. Nachi: But if the patient is still uncomfortable, even after a thorough workup, there may be a role for ED observation units. In one study of 220 patients admitted for to ED obs units for serial exams, 39% eventually underwent surgery with only 5% having negative laparotomies. Jeff: This month’s issue wraps up with some super important time and cost effective strategies, so let’s see if we can quickly breeze through some of the most important points before closing out this episode. Nachi: First - limit your abdominal x-rays as they offer limited value and are rarely helpful except in the setting of perforation, when an early upright chest film should be used liberally. Jeff: Next - limit electrolyte testing especially in young adults with nausea, vomiting and diarrhea. In those 18 to 60, clinically significant electrolyte abnormalities occur in only 1% of those with gastro. Nachi: With respect to urine testing, urine cultures are rarely indicated for uncomplicated cystitis in young women. Along similar lines, don’t anchor on the diagnosis of UTI as other lower abdominal conditions often lead to abnomal urine studies. Jeff: In your alcoholic patients, although all should be approached with an abundance of caution, limit testing to repeat abdominal exams in your non-toxic appearing patient who is already tolerating PO. Nachi: For those with suspected renal colic, especially those with a history of renal colic, limit CT use and instead consider ultrasound to look for hydro. This approach is endorsed by ACEPs choosing wisely campaign. Jeff: But as a reminder, this is for low risk patients only. Anyone with signs of infection should also undergo CT imaging. Nachi: And lastly - consider incorporating bedside US into your routine. The US is fast and accurate and compares similarly to radiology, especially in the context of detecting acute cholecystitis. Jeff: Alright, so that wraps up the new material for this episode, let’s close out with some key points and clinical pearls. The peritoneum becomes less sensitive with aging, and peritonitis can be a late or absent finding. Be wary of early diagnostic closure and misdiagnosis with a mimic of a more severe and dangerous pathology. The elderly, immunocompromised, women of childbearing age, and patients with prior abdominal surgeries are all at a higher risk for misdiagnosis. Elderly patients can present without fever, leukocytosis, or abdominal tenderness, but still have surgical abdominal pathology. Consider diagnostic imaging in all geriatric patients presenting with abdominal pain. Consider plain film if you suspect a viscus perforation or for certain foreign body ingestions. Do not forget the pelvic exam, testicular exam, and rectal exam as part of your physical, when appropriate. Testicular torsion can present with abdominal pain only. If suspected, consult urology and consider manual detorsion. A normal white blood cell count does not rule out appendicitis or other intra-abdominal pathology. Serum amylase should not be used in your assessment of the abdominal pain patient. Lack of microscopic hematuria does not rule out renal colic. CT of the abdomen with IV contrast alone is enough for most surgical conditions including appendicitis. Oral and rectal contrast does not need to be routinely administered. The 2018 American College of Radiology (ACR) Appropriateness Criteria discuss concern for delay in diagnosis associated with oral contrast use and an increased rate of perforation. There is recent literature to support that IV contrast does not cause nephropathy. The ACR 2015 Manual on Contrast Media states that concern for contrast induced nephropathy is not an absolute contraindication, and IV contrast may be necessary in many situations. Ultrasound can be used to evaluate the aorta, gallbladder, kidneys, appendix, bowel, spleen, pancreas, uterus, and ovaries. Consider bedside ultrasound and emergency surgical consult for all unstable patients with abdominal pain. For stable pregnant patients with concern for appendicitis, start with an ultrasound. If inconclusive, order an MRI. Epigastric pain in an elderly patient should raise concern for ACS. An EKG and troponin should be considered. For analgesia in patients with gastroparesis or cannabinoid hyperemesis syndrome, haloperidol is considered first-line. Low-dose ketamine (0.3mg/kg over 15 minutes) may be a better choice than opiate analgesia for abdominal pain. Nachi: So that wraps up Episode 29! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And last reminder here -The clinical Decision Making in Emergency Medicine Conference is just around the corner and spots are quickly filling up. Don’t miss out on this great opportunity and register today. Jeff: And the address for this month’s cme credit is ebmedicine.net/E0619, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 18. Gardner CS, Jaffe TA, Nelson RC. Impact of CT in elderly patients presenting to the emergency department with acute abdominal pain. Abdom Imaging. 2015;40(7):2877-2882. (Retrospective study; 464 patients aged ≥ 80 years) 38. Kereshi B, Lee KS, Siewert B, et al. Clinical utility of magnetic resonance imaging in the evaluation of pregnant females with suspected acute appendicitis. Abdom Radiol (NY). 2018;43(6):1446-1455. (Retrospective study; 212 MRI examinations) 41. Lewis KD, Takenaka KY, Luber SD. Acute abdominal pain in the bariatric surgery patient. Emerg Med Clin North Am. 2016;34(2):387-407. (Review) 57. Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996;276(19):1589-1594. (Review) 67. Magidson PD, Martinez JP. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(3):559-574. (Review) 83. Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-797. (Review) 94. Bass JB, Couperus KS, Pfaff JL, et al. A pair of testicular torsion medicolegal cases with caveats: the ball’s in your court. Clin Pract Cases Emerg Med. 2018;2(4):283-285. (Case studies; 2 patients) 106. Kestler A, Kendall J. Emergency ultrasound in first-trimester pregnancy. In: Connolly J, Dean A, Hoffman B, et al, eds. Emergency Point-of-Care Ultrasound. 2nd edition. Oxford UK: John Wiley and Sons; 2017. (Textbook)
Happy Pride Month! Jeff discusses the awesome Pride Month video from the NHL. He also talks about all the things that happened during release week for Netminder. Members of the Queer Sacramento Authors Collective had a reading this past week at the Lavender Library and will be reading again this coming week at Time Tested Books. The live streams are available on the podcast’s Facebook page. We talk about the Coastal Magic Convention 2020 lineup of m/m romance featured authors. We review the Elton John biopic Rocketman. Jeff reviews Max Walker’s A Lover’s Game. Will recommends books for Pride month: Pride: The Story of Harvey Milk and the Rainbow Flag by Rob Sanders, Stonewall: A Building. An Uprising. A Revolution by Rob Sanders, The Stonewall Riots: Coming Out in the Streets by Gayle E. Pitman, Stonewall: The Definitive Story of the LGBTQ Rights Uprising That Changed America by Martin Duberman and The Stonewall Reader curated by The New York Public Library. Jeff interviews C.B. Lee about the latest book in her Sidekick Squad series, Not Your Backup. We also discuss the origin of the Sidekick Squad, what C.B. hears from readers and what’s coming up next. Complete shownotes for episode 191 along with a transcript of the interview are at BigGayFictionPodcast.com. Interview Transcript – C.B. Lee This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Jeff: Welcome C.B. to the podcast. It’s great to have you here. C.B.: Hello, thanks for having me. I’m so excited to be here. Jeff: Yeah, it’s very exciting. We got to see you last year at the LA Times Festival of Books for a little, teeny, tiny interview. But we’re thrilled to have you back as we start to talk about “Not Your Backup” which will come out on June 4th, just the day after this airs actually. C.B.: Oh my gosh, that will be really exciting. I actually got to touch the advanced copies for the first time last week at YALLWEST, which due to this fun time jumps of podcasting… Jeff: Well, actually a bit about a month ago. C.B.: Right, right. But, yeah, it was really interesting just to, like, hold it for the first time and see it in print. Granted, the advance copies have typos since, you know, I went through and did all the pass through the typos. But it’s fun, it’s fun. It’s great that, you know, it exists, it’s in physical form, hasn’t quite felt real till now, but now it’s a real book or will be very soon, or tomorrow for your listeners and readers. Jeff: There is something about holding that physical copy, even if you see it, you know, even if it’s on your tablet as an ebook. It’s like there’s nothing like that paperback when it gets there. C.B.: Yeah. Jeff: Now, “Not Your Backup” is book 3 in the “Sidekick Squad Series.” And, for those who haven’t experienced this series or heard of it, tell us what this series is all about. C.B.: Sure, it is about a group of queer teens that take on a corrupt government superhero agency. And they live in this sort of post-dystopian world where superheroes are kind of treated like celebrities. And there’s, you know, shadowy government organizations and mysterious heroes, league of heroes, that kind of dictates who gets to be a hero and who gets to be a villain. And our protagonists all kind of uncover this huge conspiracy, and then they work together to build a resistance and take it down. Jeff: It’s quite the world that you’ve built here. I mean, you hit so many things that are dystopian, U.S. future, superheroes, villains. What was your inspiration for all of this? C.B.: So I’ve always been fascinated by kind of the, like, post-apocalyptic or dystopian worlds. But a lot of the media that I’ve read mostly focuses on kind of the…when you’re in the middle of the disaster, when you’re in the middle of the catastrophe, when everything is going wrong, how are people struggling to survive. So I really wanted to see a world that was…you know, so this is more of like a solarpunk take where the world has started to move forward, where it’s 100 years after all of these disasters have happened – kind of the impetus for the superpowers. And my book is a really extremely intense solar flare that catalyzes latent gene in people. And then after the flare, which knocks out a bunch of nuclear power plants, also, it starts kind of a chain reaction of a bunch of environmental disasters. So 100 years later the governments of the world have kind of shifted and changed, there’s been wars, there’s been fights over resources, so the United States is now part of the North American collective, which is the entire continent of North America, which is now the habitable places. There’s, you know, 24 regions, which is, you know, kind of what’s left of the states. So there’s different areas all across North America, which are now the regions in which people live and, you know, continue to move forward with, like, their amazing technology, and hover tech, and all this amazing, clean technology. But, at the same time, you have all of these like high-tech cities, but outside of those regions, everything else is like the unmaintained lands. So, you know, the government is claiming there’s radiation danger and don’t venture out, but, of course, our heroes are like, you know, what the government tells us isn’t necessarily true. So a lot of…actually, the fun of writing “Not Your Backup” is one of my working titles was “Not Your Road Trip,” because there’s a lot of road tripping in this book. Jeff: Yeah, I noticed. There’s a bit of a road trip in the sneak peek that I got to read too, that they’re out on this road trip, essentially on a mission. C.B.: Right, right. Yeah, there’s the heist in the beginning of the very first chapter. But, yeah, there’s a lot of fun. We get to see a little bit more of the country outside of the cities in this book, so that’s exciting. Jeff: Now, each of the books deals with one of the main heroes, if you will, or the sidekicks, if you will, given the titles of the book, but they’re really the heroes. In “Not Your Backup”, we focus on Emma, who is really the only one of them without the powers. What’s happening to our heroes this time out? C.B.: So at the end of “Not Your Villain,” we have destroyed the registry, which…the big name of everyone who’s ever registered with powers that Captain Orion was planning to use to kidnap people and use for experiments. At that point, our heroes have been looking for the resistance the whole time. And they find a mysterious group that’s been leaving messages on encrypted channels. But then, at the end of the book, they realize that this is actually like a group of nerds that have been joining together to watch movies like “Star Wars,” and “Harry Potter,” and stuff. So they realize that they need to start the resistance. So that’s where we are at the beginning of “Not Your Backup,” where Emma and Bells are back in Nevada, and they are kind of in the midst of this fledgling resistance group – meanwhile, Jess and Abby are at the villain’s guild hideout in the Rockies and they’re trying to corral all the other meta-humans into taking action. So, the beginning of the book, you know, where kind of everyone has different goals, but then they all come together. It’s more about like building the resistance and finding… For Emma, it’s her journey in finding who she is. And, really, she’s a very natural leader, she loves coming up with plans, and she’s definitely a Gryffindor. She’s the first to jump in and try to take action. Her default is, like, fight me. But she also is, as you mentioned, she doesn’t have powers, and so when she’s trying to take a more active role in the resistance, she kind of butts heads with a few of the other members as they have different ideas about who is and who isn’t part of the resistance. Jeff: She just needs to remind them that Batman didn’t have powers either. He just had a really good utility belt and brains. So she could definitely fill that role. What’s been the driving force behind deciding the type of character that you have at the forefront of each book? Because the three books have very different, distinct character types and personalities, and just everything about them is just…they’re just very different from each other. C.B.: So, from the beginning, I wanted to tell this story about, you know, this fun adventure story with queer protagonists. So each book would center on another one of them in the main four. So there’s…and then after “Not Your Backup”, there’s one more book which will be Abby’s story, and so she will round out the quartet. But each of their…you know, they have very different personalities, but it’s been interesting writing their stories because each of them are on their own journey in what makes them a hero and finding how do they define success, and how do other people see them, and how do they see themselves. So, for each story, because we’re moving forward in time, as we get to see who is really, you know… It’s been interesting, because all four books will fit together as a series, but in each book, everyone gets to have their own journey. Jeff: Which I really like because we’ve been introduced to all of them all the way back, you know, back in the first book, but then they get to their own story, which could essentially be read as a stand-alone, if you wanted to, I guess, although reading all of them together is much better. What was the bigger challenge to come up with the trajectory of these four diverse characters or to build this alternate universe of the U.S., or were they kind of equal challenges? C.B.: I feel like the challenge for me is I’m not like a great outliner or I haven’t ever really been a planner. So I’ve always been more of the pantser in the writing style. So when writing a series, when I wrote “Not Your Sidekick,” I didn’t know, up until I think I was about 50,000 words in when I realized that I could not basically solve the problem in that one book, you know, because when I pitched it, it was one book. And then I was like, “Well, I really love all of these characters.” There’s a huge…there’s a bigger story here that I’ve introduced, and I will need more than one book to solve it. And so, from the get-go, I knew the next story after Jess would be Bells because you get into, like, the backstory of the meta-human training and the heroes, league of heroes. And so, I think, overall, just planning a series is really challenging. Some people are great at it, where, you know, they have very detailed outlines, they know, from the very beginning to the very end, what the key points are going to be. And so, as I was writing book 1, I kind of had a panic attack and I was like, “Oh, no, I have to figure out what’s going to happen in each of the books.” And then as I restructured things and then writing book 2 and then 3, it’s kind of come to a point where I’m working on book 4 and now, like, everything that I… One of the reasons why it took me a longer time between book… So “Not Your Villain” came in 2017 and “Not Your Backup” is coming out in 2019. So I didn’t have a book come out last year because I was still working on crafting the storyline because whatever I did or didn’t do in book 3 would determine what would happen in book 4. So everything had to fall into place, and I had to like figure out a lot of stuff. So it was challenging, but I think, you know, it’s still challenging, but that’s part of the joy of writing is to figure out how to tell the story you want to tell. Jeff: If you do a series again, do you think you’ll try to do outlines more in the upfront or now that you’ve had this experience, do you kind of know how to do it and keep your pantser ways going on? C.B.: I don’t know if I’ll ever… Like, I feel like with each book, I’m like, “Oh, do I know how to write a novel now?” But like every book is its own challenge. I do have a better sense of like, okay, you know, how do I plot as a pantser? And then plotting for pantsers, and like learning how to like… For me, I just tend to think of an outline like a road map where I have these destinations I wanna hit, but I’m not committed to – I don’t have to see everything and if I go off track or take a different route, that’s okay as well. So as long as I kind of get the same…like, it’s all in the journey of how I get there, and then the destinations that I pick along the way, if I get to them or not, that’s cool. I kind of have these benchmarks that I want to reach. But I really like thinking of the framework in which I think about my books as a roadmap. So I’ll try to plan out, you know, all the cities I want to visit, but I’m open to discovering places along the way and kind of building up on that. Jeff: How does the pantser sort of method work while you’re world building? Or do you try to, at least, before you start writing, “No. This is my world. This is what’s happened. This is what the U.S. looks like now, and how all that works?” Or does that come organically as you go as well? C.B.: I actually thought like, really early on established the world and what it looked like. I drew a map of which countries were left and which, how, who, what alliances were made in probably much more detail than you’ll ever see in the books because basically I plotted out what happened in that World War III, and what areas were no longer habitable, and all of these things, and all the different lines of, like… I probably spent way too much time figuring out the socio-economic holes, ramifications of which country is now aligned with what country and which countries refuse to join a union or…and they’re all new countries. So there is this whole political backstory of, like, which country fought….you know, which alliance was at war, which alliance and what’s still happening overseas. Some of which you’ll see, but it is the world itself. I’ve always enjoyed world building, and I think it’s really fun to come up with the…I think once I wrote book one where I established, like, how do the powers work. Every power level is different. For example, like the A class, B class, or C class, depending on how…basically, I wanted all the meta-humans in my world to…their powers basically are dependent on…like, they have a limited number of time per day that they can use their powers. So once they’ve used it, then they can’t use it for the next 24-hour period. So it’s a different sort of look at superpowers and abilities because you have to be more mindful about how you use your powers. And so that was an element that I established early on, but overall, I think for me, world building, there are some details I discovered along the way, but I pretty much plotted the world building which is a funny like…and it’s interesting to think about, even though I do consider myself a pantser, how much of this series I did very much envision out from an early stage. So like some of the confrontations and the fight scenes, and the stuff that… I’ve been planning one particular scene in book 3 since book 1, and I didn’t get to do it until… And, so that was like a fun way to be like, “Oh, yes, I’m finally going to like write the scene that I’ve been waiting for.” But I’d had a lot of these moments in my head, and just planning it out and getting the opportunity to like, “Okay, yes. Now, I’m getting to that chapter. I’m getting to the point in the whole series where we’re getting…you know, it’s coming full circle.” So that’s very satisfying. Jeff: It sounds like you’d have a lot of bonus material too if you ever wanted to release it, if all the stuff that you’ve got of the world itself, and the disaster, and how it’s split up. C.B.: Yeah, I mean, potentially, I have a whole timeline that I could release. And then I did these fun… For “Not Your Villain,” I did all the deleted scenes, well, deleted as far as they were cut for length. But I still consider it part of the story, the cannon. So those are an extra that are available on my website. I’ll probably do something similar for Backup, but I’m not at that stage yet. Jeff: Right. It’s good to know about the Villain extras. I’ll be going to check those out. C.B.: Yeah, yeah, they’re fun. They’re all in one PDF. And my book designer, C.B. Macera, was amazing. And she formatted them the same way as the book because we have a lot of extra art as well because she does these amazing, like, chapter headers for each chapter. She’s so talented and amazing designing the covers and the interior of the book, really, you know, capture that feel. And so, “Not Your Villain” actually, in the edits, went from…yeah, it was cut a lot. So, you know, it’s really sad as a writer to kind of see these scenes go, but, you know, as far as, yes, and my editors are great about, like, “This scene is great. But, you know, it kind of slows down the pacing,” or like, “This scene takes us in a different tone or direction, and, like, while they’re great, they don’t fit in the story at that moment and kind of take us away from the main action.” So I understand why they had to go. And, yes, the story is stronger overall, but I like them as an extra. Jeff: Yeah, we’ve all gotten used to those on DVDs over time, so there’s really no reason books can’t have them too. C.B.: Yeah, yeah, it’s a fun extra to have the deleted scenes. Jeff: So you mentioned one more book in the series, the fourth one, is that gonna be it for these heroes? C.B.: Yeah, I can’t say for sure that the door is completely closed. But for this arc, this storyline, that will be the series. It will be completed with Abby’s book. Jeff: We could treat it like the Marvel Universe. Now, if phase 1 is over, and there could be a phase 2 eventually, once you figure out what that is. What got you started in writing? C.B.: I love telling stories. And think I was very young when I tried, like, writing a story for myself. I had an old notebook that I would scribble this adventure story in when I was in sixth grade. And then I’d kind of start and then every recess, I’d pick it up or I’d work on it when I was supposed to be doing homework or stuff in class. And so I’ve always wanted to tell stories. I didn’t really think of it seriously as a career. And then, after college, I went to school for science. And so I was going to get a PhD and do all this stuff, and I, you know, ended up going a different route. And really writing has been a journey where it kind of comes…it ties back to, and I guess like the “Sidekick Squad Series” and the titles were all, you know, the titles are all about, like, hey, I’m not who you think I am, I’m not the person that you’re claiming that I should be or expect me to be. It comes back to where, as a queer woman of color, I didn’t really see a lot of myself in books growing up. And so what I really hoped to write was, like especially when I was writing Sidekick for the first time, I wanted to write a book for my 16-year-old self. So this is the book that I wanted to read. And I wanted it to exist. And so writing…and then I also just like telling stories. So I wanted the story to be fun, I wanted them to be happy and have, you know, there’s drama in them. But overall, I wanted to see kids like myself, and kids who looked like me, and other kids, that reflect the world that we live in because trans kids exist, asexual kids exist, mentally ill kids exist. And there aren’t enough stories where they get to be part of something that’s a superhero adventure, or something fun and fantastic like this. And so I wish that I hope…and I think there are definitely now, in the past, you know, 5, 10 years, there’ve been a lot more stories, and I think that’s great. So I’m just really excited that now people are writing more and more and reading more and more, and there’s a lot of great books to come. Jeff: And one of the things to not…I don’t want to knock the coming out story because those are very important and very needed. But in these books, that’s not really part of it. I mean, this is a much bigger adventure these teenagers are on that just doesn’t revolve around their sexuality so much, that just, there’s so much more going on, which I think is awesome and gives everybody something different to read. C.B.: Yeah, I love that…like, I want us to have the breadth of different types of genres and stories that there are for, like, able-bodied heterosexual people. Like, I want there to be so many stories to choose from. And so, you know…and I really love…I think there’s a lot of power in having joyful stories as well and stories where, yes, sexuality is a part of it, but, you know, who I am is not just my sexuality. Like, every person is multitudes where who you are is made up of so many things like your passions, your dreams, your hopes, your hobbies, your friends. Who you are as a person isn’t just one thing, and we’re all…I love being able to explore that and getting to see… I want people to see that people in the LGBTQ community are like fully nuanced people that get to be complicated and have flaws and go on adventures, or fall in love, or discover more about themselves in the way that all straight people can. Jeff: Well said. I like that for sure. Who were some of your author influences as you got started on your writing journey? C.B.: So I really love the “Harry Potter” series growing up. That’s a huge influence for me. That was one of the first ways I started writing was “Harry Potter” fan fiction because I loved that world so much. And just a lot of…I read so much fantasy like Ursula Le Guin, Diane Duane, Eoin Colfer, like tons of fantasy, Jane Yolen. I started to read a lot more widely. I think when I was a kid, there was a point when I would like go to the YA section and just read like everything in the library. So I would pretty much read everything, but I tended to love fantasy and sci-fi the most. Jeff: Nice, and now you get to write your own. C.B.: Yes. I’m really lucky. Jeff: Is there a genre you want to branch into as you close up the “Sidekick Series?” C.B.: I’m excited to write more fantasy. So the “Sidekick Squad” is more sci-fi, speculative. So I’m working on some fantasy stuff. I’m excited to share it. I have some contemporary stuff. I have a short story coming out next year in the next “All Out” anthology. So that’ll be fun. It’s like a very fluffy high school romance that’s just set in like… The only magic is the friendship and the romance so… Jeff: Aww, sometimes that’s all you need though. C.B.: Yeah, yeah, it’s fun because when I was writing it, I hadn’t written just contemporary in a long time. So that was really fun to try and explore that. Plus, I got to put a lot of puns in there, so it’s all good. Jeff: You seem to travel a lot. I feel like every time I see you on social media, it’s like, “I’m going to this event” or, “Here I am at this event, come see me over here.” What drives you to be out on the road so much? C.B.: So I like the opportunity to see, meet readers. I live in Los Angeles, and I’m really lucky to have the opportunity to go to a lot of events that are fairly local. I also think it’s really important to travel when I have the opportunity to, and I’m lucky that I’ve been able to, and sometimes I will just commit to doing it out of my own pocket because I want to meet readers in those areas. So I love…yeah, I already said it, I love meeting readers. But, especially in places where you don’t get a lot of, you know, LGBTQ resources, or teens don’t necessarily get to see a lot of authors or books with this content come their way and getting to meet teens in, you know, small towns or getting to meet people even though I do a lot of web chats. And so that’s fun chatting with libraries or classrooms through the power of the internet, which is amazing. But, part of being on panels and having these conversations is important to me just because, you know, I get to share with people that might not have heard of my books before or are just learning about it for the first time. And so that’s always a very special moment to me when someone’s like, “Oh my gosh,” like, “This is exactly what I’ve been looking for. I didn’t know it exists, but now I do.” And so that’s very meaningful. And sometimes I get to meet people who have already read the books, and that’s very important to me. And that’s a part of the most rewarding things to me as a writer is knowing that your work has made an impact on someone, whether it’s just making them smile, or, you know, to the depth of having someone like… I’ve cried over several really long emails just because sometimes people are really sweet and talk about like, “Oh, this is my coming out experience”. I want people to see that they’re valid. And so knowing that someone else has read my work and recognize themselves, that’s one of the most rewarding things I’ve ever done. I was in Seattle recently, earlier this year, and one of the events I did was with the Seattle Public Library where we went to the LGBTQ Youth Center. And that was really powerful just to, like, hang out with kids and chat with them and what are they looking forward to as far as like, “Hey, what’s powerful to me, what’s fun to me?” A lot of this is stuff that I totally resonate with when they connect with a character on TV or are upset that, you know, that character got killed off in one season or whatever, because of TV. But, you know, it’s always great to chat with people. Everyone’s always going through something. Jeff: Yeah, for sure. So we’ve hinted a little bit about some stuff that’s coming up for you. You’re working on Sidekick 4, you’ve got a short story coming out next year, anything else we should know about? C.B.: I’m also writing the new “BEN 10” original graphic novels with BOOM! Studios and Cartoon Network. So one is already out. It’s called “The Truth Is Out There.” It’s where “Ben 10” is part of the Cartoon Network show where Ben can turn into 10 different aliens. So it’s fun. It’s a fun, middle-grade romp. So I’m doing a number of those graphic novels with BOOM! So those will be available throughout…I can’t recall the dates off the top of my head, but another one is coming out in July, and then one more in October of this year and then the next year, there will be some more coming as well. Jeff: What’s it like writing for graphic novel because, I mean, that’s a different sort of animal, a novel that, you know, is 60,000 or 70,000 words long? C.B.: It was definitely a new experience. It was a lot of fun trying a different medium. Like, definitely writing a script goes differently as far as…and I catch myself like “Oh, I’m being too descriptive. This is literally…the only person who will see this is the artist.” And it’s also a great collaborative process. So it’s really fun to work with the artists and editors and bring together this story that exists in its own medium. It’s not just me, the writer, but what the artist is bringing, and collaborating with them, and getting to like…you know, I’ll write the dialogue and the action. And then they’ll imagine it in a certain way of like, “Oh, I didn’t think of that,” and that’s really fun. I really like the graphic novel format. I’m hoping to do more. I’m really excited to be working on these projects. And, yeah, hopefully, I’ll be able to share more upcoming projects. Jeff: Pretty cool. And speaking of, what is the best way for people to keep up with you online? C.B.: You can always find me on Twitter and Instagram at, C-B-L-E-E_C-B-L-E-E, because it’s double the trouble. My website is cb-lee.com, and then you can find more links to other ways you can connect with me. Usually Twitter and Instagram, where you can find me the most – that’s where you can connect with me. So in my website, it has like fun stuff. I try to update it with writing resources and my upcoming events. And I also have a newsletter, which will have some special tidbits probably like the deleted scenes, which is the very first place I offered the “Not Your Villain” extra scenes. Jeff: Pretty cool. Well, C.B., thank you so much for hanging out with us. We wish you all the success with “Not Your Backup” when it comes out on June 4th. C.B.: Thank you so much for having me. And I really appreciate it. I’m so excited. And I hope everyone enjoys the book. Book Reviews Here’s the text of this week’s book reviews: A Lover’s Game by Max Walker, narrated by Greg Boudreaux. Reviewed by Jeff I was so happy that this fourth book in Max’s Stonewall Investigations series released in audio just a couple of weeks ago. I’ve been eagerly awaiting the final installment of the series and I was not disappointed. The series has been working up to the final showdown between private investigator Zane Holden and the Unicorn Killer. The Unicorn has loomed large over the series–a serial killer that terrorizes the gay community in NYC. The killer’s gone after partnered gay men and Zane’s husband was aomng the victims. In the first book we find out the Unicorn’s returned and now in the fourth one Zane’s obsessed with bringing the reign of terror to an end. At the same time, Zane is preparing for his wedding to Enzo, the defense attorney who captured his heart in that first book. Unfortunately, Zane is so occupied with the case, he’s missing things, like cake testing and venue selection, and he hasn’t told Enzo that he’s even back on it. Zane thinks he’s protecting Enzo by keeping his activities a secret, but Enzo feels it puts him more in danger not knowing. And boy does everything hurtle towards a massive, satisfying conclusion. Max had me super stressed in this installment. He always does a great job of creating suspense. Here though I suspected everything. Is the Uber driver a killer? Is that bottle of wine spiked with something? What does it mean that someone looked at them on the street? Is the person providing information or misinformation? I suspected everything and also never figured out who the Unicorn was ahead of the reveal. I love that! While Zane and Enzo have been featured in the middle two books of the series, it was great to see them returning to the spotlight. Their dynamic as the move towards their wedding date was wonderful to watch. The quiet, sexy moments they share along with their wedding planning and time they spend with Enzo’s family shows their strong relationship and amazing friends. And, man, are there some super sexy times in this book. There’s always steamy scenes in this series, but these were the best yet. Max contrasts these happy times with how they handle the increasing threats–they want to be strong for each other and also do what’s necessary to keep the other safe. They find it’s hard to maintain the balance and that only increases the tension. I both hated and loved what Max put them through because it was so realistic. Is it weird to say that I liked the terrible choices were made? Despite being great at their jobs, Zane and Enzo sometimes do things that are terrible choices and what makes those so good in the story is that I could see myself doing the same thing. These two are flawed and make bad decisions like anyone can. It makes them human. It makes you scream at them to not do something. It makes you cheer when it all works out too. Kudos to Greg Boudreaux. He’s done a great job with this series overall but I have to shoutout his work voicing the Unicorn. It’s a creep, calm yet evil voice that made me shudder. The spin off for Stonewall Investigations Miami is set up here too. That first book, Bad Idea, just released last week and I can’t wait to pick it up as soon as there’s an audio version.
Jeff discusses a deleted scene he’s offering this week from his upcoming book Netminder (Codename: Winger #4). He also recommends The Queer Creative Podcast. Will and Jeff discuss the second season of Netflix’s She-Ra and the Princesses of Power as well as Pose, which has just arrived on Netflix ahead of the new season coming to FX in June. Jeff reviews Queer as a Five Dollar Bill by Lee Wind. Gail Carriger talks to Jeff about her new novel, The Fifth Gender and some of the interesting stories about its creation. They also talk about how Gail went from archeology to writing romance, her process for world building and her travel podcast called The 20 Minute Delay. Complete shownotes for episode 189 along with a transcript of the interview are at BigGayFictionPodcast.com. This interview transcript is sponsored by Dreamspinner PressDreamspinner Press is proud to publish Hank Edwards and Deanna Wadsworth’s new book Murder Most Lovely. Check it out, and all the new mystery and suspense titles from your favorite authors like Amy Lane, KC Wells, Tara Lain, and Rhys Ford, just to name a few, and find a new favorite author while you’re at it. Go to dreamspinnerpress.com for everything you want in gay romance. Jeff: Welcome, Gail, to the podcast. Gail: Hello. Thank you for having me. I’m super excited to be here. Jeff: I’m so glad we finally got you on the show because I’ve been, you know, reading since back with “The Sumage Solution” and it’s like, “We gotta get Gail on. We need to get Gail on.” Gail: I am delighted. I am a devoted listener and so I’m quite honored to finally get to be here. It’s great. Jeff: And you’ve got a book coming out or you’ve just had a book come out actually, “The 5th Gender” just released. Gail: I did. Yes, “The 5th Gender,” it’s my like crazy, ridiculous, silly, happy yet cozy murder mystery on a space station with an alien with five genders and tentacles and purple. Jeff: You don’t often get cozy mystery space station together in one package. Gail: It is…it’s great. It was totally one of those spontaneous, I had like a strange thought/dream/idea to do this. And a bunch of us were joking on Twitter about the craziest mashups of genres we could come up with and somebody was like, “Barbarian noir,” and so on and so forth. And I was like, “Well, I wanna do space station, cozy mystery.” And then I started thinking about it and then it happened. Then I was like, “Oh, okay, I’ll write it, I’ll write it.” I was supposed to be writing something else, of course. But sometimes I succumb to the lure of the ooh, shiny. Jeff: And it was a purple shiny too. So how could you resist that? Gail: I could not. And he’s adorable, the alien character. And I, you know, I have a background as an anthropologist. I have an archaeology…couple of archaeology degrees. And so I just love the way if you’re doing an alien character, you can comment on human social structures and culture and interactions. And so I might’ve had a little too much fun with that. Jeff: Well I was actually gonna get into that. I’ll hold that. Because we should at least tell folks, because I want to talk a little bit more about the origin story on this because you wrote about it. So just like, “I had this idea in the middle of the night, and then I tweeted it, and then it was a story,” which I love, but then there’s the fact that you went away to a retreat and worked on it and had to talk to other people about it while you were writing it. Gail: Yes. So for those…I should preface this by saying that for those who don’t know, I have two names I write under. So I write under Gail Carriger and I write under G. L. Carriger and the G. L. stuff has a much higher heat level. So it’s super sexy. And this book, “The 5th Gender” is a G. L. book. So warning for anybody who doesn’t like nooky because one of the things I realized through the course of that particular writing retreat was that if you’re writing about a species with five genders, human curiosity wants to follow them into the bedroom to see what it’s like down there. And so I thought about trying to kind of clean it up a little bit and it just…it didn’t work. So I was like, “Okay, we are going into that realm.” So I was supposed to go on this retreat and write something else entirely, and instead I just spent the entire week writing this book. And one of the funniest stories from that was me being like, “Oh shoot, what does alien jizz taste like?” Because we all know, at least we do if we’ve been reading my San Andreas Shifter series that wizard or mage jizz is fizzy and werewolf is spicy. And I was like, “Well, what do aliens taste like?” And this meant that I literally had to go and you’re never…on a retreat, you’re never supposed to disturb the cooks in the kitchen. But I was like, “If there was ever a question for cooks, this is it.” There is a crazy author running into the kitchen in the middle of them making shepherd’s pie and being like, “Oh, you guys, what does alien jizz taste like? Debate.” So we had a long debate about it and we finally decided, and you’ll have to read the book to find out. Jeff: Yeah, I wasn’t gonna ask you to spoil that, but I do have to know what exactly did the cooks make of this question? Gail: The cooks were quite game actually. I think they were pretty charmed because normally like they’re doing their art form and we’re doing our art form and never the twain shall meet until meal times. So it’s really rare for one of the authors to actually want the cooks’ help on something. So I think they were kind of pleased to be asked. Jeff: That’s very cool because some of them might have been like, “I’m sorry, what?” Gail: Oh, they know what I write. We’ve been going for a long time with the same cooks for a while, so. Jeff: So this group knew you so they weren’t necessarily surprised by… Gail: No. Well, it was a little out of the blue. I haven’t been writing the super sexy stuff for very long. Like normally my questions are like, “What’s the most ridiculously named, you know, Victorian dessert you can think of,” kind of thing. But yes, it was a little different from my usual questions. Jeff: And tell us what this book is about, this cozy mystery on a space station. Gail: Well, the tagline is an alien race with no word for murder has a murderer aboard their spaceship. And essentially the galoi are the aliens in question. And they are these purple…they’re these adorable sort of purple tentacled kind of, you know, High Elf, slightly looking alien creatures. And they are super isolationist. And the only thing that humans know about them is occasionally they will kick one of their genders. It’s always as one of the examples of the fourth or fifth genders and they’re kicked off and they’re in exile, and those galoi, which is the name of this alien race, go and live amongst humans. And humans actually adore them because they think they’re like sweet and cute and adorable. And they have no…they’re pure exiles. So they have no national allegiance, they have no planetary allegiance. And so they make really great attaches. They’re kind of really kind of comforting and lots of different alien races like to be around them. So they often become attaches to like ambassadors and stuff. So a lot of space stations….space stations consider it really lucky if they get one of these. And the main character, Tristol, he’s one of these aliens and he has a mad crush on the human security chief/detective that’s onboard the space station named Dre. But he doesn’t really get kind of like human flirtation and courting rituals. So he’s sort of…the book sort of starts with Tristol trying to figure out what cats are and why you would wanna keep them as a pet because he’s been asked by some human friends to cat sit. And then, of course, the cat escapes and hijinks ensue on the space station because what happens when the cat gets into zero gravity. Nobody wants to find that out. Anyway, and then the galoi are like super xenophobic, so they never reach out to humans. And then suddenly a galoi ship approaches his space station, which is crazy in many, many ways because they shouldn’t be approaching a space station that has an exile aboard it and they never talk to humans anyway. And they have this incredibly complicated non-pronoun language that kind of indicates status and has to do with all of these different genders. And so the humans are kind of panicking and freaking out. They don’t want a war. They don’t know what’s going on. And the spaceship basically says, you know, “We have a murdered galoi and we don’t know what to do. We don’t have security, we don’t have murder investigations. We don’t. So we came to you, violent humans, to figure this out for us.” And of course Dre, the human love interest is the detective. So he and Tristol have to team up because he needs Tristol’s help to explain how the galoi work. And so the two of them gonna figure out who done it and that’s basically it in a very large nutshell. Jeff: How did you go about creating the galoi? I mean, five genders, no term for murder. There’s like so many things that kind of click into this. Is there like…? Gail: I just, so like I said, I have an anthropology background. I mean, archaeology is blank, so obviously the biology and skeletal structures and things is what I mostly studied via anthropology, but you get a lot of like gender studies and cultural representations of gender and all that sort of thing as part of an education in the United States if you do an archaeology degree. And so it’s always been super, super fascinating to me. I have a minor in classical mythology with a focus on gender. It’s just something that has interested me. It’s really hard to tease out in the archaeological record. It’s prone to misinterpretation by archaeologists and historians and anthropologists. So there’s a sort of storied history with our own relationship from a scientific perspective with understanding gender. And so I just took a lot of that both kind of my education and, you know, how the world now is changing. I spent far too much time on Tumblr, so I have a lot of like non-binary and gender fluid and gender queer fans. And so I’ve just been kind of reaching out to friends and acquaintances. One of my best friends in the world is a bioethicist and a medical ethicist. And so she deals with training doctors in how to talk to people appropriately about gender. And so I’ve had all this sort of stuff messing about, and I was like, “Well, a way for me to explore this and have this kind of conversation with myself and the world is through an alien lens.” And so I just…I love thought experiments, and I was like, “So what if we have a race with five different genders and how would their language evolve? How would their culture evolve? How would they treat each other?” Like all of these, you know, archaeological things to think or anthropological things to think about. And then how would humans, even future humans, react when encountering that? And so that’s kind of where the conception started. And then I just made them purple because I like purple. Jeff: Why not? I’m a big purple fan too. Was there a lot of research kind of building this? Gail: Yeah. I actually have multiple blog posts that either I’m releasing them right now or I’ve just released them recently, speaking from the past into the future. But I have a bunch of blog posts about like a bunch of the research that I did and like some book recommendations and stuff like that, both from a fictional perspective and a nonfictional perspective and different blogs and stuff like that. But I like that. I like researching a lot. I try not to rabbit hole too much because the point is to write the actual book. So mostly what I did is I did that intensive week where I sort of just vomited forth this whole book. And then I went back and like teased it apart and looked into different…almost as…I almost treated it a little bit as if it were a nonfiction piece to go back and see what sources do I need to look up, what like different pronoun terms might be being used in hundreds of years, you know, by humans. That sort of thing. And it’s…since both the humans involved… I try to be complex in my races, whether they’re werewolves or aliens in that like…and to not either dystopian or utopianise either race, either humans or aliens. So both races still have issues. Both are still dealing with how the cultures have evolved and all of that sort of thing. So I’m not setting the galoi up as like the perfect model of a possible future. They have a different evolution, a different model. And they’re merely a vehicle for which we can examine perhaps some of our own biases and prejudices now. And that’s getting very, very serious because mostly what I want my books to do is make you happy and cheerful and be excited, delighted. And if it makes you think a little, that’s great. But really I just want to make everybody happy and hopefully Tristol will do that because he’s delightful. I love him. Jeff: What kind of, I guess, beta reading did you do to see how your various fans handle the gender discussion? Gail: Well, I have trans and gender queer and gender bending characters already, both in my main universe and in my traditionally-published books and in all of my…like my independent and my self-published works and in my novellas and stuff. Some of the main characters, some of them side characters. And so I know that they’re open to it, and I also know that the one that, you know, for lack of a better term, I have like a queer-centered, progressive kind of comfort food brand or business model or whatever, however you wanna explain it. And so I feel like most of my super fans are gonna be excited because what they want from me is that comfort, is that sort of upbeat, fun, slightly fluffy, slightly thoughtful, but ultimately, you know, everything’s gonna be all right. I’m never gonna depress you. There’s never gonna be like scenes of torture. It’s never gonna be angsty, you know, all of those things. It’s always gonna be delicious, I guess. Jeff: I like that as a term for a book. That’s just really fun. Gail: Yeah. It’s just gonna be tasty. Yeah. So they know that and that’s the part that they trust and generally I feel like they’re pretty open minded about how I’m gonna go there and explore that. I don’t think I would’ve done this book, you know, five or six years ago because I wasn’t sure. I had to kind of test the waters with the San Andreas books and some of the other stuff. But I think they’re pretty open to it. I don’t know. You never know. We’ll see how everybody reacts. Yeah, so I mean, and I have beta readers and some of them have read it. I was more careful with this book in making sure that like I had sensitivity, what I call delicacy readers. So people within kind of the gender nonconforming community, again, for lack of a better term. That was more important to me really. I don’t wanna offend, although, you know, everybody’s opinion is their own and everyone is entitled to it. So I’m sure if you come to any book with the idea of being offended, you’re probably going to be unfortunately. So, but I did put essentially a naked purple dude on the cover as a kind of like, “Be aware, there’s gonna be sex in this book. We’re gonna go there. We’re gonna go far out there.” Jeff: It’s cozy with sex and it’s funny and it’s sci-fi. It’s got a little bit of everything in it. Gail: Exactly. Jeff: Do you think you’ll revisit this later as like as a continuing series? Gail: I’d love to. Actually, I have another murder mystery and like I don’t consider myself like a mystery writer at all, but I have this thing as a writer where I don’t write a book until I’ve had what I call the epiphany, which is I need to actually see a scene with characters in dialogue. And it might not necessarily be the first scene or whatever, but until I see that I have that crystal moment, I don’t feel like I can write the book. So I have a lot of books that I’d like to write, but I’ve never had the epiphany with. So they’re just sort of sitting there. And I’ve had an epiphany for a second book in this series with Dre investigating another murder and Tristol still there and everything. But I don’t know how people will receive this one, so I don’t know if I will write that one, but it’s definitely there percolating already. So it’s a possibility. Jeff: It’s a possibility. Gail: Yeah. And the universe on the whole, because it is a science fiction universe, actually does have another, of all things, young adult series that’s set at it that’s kind of been on the back burner for a really long time which kind of has nothing really to do with this series except that the same conceits in terms of faster than light travel. And human…like colonization and planetary evolution are the same. And there’s like a couple of crossover alien races, but that’s about it. But it is the same sort of basic far future. Jeff: If you’ve got the universe, you might as well keep using it. So you don’t have to just keep reinventing the wheel. Gail: Precisely. Yes. That’s my feeling. Jeff: What do you hope readers take away from this romp? Gail: Well, like usual, I just want them to be like… My favorite thing is somebody writes to me and says, “You either humiliated me because I was laughing loudly on public transport,” and I’m like, “Yes.” “You kept me up all night.” “Yes.” Or, “You just left me with a big smile.” So that’s really what I genuinely want is a big smile on people’s faces. But it would be nice if people who read it thought a little bit about…a bit more about gender and how we intimately link biological sex with gender and that perhaps that’s not necessarily the…I don’t know, ethical thing to do – that perhaps gender is in fact a social construct. Or cultural construct. It’s something that anthropologists just accept. Like if you’re an anthropologist, you just accept that as a fact. Like we know, we have seen all of these different ancient and modern races or cultures with varying different interpretations of genders and it just…I don’t think it would ever occur to an anthropologist to like not be like, “Yes, gender is cultural,” but it seems that in the world today that isn’t an accepted principle. And so I guess, if anything, I want people to kind of get it, to maybe think a little bit about pronoun use and all that sort of stuff, I guess. Jeff: Now, as both Gail and G. L., you run across a lot of genres. You’ve got your urban fantasy, you’ve got some paranormal. Now you’ve got cozy mysteries in space. Comedy definitely cuts across all of them. Is there a genre you like most? Gail: I would say I have wheelhouses more than anything else. So there’s a podcast called “Reading Glasses” that talks about as readers we tend to have wheelhouses and if you read heavily in romance, you define those often as tropes. You know, like, “I like the enemies to lover,” or whatever. But a wheelhouse kind of has other things. So, and I would say that there are definitely wheelhouses I gravitate to. So I always write the heroine’s journey. I never write the hero’s journey regardless… Again, this is the gender thing, right? Regardless of the biological sex or stated gender of my main character, they’re always heroines’ journeys because a heroine’s journey, it doesn’t matter who’s undertaking it. So I would say that is one of my things. I always do ‘found family’, and I realized recently I had this big revelation that one of the reasons I strongly gravitate to reading gay romance in particular is because found family is a really popular trope within gay romance for obvious reasons because if you come to the queer community, it’s usually partly found family that brings you there because real family rejected you, at least often did when I was younger. So yeah, and I just love that as a trope, for lack of a better word. And so I have found family in my books all the time. I tend to have extremely strong female main characters except when I’m writing gay romance, of course. Yeah, and lots of queer. I was thinking recently that a slogan I really embrace would be queer comfort because I feel like that’s kind of in all of my books even the books that have heterosexual main couples. It’s really hard. At this juncture, I guess you could say that I trust my readers enough to relax and just write what moves me. I wouldn’t have written this book if I didn’t think at least some of them would enjoy it. I mean, what a privilege and kind of a blessing and a joy to get to do that. But it has been 10 years. So it did take a while. Jeff: And you mentioned that you’re not known for mystery, certainly. So you’ve taken this turn now to at least explore it once. Are there other things out there like, going after and trying to write a mystery, that are still things you want to do, things you’re looking at towards the future? Gail: Absolutely. There’s always… Like I adore high fantasy. Obviously, I’m really into world building. And so like I have a young adult high fantasy. It’s actually techno fantasy, kind of like the Pern books or “Darkover.” And so, you know, I’d like to do that. There’s a bunch of stuff that I kind of am excited and interested, and I’m a pretty voracious and pretty wide reader. So I think that makes you, generally speaking, a relatively wide writer. I think it’s unlikely I would ever break the trust contract that I have with my reader base and write anything dark. I certainly would never write anything gritty or gruesome. I don’t like to read that, so I’d never write it. And I think I’m out of my dark phase now that I have left high school. I don’t do the really kind of dark or angsty stuff. I was thinking about contemporary recently actually. And I don’t think I could write contemporary. The moment I start to think about writing something that’s just a contemporary romance or like women’s lit or even something, you know, Heaven forfend, like proper lit fic, it immediately just goes fantastical. I can’t, I have to inject. And if I were to describe myself as anything, it is, you know, science fiction and fantasy rooted, I like the world building a lot. And so I think it’s unlikely that I’ll ever write something that doesn’t have at least that as part of the component. Jeff: So how did you go from studying archaeology and getting these degrees to now becoming full-time author, writing all these books? What was that path? Gail: Oh my goodness. So I’ve two master’s degrees and I was working on my PhD and I always thought I would be an academic. I genuinely love archaeology. I’m one of those incredibly lucky people who left one career that she adored for another career that she adored. So, you know, tragedy of choice. And I was about to do my defense and I was about two years out which would have been my thesis years finishing my PhD. And I always wrote. I just grew up on what essentially amounted to kind of like a hippie commune kind of thing, and surrounded by artists. And the only thing I had learned really from that is that artists never make any money. And so being an author was really a bad idea. So I was like, “Okay, I’ll be an academic because, ooh, profitable.” At least it’s quasi reliable, right? But I always wrote, I just had that need. It’s kind of like breathing or something. And I figure if I write, I might as well submit. And so I was submitting, writing and submitting. And then I wrote “Soulless” as kind of a challenge to myself. I’m a bit of a perfectionist. I have a propensity for rewriting things over and over and over a million times and never actually finishing anything. And so “Soulless” was like, “You will take six months, you will write this weird book.” This was during the paranormal romance and urban fantasy bubble of the late ’90s, early 2000s. And I was like, what I really want from…I want a bunch of things, right? I want women to write funny stuff in genre, commercial genre. And that’s pretty rare. Most of the writers I knew who wrote funny stuff were like Terry Pratchett, Christopher Moore, Jasper Fforde, like a bunch of dudes. And I was like, “Where are my ladies writing funny? Where’s my urban fantasy set in a historical time period?” You know, I wanted all of these things and nobody was writing it. And finally I was like, “Well, that means I have to.” Jeff: Take the challenge. Gail: Take the challenge. And I really did write it as a challenge. And “Soulless” is a mashup. It tends to be what I write, obviously. I mean, I’m here talking about, you know, space, cozy mystery romance. So I obviously like mashing up things. And so “Soulless” is steampunk, urban fantasy, comedy of manners, romance. It’s a bunch of these different things. And I was like, no one will buy this because I had been in and out of the publishing industry and submitting short stories and I was like, “This…it doesn’t have a place in the market. There’s no shelf it sits on, like, no one’s gonna buy this. But I wrote it so I might as well send it out.” And I had one of those slush pile telephone calls from New York where they like…within a month somebody wanted to buy my silly little bit of fluff. And I was like, “No, you’re joking.” And so “Soulless” was a slow burn. It hit the market and it was really word of mouth. The librarians and the independent bookstores were like behind me 110%. They just loved this crazy little book. And I think it was mostly the funny, but you know, super strong heroine and, you know, like gruff, overly emotional werewolves and queer characters from the get go. And it just appealed to, you know, a kind of segment of society. So I was right about to do my defense when “Changeless,” my second book, hit the hit The New York Times and that kind of seed changed everything. It changed marketing, it changed how much money New York was willing to offer me and my partner at the time was like, “I make enough money to support us. Why don’t you see if this…why don’t you take a break from academia and see if this writing thing works?” And I did and I haven’t been back. Jeff: Well done. Ten years on. Gail: Yeah, a lot of it’s serendipity. And a lot of it is good friends. And then a lot of it was also like, I am super…I’m an archaeologist. Archaeologists are like the organizers of anthropology departments. You know, we’re logistics, we get large groups of people into foreign lands and then make them shovel dirt around, you know. We feed them and house them and blah, blah, blah. You know, we’re big on spreadsheets and organizing. So I already had that kind of part of my personality that I think not a lot of authors have. And so when I was successful, I was ready to be like, “Okay, let’s figure out how many books I can write in a year. Let’s figure out, you know, like… I like trad, but maybe this independent publishing thing is interesting. Let me go research that and experiment with that. You know, let’s try this thing.” I’ve always been like that. Even with my traditional publishers, like they would be like, “You sell really good in eBooks.” And I was like, “That’s because I have romance readers.” And they were like, “How do you feel about maybe doing this strange BookBub thing?” And I was like, “I think that’s a great idea. Why don’t we do that?” You know, it’s like I am game. So I think that has also helped is I’ve always been willing to take a risk, partly because I have a safety net. It’s like I can always go back to being an archaeologist. That’s fun too. Jeff: What’s your overall process? I mean, it sounded like, if I understood from our “The 5th Gender” discussion, it almost sounded like you did the first draft of that book at the retreat. Gail: Yeah. I work really well, it turns out, in a competitive environment. I didn’t realize, but if…I really am one of those writers who I’m social in terms of I like to sit across from somebody at a cafe and just type and just the act of having another writer or a bunch of writers around me also typing is really helpful to me. And part of it is kind of looking over and being like, “How many words have you done? Oh shoot.” And then just typing some more, you know. But yeah, so I do this one retreat every year and I know I can do 40,000 words at that retreat, which is either one novella or most of one of the G. L. books. So I usually sort of get prepared ahead of time with that preparation is writing the first 10,000 or just get…I’m an outliner, so I’ll get all the outline ready. I’ll get all the world building ready. And once I hit the ground there, I can just turn out a bunch of words and that’s great. I try to do a couple of other kind of long weekend baby retreats. I’d love to find other week-long retreats. But the style that I like is pretty rare. And the style that I like is just a bunch of writers writing and no workshops or critiques or anything. So I do that and then most of the rest of the time I am not somebody who can handle multiple projects. I learned that about myself the hard way. So I have to be working on one book and then close that book out and then move to another one. And so if it’s an independent project, what I’ll often do, so if it’s something that I’m gonna be self-publishing, I’ll often write the whole thing on a retreat or over the course of a couple of months. And then just put it to bed and then focus on incoming copy edits or a proof pass or writing a completely different project, and let it sleep if I can. I find that that marination really helps. And then I’ll go back and do a reread. And I’m a multiple editor. I think a lot of comic writers have to be because I do passes for like different kinds of comedy. So I’ll do like a word play pass and then I’ll do a sort of a slap stick pass. And then I’ll do like rule of three descriptive passes to try and get as much different kinds of humor back into a book as possible. And so, and then I have an alpha reader or two and they read before it goes either into my New York editor or off to my beta readers. And then I actually hire and use a developmental editor for my independent stuff as well probably because that tends to lean more romantic. And when I first started writing it, I didn’t really think of myself as a romance author. So I wanted to make sure that I was getting kind of the beats right for romance. So I have an editor who specializes actually in gay romance, who reads all of my romances and gives me feedback. And then it goes to beta readers for the Parasol-verse in particular because they’re like, they’re 25 books in that universe and there’s lots of crossover characters. So most of my beta readers are actually just super fans who are obsessed with the universe and have written me like either critical letters about mistakes that I made in terms of like getting character names wrong or eye colors or something. And usually I’ll be like, “You, would you be interested in being a beta reader?” Jeff: Right. Put those people to work. Gail: Exactly. I was like, “If you’re going to do this anyway, how would you like to get everything ahead of time?” And I give them lots of extra perks as well, special editions and stuff. Yeah, so it’s quite a process at this point. But my beta readers are killer. I’ve got just a team of four now and they’re really fast and great. I love them. And then I have a couple of awesome copy editors that I use and then a proof. The Parasol-verse gets a woman named Shelley Adina, who’s a fantastic steampunk author in her own right and a regency and who’s really, really good on the Victorian era. So it gets a world – like historical proofing basically. And then I have a formatter. I’m a big fan of finding people who are really good at what they do and hiring them to do it for me. Like I could change my own oil, I’m sure, but I’d really rather find a good mechanic, you know. And that’s how I feel about the book world as well. So I have a fantastic cover art designer I love working with and I just got to put my team in place and then hope that no one gets sick. Jeff: Right. That’s the key. Nobody can get sick. Not right now. Gail: Nobody get sick. Nobody can leave me. Very floored when that happens. Jeff: So you mentioned that you read a pretty broad swath of stuff. What are you reading right now that you’re loving? Gail: So I just did a reread on Amy Lane’s “A Fool and His Manny,” which because it got nominated for the RITA award and it was one of the few that did that was queer. So I had read it before, I just did a reread on that and I still love it. It’s very cute, and I love Amy. Amy’s one of the nicest human beings in the world. So that was really fun to redo. And I’m a huge fan of Mary Calmes. I don’t know how to say her last name. Jeff: You actually got it right. Gail: Did I? Jeff: You did. Gail: Oh, good. Yes. I will read… Pretty much she’s an auto buy for me. I just find…I know that there are tropes in place that…but I just find her stuff really…she’s a comfort read for me and as somebody who writes what I hope is comforting for others, like I’m always hunting for authors that give me that same sensation. One of my like constant of all things, comfort, reread rotation is Alexis Hall’s “For Real,” which is a fantastic BDSM, but it’s just like, I don’t know what, the writing is so good. And I will reread R. Cooper until the cows come home, the “Being(s) in Love Series,” which I really, really adore. So, which is an urban fantasy basically. Jeff: So you’re a podcaster also on top of all this other stuff. Gail: I am. I know. That is like completely not connected to anything, side project. Jeff: Well, I’m looking at you, I’m reading the website, getting to know kind of what I wanna ask about. I’m like, “A podcast? Wow. Okay.” And it’s about travel hacks called “The 20 Minute Delay.” How did this come about? Gail: So one of the things that happened to me in the course of this career is I went from being an archaeologist, I traveled a lot as an archaeologist, to being an author where it turns out I travel like five times as much. When I was booked, where I’m regularly, I was doing two book tours a year at least. And that was not counting all of the conventions and stuff I was doing. And a book tour is like 10 cities in 10 days. I mean, it’s crazy traveling. So I turned into a frequent traveler and I’m an organizer and I like to hack things and figure out the most efficient way to do everything possible. And I realized I was doing that with travel. And there are two things that I can talk…well, there are three things that I could talk about, books that I love, like literally until the cows come home, food that I love to eat, and travel hacks. And then I met my friend Piper. And Piper has a day job that has her traveling 80% of the time. And she has, if possible, more travel hacks than I do. I was basically like, “Piper, let’s do a podcast. It’ll just be like 20 to 30 minutes and we will just get on and we will chat about a place that we’ve been recently, and some like delicate matter of etiquette when traveling, like whether you recline your seat or not and how you deal with that,” or recently we did a really good one actually on rental cars. I don’t rent a car that often, but Piper does all the time. And she had some awesome tips for like how to get the best rental car and, you know, what apps to use and all that sort of stuff. And then we do a little gadget where we’re just like, we test a gadget, like a new neck pillow or something and then we talk about, you know, what is that little gadget thing. And sometimes it’s just like, I like the snacky bags. Like you should always have at least two plastic snacky bags with you because they just always come in useful. So sometimes it’s a gadget like that, but we have a really, really good time. And I’m a voracious podcast listener. Like when we started, I’m a fan of this show. So I figured, generally speaking, you eventually become a podcaster if you are a big fan of listening to them. Jeff: That’s probably true. And I think for any of our listeners who are, you know, thinking about, you know, their trips to GRL come October, start listening to “The 20 Minute Delay” now to get all your travel situation put together. Gail: Because Piper and I are both authors, like we don’t…we try to couch our tips as much as possible in terms of anybody can use it. But we are both women. We are women who travel alone and we are both authors. So we will tackle things like how to travel with a bunch of books, like how to fly with 50 bucks or what have you. And we also talk about like safety when you’re staying in a hotel by yourself and that sort of thing. Jeff: So what’s coming up for you next this year with the writing? We’ve got “The 5th Gender” out, what’s coming next? Gail: Next, I have the final book in my Custard Protocol series coming out, which is “Reticence.” And that’s book four of the Custard Protocol that comes out at the beginning of August. And that’s actually rounding out the series in the Parasol-verse for a little while, my steampunk universe. I’m not ruling out doing another series in that universe, but I think I’m gonna take a little break. And I’m on proposal for a new Young Adult series. So who knows? It’s traditional, so it could take forever, could suddenly happen. You never know. And then in October I have a special collector’s edition coming out from Subterranean Press called “Fan Service,” which is for my super fans, which has my 2 supernatural society novellas bundled together with an exclusive short story that’s a hardcover fit, super fancy addition that there’s only gonna be 526 of those printed. And so that’s my October release. It’s so pretty. They can be very pretty covers, Subterranean. Jeff: That’s cool. And what’s the best way for folks to keep up with you online so they can keep track of all this? Gail: Well, in addition to everything else, so in case anybody’s in any doubt, I kind of have no life. I just did…this is like what I…like, I listen to podcasts, I read, and I play online, and occasionally I write, you know, because that’s my job. So I am on all the things online. I genuinely like social media. I know. I know, it’s crazy, but you can pretty much find me on any platform that you like. If you google Gail Carriger and then the name of the platform, I will probably pop up. And I try to use the platform in the way that it’s best suited. So, you know, there are pretty pictures on Instagram and there are lots of pinned gorgeous dresses on Pinterest and historical dresses and crazy aliens. And then I also have a newsletter. The newsletter is definitely for super fans. So it’s very chatty and it’s full of like sneak peeks as to what I’m actually writing and not talking about online yet. And I do freebies and giveaways and stuff there. Jeff: We’re going to link to all that good stuff in the show notes, of course, so people can find it easily. Gail, thanks so much for hanging out. It has been so much fun. Gail: Oh, it’s been a real pleasure. I can’t say how delighted I am to be on and I can’t wait to listen to this from the other side.
Jeff talks about the upcoming release of Netminder (Codename: Winger #4) and a blog post he’s written that talks about the impact the series has had on one reader. The guys also talk about the FX series Fosse/Verdon. Jeff reviews With A Kick Collection #2 by Clare London with narration by Joel Leslie and The Whispers by Greg Howard with narration by Kivlighan de Montebello. Will reviews American Fairytale by Adriana Herrera. Jeff & Will interview Adriana about the Dreamers series, including the soon to be released American Fairytale. Adriana also discusses the food that goes into her books, writing diverse characters, how her job as a social worker plays into American Fairytale and what’s coming up next in the Dreamer series. Complete shownotes for episode 188 along with a transcript of the interview are at BigGayFictionPodcast.com. Here’s the text of this week’s book reviews: With A Kick Collection #2 by Clare London, narrated by Joel Leslie. Reviewed by Jeff.Back in episode 144 I reviewed the audiobook of the first With A Kick collection. Now with collection two, once again the writing of Clare London combines with the narration of Joel Leslie to make a super awesome experience. We’ve got two stories in this collection–Pluck and Play and Double Scoop. In Pluck and Play delivery person Curtis is saved from a homophobic attack by cowboy/singer Riley. It’s an interesting meet cute since moments after Riley dispatches the attacker, he and Curtis fall into some delightful banter. Once they meet, they continually run into each other. Riley occasionally performs on the sidewalk across the street from the With A Kick ice cream shop, which is where Curtis often makes deliveries and hangs out with his friends who run the shop. The difficulty for Curtis and Riley–and I love how Clare handles this–is that they have to decide if the thing between them is just a one-off bit of fun or something more. Riley’s supposed to go back to the States eventually, plus he’s got issues going on with his family. Meanwhile, Curtis is hesitant to let anyone get close to him again after his last relationship was so disastrous. Clare does a wonderful job of finding the moments of tenderness for Curtis and Riley while also dealing with their troubles. I think I’ve developed a thing recently for the bodyguard trope. Riley has a protector streak that I loved so so much. As soon as he finds out what Curtis’s ex is up to, he wants to put a stop to it. The same can be said to for Curtis because he wants to help Riley deal with his family. It’s so clear these two are meant to be together and once they figure how to get out of their own way–and take care of their pasts–to get their happily ever after to they are golden. With Double Scoop, Clare has written my favorite of the With A Kick stories. This one centers on shop owners Patrick and Lee. As the story opens an explosion rocks the shop, injuring Lee and leaving Patrick in a fit of concern for his friend and their business. These two have had an ongoing business and flirty relationship through the series and now they get their moment in the spotlight. Patrick, as the slightly older one, can’t imagine why the younger Lee would be interested in him. He doesn’t feel particularly accomplished, despite the business, or particularly attractive. Lee, however, knows exactly what he wants and keeps going for it even though Patrick doesn’t make easy for Lee to get and stay close. Clare toys with them and the reader in the most delicious way–bringing them together and then causing a rift. It made for a fun yet tense read going back and forth. Luckily the amazing cast of characters that Claire has developed over the series come together to help get the shop reopen and bring the two men together. Their friends know what’s best for them even if they can’t figure out how to make it work. Both With A Kick collections are great for sexy short romances that have the best happily ever afters. You can’t go wrong picking it up on audio either. Joel Leslie does a tremendous job with a large cast of characters, particularly in Double Scoop since almost everyone who’s appeared in the series shows up here. Joel deserves a special shout out for Riley, who is the only American accent and it’s a southern one too. I enjoyed listening to him go back and forth between Curtis’s British and Riley’s southern. So if you’re looking for some fun reads, that will surely make you want some ice cream this summer, pickup With A Kick Collection #2 by Clare London … and grab the first one too if you haven’t already. The Whispers by Greg Howard. Narrated by Kivlighan de Montebello. Reviewed by Jeff.This was a quite an unexpected middle-grade gem that often surprised me with the depths it explored. I’ll caution as I get into this that the end packs a lot of emotional punch and some readers may want to tread lightly on this young man’s journey because it’s heartbreaking while it does conclude in a very satisfying and fulfilling place. Eleven-year-old Riley is missing his mama. She’s been gone for a few months and Riley doesn’t know why. He’s one of the last to see her and he meets regularly with a police detective to try to fill in pieces of what he knows. However, he gets frustrated with the speed the case is moving. He remembers the story his mama used to tell him about the whispers, little blue fairies who live out in the woods. He can’t help but wonder if the whispers might be the key to getting her back. What I loved so much about this book is how strong Greg made Riley’s narrative, keeping true to how an eleven-year-old might perceive the world. Riley already knows that he’s gay. He refers to that is one of his “conditions” that he has to keep secret, and this is not his only one. He also crushes on Dylan who he refers to as the redneck superhero. Dylan’s in eighth grade and he keeps up his superhero status by actually acknowledging Riley, and occasionally defending him against the school bully. Riley convinces his best friend Gary to go on an adventure in the woods to find The Whispers. Again, this trip reveals so much about Riley as he has to deal with a hobgoblin (or was it), the fact that Dylan may not be a superhero (or maybe he is) and the consequences of saying the wrong thing to your friend all the while trying to do the right thing so The Whispers will help him. One of the extraordinary characters in this book is Tucker the dog. Tucker is Riley’s faithful companion, always at the boy’s side to nudge him in the right direction and keep him safe. The dog has an amazing personality that shines through Riley’s narrative. I don’t think I’ve ever read a dog on a page quite like Tucker and I absolutely loved it. It’s a credit to Greg that he had me so invested in Riley that I didn’t try too hard to piece together what was happening. As the plot hurtled toward its conclusion I was constantly surprised and pivoted between sadness and happiness as the revelations came fast and furious. Kudos to Kivlighan as well for capturing Riley so perfectly. It was a very satisfying audiobook experience. This was my first Greg Howard book and I’ll definitely check out his other titles. I do very much recommend The Whispers if you’re looking for a superb read featuring an eleven-year-old who is going through a lot but comes out stronger and wiser on the other side. American Fairytale by Adriana Herrera. Reviewed by Will.When Camilo, a NYC social worker, goes to an absurdly swanky charity event that his boss can’t attend, he’s intent on enjoying the special evening, which includes chatting up the hottie he meets at the bar. After a few drinks and some suggestively flirty banter, he and Mr. hot stuff find a dark corner and make the night truly memorable. The next morning, Camilo’s boss introduces him to Tom, the millionaire who’ll be financing their agency’s major renovation project. Tom also happens to be Camilo’s hot charity gala hook-up from the night before. Aware how awkward the situation is, Tom agrees to keep things strictly professional from now on, but also asks that Milo be the point man on the project, keeping him up-to-date on the renovations. Their weekly meetings begin to look more and more like dates – a meal at a fancy restaurant, a walk through the botanical gardens. Camilo is no fool, but as he gets to know Tom better – he’s certainly not your average philanthropic millionaire, there is more than meets the eye – the pretense of “keeping things professional” begins to hold less and less appeal. When they can no longer deny the attraction, Tom takes Milo back to his place. The sex is amazing (of course), but the afterglow is short-lived when Tom’s ex drops buy with their daughter. Tom shares custody of Libertad, his daughter, with his former husband. Learning of all of this (which Tom failed to mention up until that point) briefly throws Milo for a loop, but it’s hard to resist the precocious the little girl, and Milo falls even harder for the millionaire and his ready-made family. A situation with Milo’s mom has him taking on more work and financial responsibility and, in addition to that, he’s working overtime as the massive renovation project is wrapping up. He’s stretched almost to the breaking point. When Tom offers to help, the fiercely independent Milo insists he has it all under control. Tom quietly takes care of things. It’s better to ask for forgiveness than permission, right? In this case, no. Camilo is furious. As a reader, it’s hard not to feel frustrated by Milo’s stubborn streak. Your boyfriend is a millionaire for god’s sake! Get over yourself! But it eventually becomes clear that Milo is, of course, right. Tom’s intervention robbed Milo of his own autonomy. It’s Milo’s choice whether or not to ask for help – no one else’s. This is a deal-breaker for Milo and it causes a major rift in their relationship. Tom has to find a way to fix things, by doing the hard work and not using his money to solve their problems. This is a romance, so Tom figures things out, and pulls off a grand gesture that is less grand, and more heartfelt and considerately thoughtful – which is exactly what Milo needed. It all wraps up with swoon-worthy family vacation to the Dominican Republic. This interview transcript is sponsored by Dreamspinner PressDreamspinner Press is proud to publish Hank Edwards and Deanna Wadsworth’s new book Murder Most Lovely. Check it out, and all the new mystery and suspense titles from your favorite authors like Amy Lane, KC Wells, Tara Lain, and Rhys Ford, just to name a few, and find a new favorite author while you’re at it. Go to dreamspinnerpress.com for everything you want in gay romance. Jeff: Welcome, Adriana to the show. Thanks for being with us. Adriana: Thank you for having me. I’ve been looking forward to this for weeks. Jeff: So have we, to be honest, since we’ve read “American Dreamer” that we loved so much. So, a good first question is, what was the inspiration behind the “Dreamer” series? Adriana: So, basically, I think I wanted to write Afro-Latinx characters. I’ve said this in a couple of other conversations I’ve had about the book. It was really a specific time, a couple of years ago, right after the election when there was just a lot of negative conversation around the place of immigrants in the U.S. And I just really felt compelled to write a story that I felt can honor my identity which is Afro-Latinx, and the Afro-Latinx immigrant experience. And I think representation has also been an issue for me, with romance specifically. There are stories of people of color in gay romance, but I felt like they were either really surface characters or there was like a real, like, toil story. You know, the person had to go through every kind of horrific thing. So, I wanted to write something that could be nuanced and also show the joyfulness and the beauty of being a person that’s Afro-Latinx and all the amazing things that we come with. So, that was kind of where I was coming from. And I also really, really wanted a book literally full of…just like the gayest, most black and brown book I could write. Jeff: That should almost be a quote on the cover. Will: That’s funny. Adriana: Yeah. I wanted it to be super gay, super black, super brown. Jeff: So, right before we did this interview, Will raved about “Fairytale.” Tell us, in your own words, what that story is about, and kind of how it falls in the series. Adriana: So, it’s the second book in the “Dreamer” series and it’s set in New York City, which is different from “Dreamer” which is set in Ithaca. And it’s about Camilo Briggs who’s one of the best friends of Nesto from the first book. And he’s a Cuban-Jamaican social worker. And he works in the domestic violence field, which is the same field that I work in. And he meets this, like, very hot stranger at a gala and he turns out to be a big donor for the agency that he works for, that Camilo works for. And Tom is an interesting character because he’s a billionaire, which we love in our romances, but he’s also Dominican and white-passing, which is something that I really wanted to explore in a book. What it means to be Latinx but also kind of have the privilege of presenting as a white person, and what that means, and how hard that is to navigate. So, I guess, it’s about… It’s a fairytale, it’s a modern-day fairytale but it’s also, again, like a different side to the Latinx experience. And it’s sweet and fun, and cute and sexy. Will: Yeah, it definitely is. First, before we get to the next question, I want to commend you on the sort of…what I found really enjoyable about not only “American Dreamer” but “American Fairytale” as well is the group of friends, the sense of found family that comes across really strong in this series. I think it’s exceptionally well done. And especially in that first book because, like, right at the beginning, from the get-go, you introduce this, frankly, a really large cast of characters. And I think, with a lesser author, that could frankly get confusing. I know when I read a book, I get confused easily if there are five, six, seven people, you know, names and personalities all thrown at you at once. But each of your characters, each of the friends in that group are so clearly delineated and…especially in that first book, in the opening scene, you give us the briefest glimpses of who they are, and we understand right away where they kind of fit in the group of friends. And of course, they’re all wonderful, and interesting, and funny. They give each other shit like good friends do. I love this group of guys so much. Adriana: Thank you. I have to admit, they’re not my friends, but those four guys are very inspired on my, like, really core group of friends in my early 20s in the DR…when I was still in Dominican Republic. My core group of friends were mostly gay men because my cousin, who’s like my brother, who’s 14 months older than I, is gay. We kind of just like started hanging out with this group of, like, queer kids in the DR. Which in the ’90s was kind of an interesting crowd to be in just because it wasn’t really okay to be openly gay. And we had so much fun. And we did so much, like, crazy stuff together. And I just kind of really wanted to kind of like write a love letter to those friendships and those years. And a lot of them ended up coming to the States at the same time I did, in my early 20s. So, I think they feel so real because they are, like, real. Jeff: These books are getting so much praise. What do you think is resonating with the readers? Adriana: I think people are more open now, or I think there were always those that were open to reading about those different experiences. But I think there’s a particular appetite now for reading more characters that are bringing with them a different lived experience. And I think that might be part of it, like why people are interested in the story. And I think everybody can connect to a striving story, you know. I think Nesto, and Jude, and Camilo, Patrice, Juan Pablo, all of them, they’re just striving to be who they know they deserve to be – for the lives that they’re working for. And I think everyone can relate to that and that struggle of fighting for what you want. Jeff: Did you also intend to make everybody hungry with “American Dreamer?” Adriana: Yes. Yes. Jeff: Was that part of, like, your side plot? Adriana: Yes. Yes, I did. I wanted because…also that’s the other piece, like Caribbean food is very similar but very different in many ways. And I talk about that a lot in “Dreamer.” And it’s the…I wanted to just show people, like, all the different flavors and how we’re all connected. So, I think it’s something that doesn’t really get talked about as much, the wide variety of our flavors. So, I did intentionally want people to be very interested in Caribbean food. I wanted people to Google Dominican restaurants and it sounds like I succeeded. Jeff: I think you did, yeah. I haven’t gotten into “Fairytale” yet. Is there food there also or do we break away from the food a little bit? Will: A little bit. Jeff: A little bit. Adriana: Yeah, a little bit. It’s not as much food. It’s more of…I feel like “Fairytale” is more about, like, Harlem and The Bronx. I have a lot of places in Harlem and The Bronx because again, there are a lot of romances set in New York City. Not many of them are set in Harlem and The Bronx. So, I wanted to go to the places where…like, the diaspora that I belong to, came to. So, I think that’s more… I’m hoping people Google places to go in The Bronx and Harlem with this one. Will: That is a good goal to have, most definitely. Now, with this group of characters, they come from a lot of different backgrounds, what is your process for basically ensuring accurate representation? Is it all from your own personal experience or something else? Adriana: Yeah. So far in this series…and I’m sure that as I write more, then I’m gonna have to go outside of that, but so far in this series, I’ve really gone with origin stories that I know of or from people that are, like, my friends or things like that, like Camilo’s mom, for example, is a Marielita, which was a specific group of Cuban refugees that came at a specific time to the U.S.. And I kind of touched upon that because that’s a very important influx of immigrants that came at a specific time. And they’re all particular experiences that I have been connected to through my friends or family. But I do think writing diaspora is something that people need to be more thoughtful about. So, I try to think a lot about like when did this person come, how did they come, what was the political situation in the U.S. at that time, how they would’ve been received. Like, with Patrice, you know, he’s Haitian and he’s black. His experience and the way he was received would be different than, for example, Camilo’s mom who came as a Cuban refugee and had protected status as she came in to the U.S. So, it’s very…like, there’s nuances there in the context that really needs to be thought about because it really impacts how the person can integrate into American life. Will: And speaking of writing from experience, you have a job in social work and advocacy, did you use your own personal experience when writing about Camilo’s work? Adriana: Yes. So, Camilo’s work and my work…I mean, I really drew from what I do every day to kind of build Camilo’s agency. I mean, kind of like my wish list almost. I wish we could have a guy that just wants to drop $2 million on my agency and tell us, “Do whatever you want with it.” So, I think it was like my fantasy of what it would be like to be in an agency that is just being well-funded, and, like, resources are just there to do the work. So, I think it’s like my own fairytale of what it would be like to work, and just have a millionaire just drop money on us. But, yes, it’s very, very connected to my own work and kind of like my philosophy around the domestic violence field and how the work should go. Jeff: I like how you set the books in our extremely modern times too. And I think in “American Dreamer” as Nesto faces the discrimination of the, who I like to call the evil woman, how he deals with it because I think that it tells a story that not everybody necessarily thinks about all the time. Adriana: Yeah. And I really wanted to contrast, even in the book like Jude’s own reactions to the racism and the obvious discrimination and sabotaging and Nesto’s reactions to it, and the reality that there are different consequences for some people than to others. And that that’s a reality you kind of just have to work with. Jeff: And I loved how he dealt with it too, taking that high road. I just like, “Go, Nesto.” Adriana: Right. I mean, it’s a reality, like, it could have a consequence that was like very, very difficult for him. So, he couldn’t just like get into a thing with this lady. Jeff: Right. “American Dreamer” was your first book. How did you come into writing romance and specifically MM romance? Adriana: So, I’ve been toying with the idea of writing an MM romance for a long time. I’ve been a MM romance reader for, like, a long time. I was at the first GRL (Gay Rom Lit Retreat). I’m like an OG of MM romance. But I was a lot more involved in the community, and then kind of stepped back. I got busy and I just kind of kept reading, but I had it in the back of my mind. I find that what MM romance brought to my life, in terms of dynamics and relationships, and seeing…like I said, having friends all my life that were gay men, and me being so close to so many men who were like looking to fall in love and not being able to see love stories. I remember when I started reading LGBT books, they were very, like, sad, very sad stories like in the ’90s, right? I mean, I grew up in the ’90s. And so just finding your romance was something that was so incredibly wonderful for me. And I thought, “Wouldn’t it be even more wonderful if I could actually find my particular experience and the particular experience of the people who I love in those books?” So, it was kind of like a combination of going to a place…like the type of story that had been really meaningful to me, and then kind of putting my own experience into the space. Jeff: What was it like to write the first book after having read so many? Was it kind of an easy process or was it crazy and hard and took years or…? Adriana: So, it didn’t take me that long, if I’m honest, but I had been thinking about it for a long time. So, before I actually started writing, I kind of did a whole year of reading a lot of craft books, and going to workshops, and trying things. And I actually started a book set in Ethiopia, which is also a gay romance. And I got through a third of that and I was like, “I cannot write this book. I am not equipped to write a gay romance in Ethiopia right now.” And I decided I wanna do this story, this “Dreamer” story. And then that’s when I started it. But it was like a year and a half before I actually felt brave enough to actually write it. Yes. Jeff: I’m so glad that you found that bravery. Who would you say your author influences are? You say you’ve read, you know, MM forever even before it was truly MM, back in the sadder days? Adriana: Yeah. I have a lot of authors that…I mean, I’ve loved a lot of authors from the beginning that I think, I don’t know if I emulate, but I think about a lot in their…kind of how they render a story. Like K.J. Charles, I think, is a wonderful author. I think she just does things that are like phenomenal in writing. E. Lynn Harris was probably the first queer romance that I ever read. I think it’s really sad that he’s not, like, in the canon of what we talk about when we talk about queer romance. So, yeah, but I mean there’s a lot of writers I like. Amy Lane’s early work was super significant for me. I thought her…some of her early books are really some of my all-time favorites. So, yeah, there’s a lot of authors that I kind of go back to and read just to kind of be inspired by the way that they render a story. Does that make sense? Jeff: But what is it about those books that resonated for you so much? Adriana: I think…well, first of all, it was they felt familiar in a way that was like a discovery almost, because I didn’t really ever know any people…a black man who was really exploring the falling in love and the feelings, and the struggle, and the conflicts of trying to make yourself happy, and to find the love that you have…to keep the love that you’ve discovered, right? So, I think his (E. Lynn Harris’) books thought were just so beautifully written, and so tender, and so heartbreaking. It was just wonderful. I think being raised in Dominican Republic where there’s, toxic masculinity on steroids, like, the tenderness of his books really was something that I hadn’t read before. I think it just was kind of like eye-opening to me. Will: Now, so far in your “Dreamer” series, we’ve had Nesto and Jude’s story, and Camilo and Tom’s story. There is, of course…thank God, there’s going to be a third book. Whose story are we gonna get in that one and what can you tell us about that one? Adriana: So, it’s Patrice’s book. Patrice is Nesto’s friend who is a Haitian-American man, who’s a professor. It’s set in Ithaca. He conveniently gets a job at Cornell in the economics department and moves to Ithaca. And he reconnects with Easton Archer who is a character that we meet in “Dreamer” who’s a prosecutor, an assistant district attorney in Ithaca. And Easton is white, so it’s an interracial romance. Yeah. Jeff: When does that one come out? Adriana: That one comes out in October. I just saw a proof for the cover last week…or no, earlier this week, and it is so nice. I love it. I think it’s my favorite one, and I really love the covers for both books so far. I’m calling it my Black Lives Matter romance, although it’s not super intense, but it’s definitely…like the conflict between Patrice and Easton is definitely revolving around kind of having to navigate both of, like, their positions in life. Will: We got a brief glimpse of Patrice and Easton, like you mentioned in that first book. And then in “American Fairytale,” there was a scene with all of the friends together and Patrice sort of like phones in on Skype while they’re, like, dishing about Camilo’s love life, which was very, very funny. So, I’m genuinely looking forward to Patrice’s story. I think it’s gonna be amazing. I can’t wait. Adriana: I know. I’ve been revising it, like I said, and I think it’s a sweet story. And then, there’s a little bit more of two characters that people have been curious about. Ari and Jin, who are employees of Nesto, and they are in their little tiny young person romance. So, they’re like a little cute element for a love story. It’s called “American Love Story.” It’s the title of Patrice’s story. Jeff: Cool. And then you mentioned before we started actually recording the interview that you’re writing the fourth book right now. Any teasers on that? Adriana: So, that one is not an MM. It’s an MF, actually. It’s Juan Pablo’s story. And Juan Pablo is…it’s like a, I’d say, a second chances story. And the heroine is Priscilla who is Nesto’s cousin, who’s a police officer. And it’s called “American Sweethearts.” So, the book starts with a wedding in the Dominican Republic, but I’m not gonna say whose. Jeff: Oh, such a tease. Will: Oh, man. Adriana: Yeah. I’ll tease a little more when I have…I feel like I can’t tease too much on this book because it’s not even halfway done yet. But right now, I’m writing the first few chapters and they’re all in this wedding in the DR. So, everybody is there. Jeff: But I do like how you…we’ve seen with some traditionally MF series where an MM book ends up in the series. And I like how you’re kind of spinning that around too, you’ve got an MM series so far and you’re putting an MF book in it just to, like, broaden that universe out. Adriana: Yeah. So, my kind of little tagline is like, I write romance full of people who look and sound like my people. And there’s a lot of my people who are gay men, like so many of them. But not all of them are. So, I wanted to, in this series at least, have one story where, you know…like both Priscilla and Juan Pablo are queer. Like, she’s pan, he’s bi. But it’s also like a different type of, you know, experience because they’re both engaging in a straight relationship, which brings in…has its own privileges in terms of how it appears. So, I also wanted to explore that a little bit. Jeff: And I think exploring the pansexuality too will be interesting because that doesn’t turn up in a lot of books, at least the ones that cross my radar. And I think it’s nice to see that representation alongside the ethic background representation that you’re bringing as well. Adriana: Yeah, yeah. And it’s something that I think it’s…because of their age, I’m trying to kind of like engage a little bit in even Priscilla arriving to a place where she’s like, “Oh, actually, I’m pan,” as opposed to like, “I thought I was bisexual,” and how she arrived at that. Because I think that’s something that, for people my age, like I’m 40, it’s something that we arrived because we didn’t even have the language for that. Like, 15, 10 years ago, we were like, “Oh, I think I’m gay.” But then it’s like, “Oh, but there’s a whole spectrum of sexuality, gender identity.” And I think there’s so much that we didn’t know – that we know now – that should be coming up in books. Jeff: It’s great that you’re leading the way to kind of get some of that out there, too. Adriana: Yeah. It’s a great time to be writing romance, I think. Jeff: So, besides the “Dreamer” books, is there anything else coming up that you’re looking to write in the coming…I’ll say years since “Dreamer” has you going for the rest of this year probably, if nothing else. Adriana: Yeah, yeah. So, I do have a couple of things that I’m working on. I’m in the process right now of getting out this…I did write the gay romance set in Ethiopia, and I’m in the process of…like, I should have some good news about it soon. And it’s a romance set in Ethiopia, and it’s a Dominican-American relief worker. I did international relief work for a long time. And I lived in Ethiopia for about five years. And so, I really wanted to write a book set in Ethiopia because I have a lot of love for Ethiopia, and my years there were very significant in my life. So, it’s a gay romance. It’s not legal to be in a same-sex relationship in Ethiopia so there are complications. And it’s a Dominican-American relief worker and a colleague who’s Ethiopian, and they fall in love. Jeff: I am so glad you finished that book. You kind of left that off back there when we were talking about it before, because that will be great to see… I have, you know, no experience in any of those spaces. So, to read a romance set there will be an adventure. Adriana: Yeah. It was wonderful to write. Like I said, I have a lot of love for that country. And I think people’s perception of it is like, you know, people starving. And there’s just so much richness and so much beauty and magic in Ethiopia, that I really wanted to just show a different face to it. And I think it’s like a really sweet romance, too. And the setting is interesting. It’s more like a new adult. They’re in their 20s. Jeff: Do you think it will be out this year, maybe? Adriana: I don’t know of this year, but definitely early next year. Like, for sure early next year, yeah. Will: Very cool. Fantastic. Definitely looking forward to that. Now, you’ve given us a lot of amazing information about all of your amazing books, but if our listeners want to learn even more, where can they find out more about you and your books online? Adriana: So, they can go to my website, it’s adrianaherreraromance.com. I’m pretty active on Twitter, and my handle is @ladrianaherrera. And Facebook, I’m also there, Adriana Herrera. So, those are the places…and I’m on Instagram but not as much. Jeff: Very cool. We will link to all of that, plus all the books in our show notes so that folks can easily click on that stuff to find you. Adriana, thank you so, so much for being with us. It’s been awesome talking to you. Adriana: Thank you. It was so much fun and just as amazing as I thought it was gonna be to chat with you guys.
April was our most downloaded month ever. Thank you to our listeners! Jeff and Will discuss their upcoming travel schedule. They will be at the Romance Writers of America national conference, Podcast Movement, Dreamspinner’s Author Conference and GayRomLit. Jeff reviews Top Secret by Sarina Bowen & Elle Kennedy and Red, White & Royal Blue by Casey McQuiston. Jeff interviews Casey about her debut novel. They talk about the inspiration for Red, White & Royal Blue and the impact the 2016 election had on the story. In addition, they discuss the recently announced movie adaptation, what got Casey into writing romance and what she’s working on next. Complete shownotes for episode 187 along with a transcript of the interview are at BigGayFictionPodcast.com. Here’s the text of this week’s book reviews: Top Secret by Sarina Bowen and Elle Kennedy. Reviewed by Jeff. I’ve been a huge fan of Sarina Bowen’s for some years now. Her Understatement of the Year is among my favorite books of all time and I also love Him and Us which were co-written with Elle Kennedy. Sarina and Elle are back with their first m/m romance in three years with Top Secret. They’ve written an extremely satisfying enemies to lovers romance that sizzles but also has some extremely sweet parts as well. Keaton’s a college junior from a privileged family whose been with his girlfriend since high school. For her birthday, she announces that she wants a threesome. After brief thought Keaton agrees. He lives in a frat house where one of his frat brothers is Luke. Luke basically keeps to himself barely gets along with anyone in the house. Luke’s a townie, going to school on an academic scholarship and as a despicable mom and older brother who only want to take advantage of him. He lives in the frat because it’s cheaper than a dorm and he’s running for president because that means free room. Keaton looks to an app to help find the right guy for this birthday present. He signs in as LobsterShorts and soon ends up talking to SinnerThree. Once SinnerThree finds out it’s Keaton’s first three way, he wants to make sure Keaton would be cool with him in the mix and to start considering what the rules would be. SinnerThree even gives sexy homework. This gets Keaton thinking because he’s buried his feelings about guys for a long time. Of course, SinnerThree is Luke, who lives right across the hall. What makes this book work so extraordinarily well is the two sides of Luke and Keaton we see between their public personas and their chats on the app. Luke wants to escape the town and the life he’s known growing up. He strives to excel in school so he can get the high-paying job and never be reliant on anybody again. Meanwhile, Keaton knows he’s got all the privilege but he also chafes at the expectations that his family and friends put on him and he keeps all that to himself because it’s what he’s supposed to do. When they’re chatting as SinnerThree and LobsterShorts the conversation occasionally drifts from figuring out what Keaton’s boundaries actually are to discussing their realities and what they want out of life. Their emotional shields fall away. The way Sarina and Elle transition from sexy to sweet and back again is perfect. Of course, the night finally comes and Keaton and Luke find out they’ve been talking for weeks. The night doesn’t go as planned, but they don’t stop exploring their sexual feelings or sharing closely guarded secrets. Both guys have great growth as Keaton comes into his own, embracing his true sexuality and the career he wants after college. I’m particularly happy this wasn’t a gay-for-you story but rather about a young man figuring out who he is. The battle for Luke is about his sexuality at all–he’s proudly bisexual. He can’t fathom that anyone could love him because of his terrible family. He’s been so battered by them, that he’s hesitant to accept help from anyone because it would surely come with strings. Thankfully, even though Keaton bungles quite a few things with Luke, he also works to make it right. It’s a credit to Sarina and Elle that they have created such fully fleshed out characters who evolve so much through the story. I was invested in so much more than the romance because I wanted these guys to find their way too. The motley crew of frat brothers also brought some great depth to the story as they were a mix of those who were genuinely kind and others were douchey. The parents were also an interesting contrast between Luke’s trailer trash and Keaton’s very well-to-do. Keaton’s father and mother are far more than meets the eye too. I don’t want to get into spoiler territory, but I have to call out them out too. It’s an example of Sarina and Elle creating multi-dimensional characters. Another extraordinary part of the story for me was how the black moment played out. A lot of stuff goes down and there were plenty of opportunities to cheapen the story. The way the last twenty percent of the book played was perfect even while it provided me with quite a few moments of stress. We’re headed into summer and this book is perfect for vacation reading. I highly recommend Top Secret by Sarina Bowen and Elle Kennedy. Red, White & Royal Blue by Casey McQuiston. Reviewed by Jeff I knew this book would be exactly right for me. I have a thing for the royal trope and the idea of an American first son and a British prince getting together made this a must read. What I didn’t expect was how Casey McQuiston elevated the material putting this enemies to lovers romance on the list of my all time favorites. Alex Claremont-Diaz is the first son. Henry is the prince. They have secretly crushed on each other for years. They developed an enemies vibe at the Rio Olympics when they had a less than good encounter, especially from Alex’s point of view. Move forward to today and a near international incident set off by the two at a royal wedding. As part of PR disaster control, a story is created that Henry and Alex are actually the best of friends. After some forced outings to appease the press they start talking to each other more and get past their public personas. One of the things that makes this story works so well is Casey has created an alternate history that many of us would like to see. Claremont took office from Obama so the Trump nightmare never happened. And it’s wonderful that her son is Mexican-American given the current hate filled climate around immigrants. There’s even a couple of lines in the book about how it’s not lost on Alex that there are some people who hate that a Mexican-American took the job of first son. Alex and Henry talk a lot about the lives they want. They’re both expected to meet family obligations and be leaders for their countries–it’s not really what they want though. The texts, emails and phone calls as Alex and Henry reveal more and more of themselves are absolutely priceless. At times funny and others heartbreakingly honest, they talk about how they feel trapped. As the first sparks of romance blossom between them their enemy side is quite fiery as they have rage filled kisses before succumbing to the fact that this is something that they both desperately want. The back-and-forth between sweet romance and the slightly angry romance enhanced the story as they fight against their feelings. The reality stays firmly rooted throughout the story and I loved that. Sometimes the royal trope, as much as I enjoy it, is far more fantasy than reality. It’s part of what makes the trope so good–that chancea prince might be your neighbor. This world could exist–a prince and a member of the first family. Casey gives them all the trappings, including secret rendezvous’s that are partially orchestrated by their security teams. Of course, as must happen the romance is horribly revealed and damages them both. The guys had to really work for the happy in this book, which makes the ending so sweetly satisfying. There were a lot of ways the end could’ve played out, but I can’t imagine one that would’ve been more perfect than what Casey gives us. I haven’t felt as overall thrilled by a book as I have by Red White & Royal Blue in quite some time. It reminded me of reading Becky Albertalli’s Simon vs. the Homo Sapiens Agenda and the wonder of such rich, vivid characters in a charming story that deserves to be real. Casey captured not only an America that I desperately want to live in but a romance that was everything that I ever wanted. I could gush on and on about this book, and will more in the upcoming interview. For now I’ll leave this by saying that I beyond highly recommend Casey McQuiston’s Red White & Royal Blue. This interview transcript is sponsored by Dreamspinner PressDreamspinner Press is proud to publish Hank Edwards and Deanna Wadsworth’s new book Murder Most Lovely. Check it out, and all the new mystery and suspense titles from your favorite authors like Amy Lane, KC Wells, Tara Lain, and Rhys Ford, just to name a few, and find a new favorite author while you’re at it. Go to dreamspinnerpress.com for everything you want in gay romance. Jeff: Casey, welcome to the podcast. Thanks so much for joining us. Casey: Thank you so much for having me. I’m very excited. Jeff: So, before we got to this segment, I spent a ton of time just going over “Red, White & Royal Blue” as being one of the best things I’ve read this year and one of my top books maybe in the “ever” category because it’s everything I needed in a romance with the prince trope and essentially royalty in the U.S. with the first son. And, I mean, Alex and Henry are so awesome. Tell us what your inspiration was behind this book? Casey: Yeah. So I first started…actually, it’s weird. A couple of days ago, I was going through my Timehop which shows you, you know, what you tweeted two, three, four years ago, and I realized that, a few days ago, which is April 13th, was the day that I tweeted, “Hey, I just had this idea for a book.” And it took me back to that moment of the exact lightning strike moment when I knew what I wanted to write. And this is a question we’ll get into later, but it was one of many attempts at a book I had started and none of them had really taken hold of me like this one did. So it was early 2016, I was obsessively following the presidential election, which, you know, we all were at the time with a lot of optimism. And, at the same time, I was reading two books. I was reading “The Royal We,” which is by Heather Morgan and Jessica Cocks, and it’s basically almost a novelization of Will and Kate with a bunch of different things changed about it. So I was reading that. And I was also reading a super dry Carl Bernstein Hillary Clinton biography, which was a fun little juxtaposition. And I had this idea in my head of I want to do… I’ve seen so many sub-versions of prince charming trope, but I feel, as a queer person, I’ve never seen one that seems the most obvious to me, which is, you know, what if, he wasn’t the perfect, going to produce a million heirs, prince, you know. And then on the other side, I was I loved “Chasing Liberty” when I was growing up and “My Date with the President’s Daughter” and I was really into the idea of a rom-com starring this rebellious first kid, and I couldn’t decide which one I wanted to do first, and I was like, “Wait a minute. If I put them both in the same story, I don’t have to pick.” So, honestly, it was me being indecisive that led to that decision. And on a wider scale, a bigger scope, I just really was looking for the perfect, fun escapist tropey rom-com that was so undeniably fun that the fact that it was also queer wouldn’t keep it out of the mainstream, you know, because a big thing that I want to do as an author and as a queer person is push those stories into the mainstream and be like, hey, you know, it’s kind of what they say in “Love, Simon,” everybody deserves to have a great love story, you know. And so everybody deserves to have a big shiny tropey, fun rom-com, you know. So, yeah, that was kind of where it came from for me. Jeff: And there is so much rom-com-y goodness floating in this book. I think you pulled a little bit from everything. Without giving spoilers, because there could be some depending on what you pick for this, what are the rom-com moments that just sticks out for you as one of your favorites among all of them? Casey: Wow, that’s a good question. I have pulled so many tropes from so many of my different favorite rom-coms. But there is this one thing that I love in every rom-com which is the gratuitous karaoke moment, which is actually if you ever watch “Crazy Ex-Girlfriend,” it’s a song on “Crazy Ex-Girlfriend” like “Shake Me Up.” Okay, yeah, that. So it’s like “27 Dresses” does it, and “10 Things I Hate About You” does it where it’s like somebody gets up and sings a song in front of a bunch people for no reason. And it’s like, “No, this doesn’t happen in real life, but it’s super fun.” And so writing the whole karaoke scene, which I don’t think is a spoiler, that was so much fun for me because I was, you know, as musical theater kid in high school, we all were, and so I got to be so indulgent with that, and it was such a blast. I loved it. Jeff: I think you picked a great one right there because you’re right, there is that moment. There’s even that movie, which of course I’m blanking out on right now, that was like…it was a Rebel Wilson movie earlier, I think this year, that she’s, like, there’s always the karaoke moment that she ends up trapped in the karaoke moment in her own little thing. Casey: I love the karaoke moment. Jeff: That says a lot about people, the songs they pick. Casey: It does. It’s character shorthand for sure. Yeah. Like when Bea gets up and sings “Call Me” by Blondie in the book I’m like, “This is what she’s about, you know.” Jeff: Yeah. There have been so many accolades on this book before it even got published. I mean, we were reading about it, I think in “Blush” almost two months ago now. What’s resonating so much with all these pre-readers? Casey: God, you know, I mean, just to start off, I’ve been, completely blown away by the response to it. When I wrote this book I was like, “This is so niche.” It’s a queer political rom-com with royal elements. And also we talk about gerrymandering in it, and I was like, “This is so niche,” no one’s gonna care, no one’s going to publish it. I was like, “I’m going to try and query this for a month, and then I’m just going to self-pub,” you know. And the fact that people have engaged with it so much and that it has gotten, I think three-star reviews now which is just blowing my mind completely, so beyond grateful for those. It’s just been so staggering and incredible. But, I don’t know, I think that right now the world is really depressing. We live in a world right now that is at times literally on fire, you know. And it is so important to have these little oases or moments of respite and little escapist things because when I first started writing this book, I’m so neck deep in the news cycle and I really couldn’t finish it until I pulled out of it because I realized that wasn’t what it needed to be. It didn’t need to be mired in all of the negativity and all of the darkness that was going on in the world. It needed to be this spark of hope, you know, that would kind of feel… I think about when Obama won re-election in 2012, and I was with my friends. I was in college at the time and we went out on the balcony, and popped a bottle of $60 French champagne, and I think about how I felt in that moment and I was like, “I want this book to feel like that moment,” you know. And I think that a lot of people have been missing that feeling. I think that we have so few things, especially when we look at the political sphere right now, to be excited about and to be hopeful about. And I think that we’re all just nostalgic almost for when we had hope. And I think that what this book does is it lives in the space of being here and now and still having hope, you know, and I think that’s really resonating with people. And then I also think that people are just excited to see…we’re seeing it with Helen Hoang and Jasmine Guillory who are writing romances that are integrating, you know, neurodiverse characters and just racially diverse characters. I think a lot of people are tired of seeing, you know, the same two straight white cisgender, neurotypical people falling in love, you know. And so I think that people are hungry for something that’s different in rom-com that can show that different types of people can have that same big, huge, escapist magical love story. So that’s kind of where I think it comes from. Jeff: You noted that you started writing this in 2016, essentially before the election happened. Do you think you would have written the same book had Hillary won? Casey: That’s a great question. And the book I had planned to write before the election went the way that it did was a different book. There were so many threads that I ended up dropping. I, at one point, had…and this was before anything about Russia had come up. I, at one, point had… a Russian double agent involved in the campaign and I was like, “This is too unrealistic. No one’s going to buy this. I’m cutting this,” you know. And now I’m like, “God…” But, yeah. I mean, it definitely…I think it would have been more lampooning the Democratic Party…not that I have anything against the Democratic Party as someone who is registered as Democrat, but it would have been more of “Veep” style, you know, that we’re all on the same side here, so we’re going to send each other up kind of thing. And instead it’s still very tongue in cheek, and it still has that “Veep” side to it, but it needed to have more of…. it needed to be less cynical, basically, you know, because I don’t think that we can really afford a lot of cynicism right now beyond what, you know, roasting the President on Twitter is cynical, I guess. But, yeah, I think that there are certain things that happen in the plot that never probably would have been explored if the results of the election had gone differently because I don’t think I would have felt as much of an urgency to put those into the story. So, yeah, it definitely would have been different. It definitely would have been a lot different. But the President was always the same. President Claremont was the same character from the moment I came up with the idea for the book. She’s like Tami Taylor, from “Friday Night Lights” meets Wendy Davis, the politician from Texas, meets a tiny bit of Selina Meyer from “Veep” and probably every strong female in my life, you know. So, yeah, long story short, yes, it would have been different. Jeff: One of the things I like about it so much, and you touched on this a little bit, is that it’s not two white guys getting together because Alex is Mexican-American. And certainly given how things have played out under the current administration, having that element in the White House as first son, it says a lot. And Alex comments on this, you know, periodically as he’s kind of going through things and how that aspect of his heritage plays into things. Did you have that set early on or did that kind of manifest as we saw how immigrants were being treated post-election and even during the election cycle for that matter? Casey: Sure. Well, the minute…it kind of was, like, the plot itself that informed what Alex would be because, like I said, the first character I came up with was the president and everything kind of formed around her. And I’m from Louisiana, and I have this huge chip on my shoulder about democrats, and liberal people, and progressive people in red states because I was one for so long. I live in a purple-y state now. But, you know, I feel they’re so often written off and discredited, and I can probably count on one hand the number of actual presidential candidates who came and campaigned in my hometown, which is the capital of Louisiana. And people just don’t see anything worth investing in. So I wanted to do a southern Democrat. I didn’t think that a Louisiana Democrat was that realistic, so I did a Texas Democrat. And from the minute I knew she was from Texas, I was like, “Well, it would make sense for her to have married a Mexican man, or a, you know, a first or second generation Mexican man.” And it just kind of went from there where I was, like, “You know, I really do like that idea of that.” I spent so much time in Texas, I know so many people from Texas, I know so many Tejanos and people… it just made sense to me. And then, you know, the more that the rhetoric kind of got really vitriolic about Mexican immigrants around the election, I was like, “Yeah, fuck you. Actually, I am gonna put some Mexican people in the White House.” Yeah, that’s what’s gonna happen. I did as much as I could with it. Obviously, I’m white, and I did a ton of research, I talked to a ton of Mexican friends of mine, and especially Tejano first or second generation people. And then what I’m really excited about with the movie is that we have the opportunity to bring in more people on the creative side who are Latino who can offer more of that voice, that can go farther than I could go with it and that can explore more things with it. So, yeah. It just felt really natural to me, he’s from Texas, of course, he could be half Mexican. That’s just so typical there. So, yeah, it was a very natural progression of the character for me. Jeff: And in a weird twist, I’m actually interviewing you from Dallas. Casey: Yes, I know. I was just thinking about it. That’s so funny. Yeah. I feel like that’s appropriate. I feel the stars aligned to have you interview me from Texas. Jeff: And finish the book while I’m in Texas. It was kind of crazy. Casey: Yeah. That’d be so appropriate. I’m really excited because my second tour stop is in Austin, and I’m so excited. I haven’t been to Austin, like, a year or two, and it’s just feels so right to go back with this book. So I’m so excited. Jeff: There is a ton of history in this book. Henry goes into a lot of history of the monarchy. And one of the things I loved is in the emails that Alex and Henry are trading, they end up and quote a lot of literature or other letters of historical people. How much of that was in your head, and how much was “I need to go off and do a ton of research?” Casey: So, for me, a lot of…when I was talking about… there’s parts where after Alex starts figuring stuff out, he starts, like, develops independent research of, like, let me remediate myself on queer American history, and reconnect with it, which I think is something that a lot of queer people in their 20s do. Especially for me when I was 20, 25, and then I started to figure myself out, I was like, “Wow, I need to know the first thing about my own community.” And so I went back and really read a lot and educated myself. And so a lot of the American history, American queer history was stuff I was already familiar with because that’s something that I felt was my responsibility to learn in the past. But, yeah, I definitely didn’t know a lot about queer British history at all. And so that was a lot of reading for me, a lot of, you know, finding history threads on Twitter, and then okay, I’m gonna go look up all these stories individually, and find out what’s the real truth, because things get twisted online. But, yeah. The letters kind of started with…and this is gonna date when I started writing this, but I was really coming off the “Hamilton” high, you know, which I think we all were in early 2016. It was like, “Oh, man, I’ve been mainlining Alexander Hamilton history for six months, you know.” And, you know, I was really interested… I love all of Hamilton’s love letters with Eliza, but there was also his letters with Florence that were really fascinating to me, and I had started looking into that and that was how I found this book called “My Dear Boy” by Rictor Norton. And I found that because I was researching the Hamilton Lawrence letters, and that was where I found a lot of the letters that are featured in the emails. And then I also was looking into Virginia Woolf, and Eleanor Roosevelt, and all those figures from history who also have a lot of archive letters that are very interesting. And, yeah, honestly, it was almost…I had a blast with it because it was just a queer history, like Easter egg hunt. And, you know, I intentionally did that in the book because I pictured this book…I pictured it being something that a lot of people at different points in their journey with queerness would read, and I would want…let’s say some 19-year old who’s just figuring things out, and they don’t really know anything about queer history, I’m like, “Well, here’s the name of something that you should go look up.” “Here is ‘Paris Is Burning,’ go watch it,” you know, kind of thing. And so it was, it’s really, a bunch of sneaky history lessons. I’m a nerd, and I was like, “You should know this, too.” But, yeah, I had a blast doing that. And then just research, in general, was just so much fun. I spent so much time poring through the royal collection archives online, just for throwaway jokes and stuff. I was a journalist for six years before I quit to do this full time. And so, yeah, I’m a huge nerd and I love historical context for everything because that’s just what I’ve been wired to do for so long. So, yeah, that’s kind of where it all comes from for me. Jeff: And my musical theater geek self loves that “Hamilton” had a play in that because I kind of felt that I was reading some of it’s like, “This seems very ‘Hamilton’ in some ways that they’re using this.” Casey: I battled with myself over whether “Hamilton” was a thing that existed in this universe, and if I should mention it in the book, and I was like, “I’m not gonna,” because it’s still so fresh and I feel it’s gonna date the book a lot. But it’s definitely, like, there’s this undercurrent of we’re doing colonial rap battles under the text, you know. Jeff: That’s one of the things I like about this so much is that it is current revisionist history, you know, because, I mean, most of it, and this doesn’t get to a spoiler, most of it is leading into the 2020 election, with Claremont being President in the here and now and having succeeded from Obama. Yeah, its current revisionist history. It’s very interesting how that plays itself out. Now, I think we mentioned that this is your first book that’s out there in the world. What got you into writing romance and specifically m/m romance? Casey: I mean, I have always consumed all types of media and this is my one sacrilegious answer that I give in interviews which is I’m really more into movies and TV than I am into books, and that is the most media that I consume. It’s not what I write, I’m not a screenwriter, I’m not good at that type of writing, but it is where I pull most of my influences from, and what I consumed the most as a kid, I mean, unless you count “Harry Potter,” which everybody read… Jeff: Which does very much exist in the “Red, White & Royal Blue” universe, which I also love. Casey: Oh, yeah, very much so. But what I engaged with about all of those things was the relationships in them. I’ve watched “Lost” and I was like, “I don’t care about Dharma, or the clues or what this island actually means to the polar bear,” I was like, “I care about that everybody’s gonna end up together that I want to end up together in the end, you know,” and it was always like that with everything I watched. I’ve watched “Buffy,” and it was always about that for me. It was like, “This is cool, mythology is cool, whatever, but, like, Spike,” you know. And it really that was just what grabbed me, and so I knew that was what I was always gonna wanna write. And I tried to write other genres. Every other book I tried to start writing was young adult, magical realism, or young adult fantasy, which is clearly not my genre. And I tried a bunch of different false starts in those genres, and it didn’t pan out for me. And this was, like I said, the first time, I had an idea that completely grabbed me. And I think, like I said earlier, I gravitate to writing queer fiction for the same reason that straight people gravitate to writing straight fiction which is that I’m a queer person, and it’s my experience, it’s what I know. I didn’t really come into this book with an idea of what the gender should be more than what the story would be and it formed around that because I didn’t think that the story would take on all of the same qualities. If it was two women, you know, I thought that it would be a little different tone. I felt if it was two women there’d be a porn parody within 15 minutes of it coming out, you know. And so it’s just, there’s just different ways that lesbian couples and gay men couples are perceived by the world I felt, and for this story it made more sense with two men, and I also wanted to do that prince charming trope sub-version. And so it just kind of told me what it wanted to be. But my next book is…it’s about two women, and it’s a completely different story. And so, yeah, I really…honestly, it’s just me trying to make queer rom-coms a mainstream thing more than anything else. Jeff: More power to you. And, so far, it looks like you’re doing a great job with that. Casey: Thank you. Thank you so much. Jeff: This question may not have a good answer based on what you just told us about your kind of TV and movie thing, but are there authors who influence you? Casey: Well, yeah, I mean there are definitely authors that influence me. I loved Oscar Wilde growing up which is, you know, I was 15, my sisters, I remember being at my sister’s college graduation with highlighter and sticky tabs going through “The Importance of Being Earnest.” So, yeah, I did my term paper in high school on “The Picture of Dorian Gray,” and I was like, “This is straight behavior.” But, yeah, Oscar Wilde was a huge influence on me. The “Harry Potter” books, yes, of course, they influenced me. I read a lot of non-fiction and a lot of memoirs actually because I love the voice of them, and I think that’s what helps me to have a good narrative voice. So I love Carrie Fisher’s writings, I love…Nora Ephron’s memoirs are all incredible, Mary Karr. Let’s see, what else. I’m looking at my bookshelf right now. What else do I read? Jane Austen, obviously, the classics of romance, you know. And then more recently, my favorite author right now is Taylor Jenkins Reid. “The Seven Husbands of Evelyn Hugo” is my favorite book I’ve read in the past couple years and definitely has earned a spot on my all-time faves shelf. And so that’s definitely… And I loved how she does a lot of…she does a lot of what we call in journalism alternate story formats, so epistolary style things that are threaded into the book, which is something that obviously I really love too. And then yeah, that’s…I mean, I read a lot…at least I read a lot of non-fictions like Rebecca Traister and Roxane Gay, those are those are all my faves. But then I pull from a lot of a lot of TV and movies. The biggest influences on this were “Veep,” “Parks and Rec.” There is this web series called “The Gay and Wondrous Life of Caleb Gallo” that I love, and it’s so millennial absurdity that it really kind of like… there’s a shout out to it in the book because they play the song, “Loco In Acapulco” by The Four Tops in that show, and I put that in the book. Yeah. So I’m kind of all over the place. I have a lot of influences and a lot of things that kind of all feed into what comes out of my brain. Jeff: So let’s talk movie. You hinted that a little bit ago. Amazon and Greg Berlanti picked this up before, you know, again before it’s even published out to the world. What was your reaction when you first heard that that was a done deal? Casey: Well, I mean, it was so many stages of reaction because what people don’t see behind the scenes is that the process is crazy. It starts with I have a Hollywood agent, and she sends it out to people and then one producer expresses interest and then more producers can if they want to, and then it turns into you’re on the phone with, you know, such and such from whatever huge production company, and it’s like, “I’m not qualified to do this.” And you talk to those and you pick your producer, and that’s how I picked Berlanti. And I was just really excited to even have a chance to work with them because I’ve loved so much of their work, not even just looking at “Love, Simon,” and going back to “Political Animals” which was a six episode series that’s on Netflix. It’s got…honestly, I have to say one of my touchstones too because it’s got Sigourney Weaver is the president in that which is just amazing, and they’ve got Sebastian Stan as one of the president’s kids, and he’s very tortured, and recovering from addiction, and he’s gay, and he’s Sebastian Stan so he’s crying, you know, and very beautiful. But, yeah. So I just knew that he had the range for it and I also knew that based on “Love, Simon” that production company had the chops to get an unapologetically queer rom-com into the mainstream. But also it was on a personal level, I just remember going to see “Love, Simon” in the theater and that was probably a week after I signed my book deal. And I showed up with an entire eight-inch Jimmy John’s sub in my purse because I knew I was going to cry and I like to eat my feelings. So it was literally me alone. I had to drive 15 minutes out of my city because I was living in Louisiana at the time to find a theater that was playing it, and it just me alone in the theater with my sandwich and was just weeping to Jennifer Garner, you know. And I just remember getting in my car and thinking if my book could make people feel half as seen as I just felt by watching that movie, then I will be so, so happy. And so I’d have the chance to do, to kind of pay forward what that feeling was for me to the next round of people, especially queer people, meant so much to me. And then yeah, Amazon, they just care so much about the project. They’re so passionate about it. They want it to, you know, really…they’re actually really invested in diversifying what is in the market, and taking some risks, and doing projects like this. And it’s just so incredibly mind-blowing, and it really doesn’t feel real yet to have people want to invest those kinds of resources in a story that I wrote. More than anything, I’m just so excited about what it could represent and what it could mean to people. I think about like…and not to at all compare the histories of these communities, but I think about “Black Panther” and “Crazy Rich Asians” and what those movies meant to have as big cinematic events geared around a demographic that wasn’t usually catered to by the mainstream, you know, and what it meant for those people and what it represented for the future of storytelling for different groups. And I like the idea of being able to make any kind of similar impact with movie is incredible. And I really hope that we can do that, and I really hope that it can be the beginning of a lot more queer rom-coms, you know. So, yeah, it’s amazing. I’m so, so humbled, and amazed, and really excited to see what comes next with it. Jeff: As you were writing, I think all authors tend to cast their books to some degree. Do you have in mind, and knowing this is totally separate from anything that Amazon and Berlanti might do… Casey: Sure. Sure. Jeff: …do you have in mind who Alex and Henry are, at least in your head, as you were writing if you had to assign them an actor? Casey: Well, it’s so hard because…and this is kind of an indictment of the state of Hollywood and that is slowly beginning to change, but there really aren’t a lot of young Latino actors out there choose from, you know. And so it was… there really wasn’t a definitive Alex in my head because I have looked and looked and it was so hard to find someone that fit. And that’s what’s exciting to me about the movie is I think that we will get a chance to kind of give a star making role to some young unknown Latino actor, which would be amazing, and I would love to do that. And Henry is just very elusive. There’s five million charming white British men, but in my head, he’s just so specific-looking, and I have not yet found anyone that matched him. But the parts that were, I think, easiest for me to assign an actor to were like… I always pictured Daniel Day-Lewis as Richards with like the silver foxy and then, Ellen Claremont in my head from day one has been Connie Briton. And then, I mean, Rafael Luna in my head is Oscar Isaac for sure, you know. Jeff: Oh, yeah. I like that. Casey: There’s some characters that I came up with the character first and then tried to figure out what they looked like, and there are other characters where… with Rafael Luna I was like, “I want a character who looks like Oscar Isaac. What’s he going to be?” you know, and that was kind of how that came to be. But, yeah, I’m really excited casting is going to be so much fun, and I’m very excited about it. And I’m really, really excited about just getting to see, you know, what we can do for some…I think there’s gonna be a lot of unknowns in the lead roles, and that’s going to be amazing because they’re going to be able to really step into and embody those characters without it being distracting, like, “Oh, that’s like so and so. I look at them and all I see is the character they played in ‘Game of Thrones’ or whatever.” Yeah. so I think that’ll be, you know, a fun thing. But, yeah, that’s kind of it for that. Jeff: Do we get to see more of Alex and Henry in the future do you think? Casey: I think that I would not rule that out, and that’s all I can really say about that. Jeff: Sure. Casey: Yeah. I think that that would be amazing. I would love to do that. Jeff: And you mentioned your next book is going to be a female pairing. Casey: Yeah. Yeah. So it’s completely different from this. It’s a much smaller scope of a world. It’s just a girl who moves to New York, and she’s from the south. I don’t think I will…I don’t know if I will ever write a protagonist that’s not from the south because that’s just so deeply ingrained in me and in my voice. But she’s from south, she moves to New York, and she kind of stumbles into this roommate situation where it’s just sort of ragtag band of misfits kind of thing. And she develops this huge crush on this hot chick who’s on her subway commute every day. And it’s kind of based on the idea of that way that you fall in love with something on public transit for like 20 minutes, and then you step off, and it’s like they never existed anywhere other than the train. They’re just there for 20 minutes, and you never see them again. But the thing is that she sees this girl every single time she’s on the train. And there’s kind of a twist as to… I will say there’s some light rom-com-y style time travel shenanigans that happened, and the girl on the train is not exactly everything that she seems. And so the whole book is about their relationship and at the same time trying to figure out what’s going on with this girl. But it is rom-com, and it’s super fun, and, of course, it has a gratuitous karaoke moment. Jeff: Excellent. Casey: Well, it’s more of like there’s a gratuitous karaoke moment, and there’s a gratuitous drag show moment. Yeah, so, range. But I’m really excited it. I’m hoping…I mean, obviously, we haven’t set a date for it yet, but it is super, super personal, book of my heart for me, and I’m really excited for people to read it. Jeff: Fantastic, definitely looking forward to that. Casey: Yeah. Yeah. It’ll be awesome. I’m excited. Jeff: What’s the best way for folks to keep up with you online so they could track your progress with what’s up with Alex and Henry and also the new book and everything else? Casey: Yeah, Twitter for sure. I’m kind of been taking a step back lately because since we announced the movie my notifications have been busted, you know. But, yeah, I’ll definitely be back on more especially during tour. I tweet out playlists and a lot of little trivial information like their birth charts and things like that on there, and then also Instagram. That one is more for like I’m here for this tour date kind of thing. So yeah, those are my big two ones. It’s casey_mcquiston on Twitter, and then casey.mcquiston on Instagram. Jeff: Very cool. Well, we will put the links to all of that in the show notes. Casey: Thank you so much. I appreciate it. Jeff: “Red, White & Royal Blue” comes out on May 14th, and we wish you just continued success because it’s been so much already and look forward to seeing the movie and everything else that comes from it. Casey: Yeah, thank you so much. I’m so, so grateful, and it’s been so much fun. So thank you so much for having me on.
Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we're moving into uncharted territories for the podcast… we're talking psychiatry Nachi: Specifically, we'll be discussing Depressed and Suicidal Patients in the emergency department. Jeff: As a quick survey of our audience before we begin, how many of you routinely encounter co-morbid psychiatric conditions in your ED patients, especially depression? Nachi: That would certainly be all of our listeners! Jeff: And how many of you struggle to admit or transfer patients for a formal psychiatric eval? Show More v Nachi: Again, just about all of our listeners I'm sure! Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Nachi: That would certainly be helpful. So now that we are all in agreement with just how necessary this episode is, let's dive in. Jeff: This month's issue was authored by Dr. Bernard Chang, Katherine Tezanos, Ilana Gratch and Dr. Christine Cha, who are all at Columbia University. Nachi: In addition, it was peer reviewed by Dr. Nicholas Schwartz of Mount Sinai School of Medicine in New York and Dr. Scott Zeller of the university of California-Riverside. Jeff: Quite the team, from a variety of backgrounds. Nachi: And just to put this topic into perspective - annually, there are more than 12 million ED visits for substance abuse and mental health crises. This represents nearly 12.5% of all ED visits. Of note, among these visits, nearly 650,000 individuals are evaluated for suicide attempt. Jeff: Looking more in depth, of the mental health complaints we see daily, mood disorders are the most common, representing 43%, followed by anxiety disorders, 26%, and then alcohol related conditions at 23% Nachi: And as is often the case, these numbers are likely underestimates, as many psychiatric complaints, especially depression, often go unnoticed by the patients and providers alike. In one study of patients who presented with unexplained chest and somatic complaints, 23% met the criteria for a major depressive episode. Jeff: Sad, but terrifying, though I suppose it all makes this issue so much more valuable. Nachi: Before we get to the evidence and an evidence-based approach, let's start with some definitions. Jeff: Certainly a good place to start, but let me preface this with an important point - arriving at a specific psychiatric diagnosis in the ED is likely neither feasible nor realistic due to the obvious limitations, most namely, time - instead, you should focus on assessing and collecting information on the presenting symptoms and taking a comprehensive psychiatric and medical history. Nachi: According to DSM-5, to diagnose a major depressive disorder you must have 5 or more of the following: depressed mood, decreased interest or pleasure in most activities, body weight change, insomnia or hypersomnia, restlessness or slowing, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate or indecisiveness, or finally recurrent thoughts of death and or suicide. In addition, at least 1 of the symptoms must be either a depressed mood or loss of interest. Jeff: These symptoms must last most of the day, nearly every day, for 2 weeks. Nachi: And these symptoms must cause clinically significant distress or impairment across multiple areas of functioning. Jeff: So those were criterion A and B. Criterion C, D, and E state that a MDD does not include factors from substance use or medical conditions, psychotic disorders, or manic episodes. Nachi: Once you've had the symptoms for 2 years with little interruption, you likely qualify for a persistent depressive disorder rather than a MDD. Jeff: And if your symptoms repeatedly co-occur around menses, this is more likely premenstrual dysphoric disorder....
Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. Jeff: As a quick survey of our audience before we begin, how many of you routinely encounter co-morbid psychiatric conditions in your ED patients, especially depression? Nachi: That would certainly be all of our listeners! Jeff: And how many of you struggle to admit or transfer patients for a formal psychiatric eval? Show More v Nachi: Again, just about all of our listeners I’m sure! Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Nachi: That would certainly be helpful. So now that we are all in agreement with just how necessary this episode is, let’s dive in. Jeff: This month’s issue was authored by Dr. Bernard Chang, Katherine Tezanos, Ilana Gratch and Dr. Christine Cha, who are all at Columbia University. Nachi: In addition, it was peer reviewed by Dr. Nicholas Schwartz of Mount Sinai School of Medicine in New York and Dr. Scott Zeller of the university of California-Riverside. Jeff: Quite the team, from a variety of backgrounds. Nachi: And just to put this topic into perspective - annually, there are more than 12 million ED visits for substance abuse and mental health crises. This represents nearly 12.5% of all ED visits. Of note, among these visits, nearly 650,000 individuals are evaluated for suicide attempt. Jeff: Looking more in depth, of the mental health complaints we see daily, mood disorders are the most common, representing 43%, followed by anxiety disorders, 26%, and then alcohol related conditions at 23% Nachi: And as is often the case, these numbers are likely underestimates, as many psychiatric complaints, especially depression, often go unnoticed by the patients and providers alike. In one study of patients who presented with unexplained chest and somatic complaints, 23% met the criteria for a major depressive episode. Jeff: Sad, but terrifying, though I suppose it all makes this issue so much more valuable. Nachi: Before we get to the evidence and an evidence-based approach, let’s start with some definitions. Jeff: Certainly a good place to start, but let me preface this with an important point - arriving at a specific psychiatric diagnosis in the ED is likely neither feasible nor realistic due to the obvious limitations, most namely, time - instead, you should focus on assessing and collecting information on the presenting symptoms and taking a comprehensive psychiatric and medical history. Nachi: According to DSM-5, to diagnose a major depressive disorder you must have 5 or more of the following: depressed mood, decreased interest or pleasure in most activities, body weight change, insomnia or hypersomnia, restlessness or slowing, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate or indecisiveness, or finally recurrent thoughts of death and or suicide. In addition, at least 1 of the symptoms must be either a depressed mood or loss of interest. Jeff: These symptoms must last most of the day, nearly every day, for 2 weeks. Nachi: And these symptoms must cause clinically significant distress or impairment across multiple areas of functioning. Jeff: So those were criterion A and B. Criterion C, D, and E state that a MDD does not include factors from substance use or medical conditions, psychotic disorders, or manic episodes. Nachi: Once you’ve had the symptoms for 2 years with little interruption, you likely qualify for a persistent depressive disorder rather than a MDD. Jeff: And if your symptoms repeatedly co-occur around menses, this is more likely premenstrual dysphoric disorder. Nachi: Moving on to suicide and suicide related concepts. Suicidal ideation is the consideration or desire to kill oneself. Jeff: These can be active or passive thoughts, for example, “I don’t want to be alive” vs “I want to kill myself.” Nachi: Other important terms include, the suicide plan, suicide attempt, suicide gesture and nonsuicidal self-injury. The plan typically includes the how, where, and when a person will carry out their attempt. Jeff: A suicide gesture is an action or statement that makes others believe that a person wants to kill him or herself, regardless of the actual plan. Nachi: I think that’s good for definitions, let’s discuss some more epidemiology. Based on 2005 data, the prevalence of 1 month MDD was 5% with a lifetime prevalence of major depression of 13%. Jeff: If those figures seem a bit high, another CDC study found that in a general population survey of a quarter million people between 2006-2008, 9% met the criteria for major depression. Pretty big numbers... Nachi: Sadly, though outpatient visits for depression and suicide related complaints have decreased over the years, while ED visits remain stable, implying that the ED is a critical entry point for depressed and suicidal patients. Jeff: It’s important to also recognize at risk populations. In several studies, the prevalence of MDD is reported as being nearly twice as high in women as it is in men. Nachi: MDD is also much more common in younger adults, with a prevalence of about 20% in those under 65 and a prevalence of just 10% in those 65 and older. Jeff: Additionally, being never-married / widowed / or divorced, being black or hispanic, having poor social support, major life events, and have a history of substance abuse are all serious risk factors for depression. Nachi: In terms of suicidality, nearly half of depressed adults in one study felt that they wanted to die, with ⅓ having thought about suicide. Taking it one step further, somewhere between 14-31% of depressed adults have attempted suicide, and roughly 1 in 10 depressed adults ultimately die by suicide. Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 billion per year in the US. Nachi: That’s an incredible amount and much more than I would have guessed. Jeff: In terms specific risk factors for suicide and suicide related complaints - white men over 80 have the highest rate of suicide death in the US, with 51.6 deaths per year per 100,000 individuals. Nachi: You snuck in an important word there - suicide DEATH. While old people die the most from suicide, younger adults attempt suicide more often. Jeff: Along similar lines, while women attempt suicide nearly 4 times more frequently than men, men are 3 times more likely to die by suicide, likely related to their respective choice of suicide methods. Nachi: Lesbian, gay, and bisexual men or women are another at risk population, with rates of suicidal ideations being nearly twice that of their heterosexual counterparts Jeff: Despite the litany of risk factors we just ran through, the strongest single predictor for suicide related outcomes is a prior history of suicidal ideation or attempt, with individuals who have made a previous attempt being nearly 6 times more likely to make another. Nachi: And lastly, those who have had symptoms severe enough to warrant psychiatric admission have an increased lifetime risk of suicide also at 8.6% vs 0.5% for the general population, in one study. Jeff: Alright, so that wraps up the background, let’s move on to the actual evaluation. Nachi: When forming your differential, a crucial aspect is identifying potential secondary causes of depressive symptoms, as many depressive symptoms are driven by etiologies that require different management strategies and treatment. Be on the lookout for toxic-metabolic, infectious, neurologic disturbances, medication side effects, and recent medical events as the etiology for depressive episodes and suicidality. Jeff: Excellent point, which we’ll reiterate a few times throughout the episode - always be on the lookout for medical causes of new psychiatric symptoms. Next, we have my favorite, prehospital care - when doing your scene assessment, look out for possible signs of overdose such as empty pill bottles lying around. It’s also important to assess for the presence of firearms. Of course, this should not be done at the expense of acute medical stabilization. Nachi: And don’t forget to consider transport directly to institutions with full psychiatric services, especially for those with active suicidal ideations. Jeff: Once in the ED - start by maximizing the patient's privacy. Always use a nonjudgmental approach and use open-ended questions. Nachi: If feasible, map the chronology of depressive symptoms and their impact on the patient’s functional status. It’s also important to elicit any psychiatric history, including prior hospitalizations. Jeff: Screening for suicidality is critical in all patients with depressive symptoms given the elevated risk in this population. Though not broadly adopted in many EDs, there are a number of screening tools to assist you in this process, including the PHQ-9, ED SAFE PSS-3, and C-SSRS, which all asses for severity of suicide risk. These have been developed primarily for the outpatient and primary care settings. Nachi: And not surprisingly, MDCalc has online tools to help you use these risk assessments, so you can easily pull up a scoring tool on your phone should the appropriate clinical scenario arise. Jeff: The PHQ-9 was validated in various outpatient settings, including the ED. This is a self-administered depression questionnaire that has been found to be reliable across genders and different cultures. Interestingly, the PHQ-9 questionnaire contains one question about suicidality - how often is the patient bothered by thoughts that you would be better off dead or hurting yourself. Responding “nearly every day” increases your odds from 1 in 250 to 1 in 25 of attempting suicide. Nachi: The next tool to discuss is the ED-Safe PSS-3. The PSS-3 assesses for depression/hopelessness and suicidal ideations in the past 2 weeks as well as lifetime history of suicide attempt. Jeff: In one study, using this tool doubled the number of suicide-risk cases detected. Nachi: Once someone has screened positive for recent suicidal ideations, further screening must be done via a secondary screener. Jeff: In one study, following this approach decreased the total number of suicide attempts by 30% following an ED visit. Nachi: And what would you advise to clinicians that are concerned that questioning a patient about suicidal ideation may actually encourage or introduce the idea of suicide in those who hadn’t already considered it? Jeff: Great question - It has been found that there has been no associated introduction of negative effect when a patient is asked about suicidal ideations. Concerns about iatrogenic effects should not prevent such evaluations. Nachi: Definitely reassuring that this has been looked into. Let’s move on to the physical. Jeff: The physical exam should include a cognitive assessment that focuses on identifying medical conditions, as well as a behavioral mental health status exam that focuses on identifying the presence and degree of depression. Nachi: And as you said, we would mention it a few times -- In the ED, you always want to make sure you aren’t missing an underlying medical condition that manifests as depression. Jeff: So important. Alright, let’s move on to diagnostic studies. And thanks to a systematic review of 60 studies on this topic, there is actually reasonably good data here. Nachi: According to this review, in patients with a known psychiatric disease presenting with exacerbating psychiatric complaints, routine serum and urine tox screening is not recommended. Additional screening tests should be considered in those with new psychiatric symptoms who are 65 years or older, those who are immunosuppressed, and those with concomitant medical disease. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. They too call for a focused history and physical to guide testing. Nachi: It’s also worth highlighting one other incredibly important point from that ACEP policy - urine tox screens for drugs of abuse should not delay patient evaluation for transfer to a psychiatric facility. Jeff: Definitely a great policy to check out if you find yourself in all too frequent disagreements with your local psychiatric receiving facility. Nachi: You should also consider serum testing in those taking psychotropic medications with known toxic effects, such as lithium, as toxicity would change management. Jeff: Ok, last point about the work up, imaging studies of the brain should not be routinely ordered unless you have a high degree of suspicion. Nachi: That wraps up testing. Let’s move on to treatment. Jeff: First and foremost, you must maintain a safe environment. Effective precautions include alerts to staff about the potential safety risk in addition to searches of the patient and his / her belongings if applicable. Nachi: With the staff notified and the patient searched, the patient should be placed in a room without potentially dangerous items, like tubing or needles. Those who are at a very high risk may warrant continuous observation. Jeff: Speaking of safety, you will definitely want to engage in safety planning with the patient. Safety planning can be completed by any emergency clinician and should take about 20-45 minutes. Nachi: And while this is typically done by a psychologist or psychiatrist, this is something any emergency clinician can also easily do. Jeff: Safety planning beings with a brief interview. Next you establish a list of personalized and prioritized steps to help the patient through his or her next crisis. In a full plan, you should identify: warning signs, internal coping strategies, people and social settings that provide distraction, people whom the patient can ask for help, professionals or agencies whom the patient can contact during a crisis, and lastly how to make the environment safe (for example, lethal means counseling). Nachi: Of course, while the plan is meant to be a step by step approach for the patient, you should encourage the patient to seek professional help at any time if it is necessary. Jeff: Great point. And while safety planning typically is most effective when combined with other interventions, research suggests that it does enhance outpatient treatment engagement after an ED visit and in one study, reduce subsequent suicide attempts by 30% vs usual care. That’s a huge win for something that’s not that hard to do. Nachi: Similar to safety planning, let’s discuss no-suicide contracts. No-suicide contracts or no-harm contracts are verbal or written agreements between the patient and the clinician to articulate that he or she will not attempt to hurt him or herself. Though there isn’t a ton of evidence, at least one RCT showed that safety planning was superior to contracts. Jeff: Lethal-means counseling on the other hand is a potentially helpful prevention strategy. In lethal means counseling, you merely have to address the patient’s access to lethal means. By slowing their access to their lethal means, it is thought that the relatively short-lived suicidal crises may pass before they could access said means. Nachi: For example, you could provide options for restricting access to lethal means, such as disposal, locking up and giving the key to someone else, or temporarily giving the means to a friend. Jeff: And this may be a good time to involve friends and or family, especially when dealing with suicidal youths. Nachi: This is such an important and simple intervention that has actually been shown to reduce suicide attempts and deaths. Unfortunately, few ED clinicians address lethal means. Jeff: Pro tip: since most ED clinicians chart with templates, add something to your standard suicidality / psychiatric template about lethal means. This will serve as an important reminder to address it in real time. Nachi: That is a really great idea to ensure you don’t skip over this underutilized counseling. Jeff: The next aspect of treatment to discuss is follow up. Follow up is critical for both depressed and suicidal patients. Follow up can come in many forms and at a minimum should include the national suicide prevention lifeline. Nachi: The authors even simplify this for us a bit, providing 5 easy steps to help make sure patients follow through with ED discharge recommendations. Jeff: First, provide a standard handout that includes a list of outpatient providers. Next provide the patient the 24 hours crisis line number. After that, ask the patient to identify the most viable resources and address any barriers the patient may have in getting there. Next, schedule a follow up appointment, ideally within a week of discharge, and lastly, document the patient’s preferred follow up resources and steps taken to get them there. Nachi: And if this seems too burdensome for a single provider, think about identifying a staff member who may help the patient with follow up - perhaps a social worker or case manager. Follow up is so important, it’s critical that the ball not be dropped after you’ve put in so much hard work to make the plan. Jeff: As always, the team approach is preferred. Alright so the last treatment to discuss is actual pharmacotherapy. Since commonly prescribed antidepressants take up to 6-8 weeks to have a clinical effect, the administration of psychotropic medications is not routinely initiated in the ED. Interestingly, there may be a role for ketamine, yes, ketamine, in conjunction with oral meds. More on that in a few minutes though... Nachi: Let’s talk first about special populations - the only one we will discuss this month is military veterans. Jeff: Recent evidence has demonstrated an association between exposure to blast and concussive injuries and subsequent depressive and anxiety symptoms. Nachi: In part, because of this, among veterans presenting for emergency psychiatric services, approximately 52% reported suicidal ideations in the prior week and 70% reported current depressive symptoms. Clearly this is a major problem in this population. Jeff: But to bring it back to ED care, in one study, among depressed veterans with death by suicide, 10% had visited a VA ED in the 30 days prior to their death. Nachi: And this is in no way meant to be a knock-on VA ED docs - they are dealing with a very at risk population. But it is worth highlighting the importance of the ED visit as an excellent opportunity to begin to engage the patient in long term care. Jeff: Exactly, every ED visit is an opportunity that shouldn’t be missed. Nachi: Let’s talk controversies and cutting-edge topics from this issue. Jeff: First, let’s start by returning to ketamine and the treatment-resistant depression and suicidality. Nachi: Recent trials, including RCTs have found that low doses of ketamine administered via a variety of routes, may have a significant therapeutic effect towards reducing suicidality in patients in the acute setting. Jeff: To this end, Esketamine, an intranasal version of ketamine has already been FDA approved for treatment resistant depression. Nachi: This has huge implications for some of the psychiatrically sickest patients, so be on the lookout for more in the future. Jeff: Next we have the zero-suicide model. This is a program of the national action alliance for suicide prevention that involves a multi pronged approach to reducing suicide based on the premise that suicide is preventable. This model involves educating clinicians on best practices, identifying screening and assessment tools for engagement, treatment, and disposition. Nachi: Though not yet implemented in the ED setting, this may offer a novel approach to ED patients with psychiatric emergencies in the ED. Jeff: The next controversy is a big one - alcohol intoxication and suicide risk. There is a bidirectional relationship between depression and alcohol abuse and dependency. Not only is alcohol abuse a lifetime risk factor for completed suicide, those who make suicide attempts or present with suicidal ideations are more likely to be intoxicated. Nachi: In addition, formerly intoxicated patients may deny their previous thoughts and intentions when sober. Interestingly, though such patients have an increased lifetime risk of death by suicide. Jeff: Given this paradox and the evidence that exists, the authors recommend observing the patient until they have reached a reasonable level of sobriety. This effective level of sobriety should be based on clinical assessment and not blood alcohol levels. If the patient unfortunately has reached a place where they are at risk of withdrawal, this should be treated while in the ED. Nachi: It’s worth noting that ACEP guidelines and guidelines from the american association for emergency psychiatry have both supported a personalized approach that emphasize evaluating the patient’s cognitive abilities rather than a specific blood alcohol level to determine when to pursue a formal psychiatric assessment. Jeff: Very important point - in this high-risk population, you are targeting a clinical endpoint, not a laboratory end point and this is backed by several national guidelines. Nachi: Moving on to the next topic - let’s discuss post discharge patient contact. Jeff: Though not something many ED clinicians routinely do, this may be something to consider implementing in your department. And this doesn’t even have to be something as time consuming as a phone call. In one study, sending a brief postcard 9 times a year with a quick “hope things are well” type message to patients discharged after deliberate self-harm reduced self-poisonings by 50%. Nachi: Though other studies including other methods of follow up have not shown as drastic results, generally the results have shown a positive impact. Jeff: Next we have to discuss the various screening tools. Though we previously mentioned screening tools in a positive light, using such decision-making tools is still of limited utility due to the fact that they rely on self-reporting and suicidal thoughts and behaviors are complex and may require the consideration of hundreds of risk factors. Nachi: And while implicit association tests are being developed to predict suicidal thoughts and behaviors, and computer models and machine learning are being used to enhance our screening tools, there is still a long way to go before such tools perform more independently with acceptable performance. Jeff: The last cutting-edge topic to discuss is telepsychiatry. Nachi: Just as telestroke has changed stroke care forever, as technology advances, telepsychiatry may provide a solution to easily expand access to outpatient services and consultation in a cost effective manner - offering quick psychiatric care to those that never had access. Jeff: Let’s move on to the final section of the article. Disposition, which can be a bit complicated. Nachi: The decision for discharge, observation, or admission depends on clinical judgment and local protocols. Appropriate disposition is often fraught with legal, ethical, and psychological considerations. Jeff: It’s also worth noting that patients with suicidal ideations tend to have overall longer lengths of stay when compared to other patients on involuntary mental health hold. Nachi: There are however some suicide risk assessment tools that can help in the disposition decision planning such as C-SSRS, SAFE-T, and ICARE2. C-SSRS is a series of questions that assess the quality of suicidal ideation. SAFE-T is 5 step evaluation and triage tool that assesses various qualities and makes treatment recommendations. ICARE2 is provided by the American College of Emergency Physicians as a result of an iterative literature review and expert consensus panel. It also integrates many risk factors and treatment approaches. Jeff: It goes without saying that none of these tools are perfect. They should be used to assist in your clinical decision making. Nachi: For depressed but not actively suicidal patients, ensure close follow up with a mental health clinician. These patients typically do not require inpatient hospitalization. Jeff: Let’s also touch upon involuntary confinement here. Patients who are at imminent risk of self harm who refuse to stay for evaluation may need to be held involuntarily until a complete psychiatric and safety evaluation is performed. Nachi: Before holding a patient involuntarily, it is important to fully familiarize yourself with the state and county laws as there is wide variation. The period of involuntary confinement should be as short as possible. Jeff: With that, let’s close out this month’s episode with some high yield points and clinical pearls. Risk factors for major depression include female gender, young or old age, being divorced or widowed, black or Hispanic ethnicity, poor social support, and substance abuse. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt. When evaluating a patient with depressive symptoms, try to identify potential secondary causes, as this may influence your management strategy. When assessing for depression, perform a complete history and consider underlying medical causes that may be contributing to their presentation. Consider serum testing for the patient’s psychiatric medications if the medications have known toxic effects. 1. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department. Imaging of the brain should not be ordered routinely in depressed or suicidal patients. Depression places patients at a significantly increased risk for alcohol abuse and dependence. In addition to providing appropriate follow up resources to your depressed patients, emergency clinicians should consider making a brief follow up telephone call to the patient. Telepsychiatry may improve access to mental health providers and allow remote assessment and care from the ED. Suicide risk assessment tools such as C-SSRS, SAFE-T, and ICARE2 can help when deciding on disposition from the ER. It may be necessary to hold a patient against their will if they are at immediate risk of self-harm. Though not routinely administered in the ED for this purpose, psychotropic medications, such as ketamine, have proven helpful in acute depressive episodes. Patients who are actively suicidal should be admitted to a psychiatric observation unit or inpatient psychiatric unit. Nachi: So that wraps up Episode 28! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And don’t forget to check out the lineup for the upcoming Clinical Decision Making in Emergency Medicine conference hosted by EB Medicine, which will take place June 27th-30th. Great speakers, great location, what more could you ask. Jeff: And the address for this month’s cme credit is ebmedicine.net/E0519, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 1. Owens PL, Mutter R, Stocks C. Mental health and substance abuse-related emergency department visits among adults, 2007: statistical brief #92. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006. (US government report) 12. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 5th ed. Washington DC: American Psychiatric Association; 2013. (Reference book) 15. Grant BF, Stinson FS, Dawson DA, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807-816. (Survey data; 49,093 patients) 16. Centers for Disease Control and Prevention. Current depression among adults---United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010;59(38):1229-1235. (Government survey data analysis; 235,067 subjects) 97. Murrough J, Soleimani L, DeWilde K, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med. 2015;45(16):3571-3580. (Randomized controlled trial; 24 participants) 100. Griffiths JJ, Zarate CA, Rasimas J. Existing and novel biological therapeutics in suicide prevention. Am J Prev Med. 2014;47(3):S195-S203. (Review article)
The guys talk about having more books than shelf space and also their upcoming 24th anniversary. Will reviews An Easter Promise by A E Ryecart. Jeff reviews Play It Again by Aidan Wayne. Jeff interviews Hank Edwards and Deanna Wadsworth about their collaboration, Murder Most Lovely, the first in the Lacetown Murder Mysteries series. They talk about how they came up with the book, their process for co-writing and what’s still to come in the series. We also find out what’s coming up for each of them in 2019. Complete shownotes for episode 186 along with a transcript of the interview are at BigGayFictionPodcast.com. Here’s the text of this week’s book reviews: An Easter Promise by AE Ryecart. Reviewed by Will. This is the continuing story of Rory and Jack, who we first met in the holiday story, A Kiss Before Christmas. In that story, Jack finds the homeless Rory huddled on his doorstep and offers him a place to stay. As they learn more about one another, Jack asks Rory to pose as his fake boyfriend when he goes home for the holidays. An unexpectedly severe winter storm prevents them from that trip, but in the few days they’ve been together they’ve fallen in love. I read A Kiss Before Christmas last year, and I still highly recommend it. In An Easter Promise, it’s now Spring and our two heroes are finally making the trip to visit Jack’s family in his ancestral manor house in the countryside. This is a particularly nerve-wracking experience for Rory, whose childhood couldn’t have been more different than Jack’s well-heeled upbringing. Things go relatively well as Jack shows Rory around the expansive estate, but they then get frosty when Jack’s mom makes it clear that she believes that Rory is after her son’s money. Gold-digging accusations aside, as a favor to her, Rory steps in as a last-minute contestant in the Best Bake competition at the village festival. Though his brownies were obviously the best, he doesn’t win. Afterward, Jack announces that he and his culinarily gifted boyfriend are going into business together and are opening a bakery. This once again raises the suspicion that Rory is only after Jack for his money, causing a major rift in family relations. Jack tells his mom where she can stick her suspicions, and is ready to return to London, but when Rory takes the family dog for a walk, he gets lost on the moors in a sudden storm. If reading fiction set in the U.K. has taught me anything, it’s that going for a walk on the moors is always a bad idea. The family organizes a search party and journeys into the dark night to find Rory. He is eventually found, and Jack makes amends with his parents. Flash forward a few months to the opening of the bakery and the beginning of a new chapter for our romantic heroes. I really like both of the stories featuring Rory and Jack and sincerely hope that this isn’t the last that we’ll see of them. The opening of the bakery certainly presents several new story possibilities. A.E. Ryecart, if you’re reading this, I’m a fan and a series set in this world would be greatly appreciated. Play It Again by Aidan Wayne. Reviewed by Jeff. I was completely delighted by new-to-me author Aidan Wayne’s Play It Again. Part of what drew me in initially is that part of it relates to what we do here on the podcast. Dovid is a YouTuber alongside his sister Rachel. They run a channel called Don’t Look Now. Among the things they do is review eateries in Seattle for how accessible they are because Dovid is blind. They also interact with their fans, go on trips, open mystery boxes–it’s the full YouTube gambit. Over in Ireland, Sam runs a Let’s Play channel where he plays a popular videogame. Rachel and Dovid become obsessed with Sam’s channel because of his easy-going, fun delivery. Dovid calls out Sam’s channel in an episode and sends Sam’s subscriber count through the roof and when Sam contacts Dovid to thank him they end up talking frequently. Dovid and Sam are single–but as I mentioned live on opposite sides of the globe. Neither of them, quite cutely, realizes how flirty they’re being as they message each other. Initially Dovid offers Sam advice on how to manage his new subscribers and ways to grow his channel but as they move beyond that and get to know each other the realization comes that perhaps there’s more there. This isn’t the first book I’ve read that relies heavily on text messages, instant messenger, email and so on. I loved how these wove into the story. There’s a good deal of, what I’ll call, regular storytelling too, coming from both points of view. Dovid and Sam have quite a lot internal dialogue about their growing predicament. Just getting time to talk on the phone is a challenge with the nine hour difference between them. It doesn’t stop them though from being ridiculously cute and challenging themselves to let this relationship go through its formative stages without being in the same physical location. Of course, the guys have to get together and that happens when Dovid and Rachel had the chance to do a European tour, which includes Ireland. As much as Dovid and Sam questioned themselves as they did the long distance thing, the jitters ratchet up as they meet. Aidan does a great job of showing the hesitancy–from Dovid wanting everything to be perfect to Sam wondering if he’s worthy of Dovid. Sam comes from a family where he was put down a lot and Dovid goes into protector mode when Sam talks about this, which is incredibly touching and sexy. For all the exploration they did via email, the time they spend together in Ireland really made me appreciate the romance that Aidan spun even more. They’d bonded so much before, they almost fall into old married couple mode with how they try to take care of each other. Dovid is particularly mindful of Sam’s asexuality and makes sure Sam isn’t doing anything he doesn’t want to do. It’s wonderful to see two such diverse characters finding their happy. Speaking if the HEA, I’d wondered how it would manifest in a book where the two characters spend probably eighty percent of the book on separate continents. I adored how Aidan brought Sam and Dovid together. I would love to see more in this universe to know how Dovid and Sam are getting on. Besides the wonderful romance, I loved the attention to detail that Aidan put into showing the work Dovid and Rachel do on their channel. From the talk of creating Patreon campaigns to managing social media and how to interact with the audience, I enjoyed it and I don’t think it’s too much for people who don’t do this kind of thing. Another excellent detail, Dovid and Rachel receive a package from a fan in Michigan–it contained Faygo Red Pop and Mackinac Island fudge, two childhood favorites that made me smile and gave me cravings! So, in case you haven’t figured it out, I totally recommend Play it Again by Aidan Wayne. I’m also looking forward to their upcoming book, Hitting the Mark, which comes out at the end of May. This interview transcript is sponsored by Dreamspinner PressDreamspinner Press is proud to publish this week’s guests Hank Edwards and Deanna Wadsworth and their new book Murder Most Lovely. Check it out, and all the new mystery and suspense titles from your favorite authors like Amy Lane, KC Wells, Tara Lain, and Rhys Ford, just to name a few, and find a new favorite author while you’re at it. Go to dreamspinnerpress.com for everything you want in gay romance. Jeff: Welcome to the podcast, Hank Edwards and Deanna Wadsworth. Deanna: Hello. Jeff: Thanks for being here. Hank: Thanks for hosting us. Jeff: You guys have written a book together… Deanna: We did. Jeff: …which is super cool. April 30, which is the day after this comes out, you’re releasing the first book in the “Lacetown Murder Mysteries” called “Murder Most Lovely.” Tell us about this new series. What is the scoop? Deanna: Who wants to go first? Hank: Deanna? You go first. Deanna: Okay, I’ll go first. So like a year ago I went out to dinner with my husband, had some cocktails and at like 11:00 at night after having like wonderful conversations in my brain with myself because I think I’m clever, I messaged Hank, and I said, “Dude, we need to write a book together.” And he’s like, “We should.” And then we did. Hank: I might have had some cocktails that night too. I can’t remember. Deanna: You may have. Hank: Might have. Deanna: And it was, “Yeah, we should,” kind of moment. And we didn’t really know where it was going. Hank: We had no idea. Deanna: What’s that? Hank: We had no idea, like nothing. That was just the random start of things. “We should do a book.” We didn’t have an idea or anything. Deanna: It was a completely inane, “Dude, we should write a book together,” kind of moment. And then seriously, the next day, we had some conversations like, “What should it be? Superhero?” And then we just kind of like spitted ideas back and forth. And Hank was like, “We would write the fuck out of a rom-com.” Am I allowed to say fuck? Jeff: Yes, you are. We’ll put a little explicit logo on the episode and you can cuss as much as you want. Deanna: So he was like, “We would write the fuck out of a rom-com.” And I’m like, “We would.” And then we’re like, “What should it be?” And we just spitballed ideas back and forth. Like, I mean, literally, like there was probably like 30 or 40, like, things we shot back and forth at each other. And then Hank picked on two of them. And he’s like, “I love the idea of a mortician and a hairdresser.” Then we ran with it. Hank: Yeah, and we just ran with it. And it just started writing. I mean, we didn’t plan, like, “You take one chapter.” What we did was each of us wrote up a character bio and sent it to each other. And so I wrote up… Deanna: It was so great. Hank: You what? Deanna: It was so great, like blind dates for our character. Hank: It was. It was really fun. So you had Michael, right, and I had Jazz. Deanna: Yeah, you made Jazz. So tell us about Jazz. Hank: So Jazz is very sassy and very snarky. And he’s a talented hairstylist and he’s uprooted his life after separating from his husband, who is a best-selling novelist and mystery novelist. And so he’s moved to this small town on the coast of Lake Michigan in Michigan. And some Michigan love there, Jeff. Yes. Jeff: I love that. Hank: Yes, always. And so he’s starting over and he’s just trying to kind of like rebuild and he works at a fun little salon but he’s kind of, he’s 49 but he tells people he’s 41 and… Deanna: He tell’s people he’s 35, remember? Hank: And he tries that too. Deanna: He totally lies about his age. He says he’s 35. Hank: We had, our editor actually called us up and she was like, “Is this right?” Because he shouldn’t have been around back then. Jazz lies about his age. Deanna: He’s almost 50 but he says he’s 35. Hank: Right. So that’s how that started. And then she brought up Michael. Deanna: Yeah. Hank created Jazz, the hairdresser, which is funny because I actually legitimately am a hairdresser in real life. But when we were talking, Hank had said, “I’ve always wanted to write a hairdresser.” I’m like, “You take the hairdresser. Run with it.” And then I took the mortician, which sounded really great and exciting. And after dozens of Google search, Google decided that I obviously want to be a coroner and mortician and they send me casket ads, but yeah, whatever. So I created a…it was fun because Hank created Jazz, this sassy, almost-50 hairdresser who’s super sarcastic, he’s got long honey blonde hair and super stylish and wears eyeliner and he’s really sassy and he has a big potty mouth. Hank: Oh, yeah. Deanna: Oh, he does. And then I didn’t know who Hank was creating when we came upon this conversation. It was very much, “Hey, you pick your guy. I’ll pick my guy. We’ll see what happens. And I made Michael Fleishman who is a 42-year-old, very uptight, very socially awkward Jewish guy who runs the local funeral home and he’s also the county coroner to our fake county…is it Carver County? Hank: Carver County, yeah. Deanna: Carver County on Lake Michigan, which is sort of like in somewhere between, I don’t know… Hank: Like Saugatuck and… Deanna: Saugatuck and… Hank: Yeah, Muskegon. Deanna: Muskegon, somewhere, a fake county in between there and he’s the county coroner. He’s very uptight and super horny and has this like hilarious like sexual imagination but he’s really reserved and he is obsessed with mystery novels. And he goes to a bookstore in Lacetown, which is our fictional town on Lake Michigan, during a literary festival to meet his favorite also author, Russell Withingham, which happens to be Jazz’s husband. They’re separated but they’re not divorced yet. Hank: And that’s the meet-cute. Jeff: Wow. Hank: I know, right? Deanna: Total rom-com, meet and greet during the rain under an umbrella, cute scene. Until Jazz gets his little…I mean, he really worries Michael thinks he’s a bitchy queen and he kind of is. He’s totally the queen. Hank: He’s really fun to write. Deanna: It’s so fun. Jeff: So when you got these characters who are obviously really opposite to each other, you could just hear it in the bios, what was it like to mash them together? Hank: Oh, man. Jeff: Sparks had to have flown off the pages. Hank: Oh, yes, right away. It was really fun. The first chapter is their meet-cute. And we had…I mean, we do a lot of like editing, right? So we’ll write the first pass and we’ll talk about it. We message a lot during the day and stuff like that, talk about where we want to go with things. And then we use Google Docs to write together. Yeah, so that was a lot of fun to just see the whole creation of it and like set up that setting and understand how they were going to meet and how that was going to go and how Michael would be so taken with Jazz at first sight. It was really fun. Deanna: Totally. Like, “Oh, you’re so handsome. Why is he talking to me?” Hank: That’s really fun. Jeff: And of course you’ve got the mystery element in this too. So rom-com mystery, which trying to think, I haven’t necessarily seen that kind of combo a lot because there’s straight up romantic suspense, of course. And then there’s like cozy mystery and maybe this ekes a little towards that with the rom-com–iness. But did you know that this was going to be like something to go for? Or did you just like mash these two elements together and say, “This thing…” Deanna: We thought about doing like a film noir concept, like a 1940s film. But see, that’s the thing. Like when Hank and I started writing, we didn’t have a direction. We were very much open to anything. And it was sort of like he created Jazz, I created Michael. We knew we wanted a murder. We knew we wanted it to be like… Hank: We wanted a murder. The murder got pretty gruesome too. I was really shocked. Deanna: Yeah, we wanted some things but then as we began to write it, it began to have elements of a real murder. So like our sheriff is blustering and funny. And Michael has his kitty cat, the little Mr. Pickles. Hank: Mr. Pickles. Deanna: Mr. Pickles, the fat, black-and-white kitty, which my dog is growling at right now. Jeff: Which we should note, for the people who may not be watching the video, Deanna just held up this stuffed kitty. And you’re going to be giving these away at GRL in a few months. Deanna: Yes, we have a few couple. So like when we created the story, I guess maybe other people with their writing collaborations might be different than we were. But Hank and I were not in a competition with each other. We were not like…we just knew we were going to have fun because we like each other and we know each other personally. And we were just like, “Let’s have fun with this.” And there was no like obsessive competition with like, “I don’t like the storyline.” Or, “I like this.” It was just sort of like, “What do you want to do? Okay, that sounds fun.” And we both ran with it. And we ended up developing this city on Lake Michigan and this little town and these little side characters. Jeff: Let’s talk about the mystery side of it. Who is dead? Deanna: Oh, yes, the mystery side of it. That’s right. So I’ll talk and then I’ll let Hank talk because I’ve been blabbering too long. So we decided we wanted it to be, like, film noir idea. And then it became like a legitimate murder mystery where there is a dead body and it’s gruesome and it’s creepy and it’s sad. And there’s like some crazy shit happening. And there’s like cops that need to come in. And there’s like a real mystery. And there’s actually a couple side mysteries that are happening over the book arc of the next two novels, novel two of which we will be submitting in the morning. We would have submitted it today but I’m being a typo psycho. I am. I’m a typo psycho. Hank: She’s finding a lot of good stuff, though. I like the changes. So, yeah. So the murder actually got more gruesome than I was anticipating. We were like, “Let’s go.” “Wait, do we want to go?” “Yeah, let’s do it. Let’s do it.” So it’s…do we want to say who it is? I mean, it happens early on. So I don’t think it’s a spoiler, right? Deanna: Oh, I don’t know. Why don’t we just talk about how creepy the murder is. Hank: Okay, we’ll just leave it just like that. Deanna: Not who is murdered. Hank: Someone’s murdered and maybe their hands are missing. Deanna: Or chopped off. Jeff: Oh, wow. Hank: So, yeah, that’s kind of… Jeff: That’s more gruesome than I expect in a rom-com. Hank: I know. Jeff: I’ll say that. Deanna: Oh, wait ’till you hear about the serial killer. Wait, that was a spoiler. I didn’t say it. Hank: But in the first book… Jeff: Is that a spoiler that we’re leaving in or a spoiler that we’re taking out? Deanna: We’re leaving it in but we’re not gonna respond about it. Jeff: Fair enough. Hank: That’s right. Jeff: A little breaking news there for the podcast that we will not do follow-up questions on. You were saying, Hank, on this murder. Hank: So yeah, so it was gruesome. And then there’s the discovery. But Michael is kind of, you know, he can’t help but be a little excited about it because it’s his first murder because he’s a small town, county coroner. And the only… Deanna: He’s not only a mortician. He’s the county coroner too. Hank: Right. So it’s up to him now to, like, investigate it. He’s never had a murder like this. He’s had a murder but they knew the victim and the attacker. So this is completely new for him. And he reads murder like mystery novels, so he’s really excited about it. So he’s, like, starting to play, like, detective. And then the sheriff is kind of, you know, like all blustering and yelling at him like, “Fleishman. Dilworth.” You know, that’s Jazz’s last name, Jazz Dilworth and he like calls everybody their last name and yells at them. And they’re always a suspect, so, “Don’t leave town.” Deanna: Everyone is a suspect until Musgrave says they’re not a suspect. Hank: “Don’t leave town.” Yeah. Sheriff Musgrave. Jeff: So if I understood correctly, you kind of just created this on the fly. Hank: Yep. Deanna: Totally. Jeff: For both the romance and the mystery? Deanna: Totally. Jeff: How did that play out in like the day-to-day writing? Because I can’t even like imagine having co-written something that there wasn’t more of a plan to it. Hank [softly]: I know! Deanna: How did it go? Hank: Actually it went smoother than I expected. Deanna: It was so much fun. Hank: Yeah. And it was a lot of fun because we chatted a lot on Facebook Messenger. And we’d text and we call each other now and then. We’d have conversations, phone conversations, and we’d plan out where we wanted things to go. And then one of us would say, “Okay, I’ll do this and then you can write that.” And then we just kind of took it. And then it was really fun because like you’d go through and you’d read…you know, how you like read through what you’ve written and it’s somebody else has written something new and you’re like, “Wow, this is like a whole new story.” Like you don’t know what you’re reading, you don’t know anything of what to expect. So it was really fun. Deanna: So awesome because, like, first, I gotta say, writing with Hank Edwards has been a pleasure. Because not only is he a great writer and like stupid funny, like so funny, I can’t even tell you how many times he writes something and I’m just like…laughing. But he and I are not…we’re not competitive individuals. We’re not like jumping into this, like, “Well, this is what I want. This is what I want.” It was so easy, where it was just like we just…Hank created Jazz and then Jazz has this profile that we went with. I created Michael and we had this profile we went with. He and I created an exterior mystery that happened to them. But because he created such a good profile and I just created such a strong profile, both of us knew who Michael and who Jazz were. And then it was like, “Well, Michael wouldn’t do that,” or, “Jazz wouldn’t say that.” And we didn’t like try to, like, undermine the other person. I don’t know. I just feel really blessed. I love you. I just feel blessed to be able to write a story with someone who is so easy and so fun and our sense of humor is both very similar and darkly twisted and inappropriate, like we both knew when our editor was gonna go, “Mm-mm. No.” Hank: I told her several times, I’m like, “This is gonna get cut out and you put it in and it’s gonna get cut out. I’m telling you right now.” And she’s like, “I want to leave it in.” I’m like, “Okay, but it’s gonna get cut.” And it did. Deanna: And I’m like, “They’re not gonna let us use the C-word.” And he’s like, “Maybe they will.” No, they didn’t. But it was so much…I don’t know. It was just one of those things that were really easy because Hank is so fun to work with. It was just easy. I mean, not that writing and editing is easy. But even as we went through the process, there would be scenes…we each knew where the scene was going to go. We knew what scene was going to happen next. And if it was…because our work…he’s very typical 9:00 to 5:00 work schedule, Monday through Friday, and I am Wednesday through Saturday, noon to 8:00, those four days. So like he would do all the stuff Wednesday through Saturday and then I’d open it up on Sunday, and then I’d do all the stuff Sunday to Tuesday. And then it wasn’t like we were fixing or changing each other’s work. It was like, “Oh, that’s a great scene.” And then I would add to it. And then he would take my scene and add to it. And it was just like layering and layering cool stuff with what was already funny. So it was like I knew what I was writing on Tuesday. I wrote this whole scene. And then Hank would write the next scene. And when I would get a chance to read on Thursday, he was like, “Oh, what am I going to read? I know what’s gonna happen but how is it gonna happen?” And he is so funny. So funny. And, I mean, it was just so great writing together. Jeff: So, Hank, for you, what’s kind of your side of that story as you’re like going through and doing your part on the book on your days? Hank: So it was a lot of fun. Like Deanna said, because I’ve been writing during my lunch hours at work, so like Monday through Friday I’d have like an hour and I usually go and I hide somewhere at the building and I’ll, like, be able to focus and write. And it was really fun to go through Google Docs and be able to accept all those changes because we always do the suggestions, right, so like the track changes so we can see what each other has done. And it’s always so much fun to see. It looks like, you know, like Deanna said, it’s like, “Oh,” it’s like a little present. You know, like, “There’s something new.” And I go through. But then seeing how she did the layering, I was talking to my husband, Fred, and I was like, you know, it’s like I’m picking up such good ideas about how to layer emotion in. Deanna is awesome at doing that and like pulling out the emotions in a scene and like digging in deeper where it needs to be. You know, that’s something that I’ve always kind of like, you know, I’m always like, “Write the action. Write the action. Write the action.” Deanna: But that’s what I love about his writing because he will write action that conveys emotion, whereas I would have written a long, drawn-out emotional monologue. And somehow the two just worked so great. I think. Hank: We are a good blend together like that. So, yeah, it’s really funny and she’s funny and really darkly funny. So it’s been a lot of fun because there’s some stuff where I like write something dark and funny and then, you know, you get the comment. It’s always fun to get that comment like, “LOL. Oh, my God.” And so then like all of a sudden like further down the page, she’s added somebody I’m like, “Oh, my God, you did not just write that.” So it’s really funny. Deanna: We’re so wrong. We’re so wrong, we’re so right, Hank. Hank: Yes. Jeff: Well, I really like the organic method it sounds like you guys had. Because like my brain can’t even begin to process trying to co-write without a plan. But I’ve heard other people do that and it works out great. What, as you got the draft done, what was the revision and also, I guess, making the book seem like it had one voice? What was that like? So was it like two different people at work? Deanna: Can I respond to this? Hank: Of course. Deanna: Okay, so, Hank would send me…well, it was in Google Docs. So we would get scenes together. So I feel like the way it went before anyone else read anything or we got any feedback from editors, from beta readers, or whatever, it was like we had our strong characters decided who they were and what they were and what the mystery was. And he would write a scene and then I would get it and I’m like, “Oh, it’s a good scene. I love where it’s going. Maybe…” Okay, so like I’m not going to give a spoiler, but there’s a scene at the end of Book 1 where the murderer is caught and our two heroes are like in this epic battle fighting them, like the murderer, right? Okay. So Hank writes that scene and I’m like, “Ah,” and then I go in and I add some fighting, some struggling, and maybe a little dialogue. Hank comes back in, he adds a little more dialogue. He remembers that the gun is on the other side of the room. Whatever the detail is, we both keep adding layers. And I think it comes back to the point that we’re both so invested in our characters and we weren’t, like, competing to try to be the better person. And I think that’s a lot of it. I mean, I think you can’t co-write a book together if you’re competitive or need center of attention. Hank and I just had so much fun. It would be like, “Oh, yeah. Add that, add that.” And he’s just like “Oh, my God. We’re great. That’s great. You shot him. Oh, I didn’t expect to shoot him. Let’s do that.” Whatever it was and we kept adding these layers and it became so much fun. But in the end, when we would get a scene and it was completed, we would…each of us would go back and read through the whole manuscript and be like, “Oh, we missed that detail.” And Hank would send that to me. And I’d be like, “Oh, yeah, that’s right. I forgot about that.” And he would add it. Or I would like, even today, we’re actually like one day off submitting Book 2. We were going to submit it today but I am like typo crazy. So I sent the manuscript to my Kindle so I could find any misspellings and typos. And I was like, “Oh, my God. We have a scene where Michael and Jazz are sitting in Michael’s living room with the TV. And in Book 1, he only has a TV in his bedroom. What are we going to do?” And Hank is like, “That’s cool. Good for catching that.” And I feel like that’s kind of how we’ve been like we’ll catch something and go. “Oh, I’m glad you caught that.” Hank: Yeah. But to your point, Jeff, you said like about planning and writing off the cuff, so the first book, I think, Deanna, you can tell me if I’m wrong. But the first book was really, I mean, it wasn’t easy because writing is hard but it was easier. Book 2, it was more of a struggle I think with writing it. Deanna: Book 2 was more of a struggle. Hank: And we had a lot going on. So we have like an overarching mystery, we have another, like, contained mystery. Deanna: Yes. Hank: So we’ve talked about it and we’re like Book 3, we really need to plan it out more. We’re gonna… Like once we let this book to get out a little bit, we’re going to like start planning Book 3 and then really like… Deanna: We need a serious luncheon with some planning. Hank: Yeah, so, absolutely. Deanna: Book 1 was very organic and natural. And Book 2, I mean, you’ll probably agree, Hank, I think we fell in love with our side characters so much we got distracted with all these sides stories. Even our editor was like, “Why are you talking about that and that?” We’re like… Hank: “Because we like them.” Deanna: So we had to cut a lot of scenes and really focus back on the romance, on book 2. Jeff: DVD extras, deleted scenes. Hank: DVD extras, exactly. Jeff: But let’s talk about those side characters a little bit because there’s a whole paragraph of the blurb for Book 1 that details the side characters. Michael’s sassy assistant, Kitty, the grumpy Sheriff Musgrave, Russell’s creepy PR rep, Norbert, Michael’s grandfather who likes his Manhattans strong and his women saucy. And of course, who we’ve already met, Mr. Pickles Furryton the Third. Hank: Yes. Mm-hmm. Jeff: So did you guys split those up in the same way that you took Jazz, Hank, and Deanna took Michael? Or did these get created on the fly as you needed them? Deanna: They were on the fly. Hank: Yeah. Deanna: We just like… Hank: We just do, kind of. Yeah. Deanna: I think I came up with Mr. Pickles Furryton the Third and Hank created Sheriff Musgrave. Because I think when we were talking, Sheriff Musgrave was actually like an old man and Hank made him this whole, like, Ron Perlman kind of character. Hank: Yes. Very Ron Perlman. Deanna: He has a lot of attitude. And Kitty, I don’t know where she came from. Hank: You created Kitty. Deanna: Did I? Okay, because I imagine her. Do you watch “Blue Blood” with Tom Selleck? Jeff: I have not. Deanna: Oh, anyways. His secretary is this voluptuous like blonde chick and I pictured her. And I don’t know who created Grandpa. Hank: I think we both did. Deanna: You had Steve. Hank: Oh, yeah, the handyman. Deanna: We both made Ezra. Hank: The apprentice. Deanna: I don’t know anything about them. That’s not a spoiler at all. Jeff: That’s very impressive to just kind of create on the fly like that. Two people pantsing would make my head explode, but. Hank: It was insane. I don’t know how we managed to do it but… Jeff: I think you had fun with it all the more. Hank: …we had really good feedback from the editor. Deanna: We did have so much fun, Jeff. Hank: Yeah. Deanna: I don’t know how lucky I am. Like a year ago, I sent him a drunk text message that we should write a book together. And we have had the best year. Jeff: Had it even crossed your minds before the drunk text to do this in some, like, other random moment? Deanna: No. Hank: Never ever really even talked about it? I mean, we see each other GRL. She comes up for Ferndale Pride because she lives about an hour and a half away from me. Deanna: I’m northwest Ohio, he’s southwest Michigan, so we’ve done some pride festivals together. But in all freaking honesty, the whiskey made me do it, Jeff. I literally texted him, “Hey, full disclosure, I’ve been drinking. We should write a book together.” I do believe, Hank, that was the quote. Hank: Pretty much. Yeah. Deanna: And he was like, “We would write the fuck out of a rom-com.” And I was like, “We would.” And then we ran with it. And then that’s that. It was just, like, all fun. Jeff: And it’s interesting that you’re evolving in Book 2 and probably in Book 3 too. You had the fun moment. Now you kind of have to make everything keep tying together in the next two books. Hank: Yes. It’s all got to come together now for the third book. Yeah. Jeff: Because that’s like, yeah, when you have all that tied together stuff, because I’ve been reading a lot of romantic suspense lately where it’s like something that arcs across a trilogy or whatever, and it’s like…it’s exciting. Hank: Right. Deanna: Yeah. Book 2 is tentatively called “Murder Most Deserving,” and it was a lot harder to write than the first book. Hank: Yeah. Jeff: As fun though, I hope? Hank: Oh, yeah. Deanna: Oh yeah, just as fun, but there were moments I feel like we both checked out. And we’ve had this conversation. We know that we checked out because we had decided on a storyline for Michael and Jazz. And then we were like, “This doesn’t feel right.” Because it’s not your book, it also belongs to someone else, you don’t just say, “Oh, that storyline can’t happen,” because two of you decided together so you keep going with it. And then there’s moments where we had to talk and we’re like…where I was like, “I don’t like this.” And he’s like, “Yeah, I don’t like it either.” And I thought I said I didn’t like it. I’m like, “Maybe you said you didn’t like it. But I didn’t really expect you didn’t like it and I don’t know why we didn’t like it. And I don’t even know why we’re doing it.” And it was like we had…I mean, there was like, there was a couple of moments like that on the story. And there was also like we said in the beginning, we love our side characters too much. And we gave them a lot of screen time they did not deserve, even though we love them. So we had to distract and take a lot of stuff out. Not that we wanted to take it out but it was like why is this thing here? No one cares… Hank: Right. Deanna: …except us. So it was a little different. Like we created this wonderful world and in Book 2 we kind of just went crazy. We, like, went crazy with the Cheez Whiz. It’s like, “I love Sheriff Musgrave. I love Missy.” And we just wrote all these scenes and we’re like… And part of that I will say is my fault because I sent a lot of scenes to Hank before we even plotted the book. I was like, “I wrote this funny scene I’m going to send you.” And he’s like, “I love it.” And we wrote it. Hank: And I was like opening emails from Oprah. “And you get a storyline, and you get a storyline.” Deanna: Totally. Jeff: Maybe these could become short stories for these characters if you can’t get them into the book. Hank: That’s great. Jeff: So take a moment to brag on each other. And outside of working on this book, what do you like about each other’s work? Hank: I’ll go. Jeff: Hank first. Hank: All right. I love Deanna’s depth of characters. So her books, I think the first one I read of yours was “The Legend of Sleepy Hollow.” And I was like, “Oh, Ichabod. Oh, you naughty boy.” But then I can’t remember in what order then I read them but like “Easy Ryder,” I love that book. That is an awesome book. And I love the time period and I love the characters and I just love all of it and the discovery. That’s a road trip, another…you love the road trip books. Deanna: Apparently. Hank: Apparently. And then “Wrecked” is awesome. It’s really good. But she has a way of just like, you know, pulling up those emotions and really getting into the romance of it and doing an awesome job with it and having the characters. And then the conflict is organic, it’s not, like, fabricated. And it all blends together. She’s got a really good sense of story. Jeff: Nice. Deanna: That’s so sweet. I feel like, Hank, your dialogue sells your story. You could write a whole book on just dialogue with nothing else and people would buy it and laugh. You’re hilarious and your dialogue is great. And I feel like our styles mesh well because I do write more… I like to write a lot of the internal monologue and the emotion. But I’ll tell you an example, and this is a semi-spoiler in Book 2. But this is what I love about Hank’s writing. Okay. I’m not gonna tell too much of the story but there is a scene where something really shocking happens for our character, Jazz, the hairdresser. And the scene is in Jazz’s point of view. You’ll know what I’m talking about in a second. So the scene is in Jazz’s point of view and then Michael, our mortician, bursts through the door. And everyone is like, “How did you get here?” And he’s like, “I ran here.” And that sounds like simplistic but the emotional intensity of why Michael would run five blocks to the salon where Jazz works on a mere phone call just conveys so much intensity with three words, “I ran here.” And that’s what I love about Hank’s writing. I mean, I write the long emotional, internal monologue. And Hank writes that same intense emotional monologue in three words, “I ran here.” And I think, I mean, I’ve always…that’s what I love about his books. But I feel like those two things complement each other in our writing. Like I like to write the long drawn out emotional and he writes that same scene in three words, “I ran here.” And that’s why I love writing with him. Jeff: Cool. They’re hearting each other for those people not watching the video right now. Jeff: So you mentioned three towns…three towns, no, three books in the “Lacetown” series are planned. Do you foresee life in the universe beyond those three since you’re having such a good time? Deanna: Yeah. Hank: We talked about it. We’ve discussed it, yeah. We’ve got the trilogy planned and then we’ll see what happens with it. Deanna: We have at least two in our head. Jeff: That’s cool. Deanna: Beyond the three. Jeff: Now what about separately? What’s coming up next outside of the “Lacetown” series for you both? Hank: You have something coming up soon, Deanna. Deanna: Well, I have one thing coming up for sure and hopefully two. I also write young adult fiction just like Hank does under his…is it RG or RD? Hank: R.G. Deanna: R.G. Thomas. Hank has a young adult series under RG Thomas. And I have a young adult series, K.D. Worth, which is very different from my Deanna Wadsworth writing. It’s young adults/new adults because my characters are 19 and there are some, I don’t know, level-three sexy moments. So you can’t really…like you know people get funny about young adult that has sexy stuff in it. There’s a strong spiritual element with the main character who was trying to kill himself because of his family sending him to like one of those creepy pray-the-gay away camps. And the moment he kills himself he’s saved by a young teenage Grim Reaper, who decides that he wants to give him a second chance in life. And there’s a sassy foul-mouthed, because no one understands why Deanna would write a character like that, a sassy foul-mouthed angel who helps these boys on their journey. And that story is called “The Grim Life.” And Book 3, the final series, the final saga in that trilogy “The Lost Souls” is coming out this fall. And I’m really, really excited about that. I mean, a lot of M/M or gay romance, whatever you want to call it, authors know that young adult isn’t where the sales and money are at, sadly, but this is like a really intense…I don’t want to say pet project because that trivializes it, but it’s really a series that means more to me than almost anything I’ve ever written. Hank: Yeah. You’ve been working on these for what? Like two years now? Deanna: Yeah, four. It took me two years to write Book 3 because I just emotionally invested in it. There’s a lot of death and questioning of what goes on on the other side and where God sees your soul and all these like intensely hard questions. And to make things harder on myself, I put a school shooting in Book 3 because why not? Hank: No, why? Deanna: It’s so emotionally intense that you can’t write it. So that comes out this fall. But I’m hoping my second book in my Pride of the Caribbean Cruise series comes out which is a merman. Hank: Nice. Deanna: A merman… Hank: On a cruise. Deanna: …on a Caribbean cruise. It’s like I like to be intense or I like to be funny. I can’t be… Hank: There’s no in between, right. Jeff: Either end of the spectrum. Hank: That’s right. Deanna: That’s what I do. So that’s what’s coming out for me. Jeff: Cool. Hank: I will be working on the final book of the “Critter Catcher” series, final book for now. It’s tentatively titled “Dread of Night.” So and I’ve got about six chapters written. I’m working on a big pivotal scene also, so I need to just like…now that Book 2 has been sent off for consideration I can like, you know, kind of focus on that because I’m really bad at like jumping between projects too. Like my mind gets stuck in the other characters because while I’m working on this other I’m like, “But wait, what about…?” So, yeah. Jeff: Cool. All right. What is the… Hank: There’s other stuff to work on too but that’s the big thing coming up. Deanna: I love the “Critter Catcher” books. They’re so good. I manipulated Hank into giving me the last book when I was sick last summer. I was like, “Shouldn’t you send it to me? I know that you’re going to submit it for publishing in a month, but I’m really sick.” Hank: “I need to beta it. I’m sick.” Yeah. Deanna: Yes. I did do that. Jeff: And it worked too, right? Deanna: It worked. Hank: I did. I sent it. I was good. Deanna: And it was worth it. Jeff: So what’s the best way for readers to keep up with you guys online? Let’s start with Hank. Hank: I have a website. It’s hankedwardsbooks.com. You can also find my young adult fiction at townofsuperstition.com. And I do have those books listed on my Hank Edwards’ website just to make it easier. And then I’m on Facebook. I have a Facebook page. It’s facebook.com/hankedwardsbooks. And I really don’t use…Twitter confuses me. I get really…it’s just this noise. It’s like people yelling at each other. And so I have a Twitter account but I’m not out there much. But I am on Instagram. I usually post pictures of my cats. You know, and that’s @hankedwardsbooks as well. Jeff: Cool. And Deanna? Deanna: I’m on Facebook, deannawadsworthauthor. And Instagram, I go by @deannawads. I don’t know why I didn’t finish my last name but I don’t know. Everybody called my grandpa Wadsy. So I should have done Deanna Wadsy but I screwed that up. But I’m on those two. A little on Twitter and a little on Pinterest, all under Deanna Wadsworth. Mostly my most activity is on Instagram or my website, deannawadsworth.com. And that’s it. And you should totally read Hank’s R.G. Thomas books. It’s like Harry Potter but gay with, like, dragons. And little garden gnomes. I fricking love those books. You better write another one after we write our book. After we write our book. You’ve got to. Hank: Got it. Jeff: You’ve got your marching orders now, Hank. Hank: I do. I get them a lot. Deanna: He doesn’t have a wife, but… Hank: It’s all right. Deanna: …I’ll jump in that role. Hank: She’s my work wife. Jeff: All right. Well, this has been a blast. We will definitely link up to everything in the show notes that we’ve talked about here. And we wish you the best of success on the “Lacetown Murder Mysteries.” Hank: Thanks very much, Jeff. It’s been fun. Deanna: Thank you, Jeff.
New movie and TV deals are discussed with both Casey McQuiston’s Red, White & Royal Blue coming to Amazon and a Love, Simon series to the Disney+ streaming service. Jeff talks about seeing The Lightning Thief: The Percy Jackson Musical. New patrons Rhonda and Regi are welcomed. Will reviews the Netflix original Special. Jeff reviews Jay Bell’s Straight Boy. Jeff & Will discuss their trip to the LA Times Festival of Books. They also share the interviews they did at the festival with Julian Winters, Kim Fielding & Venona Keyes and S.A. Stovall. Julian talks about his upcoming book How to Be Remy Cameron. Kim discusses her Stars in Peril series and Venona also tells Jeff about her co-writing with Kim. S.A. gives the origin story of her Vice City series and how she uses caricature to encourage people to read the first chapter (she also did a super cute caricature of Jeff & Will). Complete shownotes for episode 185 are at BigGayFictionPodcast.com. Here’s the text of this week’s book review: Straight Boy by Jay Bell, narrated by Kirt Graves. Reviewed by Jeff. I went into Straight Boy without knowing much about it other than it was a young adult story involving Andrew, a gay high school student, who develops a crush on Carter, a straight (or maybe not-so-straight) boy. What made me buy the audiobook was the fact I’m a huge Jay Bell fan because of Something Like Summer and also for Kirt Graves’s narration. I knew these two together would give me a great read. And they did. With Something Like Summer and its sequels, Jay proved a master of telling a story with many characters and many plot lines that involve an array of emotions. He’s upped his game with Straight Boy. Two things happen right away–Andrew, a recent transplant to Chicago, discovers a boy who lives down the street having an argument with his parents and saying things like “I was born this way.” Andrew thinks he’s found a gay friend. The next day–his first day at his new school–Andrew comes out as he introduces himself in class. This makes him a target of the school bully, Bobby. Andrew goes off on Bobby, despite the bully’s threats and ends up getting sent to the guidance office. Here he meets Carter and discovers that’s the boy he heard arguing. Both of them end up in a special program at the school where learning happens outside a traditional classroom Andrew’s year is now set. Everyone–gay, straight or otherwise–inevitably has that phase where you want a romantic relationship that you can’t have. Andrew longs for Carter but also doesn’t want to wreck their friendship, which seems to grow stronger by the minute. The thing is, Carter seems to be a little experimental too and that only makes things more confusing for them both. In the hands of a lesser writer, this would end up a disaster on the page, but Jay deftly weaves the emotions and circumstances for both guys as they figure out the place they’ve got in each other’s lives as it evolves through the school year. I cheered for the good and wanted to protect them through the bad since my fifty-year-old self could vividly recall how confusing seventeen was. Bobby’s integrated deeply into their year too. He’s a friend of Carter’s and that mean’s Andrew is around Bobby far more than he likes–and he ends up putting up with more crap that he should. Andrew accepts dealing with that because he doesn’t want to lose Carter. It’s made even harder when Carter starts dating Bobby’s ex, Olivia. Along the way another of Bobby’s friends, Jackson, becomes tight with Andrew too, creating more bonds in the group. The evolution of Andrew and Jackson’s friendship is as interesting as Andrew and Carter’s. Things get rough in the last quarter of the book. Bobby doesn’t like the changes happening to his group and he plots revenge. I have to warn here that not only does bullying happen throughout the story at varying levels but as we get into the last act there’s also off-page sexual assault and a pretty epic final battle where Andrew, Carter and the group are in way over their heads. Again, Jay does an excellent job of telling the story, ratcheting tensions and putting characters–and readers–through the wringer. The epilogue was the icing on top of this cake. Jumping twenty years into the future, we find out where everyone ended up. There were some surprises here that made me go “awwww.” It provided the perfect ending. What this book excelled at was showing friendships up close–what makes them grow, what rips them apart, and most importantly, what can make a true friend for life. It also shows, perhaps too intensely for some readers, the lengths people can go to in order to protect a relationship even if it’s toxic. I can’t commend Jay enough for how well he did all of this. Kudos to Kirt Graves too. I know well from TJ Klune’s Green Creek series that Kirt can handle a large cast of characters and high emotional impact. Kirt is perfection here handling the emotional rollercoaster without sending it over the top. His performance adds perfectly to what Jay had on the page. I highly recommend Straight Boy by Jay Bell, just make sure you’re ready for the ride. Interview Transcript - Julian Winters, Kim Fielding & Venona Keyes, S.A. Stovall This transcript was made possible by our community on Patreon. You can get information on how to join them at patreon.com/biggayfictionpodcast. Interview with Julian Winters Jeff: We are at the LA Times Festival of Books with Julian Winters. Julian: Hi. Jeff: Who I’ve just had a major fanboy moment over. Julian: I had fanboy moments. Jeff: Okay. We kinda both had the fanboy moment. Julian: Yes, yes. It is equal. Jeff: Because I had to get him to sign my “Running with Lions.” Podcast listeners know that was one of my favorite books of last year. Julian: Thank you. Jeff: And you’ve got a little sneak peek… Julian: I do. Jeff: Right now of “How To Be Remy Cameron,” which comes out September 10th. Julian: Yes, yes. September 10th, yes. Jeff: Tell us what this is about. Julian: Remy is a very personal book. It’s about an out and proud teen in high school, who has always felt like he’s known himself until he has this AP lit course. And one of the final grades he has to write an essay about who am I and it’s like the make or break essay. He’s trying to get into Emory University, and he needs this course in order to get there. And so, he has this kind of panic mode of, “Okay, but who am I?” Because he’s always been defined by, “Oh, he’s the gay kid who came out at 14,” or, “Oh, he’s one of five black students that go to our school,” or “Oh, he’s the big brother to this character,” and he’s just all these labels he wears all the time. He’s, “This is who I am.” But then he starts to realize, “Is that all I am and do these labels really define exactly who Remy Cameron is?” So, it’s kinda an exploration of what labels mean to us, but it also has a great family dynamic. A couple of secret mystery parts I can’t tell you about but there’s a lot of guessing games going on in it. And of course, it wouldn’t be me if I didn’t have like a dorky romance in there. So, that’s in there too. Jeff: A dorky romance? I like that because that’s… Julian: Yes, that’s exactly what I promise you. It’s so geeky, it’s so dorky. Jeff: That’s kind of what “Lions” was as well for sure. That’s a good label for it. How would you say that your writing has evolved from first book to second? Julian: Oh, it’s a lot. A lot. With the first book, I just kinda wanted to write the feel-good story, and that was my goal, and touching on certain issues throughout the book. And it also was written in third person and “Remy’s” written in first person. I’ve never, not even when I was like a small child, wrote in first person. I love reading books like that, but I thought, I just can’t do that, it’s just too personal. And so, it was a challenge doing that, but it was a lot of fun. And “Remy,” like I said, it’s very personal, so exploring parts of myself and things that I see throughout, you know, our community and things like that. It really helped me grow as a writer to really say, Okay, you can challenge yourself and you can fail at it, but you can also improve. And that was great. So, to fail, I struggled so much in the beginning, but to have that under my belt now, it’s I think I could write a lot of different stories. Jeff: So, you think you’ll visit first again sometimes? Julian: Oh, yeah, yes, yes. The next book I’m working on, first might be where I’m stuck now. I think this might be my calling. I don’t know. Jeff: Okay. I could tell you, first is a nice place to be. Julian: Yeah, it is. Jeff: What are some elements of this book that are so personal to you? Julian: Growing up. So, I grew up in Upstate New York where I was one of five black students at my school. And then when we moved to Georgia, I was one of 400 that went to my school. So, it’s very personal in the sense of, I went through a lot of phases of am I too gay? Am I black enough? Am I too perfect as a friend? Am I good enough friend? A lot of things that I went through, Remy goes through in the book. It also explores my love for a lot of geeky things and how for a while I wouldn’t let that define me because I thought, “Oh, no, this is bad, people are gonna make fun of me.” And Remy goes through that because he had a lot of geeky moments, but it’s almost like he’s scared to show them now that he knows that these are the things that I’m defined by. Jeff: I love that you point out the geeky thing because I saw on your Instagram earlier today of the comic books that you read into here at the Festival. Julian: Listen, I almost had to leave, you know, our booth just to go, you know, bow down at the comic book booth and just say, “Listen, thank you. I love it.” Jeff: Now, let’s talk about “Lions” for a second because you’ve had an amazing year. I mean, you started out of the gate that the book was blurbed by Becky Albertalli. Julian: Yeah. Jeff: And now, just within the last week or two, you’ve won an award for it. So, tell us a little bit about that. Julian: It’s been a wild journey because, first of all, like, I never thought I’d meet Becky Albertalli, I never thought I’d talk to her, I never thought, you know, I would become friends with her. And then just meeting all the other people along the way that I’ve met and growing in that area… I always felt like I was the kid sitting at the table in the corner where I peek over at all the cool kids and say, “Yeah, I’m never sitting at that table,” but it’s been kinda really awesome being taken in by so many different people and I never thought I’d be an award-winning author. Like, I wanted to write the book for queer kids to enjoy, to see themselves and know that, you know, you’re not some other subcategory, you’re just a normal person. It’s just that…this is just a part of you, it doesn’t define you. And to win an award, I broke down crying. It wasn’t something I was expecting going into this because my journey has always been about the reader but to have something for myself was amazing. It still is amazing. I’m not over it. I guess I won’t be over it until I actually hold the award in my hands and say, “This happened.” Jeff: This actually happened. And the cover too, which was a stunning cover, also won. Julian: Yes, the cover won for best cover. And that was so great for me in the sense that I love our cover designer, C.B. Messer. She’s amazing. She reads all the books cover to cover. And so, she knows these characters, she knows their stories, and what she did with that cover just blew me away. What she did with the “Remy” cover, I’m still in complete awe of just how well she knows these characters. Jeff: When we talked back last year, the book had hardly been out. Julian: Yeah. Jeff: How’s the reader response been to it? Julian: It’s been amazing. Today just alone, just so many people will walk by and say, “Oh my gosh, ‘Running with Lions,’ I’ve heard of that book.” And I’m just like, “What? Of all the books that came out in 2018, you heard of that book?” The response has been amazing. Going to the events and having people walk up to me and say, “Thank you for writing this book because I played soccer all my life, but there was never a queer soccer book.” Or, “Thank you for writing this because there weren’t a lot of books with bisexual main characters, or characters that were gay and Muslim, or black characters, or whatever.” It’s been amazing, the response I get. I get teary-eyed every time. I’m like, “I’m not strong enough for this, we can’t talk about this.” But it’s also been so cool to know that I’m helping someone see themselves because I didn’t always get that opportunity growing up. So, to know I’m getting to be a part of their journey, it’s just been amazing. Jeff: Fantastic. And what have you thought of the fair, of the festival? Because it’s your first time up here. Julian: Yes, this is my first time here for the festival. And I was talking to another friend about it because I went to YALLWEST last year. YALLWEST is this…it’s nice little corner and then this is like a whole city. Like, I get lost every time I go either to the bathroom or get something to drink. But it’s amazing because it brings so many different publishers, so many different books together, so many different genres, so many different kinds of authors are here. And that’s the amazing part to me, just to know how influential books are because there are people everywhere all the time, stacks of books in their arms. And you don’t really get to see that in, like, media, like how impactful books are, how much people really enjoy the art that we put out there. So, this has just been amazing to watch how excited people get when they see the books. Jeff: Yeah, it’s been very cool here. So, thank you so much for hanging out with us. Julian: Thank you. You know, I love you guys. Jeff: Best of luck on “How To Be Remy Cameron,” coming out September 10th. Interview with Kim Fielding and Venona Keyes Jeff: We are at the Los Angeles Times Festival of Books with Kim Fielding and Venona Keyes. Thanks for being here. Kim: Thanks so much. Venona: Thanks for asking. Jeff: We’re excited to have you both here. And now, Kim, of course, within the past couple of weeks, we’ve raved about the “The Spy’s Love Song” and the new “Dreamspun Desires.” Where did the inspiration for this book come from? Because it was so good. Kim: I think a big part of the inspiration came from my travels in Eastern Europe. So, you know, thinking about the way things used to be in Eastern Europe and how things are changing, plus politics as they’re happening right now. And so, yeah, I think that was the main thing. Jeff: What kind of research did you have to do to develop your spy and your rock star who becomes kind of…along on this mission without even knowing he’s on it? Kim: I didn’t have to do too much research on the spy part or on the travel part, but rock stars and music is not something I know anything or have any talent or anything else about, so that was where I had to do most of my research because I don’t know what it’s like. I don’t know what it’s like to be a rock star. I can’t even sing. Jeff: Does that mean you what it’s like to be a spy? Kim: Hmm, I’m not…I can’t divulge. Venona: You have kids. Kim: Yeah, I have kids. Jeff: And you wrote song lyrics too? Kim: I did. Yeah, I know. And it was really fun. And then in the audio version, my narrator Drew Bacca sang them, which was so cool. And it’s like, this is the closest I’m ever gonna get to being a songwriter. And it’s so much fun to listen to. And I can pretend, you know, like, I’m the next thing. Jeff: Which actually raises the question, did you give him an idea of what the melody for it was or did he just kind of make that up? Kim: I had no melody in mind. I didn’t know he was gonna sing. When I write a book, I’m sorry narrators, I don’t think about what I’m doing to my narrators. And so, sometimes I torture them, and I wasn’t even thinking about a narrator singing it. So, that was his idea and I was so pleased. Jeff: And this is a little different in “Dreamspuns” as well and I noted it in my review that you are a single point of view here. Did you go into it deliberately that way or just kind of organically discovered it was the way to go? Kim: It made more sense for this book because there’s some surprises about our spy character and I think it’s a lot more fun if we kinda discover the surprises along with the other character rather than knowing right from the start. So, you know, for some books, the dual point of view works really well, but for this one, I think this works well. Jeff: Yeah, I totally agree on that. Now, this is part of a bigger series that’s happening within the “Dreamspuns.” Kim: It is. Jeff: Tell us a little bit about the series overall. Kim: Sure. So, this series is called “Stars from Peril” and this is the first book in it. The second book comes out next month, and that’s “Redesigning Landry Bishop.” And the third book, I just finished the first round of edits on. It’ll be out in October and that one is “Drawing the Prince.” We went over several titles on that one. And so, what all three of them have in common is the main characters are from the same small town in Nebraska called Peril, Nebraska. And all three main characters have made it big in some way. So, our first guy is a rock star, our second guy is kind of a Martha Stewart type, and the third guy is an artist. And so, they’ve made it big in the world and they meet someone. And so, you can read each of them as a standalone and in any order you want to, but you’ll kind of see the characters appearing a little bit in one another’s story. Jeff: It didn’t even click for me that it was the name of the town too because peril plays into their own peril. Kim: Exactly. And I honestly cheated a little bit on that. There is a real town, a tiny little town, I think there’s like 60 people in it, in Nebraska called Hazard, Nebraska. So, Peril. Jeff: Peril, Hazard, it works. Kim: And it’s a great name. Jeff: Now, people may be wondering, why do we have both of them here together? Well, Venona and Kim also co-write. Tell us about that book. Venona: “Running Blind.” I will tell you this came about some years ago in Portland at our Dreamspinner meetup and she pulls me aside. Now, you have to understand that I was such a fan of Kim. I love “Brute”, I loved all of her stuff. And then she’s talking to me and I’m like, “You sure you’re talking to me because, you know, I don’t, like, co-write. I’m really bad at, you know, doing it by myself.” And she goes, “Oh, yeah, I heard on NPR…” And that’s how it started. Because Peter Sagal who’s out of Chicago hosts, “Wait, wait, Don’t Tell Me.” He is a running guide for blind people for marathons.” So, she had the idea and we came up with “Running Blind.” Kim: And the reason why Venona was such a perfect choice is because, unlike me, she does triathlons. So, I didn’t have to do the research on marathon running. Venona: No, or running guides either. Stuff like, “Yeah. That’s your department,” I’m like, “All right, we can do this.” And it’s a wonderful book and we decided that we wanted to have a second story because in the beginning, and it’s not giving a spoiler away, is Kyle and Matt who have been friends, who went to college together, were friends, became lovers, and now they’re in a comfortable pattern, and they really love each other but as brothers rather than lovers. So, when something happens to Kyle, Kyle breaks it off and he goes, “You gotta go do stuff.” And Matt’s reluctant, but this story is about Kyle and how he deals with the things that have happened in his life. So, the next book that we’re writing, the working title is “Playing,” is Matt’s story about how he finds romance after the breakup. Jeff: And when do we get to see that one come out? TBD. Venona: TBD. Kim: Well, that one is still in progress. Venona: It’s still in progress. It’s now in my hands. And so, we switch back and forth when we write, and I need to get it back to Kim. So, hopefully soon. Jeff: And you’ve got some other co-writing coming too? You’re working with Shira Anthony as well. Venona: Shira Anthony, it is another story. It’s actually about a farmer and a city boy. So, that one is coming up soon and that’s an honor of a friend of ours from GRL. So, we’re writing a story about a farmer which he is and who’s not out and a city boy who is. So, it’s a lot of fun. We already have the outline and we’re just getting started on writing that as well too. Jeff: Very cool. Anything else coming up we should know about? Venona: Yes. “How to Become a K-pop Idol,” I am writing that one by myself. We might get a co-writer on that one, you never know. But that one is, if people aren’t familiar with this, I love Korean culture, a lot of Asian culture, Japanese, Korean. I’m learning Korean. I’ve been a K-pop fan since 2009 proudly with the Big Bang. Jeff: Before it was cool. Venona: Before it was cool. And my bias is right now, because Big Bang, if you don’t know in Korea, you have to go in for military service mandatory by the time you’re 30. So, a lot of the K-pop idols are going in. So, new ones are coming up. So, the third gens right now is BTS, if you’ve not heard of Bangtan Sonyeondan, BTS, they’re really big. They’re the band that I’m following right now. Jeff: Very cool. Anything coming up for you, Kim, a part from the Peril series? Kim: Yes, start of the Peril series at the end of this month, so April 30th. I’ve got a new novella coming out. So, if people who are following my “Bureau” series, there’ll be a new novella in that. And I wanna push that because I give all my royalties for that to Doctors Without Borders. So, this is the fourth story in that series, but you can read them as standalones too. Venona: And they’re awesome stories too, I love those. Kim: Thanks. Jeff: And what have you guys thought of the festival? Venona: You know, this is the first time I’ve been here, and it is awesome. There’s just so many people here, there’s so many different books, and you get to browse them all at the same time instead of in a little bookstore somewhere. So, yeah. Kim: And it’s been a lot of fun just kinda hanging out with everybody, LA is fun. So, it’s been a lot of fun. Jeff: Very cool. Well, thanks for hanging out with us for a few minutes. Kim: Thanks so much. Venona: Thanks for asking us. Interview with S.A. Stovall Jeff: And we’re at the LA Times Festival of Books with S.A. Stovall. Thanks so much for being here with us. S.A.: Well, thank you for having me. It’s super exciting. Jeff: Now, you’re the author of “Vice City,” it’s currently two books in the series. Tell us a little bit about what the series is? S.A.: It’s a crime thriller like a noir style. Ironically, if you’ve ever read “Sin City,” which is a graphic novel, it’s kind of similar to that. I used to work at a courthouse and I got a lot of green, was an attorney and all that. I don’t do that anymore because it’s a little depressing, but I used some of my experience in that to write the series. And I really like redemption stories and like criminals turning it around. That’s what I did in the courts is I helped a lot of drug addicts get to rehab and turn their life around. And so, I’m really into that kind of story. So, the series follows an ex-mobster who like, you know, leaves the mob and then becomes a private detective, and then, you know, shenanigans ensue. Jeff: Shenanigans ensue? S.A.: Yeah. Jeff: And he’s consistent through the series? S.A.: He’s the main viewpoint. There’s a romance a subplot in which he falls in love with like a police academy cadet, and obviously, that’s his in to the police and you know, again, more shenanigans ensue that way. In the sequel book that just came out, one of the subplots is that a police officer suspects the main character’s actual identity, that he had connections to the mob and used to be a mob enforcer. And so, he’s out to prove that it’s him. And so, you know, it’s a thriller story so it’s got lots of thrills. Jeff: Mystery, suspense, thrills, it’s all there. S.A.: Yes, exactly. Jeff: What got you into starting to write these books? S.A.: So, I had a friend who really likes Dreamspinner Press and I used to write just books like short stories for my D&D group, because they really liked, you know, fantasy, all that kind of stuff. So, I wrote short story fantasies and she was like, “My God, you should write me a Dreamspinner-style novel, like, that’s what you should write for me.” And I was like, “Okay, I don’t know if I can do it as good as all these other people, but I’ll try.” And I wrote “Vice City” for her specifically. I even put that in the dedication. I’m like, “It’s just for you.” I didn’t think that it would go anywhere because, you know, I was just like, “Okay.” But I got an agent after I wrote this and then the agent sold it to Dreamspinner and then they published it for the DSP line because that’s where they do genre stuff. Jeff: It doesn’t necessarily have the romance in it, right? S.A.: Yeah. Well, mine does but it’s not the focal point. The focal point is the, you know, mystery and the mobster story. So, I was very surprised. I didn’t think it would go anywhere but it totally went somewhere. So, every time somebody is like, “Oh, I don’t know if I should write a novel,” there’s a piece of me that’s like, “Man, I just wrote that novel willy-nilly. So, you should try, you should do it. You should try.” Now admittedly, you know, I was writing before I wrote this because I wrote other stories and short stories, but still, if you’re thinking about it, you should just do it, you know. Don’t even think to yourself, “Oh, nobody will read this,” because I kinda thought, “Nobody’s gonna read a crime noir.” You know what I’m saying? Like, I was like, “That’s old school, nobody reads that kind of stuff anymore.” But no, people do, and people like it. So, I was really happy. Jeff: And you noted that the second book just came out. Do you have plans for third? S.A.: Yeah. Jeff: What is yet to come? S.A.: I’m about halfway through the third book and it’s a true series in the sense that it could go for as long as I want it or, you know, that kind of thing. It’s not like a trilogy or a set thing like, “Oh, something needs to happen.” But, you know, as a private investigator, anything can happen, you know, all sorts of shenanigans can ensue. Jeff: Very true, very true. S.A.: But there is a connecting theme. The whole reason that it’s the vice enforcer is that the mob that he used to work for was the vice family, and they’re still around by book three so you can kinda see the, like, he’s trying to take them down one by one. And so, I guess I could be limited to and then it got the whole vice family and then the series is over. But, you know, there’s that connecting thread too. Jeff: Now, that you’ve been writing in this genre, do you wanna expand out to other genres or is noir thriller kind of your sweet spot? S.A.: Well, it’s just a thing that I like a lot, that I thought, you know, nobody likes this anymore, but I like it. I wrote “Modern Gladiator” which is just a pure romance for Dreamspinner. It was a sports romance with UFC fighter. Jeff: Oh, cool. S.A.: I, a few years back, was dating a guy who was in the UFC. And so, I just used all of that experience to write a sports romance. And I know a lot about, you know, wrestling and all that kind of stuff just from him. And I put a lot of that kind of information in the book and it literally just came out about two weeks ago. Yeah, “Modern Gladiator” came out. And then I do a lot of fantasy and science fiction on the side as well. So, I mean, all sorts of things, all crazy things. Jeff: Very cool. Now you’re also an artist? S.A.: Yes, that’s true. Jeff: While she’s been here doing her signings and such, she’s also been doing caricatures of people who get their book signed. And so, we had this one done of us. It is so freaking adorable. How did this get started for you? S.A.: I’ve just always drawn things. I like doodling. I was really into comic books at a point in my life. I mean, so many comic books and manga. I mean, anything that was drawn and kind of that like storybook style with the panel, super loved. But I didn’t really intend for it to go anywhere. I went and got my history degree, I got a law degree. I wasn’t like, “Man, I need to study art.” But I did at least doodle enough that I was like, “I’m mildly good, you know.” And when I went to my first ever book fair, I thought, “I can’t just be the schmoe who’s standing in a booth trying to peddle their book, because I’m gonna be like 50 other people in the road doing the exact same thing. I should try and do something that’s at least enticing or to get people to read my stuff.” And I figured, “Hey, I could try a little caricature, and while I’m drawing them, they can read my book. And if it’s enticing enough, you know, they’ll buy the book, or they’ll feel guilty enough to buy the book, you know, I don’t know, whatever gets them to buy the book.” And a lot of people usually give me comments right away. Like, the first line in “Vice City,” everybody always comments, well, not everybody but like 80% of people. The first line is, “Getting hit with a wrench hurts.” And, so many people either laugh or comment like, “Oh my God, what a good line,” and I’m like, “Yeah.” And the first chapter in “Vice City” is an interrogation of that police cadet. So, Pierce, the mobster, is interrogating this guy who he thinks is a police mole. So, it’s really intense, you know, high stakes going on. I really like that first chapter and it usually hooks people. So, they read that first chapter while I’m drawing them and, bam, that’s my sales strategy. Don’t steal it. I’m joking, everybody can use it. Jeff: It’s all her’s. S.A.: Anybody can do it. Jeff: But the key is, like, I could never draw. There’s no way I’d do this, I’d have to find another hook. S.A.: I’ve been successful with it. People typically like that. And the caricatures are free. I just give them to people. So, even if they don’t buy the book, you know, it’s fine. Jeff: And it’s awesome watching her do them. We watched as she did ours. It’s like, “Oh my God, there we are just manifesting on the page.” It was very cool. Well, thank you so much for hanging out with us a little bit. One last question, what have you thought of the fair? S.A.: It’s good. There are a lot of people here though. I mean, just thousands of people all over the place. Going to the food trucks was fun, although not during lunchtime. There’s like a mile-long line from here to the sun and back. Nobody wants to do that. But the food trucks are good, the people seem to be really nice, and I don’t know, it’s just a good time. Jeff: Excellent. Well, thank you so much for spending a little bit of time with us. S.A.: Thank you for having me again, like, super awesome.
The guys open the show with a discussion of the Netflix original Unicorn Store. Jeff reviews Bad to the Bone by Nicki Bennett. Will reviews LaQuette’s Under His Protection. Jeff & Will interview LaQuette about Under His Protection. They find out about the story’s inspiration and how it ties into LaQuette’s other series. LaQuette also shares details on her upcoming Harlem Heat series, what got her started writing romance and details about what she does as the president for New York City’s Romance Writers of America chapter. Complete shownotes for episode 184 are at BigGayFictionPodcast.com. Book Reviews from this week: Bad to the Bone by Nicki Bennett. Reviewed by Jeff Bad to the Bone turned out to be one of those perfect Dreamspun Desires for me. I’m a sucker for second chance romance combined with friends to lovers and this one adds in a bit from the redeemed bad boy trope as well. It all combined to give me exactly the read that I needed. The story kicks off on the eve of a high school reunion taking place in a small Oklahoma town. Alex Morrison has been back in town for several years, taking over his family’s hardware store when his parents needed him to. One afternoon, while working with his sister at the store, they witness a motorcyclist pulled over and it’s soon revealed that the man is Alex’s high school bestie, Ricky Lee Jennings. Alex hasn’t heard from Ricky Lee since he was expelled and sent away to reform school. Alex regretted he didn’t defend Ricky Lee and prevent the expulsion, but he was scared he’d lose his football scholarship if he did. Sparks fly at the reunion when Ricky Lee shows up without a ticket and Alex gets him in as his guest. What unfolds over the coming weeks is the rekindling of far more than a friendship. Nicki does so much with this rather simple set up. Both characters complexity made me love this book so much. Alex is someone I wanted to wrap up in a comforting hug. He does so much for the community that he lives in between serving on the library board, working for Habitat for Humanity, helping out with the high school reunion committee, and anything else he can do to help his fellow citizens. Yet, all he can see in himself is failure from a lost college football career because of an injury, a failed marriage, and even coming back to manage his family business is something he considers a fail because he gave up his dreams of being an environmental lobbyist. Of course, what he’s done is made the decisions that are right in the moment but he can’t see that. Ricky Lee, on the other hand, subverts every stereotype the town has for him. It’s awesome to watch as people who believe they know exactly who he is after ten years begin to see who he has become. He’s far from the young man who was abused by his alcoholic father and just wanted to survive high school. As both relive their high school times and share what they are doing now, Ricky Lee and Alex are drawn back together. Alex, however, is sure this can’t be more than a fling. He’s scared of revealing himself as bisexual to the town and there’s no way Ricky Lee will move back to Oklahoma since he’s got a life in Portland. The wooing that Ricky Lee does with Alex is outstanding. I love a good date and their weekend trip to Oklahoma City is all that. They stay at a boutique hotel, go to art museums and the botanical gardens and eat delicious food. The sizzling sex made the date all the hotter. It showed Alex in vivid detail what life could be like in if he decides to make a go of it with Ricky Lee. The other depth that Nikki weaves into this book is the town Alex lives in. In particular, I liked the local pastor, who is nothing like what you might expect a southern pastor to be. He turns out to be one of Alex’s biggest supporters in being true to himself. We also see Alex’s work with the library, which is a central subplot for the story since Alex and Ricky Lee’s high school nemesis, Odell, who wants to expand his car dealership by buying the land the library sits on. The goings-on with Odell took some wonderful turns that I couldn’t have predicted and I might’ve cheered just a little when everything was revealed and [spoiler alert] Odell gets his. It’s a great ending for a high school bully. There’s a tremendous cast of supporting characters too. Alex’s sister Alana and his best friend, local police officer Samantha, a.k.a. Sam, both nudge Alex in the right direction. Ricky Lee comes to town with Crae, who he introduces as his friend and assistant although many initially think they are in a relationship. I actually wish Crae had had more screen time in the book as they were a fascinating character. Crae and Sam develop a friendship that might be more and I’d love to see a book that explores that. There are also some townsfolk who have interesting reveals to Alex along the way that were incredibly sweet. And if audio is your thing, certainly pick this one up. Colin Darcy is a new-to-me-narrator and boy did he make me swoon with his voice for Ricky Lee–deep, rumbly sexiness. If you’re looking for a great category romance with some very tropey goodness, I highly recommend Nicki Bennett’s Bad to the Bone. Under His Protection by LaQuette. Reviewed by Will. This book literally starts with a bang when one of our main characters, assistant DA Camden, is nearly blown up by a car bomb. In order to keep him safe, he’s put in protective police custody. Unfortunately, the man watching over him is the memorable one night stand he walked away from five years ago, a guy named Elisha. Sequestered away in Elisha’s Westchester house, our two heroes must come to grips with the attraction that still, after all this time, is still there. As things start to become more romantic, the situation becomes even more complicated when Elisha’s family shows up for a weekend visit. They assume that the two of them are a couple and Cam and Elijah play along since it’s too dangerous to explain why Cam is hiding out at Elijah’s house. Over the course of the weekend Cam can’t help but fall for Elisha and his wonderfully crazy family. You might think things get a little too close for comfort with are two heroes and the family all in one house. Elisha actually has a very small apartment in his attached garage. They escape there every once in a while, for some truly superduper scorching sex. The chemistry between these characters is very real and very palatable. As the weekend winds down, there’s an unfortunate kidnapping attempt by this crazy religious group and Cam sacrifices himself in order to save Elisha’s mom. Camden ends up in hospital and, unfortunately, his father arrives on the scene. Camden’s life has essentially been controlled by his father, who’s had his son’s life planned out from my birth to death. It’s essentially how Cam has lived his entire life. The expectations of his father are actually part of the reason why he walked away from Elisha five years ago. Having a sexy one night fling and living a life with an average guy like Elisha just wasn’t in the plan. After experiencing the possibility of loving a man like Elisha and realizing the wonderful possibilities of a fun and fulfilling family life, he tries to stand up to his father. Cam’s father puts a stop to everything, setting up some genuinely insurmountable roadblocks to our hero’s happiness. But Cam and Elisha are not only charismatic and sexy, but also really super smart. With the help of Elisha’s police chief friend, Cam concocts a way to outwit his father and get out from under his thumb, so he Elisha can live happily ever after. I don’t know if I can adequately find the correct words, or enough adjectives to tell you how much I loved Cam and Elisha’s story. It’s just really damn good. One of my favorites of 2019 so far! I hope it’s obvious that I really enjoyed Under His Protection by LaQuette and I highly recommend that everyone give it a read. Interview Transcript - LaQuetteWill: We are so pleased to welcome LaQuette to the show. Welcome. LaQuette: Thank you. Will: So I just spent several minutes praising and telling the entire world how much I loved "Under His Protection." Now, you've been writing for a while now, and I freely admit this is the very first book of yours that I have read, and I went absolutely bonkers for it. I love it to pieces. LaQuette: Oh, thank you. Will: Can you give us sort of an idea of where the concept for "Under His Protection" came from? LaQuette: Well, I was encouraged by Kate McMurray to submit a "Dreamspun Desires" concept. And I kind of read the submission guideline, and I really didn't think that the category section was for me, because I'm long-winded in my writing and there's this, you know, 50,000-word count, and I didn't know that I could meet that and make the story make sense. But I just felt like, you know, there's a lot of angst in my writing and a lot of heavy topics sometimes. And I didn't... You know, category can be light and, you know, it doesn't have so much angst to it, so I wasn't sure if it was actually the right fit for me. But she encouraged me to do it anyway. So I thought, "Well, if I'm gonna do it, it has to be, like, LaQuette style. It can't be, you know, the traditional map of a category. I've gotta throw, you know, everything but the kitchen sink in it." And I had this sort of, like, this Prince and Pauper sort of situation in my head, but in Brooklyn. And it worked out really well in my head anyway. I really enjoy the idea of Camden coming from this really, really posh existence, and then clashing with Elijah and his very loud and boisterous family. And, I think, putting those two people together and those two, you know, with their backgrounds and differences in their backgrounds and the differences in their, you know, perspectives in life, it really...it just made for a richer experience for me, as a writer. Will: I utterly fell in love with Camden and Elijah. I think they're two incredibly...they are exceptional heroes, and they're part of what makes this book really sing. But as I mentioned in my review just a few minutes ago, part of what, I think, what makes the story compelling and even more enjoyable is the sort of supporting cast that helps them along in their journey towards saying, "I love you." Elijah's family is amazing, every single one of them. But I was particularly struck by one of Elijah's co-workers, the police chief, who is his best friend, along with, you know, being a colleague. And what I was struck by is that at the beginning of the book, the character seemed, you know, pretty, you know, straightforward, it was a secondary character, and she was there to kind of like, you know, get the story moving along. But as we read further and get to know Camden and Elijah more and more, she becomes a much more integral part of the story. And in fact, she's pretty vital to the solution that Cam comes up towards the end. And I was really surprised to read in an interviewer just, I think, this last week it appeared online. I learned that one of the reasons that this secondary character is so well-drawn is because she's actually already had her own book. LaQuette: She's had three books, actually. Will: Can you tell us real quickly, for our listeners, can you tell us about the origin of this particular character and why you thought she would be such a good fit for Camden and Elijah's story? LaQuette: Captain Heart Searlington is a character from my "Queens of Kings" series, which is all heroine-centered. And she is this...you know, her name is Heart for a reason, because she has a huge heart, even though she really carries it under this gruff exterior. She's a badass, she's all about getting work done. And if you ever get the chance to read her books, you know, she's really out there hands-on in the street. And I felt like Elijah would need someone like that, professionally and personally, to kind of...to get him to the place where he could admit his flaws. Someone that's not... You know, he's a very...he's a large man, he's aggressive, you know, he carries a gun, so he could be a little bit intimidating for the average person. But for her, she's not afraid to tell him like it is to his face. And, you know, when you have that kind of a personality where people might not tell your truth because they find you imposing, having someone who will speak the truth to you, regardless of whatever the situation is, can be vital to you, you know, making the right choices in life. And I felt like having her there would give him that balance, because he needed some really cold truths told to him, for him to get his head together and do what he needed to do. Jeff: Was it always your intention to have the character crossover or did that just kind of manifest itself? LaQuette: Well, the precinct that they work at is sort of anytime I have a police situation, those cops show up in a book somewhere. So one, because, you know, the world is already created, so it's kind of easy for me to draw from that precinct, but it's also because my readers absolutely adore this woman. And so they're always asking for her, and this was an opportunity for her to show up and say, "Hi." And not in a way that overshadows, you know, the main story, which is Camden and Elijah, but just enough to make readers go, "Oh, my God. She's here." Jeff: It's always good to get those universe crossovers and little Easter eggs like that, for sure. LaQuette: It's true. It's very true. Will: Yeah. Now, "Under His Protection" is not your first M/M romance. LaQuette: No, it is not. Will: There's also "Love's Changes," which I believe came out in 2016? LaQuette: Yes. Will: And I wanted to ask you, what drew you to writing in this specific subgenre? I mean, along with all of your other books that are more traditional male/female romances? LaQuette: Well, one, I wholeheartedly believe that everyone deserves a happy ending. And when I wrote the "Queens of King" series, I always knew that Heart's cousin, because the characters, the protagonists in "Love's Changes" are Bryan, who is one of Heart's lieutenants, you met him, actually, in "Under His Protection," and her cousin, Justice. And so they get to have their own story. You get to see them a little bit in the "Queens of King" series, but they're more background. We know that they were having a hard time and they were broken up for some reason, but we don't know why. So they get, you know, readers... Which really surprised me because I didn't really believe that there was a lot of crossover between male-female readers and male-male readers. But people really asked me for a story for those two. Like, "When are we gonna get Justice and Bryan's story? We wanna know what happens to them and how they get back together." And so I that story was actually born out of the fact that readers requested it, and so I gave it to them. Jeff: That's very cool. You know, it's always nice to see as the M/F readers catch the male-male pairing to then want to know more. LaQuette: Yes, it was really a trip for me. I did not believe that they would want it at all. But it was very touching to write their story. I was very happy with how the story turned out. I was very happy with the fact that they get their happily ever after. And it's not...it's connected to the "Queens of Kings" series, but it's not really part of it. So the story kind of takes place outside of everything that's going on in that particular story. Jeff: Do you envision more, I guess, "Dreamspun Desires" books that happened in the universe you've created with everything that's going on so far? LaQuette: I really didn't, but I've been getting a lot of mail recently about this book. And, you know, people wanting to know what happens after this. They wanna see how Camden's family kind of blends with Elijah's family and how that's going to work. I'm like, "Dude, I'm not there. Like, I have so many other projects. I can't right now. But we'll come back to that maybe." Jeff: Just based on your review, I don't see how those families mesh. Will: Two different worlds. Most definitely, yeah. LaQuette: They really are. Jeff: Now, one of the things that I'm super excited about, having recently read about, is your new contract with Dreamspinner for "Harlem Heat." LaQuette: Yes, "Harlem Heat," so when stuff makes me mad, it also makes me really productive. So I was really kind of getting tired of hearing the "not historically accurate moniker" criticism given to African-American romance, especially historical African-American romance. And it just bothered me because it's not that those happily-ever-afters weren't possible. It's just people aren't really aware of the completed history. So a lot of thing...you know, a lot of people who think they know about African-American history, the only thing they know is slavery and Jim Crow, and that's it. And, you know, black people have been downtrodden since we were brought to this country. But that's not exactly the truth because even in all of the horror, there were still moments of triumph. And we didn't just, you know, survive, we thrived. We're still here, the proof that we're still here, you know, the proof that we had happiness at some point is that we're still here. So I decided I wanted to write about a time that was where to be black and to be gay wasn't something that you had to hide from the world. It wasn't something you had to...you had your own pocket of community. There was a celebration of it. And I wanted to speak to that. I wanted people to know that these two intersections of life existed with happy endings. Jeff: And this series, in particular, is gonna go to such an interesting time period in the U.S. when all of the Harlem Renaissance was happening. LaQuette: Yeah, so it's based on three actual people who lived during the Harlem Renaissance. So it's based on Bumpy Johnson, who was the godfather of Harlem for 30 years. It's based on Langston Hughes, who was a great contributor to the Harlem Renaissance as a poet and writer. And it's also based on Cab Calloway, who was sort of one of the most notable faces in jazz and jazz music and jazz performance at the Cotton Club. So we're gonna see... we won't be using their names, but those characters will be based off of those actual people. Will: Yeah, because it was...I think it was like mere moments after I finished reading "Under His Protection." I read about this Harlem Renaissance series that you were doing, and I like lost my mind. I was like, totally doing a happy dance. This is going to be so amazing. I know this is still far in the future. But when do you think we can expect this series? LaQuette: I don't know. And that's the God's honest truth. I'm actually currently writing, finishing up the series for Sourcebooks. And so "Harlem Heat" doesn't...I don't think I'm projected to start it until like the end of the year. So I don't know exactly when it's going to be ready. But I mean, you know, ready for the world anyway. But I think I can talk to someone about getting you a beta read...a copy for beta reading if you'd like. Jeff: Please do. Yes. Will: That would be amazing. Jeff: I imagine the research for that got to be a lot of fun to look at that period in history and figure out what parts you wanna take and use. LaQuette: It is. I mean, I was very fortunate when I was in college. When I did my undergrad in creative writing. I was very fortunate to have a professor who thought outside of the box, and he taught a class on Harlem Renaissance. That was amazing. I mean, it was so rich and filled with culture. And you know, not just the usual things that we see in mainstream history but, you know, getting really down to the nitty-gritty of it. And you know, showing you to...I'm sure that when you when you guys, as gay men, look at the history of the LGBT community, and you get to see it unfold, there's such a moment of connection there. And it's the same thing for black people when we're getting to experience our history because we don't often get to see it through mainstream lens. And so to see it and to see the information dispensed in a way that's positive and celebratory and uplifting, it changes your whole perception of yourself, of who you are and where you came from. And so I'm delighted to be able to dig back into that. I have Piper Huguley, who is a history professor at Spelman College. I believe it's Spelman. And she's also a romance writer, and she's brilliant. So she helps me with a great deal with telling me what books I need to read for this period, and where I need to look for information. But it's so much fun. It really is so much fun. Jeff: That's amazing. Let's talk origin story for a minute. How did you get started writing romance? What led you down this path? LaQuette: I didn't see me on the page. I started reading romance when I was about 16 years old. Way too young to be reading some of the stuff I was reading, but you know, hey. And by the time I was about 18, I probably went through every "Harlequin Presents" that my local library had. And every romance novel I read, it was never about a girl that looked like me, never about places where I lived. So it kind of pulled me out of the romance reading for a while because it was nice to read about those stories, but there was just something missing for me after a while. And I probably, at the time, didn't recognize that I was internalizing that these stories were basically saying, "Romance isn't for you. You don't look like this. You don't fit this mold, so romance isn't for you." And I kind of just pulled away from it. And I think after I finished my undergrad, I just wanted to relax and have some fun and I kind of got back into it. And at the time, I discovered black romance was a thing. And I discovered people like Rochelle Alers, and Brenda Jackson, and Zane. And I'm like, "Wow." Like, it became exciting again. It was refreshing. It was new and yet still very familiar because I could see myself in all of the antics that were going in these stories. I could see myself in those characters. And so I decided I wanted to do that. I wanted to create those spaces, create more stories like that so people could have those connections in reality, you know, reactions when they opened up a book and saw themselves. Jeff: Now that you are writing, what do you think the trademarks of your books are? LaQuette: I do sex and snark really well. Like, I do sarcasm really well because that's my language. It really is my language, and sex, yeah, that's so if you're gonna pick up a LaQuette book, you're going to get lots of sex and lots of sarcasm. Jeff: Did she meet those two in your book? Will: Oh, yeah. Just before we started this interview, we were talking about the possibilities of an audiobook for "Under His Protection." And whatever narrator lands this job is going to, number one, have the time of their life, because Camden and Elijah are very...the banter is very smart and very witty. But also, as you say, the sex scenes are...I'm not even sure what the correct adjective is. It's smoking hot. Yeah, you're gonna need a nice cool beverage after you listen to those scenes, for sure. LaQuette: I don't know that I could listen to that. I don't know that I could. It would be so weird for me. I don't know. I mean, I know I wrote the words, but to hear them aloud, I don't know that I could do that. Will: Exactly. Yeah. Jeff: Yeah, I know, you know, many authors can't listen to their own audio books. LaQuette: Especially those parts. Like I said, I do sex. Amy Lane told me, she was like, "You write sex in such a beautiful concrete way. Like, I just wanna have all the facts when I read your books." I'm like, "Amy, that is the sweetest and weirdest thing that anyone has ever said to me, and I love you for it." Jeff: That almost should be a blurb on the book cover or something. Will: Yeah. Yeah, definitely. Jeff: Is there anything you're reading right now that you wanna shout out to people as like a book to grab? LaQuette: Oh, I'm reading a few books. So I just finished Adriana Herrera's...the third book in this "Dreamer" series, and I can't remember the title because it's not actually out yet. I beta read for her, and it is fantastic. I mean, book one is great and I love it. It was so real to me that literally, I had to drive like two to three miles from my house just to go get Dominican food, because I was so hungry after reading book one. Will: Exactly. Yes. Yeah. LaQuette: And book three does the same thing. There's lots of cultural food. And it's part of the tapestry of how these two people connect and share their backgrounds, their experiences, their worldviews. And not to mention, she's so good at writing books that are socially conscious without making you feel like you're being talked down to or preached at, and I love her for that, for being... I don't know that I could do that the way she does it. She's so talented. And I'm also reading...I'm halfway through...I stumble with her name because I know her as Blue Sapphire, but she's now writing as Royal Blue for Dreamspinner, "Kyle's Reveal." Will: Yeah, I've heard of this book, yeah. LaQuette: And I'm halfway through it. And, you know, she's fire, like, she writes hot books. So I'm really excited. I can't wait to get to the end of this book. Will: What was the name of that book again? LaQuette: "Kyle's Reveal." Will: Okay. And that's the...please remind me, is the basketball book, is that correct? LaQuette: Yes. Will: Okay, yes. LaQuette: I mean, it's kind of dark because the protagonists have like a really dark traumatic history. But it's definitely deep and I'm loving it. So I'm really, really, really interested in getting to the end to see if I could just get a minute to stop writing and finish it, I'd be great. Will: Awesome. Jeff: It's such a hard thing balancing. LaQuette: It is. Jeff: "I wanna to finish this book." Then it's like, "I don't wanna read it too fast." LaQuette: Exactly. Jeff: Finding that balance. LaQuette: It's true. Jeff: Are there tropes or genres that you wanna tackle that you just haven't yet in your own writing? LaQuette: I don't know that there are any tropes, because I kind of...I throw a lot of different tropes in my books. Like, "Under His Protection" has second chance romance, it also has proximity, it also has sort of kind of enemies to lovers the way Elijah and Camden started out in the book. And it could sort of kind of be considered like a workplace romance being that they're both involved in different sides of law enforcement. But I don't know. I mean, I've done secret baby before and I love that. That was really fun. And I've done...the only thing I haven't done is like May-December romances. So I think maybe that might be something I'd might want to try. Jeff: Cool. I would read that. I love a good May-December. Absolutely. So beyond the writing, which obviously takes up a lot of time, you also are the president of RWANYC. So the New York City chapter of Romance Writers of America. Tell folks what that entails and what actually led you to running for office. LaQuette: I didn't wanna run. I had no intention of running because I have a lot of stuff to do. And it takes time away from the things that I'm contracted to do. But one of the things that's very important in romance that's happening right now is the fact that romance can be a very whitewashed world, meaning the protagonists that we see, the authors that get the most opportunities are white authors and white characters. And so if you're not white... and straight characters. If you're not writing that, it's difficult to get into the door, it's difficult to find the same resources, the same backing. It's almost impossible to get contracts. And so I ran for president of RWANYC because I wanted, in some way, to help change that landscape, to do some of the work necessary with publishers to try to change that. And it's a heavy task, it's a heavy burden, especially when we get, you know, over the last couple of weeks, we are still reeling from the RITA Awards, which is basically like the Grammys for romance. And every year, it's the same thing. It's a very, very white landscape, and very few authors of color are made finalist. No black woman has ever won a RITA in the 30 years that this award has been established. And people do a lot of mental acrobatics to justify why that is. So "Oh, maybe the writing is just not that good. Maybe that's why we've never had a black RITA award winner. Maybe black authors are not entering." You know, these are also questions that are ridiculous, because statistically, it's just impossible that no black woman would ever have won in 30 years. It's just impossible. And the reason it is, is because the judging pool, there's a bias there in terms of black women and black characters, not just black authors, but black characters. Because you cannot know who the author is, but you cannot...well, I don't write characters who are racially ambiguous. I'm proud of my blackness and my characters are as well. And so I don't try to hide that or trick people into reading my books, or make it so difficult for people to recognize who a person is or what their background is because I feel like that is an important thing. In real life, we don't really get to not know who people are by looking at them. So I don't do it in my books. And because of that, it's very difficult when you know, going into this, "I'm gonna submit this book, and it's not going to final," not because it's a poorly written book, not because I didn't do everything I could to make this book as good as it could be, but simply because my characters, especially my heroines are black. And that is just something that the judging pool cannot handle as of yet. So my work as president is a lot of, you know, being the champion for this cause and taking on this battle because it's not just about me succeeding, it's about any black author who was writing black characters having the ability to write and be supported by the industry. And if I can make any sort of headway in that and if I can help anyone along the way, I'll feel like I've done something positive with my life. Will: With books like yours, and with Adriana Herrera, who you mentioned not too long ago, do you think it's really just a matter of representation that can help build awareness for diversity in romance or is there something else that readers, specifically, should be doing or asking for? LaQuette: Well, specifically, yeah. I mean, readers have a lot of power. So if you're asking publishers, you know, "Why don't we have more diverse romance? Why don't we have romance where...you know, that shows basically the colors of the rainbow and all those brilliant facets of intersectionality in life, like, why don't we have that?" Because your buying dollars is what demands, what makes the demand. Because publishers will say, "We don't sell that. We don't contract black books because they don't sell." One of the things we discussed at Dreamspinner was the cover. That was an intentional choice. I was very clear with them when we sat down and talked about this project that Elijah needed to be on the cover. I would not subscribe to the ideology that a black man on the cover can't sell. And there are...I mean, we've seen in our writing community that some publishing houses have actually made this statement. I don't subscribe to that. So we talked about it. And then we talked about the fact that readership sometimes can have a bias. And sometimes they won't engage with the book if they feel like the person is the wrong color or wrong background. And I said, "I understand that, but we're still gonna work...you know, to work with me, this is how we're gonna work." And they were in agreement. I didn't have to convince them. I went in prepared to battle. And it was like, "Listen, I really need this guy to be black and I really need him to look like this." And they were like, "We agree. We agree." So we need more of that in the industry. And it starts with readers. It also starts with the gatekeepers. People reaching out and specifically looking for these things. It also, people who are gatekeepers also need to check themselves. So when you're reading a book and you're saying, "I can't connect to it. I didn't relate to it." Why aren't you relating to it? Is it that it's a poorly written book? I've gotten rejection letters that literally said, "This is a really well-written book, but I didn't relate to the character, so I'm not gonna buy it." That doesn't really make a lot of sense, right? So what was it that you didn't relate to? If you could see that it was a really well-written book, I mean, if it's that good, why not work with me in terms of editing to kind of get things right, you know, to where it would be something that you feel is that you could sell. But a lot of publishing houses out there don't have that mentality. And it's this sort of...it's insidious. It's not something, you know, you can actually like, look and see. Some people don't even notice it. They just think, "Oh, I don't read those kinds of books because I don't like them." And it's not that they don't like them, it's that they've not actually giving them the opportunity to be great. Jeff: So that is, obviously, great words for the readers. Kind of spinning it back to your RWA role, you're in such a diverse chapter there because you're in NYC. LaQuette: Yeah. Jeff: How are the authors in that particular region banding together to like help RWA move past the issues? LaQuette: Oh, well, a lot of my recent successes, because, you know, allies, colleagues like Kate McMurray and Tere Michaels, are like, "Listen, you're fabulous, and we want you to meet people who will also think you're fabulous. So come here." And that's part of the beauty of RWA, and that's why I fight so hard for diversity and inclusion within RWA, because my success, as I said, my recent success has all been attached to people pushing me in different directions to say, "This is where you need to be. This is the person you need to meet." And if you're not a part of the organization, you can't make those connections. And networking connections will get you further than anything you know, right? So when we cut off authors of color from that source, from the resources, from the networking connections, and the opportunities that are presented to people who are part of the organization, what we're doing is we're disconnecting them from publishing. And we're forcing them to be indie. And this is not an indie versus trad conversation. This is... some people cannot be anything other than indie, because trad will not give them the opportunity. They've been completely marginalized. And so that should not be. People should be able to publish however they choose to, whether they up to be an indie author or whether they decide that the trad route is for them, because, you know, different strokes for different folks. It is different, you know, depending on what your lifestyle is like. I have crazy children and I have to juggle being a mom, a writer, and everything else and try to keep sane. Being an indie author is a lot of work. It's a lot of effort on your end to make a book successful. I don't have that kind of time in my life, or that kind of energy, honestly. So being a trad author is a much better avenue for me and my situation. And if that is the only way that I can publish, but publishing will not give me the opportunities, then it's, you know, I'm losing out. And that's the purpose of RWA to sort of bridge those gaps. But I don't think we're exactly where we need to be yet. So we're still working on it. Will: Yeah, definitely. Jeff: We very much appreciate your efforts towards that, for sure. Will: Now, the Romance Writers of America National Conference is going to be in NYC this summer. LaQuette: Absolutely. Will: And I expect you're going to be there. LaQuette: Oh, yeah. I wouldn't miss it for the world. Will: Yeah, we're actually making a trip for the first time this year as well. LaQuette: Yay. Will: So hopefully we will... I know it's gonna be crazy busy. But hopefully, we're gonna get a chance to say hi in person. LaQuette: It is. Absolutely. Jeff: For sure. Now, we talked about "Harlem Heat." You mentioned a couple other things. What is on your docket for the rest of this year for releases? LaQuette: I don't think I have any other releases this year because I'm writing. So I've been very blessed in that I have landed these two major contracts with Sourcebooks and with Dreamspinner, both for series. So I'm halfway through Source's books. And I need to start on Dreamspinner's toward the end of the year. So there won't be any more releases from me. I mean, if I get a moment where I'm, you know, feeling really creative, I might try to get a novella together. But I'm not making any promises. Jeff: All right, so we'll look for a lot more in 2020, for sure. LaQuette: Yeah, 2020 is definitely...the first book for Source comes out in 2020. I don't have a release date yet. I have delivery dates for Dreamspinner, but I don't have release dates yet. So I'm thinking probably sometime toward the end of 2020, possibly, or maybe the beginning of 2021. Jeff: All right. Well, when "Harlem Heat" comes out, you definitely have an invitation to come back and talk, for sure. LaQuette: Oh, yay. Thank you. Jeff: Now what's the best way for everybody to keep up with you online? LaQuette: Oh, so you can find me on Facebook at, you know, my Facebook page, LaQuettetheAuthor. You can find me on Twitter @LaQuetteWrites, or you can find me on Instagram at la_quette, or you can email me at laquette@laquette.com, or you can go to my website laquette.com. Will: Fantastic. Jeff: She's well branded, and everything is the same. Will: Most definitely. Well, LaQuette, it was a genuine honor to have you on the show today. LaQuette: Oh, thank you. Will: We're so glad that you could take some time out of your extremely busy schedule that you can come talk to us. LaQuette: Thank you for having me. I mean, I was so excited and a little bit nervous also, to come on and talk to you guys because I've seen the show before. And I'm like, "Yay, I get to go hang out with them. I feel special." Will: Well, it is a genuine pleasure. We're so glad that you came. LaQuette: Thank you so very much for having me.
Show Notes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re moving from the trauma bay back to a more private setting, to discuss Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases. Nachi: And for those of you who follow along with the print issue and might be reading in a public place, this issue has a few images that might not be ideal for wandering eyes. Jeff: I’d say we need a “not safe for work” label on this episode, though I think we are one of the unique workplaces where this is actually quite safe. Nachi: And we’re obviously pushing for “safe” practices this month. The article was authored by Dr. Pfenning-Bass and Dr. Bridges from the University of South Carolina School of medicine. It was edited by Dr. Borhart of Georgetown University and Dr. Castellone of Eastern Connecticut Health Network. Jeff: Thanks, team for this deep dive. Nachi: STDs or STIs are incredibly common and often under recognized by both the public and health care providers. Jeff: In addition, the rates of STDs in the US continue to rise, partly due to the fact that many patients have minimal to no symptoms, leading to unknowing rapid spread and an estimated 20 million new STDs diagnosed each year. Treating these 20 million cases amounts to a whopping $16 billion dollars worth of care annually. Nachi: 20 million! Kinda scary if you step back and think about it. Jeff: Definitely, perhaps even more scary, undiagnosed and untreated STDs can lead to infertility, ectopic pregnancies, spontaneous abortions, chronic pelvic pain and chronic infections. On top of this, there is also growing antibiotic resistance, making treatment more difficult. Nachi: All the more reason we need evidence based guidelines, which our team from South Carolina has nicely laid out after reviewing 107 references dating back to 1990, as well as guidelines from the CDC and the national guideline clearinghouse. Jeff: Alright, so let’s start with some basics: pathophysiology, prehospital care, and the H&P. STDs are caused by bacteria, viruses, or parasites that are transmitted vaginally, anally, or orally during sexual contact, or passed from a mother to her baby during delivery and breastfeeding. Nachi: In terms of prehospital care, first, make sure you are practicing proper precautions and don appropriate personal protective equipment to eliminate or reduce the chance of bloodborne and infectious disease exposure. In those with concern for possible sexual assault, consider transport to facilities capable of performing these sensitive exams. Jeff: As in many of the prehospital sections we have covered -- a destination consult could be very appropriate here if you’re unsure of the assault capabilities at your closest ER. Nachi: And in such circumstances, though patient care comes first, make sure to balance medical stabilization with the need to protect evidence. Jeff: Exactly. Moving on to the ED… The history and physical should be conducted in a private setting. For the exam, have a chaperone present, whose name you can document. The “5 Ps” are a helpful starting point for your history: partners, practices, prevention of pregnancy, protection from STDs, and past STDs. Nachi: 5 p’s, I actually haven’t heard this mnemonic before, but I like it and will certainly incorporate it into my practice. Again, the 5 p’s stand for: partners, practices, prevention of pregnancy, protection from STDs, and past STDs. After you have gathered all of your information, make sure to end with an open ended question like “Is there anything else about your sexual practices that I need to know?” Jeff: Though some of the information and even the history gathering may make you or the patient somewhat uncomfortable, it’s essential. Multiple partners, anonymous partners, and no condom use all increase the risk of multiple infections. Try to create a rapport that is comfortable and open for your patient to provide as much detail as they can. Nachi: And as with any infectious work up, tachycardia, hypotension, and fever should all raise the concern for possible sepsis. In your sepsis source differential, definitely consider PID in addition to the usual sources. As a mini plug for a prior issue, PID was actually covered in the December 2016 issue of Emergency Medicine Practice, in detail. Jeff: Getting back to the physical exam: though some question the utility of the pelvic exam as our diagnostics get better, the literature suggests the pelvic definitely still has a big role both in diagnosing and differentiating STDs and other pathology. Don’t skip this step when indicated. Nachi: Now that we have a broad overview, let’s talk about specific STDs, covering diagnosis, testing, and treatment. Jeff: If following along in the article, appendices 1, 2 and 3, list detailed physical exam findings for the STDs were going to discuss, while table 3 lists treatment options. A great resource to use while following along or as a reference during a clinical shift! Nachi: First up, let’s talk chlamydia, the most common bacterial cause of STDs, with 1.7 million reported infections in 2017. Most are asymptomatic, which increases spread, especially in young women. Jeff: Chlamydia trachomatis has a 2-3 day life cycle in which elementary bodies enter endocervical and urethral cells and replicate, eventually causing host cell wall rupture and further spread. Nachi: Though patients with chlamydia are often asymptomatic, cervicitis in women and urethritis in men are the most common presenting symptoms. Vaginal discharge is the most common exam finding followed by cervical ectropion, endocervical mucus, and easily induced bleeding. Other presenting symptoms include urinary frequency, dysuria, PID, or even Fitz-Hugh-Curtis syndrome, which is a PID induced perihepatitis. In men, epididymitis, prostatitis, and proctitis are all possible presenting symptoms also. Jeff: And of note, chlamydia can also cause both conjunctivitis and pharyngitis. Nachi: This article has a ton of helpful images. Check out figures 1 and 2 for some classic findings with chlamydial infections. Jeff: When testing for chlamydia, nucleic acid amplification is the test of choice as it has the highest sensitivity, 92% when tested from a first-catch urine sample vs. 97% from a vaginal sample. While these numbers are similar, and you’re gut may be to forego the pelvic exam, consider the pelvic exam to aid in the diagnosis of PID and to evaluate for cervicovaginal lesions or other concomitant stds. Nachi: Similarly, in men, the test of choice is also a nucleic acid amplification test, with a first catch urine preferred over a urethral swab. Jeff: And lastly, nucleic acid amplification is also the test of choice from rectal and oropharyngeal samples, though you need to check with your lab first as nucleic acid amplification is not technically cleared by the FDA for this indication. Nachi: Treatment for chlamydia is simple, 1g of azithromycin, or doxycycline 100 mg BID x 7 days. Fluoroquinolones are a second line treatment modality. Jeff: In pregnant women, chlamydia can lead to ectopic pregnancy, premature rupture of membranes, and premature delivery. The single 1g azithromycin dose is also safe and effective with amox 500 mg TID x 7 days as a second line. Pregnant women undergoing treatment should have a documented test-of cure 3-4 weeks after treatment. Nachi: Next up, we have gonorrhoeae, the gram-negative diplococci. Gonorrhea is the second most commonly reported STD, affecting 0.8% of women and 0.6% of men, with over 500,000 reported cases in 2017. Jeff: Gonorrhea attaches to epithelial cells, altering the surface structures leading to penetration, proliferation and eventual systemic dissemination. Nachi: Though some may be asymptomatic, women often present with cervicitis, vaginal pruritis, mucopurulent discharge, and a friable cervical mucosa, along with dysuria, frequency, pelvic pain and abnormal vaginal bleeding. Jeff: Men often present with epididymitis, urethritis, along with dysuria and mucopurulent discharge. Proctitis, pharyngitis, and conjunctivitis are all possible complications. Nachi: In it’s disseminated form, gonorrhea can lead to purulent arthritis, tenosynovitis, dermatitis, polyarthralgias, endocarditis, meningitis, and osteomyelitis. Jeff: In both men and women the test of choice for gonorrhea again is NAAT, with endocervical samples being preferred to urine samples due to higher sensitivity. In men, urethral and first catch urine samples have a sensitivity and specificity of greater than 97%. Nachi: And as with chlamydial samples, the FDA has not approved gonorrhea NAAT for rectal and oropharyngeal samples, but most labs are able to process these samples. Jeff: Yeah, definitely check before you go swabbing samples that cannot be run. Lastly, in regards to testing, though it won’t likely change your management in the moment, the CDC does recommend a gonococcal culture in cases of confirmed or suspected treatment failure Nachi: It’s also worth noting that although NAAT can be used in children, but culture is additionally preferred in all settings due to legal ramifications of sexual abuse. Jeff: It pains me just to think about how awful that is. Ugh. Moving on to treatment: when treating gonorrhea, the current recommendation is to treat both with cefitriaxone and azithro. 250 mg IM is the preferred dose, up from just 125 mg IM which was preferred dose two decades ago along with 1g of azithro. Nachi: And if ceftriaxone IM cannot be administered easily, 400 mg PO cefixime is the second line treatment of choice. If there is a documented cephalosporin allergy, PO gemifloxacin or gentamycin may be used. And for those with an azithomycin intolerance, a 7 day course of doxycycline may be substituted instead. Jeff: In pregnant women, gonococcal infections are associated with chorioamnionitis, premature rupture of membranes, preterm birth, low birth weight, and spontaneous abortions. Pregnant woman therefore should be treated with both ceftriaxone and azithro in the same manner as their non pregnant counterparts. Nachi: There is also one quick controversy to discuss here. Jeff: oh yeah, go on… Nachi: The CDC currently recommends the IM dose of ceftriaxone, not IV. And this is because of the depot effect. However, it’s unclear if this effect is in fact true, as IM and IV ceftriaxone levels measured in blood 24 hours later are similar. So if the patient has an IV already, should we just give the ceftriaxone IV instead of IM? Jeff: I think it is probably okay, but I’ll wait for a bit more research. For now, I would continue to stick with the CDC recommendation of IM as the correct route. Nachi: And with the continuing rise of STD’s and the public health and economic burden we are describing here, I think the IM route, which is known to be effective, should still be used -- until the CDC changes their recommendations. Next up we have the great imitator/masquerader, syphilis, caused by the spirochete Treponema pallidum. LIke the other STDs we’ve discussed so far, cases of syphilis are also on the rise with over 30k cases in 2017, a 10% increase from 2016. Jeff: Syphilis is spread via direct contact between open lesions and microscopic abrasions in the mucous membranes of vagina, anus, or oropharynx. The organism then disseminates via the lymphatics and blood stream. Nachi: Infection with syphilis comes in three stages. Primary syphilis is characterized by a single, painless lesion, or chancre, which occurs about 3 weeks after inoculation. 6-8 weeks later, secondary syphilis develops. This often presents with a rash, typically on the palms and soles of the feet, or with condyloma lata, or lymphadenopathy. Jeff: Tertiary syphilis doesn’t appear until about 20 years post infection and it includes gummatous lesions and cardiac involvement including aortic disease. Nachi: Patients at any stage may go long periods without any symptoms, which is known as latent syphilis. In addition, at any stage a patient may develop neurosyphilis, which can present with strokes, altered mental status, cranial nerve dysfunction, and tabes dorsalis. Jeff: In early syphilis, dark-field examination is the definitive method of detection, though this is impractical in the ED setting. There are, instead, 2 different algorithms to follow. The CDC traditional algorithm recommends a nontreponemal test like rapid plasma reagin or RPR or the venereal disease research lab test also called VDRL, followed by confirmational treponemal test (fluoresent treponemal antibody absorption or FTA-ABS or T pallidum passive agglutination also called TP-PA). More recently there has been a shift to the reverse sequence, with screening with a treponemal assay followed by a confirmatory nontreponemal assay. Nachi: The reason for the change is that there is an increased availability of rapid treponemal assays. And where available, the reverse sequence offers increased throughput and the ability to detect early primary syphilis better. The CDC, however, still recommends the traditional testing pathway -- that is nontreponemal tests first like RPR or VDRL, followed by treponemal tests like FTA-ABS or TP-PA. The article also notes that emergency clinicians should rely on clinical manifestations in addition to serologic testing, when determining whether to treat for syphilis. Jeff: For neurosyphilis, the CSF-VDRL test is highly specific but poorly sensitive. In cases of a negative CSF-VDRL but still with high clinical suspicion, consider a CSF FTA-ABS test, which has lower sensitivity, but is also highly specific and may catch the diagnosis. Nachi: Treatment for primary, secondary, and early latent syphilis is with 2.4 million units of Penicillin G IM. For ocular and neurosyphilis, treatment is with 18-24 million units of pen G IV every 4 hours or continuously for 10-14 days. In patients who have a penicillin allergy, skin testing and desensitization should be attempted rather than azithromycin due to concerns for resistance. Jeff: For pregnant women, PCN is the only proven therapy. Interestingly, there is some evidence to suggest that a second IM dose may be beneficial in treating primary and secondary syphilis in pregnancy though data are limited. Nachi: We also have to mention the Jarisch-Herxheimer reaction before moving on. This is a syndrome of fevers, chills, headache, myalgias, tachycardia, flushing and hypotension following high dose PCN treatment due to a massive release of endotoxins when the bacteria die. This typically occurs in the first 12 hours but can occur up to 24 hours after treatment. Treatment is supportive. Concern of this reaction should never delay PCN treatment!! Jeff: The next condition to discuss is Bacterial vaginosis, or BV, which, interestingly, is not always an STD. It is therefore critically important to choose your words wisely when speaking with a patient who has BV. Nachi: That is an important point that is worth repeating. BV is not always an STD. So what is BV? BV occurs when there is a decrease or absence of lactobacilli that help maintain the acidic pH of the vagina leading to an overgrowth of Gardnerella, bacteroides, ureaplasma and mycoplasma. BV does not occur in those who have never had intercourse and it may increase the risk of other STDs and HIV. Jeff: 50% of women with BV are asymptomatic, while the others will have a thin, grayish-white, homogeneous vaginal discharge with a fishy smell, along with pruritis. Nachi: To diagnose BV, most use the amsel criteria, which requires 3 of following 4: 1) a thin, milky, homogeneous vaginal discharge, 2) the release of a fishy odor before or after the addition of potassium hydroxide, 3) a vaginal pH > 4.5, and 4) the presence of clue cells in the vaginal fluid. These criteria are 90% sensitive and 77% specific, with clue cells being the most reliable predictor. Jeff: And for those of us without immediately available microscopy, you can make the diagnosis based on characteristic vaginal discharge alone. Treat with metronidazole, 500 mg BID for 7 days, metronidazole gel, or an intravaginal applicator for 5 days, with the intravagainal applicator being better tolerated than the oral equivalent Nachi: BV in pregnancy increases risk of preterm birth, chorioamnionitis, postpartum endometriitis and postcesarean wound infections. Pregnant patients are treated the same as nonpregnant or with 400 mg of clindamycin BID x 7 days. Jeff: Always nice when there is really only one treatment regimen across the board. And that will be a general theme for treatment options in pregnancy with a few exceptions. Nachi: Next up we have Granuloma inguinale, or donovanosis, which is caused by Klebsiella granulomatis. Jeff: Granuloma inguinale is endemic to India, the Caribbean, central australia, and southern africa. It is rarely diagnosed in the US. Nachi: Granuloma inguinale presents with highly vascular, ulcerative lesions on the genitals or perineum. They are typically painless and bleed easily. If disseminated, Granuloma inguinale can lead to intra-abdominal organ and bone lesions and elephantiasis-like swelling of the external genitalia. Jeff: Granuloma inguinale can can be diagnosed by microscopy from the surface debris of purulent ulcers. Nachi: Once you have the diagnosis, the CDC recommends treatment with azithromycin for at least 3 weeks and until all lesions have resolved. Jeff: Next we have lymphogramuloma venereum or LGV. Nachi: LGV is a C. Trachomatis infection of the lymphatics and lymph nodes. This is predominantly a disease of the tropics and subtropical areas of the world. Jeff: On exam, in the primary stage, you would expect a small, painless papule, pustule, nodule or ulcer on the coronal sulcus of the penis or on the posterior forchette, vulva, or cervix of women. The primary stage eventually progresses to the secondary stage, which is characterized by unilateral lymphadenopathy with fluctuant, painful lymph nodes known as buboes. Nachi: Check out figure 11 for a great classic image of the “groove sign” which is involvement of both the inguinal and femoral lymph nodes, and is seen in 15-20% of cases. And actually even more common than the groove sign is a presentation with proctitis. Jeff: Testing for LGV should be based on high clinical suspicion, and NAAT should be performed on a sample from the primary ulcer base or from aspirate from a bubo. Nachi: Treatment for LGV is with doxycycline 100 mg BID x 21 days. Jeff: So, to summarize, for LGV, remember painful lymphadenopathy, especially in those with proctitis. Treat with doxy. Nachi: Next we have Mycoplasma genitalium, which causes nongonococcal urethritis in men and mucopurulent cervicitis and PID in women. Jeff: Unfortunately, there is no diagnostic test for M. genitalium, and it should be considered clinically, especially in the setting of recurrent urethritis. Nachi: Treat with azithro, but not 1g x 1. Instead, M. Genitalium should be treated with a course of azithro, with 500 mg on day 1 followed by 250 mg daily for 4 days. Moxifloxacin is an alternative. Jeff: Simple enough. Moving on to everybody’s favorite, genital herpes. Nachi: umm, I’m not sure sure anybody would call herpes their favorite. Why would you even say that? Jeff: i don’t know, seemed natural at the time… Regardless, primary genital herpes is caused by either HSV1 or HSV2. Though only an estimate, and likely an underestimate at that, it is estimated that at least 1 in 6 people in the US between 14 and 49 have genital herpes. Nachi: That’s much higher than I would have thought. Jeff: Patients usually contract oral herpes from HSV-1 due to nonsexual contact with saliva and genital herpes due to sexual contact with an infected person. Nachi: Keep in mind, however, that HSV1 can and will also cause genital infections if spread via oral sex. Jeff: Localized symptoms include pain, itching, dysuria, and lymphadenopathy and systemic symptoms include fever, headache, and malaise. In women, look for herpetic vesicles on the external genitalia along with tender ulcers in areas of rupture, see figure 12 for a characteristic image. Nachi: Though symptoms tend to be more severe in woman, men may present with vesicles on the glans penis, penile shaft, scrotum, perianal area, and rectum or even with dysuria and penile discharge. Jeff: HSV1 and 2 infections also have the ability to recur, though recurrences tend to become less frequent and severe over time. Nachi: It’s noteworthy that there is also a direct correlation between stress levels and the severity of an HSV outbreak. Jeff: Herpes can be diagnosed by viral culture of an unroofed vesicle or by NAAT. PCR based assays can also differentiate between HSV1 and HSV2 Nachi: While there is no cure, antivirals may help prevent and shorten outbreaks. Ideally you should begin treatment within 72 hours of lesion appearance. Treat with acyclovir, valacyclovir, or famciclovir. In addition, don't forget about adjuncts like analgesia, sitz bathes, and urinary catheter placement for severe dysuria. Jeff: HSV can also be vertically transmitted from mother to child so in pregnancy, treat with acyclovir 400 mg 3x/day for 7 days or valacyclovir Nachi: And because transmission is so easy, babies born to mothers with active lesions should be delivered by cesarean section. Jeff: Let’s move on to human papillomavirus, or HPV. There are over 100 types of HPV with 40 being transmitted through skin to skin contact, typically via vaginal and anal intercourse. Nachi: Most infections are asymptomatic and clear within 2 years. Jeff: Right, but one of the main reasons this is such a big deal is that HPV types 16 and 18 are oncogenic strains and can lead to cervical, penile, vulvar, vaginal, anal, and oropharyngeal cancers. Amazingly, HPV is responsible for more than 95% of the cervical cancers in women. Nachi: Hence the importance of the new vaccine series that most young adults and children are now opting for. Vaccination should occur in women through age 26 or men through age 21 if not previously vaccinated. Jeff: Critically important to take advantage of a vaccine that can prevent cancer! Nachi: And though not as important in terms of health consequences, just be aware that HPV 6 and 11 may lead to anogenital warts, known as condyloma acuminata. Jeff: In terms of exam findings, as you just mentioned, most infections are asymptomatic and self-limited. If symptoms do develop, HPV typically causes those cauliflower like or white plaque like growths lesions on the external genitalia, perineum, and perianal skin. Nachi: For testing, there is a limited role in the ED. Diagnosis should be made by visual inspection, followed eventually by a biopsy. Jeff: And just like the biopsy, which is unlikely to be done in the emergency department, most treatment is also not ED based. Treatment options include cryotherapy, immune-based therapy, and surgical excision, which has both the highest success rates and lowest recurrence. Nachi: Next up, we have trichomoniasis. Jeff:Trichomoniasis is a single-celled, flagellated, anaerobic protozoa, that directly damages the epithelium, causing microulcerations in the vagina, urethra, and paraurethral glands. Nachi: With an estimated 3.7 million infected people in the US, this is something you’re also bound to see. Jeff: Risk factors include recent or current incarceration, IV drug use, and co-infection with BV. Nachi: Note the common theme here - co infection. It’s very common for patients to have more than one STD, so make sure not to anchor when you think you’ve nailed the diagnosis. Jeff: On exam the majority of both women and men are asymptomatic. In women, you may find a purulent, frothy vaginal discharge, vaginal odor, vulvovaginal irritation, itching, dyspareunia, and dysuria Nachi: And don’t forget about the classic colpitis macularis, or the strawberry cervix. Though this is frequently taught and stressed, it’s actually only seen in 2-5% of infected women. Jeff: But to be fair, a strawberry cervix and frothy vagianl discharge together have a specificity of 99% for trich, which is really not bad. Nachi: While many EDs sadly aren’t blessed with a wet mount, the wet mount has the advantage of being simple, convenient, and generally low cost. Jeff: While all of that is true regarding the wet mount, it’s no longer first line, again with NAAT being preferred, as it’s highly sensitive, approaching 100%. Nachi: And for those of us who don’t have access to NAAT, there are also antigen-detecting tests which don’t perform quite as well, but they are much more sensitive than the traditional wet mount. Jeff: Treatment for trichomoniasis is with oral metronidazole, 2g in a single oral dose a or 500 mg twice a day for 7 days. Alternatively, the more expensive tinidazole, 2g for 1 dose, is actually superior according to the most recent evidence. Nachi: For pregnant patients, trichomoniasis is unfortunately associated with premature delivery and premature rupture of membranes, with no improvement following treatment. Still, patients should be tested and treated, preferentially with metronidazole, to relieve symptoms and prevent partner spread. Jeff: We have two more special populations to discuss in this month’s issue - those in correctional facilities and sexual partner treatment. If you are lucky enough to be involved in treating those in correctional facilities, keep in mind that rates of gonorrhea, chlamydia, syphilis, and trichomoniasis are higher in persons in both juvenile and adult detention facilities than the general public. Nachi: In general for patients in correctional facilities, maintain a lower threshold for just about everything. This is just an at-risk population. Jeff: Let’s move on to sexual partners, and expedited partner therapy or EPT. Nachi: Once you’ve diagnosed a patient with an STD, you can also provide a prescription or medication to the patient to give to their partner or partners. Jeff: This practice is critically important to stop partners from unknowingly spreading the STD further which is a real problem. Unless prohibited by law, emergency clinicians should routinely offer EPT to patients with chlamydia, gonorrhea, or trichomoniasis. To see your states’ current status, the CDC maintains a list of the status in all 50 states. Nachi: In terms of specific partner therapies, for chlamydia, EPT can be accomplished with a single 1g dose of azithromycin or doxycyclin 100 mg bid for 7 days. Consider concurrent treatment for gonococcal infection also. Jeff: For Gonorrhea, EPT includes a single oral dose of 400 mg of cefixime and a 1g oral dose of azithromycin. Nachi: For EPT for syphilis, unfortunately the partner has to present to the ED for a single IM injection of penicillin G. While this does place a burden on the partner, it opens up an opportunity for additional serologic testing and possibly treatment of his or her partners as well. Jeff: Routine EPT for those with BV is not recommend as the data shows that partner treatment does not affect rates of relapse or recurrence. Nachi: For genital herpes, you should counsel patients and their partners that they should abstain from sexual activities when there are lesions or prodromal symptoms. Make sure to refer partners for evaluation as well. Jeff: Since there isn’t much data on HPV partner notification, for now, encourage patients to be open with their partners so they may seek treatment as well. Nachi: And lastly, for Trichomoniasis, EPT includes 2 g of metronidazole or 500 mg BID for 7 days or that single 2g dose of tinidazole. Jeff: In general, it is always better to have the partner present to a physician for diagnosis and treatment, but EPT is an option when that seems unlikely or impossible. Nachi: Also, when possible be sure to inquire about drug allergies and provide some guidelines on ER presentation for allergic reactions. Jeff: So that wraps up EPT. Let’s discuss disposition. Though most will end up going home, a few may require IV medications, such as those with severe HSV, disseminated gonococcus, and neurosyphilis. Nachi: Admission should also be strongly considered in those who are pregnant or with concern for complications. Those with severe nausea, vomiting, high fever, the inability to tolerate oral antibiotics, and those failing oral antibiotics should also be considered for admission. Jeff: But if your patient doesn’t meet those criteria, as most will not, and they are headed home, stress the importance of follow up. Especially for those with gonorrhea and chlamydia, for whom a test of cure after completion of their medication is recommended. This is even more important for pregnant women. Nachi: Chlamydia, gonorrhea, HIV, and syphilis are among the many infectious diseases that require mandatory reporting. Definitely familiarize yourself with your states’ reporting laws, as most of these patients will be headed home and you’ll want to make sure you don’t miss your chance to prevent further spread. Jeff: Perfect, so that’s it for this month’s issue. Let’s close out with some high yield points and clinical pearls. Nachi: STDs are under recognized by patients and healthcare professionals. They can often present with minimal or no symptoms and are passed unknowingly to partners. Jeff: STD’s can have devastating effects during pregnancy on the fetus. Treat these patients aggressively in the ER. Nachi: The rising rate of STD’s continues to be an economic burden on the U.S. healthcare system. Jeff: Patients can present with multiple STD’s concurrently. Avoid premature diagnostic closure and consider multiple simultaneous processes. Nachi: Urinary tract infections and STD’s can present similarly. Be sure to do a pelvic exam to avoid misdiagnosis. For the exam, always have a chaperone present. Jeff: Acute unilateral epididymitis is most commonly a result of chlamydia in men under the age of 35. Nachi: Chlamydia is the most common bacterial STD. The diagnostic test of choice is nucleic acid amplification testing (NAAT). Treat with azithromycin or doxycycline. Jeff: Gonorrhea is the second most common STD. The diagnostic test of choice here is again NAAT. Treat with ceftriaxone and azithromycin. Nachi: Gonorrhea can lead to disseminated infection such as purulent arthritis, tenosynovitis, dermatitis, polyarthralgias, endocarditis, meningitis, and osteomyelitis. Jeff: Syphilis has a wide variety of presentations over three stages. For concern of early syphilis, send RPR or VDRL for nontreponemal testing as well as an FTA-ABS or TP-PA for treponemal testing. Nachi: Tertiary syphilis can present with gummatous lesions or aortic disease many years after the primary syphilis infection. Jeff: At any stage of syphilis, the central nervous system can become infected, leading to neurosyphilis. Nachi: Bacterial vaginosis presents with a white, frothy, malodorous vaginal discharge. Treat with metronidazole. Jeff: Genital herpes is caused by HSV-1 or HSV-2. Diagnosis can often be made clinically. If sending a sample for testing, be aware that viral shedding is intermittent, so you may have a falsely negative result. Antivirals can help prevent or shorten outbreaks and decrease transmission. Nachi: Lymphogranuloma Venereum presents with small, painless papules, nodules, or ulcers. Groove sign is present in only 15%-20% of cases. Jeff: Consider Fitz-Hugh-Curtis syndrome in your differential for a sexually active patient with right upper quadrant pain. Nachi: Offer expedited partner therapy to all patients with STD’s to prevent further spread Jeff: So that wraps up Episode 27 - STDs in the ED! Incredibly high yield topic with lots of pearls. Nachi: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Jeff: I’ll repeat that, since saving money is important. APPs, use the promotion code APP4 at checkout to receive 50% off on your subscription. Speaking of PAs - for those of you attending the SEMPA conference in just a few weeks, make sure to check out the EB Medicine Booth, #302 for lots of good stuff. For those of you not attending the conference, just be jealous that your colleagues are hanging out in New Orleans. Nachi: And the address for this month’s credit is ebmedicine.net/E0419, so head over there to get your CME credit. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References 3. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(Rr- 03):1-137. (Expert guidelines/systematic review) 5. Torrone E, Papp J, Weinstock H. Prevalence of Chlamydia trachomatis genital infection among persons aged 14-39 years- -United States, 2007-2012. MMWR Morb Mortal Wkly Rep. 2014;63(38):834-838. (Expert guideline/systematic review) 98. Schillinger JA, Gorwitz R, Rietmeijer C, et al. The expedited partner therapy continuum: a conceptual framework to guide programmatic efforts to increase partner treatment. Sex Transm Dis. 2016;43(2 Suppl 1):S63-S75. (Systematic review; 42 articles) 103. Centers for Disease Control and Prevention. 2018 National Notifiable Conditions (Historical). National Notifiable Diseases Surveillance System (NNDSS). Accessed March 10, 2019. (CDC website) 105. Carter MW, Wu H, Cohen S, et al. Linkage and referral to HIV and other medical and social services: a focused literature review for sexually transmitted disease prevention and control programs. Sex Transm Dis. 2016;43(2 Suppl 1):S76-S82. (Systematic review; 33 studies)
The video game website Giant Bomb recently celebrated its tenth birthday so what better time to talk to its creator about the early days of the online games media, the future of games coverage, and getting fired in front of the entire world. iTunes Page: https://itunes.apple.com/us/podcast/noclip/id1385062988 RSS Feed: http://noclippodcast.libsyn.com/rssGoogle Play: https://play.google.com/music/listen?u=0#/ps/If7gz7uvqebg2qqlicxhay22qny Spotify: https://open.spotify.com/show/5XYk92ubrXpvPVk1lin4VB?si=JRAcPnlvQ0-YJWU9XiW9pg Soundcloud: https://soundcloud.com/noclippodcast Watch our docs: https://youtube.com/noclippodcast Sub our new podcast channel: https://www.youtube.com/channel/UCSHBlPhuCd1sDOdNANCwjrA Learn About Noclip: https://www.noclip.videoBecome a Patron and get early access to new episodes: https://www.patreon.com/noclip Follow @noclipvideo on Twitter Hosted by @dannyodwyerFunded by 4,638 Patrons. -------------------------------------------------------------- - [Danny] Hello and welcome to Noclip, the podcast about video games, the people who make them, and the people who play them. On today's episode we talk to a guy who grew up a short drive from the epicenter of the online media revolution. As video game website Giant Bomb recently celebrated its 10th year of operation, we decided to talk to its founder about skipping school, hosting podcasts, and getting fired in front of the entire world. Jeff Gerstmann is a name you either know or don't, depending on whether or not you care about the world of games coverage. Outside of the world of games, Jeff is a husband, son, and a grown-up local kid in Petaluma, a city in Northern California that sits on the outskirts of what many would consider a reasonable commute to San Francisco. There he grew up with his mum and dad who operated a tire shop. A small town kid, with a small town life who loved rap, skateboards, and video games. But inside the world of games Jeff is larger than life. He's part of a dwindling older generation of journalists who were there when the magazines died, and the world of internet reporting exploded. He's lead the charge on finding new ways to talk about games, be it on video, podcast or late light E3 live shows. And crucially, his surname became a rallying cry for media ethics when he fell victim to one of the most lamentable acts of brand self-destruction of the digital age. Much of Jeff's story lives in the gaming zeitgeist. Before I met him, I thought I knew most of it. You see, to me Jeff was a hero. He had figured it all out. Growing up in Ireland, years before Twitch or even YouTube had started, I'd watch him host shows broadcast live from the GameSpot offices in San Francisco. His job was talking about games, and he knew more about games than anyone I'd ever seen trying to do it on television. His job became a north star that I'd spend years following. And when I'd eventually find myself working in the same building those shows were filmed in, sitting at a desk a short walk from his, I slowly began to get a deeper understanding of Jeffrey Michael Gerstmann. Equal parts a quiet, contemplative person and a troublemaker, now responsible for keeping order. I recently sat down with Jeff to talk about the 10 Year Anniversary of his career's second act, the video game website GiantBomb.com. But the story of Giant Bomb and the story of Jeff Gerstmann are intertwined. So to tell you how Giant Bomb was founded we have to go back to a small town in Northern California, to the kid of the folks who ran the tire shop in sunny, quiet, suburban, Petaluma. - [Jeff] The first video game console I owned, it was the Fairchild Channel F, which was, it kinda came out around the same time, same window as the Atari 2600 but it had a few more educational games so I think that tipped my parents in the favor of getting that thing, it had this terrible plunger controller, there was like a decent bowling game but it just immediately failed. I had relatives who had an Atari 2600 and would kinda covet that thing and eventually they gave it to me when the video game industry kinda crashed. But we got into computers not long after that. I got an Atari 400 and that was really the first proper like hey, this is a somewhat successful platform with stuff coming out that mattered. And so I mostly started on a computer. - [Danny] What was the impetus for your parents getting it? Were they interested in technology at all or were you crying for it or what was the story there? - [Jeff] You know, my dad played some video games certainly over the years but I think that was largely because that's what I was interested in. We were going to arcades a lot and on the weekends we would go out, there was an arcade in town called Dodge City and we would go to Dodge City. You know, my mom went once or twice, this was like the height of Pac-Man fever so like I would be there, my dad would be there, we'd be playing games and there would just be this huge line almost out the door of people waiting to play Pac-Man or Ms. Pac-Man. And it was just weird, you know, because it was just another game, like to me it was just like, all right, well yeah, I don't know, Pac-Man's over there and it is what it is and I'm over here playing Galaxian or Vanguard or you know, whatever the heck else, I don't really remember talking to too many people about video games. This was, you know, this woulda been, god, 82 ish, like early to mid 80s really and I was going to elementary school then and just there were like one or two other kids I knew that had computers but most kids didn't and they weren't really into video games per say or if they were they weren't really letting on. So there was one kid I knew that had a TRS-80 and so I'd go over to his place and play Parsec and some other stuff like that. There was a kid near the tire shop that my parents ran that had a VIC-20 and I could go over there and play like Radar Rat Race and some other stuff too. - [Danny] So, I guess, what did you want to be when you grew up when you were like a middle schooler? Obviously games journalism wasn't a target you could exactly aim for so what were you thinking about your future when you were in like middle school, high school? - [Jeff] When I was in high school we saw a posting, so LucasArts was relatively local, they were in Marin County and, you know, this woulda been like 1990, 1991, somewhere around there, and they were looking for testers. And I remember applying for it but like I was 15. Like it was, logistically it would've been impossible for me to even do that job 'cause I couldn't even drive a car yet. And it was 20ish miles away. But also like I remember writing, like they wanted a resume, I wrote an essay and it was like, you should give me this job. It was real dumb, I mean, whatever, in retrospect it was like, that is not a way to get a job. Also, ridiculous to assume that that would've even been possible at 15. But yeah, that was the first time I ever really thought about working in video games, I woulda been like 14 or 15. - [Danny] So how did it actually come to pass then? What was your first gig in the industry and how did you end up getting it? - [Jeff] So, I started going to trade shows, I met a guy a named Glenn Rubenstein who was a year younger than I was and we went to the same school, we went to the same high school. And Glenn was writing video game reviews for the local Petaluma newspaper and also I think he had a column in the San Francisco Examiner which was a newspaper. And so there would be articles about like, this youthful guy writing game reviews, look at this guy, it was like kind of a story or whatever. So we became friends, then he kinda said like, hey, I'm going to CES, do you wanna come with me? And I was like, yeah, I would love to go see video games. - [Danny] How old are you? - [Jeff] This is, I'm 16 at this point, he's 15. - [Danny] Wow, okay. It's in Vegas, right? - It's in Vegas also, yes. He's like, hey do you wanna come to Las Vegas. So I pitched it to my parents and just said like, hey, this thing's going on, I'd really like to go do it and they said yes, for whatever reason they said yes. And so me and Glenn set out to go, he had been to one before, he had been to CES I think the previous CES in Chicago might've been his first and so I went with him to that and just like I bought myself like a blazer and put it on and went to this trade show and went around and played video games and tried to play blackjack wearing a blazer because I looked like maybe I was of age. And that's where we met Ryan McDonald. We needed, honestly, I think we just needed more people to help pay for the hotel room or something like that and Ryan was doing something similar, he was writing about video games for a Healdsburg newspaper, which is about 40 miles north of Petaluma, where I'm now, which, for people who don't know, Petaluma is about 40 miles north of San Francisco, so, you know, Healdsburg's getting pretty far out there. And we met Ryan at the local mall, he seemed like an okay guy and we're like, yeah, you wanna come, let's go to Las Vegas. And so I kind of started just going to trade shows, we all met the guys from Game Informer pretty early on, Andy McNamara and Paul and some of the early other reviewers that were there at the time, Elizabeth Olsen and people like that, and we knew some people that were doing PR for video games at the time and stuff like that so we just kinda started meeting people and getting around. So that led to, Glenn ended up, so Glenn actually got me my first couple of jobs afterwards. We started going to the trade shows, we were doing a local public access show that was not about video games, it wasn't about much of anything really, and basically like barely getting by in high school 'cause we were just doing all this other stuff and not wanting to go to school very much. And so he ended up getting in at a magazine, they were starting up a magazine, they were originally gonna call it Blast, they were gonna call it Blast and it was gonna be like this lifestyle magazine funded by the, I guess the CEO of Creative Labs, so the Sound Blaster people were starting, basically funding a magazine. And so I spent a year commuting to Berkeley working for this magazine right after I got out of high school, so that woulda been like 1994. I was 19 commuting to Berkeley, working for a magazine, having no idea what I was doing, and we were covering Doom and we were covering, what are some fun things you could do with your Creative Labs branded sound card and stuff like that, that place lasted a little under a year before it folded. We made it about three issues, I think there was fourth that was almost done, and then I was out of there and had no idea what to do next. I was 19 and jaded and like burned by how that job went and angry at everything. - [Danny] Yeah, had you dropped out of high school, had you just sorta finished it and then left off or were you thinking about college or were you thinkin', oh shit, do I jump to another journalism gig, what was your head space then? - [Jeff] I finished high school. Between the public access show we were doing and this video game stuff that was still pretty nascent, you know, it wasn't really a job, it was very easy to look at that stuff and go like, man, I don't wanna go to school, like it's a waste of time. And so there was awhile there that like, I'll get my GED which is like so you can kinda test out of high school. And they tell you that it's equivalent to a high school diploma but then in some ways it's kind of not, I don't know, there was a weird. I had missed so much school and also we, so we were doing the public access show and I filmed a teacher, so a teacher at the high school I was going to, our chemistry teacher got fired and I believe the talk was, and I'm not sure, it was sexual harassment from the sounds of things, like to students. And so the first day that they introduced here's your new chemistry teacher I had the video camera that we used to tape the show so I filmed them introducing this new teacher and all this other stuff and like asked them questions like it was a press conference. And they answered, no one said, hey put that thing down. Like I was very clearly pointing a video camera at them. And then like the next day, that day, the day after, something like that, like the principal called me and said, hey, what are you gonna do with that video tape? And I said, well we're gonna put it on television. - [Danny] Oh my gosh. - [Jeff] And he was super not happy about that. - [Danny] I wonder why. - [Jeff] Yeah, and so at that point we realized we had something so we called the papers and said, hey we got this tape and they started investigating it and it became a story, it was something that they, I think they were trying to keep very quiet. Later on that teacher would show up at my doorstep looking for a copy of the tape because he was trying to sue the, I don't know, he was trying to get something out of the school district or something over what happened, this was years later after I was out of high school. So that was very strange. So after that between the amount of school we were missing, I had like a guidance counselor basically recommend that I should go on independent study. Which was basically, at the time it was primarily, it woulda been like pregnant teens and people that like were having trouble in school and that sorta stuff and they were like, oh, we're piloting a new program for kids who don't necessarily fit into the standard curriculum and they pitched it like that but basically it felt like they were just trying to get me and Glenn out of there. - [Danny] Right, journalist at heart it turns out. - [Jeff] I guess, I don't know. And so that led to me getting much higher grades and stuff because I was able to just kinda like crank through stuff really quickly. I graduated early because I just finished the work. I mean, I graduated like two weeks early, not hugely early. But it was great, it felt like I was getting one over on the school district because I was doing a full semester of science while like reading a book in my patents hot tub or, you know, just like stupid crap like that. I was getting like journalism credit for the stuff we were doing going to trade shows and like video production, they were just throwin' credits at me left and right and so yeah, I graduated early, it was great, I was able to take that and go back to the high school that I had stopped going to and go talk to like the one teacher that I liked, Mr. Moore, he was a math teacher, great guy, I think he taught some of the computer stuff also. And I remember telling him like, hey, I just graduated. And he just looked at me and said, god dammit, Gerstmann, you got 'em. He seemed like dismayed that I had managed to get one over on the system somehow but he couldn't help, but yeah, it was a, that felt pretty good. - [Danny] Through his life, Jeff's do-it-his-own way attitude has been both a source of great strength and the catalyst for much drama. He attended a local junior college for a semester, but it didn't stick, preferring to do extra-curricular work like attending trade-shows with his friend Ryan McDonald, hanging out with local bands, and as he put it, learning how to drink. Around this time Glenn, who had gotta him the job at the magazine years earlier, started working for a new website in San Francisco's Richmond district. Just a few blocks from the servers of archive.org on the cloudy avenues of Clement Street, lied an office where a staff of 20 was running the website GameSpot. They had hired Glenn to lead the charge on a new console-focused spin-off of the site that they were going to call VideoGameSpot. - [Jeff] Glenn hired Ryan McDonald not long after that to be like the strategy slash codes editor and then I started freelancing for him because they wanted 100 reviews by launch and they were lookin' to launch like three months, four months from that time. And so I started crankin' out reviews and the way I always heard it was that I was turning reviews around really quickly, really clean copy, and so Vince Broady kinda said like, hey, bring this guy and let's see. And they brought me in as like an editorial assistant which was more or less an intern type role and within two or three months, not even two or three months, within like a month, the launch editor, there was a guy, Joe Hutsko, who would come on, it was one of Vince's friends who had just come on I think to kinda see this console site through to launch and then I think he was gonna go on to do something else somewhere else and I was working late one night and Joe Hutsko walked by and saw me there and he was like, you're still here, what are you doin'? I was like, this work has to get done. And then like the next day I had an offer letter for a full time job at that point. - [Danny] GameSpot would go through several transformations and acquisitions over the coming years. But as the business side of online media was learning how to walk, emerging technologies were creating exciting new ways for people to talk about games. GameSpot led this charge with one of the first video game podcasts, The Hotspot, and a weekly live show, On The Spot. Suddenly these young game reporters were starting to become more than just bylines. For years readers, the folks writing reviews and new articles, were just names at the bottom of a page. But now, for the first time, they were people with voices and faces. People with unique perspectives, opinions and personalities. And Jeff, with his experience doing public access shows in Petaluma, was at the forefront of this new form of media. The idea of streaming video games on the internet now is so blase and normal but back then I think to a lot of people it felt like magical, like a television channel that's broadcasting about games. From your perspective on your guys's end, did it feel weird to be like doing a live show that people were watching while you were just talking about this relatively niche hobby? - [Jeff] It felt like a natural extension of the stuff we had been doing. And it felt like, I don't know, it felt fresh and cool and like the tech was weird and sometimes it didn't work the way you wanted it to but at the same time we were wearing makeup, we had built a studio, we had lights, we had a jib, it was Frank Adams lowering a camera into the shot and all this other stuff and so coming from like these lame public access shows I was doing when I was 16 and stuff, like I had a weird leg up on a lot of other people because I was already relatively comfortable being in front of a camera. - [Danny] GameSpot continued to evolve. It went from indie to being purchased by media house Ziff Davis who then eventually sold it to CNET. By this stage the editor in chief was Greg Kasavin, who you may now recognize as the creative director of Supergiant Games, a studio we're currently running an embedded series on. His two right hand men at the time were Ricardo Torres on previews and Jeff on reviews. But when Greg left to start his career in games production, the role was never properly filled. Instead Ricardo and Jeff sort of ran it together, with increased influence being exerted on them from the powers above. The original founders of GameSpot had come from a editorial background but they were gone and the site was now being managed by people were less seasoned, more traffic orientated, and didn't value the power of editorial independence as much as they should have. - [Jeff] You know, there was an understanding about like this is kinda how this stuff is supposed to work, it's not always supposed to be an easy relationship if everyone's kind of sticking to their guns and doing their jobs and stuff. I don't know that they always saw the value of that, I think that's something that they corrected quickly, it was just kind of, it was a blip, if you look at GameSpot as a 20 plus year institution there was that brief period of time there where it was like, man, this went a little sideways for a bit and I was just in the right place at the right time, wrong place wrong time, whatever it was. - [Danny] What happened to Jeff next has been told a thousand times with new pieces added as time has provided new context. I myself spent years trying to fill in the blanks on how it all went down. Talking to friends and colleagues of Jeff who were there that day. It was a Wednesday in November, 2007 and the office was busily preparing for the weekly live-show which aired on Thursday afternoon. Jeff had just another another brush-up with management, this time over a review of Kane and Lynch which had made the sales department uncomfortable as they had sold a large advertising campaign to the game's publisher Eidos. If you visited GameSpot that week, the entire homepage was taken over by messaging about the game alongside a six out of ten review from Jeff. Jeff had had some run ins with top brass before and felt like he'd come close to losing his job a few times but this wasn't one of those times. It seemed like it had been dealt with, and he was already working on his next review. Later that morning his supervisor called him into a meeting and then called HR. He was told he was being terminated immediately, and as California is an at-will employment state, Jeff had no recourse. He was told to clean out his desk and bizarrely he was allowed to walk the halls for the rest of the day. Saying goodbye to his friends and colleagues, who were cursing the names of those in charge. Jeff drove home that day, the same 40 mile commute between San Francisco and Petaluma he had done thousands of times before. But this time it would be different, it would be a number of years before he stepped foot in the building again. There was no live show that week, the Kane and Lynch review had been taken down and then reposted and slowly over the coming days rumors began to circulate about Jeff's termination. Popular webcomic Penny Arcade ran a strip outlining the pressure from Eidos. Staff from the website 1UP, who were located just a block north of GameSpot on San Francisco's 2nd Street, held a protest outside the lobby of the building in support of the remaining staff. In an age before social media it would be a full eight days before the staff would actually speak up. And it happened on the next episode of On The Spot. The show ran with a somber opening. Ryan McDonald flanked by Ricardo Torres and a wincing Alex Navarro explained the situation. The camera pans out to reveal a full set with previewer Brad shoemaker, new hire Kevin VanOrd, community manager Jody Robinson and reporter Brendan Sinclar among a dozen of other staff. - [Ryan] Obviously we wanted to start today's On the Spot off a little different than we had in the past. The recent events and what happened last week in regards to our longtime friend and colleague, Jeff Gerstmann, being dismissed. It's been really hard on us and the response obviously's been tremendously immense and it's been on both sides. It's nice to see that everybody speaks up and has been kinda pullin' for us. On the other hand it's been hard obviously seein' GameSpot sucks written 100,000 times on forums and stuff so obviously we wanted to address this and talk to you guys today. Jeff was a personal friend to pretty much everybody so it was really, really hard that it happened the way it did. But yeah, we really wanted to say that we love and miss Jeff and give him, honestly, the proper send off that he deserves so that's what today's show's all about. And obviously you can see this is hard for me personally. - [Danny] For Jeff things were equally as bizarre. Tech Blogs like ValleyWag were running stories about the state of the site which were clearly sourced from somebody inside of GameSpot. The LA Times ran a story about the firing. And Jeff's mother received a phone call from a newspaper in Norway looking for a quote. It was three a.m. when the phone rang. - [Jeff] You know, some of it was just like, some of the people I talked to were very like looking for more dirt, they were expecting me to get on the phone and be like, oh, well here's where the rest of the bodies are buried. But like, you know, I was shocked. I was not happy about the whole thing but at the same time I feel good about the work I did while I was there and there were so many great people there that kinda got caught in some of this crossfire a little bit. I wasn't like, oh well here's the other nasty things that happened, there wasn't any. There wasn't anything else. So some people were coming to me looking for like some bigger story that I just didn't have to give. And that was strange, it seemed like everyone wanted something from me for a little while and it was a very weird time. And so at that point it was like, 'cause you know, like I was not an editor in chief in title but you know, we were running an editorial team. And so there aren't a lot of jobs out there at that level. It wasn't like I could walk into IGN or 1UP or, you know, I don't even know who else was even out there at that point, it wasn't like I could walk into those places and say, yes, make me your editor in chief. Like, they already have people in those roles, it wasn't really a viable thing. So at that point I was like, well I kinda need to maybe start something new. The weekend after everything went down or it might've been, it was like the Friday after or maybe it was like a full week afterwards, a bunch of people that I used to work with came up here to my place and we just hung out, like kinda impromptu, just have a bunch of drinks, play some Rock Band, and that sorta thing, and Dave Snider came by, Ryan Davis invited Dave over. And Dave was working on his stuff, I think Boompa was still up, they had a car website, you know, they were running Comic Vine, they were building Political Base which was another kind of wiki focused site for political donations in the run up to that election there, this was November, 2007. And so they were starting a new company and looking to build, they were building websites. And I was like, oh, that's cool, awesome, and nothing really came of it for a little bit. So I went and did a show on Revision3, so I drove into San Francisco, did that show, and then on the way back from or as I was finishing up that show I got a call from Dave and he said, hey, you should come by the office in Sausalito and just come by. I was like, all right, cool. And so on my way back from there I stopped at the office in Sausalito and looked at Comic Vine, the other stuff they were doing, and we sat in a room and ate sandwiches and I more or less committed to them right there. It was kind of like an, oh, we'll think about it and they were very much like, hey, why don't you just take a month and get your head together, like take an actual break 'cause this is so crazy and then let us know what you wanna do. And so we kinda started building a website not too long after that. - [Danny] Over the coming weeks several of Jeff's friends would leave GameSpot. Some were burned out from games coverage, this latest spell just being the straw that broke the camel's back. But others were leaving to work with Jeff. Fellow Sonoma County local Ryan Davis was the first. The two of them set up a blog, and started to a run a podcast which they hurriedly titled, Arrow Pointing Down. - [Jeff] So, every single person at the company that we were, that I was now a part of were people that had worked at that old company. And so we did not wanna give the appearance of people getting poached out of there and like I don't know if there was an actual non compete with some of the people in the building or anything that would've prevented them from doing this stuff but all of it had to be kind of like quiet and so it couldn't be something as simple as like, hey we want to hire you over here. It had to be like, well, if you were, if you were no longer working and you needed a place to work we do have some opening. You know, it was very much that sort of thing. But I knew pretty immediately looking at it and going, okay, we wanna team of about this size and I knew that Alex would not be available, Alex Navarro, I knew that he was not looking to do this sort of work at that time. He was, you know, I think already thinking about Harmonix, he ended up doing public relations for Harmonix for a brief period of time. Like I pretty much had a whiteboard, I knew in my head that I, at that point it was like okay, this is me, it's Ryan, it's Brad, it's Vinny. Which is not how you're supposed to hire people. You know, some people are like, well what are the positions that we're looking to fill and all this other stuff and, but like knowing like what we looking to build and we needed to be a tight team, who were the people that are gonna be impactful in those roles, like okay, Brad has a lot of experience in previews, he is a person that I know, like he knows a ton of people around the game industry. Like, I've worked reviews and so on the review side of things we didn't talk to companies all that often. Brad had that in his role so he left, he left and he had other things that he was maybe thinking about doing, it wasn't like a, it was not a clandestine like, he left specifically to, it was like, okay, he's out and we're gonna figure this out. And then we needed someone to do do video and we had been working with Vinny for awhile and Vinny was fantastic and it was like, okay, Vinny's really funny, this seems like a good fit for him and so we kinda went about it that way. It felt like night and day a lot of ways, but very similar in others. We were able to sit down for the first time, for me the first time ever, like I never thought I would have the opportunity to build something like this, you know. I was always like very respectful or very envious of like Vince Broady as like the editorial lead of the founder of GameSpot and so I was like, man, he took a chance and built this thing and built it from the ground up and look at it, it's this huge, this monument, it's lasted so long. And I never thought I would have an opportunity like that in my career, it just never seemed like it was in the cards. And so being forced into it was exciting. Because it let me sit down and be like, okay, what do we actually want to do? What do we think is actually the best way to cover games with a small team in this day and age? And when we started in 96 on VideoGameSpot, like the videos had to be very low frame rate and very short because no one could download 'em and, you know, it was like we were doing minute long video clips of gameplay and that was revolutionary at the time. You know, you had to install the Real Video Player and all this, you know, all this other stuff. And here we were on the cusp of like, actually we can kind of, we can kinda livestream, you know, the services to do it easily weren't in place, you still had to host it yourself and that got very expensive and all that and YouTube wasn't really there in the way that they are now, YouTube existed but it was, I don't think you could put up videos that were longer than five or 10 minutes at the time and it just was not a viable place for that at the time. And so we had to kinda sit down and say, well with the technology we have available what can we do? And we wanted to be a podcast, the Hotspot was one of the most fun things I had doing in my entire time at GameSpot and we knew right out of the gate that we wanted to have a podcast be kind of one of the main things. And then from there it was like, okay, well, do we wanna write news? Not really, none of us are really news writers per say. And it was like, well, we need to able to capture video of games and put it on the internet. And we need to be able to talk alongside it or something like that, whether we're cutting it together or doing it on the fly. And so Mike Tatum, who was the head of biz dev for the company just went out to the Apple Store and came back with the biggest ass Mac Pro he could've gotten at the time and set it the room with me and Ryan and we looked at it and we were like, neither of us know how to use any of this shit. And we messed around with it long enough to figure out eventually we could capture some footage. We were like, okay, we figured out, first the game we captured footage of was Hot Shots Golf for the Playstation 3. And we were like, okay, we captured the footage, now what do we with it? And we hadn't answered that question yet 'cause there was no website to put it on or anything like that. So those early silly days of just like putting that stuff together. We didn't really know exactly what we wanted to do, it was just a matter, it was very freeing in way to be able to sit down and be like, okay, here are the things that we liked doing before, let's try to keep doing that. And then the rest is up in the air. For a long time there we weren't even necessarily sold on the idea of just covering video games. It was always meant to be bigger than that. We were gonna cover music, we were gonna cover movies, you know, all this other stuff. But at the end of the day old habits die hard, it was very easy for us to cover video games compared to like, calling music PR people out of the blue and being like, hey, we wanna interview this artist that's coming to town, can you set, you know, it was just, we stuck with what we knew and kinda just mainly covered video games and flavors of Gatorade. Really it was the original mandate for GameSpot was we wanna create a site that we ourselves would use. And I approached it that way and said like, well, what kind of game coverage do I actually care about? And a lot of the preview related stuff at the time was just not, it was a lot of like carved up little parts of a game. Like, we're gonna give you assets on these three new guns and this two new trees and it was like, here's the rims and tires of Grand Theft Auto: San Andreas. Outlets used to compete for the exclusive rights to run stuff like that. It was a very different time so we knew we were never gonna matter to publishers the same way the big sites did and that was fine, we wanted to kinda do our own thing and so that led to it being a little more guerrilla. You talked earlier about long footage of games being something of a novelty or a weird impossibility back then but for us it kinda just became a necessity because of the number of people we had and the lack of time we could devote to actual editing. It was like, just stuff kinda came in long out of the gate. And so we first launched as just a WordPress blog and we went to our first E3 in 08 with just a WordPress blog. We could run videos on it but it was pretty bare bones. It was mostly a placeholder, it was like, here's the name of the site, you can comment on these stories, and we were just kind of writing news and reviews and putting up videos here and there. And it was all pretty straightforward stuff, it was like that and the podcast. And then we rolled out the full site not long after that E3, it was like July of that year I think and then that was like, okay, now here's this full wiki, here's all this other stuff. Better user features, full message boards, all this other stuff. And so we went at it that way for awhile and then the premium membership stuff came later. - [Danny] It wasn't just old staff who were leaving GameSpot for Jeff's new project, users were flocking too. Once the full site was launched tens of thousands of profiles were created, a large portion of which were disenfranchised GameSpot fans who wanted to support Jeff and the staff who had left. I was one of them and I remember that time well. The passion and excitement of those days was one of the most powerful moments I've had as part of an online community. And the folks at Whiskey Media used this passion to help fund the site. Giant Bomb had taken the ad-free subscription model that GameSpot had pioneered, and added much more. For $5 a month you not only supported some of your favorite creators, but got access to bonus videos and features. New users signed up in their droves. - [Jeff] The launch of the site proper exceeded our expectations in a way that like wiki submissions were taking a week or more to approve because so many people were signing up and contributing and all this other stuff, it was just, we were staying up all night working on just the community stuff, moderation stuff. And then the premium membership stuff did well out of the gate. We went back and forth on a few ideas about what are we offering here and all that sort of stuff but yeah, it did really well that first day. Advertising was never really a thing for us, we had one in house ad person eventually for a brief period of time but like, you know, advertising's all about eyeballs and we were never gonna be the biggest website in the world, it was we were about, okay, well we want people who really care about this stuff and so, you know, in advertising you're trying to make a case for just like, oh no, this is a smaller audience but they're smarter and they spend more money and you know, at some point you have to go out and educate brands and say like, here's why you wanna advertise here instead of there or spend your money with us because our people are smarter or this and that and at the end of the day advertisers just want eyeballs so like you can go in and pitch that story all you want, it's just not how the advertising model typically works. So we had a few things where like, you know, we had some sponsored achievements on the site and there was a livestream, I was actually against it, but they did a livestream for, NTSF:SUV:SD, I think was the ordering of that, an Adult Swim show. Actually, I thought it was pretty funny. They did a livestream like live watch along with it. And so we were doing a few things like that that were innovative at the time I guess and so you would have people who understood like, hey, the internet is changing, it's not necessarily about just raw eyeballs. We wanna find people who are more engaged with a thing and you know, this was kinda like the nascent form of like the influencer type stuff about like figuring out who are these people we can get that have sway with their audiences and so on and so forth. But, us being an editorial operation, we could never really go fully into that world. So the stuff that I would be comfortable doing in those spaces kinda, we ended up shooting down a lot of stuff, probably more stuff than we signed because it was like, no, I don't think we can do that. So the advertising stuff was never really gonna be for us and for those reasons, it's just, you know, the advertising market just wasn't really compatible with our size and our scope but also kind of our mentality and where we were at with stuff so we wanted to try and find something different. And again, that was another Dave Snider, Dave was kind of the main first proponent about like, no, people will pay for good stuff on the internet, I know it. And I think I was a little more like, I don't know, man, people like to pirate stuff. But he's like, no, this will, he won me over pretty fast and we went through with it, we went on with it. - [Danny] Giant Bomb has been running for a decade and in that time the site has evolved to keep up with the changing desires of its audience. But there are a few shows that have lasted the test of time. Their weekly podcast The Giant Bombcast has had over 570 episodes and is one of the most popular video game podcasts in the world. And their Quick Looks series predated the creation of Let's Plays, still exists today. I asked Jeff to tell me about some of his favorites are. He notes their live E3 internet show, and eventually making the podcast profitable as some of his proudest achievements. As shows have come and gone, so too have staff. Just like GameSpot created a platform for Jeff to make a name for himself. Giant Bomb has become an incubator of talent all to itself. As the sort of captain of the ship as well, what does it feel like to be responsible for kind of what Giant Bomb has become in terms of its, as an incubator for talent, right. You've had people come through the doors and leave out the other side to go on to wonderful careers as well. Do you take a pride in that, especially considering, you know, how you seem to have a reverence for the people who gave you opportunities in your early career. - [Jeff] It's cool, I don't always think about it. Like, I don't know, like I look at it and go like, did I do anything for anyone, I don't know, I'm just here, I don't know, I just do my thing. And I don't know that I always, I used to take it really personally back in the GameSpot days when anyone would leave. I would always think like, man, why would you, why would you go do something else, we're doing great, we're doing all this other stuff, and now I look at it in retrospect and go like, maybe it was people like me in the senior roles for as long as we were that led to people below us wanting to get out for more opportunities, and go like, man, yeah, okay. But yeah, I used to take it really personally 'cause I just, you know, it was great to just, there were times where, you know, man, this is the best team I've ever worked with, this is great. Oh, three people are leaving over the course of six months, what's goin on? And the people that left in the run up to me leaving, at the time I was really bummed out, in retrospect I was like, oh, yeah okay, I get it. And things change and people change and they want something else out of their careers and they wanna take on new challenges and all that sorta stuff and I think that's great. At the same time, like I miss the people that have moved on. Like, there was a time there that there were, we were starting to have conversations, it's like, no, we need to move Danny O'Dwyer over to Giant Bomb, like we have, this should happen. And then he went out and found fame and fortune on his own without us and I was like, well, shit. Let that one slip away, I guess. - [Danny] There will always be a part of me in my professional sort of hindsight that will, I remember when you mentioned that to me at a certain point, I can't remember, was it when I had already handed in my notice or I think it was probably a little bit before maybe, where like, that is like the ultimate dream come true. But now I have a new dream come true which is that I get to just pop into the office and review European sports games twice a year or whatever. - [Jeff] Right, yeah, I mean, I have a code for FIFA that I don't know what to do with so. Might be callin' you for that one. So, it's stuff like that, like it's great seeing people out there doing their thing, and the thing I've tried to be better at this time around that I was terrible at back in the GameSpot days is try to keep in touch with people on a regular basis. Like it can be so easy just to put your head down and be like, I'm surrounded by these people, these are the people I see everyday, these are the only people I talk to because I don't have time for anything else. Discord has actually been really useful at that, honestly. Like hey, let's keep in touch with friends and try to maintain these friendships and stuff like that. So yeah, it's great being in regular contact with people like Patrick and Austin Walker and stuff like that. - [Danny] Giant Bomb lived under the Whiskey Media banner for four years, but the media startup was struggling to grow at a rate required by the landscape of the bay area investors and so the decision was made to fold the company to sell of its assets to suitable suitors. What happened next seemed impossible to anybody watching from the stands. - [Jeff] The process of us selling the company was strange, for a lot of the reasons you would expect. But you know, I think the thing that happened, every start up that sells or fails or anything always like to say, aw, we were just too early. We had the best ideas, too early. But you know, in some cases if we were a year later or something like that and YouTube had been more viable for longer form videos, like who knows what woulda happened. You know, we made the best choices we could along the way but at the end of the day, you know, they had launched a lot of other sites and wanted it to be this big network and when that kinda, I think that wasn't happening at the rate that they needed it to happen so it became a case of just like, okay, maybe it's time to move on and move onto a different business and do a different thing and so we were at that point lucky enough to be something that was sellable, you know. Like you think about the number of start ups now, especially the number of content companies that launched and just went under. And with Giant Bomb with the premium memberships and that sort of stuff we were in a pretty good position there to where we were doing something that people I think were just starting to get a sense of just like, hey, maybe this direct to consumer like subscription type stuff is something we should care about. And so it was something that people were starting to wake up to and be like hey, maybe we want some kind of back pocket plan in case this advertising thing doesn't always work the way it works now. So Mike Tatum, the head of biz dev for Whiskey, asked me one day, he said, hey, would you be open to maybe selling the company to CBS? And I just laughed. And I was like yes, of course, absolutely, go have those conversations, that's the craziest thing anyone's ever said to me, absolutely, yeah, of course. That's the thing, it was a very different time, a very different company, all that other stuff. Like the stuff that happened to me was this blip on this timeline of this multi decade operation that has had good people at the helm of it for almost all of its time, you know. And most of the people that were there when I was there last time and involved in some of that unpleasantness were long gone. So at this point it was like, hey, do you wanna go talk to John Davison about, you know, maybe comin' over there, and Simon Whitcombe. Yeah, they've been around this space for years, it's totally different people, like yeah, of course. And there were other people that were interested, the company that ended up buying tested was like lightly interested but not in a way that sounded all that exciting to me. And so yeah, I had lunch with John and Simon and in, this would've been, it was around the holidays, I don't remember the exact year anymore, it all runs together, man. But it was the holidays, it was like right after Christmas, we went into Christmas break knowing that it was likely that the company was gonna be sold early the following year. And that the GameSpot team was interested, was kind of like what I went into the holidays knowing. And so I met with them and we just kinda talked it out and, you know, like they had a good head on their shoulders and we were, you know, fairly attractive I guess in the sense that we had our own revenue, it wasn't like we were coming in and like, okay, you gotta bolt us to a sales team, you gotta bolt us to this 'cause otherwise we're gonna be losing money overnight. We were coming in doing pretty well in the grand scheme of things. So yeah, I wasn't in all the negations and meetings and all the back and forth for that sorta stuff but, yeah, it was an exciting weird time because we knew it was happening but we couldn't say it was happening. And rumors started getting out there a little bit, it was a very strange time, you know. It was so hectic. My dad went into the hospital as we were packing up the office to get everything out, and we were entering this quiet period where we wouldn't even have an office and we couldn't even say why, which was so unlike everything we had done with our community and all this other stuff. It was like, here's the thing where we are forced to not talk about this deal or act like anything is weird but we also are not in an office, it's hard to generate content when you're not in the studio. And there was just so much going on around that time, it was really, it was bizarre. I came out of it feeling like we did pretty good. For someone who came into that situation with little more than his good name I feel like I came out of it better. Personally better, better at my job, better at more types of things, better at running a, a little bit more respect for what it takes to run a business but also knowing when to sacrifice the business needs for editorial interest, you know, that sorta stuff. I was able to grasp more pieces of the puzzle, I guess. And so yeah, we came back in and it was fun because I had set up Giancarlo Varanini, I set him up real good where I saw him at an event the week before the deal was getting announced and I think my exact words were, hey I'll see you next week. And we left this Microsoft event or whatever we were at and. - [Danny] Did he know, did he twig it or? - [Jeff] He didn't know at the time but he pieced it together and then he was like, oh my god, you were saying what you were saying, yeah. 'Cause, you know, we still talk to a lot of those people that were over there. - [Danny] So strange, I think I told you, we were in the bizarre situation where the UK, I was at GameSpot UK and the UK sales team had leaked the deal to us, I think maybe six weeks before it was announced. - Wow. - We all knew and we couldn't tell the American office about it. - [Jeff] That's GameSpot UK for you, man. One year they tried to give FIFA an 11. - [Danny]Did they actually? - [Jeff] Actually, yes. They turned in a FIFA review that was trying to give it an 11 out of 10. And we had to be like, no, you absolutely cannot under any circumstances do that. - [Danny] For most of Jeff's life his career and hobby have been impossible tangled. And so for much of his life his identity has been too. For years his Xbox Gamertag was GameSpotting. He only changed it when he set up his new site, to GiantBombing. But since selling to CBS he's tried to create more distance between these two worlds. Jeff isn't the most social person you'll work with. He commutes to and from Petaluma every day, a 40 mile drive during bay area rush hour. Perhaps it's why he doesn't socialize much after work. Or maybe it's a convenient excuse to not have to. At his desk, he sits with headphones on, usually working on something. When he talks to you he speaks openly and honestly. When he doesn't want to talk, he doesn't. He's always struck me as a person who's gears are always turning, thinking about the work. Half enjoying it, half burdened by the weight of it all. He's tried to get better at delegating responsibility but in many ways Giant Bomb is his child and he feels like he needs to be in the room when decisions about it are being made. - [Jeff] For me that's the struggle. Like my personal struggle is like the time management aspect of it and like keeping everything going. Because before I had other things going on in my life you could throw as much waking time as you could at a thing and also we owned the company. It was a sick cycle where in the back of your head you could always say like, well I need to work until three a.m. because this could be the video that puts us over the edge and turns this thing into an even bigger thing. And so it was very easy to justify to yourself incredibly unhealthy work habits that didn't make the site better, that didn't lead to necessarily more content or anything like that, it was just it was very easy to spend every waking moment thinking about it. And now I don't and at first that made me feel guilty, yeah, that's the weird struggle of just like, it's all just kind of a weird head trip. And the worrying goes from like, am I spending enough time with my family, am I spending enough time with my job, this seems like stuff that everyone else figured out a long time ago but I'm coming to it over the last few years and going like, man, this is an interesting new challenge. But it's been great, I wouldn't, if it wasn't for my wife I don't think I would, I'm not even sure if I would still be doing this, honestly. I probably would've completely burned out or something by now without her to kinda have my back and all that sorta stuff. Yeah, she's been great. She's the best thing that ever happened to me, totally. - [Danny] Trying to create a distance between life and work you're passionate about can often be a struggle. But it was impossible for the staff of Giant Bomb to do so in the summer of 2013. This July will mark the 6th year since the tragic passing of their friend and colleague Ryan Davis and in recent months it's been on Jeff's mind a lot more. Last year the site launched a 24 hour livestream that plays videos from throughout the 10 year archive of Giant Bomb and users often vote for videos that Ryan is featured in. So Jeff is confronted with the memory of their friendship a lot more these days. - [Jeff] You know, going back to those videos and stuff, the relationship that Ryan and I had was very complicated and changed a lot over the years because, you know, we were close friends, we were in a band, we were inseparable, I got him hired, we became coworkers, I became his boss. And so the relationship changed along the way too. So yeah, I don't know, when I think about Ryan I think about the days before were working together, primarily. Those are my Ryan memories, usually. The videos, the stuff we did along the way, yeah, we did some really cool shit and I like a lot of it just fine, but me personally, I think about the stuff prior to, when Ryan was answering phones for AT and T internet at three in the morning when people couldn't get into their email, that's the Ryan I think of. The Ryan that was living with three other guys in this tiny ass place and we'd just go hang out and he wasn't 21 yet so I was indispensable. Like that sort of stuff, that's the stuff I think about when I think about Ryan. - [Danny] When I asked Jeff about the future of Giant Bomb he's excited, but cautious. Years of working on the internet has taught him to be careful about over-promising before stuff is built. Perhaps his experiences have also taught him not to plan too far ahead. As the site enters its 11th year its been changing its programming to try and bring in new viewers. Giant Bomb has been successful, it pays its own way at CBS, but it's still a website owned by a large media organization, so often the future is planned quarter by quarter, year by year. Perhaps the most surprising thing in coming to know Jeff, is how excited he still is about games. His Twitter profile reads "I've been writing about "video games my entire life. "It would be insane to stop now." So you wouldn't blame him for being burned out on video games after 30 plus years of talking about them. But if nothing else, the thing that strikes me about Jeff Gerstmann is that these days when you can be so cynical about video games he's still a true believer in the power of the medium, whether it be players of Pac-Man or Fortnite. - [Jeff] I think games are only gonna continue to get more popular. If you look at what we're seeing with something like Fortnite right now. Like, it's having a moment that, that Minecraft had before it. It's huge, it's bigger than a Five Nights at Freddy's, it's crazy. But like I'm just trying to think about like, you know, games that have penetrated the mainstream in a huge way. What we're seeing with Fortnite right now feels almost unprecedented. It's Pac-Man esque. You know, like Minecraft was huge, but not in a, like kids loved Minecraft, kids love Roblox, but Fortnite is cut such a wide swathe across society to where it's like all these popular mainstream sports figures are now doing Fortnite dances in actual sports and it's never been like that before. So in some ways like, gaming has kind of never been cooler or less cool depending on your perspective. Because it's literally everywhere. You know, everyone is carrying around a device in their pocket that is capable of feats that like it would've been insane, no console 10 years ago could've done anything like this. Granted, the controls are still bad. The technology is pushed so far forward and it's so pervasive and in so many different places and in so many different styles. You look at like Pokemon Go and the idea of location based gaming, you know, people getting out there and moving around to catch Pokemon, like all that stuff is amazing and it's crazy. But like where we're going on that front, I think if the technology bears out and data caps don't kill the dream and all this other stuff, we're gonna reach a point where anyone can play top level video games on the device they carry around with them every single day. And in some cases they are, I mean, Fortnite's on phones for whatever that's worth. So I think that this isn't gonna go away, this is gaming's kind of big push into the mainstream kind of once and for all. And I think that games coverage, that's a more complicated thing. If you look at YouTube right now with demonetizing videos and everyone trying to stream and everyone trying to have a side hustle streaming or something like that. Kids growing up like commentating games as they're playing 'em because they just watch people on YouTube and they think that's how you're supposed to play games. That's it, that's where we're going, or that's where we are already. And so I think over the next five years it'll be tumultuous because I think you'll see the bottom drop out of ads in a way that makes the Twitch streaming and YouTube and like the kinda hobbyist turned pro streamer, I think that that's gonna have to even out. I think it's only gonna get harder and I think that will keep a lot of people out eventually, or it'll lead to a growth in just the hobbyist streaming and people will have different expectations. They'll just be like, I'm streaming 'cause I like it, I'm not gonna sit here and think I'm gonna make a bunch of money. The same way I made public access when I was 16, it's like, oh, we're on television. Like I'm not making any money off of it the way real people on TV do but I just wanna do it 'cause it's fun. - [Danny] Thank you so much for listening to this episode of the Noclip Podcast. Sorry it took so long to get this one out, it was quite a long story and it's also kind of an impossible story to tell in its entirety so I had to pick my battles and figure out a narrative that kind of worked. I hope you enjoyed it and I hope it was nice piece to celebrate a website that means a lot to me and I'm sure a lot to you as well. Now for the housekeeping, if you wanna follow us on Twitter we are @Noclipvideo, I am @dannyodwyer, we have r/noclip if you're interested in getting on board and talking on Reddit and of course if you're a Patron keep up to date on all the Patreon posts. Podcasts are available on iTunes, Spotify, Stitcher, Google Play, and loads of other places anywhere podcasts are sold basically. We also have a YouTube channel where you can watch the podcast. That's Youtube.com/Noclippodcast. If you didn't know, we also make documentaries about video games, those are available for free with no advertising at Youtube.com/noclipvideo. Patrons get this show early for 5$ a month, if you're interested in supporting our work please head over to Patreon.com/noclip. And that's the podcast for another episode. We are actually at the Game Developers Conference in San Francisco right now recording bunches of interviews which will be going up on the channel in the next couple of weeks. But we'll be back with another podcast in the not too distant future so make sure you hit that subscribe. We've never actually asked people to rate it, so if you're listening now and you're still listening at the end of this podcast, hey, why not rate us? Thank you so much for listening, we'll see you next time.
Jeff & Will talk about their upcoming trip to the 2019 LA Times Festival of Books. They also discuss two series they’ve been watching: Comedy Central’s The Other Two and Freeform’s Pretty Little Liars: The Perfectionists. Books reviewed this week include Kim Fielding’s The Spy’s Love Song, Ari McKay’s Take Two and Erin McLellan’s Clean Break. Jeff interviews Erin McLellan about Clean Break, the second book in her Farm College series, and about why it’s important for her to tell stories based in her home state of Oklahoma. They also talk about her Love Life series, what got her started writing, her author influences and the TV she likes to binge watch. Complete shownotes for episode 182 are at BigGayFictionPodcast.com. -------- Here’s the text of Jeff’s book reviews: The Spy’s Love Song by Kim FieldingRock star and secret agent on a mission to a foreign country to topple a dictator all wrapped up in a Dreamspun Desires package. That combination pushed all of my romantic suspense buttons and I had no choice but to pick up this book. And I loved it every bit as much as I thought I would. I was in tropey goodness heaven with the rock star thing, a bodyguard vibe plus lovers on the run and some occasional forced proximity. Jaxon Powers is a jaded rock star who’s at the end of a long tour. After waking up in a hotel room barely remembering what happened the night before, he might also be ready for a change in lifestyle. He gets a lot more than he bargained for when his manager brings him to a meeting with the State Department. It seems the dictator that runs the small country of Vasnytsia is a fan and wants Jaxon to perform a private concert as well as a large outdoor one for a worker’s festival. The U.S. wants Jaxon to do this because it’s a chance to improve US relations with the Russia-supported dictator. The only person going with Jaxon on the trip is secret agent Reid Stanfill. Besides keeping Jaxon safe, Reid’s got an agenda that has global ramifications. I fell in love with this book right from the beginning. Kim plays with expectations from the beginning. While Jaxon appears to be the spoiled rock star we quickly find that’s not what he wants to be. He’s a small town boy, doing what he loves to do but he wants more substance to the way he’s living. The trip to Vasnytsia does exactly that as his world view gets a complete makeover. Not only does Jaxon end up traveling without the entourage he’s used to, as Reid’s mission goes sideways the two end up on the run. Reid’s mission is to try to destabilize the country and force elections and that makes him an enemy of the state. Despite his fear, Jaxon won’t leave Reid to fend for himself. Jaxon knows his celebrity can protect both of them and he sticks by Reid even as Reid tries to force the star to safety. Through all of the crazy events that could result in either of them dying, Jaxon and Reid manage to start a romance. Reid tries to keep it from beginning since they’re in a country where homosexuality is illegal but they give in to their passions. That’s just the beginning as they share stories about their pasts, which only endears them more to each other. The mix between the romance and suspense is perfect, giving our guys time to fall in love even while things around them go crazy. I liked that Kim avoided the usual Dreamspun scenario of having alternating points of view. Everything in the story is Jaxon, which works perfectly so we don’t know Reid’s mission or anything else too early. It makes for a very snappy read going on the roller coaster that Jaxon experiences. Kim brings Vasnytsia to life through its people. It starts with the guides taking Jaxon around the country, giving him peek behind the propaganda. As he meets fans who must covertly speak to him as it wouldn’t be proper for anyone to talk with the American he begins to understand why Reid’s mission is so important. Ultimately it’s these people who shelter Reid and Jaxon and help complete his mission–with a particularly awesome assist from Jaxon. Drew Bacca does a great job on the audiobook, including having to sing a couple of Jaxon’s songs. This is the first book in the “Stars From Peril” series that Kim has in the Dreamspun line. The second book, Redesigning Landry Bishop, comes out in May and I’m already looking forward to it. -------- Clean Break by Erin McLellanI almost didn’t pick this book up because I couldn’t imagine reading a book that included the characters taking care of Madagascar hissing cockroaches. I’m not a fan of bugs and the trigger warning page discusses more about the bugs than anything else. However, I’m glad I listened to the re-assurances I wouldn’t be creeped out because this is a terrific book–and the bugs really are a non-thing. This book, the second in Erin’s “Farm College” series, throws together Connor Blume and Travis Bedford–two guys who very much don’t like each other in the aftermath of an awkward, failed hookup. As their final college term begins, Connor and Travis are taking Entomology 101 and because the professor likes students to sit alphabetically, they’re next to each other and end up becoming class partners. Their dislike for each other radiates from them during that first class. Connor’s OCD and anxiety flare up just being near the guy, who he’s still wildly attracted to and wants to have a real discussion with. Travis has the attraction too but carries the anger from their previous hookup. It only gets worse as they get the assignment that they’ll be caring for Madagascar hissing cockroaches for the semester or that they’ll have to answer discussion questions together. It doesn’t take long for the sparks of dislike to turn into sparks of desire and they end up spending time after class in a storage closet making out. Neither of them is particularly happy that they’re giving in to their desires, which makes the scenes cuter and hotter. Travis wants the fussy farmer and Connor very much wants the stand-offish English major. Even as their make out sessions start to cool their hatred, they realize they’re constrained by time. At graduation, Connor is set to take over management of his parent’s farm, even though he doesn’t necessarily want that. Meanwhile, Travis can’t wait to get out of the small town for his legal aid internship and then on to law school. The guys have their futures mapped out and there’s no space for the other. That doesn’t stop them from getting emotionally entangled. Erin does a terrific job of bringing these two together. As they move their hookups to the bedroom, Travis discovers he likes Connor’s controlling side and gives himself over to it. Connor though never takes advantage, making sure that he’s always got Travis’s consent and that Travis enjoys himself. That continues as Travis reveals he’d like to be spanked. Both guys discover this is exactly what they need. Beyond the sex though, their efforts to not get too attached aren’t helped by their post-sex talks. Travis usually wants Connor to tell him a story and it’s here that he opens up bit by bit about his anxiety, his OCD and his pre-determined future. There’s so much going on for him, as a reader I wanted to wrap him in a hug and do whatever I could to ease the load he carried. Travis talks a lot too and over time we learn what makes him so driven–it turns out he lost one of his dreams due to an accident and he doesn’t want to let anything or anyone cost him this one. Just a she was great at bringing them together, Erin tears the guys apart just as expertly. It’s a tough go as Connor and Travis force themselves apart as graduation nears. Erin does a number on the characters as they emotionally hurt themselves and each other as they keep to their plans. Both guys want to talk to the other so badly and yet they’ve promised not too. For Connor, this is particularly bad for his OCD. Of course, this is a romance, so all must end happy. Thankfully how Erin gets the guys back together his as satisfying as everything she did earlier in the book. There is a way for them to be together–it just takes time for them to get there. -------- Interview Transcript - Erin McLellan Jeff: Welcome, Erin, to the podcast. Erin: Hi. Thanks for having me. Jeff: Very excited to have you here. You’re a new-to-me author and I just finished reading “Clean Break,” which I have to tell you, I adored so much. I’m reviewing it right before we get into the interview segment I’ll have reviewed it to kinda tell everybody about it. Erin: Yay, thank you. Jeff: It is the second book in your “Farm College” Series. So before we dive into “Clean Break,” tell us more about what the “Farm College” Series is about. Erin: Okay. So it’s just two books so far like you said and they are set in a fictional college in Western Oklahoma. And I would say kind of the overarching themes are… Since they’re college stories, they’re new adult that’s kind of coming of age and self-discovery, finding your authentic self, finding a home is kind of a big one. I think that’s kind of important at that age. You’ve moved out of your parent’s house or wherever you grew up for a lot of people and kinda figuring out what is home, what is family, that kind of thing. So those types of themes are kind of follow both books. They’re both kind of angsty to be honest though “Controlled Burn,” more so than “Clean Break” actually. Jeff: Oh, my goodness. Erin: So be prepared. But, yeah, and I think in terms of… The setting is really important to me at least as the author and those books is important to me. I’m from Oklahoma. I live in Alaska now, but I’m from Oklahoma. And it’s important to me to write stories that are set in Oklahoma that have, you know, LGBTQIA+ characters in Oklahoma. And I know as somebody that reads a lot of romance, I don’t see that very often. I don’t see romance set there or it might be… I have seen it where it’s, you know, characters that are like, escaping Oklahoma which certainly is the case for a lot of people, but it’s also the case that people live and love, and make their lives there. And I kinda wanna show that. Jeff: Does a farm college like this exist in Oklahoma? Is it based on a real place? Erin: No. Kind of I guess. A lot of the kind of small details mirror Oklahoma State which was my alma mater for undergrad, but Oklahoma State is so much bigger than the college that I created. So Farm College is kind of a smaller college in Western Oklahoma that I’ve created, but in terms of being, you know, having a strong agriculture program, but also kind of having this liberal arts situation that’s going on and a pretty vibrant LGBTQIA community, I’ve kind of made most of that up. So… Jeff: And I agree that we don’t see, I mean, besides books set in Oklahoma, really the more rural settings kinda, it’s always escaping from those places. And I like that you kind of built a place as if this is what you’d like to see even if it doesn’t quite exist there now. Erin: Right. And I think it’s kind of funny when I started writing “Controlled Burn.” It was pre-2016, right? And I kind of had this, you know, I kind of had this idea that it’s getting better, right? It’s looking up for lots of communities and I’m not sure if that’s necessarily the case anymore. I hope it will be and I hope it is eventually. But, you know, there’s good and bad, I think, about places like Oklahoma and Kansas, and Texas. And, you know, Oklahoma is really special to me. It’s really important to me. Kansas is the same, but there’s also problems and, you know, I wanna kinda write those stories. And I also, thinking about Oklahoma or Texas probably more so, a lot of the romances that I’ve read that are set there are like, ranch, you know, the cowboys, the farmers which there is kind of a farmer in “Clean Break.” But there’s a lot of people that live in Oklahoma and in Texas, in Kansas that aren’t cowboys. So I wanted to tell that story too. Jeff: Right. And you really hinted that a little bit with some of the dialogue between Travis and Connor in “Clean Break” too as they kind of talk about the difference between cowboy and more the farmer type that Connor and his family are. Erin: Right. Jeff: And so, as we kinda move this direction, tell us what “Clean break” is about and kind of who Travis and Connor are. Erin: Right. So “Clean Break” is about Travis and Connor. Travis is…he’s the best friend in “Controlled Burn.” So if you read “Controlled Burn,” you see quite a bit of him. He’s an English major. He’s from Houston, Texas, very ambitious. He’s got these kind of life plans and nothing’s gonna slow him down, right? He wants to go to law school. He’s got an internship after for the summer. He’s planning to move to Saint Louis eventually to work at this legal aid charity. He has this very, you know, set goals and he’s also kind of a unique, quirky, funny character to me. And then you have Connor who comes in and I don’t know if I would say at the beginning of the book, it’s more like pre-book before the book happens, they have a little bit of a failed hookup in a lot of ways. Some misunderstandings and so, they don’t like each other very much. And then in the first chapter, they get paired together as class partners in a class. And Connor is a farm boy. He’s kind of a townie, right? He’s from Elkville which is the city that’s it’s set in. He’s expected to take over the family farm and so, he’s got this, you know, he kind of his future plans are set, right? He doesn’t have a say over them and he’s… I have a big soft spot in my heart for him. He’s got anxiety, he has OCD. I really wanted to kind of write against the archetype of the like, lackadaisical cowboy or even like, the kind of the hard cowboy or, you know, that kind of archetype that I had in my head. I wanted to write a sensitive farm boy who’s in therapy and, you know, it doesn’t really match some of the people or the characters that I have seen written that way. And kind of the main issue between them, first is that they don’t like each other, but they’re attracted to each other, right? But the kind of the main two things that I wanted to do with the book is I wanted to write a complex authentic characters that are really well-rounded and hopefully, I accomplish that. And then the other thing that I really wanted to do was kind of write to people that are heading towards their future which is graduation and then, you know, the future beyond. And then their futures don’t mesh. There’s not really a way to come together at the end of graduation. They’re moving in different directions and I think that’s a really universal thing for people in college that are dating and dating seriously… do you compromise your future for somebody else? Do you change it? How do you make it work? So those are kind of the two things that I really wanted to hit on and of course, there’s, you know, there’s some kink that happens in the book and kind of self-discovery with that especially on Connors’ part. So there’s a lot going on, but those two things. The characterization and the conflict there with their futures not meshing are the two things I really wanted to hit. Jeff: And I think you did them both, I mean, really well. This book has so much going on in it and yet it never…the story also never gets way down either with the weight of everything that’s kind of moving around here. Erin: Thank you. Jeff: And really, you started them off as enemies who sort of move to friends to sort of get to lovers. Erin: Right. Jeff: Just that progression was so fun to watch unfold as they both pick at each other and then also help each other grow at the same time. It’s like, they lift each other up and kinda tear each other down at the same time. Erin: Right. And I hope that that is realistic. I think people… Because in a lot of ways they are kind of mean to each other at certain points and people can be mean to each other in real life. Especially, they’re not very old, you know, they’re 21, 22. So they kinda make stupid mistakes sometimes and say things that can be hurtful and then have to figure out how to make it better. Jeff: And I think with Connor too, you talked about writing against the archetypes and just having kinda the anxiety plus the OCD. And being, you know, a young gay man in that setting really just sets up so much for him in that situation. Erin: Right. Yeah. He has a lot going on. He’s bi actually and… Jeff: Right. I’m sorry. You’re right. Yes. Erin: And so, kind of a lot. I mean, it’s just a lot and I think it’s a lot for him to kind of deal with all at the same time. Jeff: What was your research on the mental health side of it to kind of figure out what traits to weave into his personality? Erin: So I did a lot of research and I had some readers too that read it for me. One of the main things that I really looked at was kind of the myths especially with OCD, kind of the myths surrounding OCD. I think a lot of people think it’s just, you know, a cleanliness thing or even an organizational thing where they, you know, people with OCD have an impulse to organize or clean. And that’s not really how it presents for a lot of people. A lot people have intrusive thoughts which he has or, you know, they have checking where he checks the expiration dates on food and he can’t kind of stop doing that even though he knows he shouldn’t be doing it, and it’s not healthy for him to do. And so, I did a lot of research about the myths and the different ways that it presents for people and kind of the hardships that it causes them. And I also really wanted to make sure that I kind of made it clear. It’s something that he’ll always deal with, right? It’s not going away and so, it’s really… I did a lot of research on how to manage it, how, you know, how to kind of continue life dealing with a mental health problem like that. Jeff: Yeah. I just… So often I wanted to just give him a hug when he was starting to lapse into it. It’s like, “Oh, I’m so sorry this is happening.” What you did through the black moments and I don’t wanna give spoilers for folks who, you know, need to read the book. But what you did to the black moments for both Connor and Travis as they dealt with their emotions and for Connor how those emotions kinda manifest themselves in his OCD was really just, I really liked seeing two young adults kinda come to grapple with all of that. Erin: Yeah. And I think it’s pretty normal when you’re more stressed, right? Or when there’s more and more stress for, you know, the OCD to kind of build on itself. The same with anxiety like, whenever I am really stressed about my anxiety, it’s gonna be worse about small things, you know, you can kind of blow them out of proportion. I know I do that and so, I was kind of trying to show that how it’s like as things got more stressful for him with graduation moving and with kind of this relationship with Travis, that’s not going away he wants it to go. It does kind of snowball for him and it kinda snowballs for Travis too just in different ways because he doesn’t, you know, he doesn’t have anxiety or OCD of course, but, you know, he struggles just kind of the same way. Jeff: Yeah. When you were talking about with this books about you left out one of its major points. Erin: The bugs? Jeff: That is the inclusion of the the hissing cockroaches. Where did that idea even come from? Erin: So I knew I wanted to put them in a class together and I wanted them to be class partners. But Travis is an English major and Connor is agriculture sciences, agribusiness major. And so, I knew it had to be like a gen ed class for at least one of them. And so, I really started thinking about the gen ed class that I had taken as an English major whenever I was an undergrad trying to figure out what class would make sense. And then I realized that I actually had taken an ag class that was Entomology 101. And I loved it, I, you know, I held like, tarantulas and I held millipedes. And I could see myself being that like, weird bug girl a little bit. I just loved it. And so, that’s kinda how I decided to put them in an entomology class. And it’s funny because, I mean, I do think that college is one of those times to take the weird class and do the weird thing. And so, I think it kind of made sense there and I also felt like, I gave a degree of what kind of humor and lightness I thought it would to the story. But I realize now that a lot of readers maybe don’t like bugs. So it’s something that’s like a little distracting to some people. When I had took the entomology class, we had an assignment where we had that exact assignment with the Madagascar hissing cockroaches where we had to take them home and observe them. And so, you know, for an entire semester, I had a Madagascar hissing cockroach in my dorm room with me. I never took it out of its box. I like, you know, I fed it, like, carrots through the little hole that it couldn’t get out and so, that would be fun to put that in the story. And I can tell you for the readers, the cockroaches do not escape ever. They never… There’s no, like, unexpected cockroach scenes. I promise. Jeff: Yeah. And I can vouch for that. There are no unexpected scenes and in fact, I had to check… I had to ask about that before I took the book to read and I’m like, “Bugs, I don’t know about that.” Erin: I know. I have put it in the trigger warnings for the book and on my website, it really does lay out kinda scene by scene where they’re at and kind of the degree that they’re on the page. And they’re not on the page that much. Jeff: No, they’re not and I never got squirmy reading it either because I really don’t like bugs. But I was totally fine with how this turned out. So… Erin: Yeah. I know. I don’t know why it hadn’t occurred to me that it would gross people out. At that point it was too late when it, like, finally hit me. I was like, “Well, I can’t do anything about it.” But I kind of thought that they were funny. Jeff: Well, I think it really fits with the whole ag culture of the college that of course, they’re gonna end up with bugs or whatever and have to learn about them. So it all meshed in together and like you said, there’s no point where they’re escaping or, you know, being gross. They’re just kind of there. Erin: Right. And students… Jeff: I like to, you know, those classes sometimes you take in high school where you’re having to take care of the doll for a week or whatever. And in this case you’re hanging out with a cockroach. So… Erin: Right. It’s kinda like a little pet for them for this semester. Jeff: So is there more plan for the Farm College Series? Erin: I have not kind of set plans. I do want to write a story for Alex. He’s in both books. He’s not in “Controlled Burn” for very much though his part is kind of important in “Controlled Burn.” He’s a friend of Connor’s really in “Clean Break” and I do wanna give him a story and I will. I’ll probably start writing that soon. Kind of be on that. I don’t know how much more I’ll write in the Farm College Series though I do wanna do a spin off that’s kind of several years in the future. So they’re not really in college anymore and I want to do an F/F romance for Desie and Lena. So I would start there for them. Jeff: Yay. Yeah. I would totally read that book because one of the things you did in “Clean Break” and I’m sure you established it back in “Controlled Burn” too, was just the tight community of friends that Travis and Connor both have, and even, like, the strong family presence of Connor’s family and how they support him. So it would be great to see more of all of that. Erin: Yeah. So… Yeah. And I definitely… I think I did a little bit more successfully in “Clean Break” for sure where they have very supportive families and they do have kind of a big wide friend group. And so, yeah, I’m glad that you like that, but I do want to do the F/F romance for Lena and Desie kind of. But Lena is quite young in this book. She’s 20 and so, I wanna give her a little bit of time to grow up, I guess. Jeff: Yeah. That’s cool. Now, you’ve got another series out there called “Love Life.” And tell us a little bit about what goes on in that series? Erin: Sure. So that’s also, they’re both male/male romances. Set in Oklahoma, Eastern Oklahoma for the first book, “Life on Pause.” They’re kind of small town romances there. The first one is about a guy that works at a homestead kind of prairie museum. They’re kind of common in Oklahoma where the people that work there have to dress in like, historical costumes of the time. So he works at that type of museum and then he is paired with a high school choir teacher. And it’s kind of them trying to fall in love and figure out how their relationship will work. It’s definitely kind of lighter in tone than the farm college series, but it’s still a little angsty. The second book in the series, “Life of Bliss,” is more novella link that’s a little short and it’s very tropey. It’s kind of two people that don’t like each other very much, but are fooling around kind of behind their friends’ backs. They agree to be fake boyfriends for a family wedding in Arkansas and Arkansas kind of, well, it has this… Historically in the area, it was the only state that didn’t have a waiting period for marriage licenses. Now, most of the states don’t, but back in the day, you know, they made you like, test for syphilis and all kind of stuffs. But extended the marriage license period. So Arkansas is kind of the place where people go for their shotgun weddings historically. So this is going back quite away, but in this book they go to a wedding in Arkansas, they get drunk at the wedding and basically, end up getting married themselves. It’s set in Eureka Springs, Arkansas for the wedding part and I don’t know if anybody would be familiar with that. But you can get married practically anywhere in Eureka Springs. It’s kind of an economy there. So it’s quite easy to get married and that’s what happens. So it’s kind of fake dating to accidental marriage. Jeff: Fake dating to accidental marriage. I like… Those are favorite tropes right there. Erin: Yeah. It’s a fun one, I think. Jeff: So what is your writing origin story? You’ve got these four books out. How did all this start? Erin: Well, I was a creative writing English major in undergrad, but then I ended up going to grad school for library and information studies. And I was a public librarian. And I had… I kind of had a lot of big changes in my life. I just graduated grad school. I just got married, I just moved away from home like, all of these big changes. I had a full time job for the first time and I had… I was living in Houston, Texas and I had this horrible commute. It was like, an hour and a half each way and… Jeff: Yeah. that’s pretty horrible. Erin: I think most people that have been in Houston know what I’m talking about. And I had all this time to kind of think and I basically on my commute started plotting a book. And some of it came from, I missed kind of the creative outlet writing research papers and stuff like that from school. And so, yeah, that’s kind of how I started writing as I plotted this book on my commute and then finally, I decided that I was gonna sit down and write it. And that book was “Controlled Burn.” Jeff: That’s an awesome story. Erin: Thank you. Jeff: What led you into putting this creativity towards M/M romance amongst all of the genres that were possible? Erin: Yeah. Some of it I think is that I was reading a lot of it at that time, I kind of got into M/M romance I guess if we’re going further back by reading Suzanne Brockmann, right? So she has the “Troubleshooters” series and that has Jules Cassidy who’s the gay FBI agent, right? He’s got that kind of the secondary romance through several books and then the primary thorugh a novella. And then whenever I was in grad school, I kind of didn’t have time to read for pleasure very much. So I wasn’t reading very much and then I took a class about reader’s advisory that we had to read like, the books from the best books of the year for “Publishers Weekly” and “Kirkus,” and stuff. And I just kind of… I can’t remember what year it was, but I grabbed kind of a random book off the romance list and it ended up being “Brothers of the Wild North Sea” by Harper Fox and I didn’t really realize that it was a male/male romance. So I just kinda grabbed it and started reading, and then it became quite clear, you know, very early on what it was. And it’s a beautiful book. Harper Fox is, you know, is a beautiful writer. Everything that she writes is really awesome and so, I kind of gobbled up everything that she had written and then it kind of hit me at that time. There has to be other writers that are doing this and, you know, they weren’t the books that were in the libraries. They weren’t in my libraries. So I kind of started searching them out and, you know, read a lot of K.A. Mitchell and Z.A. Maxfield, and some of those authors at that time that were the most prolific. And I was just very excited because I felt like there are all these authors that I had never heard of that I didn’t know about and they were all really, really good. And they were writing, you know, stories that kind of the themes were very important to me. And so, then when I write finally, eventually, decided to sit down and write a book. I think probably the main thing for me is that I wanted to write characters who are LGBTQIA in Oklahoma and it just happened to be that the first book that kind of came to mind, and that I plotted fully was an M/M romance in “Controlled Burn.” So that’s definitely how I got started. Jeff: That’s very cool and some great authors there to get you introduced to the genre as well. Who do you count as your author influences? Erin: Well, definitely, you know, my gateways were Suzanne Brockmann into romance in general and then Harper Fox. Kind of on a wider scale, I really like Alisha Rai. She kind of, she writes the heroines that are the type of parents that I just love. They are raunchy and rowdy, and wonderful. I would say also Annabeth Albert in terms of contemporary romance. Alexis Hall, I think kind of teaches or his books are like a master class on first person point of view if you look at “For Real” or “Glitterland.” And so, I really, really like his books too. Jeff: Now, your bio mentions that you like binge worthy TV shows. So of course, we have to know what are you binging these days or have binged recently that you would recommend? Erin: So my husband and I have been rewatching “Game of Thrones” of course, because the last season was about to come out. So when you binge that show, you just kind of realize how many awful things happened back to back to back because the first time we watched it, we didn’t binge it. We are watching it week to week, but when you’re binge watching that it’s like, “Oh, my God. That’s so awful, these things that keep happening.” Other than that, I really like… I like true crime, but I’m not watching any kind of true crime right now. And I like comedies. So I’ve watched “Schitt’s Creek” recently which I love, “The Good Place,” “Brooklyn Nine-Nine,” “One Day at a Time,” all these sitcoms that I think are really good, “Crazy Ex-Girlfriend” because I love musicals is really good. And then I also watch a lot of like, reality TV. So I like, like, “Tiny House Hunters,” and “Instant Hotel,” and “Project Runway,” shows kind of like that. Jeff: Very cool. Yeah. Some good stuff on there. Erin: You can tell me I watch a lot of TV. Jeff: “The Good Place” is a particular favorite. Erin: Yeah. It’s so smart. It’s so different than like, yeah, it’s very, very unique. So this is a great list for everybody who’s looking for something to binge the spring right here. So what’s coming up next for you in your release plans? Jeff: So I don’t have anything kind of set in stone. I’m not very good at planning. [I”m working on one about] tornado chasers or storm chasers. That’s a male/male romance that I have on submission right now to a publisher that I’m hoping will pick it up. If they don’t, then, you know, it’ll keep going out and hopefully somebody else will want it. I’m currently writing a book about a rec league softball team and I want this to be really, really tropey and kind of fun and light. The first one is using kind of the one bed trope. So I hope that that would be a lot of fun. I’ll write Alex’s story pretty soon and then I have a book that I wrote. But I’m hoping to put out at Christmas, it’s called “Stocking Stuffers.” And it’s a M/F romance with a bi heroine who sell sex toys. You know, like the Tupperware parties, but it’s like the, you know, the sex toy Tupperware parties kind of. And so, she works for a company kinda is the marketing person for a company like that and she’s hosting one of those parties, get snowed in, you know, with a big red bag of toys basically. Jeff: Yeah. That’s like an interesting forced proximity story. Erin: yeah. So it was a lot of fun to write. Jeff: And I’m very interested in the storm chasers one too because I’m kind of a weather geek at heart. So you kind of got me on that one. Erin: It was a lot of fun to write. Growing up in Oklahoma, you know, tornadoes are such a kind of a constant really. I mean, my parents have lost a house in tornado. I know lots of people that have lost houses in tornado. It’s so common. It’s just kind of a part of your life especially if you’re from Central Oklahoma like me and so, it’s… Yeah. It was a really fun one to write because you are just kind of entrenched in bad weather in Oklahoma in the spring all the time. So… Jeff: Very cool. And how can readers keep up with you online to keep track of all these projects? Erin: So I have a Facebook group called Erin McLellan’s Meet Cute. That’s a good one if you kind of… I do giveaways and book recs, and stuff. On Twitter my handle is @emclellanwrites and I’m on Twitter pretty often. On Instagram it’s @erinmclellanwrites and on Instagram, I would say it’s about 70% Alaska stuff like, every moves that I’ve ever seen and then 30% books. Unless there’s a book released and then it flips. But it’s a lot of Alaska if you follow me on Instagram. And then my newsletter which you can get too on my website or through any of the social media too. You would be able to kind of find the link to my newsletter and that’s probably the best way if you just want like, to know about new releases or sales, or things like that without having to kind of trudge through Twitter. Jeff: Well, fantastic. Well, I thank you so much for coming to talk to us about “Clean Break” and wish you all the success on that one and the upcoming releases as well. Erin: Thank you so much. It was so fun.
Join our growing entrepreneur community on Facebook: www.facebook.com/groups/139597470073188/ Got any questions? Ask me on Facebook: www.facebook.com/AleksanderVitkinPage/ Check out my free business training: www.businessmentor.com Jeff: Well, actually the way the business got started was I began a YouTube channel where I was doing these whiteboard animations of book summaries. And then from there I built a bit of a following on YouTube, and then people just started asking for these videos for themselves, for their companies, so we ended up working with some local clients, and from there started bringing on different team members who could do stuff better than I could do, such as animation. I’m not the best animator, but I have a team that is very good now. So we’ve abandoned the YouTube channel for a little bit, and just worked on growing the business, and then from there, it’s kinda grown. Aleks: Yeah, and what year did you join, what was back then DBH, or what is now Business Insiders, what year was that, 2016 or 17? Jeff: I think that was 2016, so towards the end of 2016 I joined what was then DBH. Aleks: And what funnels did you run then, what did you start doing then, or what were you doing then? Jeff: So when I joined it was pretty much just Upwork, and referrals we were using, and over the course of towards the end of 2017, 2018, we started implementing LinkedIn. And then it’s grown substantially from there. What I find very interesting about your business right now, is we were just talking before the interview, and you said that you have quite a large following now on LinkedIn. I think most people don’t really use LinkedIn to build large following, they think YouTube is more suitable for that, and you’ve done both. So what have you found so far? Jeff: Yeah I mean, in terms of building the YouTube following, every once in a while you’ll get someone reaching out and saying, hey can we get something like this for our business? But LinkedIn is more like people are there for business. They were there to make connections in a business setting, and they’re there to see what you have to offer, and then they talk about what you make, and ways you can work together, so it’s definitely better to work with LinkedIn than it is, on YouTube it’s more so just people who are looking for entertainment. Aleks: Hmm, yeah, so you have to go through a longer cycle before they buy on YouTube than on LinkedIn where they’re already in the business kind of mode, and they’re probably at work while watching it right? So what kind of stuff have you done to build up the following on LinkedIn, because you have what now, 10,000 people or something like that, that are following your stuff on LinkedIn? Jeff: Yeah, about almost 9000, maybe past 9000. It’s just a following, just making connections, and then it expands from there, so it’s just an entire specific industry, we are pretty well-known, so we have a big following, and yeah, just connecting with people, and making, building relationships is the main thing that you want to be doing on LinkedIn, is talking to people, see how you can help them, see what they’re interested in, see what their strategies are, and just have a conversation and go from there, and if you can help them, then by all means, work together. So some people on LinkedIn, I’ve noticed, especially in my industry, they’ve been messaging people like me then messaging people like my friends, and they’re just saying, hey man, do you want to buy this thing? I think it’s pretty annoying. I get a lot of messages as well on LinkedIn, where it’s just people are like, you can tell it’s a copy paste message that they send out, so I immediate end it there. They only seem to care about what they’re up to, they don’t seem to like have any interest in helping you.
更多英语知识，请关注微信公众号: VOA英语每日一听Todd: So, Jeff, let's talk about technology. These days we have all types of new technology, computers,Jeff: Can we just end this right now. I don't like technology, so can we talk about something else.Todd: What? You don't like technology.Jeff: No, I don't like technology.Todd: What do you mean you don't like technology.Jeff: Technology is, I think it's gone against what it was originally invented for, and that is for convenience to make people's lives more easy and to give them more free time, and I think it's totally gone against what it was originally invented to do.Todd: Yeah, but technology does make your lived easier, like it saves us time, it communicates,Jeff: But does it save us time?Todd: I think so. I mean, before you had to type something up, now you can just type it up on a word processor. It's quicker. Before you had to walk to a phone. Now the phone is in your pocket. You can just pick it up and call anytime, anywhere in the world.Jeff: Kind of. I kind of agree with that, but sometimes that walk to the phone is sort of pleasant and you had time to think about other things, but now as you're walking to the phone, you're typing something into your PDA while you're listening to your MP3 player, and then you get into your car and you drive to your office and the first thing you do is check your e-mail and then right after that you check your voice mail and then you send an e-mail to someone and then, I think it's just sort of, it's cluttered. It;s cluttered our lives versus clean it up.Todd: Yeah, but maybe if you did not have that, then you would probably have something else that would just clutter up your life. I'm sure people were busy before they had technology.Jeff: Mm, I agree. I think they were busy but maybe more wholesome things, or less, I think, I think you, we, our mind's are sort of, our minds are always bombarded with images or news and a lot of this stuff is not needed but because it is there we use it. I don't think we have to see so much news or read so many different things on the internet and see so much on television and the DVD player, get our news on our MP3 players and our hand-held, our little hand-held computers, our PDA's. I think it's just, we fill our time now with things that are not really needed or not maybe as useful or as clean as the old days: reading and writing and poetry, and when was the last time you wrote a letter to one of your friends and a nice hand-written letter, and put it in an envelope and put it in the mailbox.Todd: About three or four years.Jeff: Or a postcard even.Todd: Four years.Jeff: So, I think it's, technology is good but I think it's sometimes defeats it's own original purpose.
Shownotes Jeff: Welcome back to EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Fear not, this will not simply be “who needs a head CT episode”; we’ll cover much more than that. Listen closely as this is an important topic, with huge consequences for mismanagement. Jeff: Absolutely. As some quick background - headaches account for 3% of all ED visits in the US, with 90% being benign primary headaches and less than 10% being secondary to other causes like vascular, infectious, or traumatic etiologies. It’s within these later 10% that we are looking for the red flag signs to identify the potentially life-threatening headaches. Nachi: And to do so, Dr. David Zodda and Dr. Amit Gupta, PD and APD at Hackensack University Medical and Trauma Center, and their colleague Dr. Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all. Jeff: We would be remiss to not also mention Dr. Mert Erogul of Maimonides Medical Center and Dr. Steven Godwin, Chair of Emergency Medicine at the University of Florida College of Medicine. Nachi: Alright, so let’s get started with some definitions and pathophysiology. The international classification of headache disorders 3, or ICHD-3, classifies headaches into primary, secondary, and cranial neuropathies. Jeff: Primary headache disorders include migraine, tension, and cluster headaches. Secondary headaches include those secondary to vascular disorders, traumatic disorders, and disorders in hemostasis. These are the potentially life threatening headaches that can have a mortality has high as 50%. Nachi: And the final category includes cranial neuropathies, such as trigeminal neuralgia. Jeff: And I think we can safely say that that wraps up our discussion in this episode on cranial neuropathies, moving on…. Nachi: Headaches result from traction to or irritation of the meninges and blood vessels, which are the only innervated central nervous system structures. Activation of specific nerve ganglion complexes by neuropeptides like -- substance P and calcitonin gene-related peptide -- are thought to contribute to head pain. Jeff: It is important to note that all headache pain shares common pain pathways, thus response to pain medications does not exclude potential life threatening secondary causes of headache. This led to the ACEP guideline which states just that.. Nachi: I feel like that deserves ding sound as it's a critically important point. To repeat, just because a pain medication relieves a headache, that does not exclude dangerous secondary causes! Jeff: And what are the life threatening headaches? Life-threatening headaches include subarachnoid hemorrhage, cervical Artery Dissection, which includes both vertebral Artery Dissection and carotid artery dissection, cerebral Venous Thrombosis, idiopathic intracranial hypertension, giant cell arteritis, and posterior reversible encephalopathy syndrome, or PRES. Nachi: Slow down for a second and let’s not skip over your favorite section.. Let’s talk pre hospital care for headache patients. Jeff: Good call! Pre-hospital care is fairly straightforward and includes a primary survey, conducting a focused neurologic exam, and assessing for red flag signs, which include focal neurologic deficits, sudden onset headache, new headache in those over 50, neck pain or stiffness, changes in visual Acuity, fever or immunocompromised State, history of malignancy, pregnancy or postpartum status, syncope, and seizure. That’s quite a list. For a visual reference, see Table 3 in the print issue. Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Tylenol should be offered for pain management. Avoid opioids and nsaids. Jeff: Upon arrival to the emergency department, history and physical should include your standard vitals, testing neurologic function, cranial nerve testing, head and neck exam, as well as a fundoscopic exam. As was the case for your pre-hospital colleagues, you should also assess for red flag signs for life-threatening headaches. Check out tables 2, 3, and 4 for more details here. Nachi: With respect to Vital Signs, in the setting of an acute headache, severe hypertension should prompt a search for signs of end-organ damage such as hypertensive encephalopathy, intracranial Hemorrhage, PRES, and preeclampsia in pregnant women. Additionally, fever, and especially fever and neck stiffness, should raise concern for CNS infection. Jeff: For your neurologic examination, make sure to include assessments of motor strength, coordination, reflexes, sensory function, and gait. Don't forget that lesions involving the anterior circulation, such as dysarthria, cognitive impairment, and Horner syndrome may be indicative of a carotid artery dissection, whereas dizziness, vision changes, and limb weakness may be due to a vertebral Artery Dissection. Nachi: And for cranial nerve testing - pay particular attention to cranial nerves 2, 3 and 6. For cranial nerve 2 - look out for an afferent pupillary defect, or a marcus-gunn pupil, which is seen in optic neuritis, giant cell artertitis, and central retinal artery occlusion. For CN3, oculomotor nerve palsies raise concern for a posterior communicating aneurysm and SAH. And lastly, CN6 palsies, which often presents with diplopia on lateral gaze , are often seen with intracranial idiopathic hypertension and cerebral venous thrombosis, in addition to impaired visual acuity, visual field defects, and tunnel vision. Jeff: For the head and neck exam, remember that a partial horner syndrome, with miosis and ptosis without anhidrosis, may be indicative of a cervical artery dissection. Unfortunately, if the patient presents acutely, their only complaint may be pain, as the neurologic sequelae may take days to develop. Nachi: Additionally, with respect to the head and neck exam, evaluate the patient for tenderness and beading along the temporal artery. Jeff: One review noted that temporal artery beading actually had the highest likelihood ratio for GCA, 4.6, whereas temporal artery tenderness only had a LR of 2.6 Nachi: And the last physical exam maneuver you should ideally perform is a fundoscopic exam for papilledema, which is often seen in IIH, malignant hypertension, and CVT. Jeff: Perfect so that rounds out the physical, next we have diagnostic studies. Most importantly, routine lab testing is typically of low utility in aiding in the diagnosis of headache. Nachi: Even ESR and CRP in the setting of possible giant cell arteritis have poor sensitivity and specificity to diagnose it. So even if the ESR and CRP are negative, if the suspicion for GCA is high enough, it should be treated and you should get a biopsy. Jeff: Do consider adding on a venous or arterial carboxyhemoglobin in the right clinical scenario, as CO poisoning represents an important cause of headache you wouldn’t want to miss. This is especially important at this time of year when heating systems are working overtime here in the states. Nachi: And hopefully you have a co-oximeter, so you can even check this non-invasively. Jeff: Interestingly, there may be a unique role for a d-dimer here as well. Several small studies have used the d-dimer to risk stratify patients with possible CVT. In one study a d-dimer level < 500 mcg/L had a 97% sensitivity and a negative predictive value of 99% - not bad! Nachi: Pretty impressive performance characteristics. I think that about wraps up lab work. Let’s talk radiology. Jeff: Though low yield, CT utilization is estimated at 2.5-10% of non-traumatic headaches. A non-con CT should be reserved for those with suspicion for an intracranial hemorrhage, while a contrast CT would be required in those in whom there is concern for an infectious process or space occupying lesion. Nachi: CT angio or MRI should be used in cases of possible cervical artery dissection. MRI also is the neuroimaging of choice for PRES, which is more sensitive for cerebral edema than CT. Jeff: Similarly, MRV is recommended in those with a concerning story for CVT. Nachi: To help guide your emergent neuroimaging utilization, ACEP suggests imaging in those with headache and an abnormal finding on neuro exam, those with new and sudden-onset severe headache, HIV positive patients with new headache, and those over 50 with a new headache. Jeff: With that in mind, let’s dive a bit deeper into the use of CT for SAH, a topic which doesn’t get a ding sound, but is certainly critically important. Recent literature have found that a CT within 6 hours of symptom onset has a sensitivity and specificity and negative predictive value of 100%. In addition, one 2016 study demonstrated a LR of 0.01 in those with a negative HCT within 6 hours. These are really important results because that means SAH is essentially ruled out with a negative study. Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Luckily the ACEP guideline is currently being revised so your decision to forego the LP with a negative HCT in the first 6 hours will likely also be backed by ACEP in the near future. Jeff: That’s a nice transition into our next test - the LP. Since LP carries a risk of herniation, in those with signs of increased ICP, make sure to get appropriate neuroimaging before attempting the puncture. In those without signs of increased ICP, no imaging is necessary. Nachi: While the position in which the LP is performed doesn’t matter as much when ruling out infection or SAH, in those with suspected IIH, make sure to obtain an opening pressure with the patient lying in the lateral decubitus position. An opening pressure of greater than 25 is often seen in IIH. Jeff: And the LP in the setting of IIH is not only diagnostic but also potentially therapeutic, as the removal of 1 ml of CSF can lower the pressure by 1 cm of H20 and potentially relieve the patient’s symptoms. Nachi: Always rewarding to diagnose and treat simultaneously... Jeff: Absolutely. But back to the LP for SAH for a second or two. When evaluating for a subarachnoid hemorrhage, you’ll often note an opening pressure of greater than 20 with persistent RBC in all tubes. Nachi: While there are no RBC cutoffs, one study found no patients with a SAH with less than 100 RBC in the final tube. In contrast, greater than 10,000 RBC increased the odds by a factor of 6. In addition, one 2015 study found that patients without xanthrochromia and less than 2000 RBC were effectively ruled out of having a SAH with a combined sensitivity of 100% Jeff: Lots of 100% sensitivities and specificities being thrown around today, which is definitely not the norm. No complaints here, I’ll take it. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. Nachi: Examining the optic nerve sheath 3 mm posterior to the globe, an optic nerve sheath diameter of 5 mm or greater is predictive of an ICP greater than 20. Jeff: Keep in mind that this may expedite the work up, though a normal diameter does not rule out increased ICP, so a head CT may still be indicated. Nachi: Alright, so we’ve talked a lot about testing, both lab and imaging, and we’ve mentioned a bunch of pathologies, but let’s spend a few minutes going over the specifics of each. Jeff: Let’s start with SAH. SAH account for 1% of all headache visits to the ED. Most nontraumatic SAH are caused by aneurysm rupture. A missed diagnosis of SAH can have a case-fatality rate as high as 50% Nachi: Although 75% of SAH patients report an abrupt onset, objective neck stiffness has the highest likelihood ratio of 6.6. Other important features include LOC, neurologic deficit, subjective neck stiffness, photophobia, and onset during exertion or intercourse. Jeff: Additionally, approximately 20% of patients with a SAH have warning signs of a sentinel bleed including headaches, cranial nerve palsies, neck pain, or nausea and vomiting. Nachi: In order to aid you in diagnosing a SAH, you should consider the ottawa SAH Rule which has a 100% sensitivity and a 15% specificity. To use this rule you must be between 15 and 40 with a GCS of 15 and present with a headache with maximal intensity within 1 hour of onset. If you meet those inclusion criteria, and you have no neurologic deficits, no neck pain or stiffness, no witnessed LOC, no onset during exertion, no limitation of neck flexion, and no thunderclap onset, you can essentially rule out a SAH. Jeff: While the ottawa SAH rule has been prospectively validated, know that this study has been challenged for its interobserver variability, but in any case it still provides helpful red flags to consider. If your patient is found to have a SAH, a CT angiogram and neurosurgical consultation should be considered immediately. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. Also consider elevating the head of the bed to 30 deg, which may also improve venous drainage and decrease ICP. Jeff: In terms of BP management, guidelines from the american stroke association recommend targeting a SBP of 160 with a titratable agent like nicardipine or clevidipine. Nachi: In addition, nimodipine, 60 mg q4h, should be given to those with aneurysmal SAH to improve outcomes. Jeff: and any role for anti-epileptics? Nachi: That’s controversial and the authors state it may be considered in the immediate post-hemorrhagic period and should be limited to a 3-7 day course with longer courses required in special populations. Jeff: The next pathology to discuss is cervical artery dissections, which account for 2% of all strokes and nearly 20% of strokes in those 50 and under. cervical artery dissections are most commonly due to trauma, but can occur spontaneously. Nachi: Risk factors include Ehlers-Danlos syndrome, osteogenesis imperfecta, and Marfan syndrome. Jeff: Regardless of the etiology, the management of cervical artery dissections is primarily medical with IV heparin followed by warfarin or a direct oral anticoagulant in those with extracranial dissections, and antiplatelet therapy like aspirin or clopidogrel in those with intracranial dissections. Nachi: Thanks to the CADISP study, we know there is no difference in mortality or neurologic outcome when choosing between antiplatelet therapy and anticoagulation. Jeff: Next we have cerebral venous thrombosis. This typically presents with a gradual onset headache. Though it can happen to anybody, cerebral venous thrombosis typically results from thrombotic disease. Nachi: Important risk factors include oral contraceptive use, pregnancy and postpartum states, Factor V Leiden deficiency, and lupus. Jeff: Treatment for CVT is controversial due to a high risk of hemorrhage and hemorrhagic transformation. According to the best available evidence, anticoagulation is the standard therapy with full dose anticoagulation of low-molecular weight heparin or heparin as a bridge to warfarin. Nachi: Yeah, it’s really a tough spot to be in as one third end up having some form of hemorrhage too…. Jeff: Perhaps yet another good place for shared decision making? Nachi: Honestly, it’s a good thought, but anticoagulation is the guideline recommendation, so I think that is likely the best route in this case. Jeff: Great point. Next we have idiopathic intracranial hypertension. This is typically associated with obese women of childbearing age. It may also be due to hypervitaminosis A from excessive dietary intake and even drugs like the retinoids used in treating dermatologic conditions and cancers. Nachi: idiopathic intracranial hypertension can be diagnosed by the modified dandy criteria which are found in table 8 on page 11. Let’s just run through the criteria. Jeff: The modified Dandy criteria for idiopathic intracranial hypertension include: signs and symptoms of increased ICP, no other neurologic abnormalities or altered level of consciousness, ICP > 20 on LP with normal CSF composition, neuroimaging without another etiology for intracranial hypertension, and lastly no other identified cause of intracranial hypertension. Nachi: And as we mentioned a few minutes ago, an LP can be both diagnostic and therapeutic, though the relief is likely temporary Jeff: For more permanent treatment, weight loss is the key. Acetazolamide, 250 mg to 500 BID is the first line pharmacotherapy. Combined with weight loss, acetazolamide and a low sodium diet has been shown to improve visual field function. Nachi: And if this fails, topiramate, furosemide, and in the worst case surgical options like CSF shunting, venous sinus stenting, and optic sheath fenestration are all options. Jeff: I imagine taking a diuretic for a headache could be a real hindrance on quality of life, though I suppose it’s better than risking vision loss or having a significant neurosurgery. Nachi: Agreed. Next we have giant cell arteritis. GCA is rare, with a prevalence of
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we're talking about a topic… Nachi: … woah wait, slow down for a minute, before we begin this month's episode – we should take a quick pause to wish all of our listeners a happy new year! Thanks for your regular listenership and feedback. Jeff: And we're actually hitting the two year mark since we started this podcast. At 25 episodes now, this is sort of our silver anniversary. Nachi: We have covered a ton of topics in emergency medicine so far, and we are looking forward to reviewing a lot more evidence based medicine with you all going forward. Jeff: With that, let's get into the first episode of 2019 – the topic this month is first trimester pregnancy emergencies: recognition and management. Nachi: This month's issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. In addition, this issue was peer reviewed by Dr. Jennifer Beck-Esmay, assistant residency director at Mount Sinai St. Luke's, and Dr. Taku Taira, the associate director of undergraduate medical education and associate clerkship director at LA County and USC department of Emergency Medicine. Jeff: For this review, Dr. Pedigo had to review a large body of literature, including thousands of articles, guidelines from the American college of obstetricians and gynecologists or ACOG, evidence based Practice bulletins, ACOG committee opinions, guidelines from the American college of radiology, the infectious diseases society of America, clinical policies from the American college of emergency physicians, and finally a series of reviews in the Cochrane database. Nachi: There is a wealth of literature on this topic and Dr. Pedigo comments that the relevant literature is overall “very good.” This may be the first article in many months for which there is an overall very good quality of literature. Jeff: It's great to know that there is good literature on this topic. It's incredibly important as we are not dealing with a single life here, as we usually do... we are quite literally dealing with potentially two lives as the fetus moves towards viability. With opportunities to improve outcomes for both the fetus and the mother, I'm confident that this episode will be worth your time. Nachi: Oh, and speaking of being worth your time…. Don't forget that if you're listening to this episode, you can claim your CME credit. Remember, the indicates an answer to one of the CME questions so make sure to keep the issue handy. Jeff: Let's get started with some background. First trimester emergencies are not terribly uncommon in pregnancy. One study reported 85% experience nausea and vomiting. Luckily only 3% of these progressed to hyperemesis gravidarum. In addition, somewhere between 7-27% experience vaginal bleeding or miscarriage. Only 2% of these will be afflicted with an ectopic pregnancy. Overall, the maternal death rate is about 17 per 100,000 with huge racial-ethnic disparities. Nachi: And vaginal bleeding in pregnancy occurs in nearly 25% of patients. Weeks 4-8 represent the peak time for this. The heavier the bleeding, the higher the risk of miscarriage. Jeff: Miscarriage rates vary widely based on age, with an overall rate of 7-27%. This rises to nearly 40% risk in those over 40. And nearly half of miscarriages are due to fetal chromosomal abnormalities. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: So key points here, since I think the wording and information you choose to share with often scared and worried women is important – nearly 25% of women experience...
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re talking about a topic… Nachi: … woah wait, slow down for a minute, before we begin this month’s episode – we should take a quick pause to wish all of our listeners a happy new year! Thanks for your regular listenership and feedback. Jeff: And we’re actually hitting the two year mark since we started this podcast. At 25 episodes now, this is sort of our silver anniversary. Nachi: We have covered a ton of topics in emergency medicine so far, and we are looking forward to reviewing a lot more evidence based medicine with you all going forward. Jeff: With that, let’s get into the first episode of 2019 – the topic this month is first trimester pregnancy emergencies: recognition and management. Nachi: This month’s issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. In addition, this issue was peer reviewed by Dr. Jennifer Beck-Esmay, assistant residency director at Mount Sinai St. Luke’s, and Dr. Taku Taira, the associate director of undergraduate medical education and associate clerkship director at LA County and USC department of Emergency Medicine. Jeff: For this review, Dr. Pedigo had to review a large body of literature, including thousands of articles, guidelines from the American college of obstetricians and gynecologists or ACOG, evidence based Practice bulletins, ACOG committee opinions, guidelines from the American college of radiology, the infectious diseases society of America, clinical policies from the American college of emergency physicians, and finally a series of reviews in the Cochrane database. Nachi: There is a wealth of literature on this topic and Dr. Pedigo comments that the relevant literature is overall “very good.” This may be the first article in many months for which there is an overall very good quality of literature. Jeff: It’s great to know that there is good literature on this topic. It’s incredibly important as we are not dealing with a single life here, as we usually do... we are quite literally dealing with potentially two lives as the fetus moves towards viability. With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: Oh, and speaking of being worth your time…. Don’t forget that if you’re listening to this episode, you can claim your CME credit. Remember, the indicates an answer to one of the CME questions so make sure to keep the issue handy. Jeff: Let’s get started with some background. First trimester emergencies are not terribly uncommon in pregnancy. One study reported 85% experience nausea and vomiting. Luckily only 3% of these progressed to hyperemesis gravidarum. In addition, somewhere between 7-27% experience vaginal bleeding or miscarriage. Only 2% of these will be afflicted with an ectopic pregnancy. Overall, the maternal death rate is about 17 per 100,000 with huge racial-ethnic disparities. Nachi: And vaginal bleeding in pregnancy occurs in nearly 25% of patients. Weeks 4-8 represent the peak time for this. The heavier the bleeding, the higher the risk of miscarriage. Jeff: Miscarriage rates vary widely based on age, with an overall rate of 7-27%. This rises to nearly 40% risk in those over 40. And nearly half of miscarriages are due to fetal chromosomal abnormalities. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: So key points here, since I think the wording and information you choose to share with often scared and worried women is important – nearly 25% of women experience bleeding in their first trimester. Not all of these will go on to miscarriages, though the risk does increase with maternal age. And of those that miscarry, nearly 50% were due to fetal chromosomal abnormalities. Nachi: So can we prevent a miscarriage, once the patient is bleeding…? Jeff: Short answer, no, longer answer, we’ll get to treatment in a few minutes. For now, let’s continue outlining the various first trimester emergencies. Next up, ectopic pregnancy… Nachi: An ectopic pregnancy is implantation of a fertilized ovum outside of the endometrial cavity. This occurs in up to 2% of pregnancies. About 98% occur in the fallopian tube. Risk factors for an ectopic pregnancy include salpingitis, history of STDs, history of PID, a prior ectopic, and smoking. Jeff: Interestingly, with respect to smoking, there is a dose-relationship between smoking and ectopic pregnancies. Simple advice here: don’t smoke if you are pregnant or trying to get pregnant. Nachi: Pretty sound advice. In addition, though an IUD is not a risk factor for an ectopic pregnancy, if you do become pregnant while you have in IUD in place, over half of these may end up being ectopic. Jeff: It’s also worth mentioning a more obscure related disease pathology here – the heterotopic pregnancy -- one in which there is an IUP and an ectopic pregnancy simultaneously. Nachi: Nausea and vomiting, though not as scary as miscarriages or an ectopic pregnancy, represent a fairly common pathophysiologic response in the first trimester -- with the vast majority of women experiencing nausea and vomiting. And as we mentioned earlier, only 3% of these progress to hyperemesis gravidarum. Jeff: And while nausea and vomiting clearly sucks, they seem to actually be protective of pregnancy loss, with a hazard ratio of 0.2. Nachi: Although this may be protective of pregnancy loss, nausea and vomiting can really decrease the quality of life in pregnancy -- with one study showing that about 25% of women with severe nausea and vomiting had actually considered pregnancy termination. 75% of those women also stated they would not want to get pregnant again because of these symptoms. Jeff: So certainly a big issue.. Two other common first trimester emergency are asymptomatic bacteriuria and UTIs. In pregnant patients, due to anatomical and physiologic changes in the GU tract – such as hydroureteronephrosis that occurs by the 7th week and urinary stasis due to bladder displacement – asymptomatic bacteriuria is a risk factor for developing pyelonephritis. Nachi: And pregnant women are, of course, still susceptible to the normal ailments of young adult women like acute appendicitis, which is the most common surgical problem in pregnancy. Jeff: Interestingly, based on epidemiologic data, pregnant women are less likely to have appendicitis than age-matched non-pregnant woman. I’d like to think that there is a good pathophysiologic explanation there, but I don’t have a clue as to why that might be. Nachi: Additionally, the RLQ is the the most common location of pain from appendicitis in pregnancies of all gestational ages. Peritonitis is actually slightly more common in pregnant patients, with an odds ratio of 1.3. Jeff: Alright, so I think we can put that intro behind us and move on to the differential. Nachi: When considering the differential for abdominal pain or vaginal bleeding in the first trimester, you have to think broadly. Among gynecologic causes, you should consider miscarriage, septic abortion, ectopic pregnancy, corpus luteum cyst, ovarian torsion, vaginal or cervical lacerations, and PID. For non-gynecologic causes, you should also consider appendicitis, cholecystitis, hepatitis, and pyelonephritis. Jeff: In the middle of that laundry list you mentioned there is one pathology which I think merits special attention - ovarian torsion. Don’t forget that patients undergoing ovarian stimulation as part of assisted reproductive technology are at a particularly increased risk due to the larger size of the ovaries. Nachi: Great point. Up next we have prehospital care... Jeff: Always a great section. First, prehospital providers should attempt to elicit an ob history. Including the number of weeks’ gestation, LMP, whether an IUP has already been confirmed, prior hx of ectopic, and amount of vaginal bleeding. In addition, providers should consider an early destination consult both to select the correct destination and to begin the process of mobilizing resources early in those patients who really need them, such as those with hemodynamic instability. Nachi: As with most pathologies, the more time you give the receiving facility to prepare, the better the care will be, especially the early care, which is critical. Jeff: Now that the patient has arrived in the ED we can begin our H&P. Nachi: When eliciting the patient’s obstetrical history, it’s common to use the G’s and Ps. This can be further annotated using the 4-digit TPAL method, that’s term-preterm-abortus-living. Jeff: With respect to vaginal bleeding, make sure to ask about the number of pads and how this relates to the woman’s normal number of pads. In addition, make sure to ask about vaginal discharge or even about the passage of tissue. Nachi: You will also need to elicit whether or not the patient has a history of a prior ectopic pregnancies as this is a major risk for future ectopics. And ask about previous sexually transmitted infections also. Jeff: And, of course, make sure to elicit a history of assisted reproductive technology, as this increases the risk of a heterotopic pregnancy. Nachi: Let’s move on to the physical. While you are certainly going to perform your standard focused physical exam, just as you would for any non-pregnant woman - what does the evidence say about the pelvic exam? I know this is a HOTLY debated topic among EM Docs. Jeff: Oh it certainly is. Dr. Pedigo takes a safe, but fair approach, noting, “A pelvic exam should always be performed if the emergency clinician suspects that it would change management, such as identifying the source of bleeding, or identifying an STD or PID.” However, it is noteworthy that the only real study he cites on this topic, an RCT of pelvic vs no pelvic in those with a confirmed IUP and first trimester bleeding, found no difference between the two groups. Obviously, the pelvic group reported more discomfort. Nachi: You did leave out one important fact about the study enrollment - they only enrolled about 200 of 700 intended patients. Jeff: Oh true, so a possibly underpowered study, but it’s all we’ve got on the topic. I think I’m still going to do pelvic exams, but it’s something to think about. Nachi: Moving on, all unstable patients with vaginal bleeding and no IUP should be assumed to have an ectopic until proven otherwise. Ruptured ectopics can manifest with a number of physical exam findings including abdominal tenderness, with peritoneal signs, or even with bradycardia due to vagal stimulation in the peritoneum. Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. Nachi: And that’s a perfect segue into our next section - diagnostic studies. Jeff: Up first is the urine pregnancy test. A UPT should be obtained in all women of reproductive age with abdominal pain or vaginal bleeding, and likely other complaints too, though we’re not focusing on them now. Nachi: The UPT is a great test, with nearly 100% sensitivity, even in the setting of very dilute urine. False positives are certainly plausible, with likely culprits being recent pregnancy loss, exogenous HCG, or malignancy. Jeff: And not only is the sensitivity great, but it’s usually positive just 6-8 days after fertilization. Nachi: While the UPT is fairly straight forward, let’s talk about the next few tests in the context of specific disease entities, as I think that may make things a bit simpler -- starting with bHCG in the context of miscarriage and ectopic pregnancy. Jeff: Great starting point since there is certainly a lot of debate about the discriminatory zone. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Generally 1500 is used as the cutoff. This corresponds nicely to a 2013 retrospective study demonstrating a bHCG threshold for the fetal pole to be just below 1400. Nachi: However, to actually catch 99% of gestational sacs, yolk sacs, and fetal poles, one would need cutoffs of around 3500, 18000, and 48,000 respectively -- much higher. Jeff: For this reason, if you want to use a discriminatory zone, ACOG recommends a conservatively high 3,500, as a cutoff. Nachi: I think that’s an understated point in this article, the classic teaching of a 1500 discriminatory zone cutoff is likely too low. Jeff: Right, which is why I think many ED physicians practice under the mantra that it’s an ectopic until proven otherwise. Nachi: Certainly a safe approach. Jeff: Along those lines, lack of an IUP with a bHCG above whatever discriminatory zone you are using does not diagnose an ectopic, it merely suggests a non-viable pregnancy of undetermined location. Nachi: And if you don’t identify an IUP, serial bHCGs can be really helpful. As a rule of thumb -- in cases of a viable IUP -- b-HCG typically doubles within 48 hours and at a minimum should rise 53%. Jeff: In perhaps one of the most concerning things I’ve read in awhile, one study showed that ⅓ of patients with an ectopic had a bCHG rise of 53% in 48h and 20% of patients with ectopics had a rate of decline typical to that of a miscarriage. Nachi: Definitely concerning, but this is all the more reason you need to employ our favorite imaging modality… the ultrasound. Jeff: All patients with a positive pregnancy test and vaginal bleeding should receive an ultrasound performed by either an emergency physician or by radiology. Combined with a pelvic exam, this can give you almost all the data necessary to make the diagnosis, even if you don’t find an IUP. Nachi: And yes, there is good data to support ED ultrasound for this indication, both transabdominal and transvaginal, assuming the emergency physician is credentialed to do so. A 2010 Meta-Analysis found a NPV of 99.96% when an er doc identified an IUP on bedside ultrasound. So keep doing your bedside scans with confidence. Jeff: Before we move on to other diagnostic tests, let’s discuss table 2 on page 7 to refresh on key findings of each of the different types of miscarriage. For a threatened abortion, the os would be closed with an IUP seen on ultrasound. For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. Patients may or may not note the passage of products of conception. Nachi: A missed abortion presents with a closed os and a nonviable fetus on ultrasound. Findings such as a crown-rump length of 7 mm or greater without cardiac motion is one of several criteria to support this diagnosis. Jeff: An inevitable abortion presents with an open OS and an IUP on ultrasound. Along similar lines, an incomplete abortion presents with an open OS and partially expelled products on ultrasound. Nachi: And lastly, we have the septic abortion, which is sort of in a category of its own. A septic abortion presents with either an open or closed OS with essentially any finding on ultrasound in the setting of an intrauterine infection and a fever. Jeff: I’ve only seen this two times, and both women were incredibly sick upon presentation. Such a sad situation. Nachi: For sure. Before we move on to other tests, one quick note on the topic of heterotopic pregnancies: because the risk in the general population is so incredibly low, the finding of an IUP essentially rules out an ectopic pregnancy assuming the patient hasn’t been using assisted reproductive technology. In those that are using assisted reproductive technology, the risk rises to 1 in 100, so finding an IUP, in this case, doesn’t necessarily rule out a heterotopic pregnancy. Jeff: Let’s move on to diagnostic studies for patients with nausea and vomiting. Typically, no studies are indicated beyond whatever you would order to rule out other serious pathology. Checking electrolytes and repleting them should be considered in those with severe symptoms. Nachi: For those with symptoms suggestive of a UTI, a urinalysis and culture should be sent. Even if the urinalysis is negative, the culture may still have growth. Treat asymptomatic bacteriuria and allow the culture growth to guide changes in antibiotic selection. Jeff: It’s worth noting, however, that a 2016 systematic review found no reliable evidence supporting routine screening for asymptomatic bacteriuria, so send a urinalysis and culture only if there is suspicion for a UTI. Nachi: For those with concern for appendicitis, while ultrasound is a viable imaging modality, MRI is gaining favor. Both are specific tests, however one study found US to visualize the appendix only 7% of the time in pregnant patients. Jeff: Even more convincingly, one 2016 meta analysis found MRI to have a sensitivity and specificity of 94 and 97% respectively suggesting that a noncontrast MRI should be the first line imaging modality for potential appendicitis. Nachi: You kind of snuck it in there, but this is specifically a non-contrast MRI. Whereas a review of over a million pregnancies found no associated fetal risk with routine non-contrast MRI, gadolinium-enhanced MRI has been associated with increased rates of stillbirth, neonatal death, and rheumatologic and inflammatory skin conditions. Jeff: CT is also worth mentioning since MRI and even ultrasound may not be available to all of our listeners. If you do find yourself in such a predicament, or you have an inconclusive US without MRI available, a CT scan may be warranted as the delay in diagnosis and subsequent peritonitis has been found to increase the risk of preterm birth 4-fold. Nachi: Right, and a single dose of ionizing radiation actually does not exceed the threshold dose for fetal harm. Jeff: Let’s talk about the Rh status and prevention of alloimmunization. While there are no well-designed studies demonstrating benefit to administering anti-D immune globulin to Rh negative patients, ACOG guidelines state “ whether to administer anti-D immune globulin to a patient with threatened pregnancy loss and a live embryo or fetus at or before 12 weeks of gestation is controversial, and no evidence-based recommendation can be made.” Nachi: Unfortunately, that’s not particularly helpful for us. But if you are going to treat an unsensitized Rh negative female with vaginal bleeding while pregnant with Rh-immune globulin, they should receive 50 mcg IM of Rh-immune globulin within 72 hours, or the 300 mcg dose if that is all that is available. It’s also reasonable to administer Rh(d)-immune globulin to any pregnant female with significant abdominal trauma. Jeff: Moving on to the treatment for miscarriages - sadly there isn’t much to offer here. For those with threatened abortions, the vast majority will go on to a normal pregnancy. Bedrest had been recommended in the past, but there is little data to support this practice. Nachi: For incomplete miscarriages, if visible, products should be removed and you should consider sending those products to pathology for analysis, especially if the patient has had recurrent miscarriages. Jeff: For those with a missed abortion or incomplete miscarriages, options include expectant management, medical management or surgical management, all in consultation with an obstetrician. It’s noteworthy that a 2012 Cochrane review failed to find clear superiority for one strategy over another. This result was for the most part re-confirmed in a 2017 cochrane review. The latter study did find, however, that surgical management in the stable patient resulted in lower rates of incomplete miscarriage, bleeding, and need for transfusion. Nachi: For expectant management, 50-80% will complete their miscarriage within 7-10 days. Jeff: For those choosing medical management, typically with 800 mcg of intravaginal misoprostol, one study found this to be 91% effective in 7 days. This approach is preferred in low-resource settings. Nachi: And lastly, remember that all of these options are only options for stable patients. Surgical management is mandatory for patients with significant hemorrhage or hemodynamic instability. Jeff: Since the best evidence we have doesn’t suggest a crystal clear answer, you should rely on the patient’s own preferences and a discussion with their obstetrician. For this reason and due to the inherent difficulty of losing a pregnancy, having good communication is paramount. Nachi: Expert consensus recommends 6 key aspects of appropriate communication in such a setting: 1 assess the meaning of the pregnancy loss, give the news in a culturally competent and supportive manner, inform the family that grief is to be expected and give them permission to grieve in their own way, learn to be comfortable sharing the products of conception should the woman wish to see them, 5. provide support for whatever path she chooses, 6. and provide resources for grief counselors and support groups. Jeff: All great advice. The next treatment to discuss is that for pregnancy of an unknown location and ectopic pregnancies. Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention. Jeff: For those that are stable, with normal vitals, and no ultrasound evidence of a ruptured ectopic, with no IUP on ultrasound, -- that is, those with a pregnancy of unknown location, they should be discharged with follow up in 48 hours for repeat betaHCG and ultrasound. Nachi: And while many patients only need a single additional beta check, some may need repeat 48 hour exams until a diagnosis is established. Jeff: For those that are stable with a confirmed tubal ectopic, you again have a variety of treatment options, none being clearly superior. Nachi: Treatment options here include IM methotrexate, or a salpingostomy or salpingectomy. Jeff: Do note, however, that a bHCG over 5000, cardiac activity on US, and inability to follow up are all relative contraindications to methotrexate treatment. Absolute contraindications to methotrexate include cytopenia, active pulmonary disease, active peptic ulcer disease, hepatic or renal dysfunction, and breastfeeding. Nachi: Such decisions, should, of course, be made in conjunction with the obstetrician. Jeff: Always good to make a plan with the ob. Moving on to the treatment of nausea and vomiting in pregnancy, ACOG recommends pyridoxine, 10-25 mg orally q8-q6 with or without doxylamine 12.5 mg PO BID or TID. This is a level A recommendation as first-line treatment! Nachi: In addition, ACOG also recommends nonpharmacologic options such as acupressure at the P6 point on the wrist with a wrist band. Ginger is another nonpharmacologic intervention that has been shown to be efficacious - 250 mg by mouth 4 times a day. Jeff: So building an algorithm, step one would be to consider ginger and pressure at the P6 point. Step two would be pyridoxine and doxylamine. If all of these measures fail, step three would be IV medication - with 10 mg IV of metoclopramide being the agent of choice. Nachi: By the way, ondansetron carries a very small risk of fetal cardiac abnormalities, so the other options are of course preferred. Jeff: In terms of fluid choice for the actively vomiting first trimester woman, both D5NS and NS are appropriate choices, with slightly decreased nausea in the group receiving D5NS in one randomized trial of pregnant patients admitted for vomiting to an overnight observation unit. Nachi: Up next for treatment we have asymptomatic bacteriuria. As we stated previously, asymptomatic bacteriuria should be treated. This is due to anatomical and physiologic changes which put these women at higher risk than non-pregnant women. Jeff: And this recommendation comes from the 2005 IDSA guidelines. In one trial, treatment of those with asymptomatic bacteriuria with nitrofurantoin reduced the incidence of developing pyelonephritis from 2.4% to 0.6%. Nachi: And this trial specifically examined the utility of nitrofurantoin. Per a 2010 and 2011 Cochrane review, there is not evidence to recommend one antibiotic over another, so let your local antibiograms guide your treatment. Jeff: In general, amoxicillin or cephalexin for a full 7 day course could also be perfectly appropriate. Nachi: A 2017 ACOG Committee Opinion analyzed nitrofurantoin and sulfonamide antibiotics for association with birth defects. Although safe in the second and third trimester, they recommend use in the first trimester -- only when no other suitable alternatives are available. Jeff: For those, who unfortunately do go on to develop pyelo, 1g IV ceftriaxone should be your drug of choice. Interestingly, groups have examined outpatient care with 2 days of daily IM ceftriaxone vs inpatient IV antibiotic therapy and they found that there may be a higher than acceptable risk in the outpatient setting as several required eventual admission and one developed septic shock in their relatively small trial. Nachi: And the last treatment to discuss is for pregnant patient with acute appendicitis. Despite a potential shift in the standard of care for non pregnant patients towards antibiotics-only as the initial treatment, due to the increased risk of serious complications for pregnant women with an acute appy, the best current evidence supports a surgical pathway. Jeff: Perfect, so that wraps up treatment. We have a few special considerations this month, the first of which revolves around ionizing radiation. Ideally, one should limit the amount of ionizing radiation exposure during pregnancy, however avoiding it all together may lead to missed or delayed diagnoses and subsequently worse outcomes. Nachi: It’s worth noting that the American College of Radiology actually lists several radiographs that are such low exposure that checking a urine pregnancy test isn’t even necessary. These include any imaging of the head and neck, extremity CT, and chest x-ray. Jeff: Of course, an abdomen and pelvis CT carries the greatest potential risk. However, if necessary, it’s certainly appropriate as long as there is a documented discussion of the risk and benefits with the patient. Nachi: And regarding iodinated contrast for CT -- it appears to present no known harm to the fetus, but this is based on limited data. ACOG recommends using contrast only if “absolutely required”. Jeff: Right and that’s for iodinated contrasts. Gadolinium should always be avoided. Let me repeat that Gadolinium should always be avoided Nachi: Let’s also briefly touch on a controversial topic -- that of using qualitative urine point of care tests with blood instead of urine. In short, some devices are fda-approved for serum, but not whole blood. Clinicians really just need to know the equipment and characteristics at their own site. It is worth noting that there have been studies on determining whether time can be saved by using point of care blood testing instead of urine for the patient who is unable to provide a prompt sample. Initial study conclusions are promising. But again, you need to know the characteristics of the test at your ER. Jeff: One more controversy in this issue is that of expectant management for ectopic pregnancy. A 2015 randomized trial found similar outcomes for IM methotrexate compared to placebo for tubal ectopics. Inclusion criteria included hemodynamic stability, initial b hcg < 2000, declining b hcg titers 48 hours prior to treatment, and visible tubal pregnancy on trans vaginal ultrasound. Another 2017 multicenter randomized trial found similar results. Nachi: But of course all of these decisions should be made in conjunction with your obstetrician colleagues. Jeff: Let’s move on to disposition. HDS patients who are well-appearing with a pregnancy of undetermined location should be discharged with a 48h beta hcg recheck and ultrasound. All hemodynamically unstable patients, should of course be admitted and likely taken directly to the OR. Nachi: Also, all pregnant patients with acute pyelonephritis require admission. Outpatient tx could be considered in consultation with ob. Jeff: Patient with hyperemesis gravidarum who do not improve despite treatment in the ED should also be admitted. Nachi: Before we close out the episode, let’s go over some key points and clinical pearls... J Overall, roughly 25% of pregnant women will experience vaginal bleeding and 7-27% of pregnant women will experience a miscarriage 2. Becoming pregnant with an IUD significantly raises the risk of ectopic pregnancy. 3. Ovarian stimulation as part of assisted reproductive technology places pregnant women at increased risk of ovarian torsion. 4. Due to anatomical and physiologic changes in the genitourinary tract, asymptomatic bacteriuria places pregnant women at higher risk for pyelonephritis. As such, treat asymptomatic bacteriuria according to local antibiograms. 5. A pelvic exam in the setting of first trimester bleeding is only warranted if you suspect it might change management. 6. Unstable patients with vaginal bleeding and no IUP should be assumed to have an ectopic pregnancy until proven otherwise. 7. If you are to use a discriminatory zone, ACOG recommends a beta-hCG cutoff of 3500. 8. The beta-hCG typically doubles within 48 hours during the first trimester. It should definitely rise by a minimum of 53%. 9. For patients using assisted reproductive technology, the risk of heterotopic pregnancy becomes much higher. Finding an IUP does not necessarily rule out a heterotopic pregnancy. N. Send a urine culture for patients complaining of UTI symptoms even if the urinalysis is negative. J. The most common surgical problem in pregnancy is appendicitis. N, If MRI is not available and ultrasound was inconclusive, CT may be warranted for assessing appendicitis. The risk of missing or delaying the diagnosis may outweigh the risk of radiation. J. ACOG recommends using iodinated contrast only if absolutely required. N. For stable patients with a pregnancy of unknown location, plan for discharge with follow up in 48 hours for a repeat beta-hCG and ultrasound. J For nausea and vomiting in pregnancy, try nonpharmacologic treatments like acupressure at the P6 point on the wrist or ginger supplementation. First line pharmacologic treatment is pyridoxine. Doxylamine can be added. Ondansetron may increase risk of fetal cardiac abnormalities N So that wraps up episode 24 - First Trimester Pregnancy Emergencies: Recognition and Management. J: Additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. N: And the address for this month’s credit is ebmedicine.net/E0119, so head over there to get your CME credit. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!
It’s time for Toby Mathis and Jeff Webb of Anderson Advisors to answer your questions about taxes, the IRS, and much more. Do you have a tax question for them? Submit it to Webinar@andersonadvisors.com. Highlights/Topics: What is Nexus? Why do I care? Nexus is a state’s right to tax your income; different types (tax and physical), state laws, and throwback rule - how they affect you Does IRS reimburse me for corporate expenses? Misconception about reimbursement from the client’s company or IRS; IRS doesn’t give you money, but let’s you write it off How do I qualify for a real estate professional status? Requires 750 hours as #1 use of personal professional time; know importance of passive activity loss and logging time What are self-dealing rules for non-profits, IRAs, QRPs? Particular entities can’t interact with a disqualified person - can’t sell them anything; but self-dealing exceptions exist Am I dealer or investor? What’s the difference? Investor is passively involved, dealer is actively buying/selling real estate; can depend on the intent and timeframe Why set up an LLC that does flipping as a C or S Corp instead of a partnership? Because it’s taxed as ordinary income and subject to self-employment tax What is UBIT? Unrelated business income tax is when a plan/non-profit isn’t doing what it’s set up to do; can have passive activity until it competes with active businesses I hold rental property in a self-directed IRA. What can I do? There’s things you can/can’t do, especially add value to a property, so find a property manager and IRA custodian My wife’s previous employer’s stock options were exercised and have peaked. If we cash in, what’ll be the tax consequences/burden? Long-term capital gain and opportunity zone I’m helping a friend with a crowdfunding project. What are tax consequences with no deductions? Does he pay tax on donated money? No tax for less than $15,000 per donor How to aggregate all properties? Disadvantages? Election form that your print with your tax return to identify properties; doesn’t free up large losses tied up If real estate investing part time, are you considered a part-time investor? You’d be a part-time investor, not real estate professional; determining factor is to document time How do I get the 501(c)(3) tax-exempt? Use the 1023 application How do you create an LLC in an IRA? IRA custodian enters into a contract with a company to create an LLC, or set up a 401(k) to roll the IRA into it without a custodian Investing in LLC for holding rental property. How do you avail to a 1031 exchange? Need a 1031 exchange facilitator and LLC must buy or sell the next property within 180 days If I receive social security benefits at 62 and not currently employed, but do receive interest income. Will it affect my SS benefits? Can be isolated into its own taxable entity My wife and I are the only shareholders and both take a ⅓ salary. Is that the right amount? You should take a ⅓ of the net profit as salary instead How do you put an LLC on hold? Do nothing with it or pay the state; file non-activity return Will real estate holding LLC taxes partnership qualify for 20% pass-through deduction? Yes, if not triple net property For all questions/answers discussed, sign up to be a Platinum member to view the replay! Resources Anderson Advisors Tax and Asset Prevention Event Toby Mathis Anderson Advisors U.S. Supreme Court Reverses Long Standing Law On Collection Of Sales Taxes Northwest Energetic Services LLC vs. California Franchise Tax Board Throwback Rule SALT Limit After 24 years, wealthy inventor gets his day in tax court – and wins 10 Tax Deductions That Will Disappear Next Year Passive Activity Losses - Real Estate Tax Tips Real Estate Professional Status - Becoming More Important - Very Hard To Prove Acts of self-dealing by private foundation Unrelated Business Income Tax Opportunity Zones Frequently Asked Questions About Form 1099-INT | Internal Revenue Service Exemption Requirements - 501(c)(3) Organizations Form 1023 Taxbot MileIQ Tax Cuts and Jobs Act, Provision 11 011 Section 199A - Qualified Business Income Deduction FAQs Full Episode Transcript Toby: Alright, welcome to Tax Tuesday, this is Toby Mathis joined by our tax manager Jeff Webb. Jeff: How do you do? Toby: We're going to get jumping on here. We're just going to jump right in. no time like the present to just get business done. So first off, happy Tuesday. Second off, let's jump into a bunch of questions that are giving us a steady feed from folks even before we got started. I'm sure I'll be more happy than to answer your questions. I also got emails in from folks that I may be trying to make sure I answer all of those and we'll just make sure that we're getting through each and every question to the extent humanly possible within this hour. So the first one is, what is Nexus and why do I care. Second one is going to be, does the IRS reimburse me for my corporate expenses. Third one is, how do I qualify for real estate professionals, technically real estate professional status. What are self doing rules for nonprofits in QRPs. I'm going to throw in IRAs in there as well. Am I a dealer or an investor, what difference does it make. Those are the ones that we're going to hit one after the other in succession. I'm making sure that we're getting through these. So the first one is, what is nexus and why do I care. Jeff, do you want to hit tax nexus because there's different types of nexus. There's physical presence for lawsuits and there's tax nexus for taxation. I'm going to have Jeff hit the tax and then I'll touch base on the physical nexus. Jeff: So when we're talking about tax nexus what we're primarily talking about is a state's right to tax you on your income. For example, you may live in Nevada, have a rental property in California. California has a right to tax any income on that property because you're doing business within California. There are different roles, there have been numerous cases on nexus. Toby: Most recently, our Supreme Court reversed a physical presence test that the error that Amazon, everybody that was an online retailer use to avoid state sales tax and that was just changed. Jeff: Yeah, on that one in particular the Supreme Court as Toby said, gave the states the right to tax online sales in their states. The thing is, the states now have to write tax walls to accomplish this. Most of the states don't have anything that accomplishes this. Toby: A lot of times, ignorance is bliss. People would avoid sales tax like for example, I live in Washington, Florida, Oregon and avoid the sales tax and they ignored Washington's use tax. A lot of states have this. You don't pay sales tax and you go someplace where there is no sales tax, you still owe sales tax on it but they call it use tax because you brought the physical item into your state and you never paid sales tax on it. So then they would say, "Aha." And the really interesting thing – there were actually some interesting cases that were popping up from the nexus, ones that came out of Washington, was Northwest Energetic Services too and that was a case in California where they tried to tax an organization that was registered to do business there that didn't actually do any business in California but they wanted to tax its worldwide revenue. The franchise tax board of the board of equalization lost that one and they had a few others but what you'll find is that this is a continuously active in generating area of tax law and we tend to fall into the category of ask for forgiveness not for permission all the time because if you ask a state whether you should be paying tax, they will gladly say yes even if it's not a legitimate tax. They'll tell you that you have to pay it even though it's made to be unconstitutional, unlawful, you fill in the blank. Even if you don't owe it, they'll oftentimes just answer, "Yes, of course you should." They can't actually be giving you any tax advice anyway so it's the wrong party to be asking. I'm sure Jeff you get to deal with that more than I do. Jeff: Yeah, in a state like California, it used to be an old joke for the CPA's that you could be flying over the state of California, make enough business phone call and California would want to so you have nexus and we can now tax you. They're also a state that's very difficult to leave if you're a resident. We had a case where somebody, NBA player for the Sacramento Kings was traded to Seattle Sonics and moved there. Toby: Yeah, now the Oklahoma City Thunder, I was there when they move, horrible. Jeff: The state of California wanted to say, "No, you're still resident of California, we're still going to be taxing you because you got friends here and you have club ownership, some relationships. California in particular is very tenacious with Nexus. Toby: Yeah, so you're going to see things evolving over the next few years since the Supreme Court decision was literally this last, I think it was just months ago or end of the year last year. You're going to see the states trying to fill in the blanks. So you have some states for example in drop shipping, Pennsylvania would tax you if you drop ship out of their state where it used to not be, other states did before. We were talking earlier before the webinar, Jeff and I were talking about what is like a claw back. Jeff: Yeah, it's called a throwback rule that says if your sales into a state that doesn't have taxes then where it got shipped from can tax instead. Toby: Somebody's asked, what are the worst three states for nexus. It really depends on what you're doing, but I would say just off the top of my head probably New York, Connecticut and California. They're pretty heinous. Look at the states that just filed a lawsuit against the federal government under the SALT limitation which is the State and Local Tax Limitation. You'll see I think there was four states Maryland was one of them, where they try to hit you with so many different taxes. It's not just business, it's on your personal as well. It's just for nexus, for a person, it's really easy to figure out, "Hey, where do you live?" Because when I say it's easy, it can be difficult if you have two residences that you spend time with equally. They're going to add up things like how much utility you use, where your driver's license is. Where your kids go to school, where your vehicles are registered, you're going to look at those types of things. There's Hyatt v. Commissioner Case or what was it, Hyatt versus board of equalization I think is actually what it was. Where a gentleman moved to Nevada and the California franchise tax board sent agents to Nevada they climbed to his garage and break into his apartment to prove that he was actually residing more in California than he was in Nevada because his tax bill would've been so great and when they got caught, they said they're immune. Our Supreme Court and Scully I remember the opinion was scathing on them saying, "No, you're immune in your jurisdiction. When you cross the state lines, don't expect any immunity." They just harassed that poor guy. They were climbing around his house. So let's just narrow it down though. You asked a question what is nexus. There's two sides, there's tax nexus and then there's physical nexus. In the physical nexus again where you reside, it's pretty easy. If you live there, then you have a physical nexus in that state, it's where you have a house. In the business it's no different. In a business, you have to decide where it's going to have its main presence and the courts have held having a bare office and nothing more isn't going to be sufficient. You actually have to do something there. That's when you actually have to have a physical office space. We use virtual office where it's doing more than just maintaining a registered agent. There we're actually giving conference facilities, phone answering, we'll do document prep and things like that for the governance of the company so the company can actually have a physical presence. The reason that you do that is to make sure it has a home. So if somebody's coming after one of its shareholders or members, one of its owners that it does not draw that entity into the state where they're located. So, if I have owners in a company and I have my company set up in Wyoming and they sue me in Nevada and they sue somebody else in Texas and somebody else in Florida, you don't have a choice between the Nevada, Texas and Florida where the shareholder or where the members of the LLC are located, they would actually have to go to Wyoming where the actual entity is located. That's what you're trying to do. So if Anderson does my meeting notes, that's why that's important. We're not talking about Canadian, US the nexus pass. I could tell you a fun one. We had a client that just got nailed by California. It's actually under the FBAR which is Foreign Bank Account Regulations. They had some interest on a bank account that was there for a condo they had in Whistler and they sold the condo in Whistler and they didn't report, I think it was like $70 or $76 worth of interest. Jeff do you know these off the top of your head? How much the penalty is? Jeff: No. Toby: If the IRS catches you, it's 50% of the account balance per year. But if you go under amnesty which they have taken an amnesty was a $38,000 fine which they paid for that $76. Canada is still offshore. Anyway, so what is nexus and why do I care. It gets a little convoluted but the reason you care is you don't want to draw your company into your state, you want to make it very difficult for somebody to get a hold of your assets if they're coming after you. From a tax standpoint, it matters because we want to keep our business activities to the extent possible in the lowest taxing jurisdiction as humanly possible. So that's that one. Jeff this is one of your favorites, I know. Does the IRS reimburse me for my corporate expenses? Jeff: Of course they do. IRS is really giving out money. We get this question more often than you would think. I think it's a misconception that clients are being told that their companies can reimburse them for certain expenses which will reduce our taxes and sometimes the clients are hearing IRS is going to reimburse us. The only time you get back money from IRS is if you pay money into IRS for taxes and you don't owe them any tax or maybe overpaid them. Toby: Yeah. IRS is a policing agency. Your taxes when you pay it, they don't even go to the IRS, it goes to the US treasury. So the IRS is merely, pay my boss, is all they are. So they don't give any money out whatsoever so the IRS does not reimburse you for your corporate expenses. What the IRS does is it enforced the laws which is the United States code and issues regulations interpreting that code and is basically the enforcement arm for the US department of treasury. What ends up happening for corporation is they're allowed to reimburse shareholders many expenses that are not included on the shareholder's personal tax returns. So it sometimes seems like they're giving you money when in all reality, they're allowing you to not pay tax on your expenses which is always the battle because there's lots of rules out there that say things are not deductible. Nothing more telling them what we just had happened in this tax change where they eliminated all miscellaneous itemized deductions. All of them are gone in case you've been sleeping. In 2018, you do not get to write them off anymore. Jeff: Now that's your union dues, your tax preparation fees. Toby: Any unreimbursed business expense if you're a teacher and you're providing stuff for your classroom, you don't get to write it off. Jeff: If you're paying substantial amounts to your broker for advisory fees. Toby: That's a huge one. We're going to see that one come back and bite people in their touché. Jeff: That's no longer deductible. Toby: So it's horrible. So no, the IRS does not reimburse you for your corporate expenses. Your corporation reimburses you for your corporate expenses and the IRS lets you write it off. How do I qualify for real estate professional status. Jeff do you want to play with this one or do you want me to handle it? Jeff: I'll do a little and then you can correct me. So real estate professional has a hours commitment. I believe it's 750 hours a year. Toby: So it's a minimum of 750 hours. There's a second part to that too, you know that. Jeff: And the 750 hours can be earned by you or your spouse. What's your second one? Toby: The second one is it has to be the number one use of your personal professional time. Jeff: Oh, correct. Toby: The way I always explain this is if you did 1001 hours doing bicycle repair and you did 1000 hours of real estate, you do not qualify as a real estate professional. But if it's reversed and you did 1000 hours of bicycle repair you did 1001 hours of real estate activities, then you do. And the reason this is important is because ordinarily, your real estate expenses are offset your real estate income and you can only take losses from real estate. In other words, the excess depreciation, or repairs, or whatever, your losses are limited to $3000 a year against your other active income. So that's called the passive activity loss rule. Jeff: $25,000. Toby: If you materially participate and then you have $100,000 to $150,000 scale up. There's some little nuances which don't bring your head with. At the end of the day, there are restrictions on taking passive activity loss. Real estate professional status removes that restriction. The other thing that's really important about real estate professional status is it is per property. So if you have three properties, you'd have to meet it for each of the three unless you elect to aggregate all your properties on your tax return. We have seen this missed by accountants who don't do real estate. They don't aggregate and there are actually cases on the book where people had to fight and they literally had tons of properties they easily met the 750 if you aggregate it but their accountants miss the aggregation election. Jeff: And the sum of 750 hours is not just for your rental properties. Toby: Any real estate. Jeff: Any real estate activity. Toby: Yeah. Jeff was actually right when he said your spouse could qualify, either you or your spouse if you're filing jointly. Jeff: So if you have a full time job and you're getting a W2, I can guarantee you that you will not legally qualify. Under audit, you're going to lose. However, if you have a full time job and your wife does not or your husband does not, they can qualify to be that real estate professional. Toby: We had a fun one. A good friend of ours and a colleague in Georgia was making somewhere between $2 million and $3 million a year in his professional practice. His wife qualified as a real estate professional and he quite literally bought enough commercial property and did something called cost segregation where you're rapidly depreciating it where he generated enough loss off the real estate to offset his income. The IRS audited it, he is self represented because he knew the rule. It withheld, he stood up. His wife just did their real estate activities and he did their practice and at the end of the day, she met the requirement for the real estate professional status and the rule is pretty straightforward. IRS didn’t like the outcome but that's not their job. So they picked a fight and lost the audit which is not uncommon. All right, so how do I qualify for a real estate professional. Keep a log of your time and make sure that you're aggregating all of your real estate activities. Even if it's for a closely held company, it's still going to match, it's still going to work. Next one, what are the self dealing rules for nonprofits in QRPs. I'm going to add in there IRAs as well since when we talk about a qualified retirement plan, we're really talking about 401K and 401A. This is going to dovetail in with one of our other questions that came in off the internet as well. But here's how it works. If you are in a particular type of entity where it says you cannot interact and engage in business with a disqualified person, you could not sell them a $1 million building for $1. It is an absolute prohibition against self dealing. The most important first step is determining whether or not you're within one of those rules. Then if you are, then you look and say are there any exceptions to that rule. So for nonprofits, nonprofits are going to fall into broad categories foundations, private foundations are one. These are nonprofits that aggregate money and give money to other nonprofits, they don't do anything. And in that one, you have an absolute bar from self dealing. The next one is an operating nonprofit that is doing something and in that case, you just have to use arm's length transactions. So we look at that, that's our step number one. So let's go back to the first one, private foundations then you look and say, are there any exceptions. The only exception is reasonable compensation, it can always be reasonably compensated. But other than that, no more transactions. So for nonprofits 501(c)(3) you can enter into transactions as long as it's an operating nonprofit. It can give you benefits, it can pay you and it can engage in sales and other transactions between you and the agencies so long as they are arm's length. And the way you make sure it is arm's length is you have non-interested parties looking at it saying, "Hey, that looks okay to me." somebody who doesn't have a dog in the fight. Now we go to QRPs and IRAs. In either one of those, you have absolute prohibitions against self dealing with disqualified parties and disqualified parties are lineal descendants which would be grandparents, children and their spouses, great children and their spouses. It does not include your siblings. So what's interesting is you could actually engage in transactions with your IRA for example, loan money to your brother. You cannot loan money to your mother. You could not loan money to your kids or your grandkids, you could not do a second on their house, you could not do anything between the company. You could not buy a house from them. That is an absolute bar that's called, disqualified party. Jeff: The way I kind of look at it as to whether you may be violating self dealing rules is, are you benefitting from a transaction between you and the nonprofit or the QRP or the IRA. That's really what they're out to prevent. And unfortunately the rules are pretty severe for violations of the self dealing. Toby: If you self-deal, you're just going to disqualify your IRA. If you're using a QRP and you're using a 401K, then we have different rules, and in that particular case, it would just disqualify the money that you actually were utilizing. Their far more lenient. Jeff: I had a client who had a QRP, it was actually defined benefit plan, who had a required minimum distribution to make and the plan was not funded at the time. The client had to make a loan to the QRP, which is a self-dealing but unfortunately there's an exception for that that one was quickly repaid. There was no profit or interest earned on it. Toby: Was it within the 60 days? Jeff: I believe it was within 60 days. Toby: There's some more fun stuff. Then we go into the 401Ks and this is where you get into people acting on behalf of the company. I know that there were some questions, that were already posed in the chat feature here. You're not supposed to be getting any personal benefit or using those funds at all when you have an IRA or a 401K. In an IRA, it's much more severe because you have a custodian. So if a renter for example is paying you money and they pay it to you individually, technically you have a violation of the self dealing rules because you just received money. Even if you go ahead and put it right back in the IRA, you're going to have an issue because technically you weren't supposed to receive the money, the custodian was supposed to be receiving the money. So you should actually have rental money going to your custodian if you’re using an IRA. If you’re using a 401K or 401A, which the profit sharing plan or 401K, then you are the trustee and you're able to accept the money and endorse it right into the account and make sure that the money goes to the right place. IRA's are a little more difficult. To get around this, a lot of people with IRA's will set up an LLC which you can be the manager of. Actually, the IRA is technically the member— you're in non compensated role and we have to make sure that the LLC agreement says that if we drafted it, then we make sure that we're putting in the non-prohibitionals. You cannot personally benefit from these activities. It has to all go back to the retirement plan. People will do the LLC and they will be all right, now I can go ahead and accept the funds through the LLC, that's how they do with an IRA. If you're doing with the 401K, we're going to suggest that you still set up an LLC anytime you have real estate, just because we don't want the liability to flow through to you. But there, now, you don't need the custodian. You could technically do it inside the 401K directly though you should still have the LLC and it's the same scenario where you're able to accept the proceeds. That's not going to be a technical violation because you're acting on behalf of the plan. And that is not a violation of the self dealing rules. So the biggest takeaway from all this, is that you can act on behalf of the plan. The second a just qualified person starts to get personal benefit, you have violated the rules and if it's an IRA, the whole thing is violating—considered a taxable event, which should be that 10% penalty plus income tax on it for the entire amount if it's at 401K or 401A, it would just be the portion that you violated. We tend to be very bullish on using 401Ks and 401A's, profit sharing plans around here also known as QRP. And this is why, because they're far more forgiving and they have a less moving pieces. I hope that explains that. We're going to have—I know there's a couple more questions that are in here, that are going to be relevant to this section as well. Let me jump on to something. The questions, this is something you can ask detailed questions via our email. I will answer them, Jeff or Tony, whoever's from the tax department here. We will answer these on the tax Tuesday. We will also more likely be responding back out to you directly as well because we want to make sure you get your questions answered, but just jot down that address, webinar@andersonadvisors.com and feel free to shoot them in. Since our last one, Tax Tuesday, we had a couple of questions and I want to go through these. Number one was from Karen out of Alaska, "I have a revocable trust in Alaska that owns and sells real property, does the trust to pay income taxes on the profit or does the profit end up on my personal tax return? Is it taxed at the same rate as everything else? So the most important word she used in her question was revocable, because trust come in two flavors, revocable are irrevocable. If they're irrevocable, then we have two choices, we don't have to worry about the irrevocable.. Since it's revocable, it's a grand tour trust is ignored, it's you, for tax purposes until your dead. So you're good, sorry, sometimes I'm blunt. So if you're buying and selling real estate, real property it's taxed no differently than if you're on the real property. Now here's the rub, it also gives you know asset protection. So revocable trust is giving you know asset protection with that real property, so I would really strongly suggest that the revocable trust actually be the owner of an LLC that is buying and selling the real estate and depending on how quickly you are turning this, will depend on whether that say, S or a C-Corp., if it's a flip versus if it is a long-term holds, then we just put it as an LLC. It would either be disregarded or taxed as a partnership. We want it to flow under our return. Those are kind of our choices. There was a question, I don't know if I got to that. I'm going to skip back to our slides. There's something about—Am I a dealer or an investor? So I want to make sure that I'm getting this one right here. Because this is relevant to one of these questions. A dealer and an investor is something that we talk about in real estate, you want to hit on this? Jeff: No, you're doing fine. Toby: An investor is someone who's passively involved, a dealer is somebody who is actively buying and selling real estate. So if you buy real estate with the intent to hold it for its long term appreciation cash flow, then you are an investor. If you buy real estate with the intent to sell it, then you are a dealer. The easiest way to conceptualize this is if I am an investor, I am passive. If I am a dealer, then I am a supermarket with inventory. And I'm putting my real estate on a shelf and it's constantly for sale. Just like at your grocery store, it may take a couple years for something to sell. I'm just imagining the items that are on the shelf. Jeff: Your durable goods. Toby: Right, so you sell something, I used to do liquidation. We would grab all the expired items we would sell them but let's say, it doesn't matter how long you held them. A lot of people think, well if I held it over a year, I can't be a dealer. That's not the case, we actually have cases on the book where they held it over 10 years. What matters is what your intent was when you buy it. And the difference it makes is active income versus passive income. The difference is an investor can 1031 exchange and defer all other taxes. An investor can get long-term capital gains, an investor can do installment sales, an investor can spread out the tax liability over a long period of time. Whereas a dealer is active. It's subject to social security taxes, it's taxable immediately even if you don't receive the money. It is active ordinary income, it's no difference than I just sold that box of Cheerios on the shelf that I've been waiting to sell. It makes a huge difference. Dealer activity we're going to isolate inside of an S-Corp or a C-Corp. Investor activity, we're going to make sure it flows on your personal return either by using a disregarded LLC or a partnership LLC, one of the two. Jeff: Intent has really made a difference in a couple of cases. One, where somebody bought a property that they go allow their child to live in, something end up happening then they sold it after a short time. They were considered to be an investor not a dealer. Toby: It doesn't even matter. It does not matter whether you ever rented it, there's plenty of cases where somebody tried to rent it and they were going to use it as a long term hold and then things change and they sold it. Just know that if you buy or sell within a year, the presumption is going to be that you're a dealer. If you hold for over a year, the presumption is going to be that you're an investor but it's not a guarantee. We're going to get back to these questions. How does Flip LLC income flow into S-Corp and then what will be distributions of the seller? So, we talked a little bit about this last week but I'm going to go and we're going to hit this. When you set up an LLC, it doesn't exist to the IRS. So when you say how does the Flip LLC flow into S-Corp, it doesn't. A Flip LLC is an S-Corp if you elect to have it be treated that way with the IRS. The income is just going into an S-Corp. Then you have to decide what your salary will be because if you know anything about an escort S-Corp, you want to make sure you pay yourself a reasonable salary if it's making money. The rule of thumb to use is, one third of your net income should be paid out as salary. That's just a rule of thumb but it's all in all reality the IRS has this funky test where you're supposed to say, "Hey, what would it be? What could it be paid?" they never tell us exactly. So I'll just say this, pay a third, don't worry about it. If you get too much money, if you start making over $300,000, then we're going to have a chat but where you're going to be on our radar anyway, we're going to be making sure you're paying a reasonable salary anyway. The reason this is important is because the salary is subject to old age death and survivors in Medicare also known as FICA or social security and the distributions are not. So what you would do is you'd be cutting your social security tax by about two thirds if you did it that way. I hope that explains it. So it makes its money and it pays it out. We do need to make sure that if you're flipping, that the money goes into the LLC. Jeff: A quick comment on distributions on an S-Corporation. Distributions are typically the money that's already been taxed are in you're just pulling the cash out. What you don't want to do is go out and get a bank loan in S-Corporation and take distributions from that for several reasons. One, you don't have basis in those distributions. Two, it gets into the whole finance distribution issues and things of that nature. So you really only want to be pulling money out of the company that you’ve already been taxed on. Toby: Fair enough and then if you don't pull any money out of an LLC that's taxed as an S-Corp, you don't technically have to pay yourself a salary. You just let it sit in there and keep growing which your accountant is not going to tell you because they don't know that. The reason I know that is because I have spoken to probably 100 accountants that missed that one. It says, why do you want the LLC that does flipping set up as an S-Corp or C-Corp instead of a partnership? Mark, we were just talking about that because it's taxed as ordinary income as subject to self employment tax. So the reason we want that in an SRC is so that you do not get classified as a dealer because then all of your real estate is dealer real estate and you could lose all your long-term capital gains, you to lose your 1031, you could lose your installment sale. So we want it to be a separate taxpayer from you so the IRS notes clearly who the investor is and who the dealers is and then you can reduce the amount of tax hit by using the S-Corp that will reduce your self-employment tax significantly, if you add a 401K to it, you could eliminate your tax or defer it out into the future. If you use a C-Corp, then depending on what your expenses are, we can also eliminate all your tax or at least reduce it significantly. So that's why we use that. All right, we have a whole bunch of questions to go through so I'll go through this. What is UBIT and UBITA. UBIT is unrelated business income tax and the easiest way to understand this is when you have a tax deferred entity or tax, it's not actually a tax rates, it can be tax rate if it's a Roth but when you have a qualified plan or a nonprofit and it is not doing what it's set up to do, so let's say in an IRA or a 401K or a 401A, or a nonprofit, they're all set up to do certain things. They're allowed to have a passive activity which is rents, royalties, dividends, interest, even capital gains and it can have those and you don’t have to worry about it at all. But once it starts competing with other businesses, active businesses, now you have an issue and that's what's called—let's say that you have these ordinary businesses. Then they would be taxed, generally speaking it's going to be the highest rate at 37% I believe is what it's going to be as kind of a disincentive to engage in traditional businesses inside those exempt organizations. The easiest way to look at this, let's say you set up an IRA and it runs a mini mart, you're going to pay tax on those profits just like anybody else would. The exception is if that IRA owns a corporation that does not pay out the profits directly. It would have to own C-Corp and then it would only receive dividends and then those are considered passive. So it gets funny and a little bit difficult. The other one is let's say you set up a nonprofit, that's for—what's a good one? Helping Vet and then it sets up a pizza business on the side and starts competing, it buys a bunch a Domino's franchises. It's going to pay tax on the Domino's franchise. It doesn't get a big huge competitive advantage selling pizzas because it's a nonprofit. It would have to be for its charitable purpose and that's UBIT. Jeff: One place we see a lot is like hospitals, they're usually tax exempt but they may have a gift shop which they have to pay the business income tax on because it's not directly supporting them but it is a business. Toby: But you're allowed to do that for like what is it, Salvation Army and some these other thrift stores. They'll let you have one for a church and whatnot. If it's ancillary, if it's completely ancillary and it's just being used like thrift stores I think are one of the few exceptions, gift shop absolutely, you're head to head. Here's another one and I think that this may be what Diane was looking at, it's debt financed income. What that is, is if I'm using the leverage, then there's an exception for IRA's where it cannot use loans to generate income, it's considered an unrelated debt financed income. It will be taxable That is not the case for 401Ks and for 401As, which is what—if you've ever been to one of our events, you hear us railing on the idea that if you are going to finance real estate, real estate is considered passive and it's considered okay not UBIT. The only way you make it taxable is if you leverage it inside of an IRA, so don't do that. If you're going to leverage it, make sure your rolling that IRA into a 401K or profit sharing plan which is the 401A. So there, that's my two cents. I figure that maybe they had a funky—UBITA, I have no idea what that is, but it looks neat. I think they were probably referring to get financed income, since those things usually go side by side. All right, we have a ton of questions that have been posed and this is so much fun, we have like literally a jillion questions, if that's the number. All right, so here's the first one, if I cash out refinance or borrow an equity loan from my primary residence, use the money to do private lending by rental property, can I deduct the interest expense as an investment expense beyond $750,000 amount? They're throwing some things in here. This is actually a really long question, I'm giving you the thumbnail sketch of it. Hey guys email those types of questions in, because nobody's going to be out to follow this, but here's what here's what they're saying, we now have a restriction on your mortgage interest, it's $750,000. If you borrow on your house, and by the way it's $750,000 now, if you had a loan on it up to $1 million, you're grandfathered in, if those prior to what was it, 12/15/2017, you're good or if you got your long before April 15th and you already started the process before December 15, don't you make my head hurt. Long and short of it is, let's say $750,000, but your house is worth $1.5 million. You borrow money out of your house. You will not be writing that off personally, you are capped at $750,000 and that's on your schedule A. Whether or not you're getting any benefit out of that is to be seen because you have your standard deduction. I imagine it's going to be above the standard deduction if you're borrowing up to $750,000. Let's just say we have our $750,000 and we borrowed an extra $500,000, it can't go on your schedule A, but it can go someplace else. The someplace else would be, for example, if I put it into my schedule E, because I'm using it to buy rental property. Then I can use the income of the rental property and I can use the interest being paid as a separate expense, it's just going on a different tax form. The other route that you can go is, if I give that $500,000 and I loan it to a corporation and the corporation re-loans, in the words the corporation is going out loaning its money out and it's reimbursing my interest, then in all reality the loan is really to the corp, and I'm not getting any tax benefit but the corporation is reducing its income by reimbursing me the right to use basically my line of credit. This is no different than if you do this with your credit card. It's reimbursing you, so you make no money on it, but you don't pay tax on it, it such a fancy work around. That's number one. Next question, I hold rental property in a self directed IRA. I do tenant screening, manage the rental, hire vendors to do the repair work and I don't physically work on the house. Good, because you can't physically work on the house, you can do everything else, you can hire, do screening. I would actually have a property manager on it. All income expenses come and goes to the same self directed IRA account, hopefully that's with the custodian or you have an LLC, disregarded to the IRA. Somebody asked this, the IRA custodian sets up the LLC, you can't do it. You shouldn't be going out and doing it yourself, paying your money, you should actually have the IRA do it to keep it clean. Is it allowed? Yes, some people say, "If only I don't work on the house myself, that's okay," and they're correct. Some people say, even screening, collecting rent is not allowed, can you please clarify? You should not receive the money, the IRA should receive the money, you can direct you to the custodian though. You can even get the check and hand it to the custodian, forward it to the custodian, whatever, as long as what you're doing is not adding value to the property. That's the big no, no. Don't go get a paint brush and start painting the house because you're increasing the value to your personal efforts. Next question, my wife's previous employer stock options were exercised and we feel have peaked, cost basis 132, market value 280, if we cash in, what will be the tax consequences and how can we reduce the tax burden? We need to pull the trigger shortly. Aziz, this is you, there's two ways you can do this. First off, you're going to end up with long term capital gains, so it's not horrible. Secondly, there's something called an opportunity zone which just enacted at the end of the year and the just published out all these zones. If you reinvest the money in a opportunity zone, you defer to the tax. In the opportunity zones, there's tons of them. It's any neighborhood that is considered—that needs public support and there's a laundry list. I would actually encourage you to go Google, opportunity zone, tax and you'll find a big old list. But the communities in your area that are typically low to moderate income house. If you took your entire amount of increase, so let's say that we have $150,000 of taxable capital gains, you could buy $150,000 of opportunity zone properties and pay zero tax. Now, the question is, what happens when I sell? So there's holding periods and the minimum holding period, I believe, is you're going to be looking at five years, where then you're going to not have to pay tax on 15%, I'm going off of memory. So you'll have to excuse me if I'm not spot on, but it's 15% then it jumps up. At 10 years, the entire $150,000 is no longer taxable. And I believe that you're not going to be paying tax on the gain in the opportunity zone, it's kind of a two pronged, are you familiar with that one, Jeff? Jeff: Somewhat, I know that you replaced the old enterprise some number of years back. Toby: Something to look at, but would be it. The last way to avoid tax is give them, before you exercise it, is give that to your non-profit, if you have one and you would get a $280,000 deduction. And then the nonprofit can sell it zero tax. You'd get a monster tax and you could have these too, you could say, "Hey, I really need to offset a bunch of the tax, so I'm going to make a contribution," it doesn't matter what your basis is, it only matters, the fair market value of those assets and if you transferred let's say $140,000, half of it, let's see transferred $140,000 worth of stock, you would get $140,000 tax deduction and it can offset your income up to 60%. In either case, if you're pretty confident that we can mitigate or eliminate that tax bill if you wanted to. If you keep it out of state, somebody says, if you keep it as state for 36 months, can it be avoided? I am helping a friend with crowdfunding project and due to medical needs, we'll need a large sum, maybe $100 million what would his tax consequences be if he has no deductions? Does he have to pay tax on donated money? Fred, generally speaking, if you're getting these little gifts, as long as they're less than $15,000 there's no tax and when I say $15,000 that's per donor. So if I do a crowdfunding and everybody gives $100, there's no tax to the recipient. So go ahead and raise them a bunch of money. Jeff: Keep in mind when you're doing this crowdfunding, if you're contributing to a crowd funding, it is a gift, it's not a donation. Toby: And it's not a tax deductible donation. In 2017, I sold a rental house and took a $40,000 note. In 2017, I received $944 in interest but have not issued a 1099-INT. I did report the amount on my personal 2017. What should my next step be? Wait until 2019 or file now. So he's the one who holds the note, he was paid interest. What do you have to say? Jeff: This is kind of a darn if you do and darn if you don't. There is a penalty for not issuing the 1099. You did the right thing by reporting the amount of interest. However, there's a penalty for not following the 1099. There's a penalty for filing them late. Toby: What's the penalty like? Jeff: I think it's $50 or $75. I think it's $50 up to $99. Toby: So what you're saying is do it next year? Jeff: I didn’t hear anything. Toby: Hey do it next year unless they start digging in. I've had that, we actually went through a super audit here once and they went through every—they let you fix it. So I just wouldn't do it. I would just do it next year and say, "Hey, oops." How to aggregate all properties. What are the disadvantages to doing. You file an aggregation election, is it a form or you just check in the box? Jeff: It's an election. It prints out a form with your tax return. It says exactly what properties or investments you're aggregating together. The only real disadvantage is. Once you aggregated these properties, let's say you have two houses and one has significant passive losses. When you become a real estate professional, those passive losses gets stuck in there. Normally they get freed up when you sell that property but once you aggregator properties, it's all considered one property. So it doesn't free up those if you have a large losses tied up, it doesn't free them up until you get rid of all your aggregated properties. Toby: Cool. Nicely put. Are the purchase and sale of mortgage notes considered real estate for real estate professional status I'm assuming. Jeff: This is my gut feeling, I would say no. it's more of a lending, more of an investment in the notes. Toby: Depends on whether you're ending up with the properties. It depends on what your intent is and if your intent is just to buy and sell mortgage notes, then you're dealing with lending. In order to be real estate, it's really got to be focused in on the purchase and sale of real estate. Jeff: So we kind of run into the same thing with construction companies and such that they meet the test for certain things but not for other test. There are some input to it so real estate broker is kind of the same thing. Toby: Here's the thing, so this is Dean. Dean, if I am in your shoes, I am documenting the time I'm spending in real estate. so even though I may be going after a note, if the reason that you're going after the note is with the intent that possibly end up with that property and you do the research and you can back it up, then you add it into the real estate column as far as your time and you aggregate all your time. The only time this is going to come up is if somebody audits you in goes through all of your records that thoroughly which is rare that that happens. But let's say that it does, then you're the one who's tracking all of your expenses and your time. Then it would be up to the IRS to sit there and say, "Hey, that was actually for the mortgage." and so the old adage is pigs get fat, hogs get slaughtered. You don't take all of it but you aggregate that a little bit. Jeff: Can I bring up a pet peeve? I hear on the radio frequently about all these auditors that IRS has hired and they haven't had a real hiring since 2010. Toby: They're so toast right now. Jeff: The last big hiring they did most recently was to deal with Obamacare for that audit purposes. But really, they're dealing with almost a skeleton crew anymore. Toby: We just got proposed tax forms for 2018. We don't even know, we just had proposed regulations issued on the tax changes two weeks ago, three weeks ago. They're way behind the eight ball and sometimes we put ourselves in a disadvantage. Don't be crazy about it, but you can be pretty aggressive and especially if it's the truth. If what you're spending your time on is real estate, count it towards real estate. So if you're doing real estate investing part time, can you be considered a part time investor? Yeah, you'd be a part time investor but you wouldn't be a real estate professional. So the biggest important thing and this is for Darlene and Ken, is to document your time and if you go over 750 hours and it's more than you spend than anything else, then you're going to be a real estate professional. Otherwise, you're just an investor, unless you are buying properties to sell. So when you say investing, that means you're going to hold on to them, you're letting them depreciate a little bit but you get the cash flow. Does time spent lending money on real estate for real estate qualifiers and real estate professional. No investing, didn’t we just answer that one? It depends on your real intent of investing in the note. A lot of people are buying notes to end up with a real estate in which case then I'd say probably. Jeff: No, what if she's gap funding? Toby: If you're gap funding then I would say no, then you're lending. So you really have to take a look at the totality of the circumstances. I wish I could say yes or no. what we want is a yes and there's a way to get there. So it's making sure that you're documenting things to support your position. We could dig into that a little bit more, if you want to shoot us the email then let us dig into it. Then the next tax Tuesday, I can answer that one and Jeff can answer that one with a little bit of research behind it. Nexus question, "I'm a resident in California, I'm moving to Arizona. I plan to keep a single family rental in California. The California houses and the land trust is owned by Wyoming LLC, does California have the right to tax my pension income after I move in addition to my income in California rental." Shelly the answer is, it depends on where the rental was earned and whether you're taking out over a 10 year period then the answer is, no. and my guess is that you're going to be a big no. They will be able to tax technically the rental income that is being derived from California but for the most part, that's going to be zero. Jeff: A really important number to remember when you have a property in more than one state is 183. That's typically the number of days you need to spend in a state to be a resident in that state. Toby: "How do I get the 501(c)(3) tax exempt?" Marie, that’s the 1023 application. Yes, it's the 1023 application. So with a nonprofit, I always look at these things in threes, we file with the state which is a corporation. We document it to make sure there's no shareholders which is for private parties, and then we file with the feds and we're telling them we want to be an exempted organization and that exemption is done via 1023. So we go through that process. When we set them up, we set up about 3,000 of them successfully. "How do you create an LLC and an IRA?" Darlene and Ken, what you do is you have the IRA custodian internal contract with a company like us and we create the LLC, or we set up a 401K, roll the IRA into it and then we'd let you do it so you don't need a custodian. "Is this recorded and will a replay be sent out?" Robin, it's made available to anybody who's platinum and then I'm cutting out a bunch of the Q&As and will throw them all over the internet. The recording, yes we record them. Join platinum, it's fun. "If I sell a partial note to a family member from my QRP, is that disqualified?" it depends on the type of family members. When they're your kids, yes. If it's to a brother or sister, no. then you can do it. When you make a contribution and that's just the whole disqualified person argument we had earlier. So you can always ask again, ask the question specific to your situation, we'll give you a very specific answer. But just know that if you sell a partial note out of your QRP, it depends on the relationship of the family member. If it's lineal, you have a problem. Which means kids, parents, grandparents you have a problem. If it's horizontal, siblings, not a problem. If it's the spouses of the disqualified person, you're going to have a problem. "Investing in LLC for holding rental property, how does one avail to a 1031 exchange?" Here's how it works, so I'm not going to worry about this. The 1031 exchange, you have to have a 1031 exchange facilitator. The LLC has to buy the next property. So you sell one and buy one within 180 days and there's some other roles in there about when you identify it or you do a reverse exchange where you buy the replacement property then sell the other property within 180 days. But neither cases, in the name of the LLC, you don't have to do anything else. "I should be able to still qualify as an investor and still be active in real estate by investing more than 750 hours." yes, but in actually is a full time job. So if you have a full time job as a real estate professional, then you're good. But remember, your activity as a real estate investor has to exceed your activities of any other profit making activity. So if you work and you work 1,500 hours, even if you did 1400 hours as real estate, you are not a real estate professional, still below that 1,500. Investment in LLC for holding rental property, how does or somebody asked that. If you in invest funds to have an equity in a project, oh my god, this one's going to kill me, built by someone else, I'm trying to think what this is. So you're investing funds for a piece of an LLC in which you are passive and they are a builder, are you a dealer? So Judith, no, you are a passive investor in an active business, is what you are. I see what you're saying, what she's asking is, "Hey, I have Bob the builder come up to me and says, 'Hey, we're going to build this big apartment complex, we're going to develop and everything. You put in $100,000 everybody else puts on $100,000.'" You are passive. You are not considered the dealer. Here's a fun one, did you already read this one? Jeff: No, I haven’t read this one. Toby: Okay, I am planning to receive social security benefits at 62, and currently not employed. I do private lending to real estate investors through promissory notes. So I do receive interest income in the amount of $40,000 to $50,000. Will this affect my social security benefits? At what point to social security benefits are taxable? So Joe, the answer is that there are certain types of income that are exempt from calculations, social security, Jeff you know off the top of your head? Jeff: If you're receiving earned income and that's all social securities could ever know about, so we're talking about self employment income, W-2 wages, that's going to affect your social security benefits. Toby: But if you're just receiving interest income, is it going to affect it? Jeff: Well, here's the thing, if you're in the business of lending money, we would typically set you up as a business, either on schedule C or through an S-Corp or something. That interest you receive wouldn't be, interest income, it would be business income. You'd be able to deduct certain expenses from that income… Toby: We got to look at it, because usually you're going to want to be treated as active, in this particular case you're not going to outdo yourself. Jeff: The downside of this is, any money, any net income you have from this business of lending money is going to affect security until you're 65, or 67, full retirement age. Toby: Joe, the answer is, we may one isolated into its own taxable entity, so that it doesn't affect you. We may. Jeff: I kind of feel like this would be in a great place for an S-Corporation. It's not earning income flowing through to them. Toby: Would he have to take a salary? Jeff: Yeah there we go. Toby: I'm going to take a look. Joe, that's a great question, could you submit it to the webinars at Anderson Advisors, so we can research it. In that way we can hit it in two weeks, to get you a much more thoroughly research, because you're asking a very complicated question. That’s just not going to be at the top of our head. We're going to make sure that we don't step on a landmine. Jeff: So the answer's, maybe. Toby: My wife and I are the only shareholders and we both take a one third salary. No, you should take about one third of the net profit as salary, total between the owners. So greater than 2% shareholders or you and your spouse, so you could each take, I'll throw numbers out, let's say you made $100,000, you could each take up to $18,500. If you're under 50 and immediately dump it into a 401K and not pay any tax. So, "Hey we like that." We have a medical coding business, perfect, yeah, so that's when we want to take a look at. "This is so much fun, really appreciate it," I hope that's not sarcastic, Al. "I opened a couple of LLC, I'm going to use to purchase flipping, can I put them on hold until I do? Do I have to do tax returns?" It all depends on what you're doing with those, the answer is, yes you could put them on ice. "Thanks for the answer on UBIT." Diane, no problem. See we actually do answer questions here. "What are the legal benefits of incorporating in Puerto Rico, if any compared to Nevada?" If you live there, I think they give you 4% tax rate, but you actually have to reside there. There's legal benefits, not really any, other than the tax benefits and the fact of the matter is Puerto Rico has Spanish law, which means they could probably take your company from you. But you can still go down there and Jeff… Jeff: Well, I mean, there are certain industries that have great tax benefits pharmaceutical companies was always a big one. Some of those old laws have sunsetted but might be a good opportunity. Toby: Cool, look at all these questions. All right, some people are saying nice things, great. I like nice things better than, "You guys are jerks." In 2017, I was self employed under my LLC, I have not filed my taxes yet and not considering retirement. Would I still be able to do that? What is best options?" Casey, are you under—self employment under my LLC. So it depends on whether—it was an S-Corp. Did you file an extension because you would be able to do a retirement plan either a sub-IRA or if you already had the 401K then you can make a contribution from the company for it. It would either be a 401A or a 401K. or sub-IRA, I think those are going to be your... Jeff: And if you do extension, you have 11 days to get it done. Toby: Yeah, you have 11 days. Casey, get off your butt. All right, Brian wants advice with the start up pre revenue, he is offering 10% stock, "Not sure I want ownership that subject to capital calls, expectation, potential—is it better to take an offshore [inaudible 01:06:53] until there's more value in the company?" It really depends, so Clark, nice to see you. Awesome. I know Clark's brother very well, studs, nice family. All right, friends, if I was going to have a piece, the whole thing is, if I'm putting money into an endeavor, it's going to be, "What am I going to get out?" It would really depend on the agreement, I don't want to be subject to having to put more money in, nor do I want my interest necessarily being diluted by somebody who is. So one of the one of the ways you can do it, is sometimes do it is a convertible note where you loan the money, so you know you can at least get it back, but it's convertible into equity at the fair market value at that time. You guys can actually agreed to this ahead of time. So that if you decide you want to contribute it, you see they're doing what you want but then you convert it into equity. Otherwise it just remains a note that they pay you on. Clark, that's probably the route I would go. Jeff: But the assumption here is, this is a C-Corporation he's talking about. Toby: I don't even care… Jeff: Well if it's an S-Corporation that we wouldn’t be able to have all these secondary notes and stuff. Toby: If it's an S, I could so convert it. Jeff: Could you? Toby: Yep. Jeff: As long as it converts into the same… Toby: Yep. The risk is I don't want to have a convertible debt to anything other than an individual that would qualify for S.. Jeff: Okay. Toby: But I don't see S-Corps raising money this way. It's almost always C-Corps with partnerships. So the ones that I've been personally involved in, we did three levels of financing this exact way with Vegas Tax fund. That's the little Tony Hseih group and they dumped a bunch of money to a company called Role Tech. You can look them up online, because we exited that wanted with the sale to Brunswick. In a way they did all their money was purely—that was a C-Corp, but it was purely through convertible notes. All right, "What are the best tools you can recommend for tracking time mileage and expenses for real estate investors? My desire to be paperless and get everything out…" People use Taxbot for mileage, it's mileage IQ, MileIQ, I think it's the one that I use, but if you're tracking time, it's just using—sometimes is just using your calendar or spreadsheet. Let's see, "Is full time realtor, a real estate professional?" Chances are, you're going to aggregate and all that. "I understand and agree." I'm not sure I understand that. "I executed a 1031 exchange where trust all the owned property, sold it, and took title of the up leg property in the trust using 1031 exchange. But now I want to transfer up leg property into an LLC." Diane, there is no time restriction that you have to hold it as long as you are the one and still the end beneficiary. If you extend loan through an LLC owned by Roth IRA, they want to transfer, sell the remainder, but then season it out to a lower interest rate. Can Roth continue to receive the full payment from the borrower and the relay the portion?" Yes, as lines is non-convertible, same as you do in an S-Corp. "Is the answer the same best self administer S 401K? So what they're asking is," If you extend a loan through—we're just going to call it the Roth IRA, because the LLC looks right into it from a tax standpoint. And then you sell the remainder of that then season notes. So you start collecting and then you sell the note because it's doing really well and you say, "Hey does anybody want to pay me for this?" I know a guy that that's what he does. He puts the notes together and he sells his notes out and so he can get the money to go to another one and he aggregates them altogether, they call it flying in flocks. The lenders flock together and together they do a loan and he sells his portion. Yeah, you could sell it and then you can continue to receive it and keep a portion of it. the only issue you have is if it's a convertible note then you wouldn’t want to do a convertible note because boom, that Roth IRA depending on the type of entity if it's an S-Corp you'd kill the S-Corp's status of it. How do you put an LLC on hold? You get quite literally do nothing with it or you just pay the state and then you file a non activity return. You say it's not doing anything. So you're allowed to do that or you just do nothing. Which is what I tend to do. It just depends on your state. If there's not much penalty then I just kind of sit it and then two years later I might reactivate it. Will real estate holding LLC taxes partnership qualify for the 20% passed through deduction? Yes, it will. Here's the deal, as long as it's not triple net property. What she's asking is, "Hey, I have a whole bunch of LLCs and they all receive rental income and there's a net income amount." let's say it comes through with $50,000 there's something called a 199A deduction that was enacted by the 2017 tax cut and jobs act. And it gives you a 20% deduction off that amount or 20% of your taxable income whichever one is less/ but if you earn over a certain amount so for individuals it's over, $100,575 if it's a married couple it's $315,000 which is going to make your head hurt I'm going to suffer memory here. Then you scale up and then you have a new test it's 50% of the W2 income that's being paid on that particular busine
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’re back with our old routine – no special guests. Nachi: Don’t sound so sad about it! Jeremy was great last month, and he’s definitely paved the way for more special guests in upcoming episodes. Jeff: You’re right. But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Nachi: And this is obviously not something we see that often, so listen up for some easy to remember high yield points to help you when you get an electrical injury in the ED. And pay particular attention to the , which, as always, signals the answer to one of our CME questions. Jeff: I hate to digress so early and drop a cliché, “let’s start with a case…” but we, just a month ago, had a lightning strike induced cardiac arrest in Pittsburgh, so this hits really close to home. Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. Nachi: This month’s print issue was authored by Dr. Gentges and Dr. Schieche from the Oklahoma University School of Community Medicine. It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. In total, they pulled references from 1966 until 2018. Their search yielded 477 articles, which was narrowed to 88 after initial review. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015. On average, between 25 and 50 of the yearly fatalities can be attributed to lightning strikes. Jeff: Interestingly, most of the decrease in fatalities is due to improvements in occupational protections and not due so much to changes in healthcare. Nachi: That is interesting and great to hear for workers. Also, worth noting is the trimodal distribution of patients with electrical injuries: with young children being affected by household currents, adolescent males engaging in high risk behaviors, and adult males with occupational exposures and hazards. Jeff: Electrical injuries and snake bites – leave it to us men to excel at all the wrong things… Anyway, before we get into the medicine, we unfortunately need to cover some basic physics. I know, it might seem painful, but it’s necessary. There are a couple of terms we need to define to help us understand the pathologies we’ll be discussing. Those terms are: current, amperes, voltage, and resistance. Nachi: So, the current is the total amount of electrons moving down a gradient over time, and it’s measured in amperes. Jeff: Voltage, on the other hand, is the potential difference between the top and bottom of a gradient. The current is directly proportional to the voltage. It can be alternating, AC, or direct, DC. Nachi: Resistance is the obstruction of electrical flow and it is inversely proportional to the current. Think of Ohm’s Law here. Voltage = current x resistance. Jeff: Damage to the tissues from electricity is largely due to thermal injury, which depends on the tissue resistance, voltage, amperage, type of circuit, and the duration of contact. Nachi: That brings us to an interesting concept – the let-go threshold. Since electrical injuries are often due to grasping an electric source, this can induce tetanic muscle contractions and therefore the inability to let go, thus increasing the duration of contact and extent of injury. Jeff: Definitely adding insult to injury right there. With respect to the tissue resistance, that amount varies widely depending on the type of tissue. Dry skin has high resistance, far greater than wet or lacerated skin. And the skin’s resistance breaks down as it absorbs more energy. Nerve tissue has the least resistance and can be damaged by even low voltage without cutaneous manifestations. Bone and fat have the highest resistance. In between nerve and bone or fat, we have blood and vascular tissue, which have low resistance, and muscle and the viscera which have a slightly higher resistance. Nachi: Understanding the resistances will help you anticipate the types of injuries you are treating, since current will tend to follow the path of least resistance. In high resistance tissues, most of the energy is lost as heat, causing coagulation necrosis. These concepts also explain why you may have deeper injuries beyond what can be visualized on the surface. Jeff: And not only does the resistance play a role, but so too does the amount and type of current. AC, which is often found in standard home and office settings, but can also be found in high voltage transmission lines, usually affects the electrically sensitive tissues like nerve and muscle. DC has a higher let-go threshold and does not cause as much sensation. It also requires more amperage to cause v-fib. DC is often found in batteries, car and computer electrical systems, some high voltage transmission lines, and capacitors. Nachi: Voltage has a twofold effect on tissues. The first mechanism is through electroporation, which is direct damage to cell membranes by high voltage. The second is by overcoming the resistance of body tissues and intervening objects such as clothes or water. You’re probably familiar with this concept when you see high voltages arcing through the air without direct contact with the actual electrical source, leading to diffuse burns. Jeff: As voltage increases, the resistance of dry skin is -- not surprisingly -- reduced, leading to worse injuries. Nachi: And for this reason, the US Department of Energy has set 600 Volts as the cutoff for low vs high voltage electrical exposure. Jeff: It is absolutely critical that we also mention and then re-mention throughout this episode, that those with electrical injuries often have multisystem injuries due to not only the thermal injury, electrical damage to electrically sensitive tissue, but also mechanical trauma. Injuries are not uncommon both from forceful pulling away from the source or a subsequent fall if one occurs. Nachi: That’s a great point which we’ll return to soon, as it plays an important role in destination selection. But before we get there, let’s review the common clinical manifestations of electrical injuries. Jeff: First up is – the cutaneous injuries. Most electrical injuries present with burns to the skin. Low voltage exposures typically cause superficial burns at the entry and exit sites, whereas high voltage exposures cause larger, deeper burns that may require skin grafting, debridement, and even amputation. Nachi: High voltage injuries can also travel through the sub-q tissue leading to extensive burns to deep structures despite what appears to be relatively uninjured skin. In addition, high voltage injuries can also result in superficial burns to large areas secondary to flash injury. Jeff: Electrical injuries can also lead to musculoskeletal injuries via either thermal or mechanical means. Thermal injury can lead to muscle breakdown, rhabdo, myonecrosis, edema, and in worse cases, compartment syndrome. In the bones, it can lead to osteonecrosis and periosteal burns. Nachi: In terms of mechanical injury – electrical injury often leads to forceful muscular contraction and falls. In 2 retrospective studies, 11% of patients with high voltage exposures also had traumatic injuries. Jeff: While not nearly as common, the rarer cardiovascular injuries are certainly up there as the most feared. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. Common arrhythmias include AV block, bundle branch blocks, a fib, QT prolongation and even ventricular arrhythmias, including both v-fib and v-tach, both of which typically occur immediately after the injury. Nachi: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence. Jeff: It’s also worth noting that ST elevation MIs have also been reported, however this is usually due to coronary artery vasospasm rather than acute arterial occlusion. Nachi: Respiratory injuries are somewhat less common. Acute respiratory failure usually occurs secondary to electrical injury-induced cardiac arrest. Thoracic tetany can cause paralysis of respiratory muscles. Late findings of respiratory injury including pulmonary effusions, pneumonitis, pneumonia, and even PE. The electrical resistance of lung tissue is relatively high, which may account for why pulmonary injury is less common. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. In addition, those with severe burns are at increased risk of DVT, especially in those who are immobilized. In at least one study, the incidence of DVT in hospitalized burn patients was as high as 23%. That’s -- high. Nachi: Neurologic complaints are far more common as nerve tissue is highly conductive. While the most common injury from an electric shock is loss of consciousness, other common neurologic insults include weakness, paresthesias, and difficulty concentrating. Jeff: And if the entry and exit sites traverse the spinal cord – this also puts the patient at risk for spinal cord lesions. Specifically with respect to high voltage injuries – these victims are at risk for posterior cord syndrome. In addition, depression, pain, anxiety, mood swings, and cognitive difficulties have all been commonly described. Nachi: Rounding out our discussion of electrical injuries, visceral injuries are rather rare, with bowel perforation being the most common. High voltage injuries have also been associated with cataracts, macular injury, retinal detachment, hearing loss, tinnitus, and vertigo. Jeff: Perfect. I think that more or less rounds out an overview of organ specific electrical injuries. Let’s talk about prehospital care for these patients -- a broad topic in this case. As always, the first, and most important step in prehospital care is protecting oneself from the electrical exposure if the electrical source is still live. Nachi: In cases of high voltage injuries from power lines or transformers or whatever oddity the patient has come across, it may even be necessary to wait for word from the local electrical authority prior to initiating care. Remember, the last thing you want to do is become a victim yourself. Jeff: For those whose electrical injury resulted in cardiac arrest, follow your standard ACLS guidelines. These aren’t your standard arrest patients though, they typically have many fewer comorbidities – so CPR tends to be more successful. Nachi: Intubation should also be considered especially early in those with facial or neck burns, as risk of airway loss is high. Jeff: And as we mentioned previously, concurrent trauma and therefore traumatic injuries is very common, especially with high voltage injuries, so patients with electrical injuries require a complete survey and not just a brief examination of their obvious injuries. Nachi: When determining destination, trauma takes priority over burn, so patients with significant trauma or those who are obtunded or unconscious should be transported to an appropriate trauma center rather than a burn center if those sites are different. Jeff: Let’s move on to evaluation in the emergency department. As always, it’s ABC and IV, O2, monitor first with early airway management in those with head and neck burns being a top priority. After that, complete your primary and secondary surveys per ATLS guidelines. Nachi: During your survey, make sure the patient is entirely undressed and all constricting items, like jewelry is removed. Jeff: Next, make sure that all patients with high voltage injuries have an EKG and continuous cardiac monitoring. Those with low voltage injuries and a normal EKG do not require monitoring. Nachi: Additionally, for those with severe electrical injuries, an IV should be placed and fluid resuscitation should begin. Fluid requirements will likely be higher than those predicted by the parkland formula, and you should aim for a goal of maintaining urine output of 1-1.5 ml/kg/h. Jeff: With your initial stabilization underway, you can begin to gather a more thorough history either from bystanders or EMS if they are still present. Try to ascertain whether the current was AC or DC, and whether it was high or low voltage. Don’t forget to ask about the setting of the injury as this may point to other concurrent traumatic injuries, that may in fact take precedence during your work up. Nachi: Moving on to the physical exam. As mentioned previously, disrobe the patient and complete a primary and secondary survey. Jeff: If the patient has clear entry and exit wounds, the path through the body may become apparent and offer clues about what injuries to expect. Nachi: A single exam will not suffice for electrical injury patients. All patients with serious electrical injuries will require serial exams to evaluate for vascular compromise and compartment syndrome. Jeff: So that wraps up the physical, let’s move onto diagnostic studies. Nachi: First off -- I know we’ve said it, but it’s definitely worth reiterating. All patients presenting with a history of an electric shock require an EKG Jeff: In those with a low voltage injury without syncope and a normal EKG, you don’t routinely need cardiac monitoring. However, in the setting of high voltage injuries, the data is less clear. Based on current literature, the authors recommend overnight monitoring for at least 8 hours for all high voltage injuries. Nachi: While no routine labs work is required for minor injuries, those with more serious injuries require a cbc, cmp, CK, CK-MB, and urinalysis. Jeff: The CK is clearly for rhabdo, but interestingly, a CK-MB greater than 80 ng/mL is actually predictive of limb amputation. Oh and don’t forget that urine pregnancy test when appropriate. Nachi: In terms of imaging, you’ll have to let your history guide your diagnostic studies. Perform a FAST exam to screen for intra-abdominal pathology for anyone with concern for concurrent trauma. Keep a low threshold to XR or CT any potentially injured body region. Jeff: Real quick – in case you missed it – ultrasound sneaks in again. Maybe I should reconsider and do an US fellowship – seems like that’s where the money is at - well maybe not money but still. Let’s move on to treatment. Nachi: In those with minor injuries like small burns and a low voltage exposure – if they have a normal EKG and no other symptoms, these patients require analgesia only. Give return precautions and have them follow up with their PCP or a burn center. Jeff: In those with more severe injuries, as we mentioned before, but we’ll stress again, protect the patient’s airway early especially if you are considering transfer and have any concerns. In one study, delays in intubation was associated with a high risk of a difficult airway. Always make sure you have not only your tool of choice but also all of your backup airway devices ready as all deeper airway injuries may not be apparent externally. Nachi: Fluid resuscitation with isotonic fluids is the standard -- again -- with a goal urine output of 1-1.5 ml/kg/h. Jeff: Address pain with analgesia – likely in the form of opiates – and don’t be surprised if large doses are needed. Nachi: Dress burned areas with an antibiotic dressing and update the patient’s tetanus if needed. While there is ongoing debate about the role of prophylactic antibiotics, best evidence at this point recommends against them. We talked about thermal burns in Epsiode 13 also, so go back and listen there for more... Jeff: There is also a range of practice variation with respect to early surgical exploration of the burned limb with severe injuries. At this time, however, the best current evidence supports a conservative approach. Nachi: Serial exams and watch and wait it is. . We have some interesting special populations to discuss this month. First up, as is often the case, the kids. Jeff: Young children are sadly more likely to present with orofacial burns due to, well, everything ending up in their mouth. And since many of our listeners are likely in boards study mode – why don’t you fill us in on the latest evidence with respect to labial artery bleeding. Nachi: Sure – . There is up to a 24% risk of labial artery bleeding and primary tooth damage with oral electrical injuries. Although there isn’t a clear consensus, current evidence supports early ENT consultation and a strong consideration for admission and observation for delayed bleeding. Jeff: Keep in mind though, that labial artery bleeding is often delayed and has been reported as far as 2 weeks out from the initial insult. Nachi: Moral of the story: don’t put electrical cords in or anywhere near your mouth. Next, we have pregnant patients. Case reports of pregnant patients suffering electrical injuries have described fetal arrhythmias, ischemic brain injury, and fetal demise. For this reason, those that are past the age of fetal viability should have fetal monitoring after experiencing an electric shock. Jeff: If not already done, an ultrasound should be obtained as well and a two week follow up ultrasound will be needed. Nachi: We’re switching gears a bit with this next special population – those injured by an electrical control device or taser. Jeff: Tasers typically deliver an initial 50,000 volt shock, with a variable number of additional shocks following that. Nachi: Most taser injuries are thankfully direct traumatic effects of the darts or indirect trauma from subsequent falls. Jeff: While there are case reports of taser induced v fib, the validity of taser induced arrhythmias remains questionable due to confounders such as underlying disease and previously agitated states like excited delirium Nachi: Basically, [DING SOUND} those with taser injuries should be approached as any standard trauma patient would be, with the addition of an EKG for all of these patients. Jeff: The next special population --- the one I’m sure you’ve all been waiting patiently for -- is lightning strike victims. Lightening carries a voltage in the millions with amperage in the thousands, but with an incredibly short exposure time. Because of this, lightening causes injuries in a number of different ways. Nachi: First, because it’s often raining when lightning strikes, wet skin may cause the energy to stay on the skin in what is known as a flashover effect. Jeff: Similarly and not surprisingly, burns are common after a lightning strike. Lichtenberg figures are superficial skin changes that resemble bare tree branches and are pathognomonic for lightning injury. Thankfully, these usually disappear within a few weeks without intervention. Nachi: Next, the rapid expansion of the air around the strike can lead to a concussive blast and a variety of traumatic injuries including ocular and otologic injury like TM rupture which occurs in up to two thirds of cases. Jeff: An ophthalmologic consult should be obtained in most, if not all of these cases. Nachi: Making matters worse, lightning can also travel through electric wiring and plumbing to cause a shock to a person indoors nearby the strike! Jeff: And like we mentioned earlier, just as was the case with my fellow Pittsburgher or ‘Yinzer. Nachi: Yinzer? Jeff: Forget about it, it’s just what Pittsburghers call themselves for some reason or another - but we’re still talking lightning. Cardiac complications including death, contusion and vasospasm have all been reported secondary to lightning injury. But don’t lose hope – in fact – you should gain hope as these patients have a much higher than typical survival rates. Nachi: From the neurologic standpoint – it’s a bit more complicated. CNS dysfunction may be immediate or delayed and can range from strokes to spinal cord injuries. Cerebral salt wasting syndrome, peripheral nerve lesions, spinal cord fracture, and cerebral hemorrhages have all been described. An MRI may be required to elucidate the true diagnosis. Jeff: Clearly victims of lighting strikes are complex and, for that reason, among many others, the American College of Surgeons recommends that victims of lightning strikes be transferred to a burn center for a comprehensive eval. Nachi: Let’s touch upon any other details regarding disposition. Jeff: Those with low voltage exposures, a normal EKG and minimal injury may be discharged home with PCP follow up and strict return precautions. Nachi: High voltage injuries on the other hand require admission to a burn center and the involvement of a burn surgeon, even if it involves transferring the patient. Jeff: And remember, trauma takes precedence over burn and those with traumatic injuries or the possibility of traumatic injuries should be evaluated at a trauma center. Don’t forget to take the airway early if there is any concern, and consider transporting via air as the services of a critical care transport team may be required. Nachi: That wraps up Episode 22, but let’s go over some key points and clinical pearls. During evaluation, consider multisystem injuries due to not only the thermal injury and electrical damage to electrically sensitive tissue, but also mechanical trauma. Thermal injury can lead to muscle breakdown, rhabdomyolysis, myonecrosis, edema, compartment syndrome, osteonecrosis, and even periosteal burns. Mechanical injury can be a result of forceful muscular contractions, and trauma can manifest as fractures, dislocations, and significant muscular injuries. Electrical injuries due to grasping an electric source can induce tetanic muscle contractions and therefore the inability to let go, increasing the duration of contact and extent of injury. Current tends to follow the path of least resistance, which explains why you might have deeper injuries beyond what can be visualized in the surface. Nerve tissue has the least resistance and can be damaged by even low voltage without cutaneous manifestations. Bone and fat, on the other hand, have the highest resistance to electrical injury. High voltage injuries place patients at risk for spinal injuries, most notably posterior cord syndrome. High voltage injuries have also been associated with cataracts, macular injury, retinal detachment, hearing loss, tinnitus, and vertigo. All patients with electrical injury require an EKG. Low voltage injuries with a normal presenting EKG do not always require cardiac monitoring. High voltage injuries require cardiac monitoring for at least 8 hours. Intubation should be considered early in patients with facial or neck burns, as risk of airway loss is high. Make sure to have airway adjuncts and back up equipment at bedside, as deeper airway injuries may not be obvious upon external exam. For severe injuries, target a urine output rate of 1-1.5 mL/kg/hr. All patients with serious electrical injuries require serial exams to evaluate for vascular compromise and compartment syndrome. Address pain with analgesia. Larger than expected doses may be needed. Dress burned areas with an antibiotic dressing and update the patient’s tetanus if required. For pediatric patients with oral electric injuries from biting on a cord, consult ENT early and consider admission for observation of delayed arterial bleeding. Pregnant patients who are past the age of fetal viability should have fetal monitoring and ultrasound after experiencing an electric shock. Tympanic membrane rupture is a commonly noted blast injury after a lightning strike. Cardiac resuscitation should follow ACLS guidelines and is more likely to be successful than your tyipcal cardiac arrest patient as the patient population is typically younger and without significant comorbidities. When determining destination, trauma centers take priority over burn centers if those sites are different. So that wraps up episode 22 - managing electrical injury in the emergency department. Additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. And the address for this month’s credit is ebmedicine.net/E1118, so head over there to get your CME credit. As always, the you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!
Disclaimer: This is the unedited transcript of the podcast. Please excuse any typos. Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine's Emergency Medicine Practice. I'm Jeff Nusbaum, and I'm back with my co-host, Nachi Gupta. This month, we'll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We've brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeremy: Dr. Jeremy Rose here. Thanks for having me in on this conversation. I'm always happy to talk about this topic because it's clearly important. There's a great deal of confusion around sepsis and I hope that in the next couple minutes we can clarify things in a way that really help your average front line doc trying to get it right. Nachi: So Dr. Rose, before we get started, tell us a bit about your background and your interest in sepsis… Jeremy: I'm the Assistant Medical Director and Sepsis Chair at Mount Sinai Beth Israel in Manhattan. For those listening, my hospital probably looks a little bit like yours. We're busy, interesting, and just a little rough around the edges. We like it that way. More importantly, though, we mirror the national averages regarding sepsis. Roughly half of in-hospital mortality is associated with septic in some fashion. Pretty incredible when you think about it. Half. Jeff: Sepsis chair... clearly this is an important topic if it warrants it's own chair at a major hospital in NYC. But getting back to the article this month. This month's issue was authored by Faheem Guirgis, Laurent Page Black, and Elizabeth DeVos of the University of Florida, Department of Emergency Medicine. Nachi: And it was peer reviewed by Michael Allison, Assistant Director of the Adult ICU at Saint Agnes Hospital, and Jeremy Rose and Eric Steinberg of Mount Sinai Beth Israel. Jeff: So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? It seems that every month or so we have a new guideline, bundle, definition, or whatever… I think it's best to start with the basics - At its core, sepsis is a dysregulated response to infection that can be life-threatening. Nachi: Right and it's the combined inflammatory with immunosuppressive features of sepsis that lead to the devastating organ dysfunction and even death. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeremy, can you give us a little historical context there? Jeremy: Rivers was a real pioneer. He found a 16% mortality reduction with randomization to an early aggressive care bundle. Amazing work. That being said, many components of that bundle have since been disregarded. For example, Manny Rivers would measure CVP in all of his patients, something we rarely do. Nachi: Not to cut you off and steal your thunder there, but we'll get to the most recent updates in management shortly. Let's first talk definitions and terminology, and specifically, diagnosis, which is definitely a big elephant in the room. As Jeff mentioned a few minutes ago, diagnostic criteria have undergone so so so many changes. Jeff: Yes it has! 1991 marked the first standardized definition. Then in 2001, sepsis-2 was introduced. In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Sepsis-3!! A lot of this came after the realization that SIRS was just too broad and was overly sensitive and non-specific. Jeremy, why don't you take us through Sepsis 3. Jeremy: So just to back up a little and frame this: Here's the fundamental problem: As we likes to say, “there's no troponin for sepsis.” And if you look at our patients, we tend not to miss the hypotensive, tachycardic, febrile patient. We know they're septic.
Disclaimer: This is the unedited transcript of the podcast. Please excuse any typos. Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. We have a special episode for you this month… We’ve brought Dr. Jeremy Rose, one of the peer reviewers, and a sepsis expert, on with us to talk through the content this month. Jeremy: Dr. Jeremy Rose here. Thanks for having me in on this conversation. I’m always happy to talk about this topic because it’s clearly important. There’s a great deal of confusion around sepsis and I hope that in the next couple minutes we can clarify things in a way that really help your average front line doc trying to get it right. Nachi: So Dr. Rose, before we get started, tell us a bit about your background and your interest in sepsis… Jeremy: I’m the Assistant Medical Director and Sepsis Chair at Mount Sinai Beth Israel in Manhattan. For those listening, my hospital probably looks a little bit like yours. We’re busy, interesting, and just a little rough around the edges. We like it that way. More importantly, though, we mirror the national averages regarding sepsis. Roughly half of in-hospital mortality is associated with septic in some fashion. Pretty incredible when you think about it. Half. Jeff: Sepsis chair... clearly this is an important topic if it warrants it’s own chair at a major hospital in NYC. But getting back to the article this month. This month’s issue was authored by Faheem Guirgis, Laurent Page Black, and Elizabeth DeVos of the University of Florida, Department of Emergency Medicine. Nachi: And it was peer reviewed by Michael Allison, Assistant Director of the Adult ICU at Saint Agnes Hospital, and Jeremy Rose and Eric Steinberg of Mount Sinai Beth Israel. Jeff: So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? It seems that every month or so we have a new guideline, bundle, definition, or whatever… I think it’s best to start with the basics - At its core, sepsis is a dysregulated response to infection that can be life-threatening. Nachi: Right and it’s the combined inflammatory with immunosuppressive features of sepsis that lead to the devastating organ dysfunction and even death. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeremy, can you give us a little historical context there? Jeremy: Rivers was a real pioneer. He found a 16% mortality reduction with randomization to an early aggressive care bundle. Amazing work. That being said, many components of that bundle have since been disregarded. For example, Manny Rivers would measure CVP in all of his patients, something we rarely do. Nachi: Not to cut you off and steal your thunder there, but we’ll get to the most recent updates in management shortly. Let’s first talk definitions and terminology, and specifically, diagnosis, which is definitely a big elephant in the room. As Jeff mentioned a few minutes ago, diagnostic criteria have undergone so so so many changes. Jeff: Yes it has! 1991 marked the first standardized definition. Then in 2001, sepsis-2 was introduced. In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Sepsis-3!! A lot of this came after the realization that SIRS was just too broad and was overly sensitive and non-specific. Jeremy, why don’t you take us through Sepsis 3. Jeremy: So just to back up a little and frame this: Here’s the fundamental problem: As we likes to say, “there’s no troponin for sepsis.” And if you look at our patients, we tend not to miss the hypotensive, tachycardic, febrile patient. We know they’re septic. But how do we find the ones who don’t look as sick. Frequently elderly, possibly with normal-ish vitals and no fever. Those can be a lot harder to spot, but they may indeed be septic. Also, for research purposes we have to have a common definition, so Sepsis 3 came up with something called the SOFA score. The problem with the SOFA score is that its difficult to perform in the ED. It has parameters like bilirubin that often aren’t available when we want to screen out very sick patients. Fortunately there is the abridged version qSOFA, which identifies non-icu patients who are at high risk of inpatient mortality. So here it is, and if you get one thing from this episode, this is it: There are ONLY 3 criteria to the qSOFA. 3 Criteria. RR > 22; AMS; SBP 2. So quite a few changes! Jeff: And Jeremy, sticky topic coming up here. Center for Medicare and Medicaid Services (or CMS) quality measures - They haven’t really caught on to and adapted to Sepsis-3 yet, have they? Jeremy: The CMS mandate is based on the presence of SIRS criteria. Sepsis 3 is based on SOFA. This is definitely confusing. Part of the challenge in discussing this topic is separating out the QI guidelines from what is actually relevant to patient care based on the latest evidence-based medicine. Nachi: That seems fair. We’re really going to put you in an uncomfortable spot for a second and push you here Jeremy. Do you have any insight into why CMS isn’t interested in following the mountains of research that have led to sepsis-3? Is there a reason they are sticking to their current criteria? Jeremy: I think some of it is the slow pace of bureaucracy and the time that it takes to develop a consensus on management. Even if we can agree on who is septic, it’s really hard, if not impossible to link the care to a pay-for-performance metric which is what CMS ultimately would like to see. That’s not how Sepsis-3, or for that matter, SIRS, was designed to be used. You’re trying to take a tool which was originally designed for research and mold them into a tool used for pay for performance. Nachi: What a struggle. The CMS metrics are slightly different from the 2001 sepsis guidelines also. Take a look at Table 2 of the article for a quick comparison of sepsis-3, 2001 sepsis, and cms side-by-side. And for those on twitter, we’ll be sure to tweet this table out too for your review. Jeff: With so many different scores and definitions, I think that adequately sets the stage for the challenge this month’s authors faced coming up with real evidenced based guidelines. Nachi: Oh absolutely. And to make matters worse - this is a HUGE problem. We’re talking up to 850,000 ED visits annually in the US, and 19 million cases worldwide. Compounding this, sepsis results in death in approximately 1 out of 4 cases. Not only is it lethal, it is also very costly -- 17 billion dollars per year in the US alone! Jeff: And don’t forget importantly the 30-day hospital readmission rate. Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA. Nachi: Let’s speak briefly on the etiology and pathophysiology of sepsis: we all know that sepsis is due to local infections that then become systemic. Previously, it was believed that the bacterial infection itself was the cause of the clinical syndrome of sepsis. However, we now know now that the syndrome of sepsis is due to the inflammatory and immunosuppressive mediators that were triggered by the infection. Normal immune regulatory safeguards fail and this leads to the syndrome. And interestingly, several studies have shown that critically ill septic patients experience reactivations of specific viruses that were previously limited to patients with severe immunosuppression. Jeff: Definitely something to look out for in your critically ill septic patients. We should talk briefly about the most common inciting infections that lead to sepsis. In order, these are: pneumonia, intra-abdominal infections, and urinary tract infections. No surprises there! Nachi: Yeah, that basically parallels my own experience, so that’s reassuring! That takes us to our next potentially controversial topic - blood cultures. Jeremy - we’re going to punt this one back to you Jeremy: This is another interesting topic that has received plenty of attention. CMS loves blood cultures. It’s an easy metric to track. That doesn’t mean they’re always helpful. We looked at our patients with lactates between 2.1 and 4.0 which had “severe sepsis.” These patients were normotensive though, In other words, the ones that aren’t that sick. We found that blood cultures are useful about 20% of the time. That’s not bad. So what do we do? We draw cultures before pushing antibiotics. Is that helpful? Sometimes yes, does it waste money? Debatable. Does it help us meet our metrics, yes. Jeff: And I think that gets at the crux of the problem here: we don’t want to delay antibiotics on anybody, but we must balance this with the potential harm of further increasing the drug resistant bacterial population via sound antibiotic stewardship. Remember also that there is a broad differential for sepsis, with several “sepsis mimics”. To name a few, we have PE, MI, CHF, acute pulmonary edema, DKA, thyroid storm, GI bleeds, drug intoxications, and withdrawal syndromes, just to name a few. In case that wasn’t enough check out Table 3 of the article. Nachi: And we already mentioned the leading causes of sepsis, that’s pneumonia, intra abdominal infections, and uti’s. But remember the source can be anywhere. Be sure to also think of pyelonephritis, central line associated bloodstream infections, prosthetics, endocarditis, necrotizing fasciitis, and meningitis. Jeff: I don’t think we need to dwell on this much longer - basically the differential is huge. Let’s move on to my favorite section - prehospital care. Jeremy: 20 pages of evidenced based recommendations and your favorite is the prehospital section, what’s up with that? Jeff: I’m an EMS fellow, what can I say… Anyway, on to my favorite section -- prehospital care. This is always a hot topic because the prehospital period is a special opportunity to get early interventions in for septic patients as 40 - 70% of all severe sepsis hospitalizations arrive via EMS. Nachi: And in one study taking place in a large metropolitan area, prehospital care time was over 45 minutes, and less than 37% arrived with IV access. Of course, these numbers would vary significantly based on where you practice. Jeff: So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission. So clearly early recognition and therapy may play a role here. Another study, however, showed knowledge gaps by advanced EMS providers in diagnosis and management of sepsis. And yet another study showed that only 18 to 21% of confirmed septic patients were suspected of having sepsis by EMS. Out of hospital fluids were started in only half of patients with severe sepsis. In essence, there is likely a strong role here for pre hospital protocols for identifying and treating sepsis. Nachi: In terms of pre hospital treatments though, prehospital IV fluids haven’t been shown to improve mortality, but have been associated with shorter hospital stays. Prehospital sepsis protocols have been described, but in general more research is needed in this area. Jeff: While prehospital care hasn’t yet been shown to improve the prognosis of septic patients, those presenting via EMS do have shorter delays to initiation of antibiotics, IV fluids, and early care bundles. EMS should focus primarily on stabilizing vital signs and providing efficient transport. If it’s possible to establish an IV and initiate fluids without delaying transport, EMS should do that as well. Nachi: And of course, oxygen for the hypoxic patients! Moving on to history and physical for your presumed septic patient. Jeremy, what are the big hitting things here that you always ask and check for, and that you make sure your residents are doing? Jeremy: After ABC’s and glucose, AMS is really important, it’s in the QSOFA SCORE. Unfortunately, this can be hard in many septic patients where they’re baseline mental status is less than perfect. The other thing is to try and find the source. Finding the source lets you make wise choices about therapy. Jeff: Great point about the mental status - so many of our older population have an altered baseline, but recognizing changes from that baseline is key. Nachi: Absolutely, with that in mind, let’s talk diagnostic studies, especially lactate. Where I trained, basically everybody was getting a lactate, even tired looking residents seemed to be having their lactates checked, and trust me, they weren’t looking that good... Jeremy: Brace yourself: lactate is really important in septic patients. That being said, not every cause of elevated lactate is sepsis. There is this animal called Type B lactic acidosis can come from numerous drugs like albuterol. Just because you see elevated lactate doesn’t mean you can forget about the other causes. That being said, we know that patients with sepsis do better when they clear lactate. Jeff: Seems like the evidence is definitely in favor of serial lactate testing… Jeremy: For sure. At least until you have a reasonable trend towards improvement. We know lactate clearers do better. We’ve looked at our own lactate numbers. Interestingly, the takeoff point for sepsis seems to be around 2.5. Meaning that patients with altered vitals and lactates above 2.5 tend to do worse. But, there is a broad ddx to elevated lactate. What is true, though, is that lactate is a marker for badness. If your patient’s lactate is rising, yours should be too. Nachi: I bet I’m a “lactate clearer”. I may add “lactate clearer to my CV,” sounds impressive. But I digress… Next up we have Procalcitonin. Since procalcitonin becomes elevated in those with bacterial infections, intuitively, this should be a valuable marker to assess in potentially septic patients. Unfortunately procalcitonin lacks negative predictive value so most literature supports its use in diagnosing pulmonary infections and for antibiotic de-escalation. Jeff: Good to know, I’ve seen it being used a lot more recently and wondered how evidence based this test was. Jeremy: Honestly, I don’t see Procalcitonin changing ED management at the moment. If you’re waiting for Procalcitonin to start antibiotics or fluids, you’re waiting too long. Nachi: Moving on, let’s talk imaging. Based on current studies, the authors recommend focused imaging only. In addition, they also note that our good friend, the point of care ultrasound, likely plays a role, as in one study, POCUS demonstrated a 25% improvement in sensitivity from clinical impression alone. Jeremy: I think there are two ways POCUS comes in. One, lung ultrasound can be really useful to find that occult pneumonia or differentiating pneumonia from CHF. Two, your ultrasound is your best tool for assessing volume status. I try to look at the IVC of all my septic patients and echo them when possible. Nachi: Right. So now we’ve examined, drawn labs and cultures, checked a lactate, may be obtained imaging… next up we should probably start treating the patient. Whether you like it or not, we have to discuss CMS. Jeremy: Just to clarify before we start. CMS defines “severe sepsis” as SIRS + infection with a lactate of 2.1-4.0. Septic shock is SIRS + infection with hypotension or a lactate > 4.0. That’s where we’re at. Jeff: Good point. Back to treatment: within the first 3 hours, for any patient with sepsis and septic shock, you must measure a lactate, obtain 2 sets of blood cultures, administer antibiotics, and give an isotonic fluid challenge with 30 cc/kg to patients with hypotension or a lactate greater than 4. Then, within the first 6 hours, you must apply vasopressors to achieve a MAP of at least 65, re-assess volume status and perfusion, and remeasure a lactate. Nachi: This begs the question - are these recommendations evidenced based? Jeremy…. Jeremy: I’m so glad you asked that . Let’s start with fluids. Patient’s need adequate fluid resuscitation. Interestingly there are 3 large RCT’s, PROMISE, PROCESS and ARISE, that compared a Rivers type bundle to usual care. Surprisingly, they showed no difference. But when your drill down into these 3 trials, you see that “the usual care,” now generally includes at least 2 liters of fluid. Jeff: Ok, so it seems that there is some pretty good data to support a rapid fluid challenge of at least 30 cc/kg. But how do we determine who needs more fluids and how much more they need. There must be an endpoint to all of this? Jeremy: Another million dollar question. 30cc/kg is probably a good place to start. How much is too much? I think we need to be smart about our fluids. Some patients will need less and some will need much more. So, I remind my resident’s to be smart about fluids. Sono an IVC, trend a lactate, follow a urine output, do a passive leg raise, even check JVP. I mean just because you haven’t seen a unicorn doesns’t mean they’re not real. Do something to monitor volume status. Nachi: Very important. Put your ultrasound skills to work here. They’ll only improve as you practice more. Jeff, let’s get started on the ever important topic of antibiotics. Jeff: Sounds good. Current guidelines recommend that broad spectrum antibiotics be administered within the first hour of presentation for those with sepsis or septic shock, ideally with blood cultures being drawn beforehand. In one study, every hour of delayed abx administration was associated with an 8% increase in mortality. Since this 2006 study, other studies have had mixed results - with studies showing increased odds of death with delays in abx administration and others showing only a benefit in those with septic shock with or without hypotension with no benefit to those without shock. Nachi: In terms of antibiotic coverage - you need to consider the site of infection, local resistance patterns, the presence of immunosuppression, and the patient’s age and comorbidities. Table 5 of the article is very thorough and should be kept as a quick reference. Jeremy do you have any specific recommendations for our listeners on how we should approach antibiotic usage in the septic patient? Jeremy: I like to think about antibiotics a little more simply than referencing a table. I ask a couple questions. Does my patient need MRSA coverage ? Does my patient need Pseudomonal coverage? If the answer is no and no, then narrow your coverage. You don’t necessarily have to use a bunch of Vanco, or a big gun antipseudomonal like Pip/tazo. Also, have a look at your local antibiogram. I can’t tell you how many times this changes prescribing habits for even things like simple UTIs. I’m going to stray into some controversial territory here. The benefits of sepsis protocols are measured one patient at a time, but the harms are only measured in the aggregate. What does that mean? CMS metrics have caused us to use to use more broad spectrum antibiotics. As a result, we’re seeing more resistance. My resident’s tell me to make it easy, give em VZ (that’s vanco/zosyn) and it kills me. Every time you put a Z-pack into the world a pneumococcus gets it’s wings. So think more about your antibiotics, and know your local biograms. Jeff: That’s a great way to think about it, I fear I’ve given a lot of pneumococci wings during my training… Next we’re on to vasopressors. The data is pretty clear on this one - norepinephrine is the recommended first line vasopressor for septic shock. In numerous trials comparing Norepi to dopamine, NE was far superior, with dopamine increasing arrhythmias in one trial and associated with an increased risk of death as compared to NE in another trial. Jeremy: So here’s a question I get all the time: How can I give Norepi without a central line. Let’s use Dopamine, its safe peripherally. Ok, so follow that through. We’re going to give a drug to increase blood pressure by constricting blood vessels, but don’t worry, it’s safe peripherally. What does that mean? It means it doesn’t work!! It doesn’t give much blood pressaure. Dopamine is a lousy pressor. It causes a lot of tachycardia, which is not what you want in failing septic hearts. So what do we do if we don’t have a central line? We start norepi peripherally into a large bore IV for the time it takes us to get a central line. That’s where the evidence is. There’s a mortality benefit to NE over dopaine in septic shock. Jeff: Right, this month’s authors note peripheral pressors may be safe for brief periods in settings with close monitoring. While this is commonplace in some hospitals, others haven’t yet jumped on that bandwagon. I think it’s important to mention that this is becoming more and more commonplace, even in the prehospital realm. With the service I fly for, we routinely start peripheral vasopressors without hesitation. But this isn’t limited to the air. Many ground 911 services have also adopted peripheral vasopressors in a variety of settings. Nachi: I’m sure there are many trials to come in the future documenting their safety profile, but moving on to the next pressor to discuss... vasopressin. This should be your second line vasopressor for septic shock. In the VASST trial, low-dose vasopressin was found to be noninferior to NE. In other trials, vasopressin also appeared to show a potential benefit in those with AKI and sepsis, although the subsequent VANISH trial (perhaps the best name for a clinical trial so far) failed to demonstrate a benefit to vasopressin titration with regard to renal outcomes in septic shock. Vasopressin has also been shown to reduce NE dosing when administered at a fixed dose of 0.03-0.04 units/min. Jeff: Next we have epinephrine. In one study epinephrine and NE were equivalent in achieving MAP goals in ICU patients with shock, however several of those receiving epi developed marked tachycardia, lactic acidosis, or an increased insulin requirement. The increasing lactic acidosis could confound the trending of lactates, so in those requiring inotropy in addition to some peripheral squeeze - the authors recommend adding dobutamine to norepinephrine instead of starting epinephrine. Although, keep in mind, this can lead to some hypotension so remember to start at low doses. Nachi: Phenylephrine, a pure alpha adrenergic agent, is next and should be considered neither first nor second line, but it may have a role as a push dose agent while preparing other vasoactive agents. Jeff: And lastly, we have angiotensin 2. One recent 2017 study examining the role of angiotensin 2 in those with septic shock already on 0.2 mcg/kg/min of NE found that those receiving AT2 had significant improvements in MAPs as well as cardiovascular SOFA score at 48h with no difference in mortality. Unfortunately, these benefits do not come without risk as AT2 may increase risk of arterial and venous thrombosis and potentially thromboembolism. Clearly, one study isn’t enough to change practice, but it’s certainly food for thought. Nachi: So that wraps up vasopressors. Jeremy, we’re on to corticosteroids -- another hotly debated topic. When do you give steroids in sepsis? Jeremy: Hmmm steroids, this is an age old question. No study has clearly supported the blanket use of steroids in septic shock. Several like CORTICUS and ADRENAL showed no difference. I will use hydrocortisone for pressor refractory shock. Meaning, you’ve tried everything else, so you might as well try. Also, I do tend to avoid Etomidate, given the possibility of adrenal suppression and that there are several other induction agents, notably Ketamine that don’t have this problem. Jeff: Those trials are certainly important, thanks for bringing them up - Especially with all the FOAM content out there, it’s incredibly important to look back at the data to understand where certain recommendations are coming from. Anyway… one quick note on blood transfusions before we move on to special populations - Although part of the original early goal directed therapy, thanks to data from the TRISS trial which showed no difference in outcomes with a transfusion goal of 7 vs 9, transfusions are reserved for those with a hbg of less than 7. Jeremy: One population we should make sure to mention and be careful with is end stage liver disease. In the ER, we tend to miss SBP alot. Mostly because these patients have lots of reasons to be sick and they already have elevated lactate because of their deceased clearance. My practice is to give a dose of Ceftriaxone and sent a diagnostic tap to patients who are sick and have ascites. Nachi: Alright Jeremy, let’s talk controversies in sepsis. We’re giving you all the big questions this month! Jeremy: We’ve already talked about fluids and how much to give. Just a reminder that a history of CHF doesn’t preclude proper fluid resuscitation. I think broad spectrum antibiotics for relatively well patients is a big controversy. Our national rates of antibiotic resistance are terrible, and yet we’re using more antibiotics all the time. There are very few if any antibiotics coming down the pharma pipeline and we’re going to have to face the music eventually. Finally, we need national metrics that mirror clinical evidnece. Protocols should be a tool and not a crutch. You know what’s best for the patient in front of you, so don’t let metrics or protocols make you do things you think are not in your patient’s best interest. Nachi: So how do you escape the hospital protocols and CMS and do what’s best for your patient without “getting in trouble”? Jeremy: Here’s how I deal with it as the one who reads and QI’s all of our sepsis charts. I tell my colleagues to do what’s right, and if you need to deviate from the protocol tell me why. As long as you can explain your decision, I’ll support it. Explaining your thinking is good clinical practice and is good medico-legal practice. CMS has been unable to link these metric to payment, simply because no hospital can meet them with any regularity. It’s important that we advocate for our patients or nothing will change. Make them respect you for the highly educated professional that you are, and your patients will ultimately benefit. Jeff: Preach!! And before we close out with disposition, there are a few new therapies and trials on the horizon to keep a lookout for. The RACE trail examined the role of L-carinitine. The VICTAS trial is looking at vitamin C, thiamine, and steroids in sepsis. The CLOVERS trial is looking at early vasopressors vs a crystalloid liberal strategy. And lastly, IL-7 is also being investigated. All really cool stuff that could change how we manage sepsis in the future.. Nachi A few quick notes on disposition before we close this episode out. Certainly not all patients meeting SIRS require admission, but many do. Those with qSOFA of 2 or higher represent a sick population and an ICU admission should be considered. Even for those with a qSOFA of 1 but a lacate over 2 -- they have a mortality approaching that of patients with a qSOFA of 2. Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes. Jeff: That’s in line with the general themes we’ve laid out today - definitely better to start early with aggressive care rather than play catch up later. Jeremy - in 30 seconds or less, what are the most salient points in the management of sepsis that you would like our listeners to take with them from this episode. Jeremy: Here are my take aways: qSOFA, RR, AMS SBP < 100 Norepi, not Dopamine - it doesn’t work! Be smart about fluids!! Be smarter about antibiotic use! You are the best advocate for your patient, despite what anyone else says! Jeff: Excellent, so that wraps up the October 2018 episode of Emplify. A big thanks to Jeremy Rose for joining us. Jeremy: Thank you for having me!!! It was great talking with you. Nachi: For our listeners -- additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at www.ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credits. You’ll also get enhanced access to the podcast, including the images and tables mentioned. You can find everything you need to know at ebmedicine.net/subscribe. Jeff: And the address for this month’s credit is ebmedicine.net/E1018, so head over there to get your CME credit. As always, the ding sound you heard throughout the episode corresponds to the answers to the CME questions. Nachi: Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at emplify@ebmedicine.net with any comments or suggestions. Talk to you next month!
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. Nachi: Although this isn’t something we encountered too frequently – it does seem like I’ve been hearing more about snake bites in the recent months. Jeff: I actually flew someone just the other day because the local ED ran out of CroFab after an envenomation in Western PA. Nachi: Yeah, this is definitely more than “just a boards topic,” and it’s really important to know about in those rare circumstances. In terms of incidence, there are actually about 10,000 ED visits in the US for snake bites each year, and 1/3 of these involve venomous species. Jeff: That’s a good teaser, so let’s start by recognizing this month’s team – the two authors, Dr. Sheikh, a medical toxicologist, and Patrick Leffers, a pharmD, and emergency medicine and clinical toxicology fellow. Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Nachi: And don’t forget our peer reviewers this month, Dr. Daniel Sessions, a medical toxicologist working at the South Texas Poison Center, and our very own editor-in-chief, Dr. Andy Jagoda, who is also Chair of the Department of Emergency Medicine at Mount Sinai in New York City. Jeff: What a team! But, let’s get back to the snakes. As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US. Of course, this number likely underestimates the true total. Nachi: And there are two key subfamilies of venomous snakes to be aware of – the Crotalinae – or pit vipers – which includes rattlesnakes, copperheads, and water moccasins; and the Elapidae – of which you really only need to know about the coral snake. Jeff: And while those are the only two NATIVE snake subfamilies to be acutely aware of, don’t forget that exotic snakes, which are shockingly popular pets -- they can also cause significant morbidity and mortality. Nachi: Oh, and one other quick note before we get into the epidemiology – most of the recommendations this month come from expert opinion, as high quality RCTs are obviously difficult. In addition, many of the studies were based in other countries, where the snakes, the anti-venoms and their availability, and the general healthcare systems are different from those that most of us work in. Jeff: Unless we have listeners abroad? Do we have listeners in other countries? Nachi: Oh we definitely do... but we are going to be a bit biased towards US envenomation today. In any case, venomous snake bites occur most frequently in men aged 18 to 49 during warmer months with provoked bites occurring more frequently in the upper extremities and unprovoked bites in the lower extremities. Jeff: In one study of poison center data from the last decade, nearly half of all victims of snake bites were victims of unknown type snakes. However, of those that were known, copperheads were the most common, while rattlesnakes caused the most fatalities – 19 of 31 in this dataset. Nachi: In a separate study of snake bites in the early 2000s, 32% of exposures were from venomous snakes and 59% of those resulted in admission. That’s remarkably high. Jeff: Snake bite severity depends on several key factors: the amount of venom, the composition of the venom, the body size of the bite victim, the victim's clothing, the size of the bite, comorbid conditions, and the timing and quality of medical care the victim receives. Nachi: To be a bit more specific - First, the amount of venom will depend on the species of snake, with variations even occurring within the same species. Secondly, while there is a correlation between rattlesnake size and bite severity, there is much more at play. Some snakes can even vary the amount of venom based on threat risk – with defensive bites having different profiles than bites to strike prey. Jeff: I found it pretty interesting that an estimated 10-25% of pit viper bites are considered dry bites, that is, ones in which no venom is released. Nachi: Right, this is just one reason why all victims shouldn’t immediately get anti-venom, but we’ll get there. Jeff: We definitely will. As we already stated – venom composition varies greatly. Pit vipers produce a predominantly hemotoxic venom. Systemic effects include tachycardia, tachypnea, hypotension, nausea, vomiting, weakness, and diaphoresis. Neurotoxicity is rare and is usually due to inter-breeding between species. Nachi: While rattlesnake bites are associated with higher morbidity and mortality, the more common copperhead bites typically only cause local tissue effects. More serious systemic findings such as coagulopathy and respiratory failure have been reported though. Jeff: So that’s a solid background to get us started. Let’s talk about the individual snakes. Why don’t you start with the crotalinae family – aka the pit vipers. Nachi: Sure – the crotalinae includes rattlesnakes, cottonmouths (also known as water moccasins), and copperheads. These make up the vast majority of reports to the poison centers. They can be identified by their heat sensing pits located behind their nostrils (hence pit vipers). As a general rule, you can also identify the venomous snakes by their triangular or spade-like head, elliptical pupils, and hollow retractable fangs. Jeff: wait, so you want me to walk up to the snake and ask to see if their fangs retract… yea, no thanks. Nachi: Haha, of course not, I’m just giving you some of the general principles here. In contrast, non-venomous pit vipers have rounded heads, round pupils, a double row of vertical scales, and they lack fangs. Jeff: In terms of location, rattlesnakes are found in all states but Hawaii, and cottonmouths and copperheads are distributed mostly throughout the southern and southeastern states, with copperheads also extending further north, even into Massachusetts. Nachi: Moving on to the Elapidae – there are 3 species of coral snakes, only two of which you need to know about, Micrurus fulvius fulvius or the eastern coral snake and Micrurus tener or the Texas coral snake. Of the two, the eastern or Micrurus fulvius fulvius produces more potent venom. Jeff: As you may have guessed by their names, the eastern coral snake is found in the southeastern united states, specifically, east of the Mississippi -- whereas the Texas coral snake lives west of the Mississippi. Nachi: Venomous North American coral snakes can be recognized by the red and yellow bands around their bodies whereas their nonvenomous counterparts can be recognized by their characteristic black band between the red and yellow bands. I’m sure you’ve heard the popular mnemonic for this… Red touch yellow kill a fellow, red touch black, venom lack. Jeff: I have heard that one, and it’s not a bad mnemonic. Just remember that this is more of a guideline than a rule, as it doesn’t always hold true. Nachi: Coral snakes also tend to chew rather than bite thanks to their short, fixed, hollow fangs. Locally, bites can lead to muscle destruction thanks to a certain myotoxin. Systemic signs of infection include nausea, vomiting, abdominal pain, and dizziness. Jeff: The venom also contains a neurotoxin which can lead to diplopia, difficulty swallowing and speaking and generalized weakness. Nachi: Complicating matters even further, the onset of these symptoms may be delayed for many hours. Jeff: Alright, so I think that about wraps up the background. Let’s move on to the meat and potatoes of this article, starting with the differential. Nachi: For differential this month, we are really focusing on differentiating a venomous snake from a non-venomous one. Jeff: Oh yeah, this is where you want us to ask the snake if it can retract its fangs, right? Nachi: Ha very funny – Although the type of snake may be obvious if the patient owns the snake, for most cases you see in the ED, the type of snake won’t be clear. Try to get a description of the snake and consider your local geography. Some patients may even bring the snake in with them. Jeff: yea, no thanks. As for prehospital care, it’s actually pretty interesting stuff as recommendations have changed many times. You may have heard of the recommendations for incision / excision, use of venom extraction devices, tourniquets, chill methods and even electroshock therapy – well these methods are all OUT. Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Jeff: And while we definitely don’t want to encourage ill-advised attempts at capturing the snake, taking pictures at a distance may be helpful in identifying it. Oh and the authors do note- pretty terrifying stuff coming up here so brace yourself - even if the snake is dead the bite reflex is still intact… Nachi: And that’s why I work in city hospitals… Jeff: There’s also a bit of controversy here with regards to pressure immobilization, which is definitely something I thought we were supposed to do in the prehospital setting. Apparently in other countries, like Australia, prehospital providers frequently employ pressure immobilization – that is, wrapping bandages proximally up a splinted limb to impede lymphatic toxin spread. Nachi: Right, but in Australia, not only are the snakes more venomous but the hospital transport distances are much longer, so, basically they sacrifice the limb to potentially save a life. In the US, with our current indigenous snake population and the relatively short transport distances, this isn’t justified at all! Jeff: Take home: based on the current literature, the American College of Medical Toxicology, other experts, and Drs. Sheikh and Leffers recommend against pressure immobilization in lieu of prompt patient transport to definitive treatment. Nachi: Good to know – alright so now we have the patient in the emergency department, let’s begin ED care. As always – IV, O2, Monitor including end tidal CO2 if you suspect a neurotoxic or exotic snake bite. Of course, avoid using the affected limbs for vitals… Jeff: If not done already, remove any constrictive clothing or jewelry and mark the leading edge of pain, edema, and erythema both above and below the bite. If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. Nachi: And definitely involve the poison control center or a medical toxicology service early as they are an amazing resource. It’s an easy number to remember.. 1-800-222-1222. If you just type “poison control center” into google, that number will come up immediately. Jeff: Hypotension should be treated with isotonic fluids and, as usual, anaphylaxis should be treated with the usual cocktail of antihistamines and epinephrine at first IM and then via infusion if refractory. Note that antivenom will NOT reverse anaphylaxis on its own. Nachi: When eliciting a history, there are a number of important factors to look out for, including – time and location of the bite, description of the snake, tetanus status, comorbid conditions, medications and allergies, any systemic or neurologic symptoms, muscle cramps, perioral tingling or numbness, metallic taste, history of previous snakebites and any reactions to previous envenomation or antivenom treatment. Jeff: Moving on to the physical exam, when examining the wound, look specifically for local tissue effects which occur in over 90% of patients after pit viper envenomations. In such cases, you would expect pain, erythema, swelling, tenderness, and myonecrosis beginning at the wound site and then spreading via the lymphatic system. Nachi: In addition, specifically with pit viper envenomations, monitor the patient for possible compartment syndrome as the venom can lead to local tissue destruction, increased cell permeability, third spacing of fluids, and bleeding. And remember that while the local compartment may be hypertensive, the patient may also have systemic hypotension. Jeff: Just to reiterate what I said before – hypotension may indicate severe anaphylaxis and its not necessarily just due to third spacing. Regardless, the treatment is the same – epinephrine. Nachi: Good point, but let’s focus on compartment syndrome for a minute. True compartment syndrome is actually quite rare --- its really subcutaneous hypertension with preservation of otherwise normal compartment pressures that you’re most likely to see. Compartment syndrome should therefore only be diagnosed by actual compartment measurements and not just the exam. However, if you are dealing with compartments that can’t be measured, like in the fingers, you’re only choice is to be guided by the exam… Jeff: Risk factors for compartment syndrome in the setting of a snake bite include envenomations in small children, involvement of digits, application of ice or cold packs, and delayed or inadequate antivenom administration. Nachi: In terms of respiratory effects of envenomations – they aren’t common. Both bites to the head or neck and neurotoxin containing venom are potential causes. In the setting of respiratory failure, be prepared with advanced airway maneuvers like nasotracheal intubation or cricothyroidotomy. Antivenom will not reverse respiratory failure. Jeff: Neurologic effects may be present upon arrival but may also be delayed up to 12 hours in the case of eastern coral snake bites. Nachi: It’s noteworthy that in one study of almost 400 eastern coral snake exposures, the onset of systemic symptoms occurred on average 5.6 hours after the bite. So definitely remember that repeat exams and observation will be tremendously important. Jeff: The actual neurologic symptoms to look for depend on the snake. Coral snake venom can produce a descending flaccid paralysis characterized by motor weakness, especially of the cranial nerves. Similarly pit vipers, especially the Mojave rattlesnake, have also been associated with muscular weakness of the cranial nerves and even respiratory insufficiency. Nachi: Pit viper envenomation can also lead to myokymia which is repetitive small muscle fasciculations. Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases. Both myokymia and myonecrosis may lead to rhabdo in the case of significant envenomations. Jeff: Pit viper envenomation can also cause hematologic effects. Fibrinolysis and platelet consumption at the bit site can lead to decreased fibrinogen and thrombocytopenia. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Those on anticoagulants and anti-platelet agents are at increased risk. Nachi: Dermal effects such as edema, ecchymosis, bullae, and bleeding are not uncommon, but up to 50% of coral snake bite victims may have none of these. Jeff: And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported. Nachi: Let’s move on to diagnostic studies. Most patients require a CBC, coags, and a fibrinogen concentration. Those with systemic toxicity should also have their electroyltes, CPK, creatinine, glucose, and urine tested. Jeff: And while the data is somewhat mixed, one study suggests that all patients with pit viper envenomations need their coags checked, not just those with severe symptoms as in one series nearly 90% of patients had missed coagulation abnormalities. The clinical consequences of this aren’t clearly explained, so the authors don’t make a specific recommendation. Nachi: In terms of imaging, a chest x-ray should be obtained in those with respiratory symptoms and ultrasound may even have an expanding role here for tracking edema, looking for fluid collections, and assessing deep muscle compartments and vascular flow. Jeff: I feel like we should get some entry music for every ultrasound reference because it seems to make its way into just about every episode. Nachi: What would it sound like? You bring this up every month. I’ll look into something for a future episode. If any of our listeners have a suggestion, shoot us an e-mail at emplify@ebmedicine.net. In terms of monitoring and observation, this is important, ALL patients with suspected pit viper envenomations should be observed for 8-12 hours with the leading edge marked every 15-30 minutes. Jeff: In addition, serial diagnostic testing may also be needed as such changes will be used to guide treatment. In those with systemic symptoms, lab testing will be required every 4-6 hours prior to discharge. Nachi: Before we move onto treatment – let me quickly mention grading. There is no universal grading system. The snakebite severity score, the minimum-moderate-severe score, and grade 1-4 score which consider symptoms, exam findings, and lab abnormalities have all been studied. None have been validated and none track changes, so the authors recommend relying on severity of symptoms and progression of symptoms to guide treatment. Jeff: The crux of treatment for pit viper envenomations is with supportive care and anti-venom. Nachi: FabAV or CroFab is the antivenom of choice for pit viper envenomations. This antivenom is made from extracting the Fab portion of anti-venom antibodies from envenomated sheep and processing them with papain. Jeff: Since the sheep are injected with venom from the western diamondback, eastern diamondback and Mojave rattlesnake as well as the cottonmouth, the FabAV is most effective against venom from these snakes, however it does have cross reactivity to other immunologically similar venoms. Nachi: Indications for FabAV include a more than minimal local swelling, rapid progression of swelling, swelling crossing a major joint, evidence of hemotoxicity, signs of systemic toxicity including hemodynamic compromise, neuromuscular toxicity, and late or recurrent new-onset coagulopathy. Jeff: Initially, dose FabAV as a bolus of 4-6 vials, IV. With life threatening envenomations or those with cardiovascular collapse, double the starting dose to 8-12 vials. The goal is arresting progression, improvement in coagulation abnormalities, and resolution of systemic symptoms. Nachi: Although FabAV will reduce the duration and severity of symptoms and lab abnormalities, it will not reverse tissue necrosis and may not reverse neurologic effects. Jeff: Once the symptoms have been controlled after the bolus dose or a second bolus dose, maintenance dosing of 2 vials every 6 hours for 3 doses is recommended to prevent recurrence. Nachi: So to reiterate. 4-6 vial bolus to start, doubled in severe cases and then 2 vials every 6 hours for 18 hours after that. Jeff: You got it. Nachi: And like most, maybe all medicines, there are side effects and contraindications to be aware of. Hypersensitivity reactions and serum sickness to FabAV have been reported as 8% and 13% respectively. Most are mild and can be treated with your standard bundle of steroids, antihistamines, fluids and epi. Jeff: Risk factors for developing allergic reactions to FabAV include a known allergy to papaya, papain, chymopapin, pineapple enzyme bromelain, and previous allergic reaction to FabAV. Nachi: Although FabAV isn’t produced using copperhead venom, it may be effective in severe envenomations and in one study, FabAV reduced limb disability compared to placebo. Jeff: Therefore, the authors very reasonably advise that you should use the patient’s clinical picture and individual factors rather than the snake species to guide your treatment. Nachi: Interestingly, compartment syndrome should be treated with the initial 4-6 vial dose of antivenom and not necessarily a fasciotomy. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment. Jeff: The reason for this is that antivenom may reduce tissue pressures obviating the need for fasciotomy. In addition, fasciotomy wouldn’t affect muscle necrosis that is occurring so fascia removal really doesn’t solve anything. Nachi: And just as anti-venom can be used to treat elevated compartment pressures, it can also be used to treat coagulopathy. Jeff: Blood products should be used for those who are actively bleeding or severely anemic as venom does not discriminate and will destroy whatever blood it comes across. Nachi: Recurrent and late onset coagulopathy after FabAV treatment has also been well described. Although not exactly clear why, some speculate that it occurs for one of 4 reasons. 1) because the half life of FabAV is shorter than that of the venom, or 2) because the venom is initially stored in the soft tissues and then slowly released over time or 3) because the venom has a late onset component, or lastly, 4) there is delayed dissociation of the venom-antivenom complexes. Regardless of the mechanism, late onset coagulopathy can be treated with FabAV. Jeff: Luckily, bleeding associated with coagulopathy and bleeding associated with late onset coagulopathy are both extremely rare. Nachi: Moving on to coral snakes. Coral snake bites should be treated with NACSA or North American Coral Snake anti-venom. This antivenom halts or at least limits the progression of muscle paralysis and shortens the clinical course. Jeff: Most experts recommend NACSA treatment with the first signs of systemic toxicity and not for all comers. This recommendation is backed by the literature as in one observational study those treated with prophylactic NACSA did less favorably as compared to those who got it only after symptoms onset. This is probably because NACSA doesn’t reverse neuromuscular weakness and only limits progression. Nachi: And it’s not like you are just sitting by and watching while doing nothing – focus your initial treatment on wound care, pain control, and then observation for the development of systemic symptoms. The exact length of observation will depend on the snake, but should be somewhere between 8 and 24h. Jeff: As for dosing – the initial NACSA dose is 3-5 vials IV for both peds and adults with a repeat dose if the initial symptoms don’t improve. Nachi: Side effects and adverse reactions occur somewhere between 8-11% of the time with dermal reactions being most common and anaphylaxis being the most severe. Jeff: There is also one last anti-venom to be aware of – Coralmyn, for coral snake envenomations. Coralmyn is a polyclonal antivenom F(ab’)2 coral snake antivenom, developed because the current lot of NACSA has technically expired although the date has been extended numerous times. It’s currently in a phase 3 trial, so keep your eyes out. Nachi: Other non-antivenom treatments that have been tested include acetylcholinesterase inhibitors and trypsin at the bite site – both should be considered experimental at this point. Jeff: To wrap up the treatment section, let’s talk exotic snakes. You may recall from the intro that these have a higher morbidity and mortality compared to native species. Nachi: You will have to rely on your local poison control center or toxicologist for advice and you may even need to turn to the zoo or aquarium for antivenom, if it exists at all. Patients with bites from exotic snakes should be monitored, likely in the ICU, for up to 24 hours as toxicity from some venom may have a delayed onset of up to 20 hours. Jeff: Scary stuff, hopefully the patient knows which type of exotic snake they own and you don’t have to sort through a million google images to try to get to the bottom of this. Anyway, there are 3 special populations to discuss. First are pregnant patients. Nachi: The authors cite a 1.4% incidence of snake bites in pregnant patients. They note that this is low, but from my perspective, this seems shockingly high – why would a pregnant person ever get anywhere near a snake, seems just ill advised… Jeff: haha, true. But regardless, treatment is the same with antivenom as needed for all the same indications. With fetal demise rates as high as 30%, in addition to maternal monitoring, the fetus should also be monitored. Nachi: That number may seem high, but keep in mind that that’s from studies in other countries with more venomous snakes, so it’s likely to be lower in the US. But the point remains, that antivenom is generally recommended to be given if the mother has indications for treatment, as poor fetal outcome is tied directly to the severity of envenomation in the mother. Jeff: Continuing right along, the next special population to discuss are pediatric patients. Because dosing is based on the amount of venom delivered and not on patient specific factors, dosing is the same for peds and adults. Nachi: How rare – so few meds seem to be the same for peds and adults. The last population to discuss are anticoagulated patients. Patients on antiplatelet or anti-coagulants are at increased risk of bleeding after pit viper envenomations and therefore should have their coags checked every 2 days following the last dose of FabAV. Jeff: I think we’ve at least mentioned most of this months controversies, but it’s probably worth quickly reviewing them since they mostly dispel common myths. Nachi: Good idea. Incision and suction of snake bites is nearly universally not recommended. Jeff: In the absence of ischemia, fasciotomy for snake bites is not recommended, even with elevated compartment pressures. Instead treat compartment syndrome with anti-venom and save the fasciotomy for true cases of ischemia refractory to antivenom. Nachi: With a known or suspected coral snake envenomation, due to shortages of NACSA, wait until the patient develops symptoms instead of empirically treating all bite victims. Jeff: Maintenance dosing of FabAV continues to be debated. The manufacturer recommends 2 doses every 6 hours for 3 doses while some experts recommend only maintenance dosing as needed. It’s therefore probably safest to punt this to whatever poison control center or toxicologist you speak with. Nachi: I feel like we are plugging the poison center a lot, but it’s such a good free, and usually very nice consult to have on your team. Jeff: Nice consultant – what a win! Moving on to the cutting edge. There is a new Crotalidae antivenom called Crotalidae Immune F(ab’)2 or, more simply, Anavip. It should be available in the next few months. The dosing will be 10 vials up front over 60 minutes followed by an additional 10 vials if the symptoms having been controlled. 4 more vials may be given for symptom recurrence. Patients must be observed for a minimum of 18 hours after initial control of symptoms. Nachi: This would be a really nice development as Anavip has a longer half life and therefore should reduce the rates of late coagulopathy and decrease the need for maintenance dosing, follow up, and repeating coags. Jeff: And finally, like we mentioned before, injection of the trypsin has been tried as a bridge to antivenom, as has carbon monoxide, which may mediate degradation of fibrinogen dependent coagulation. Nachi: Alright, so let’s talk about the disposition next. Victims of pit viper envenomations should be monitored for 8-12 hours from the time of the bite. They will need baseline labs and repeat testing ever 4-6 hours. IF there is no progression of the symptoms and repeat testing is normal, the patient can be discharged. Jeff: Victims of coral snake bites should be admitted and observed for 12-24 hours regardless of symptoms. Nachi: Victims of rattle snake envenomations who initially develop hematologic abnormalities and are treated with FabAV should have repeat testing done in 2-4 days and 5-7 days. Jeff: Wounds should also be closely followed to avoid complications and long term disfigurement and disability. PT/OT may be necessary as well. Nachi: Perfect, let’s round this episodes out with a review of the key points and clinical pearls from this month’s issue. There are about 10,000 ED visits in the US for snake bites each year, and 1/3 of these involve venomous species. Pit vipers produce a predominantly hemotoxic venom. Both local and systemic effects can occur. Systemic effects include tachycardia, tachypnea, hypotension, nausea, vomiting, weakness, and diaphoresis. In general, venomous snakes have a triangular or spade-like head, elliptical pupils, and hollow retractable fangs. In contrast, non-venomous snakes have a rounded head, round pupils, lack fangs, and can have a double row of vertical scales on the tail. Venomous North American coral snakes often have adjacent red and yellow bands, whereas their nonvenomous counterparts usually have a characteristic black band between the red and yellow bands. For prehospital care in the US, the following strategies are not recommended: incision or excision, use of venom extraction devices, tourniquets, chill methods, and electroshock therapy -- and they can all actually worsen outcomes. Prehospital providers should focus on rapid transport. Be cognizant of compartment syndrome, but measure compartments when possible, as some envenomations present similarly but have only subcutaneous hypertension. Neurologic effects can be delayed up to 12 hours after coral snake envenomations. Symptoms can include a descending paralysis. For diagnostic testing, consider a CBC, coags, fibrinogen level, electrolytes, cpk, creatine, glucose, and urine studies. All patients with envenomation should be observed for at least 8 hours. Mark the site of envenomation circumferentially to monitor for changes. Management of patients with snake bites should be treated with supportive care, pain control, and specific antivenom when indicated. FabAV or CroFab is the antivenom of choice for pit viper envenomations. Although FabAV will reduce the duration and severity of symptoms and lab abnormalities, it will not reverse tissue necrosis and may not reverse neurologic effects. Be aware of the possibility for a hypersensitivity reaction or serum sickness to FabAV. Treat with steroids, antihistamine, IV fluids, and epinephrine as appropriate. Coral snake envenomations can be treated with NACSA, which halts or at least limits the progression of muscle paralysis and shortens the clinical course. Side effects to NACSA include dermal reaction as the most common -- and anaphylaxis as the most severe. Patients with bites from exotic snakes should be monitored, likely in the ICU, for up to 24 hours as toxicity from some venom may have a delayed onset of up to 20 hours. You may have to turn to your local zoo for help with anti-venoms here. Management of pregnant patients is the same as nonpregnant patients with regards to snake envenomations. Dosing of antivenom is based on the amount of venom. Dosing is the same regardless of the age of the patient. All patients requiring antivenom or with suspected envenomation should be admitted. Seek consultation with your regional poison center and local toxicologist Jeff: So that wraps up the September 2018 episode of Emplify. Nachi: As always - the address for this month’s credit is ebmedicine.net/E0918, so head over there right away to get your credit. Remember that the you heard throughout the episode corresponds to the answers to the CME questions. Jeff: And don’t forget to grab your free issue of Synthetic Drug Intoxication in Children at ebmedicine.net/drugs specifically for emplify listeners. Feel free to share the link with your colleagues or through social media too. Next month we are talking sepsis and the ever frequently changing guidelines so it’s not something you want to miss. Talk to you soon Most Important References 4. *Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2-227X-11-2. (Consensus panel) 6. *Bush SP, Ruha AM, Seifert SA, et al. Comparison of F(ab’)2 versus Fab antivenom for pit viper envenomation: a prospective, blinded, multicenter, randomized clinical trial. Clin Toxicol (Phila). 2015;53(1):37-45. (Randomized controlled trial; 121 patients) 7. *Gerardo CJ, Vissoci JR, Brown MW, et al. Coagulation parameters in copperhead compared to other Crotalinae envenomation: secondary analysis of the F(ab’)2 versus Fab antivenom trial. Clin Toxicol (Phila). 2017;55(2):109-114. (Randomized controlled trial; 121 patients) 8. *American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, European Association of Poison Control Centres and Clinical Toxicologists, International Society on Toxinology, Asia Pacific Association of Medical Toxicology. Pressure immobilization after North American Crotalinae snake envenomation. Clin Toxicol (Phila). 2011;49(10):881-882. (Position statement) 10. *Wood A, Schauben J, Thundiyil J, et al. Review of eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010. Clin Toxicol (Phila). 2013;51(8):783-788. (Retrospective; 387 patients) 48. *Cumpston KL. Is there a role for fasciotomy in Crotalinae envenomations in North America? Clin Toxicol (Phila). 2011;49(5):351-365. (Review) 75. *Walker JP, Morrison RL. Current management of copperhead snakebite. J Am Coll Surg. 2011;212(4):470-474. (Retrospective; 142 patients) 81. *Kitchens C, Eskin T. Fatality in a case of envenomation by Crotalus adamanteus initially successfully treated with polyvalent ovine antivenom followed by recurrence of defibrinogenation syndrome. J Med Toxicol. 2008;4(3):180-183. (Case report) 118. *Hwang CW, Flach FE. Recurrent coagulopathy after rattlesnake bite requiring continuous intravenous dosing of antivenom. Case Rep Emerg Med. 2015;2015:719302. (Case report)
Show Notes Disclaimer: This is the unedited transcript of the podcast. Please excuse any typos. Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Nachi: This month’s topic is one that Jeff has significant personal experience with from his college days. We’re reviewing Cannabinoids -- and emerging evidence in their use and abuse. Jeff: Um… that is definitely not true. I was actually a varsity rower in college... Are we still reviewing talking points together before we start recording these episodes? Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. Nachi: We’re going to be talking about the pathophysiology of cannabinoids, clinical findings in abuse, best practice management, differences between natural and synthetic cannabinoids, and treatment for cannabinoid hyperemesis syndrome. So buckle up and get ready. Jeff: As you’re listening through this episode, remember that the means that we are about to answer one of the CME questions from the end of the print issue. If you’re not driving while listening, be sure to jot down these answers and get your CME credit when we’re going through this issue.. Nachi: As of June 2018, there are 31 states, the District of Columbia, and 2 US territories that possess state and local-level laws allowing the use of cannabis medicinally or in recreational formulations. Marijuana actually maintains the highest lifetime use of an illicit drug used within the US. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9 million. Clearly, an important topic worth discussion, especially as synthetic products have become more widely available. Nachi: And worth noting -- Colorado, where medicinal and recreational marijuana use has been decriminalized and later legalized, has shown a nearly 2-fold increase in the prevalence of ED visits, which may be related to marijuana exposure. Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders. In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Nachi: All of that being said though, there is an absence of high-quality reviews and evidence to support the use of cannabinoids for any of the indications you just mentioned. And the US DEA maintains cannabis as a Schedule I substance. Jeff: This DEA designation limits the ability to do research and obtain federal funding for such research. General lack of federal regulations on chemical content also leads to product variation, which may be a cause of increased incidences of accidental overdoses. Nachi: To attain the most up to date information for this article, Dr. Williams searched the PubMed and Cochrane Databases from 1950 to 2018. This produced predominantly case reports and retrospective studies. There were just a few randomized prospective studies -- not surprising. Jeff: Let’s get started with the pathophysiology. There are 3 cannabis species to be aware of: Cannabis sativa, cannabis indica, and cannabis ruderalis. Within these species, over 545 active cannabis-derived components have been described. Nachi: There are ten main constituents of cannabis sativa. Of these, 9-tetrahydrocannabinol (delta-9-THC) and cannabidiol (CBD) are found in the greatest quantities. The neuropsychiatric and addictive properties of cannabis are due primarily to the delta-9-THC. Jeff: THC and other cannabis derivatives work through the endocannabinoid system and other neuroregulators. The endogenous cannabinoid system has 4 components: (1) endogenous endocannabinoids, (2) receptors, (3) degradation enzymes, and (4) transport mechanisms. Nachi: There are two endogenous endocannabinoids to know about: anandamide (AEA) and 2-arachidonoyl-glycerol. Jeff: Cannabinoid receptors are broadly dispersed through the central nervous system, and to a lesser degree, also to other organ systems. Nachi: Because CB receptors are concentrated within the central nervous system, they exert the majority of their effects on the neuropsychiatric systems. And -- yes that’s a double ding -- the cannabinoid 1 (or CB1) receptor is most responsible for cannabis-induced neuropsychiatric effects. Jeff: Interestingly, the anti-emetic effects and possible palliative properties of cannabis derivatives are thought to be secondary to the inhibitory effects on serotonin receptors and the excitatory effects on the transient receptor potential vanilloid 1 (or TRPV1). More on TRPV1 later... Nachi: So far we have been talking about cannabinoids from the cannabis plant, but with cannabis being illegal in many states, there has been a growing emergence of synthetic cannabinoids. Synthetics were initially developed in the 1980s largely for research purposes. Jeff: Because the current DEA controlled substances schedule designations are based on original chemical names, synthetics have gained popularity as manufacturers are able to produce newer compounds and circumvent DEA designation as well as routine urine drug screening tests. Nachi: You may be familiar with some of the street names for synthetics -- like spice, K2, scooby snacks, black mamba, kush, and kronic. These can often be purchased over the internet or through specialty smoke shops. Jeff: Scooby Snacks, what a fantastic name, mooovingggg on… Synthetic cannabinoids often have greater affinity for the CB1 receptor than naturally occurring cannabinoids -- and synthetics can produce 100 times the effect. As a result, the presenting symptoms with synthetic intoxication can be difficult to differentiate from crystal meth or bath salt abuse. Nachi: Manufacturers sometimes use solvents and other contaminants. Clusters of toxic ingestions and deaths have occurred. Emergency clinicians need to be aware of this and should report suspicious events immediately. Jeff: For more on synthetic intoxications in the ED, be sure to take a look at the recent May 2018 issue of Pediatric Emergency Medicine Practice on Synthetic Drug Intoxication in Children if you haven’t already read it. Also, just a quick FYI - If you’re not a current subscriber to Pediatric Emergency Medicine Practice, we’re giving away a free copy of the issue specifically for our listeners. Just head over to ebmedicine.net/drugs for the PDF of the issue. Nachi: A free issue for our listeners, that’s nice! Let’s move on to a discussion about current indications for cannabinoids. So, there is no clear consensus on these indications, but there is some research of varying quality that supports the treatment of some chronically debilitating diseases with cannabinoids. Jeff: A systematic review and meta-analysis from 2015 found low-quality evidence to support cannabis therapy for appetite suppression in HIV and aids patients; moderate-quality evidence for treatment of chronic pain and spasticity; and also moderate quality evidence for some chronic debilitating diseases. Nachi: While talking about evidence-based medicine here, another review by the National Academies of Science, Engineering, and Medicine on possible associations between cannabis and cancers arising in the lungs, head, and neck, or testicles -- showed no statistically significant associations exist. Jeff: So in case that wasn’t clear - the overall evidence to support cannabis therapy, in general, is weak. Also, be aware that there are various formulations of cannabis that allow for different routes of administration. We’re talking oils, tinctures, teas, extracts, edibles like candies and baked goods, parenteral formulations, eye solutions, intranasal, sublingual, transmucosal, tablets, sprays, skin patches, topical creams, rectal suppositories, and capsules -- just to name, a few. Nachi: A few! That seems pretty complete to me. Basically, any way you can imagine, it seems like a route of administration has been explored. But of importance, these formulations have different absorption times -- as you might expect. The shortest duration to peak plasma levels of delta-9-THC is through the inhalation route, which can produce effects within 3 minutes. On the longer end, rectal cannabis administration can take up to 8 hours to reach peak plasma concentrations. Jeff: Let’s talk about some of the clinical findings and systemic effects associated with cannabis use. First up is the link between cannabis use and stroke or TIA. Cannabis users who smoked at least once weekly had a 3.3 times higher risk of stroke or TIA. Nachi: And there is moderate quality evidence that this link may be dose-dependent. Larger amounts of cannabis use lead to cerebral vasospasm and a reduction in cerebral blood flow. Jeff: In terms of psychiatric effects, several low-to-moderate quality studies have shown statistically significant associations between psychosis and self-reported cannabis use. Some association between high potency cannabis or synthetic cannabinoid use with new-onset psychosis or relapse in previous psychiatric disorders has also been found. Lastly, there is weak data supporting a correlation between cannabis use and depression. Nachi: From a cardiovascular standpoint, cannabis use is associated with increased resting heart rate, hypertension, and decreases in the anginal threshold for patients with chronic stable angina. A 2001 study described an augmented risk of myocardial infarction within the first hour of cannabis use and found an almost 5-fold increase in those who reported smoking cannabis at least weekly when compared to those who smoked monthly or less. Jeff: Dysrhythmias, qt prolongation, av blocks, myocarditis, and sudden death have all been reported with cannabinoids. Nachi: In terms of pulmonary effects, these are not really related to cannabis use directly, but rather the smoke inhalation and combustion materials of synthetic cannabinoids. Effects from chronic use can be seen. Jeff: Renally speaking, acute kidney injury and rhabdomyolysis are associated with synthetic cannabinoids and have been observed in several case reports. The rhabdo is believed to be due, in part, to associated seizures, muscle tremors, and agitation. Nachi: Among metabolic abnormalities, patients can present with hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. Jeff: Orally and dentally, dry mouth is the most common finding in acute cannabis toxicity. Chronic use has also been linked to severe periodontitis. Nachi: And ophthalmologically, there is, of course, the commonly seen conjunctival injection. Cannabis has also been found to decrease intraocular pressure when used topically -- and of note, there have also been rare reports of acute angle closure glaucoma and central retinal vein occlusion. Jeff: While talking about clinical findings and systemic effects of cannabis use, we certainly need to go over cannabinoid hyperemesis syndrome (or CHS), which is -- quite simply put -- associated with frequent visits to the ED in chronic users. It presents with nausea, vomiting, and abdominal pain. Nachi: CHS is commonly misdiagnosed as cyclical vomiting syndrome. After the legalization of marijuana in Colorado, it was reported that nearly twice as many patients had presented for what was thought to be cyclical vomiting syndrome. And ironically, though cannabis has been used as an anti-emetic, chronic use can cause the opposite reaction, leading to CHS, which is typically refractory to traditional anti-emetics. Jeff: And the etiology of CHS is not well understood. Similarly, the exact criteria for CHS are poorly defined. It presents as a recurrent and relapsing disorder that can be divided into 3 phases: prodromal, hyperemetic, and recovery. Nachi: In the prodromal phase, patients complain of early morning nausea without vomiting, and they can have mild abdominal discomfort. This can last from months to years. In the hyperemetic phase, patients complain of severe, unremitting abdominal pain with repeated episodes of vomiting and retching. This is often associated with an inability to tolerate po. Jeff: The hyperemetic phase lasts 24-48 hours and can lead to dehydration, electrolyte abnormalities, and weight loss. Patients may learn to relieve symptoms by compulsively bathing in hot water. Nachi: Resolution of symptoms is seen when the patient stops using cannabis. This is during the recovery phase, which can last from days to months. But this can be short-lived if the patients begin using cannabis again. Jeff: On that note, we should also touch on cannabis withdrawal. Termination of heavy and habitual use can lead to withdrawal syndromes within 48 hours. Symptoms here include irritability, anxiety, restlessness, sleep difficulty, seizures, and aggression. Medications that can be helpful include benzodiazepines, neuroleptic agents, and quetiapine in refractory cases. Nachi: Moving on to the next sections in the article, let’s talk about differential diagnosis and prehospital care. The differential for acute cannabinoid intoxication, as you might suspect, is broad, and it includes some life-threatening processes. We won’t list them here, but be sure to think broadly before deciding on cannabis as the cause of your patient’s symptoms. Jeff: For the prehospital providers -- care here is mainly supportive. Provide airway protection as needed - gather information from the patient’s environment, looking for empty pill bottles or another empty packaging. Nachi: Let’s move on to care once in the ED. All patients who are in distress and suspected of drug ingestion should be disrobed completely and placed on a cardiac monitor. Fully assess for trauma and place an IV in the patient. Search the patient’s clothing for drugs and paraphernalia, which may help in making the diagnosis. Jeff: When getting a complete history from the patient, it may also be worthwhile to talk with any persons accompanying the patient to the ER for more information. In your history, be sure to ask about a pattern of use and possible co-ingestions. Nachi: When considering cannabis hyperemesis syndrome, a detailed history and physical exam are crucial for making the diagnosis. To differentiate between other etiologies of abdominal pain and vomiting, be sure to ask about the use of hot baths for relief, resolution of symptoms after stopping cannabis use, and the predominance of symptoms in the morning hours. Jeff: On physical exam, for cannabis intoxication, there isn’t a particular toxidrome to look for. Monitor vital signs closely, looking out for alterations in blood pressure and heart rate. A complete neurologic and mental status examination will be the key here. Nachi: Decisions for lab testing should be dependent on the patient’s presentation. Possible tests include CBC, BMP, LFT’s, lipase, cpk, ckmb, troponin, urinalysis, urine drug screening, serum tox screens (for alcohol, aspirin, and acetaminophen), and any other drug levels for medications that the patient is taking for medicinal purposes, like phenytoin or lithium levels. Jeff: One study supported point of care urine drug testing in the ED. However, know that acute cannabis intoxication can be difficult in the chronic user, as delta-9-THC will be present in urine for up to 24 days. Testing for synthetically derived cannabinoids is difficult due to changes in synthetic compounds. Nachi: Interestingly, there are a number of medications that are associated with false positive cannabinoid screenings. These include ibuprofen, pantoprazole, efavirenz, and lamotrigine. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG. You’re looking for signs of ischemia, arrhythmia, and interval abnormalities. Serum and urine tox tests are not particularly helpful in the acute chest pain patient who is using synthetic marijuana. Nachi: Not surprisingly, there are no specific diagnostic imaging modalities to help diagnose cannabis or synthetic cannabinoid intoxication. But imaging may help with assessing other disease states on a patient’s differential, so stay mindful of that. Jeff: Now that we’ve talked about history, physical exam, and useful testing modalities, let’s talk about treatment for cannabis and synthetic cannabinoid toxicity… therapy is primarily focused on supportive care. Most ED visits only require a short stay. Nachi: That’s right, there are no antidotes to give for treatment here. Be sure to look for and treat dehydration, acute renal failure, and rhabdo though. In severe cases of neuropsychotropic effect, give benzodiazepines, like lorazepam, to help with control. Jeff: For GI effects, first-line treatment is traditional anti-emetics like ondansetron or metoclopramide. Recent literature and case reports have shown significant improvement with butyrophenones like haloperidol as a second-line treatment. Nachi: While talking about treating the gastrointestinal effects of cannabis toxicity, let’s also discuss methods to control cannabinoid hyperemesis syndrome. The mainstays for treatment here are actually supportive therapy and cessation of cannabis use. Jeff: And can you tell us more about why these patients crave hot showers and improve after? Is there a pathophysiology or mechanism to know about there? Nachi: There is a well-studied theory here and it relates to the TRPV1 receptor that we talked about earlier. Temperatures in excess of 109 degrees Fahrenheit, acidic conditions, and compounds found in certain foods and plants (like cannabis) activate this receptor. It’s believed that intermittent and repetitive exposure to agonists of the TRPV1 receptor leads to a persistent state of nausea and vomiting. Desensitization of the receptor happens after repeated stimulation, and repetitive topical capsaicin or hot water is believed to function as an exogenous agonist. Jeff: In any case of repetitive emesis, be sure to consider electrolyte replacement if needed. In many cases, hydration or repletion will need to happen through an IV. Proton pump inhibitors can also help in some cases where GI symptoms are a dominating complaint of the patient. Nachi: Recent literature supporting the use of haloperidol for nausea and vomiting has found that symptoms improve approx 1hr after administration. This can decrease the need for observation or admission. Jeff: Haloperidol works via dopamine 2 receptor antagonism. D2 receptors are found in high concentrations throughout the nervous system and bind with high affinity to haloperidol. The suggested starting dose is 2.5mg IV with a repeat dose of 5mg IV if needed. An RCT is underway in Canada on the use of ondansetron versus haloperidol with an estimated completion of July 2019. Nachi: Capsaicin has similarly shown promise in cannabis hyperemesis syndrome through the TRPV1 receptor as we discussed already. Currently, there are no dosing recommendations or application instructions for capsaicin. There is some evidence supporting relief within 30 to 45 minutes, and capsaicin can be applied topically to any nonmucosal surface like the abdomen, chest, or back. Jeff: So to recap -for cannabis hyperemesis syndrome, treat with anti-emetics, PPI’s, electrolyte repletion, and IV hydration as needed. As a second line treatment, consider haloperidol and topical capsaicin applied to the chest, abdomen, or back. Nachi: Let’s talk about some special populations next -- starting with Pediatrics. According to data from 2012, of the 130 million people reporting illicit drug use within their lifetime, 25% were children between 12 and 17 years of age. Jeff: And according to the national poison data system, states with marijuana use laws have seen a 30% increase in calls related to marijuana use by children. From 2010 to 2011, the number of ED visits by children aged 12 to 17 years old due to synthetic cannabinoid use also has doubled. Nachi: Many children and adults believe that synthetic cannabinoids don’t pose serious health risks, as these are not illegal to purchase. And this class of drugs is particularly attractive to adolescents since it will not readily test positive on urine drug tests. All of this is very concerning for emergency clinicians. Jeff: There have been several recent reports of myocarditis in association with marijuana use. One case resulted in death due to myocyte necrosis after an unknown amount of edible marijuana was consumed by a toddler. Nachi: Horrific! Jeff: And the exact mechanism through which the myocardial necrosis happens isn’t known. Nachi: For all children and adolescents who present to the ED with alteration in mental status, psychosis, or chest pain -- be sure to screen for cannabis or synthetic cannabinoid use. There are case reports in the pediatric literature of STEMIs seen in patients without pre-existing cardiac disease or risk factors. Jeff: Keep in mind that urine drug screens can be falsely positive from certain proton pump inhibitors, so if possible, assess a urine drug screen prior to starting a PPI in these patients. Nachi: Moving on to our next special population… pregnant women. Know that it can be difficult to the differential between hyperemesis gravidarum and cannabis hyperemesis syndrome in pregnant patients. Ask specific questions regarding marijuana use before and during the pregnancy. Jeff: It’s also worth noting that cannabis is known to cause adverse outcomes on babies such as low birth weight and more frequent perinatal ICU placement. Nachi: Let’s move on to the final major section of the article, which is on the legal status of cannabis and cannabinoids. Much of the controversy surrounding cannabis for medicinal use relates to the absence of quality evidence. More research is needed to evaluate potential public health risks posed by variations in quality and potency, potential impact to our healthcare system, and ability to legislate for synthetic cannabinoids. Jeff: Though marijuana and all whole-plant derivatives are schedules I controlled substances, there are a few cannabinoid-based drugs approved by the FDA for medicinal purposes -- with lower schedule designations. Dronabinol is a schedule III drug derived synthetically from delta-9-THC. It’s used in chemotherapy-induced nausea/vomiting, as well as anorexia and weight loss from AIDS/cancer. Nachi: Nabilone, a schedule II synthetic variant of THC, has been approved in the treatment of aids-related anorexia and chemotherapy-induced nausea also. Jeff: Nabiximols, a plant-derived cannabinoid, has been approved in Europe and Canada for multiple sclerosis induced spasticity and cancer-related pain. Nabiximols are not yet approved in the US. Nachi: And lastly, we should mention cannabidiol, which is a schedule I controlled substance approved for treatment of seizures with 2 rare diseases -- Lennox-gastaut syndrome and dravet syndrome. Compared with placebo alone cannabidiol and other medications have shown efficacy in lowering the rate of seizures for these diseases. Jeff: Lots of interesting stuff to look out for there in cannabinoid-related medications. Alright, on to disposition - Nachi: Most patients who present with uncomplicated acute cannabis or synthetic cannabinoid intoxication can be observed until clinically sober. Discharge home should be in the care of a sober family member or friend. Make sure that the patient knows not to operate vehicles or heavy machinery under the influence of drugs. Counsel them on drug abuse also. Jeff: In more rare situations, patients will require admission. Consider this particularly for patients who have end-organ damage, rhabdomyolysis, acute renal failure -- evidence of cardiovascular, cerebrovascular, or ophthalmologic insults -- intractable vomiting, or acute psychosis. Nachi: And for cannabinoid hyperemesis syndrome, patients may require admission for IV hydration and electrolyte correction. Once the patient is tolerating PO and lab derangements have been corrected, they can be discharged. Jeff: Let’s wrap up the episode with key points and clinical pearls… N: Marijuana is the most commonly used illicit substance in the US. States that have legalized marijuana for medical and recreational purposes are showing increased rates of marijuana abuse and dependence. J: When concerned with drug intoxication, search your patient’s clothing for drugs and paraphernalia on arrival. N: The neuropsychiatric and addictive properties of cannabis are due primarily to delta-9-THC. J: Synthetic cannabinoids have gained popularity as manufacturers are able to produce newer compounds and circumvent DEA designations as well as routine urine drug screening tests. N: Manufacturers of synthetic cannabinoids sometimes use solvents and other contaminants, which have caused clusters of toxic ingestions and death. J: The shortest duration to peak plasma levels of delta-9-THC is through the inhalational route. Effects can be seen within 3 minutes. N: Cannabis users who smoke at least once weekly can have a 3.3 times higher risk of stroke or TIA. J: The risk of myocardial infarction is increased within the first hour of use, and there is an almost 5-fold increase for individuals who smoke at least once per week. N: Acute kidney injury and rhabdomyolysis have been noted with synthetic cannabinoid use in several case reports. J: Cannabis intoxication is associated with many metabolic abnormalities like hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. N: Cannabis hyperemesis syndrome, which presents with abdominal pain and vomiting, is associated with frequent visits to the ED in chronic users. J: The mainstay for treatment of cannabis hyperemesis syndrome is supportive therapies and cessation of cannabis use. N: Patients with cannabis hyperemesis syndrome crave hot showers because of activation of the TRPV1 receptor. J: Topical capsaicin may also help in the treatment of cannabis hyperemesis syndrome through activation of the TRPV1 receptors. N: Haloperidol at 2.5mg IV may help in refractory vomiting associated with cannabis hyperemesis syndrome. J: Many children and adults do not believe synthetic cannabinoids pose serious health issues as the they are not illegal to purchase. This is incorrect. N: Most patients with acute uncomplicated cannabis intoxication can be observed and discharged. Admit if there are any signs of end organ damage, intractable vomiting, or acute psychosis. Jeff: So that wraps up the August 2018 episode of Emplify. Nachi: For those of you looking for CME - the address for this months credit is ebmedicine.net/E0818, so head over there right away to get the credit you deserve. Remember that the you heard throughout the episode corresponds to the answers to the CME questions. Jeff: And don’t forget to grab your free issue of Synthetic Drug Intoxication in Children at ebmedicine.net/drugs specifically for emplify listeners. Feel free to share the link with your colleagues or through social media too. See you next time! Most Important References 5. * Kim HS, Monte AA. Colorado cannabis legalization and its effect on emergency care. Ann Emerg Med. 2016;68(1):71-75. (Literature review; 21 studies)7. * Baron EP. Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: What a long strange trip it’s been …. Headache. 2015;55(6):885-916. (Review)9. * Whiting PF, Wolff RF, Deshpande S, et al. Cannabinoids for medical use: a systematic review and meta-analysis. JAMA. 2015;313(24):2456-2473. (Retrospective chart review; 4 cases)64. * Tournebize J, Gibaja V, Kahn JP. Acute effects of synthetic cannabinoids: update 2015. Subst Abus. 2016:1-23. (Systematic review; 46 articles, 114 patients)83. * Wallace EA, Andrews SE, Garmany CL, et al. Cannabinoid hyperemesis syndrome: literature review and proposed diagnosis and treatment algorithm. South Med J. 2011;104(9):659-664. (Review)
Mighty Mike: What's up, Server Nation? This is Mighty Mike, the Podcast Server, and you are listening to www.ProcessServerDaily.com Mighty Mike: You guys, I'm super excited about today's episode. If you have a story that you want to tell, that you're excited about. Maybe a dog chased you, maybe a guy tried to shoot you with his gun, maybe you had a heart-warming story where you helped somebody in need. Guys, I want to hear the story on this show. Go to www.ProcessServerDaily.Com/BeAGuest.html Find some studio time, go to www.ProcessServerDaily.Com/BeAGuest.html Mighty Mike: I look forward to speaking to you and hearing your story! Let's get to the show. Mighty Mike: What's up, Server Nation? You are listening to Process Server Daily, and I am your host, Mighty Mike the Podcast Server. Our guest today has recently appeared on Vice TV where he has been on the hunt for the most notorious Neo-Nazi of our time. He has been in business for 25 years and he owns and operates Encore Delivery Systems located in Columbus, Ohio. Mighty Mike: Jeff Cremeans, welcome to the show. Jeff C.: Pleasure to be here, Mike. Mighty Mike: Awesome, Jeff. I want to hear from you, Jeff! Tell us a little bit about yourself that wasn't in the intro. Take it away. Jeff C.: Sure. My name is Jeff Cremeans. I've been a process server for about 25 years. I started off, giving my age here, back in 1989 working for a law firm in Columbus, Ohio. Started off as a messenger working in the mail room. Did filings at the court house. Started to do the subpoenas, that type of thing. I'll make a long story short. I had an attorney, of the many duties I did in the mail room, wanted me to go get him a hotdog. So I went and got him a hotdog, I brought it back and he yelled at me, he said, "Why wasn't there mustard on it?" I thought, "You know, I'm gonna start my own business and I'm gonna charge this guy 25 bucks to go get his hotdog." Jeff C.: So I started a company out of law firm called City Wide Legal Messenger Service. Took off really well in Columbus, Ohio. There's a need for that type of thing here. I owned that for a few years. I sold that company to another company. I worked there for 11 years and then I've owned Encore since then. So I've had Encore for about 14 years. So ... Mighty Mike: That's awesome. Yeah, when I was watching the show, it's really cool, your office looks really cool. It looks like you got a pretty good size operation going on there. Jeff C.: Yeah, doing good. In any given time, we'll have eight or nine servers out, serving anything from child support papers to foreclosures. I don't get out as much and serve, certainly on this big case I'm helping out on, the Andrew Anglin case. But, yeah, I have a great group of servers. Very hard workers and do a great job. So ... Mighty Mike: Jeff, one of the most important things as process servers, for anybody, actually, is family. You got a family? Jeff C.: Sure do. I have a daughter at Ken State. Freshman at Ken State University. I've a son that's a sophomore. Yeah, they're pretty much my world, so ... Yeah. Mighty Mike: That's awesome. Jeff, there's a reason why you're on my show. You have a lot going on right now. Full of great experiences. But first, tell me about your worst experience working in the field. Jeff C.: You know, I think a lot of the process servers cross and that start talking about bad stories. Everybody's got a lot of bad stories. I think the one that really stood out to me was one, believe it or not, where I wasn't out in the field. Long story short, I'm sitting in my office, I had let everybody go early. I'm in the office by myself, just doing paperwork and in walks four people. I won't put their description out, but they were not very nice-looking people. I said, "Can I help you?" They said, "Yeah. One of your servers have been pounding on the door at my grandmother's house. We're here to see what's going on." Course, they were not so nice about it. I thought, "Well," I looked up and I saw these four guys. They meant business and they were there to do some damage or something. I thought, "Well, gosh, here we go." I can hold my own, but not with four guys. They were really upset that the server ... Now, how they go to where we were, they did some diligence on finding who we were and our address and everything. I got to give 'em that. Jeff C.: Anyway, I'll be honest with you, I was scared for my life. I thought if these guys want to start one me, there's not a whole lot I can do, but I explained to them. I calmed 'em down, I said, "Look, I'm sorry. This is not the way we do business and I apologize that your grandmother was scared," and all this stuff. Turns out that the server that went out, he was a newbie. He was trained and everything, but he had it to where he thought he could pound on doors and maybe even intimidate people, scare people to come to the door. Boy, did I have a long talk with after him that. I told him, "Hey, look, you're gonna go out, you're gonna go looking for trouble. You're gonna get it." Jeff C.: Fortunately, the trouble came to the office and it affected me. Nothing ended up happening. I talked to these guys and they end up not hurting me, which is a good thing. So the moral of the story, and for everybody out there, whether you're training a server or you're serving yourself, you don't have to ... there's times you have to get creative and aggressive. We can talk about that later in the podcast, but the big thing is, I explained to the server, "There was an old lady in there. You were scaring her to death. She had her grandkids come here and threaten me and want to know what's going on. Take it easy, man. You don't have to do that. If they don't answer the door, you don't have to pound on it." The lady wasn't even avoiding servers, so he learned a big lesson. He learned from that and turned out to be a great server. Not so aggressive anymore after that. Mighty Mike: I've recounted an experience that I've had too in a previous podcast about knocking on a door and being really gung-ho, and then realizing it was a 14 year old girl in there, terrified! She's told not to answer the door and it really helped correct my perspective that you never know ... I just had one yesterday. They told me she's an elderly lady and I've been there at all different times during the day. So I decided to come at night. Sure enough, her car was there, but she wasn't answering the door. The neighbors said, "Oh, she's in there." But I thought, "Man, I'm just gonna come back again at night and maybe she won't be in the shower or in the back room or wherever. Whatever she's doing to keep her from answering the door, giving her the benefit of the doubt- Jeff C.: Right. Mighty Mike: That she might actually answer the door if I come in a different time. Jeff C.: Yeah. Mighty Mike: Yeah, what I take from your story is prudence. Have a little bit of prudence when you come to the door. It's one of the most valuable asset in any industry. Mighty Mike: Jeff, tell us about your greatest experience working in the field. Jeff C.: Well, as many as there are bad, there are some good experiences out there. I think one that stands out to me is, and this is back in my City Wide Legal Messenger Service days, I was young and I was just new to the industry and learning, and doing stuff. I got a job to serve a wealthy person in a domestic case. Long story short, I had attempted many times. Pulled out all the tricks. I dressed up for Halloween, did the whole pizza delivery thing. Nothing worked. This guy, he was a dodger and he knew the game. He had been served before. Jeff C.: I pulled up one day, I just happened to be around the neighborhood. I thought, "Let me go try this guy again." I got there and he was out back, washing one of his expensive cars with his brother. I pulled up and he looked at me and started to run. Then he stopped and he's like, "You got me." He put out his hand and he shook my hand. He's like, "Congratulations, man. You played a good game." He was serious, very nice. We ended up talking there for a minute, so it was kind of ... never had that happen before, but it was nice to know that old game of hide and seek, he was not a sore loser, you know? So, yeah, that's kind of a good story. Mighty Mike: That's cool when they're like that. Some people just have a habit of dodging and ducking and hiding under couches, and things like that. Every once in a while, you'll get that guy that's probably like you would be when you're retired or something like that, or if someone else was trying to serve you. Ultimately, you're gonna accept the responsibility for your own problems, but you don't mind giving 'em a little run for his money. Jeff C.: Sure. Mighty Mike: That's a great experience. Mighty Mike: Jeff, tell me what you're working on right now that you're most excited about. Jeff C.: Well, in the past few years, we've gotten accounts with the Children's Services and the child support. It's a lot of work. It's lucrative, but dodging has increased with the child support papers as everybody knows, especially at that end of the stuff that we serve. So I've been able to hire more servers, it's broadened our horizons as far as learning more about the industry and finding people, the skip tracing, that type of thing. Jeff C.: Then, of course, there's the case we're trying to serve, the famous neo-Nazi. That has been the most challenging serve in my career in 25 plus years. So the reason why this case is so challenging to serve, this guy, he's a national, if not worldly-known neo-Nazi. He's got his own website, the Daily Stormer, that's been very controversial, but he has so much help hiding out. I've never seen anybody have so much support in hiding out. Anything from his father with all his property he owns, and people putting him up in places, this type of thing. But, yeah, it's been a very challenging serve. Worked very hard and done all the skip tracing. Done everything we possibly can to this point. Right now, we're relying on tips from a lot of different people that have maybe spotted him or know where he's at. We had a pretty good tip, as you saw in the Vice show. That's probably our best tip and missed him there. But, so, yeah. Jeff C.: There's a lot of things going on, a lot of good things. Growing at a steady pace and, again, I think any processor out there will tell you each case is different, each server's different. You don't want to get too emotionally involved, especially when someone's dodging, but there comes a time where, "Ask us for help," you know. One person can't do everything. If you feel like you've exhausted all your efforts in getting the serve, get somebody else on it. Get a fresh face, that type of thing. So ... Mighty Mike: Yeah, that's good, Jeff. I'll tell you, when I was watching the video, and you were going over the footage in the store where you were watching him with his protein powder, I got this feeling, almost like that's happened to me before where I've seen someone I was hunting for three months. He was a pot farmer up in [inaudible 00:09:36] Creek. Anyone knows you go up there, you gotta go up there with the AKs and [inaudible 00:09:40] dogs, and ready to go. Mighty Mike: I saw him in a park. He was apparently getting visitation with his kids, and I didn't have the papers, so I ran back, I drove back to my house. By the time I got there, he wasn't there. I was so mad at myself. How did you feel when that- Jeff C.: First, it was just shock and awe seeing him there. My son and I were just walking through the store and it was one of those things, when I first saw him, I thought, "Oh, man. That guy looks familiar," and I got closer. As I got closer, I thought, "Oh my gosh, that's him." No doubt in my mind whatsoever. In fact, I submitted a declaration to the court for the attorney's request to explain that I saw him. I got up, I was watching him. I was standing there as you could see in the video, watching him. Very nervous. He was kind of looking behind his shoulders and just kind of looked really, really paranoid, that type of thing. I thought, "You know, I don't have the papers. They're not even in my car. They're at home. By the time I get it and do that, it's not gonna happen." Plus, I had my son with me. It was really not a whole lot I could have done, like I couldn't leave him there. Jeff C.: As he was checking out, I proceeded to go through the store, past self check out lines. I looked over and I just thought, "You know, I gotta say something to him. I gotta go talk to him. I just can't" ... So as he was walking out, I pulled up right in front of him with my car. My exact words to him was like, "You know, you look like somebody I know. Is your name Andrew?" "Nope." He was gone. He was not gonna hang around. It was him, it was definitely him. Now- Jeff: He was not going to hang around, and it was him. It was definitely him. Now, people, especially his attorney ... What are the odds? What are the odds of tracking somebody down for almost a year and you see them at a grocery store? I don't know, but it happened and it was ... Needless to say, I have the papers with me every time. I have them in my briefcase, I have them in my car, I have them at work. I have other people that have them. All my servers have a copy of this stuff [inaudible 00:11:24] just in case something like that were to happen again. Don't think I'll ever get that opportunity again, but you never know. Mighty Mike: Yeah, I actually keep a bucket now, because of that experience that I had. I'll tell you one fun experience. I was in the courthouse and I'd been hunting this ... trying to serve this professor of Chico State University. He was retired. And so, I had served him like three times before and then he moved. We go to court every day to file papers at the courthouse. And so, I was in line at the courthouse and I heard this voice, and I was like, "I know that voice." And I listened and I heard it. He's just shooting it with a couple guys, "Yeah, no, I'm a professor down over at Chico State." And I thought, "That's him." And I didn't have the documents, but I was at the courthouse. So I said ... I looked it up on my phone, and I bought a copy of the paperwork at the courthouse. I checked the box individual and said, "Here you go." Jeff: Oh, nice. Very nice. Mighty Mike: I felt like such a ninja when I did that. It was cool. Jeff: Yeah. Mighty Mike: So I mean, if I would have saw him at the store I would have been in trouble. What I wanted to know, and I'm sure other servers are the same, is what's the next step? You can only skip trace them so much, right? Jeff: Yeah. Mighty Mike: You can only- Jeff: Yeah, there's a lot of people looking for this guy for one reason or another. It's not just to serve him papers. As you can imagine, he's made a lot of people upset with his comments and his viewpoints. Hey, you know, I believe in the first amendment. I think everybody can believe in whatever they want to believe in. You believe clowns should make more money when they go to parties? Fine. Just the fact that threaten violence and harass people I don't think bodes well. Jeff: So anyway, with that being said, a lot of people look for him. We're all trying to put feelers out there and we're all going off tips, whether it be the media, reporters, and other process servers. And from here, where do we go? Waiting on a tip. There's been rumor that he claims he's in Cambodia, then he was in Nigeria, then he was in Russia. Personally, my opinion, I think he's right here, whether it be in town or the state of Ohio, at least in the United States. He's not overseas. So it's going to be off a tip. It's going to get lucky. Somebody's going to see him, he's going to show his self somewhere. That's pretty much all we can do right now, just sit back and wait. Mighty Mike: Yeah, you just have got to post somebody up over by the protein powder. That's what you have got to do. Jeff: Yeah. Yeah. Mighty Mike: Okay. So I hope you get him and when you do get him, maybe we'll have you back on the show or even we'll do a Facebook Live so that'll just be [inaudible 00:13:49]. Jeff: I look forward to the day, believe me. Mighty Mike: Now dreams of the day. Jeff: Yeah. Mighty Mike: Server Nation, Jeff has been dropping some major value bombs on us today, but prepare yourself, because we are headed into the rapid fire round right after a word from our sponsors. Mighty Mike: Server Nation, I know you're with the times and you want to do whatever you can to have all of the resources for your client. That is why I created 123efile.com. As a process server, attorney, or even an improper you can visit the website and file your documents in any of the Tyler courts in California. With it's easy to use one-page operation, you can have your e-filing done in a matter of minutes and get back to what really matters. If your time is important to you, visit 123efile.com. Mighty Mike: Welcome back to the show. Jeff, are you ready for the rapid fire round? Jeff: I think I am. Mighty Mike: If you could recommend one app, what would it be and why? Jeff: I think Road Warrior's a good app. I'm not a humongous app fan. I kind of do a lot of things old school. I think if you're diligent enough and you really want it bad, you can find the right app and it'll get you where you need to be. Mighty Mike: Very good. Road Warrior is ... I swear by the Road Warrior. Jeff: Yeah. Mighty Mike: I mean, if another one came out I would try it, but I haven't found any other app like that. Jeff: Yeah, it's a good app. Mighty Mike: And if you have it set to go straight into the Waze app, it works really good in the city. You can pick different navigators, but yeah, Road Warrior's a great one. What case tracking software would you recommend as the best? I would take you as a Process Server Toolbox guy. Jeff: Yeah, yeah, Process Server's Toolbox or like Serve Manager. Again, I don't even ... To be honest with you, I don't use them. Again, I'm- Mighty Mike: Really? Jeff: Yeah, I'm a firm believer in the old fashioned way of doing things, and my customers seem to like it. I've tried to offer them the different softwares and the Process Server's Tool and everything, and my customers like, you know, "Just use the court's return. We don't want this. We don't want that." And I've just kind of been doing that for years, and it works for me so far. Mighty Mike: No, I'm intrigued, Jeff, because, let me tell you something, there's a beauty in simplicity. So I'm just curious, we don't have to go too far into it, but you have like a service request form? Jeff: Yes. Mighty Mike: And they fill that out. And is your return or your field sheet, if you were, is that a part of the same form? Jeff: No, that's a different form in fact. And that's the thing, we kind of create our own affidavits and our own returns of service if they want. For anybody that has just your federal district return of service, we'll start off with that. If somebody wants something different, we've created so many different types of affidavits and non-serve affidavits and returns of service. We've had people say, "Yep, we don't want this notarized. You don't have to notarize it," so we'll just make it a simple proof of service. Mighty Mike: Yeah. Jeff: Of course, as you know, in California they have their own and New York wants certain things. A lot of the different states and people want different things. Mighty Mike: Definitely. Jeff: So we kind of have a variety of affidavits and stuff we use. Mighty Mike: That's cool. Yeah, that's cheaper. Jeff: Yeah, it is. It is. Mighty Mike: I tell you, there's beauty in simplicity. When I first started out, I had a form and I thought I was a genius because I had my service request area on top where I gave the customer's info and special instructions, and then at the bottom it had four spots for first attempt, second attempt, third attempt. And I only did four attempts because most of my customers were for unlawful detainers. In our local area, you had to get three attempts for diligence before you could post or subserve. So yeah, there's beauty in simplicity. I appreciate that. Mighty Mike: What is your favorite skip trace tactic? Jeff: I think what's worked for us over the years are the neighbors. Knocking on the doors next to it. I tell you, there's ... We have had more nosy neighbors help us get people served than anything. It's a simple skip tracing tool. There's a lot of ways of skip tracing, but, boy, just I don't know how many times ... And I'm sure a lot of servers have experienced this. The neighbor's out washing the car, you go over, "Hey, is so-and-so here?" "Oh, you know what? No, they're down the street at this park at the baseball game." "Oh, really? Which park is that?" "You know, blah, blah, blah park." You go down there. Now, if somebody's been dodging for a few weeks and you really want to get them served, I don't mind going to a park at a ballgame and getting them served. It may be the only opportunity to get them. So yeah, I think neighbors are very informative, and can be very helpful for getting somebody. Mighty Mike: Yeah, and actually, you can skip trace a specific address, not a person, and it'll give you the people that live in that general area. Or you can go on Google and find out what the nextdoor neighbor's address is and skip trace them and get the phone number. And then call them up, say, "Hi, is this ..." So if you're looking for Jill, you call up the neighbor and say, "Hi, is this Jill?" And then she's going to go, "Oh no, Jill lives nextdoor." "Okay. Oh, sorry about that." You know? Jeff: Right. Yeah, yeah, yeah, yeah, yeah. Mighty Mike: That's a good one that works a lot. Jeff: Yeah. Mighty Mike: Jeff, what is your favorite tool for defense? Jeff: I think there's weapons and there's this and there's that. I firmly believe in being human with people, talking to them. One thing that taught me about that bad experience, I think if you're there and you're calm and you hear them, and you're honest with them, say, "Hey, look, I got these papers," well I think that's worked more than anything. To be, for lack of a better word, aggressive or cocky or pushy and doing too much, I don't think that's going to help you out. I think really trying to talk to people. And there's a lot of different ways of doing that. Jeff: My biggest thing is somebody that's wanting to avoid service, I try to tell them, "Hey, look, I'm going to come back. I'm going to keep coming back. I'm not going to go away and this is not going to go away." I'm not a lawyer, I can't give them legal advice, but I try to tell them, "Hey, look, you're best off taking this now." So things like that and that nature, that to be me has been the best tool. Call it a tool. Call it whatever you want. I think it's a really good tool to use. Mighty Mike: Yeah, I did a poll on Facebook and, "What was the best tool for defense?" And people came back ... And actually, I gave some options and I gave like a gun, and a knife, and all these things. And then, I gave a few options. It was like common sense ... Jeff: Yes. Mighty Mike: Those things that are inside of you, like in your brain and in your habits, and the way that you treat people, the way that you talk to people, those are the things that had the most hits. I think one of them had like 64. Common sense had like 64, and the next one had 30. And the actual gun I think only had like 16. We all like to talk about the guns that we own, but the truth is, when you're out there serving, using your gift of gab or your ability to control a situation with your words is way more powerful than a gun. Jeff: Absolutely Mighty Mike: A gun is an immediate ... It's not an answer. It's not a resolution. It's a tragedy if you did have to pull it out. Now, don't get me wrong, I'm not anti-gun. I'm just saying I agree with you. That's absolutely correct. Jeff: And yeah, guns can be dangerous and they can promote ... get you into a situation where somebody could get hurt or killed. Again, I'm totally not anti-gun either. I totally believe in that, and a lot of people should have one for their protection. I've never been a really big badge guy. Again, I'm just kind of human, old fashioned way of doing things. Mighty Mike: Yeah, in California it's actually become quite a ... most of the server companies, it's quite anti-badge, because a lot of people are getting convicted and charged, and potentially convicted for impersonating an officer. Jeff: Yes. Mighty Mike: Throwing around words like, "Officer of the court," and things like that. Jeff: Mm-hmm Mighty Mike: You know, I used to do it when I first started because that's what they said in my training class, and really we're not. Joe down the street could serve papers, but he can't serve more than 10 in California. I know it's different in every state, but ... Jeff: Mm-hmm Mighty Mike: Jeff, what book would you recommend? Jeff: Anything John Grisham. I'm a huge John Grisham fan. In fact, the older I get, I'm doing a lot more reading. And I love to read, it's just like a lot of people, you just don't have the time. But John Grisham, really just the fact ... You know, he's mentioned process servers in his stories and subpoenas being served. I always kind of liked that part of it, but just his work is just I think is amazing. And the legal aspect of it, I'm really interested in that part of it. http://www.jgrisham.com/books/ Mighty Mike: That's really cool. I'm going to have to check it out, John Grisham. I'm actually writing a book. It's going to be done here in about 90 days is my goal. And it's going to be on process server safety and best business practices. It's going to be great! Jeff: That's awesome! Mighty Mike: Yeah, you can get a free copy at www.processserverdaily.com/freebook.html when it comes out. Mighty Mike: Jeff, did you have a mentor? Jeff: I started off at a young age. I’m the second youngest of 10 children. Growing up, it was one of those things where, as you can imagine, you either go off to college or go get a job. You're not going to hang around the house, that type of thing. My mentor was no doubt about it my father. He was a hard-working man, raising 10 kids, him and my mother. To me, they’re the most awesome people in the planet, but nevertheless, he said, “Work hard and be nice and don’t ever give up.” He was always supportive of all my brothers and sisters, whatever road they took. He was so excited for me when I started City Wide Legal Messenger Service. He loaned me $1,000, which I had to pay him back by the way. He wasn’t that nice! Jeff: He was truly my mentor. Did he know anything about filing stuff at the courthouses, doing certain papers? Absolutely not. Just his life lessons taught me, even to this day, I still use them. It has really taught me a lot and just got me far. Mighty Mike: That’s great. You answered one of the questions. What’s the greatest advice you’ve ever received? Jeff: The greatest advice I’ve ever received is definitely from my father. Be humbler. Be nice. Work hard. I taught my own kids that. I’d tell you. If you're nice … Don’t be too nice. You're going to be taken advantage of. I’m not saying that, but I’d say being nice, being compassionate, being humble will get so you much further in life. I truly believe that, and that’s the way I try to live my life and do my work. Mighty Mike: To provide an abundance of value without expectation just as a business practice, but also just as a person. There are many examples of that, whether it’s in your love life or with your family. If you provide value without expectation, it will come back to you. Like you said, don’t be taken advantage of, but sometimes it might feel like it and then the next day, you're like, wow, I didn’t expect you to do all these nice things for me. Jeff: Right. Mighty Mike: That’s the idea. Jeff, what would you do if you woke up today, had all the same skills and knowledge, had no clients, a smartphone, a car and only $100? What would you do in the next week? Jeff: I would definitely do some work reaching out to other people, advertising to a certain extent. I’d tell you. The best thing that I would do is to get out there and do a good job for folks. I think word of mouth advertisement has been a key for me to my success. It’s one thing to go out and say you're a process server or say you're going to do this and do that, but if you do it, it takes that one paralegal that you do a great job for. You communicate the whole time. You're doing everything you need to be doing. That paralegal could be involved in a group that tells another paralegal and so on and so forth. Jeff: I think part of doing that good job is communicating. Somebody sends you a paper. Don’t take three days to get back to them if it’s a rush and what’s going on. Certainly don’t take another week to send them back to return a service, that type of thing because again, that word of mouth could also hurt you too. It could be a very valuable factor. It could also hurt your business. I would pound the pavement and get out there and try to talk to as many people as I could, talk to paralegal groups, bar association, that type of thing. Mighty Mike: That’s good. One of the things that I take from your story is that, from your methods, is that be diligent. Get out there. Sometimes it’s nice to have a little hand-up, not a hand-out, but the truth is in this example, you only have $100. You have a car. You have the knowledge that you already have, and you have a smartphone so you can give the internet … You can search things. Guys, anybody can do this. You get out there and go after it. I say anybody can do it, like anybody who wants to build a business. Some people, they’re not cut out for serving papers, and if that’s the case, build the business; have someone else serve the papers. There’s a lot of really good husband and wife teams out there. Jeff, what is a parting piece of guidance you want to give to the servers out there? Jeff: Again, what we’ve talked about previously. Stay humble. Treat people with kindness. You have a job to do and certainly do it. In doing so, just remember this thing is bigger than you. Don’t go out there thinking you're Captain Bob, the process server and think that you're better than everybody, that type of thing. Just go out and communicate with your customer. Take good care of your customer. Communication is key. Jeff: I touched base on it earlier. I don't know how times I’ve used servers across the nation where they do 75% of the job. What I mean by that is, hey man, I got this rush. I need to serve right away. This is a big customer, blah, blah, blah. By gosh. They went out and they got it served right away, did a great job. A week later, hey, where is my return of service? I got to get this filed. The attorney is screaming at me. They got to get this filed. Follow through on your job. Do what it all right, not just half of it. Definitely get in the network groups. Meeting new guys and get involved with this and NAPPS members and stuff, a great, great tool. It’s great to get advice to people. Jeff: Again, I’ve been doing this for a lot of years. I still seek advice. I’ll call a server that I’ve been dealing with for 20 years and say, “Hey, man. How would you do this? What’s your viewpoint on this?” Never stop learning because I’d tell you. There’s a lot to learn in this industry. Mighty Mike: You're right, Jeff. There is. A big part of the industry for process servers, what I find most often is that they find themselves in a chasm alone by themselves and the way that they think that every other processor is their competition. The truth is that many process servers out there have too much work and they would be more than glad to give you the work if you can give them a discount. Jeff: Absolutely. Mighty Mike: If that’s what you need to get off the ground and to get your business rolling so you can raise your prices and have some more customers, more attorney clients come in, then that’s what you got to do. Jeff: Absolutely. Mighty Mike: I started out making $20 a paper. How about you? Jeff: When I worked at the law firm, I think I made about $4 an hour. Whether that’d be filing at the courthouse or serve a paper even add to that, yeah, it’s … I think then after that, as time went on, I think I was getting $20 a paper at that point. It’s been a long road. I certainly charge more for that these days. Mighty Mike: Jeff, I appreciate your story. I want to personally thank you for being on the show. I’ve been really impressed with your story and the whole situation with the neo-Nazi. That’s just a side thing. Watching the video and seeing your operation going on, it’s definitely worth being excited about. I’m excited to share it with the world. Jeff, what’s the best way that we can connect with you and then we’ll say goodbye? Jeff: Sure. You can reach us via email. Our email address is jeffENCORE@sbcglobal.net. Definitely a phone a call away, (614) 414-0730. Mighty Mike: Excellent. You can get that information in the show notes at www.processserverdaily.com/jeff.html Until next time, server nation, you’ve been served up some awesomeness by Jeff, the Nazi hunter and Mighty Mike, the podcast server. Mighty Mike: Server nation, I know that you know all about directories and that you know the importance of getting yourself on the web in as many places as possible, but it’s more than that, server nation. It’s about putting yourself on the websites that get ranked on Google, Yahoo and Bing. I’m excited about a new program that I’m starting. Really quickly, let me tell you. As a process server, I don’t cover the whole country, right? We send servers out to other process servers and we call that affiliates. My new program is going to incorporate a system. When my customers come on to my website and they do a location search, try to find a process server in a specific location, many times, I do not serve that area and so I might hire an affiliate in another area and manage to serve that way. That takes time and effort away from my local customers and the local efforts that I have here in Northern California. I want to personally invite each and every member of server nation to add themselves to my directory on my website. This is what’s going to happen. My customers who come to me loyally will search a specific location. If I don’t cover a specific location but you do, guess who shows up? You do. How great is that, server nation? I’m going to share something that means so much to me, my customers. I believe that this will benefit my customers because they will have a resource to go to, to find process servers and to get the best rates nationwide. Oh, but there’s a catch, server nation. There’s always a catch... My directory is free for an affiliate to sign up and get the basic affiliate level. If you do not perform when my customers come and they see that it’s not me or one of my employees or contractors and they see that it’s you, they’re going to see a rating next to your name. If your rating falls, you may not get any business. Server nation, give it a shot. Sign up for the free listing, but please, take care of my customers. I love them like they’re family. Visit www.processserverdaily.com/affiliates.html Mighty Mike: Until next time, server nation, stay safe out there!
In partnership with State Services for the Blind of Minnesota we are proud to present, PACER Center – Champions for Children with Disabilities: A Visit with pACER’s National Bullying Prevention Center Director Julie Hertzog Julie helped start the Bullying Prevention Center back in 2006 and is a recognized National Leader in Bullying Prevention. She has been featured on CNN, NBC Nightly News with Brian Williams, Time for Kids, PEOPLE, Family Circle and The Huffington Post. Julie sits down with Jeff Thompson of Blind Abilities in the first of a series of podcasts in partnership with PACER Center and State Services for the Blind. Be sure to check out our upcoming Pacer Center podcast featuring the Simon Technology Center and how innovations and opportunities are being created every day and every way. From the web: PACER Center enhances the quality of life and expands opportunities for children, youth, and young adults with all disabilities and their families so each person can reach his or her highest potential. PACER operates on the principles of parents helping parents, supporting families, promoting a safe environment for all children, and working in collaboration with others. With assistance to individual families, workshops, materials for parents and professionals, and leadership in securing a free and appropriate public education for all children, PACER’s work affects and encourages families in Minnesota and across the nation. You can find out more about PACER Center on the web at www.Pacer.org And PACER’s national Bullying Prevention Center at www.Pacer.org/Bullying You can reach pACER Center by phone at 952-838-9000 You can find out more about State Services for the Blind on the web at www.MN.Gov/Deed/SSB And by calling 651-539-2300 Live Learn Work and Play Thank you for listening! You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Get the Free blind Abilities App on the Google Play Store. Full Transcript [Music] Child 1: Bullying is hurting too many people in this world. Child 2: Sometimes I cry when I'm being bullied. Child 3: Bullying makes me feel sad, when I am bullied I try to walk away. Child 4: Sometimes they punch you in the eye, it's so bad that you could cry. Child 5: I got bullied at school. Child 6: Children leave me out of games. I don't like it at all. [Music] Jeff: State Services for the Blind of Minnesota presents "PACER Center Champions for Children with Disabilities". This episode focuses on bullying and with us today we have Julie Hertzog, director of PACERs National Bullying Prevention Center. Julie helped start the bullying prevention center back in 2006, and is a recognized national leader in bullying prevention. You can find out more about PACER Center and PACER's National Bullying Prevention Center on the web at www.PACER.org, we hope you enjoy. [Music] Jeff: Welcome to Blind Abilities, I'm Jeff Thompson. We are at the PACER Center located in Bloomington, Minnesota. We're talking to the director of PACER's National Bullying Prevention Center, Julie Hertzog. Julie, can you fill us in on what Pacer Center is all about and what you do as Director the National Bullying Prevention Center? Julie: Sure, thank you Jeff. Yes, we are in Bloomington Minnesota at Pacer Center and PACER is actually an acronym, P A C E R, and its Parents Advocacy Coalition for Educational Rights ,though that's probably outdated. We've been around since the late 70's and we, our organization began when students with disabilities were given the federal right to be included in the classroom and so that law today is called the IDEA, Individuals with Disabilities Education Act, and so we are a parent advocacy organization and what we do is help parents understand what their rights are when their child has a disability in an educational setting. People will oftentimes say, well where does your connection to bullying come in then as a disability organization? In response to that, as an organization we're here in Minnesota, so we do take a lot of calls from parents in Minnesota, and starting in, well it was around early 2000, we noticed that our staff noticed that we were taking more and more calls about kids who were involved in bullying situations and really both kids who were being bullied as well as kids who were doing the bullying, and a lot of those stories just kind of broke our hearts. We knew that we wanted to, to do something we knew we wanted to take action. And at the time bullying in early 2000, it really wasn't something that people were talking about and so PACER pioneered a lot of the education that happened around early 2000, and in 2006 we actually formed a program under the PACER umbrella called PACER's National Bullying Prevention Center. And the connection to our mission with disability is that students with disabilities are bullied two to three times more than their non-disabled peers, and at the time when we formed the National Bullying Prevention Center we knew that, we wanted to always make sure that we emphasize students with disabilities, but to really make a difference, we realized that we, we also wanted to focus on any kids who are vulnerable to bullying and whether that was a student with a disability, are being bullied based on their disability, on their race, their religion, their weight, their gender, we wanted to be inclusive. But we also didn't want to focus just on the kids who are being bullied, we wanted to really engage, we knew to make a difference, we wanted to engage the entire community, so we wanted to be speaking to schools, we want to be speaking to teachers, and and parents, and the students themselves because at that time we had adopted the tagline, the end of bullying begins with you, and we knew that we wanted to really have a community conversation about this. That it wasn't about saying that, you know, schools need to fix this, or teachers need to fix this, or the kids need to fix it, it was really about all of us working together. And so that is the background on the National Bullying Prevention Center and how we got started. Jeff: You mentioned something that really struck me as it's more than just one person, it well, it is about one person, what I'm getting at is, it's a community, it's the family, and the communication that happens between all of them that will help solve this. Julie: Yeah for so long we talked about some of those misperceptions that we had about bullying or some of those stereotypes that we had about bullying and if you think back to early 2000, I remember when I first started working on this and again I've been on this project since its origin and there was so many statements such as boys will be boys, yeah, meaning that it was justified because they were boys, that it was okay for them to fight, that's just the way it was. Of course, we've all heard that universal one, sticks and stones will break your bones, but words will never hurt you. We know that that is not true, that bullying is not only about physical, it's about emotional, and you know through the years we've had kids say some really poignant things like, words are like weapons, or words will break your heart, and we know that that emotional bullying has just as much effect on students and probably lives inside them much longer even than the physical bullying has. There's also other stereotypes and misperceptions out there that have rationalized bullying for so long such as, you know, just fight back, or you know, kids have also been blamed for why the behaviors happening to them and parents or adults have said to kids, well if you didn't act that way, bullying wouldn't happen to you. And so those are all things that in early 2000, just those stereotypes allowed bullying behavior to perpetuate because we were silent, so when a child was reaching out to us and we were saying things back to them like, well what did you do to make that happen? Really what we were doing is shutting down the conversation and any options that they had to make it stop. Or even when kids would tell an adult that someone else was being bullied, you know our response was, don't be a tattletale. And so again if we're so long what has happened is our society allowed the behavior to perpetuate not, not intentionally but, there was also that statement of, bullying is just a natural part of growing up, I mean those, those were all rationalizations for the behavior for so long. But I will say around you know in that early kind of mid-2000's that people really started recognizing the incredibly negative impact that bullying had, not only short term, but also long term. And there was a couple things that happened at that time in that, the results of the advent of social media at that time. I can remember saying that in 2006 that the Internet is the new bathroom wall, meaning that bullying used to be limited to the school or you know, possibly the neighborhood and kids could go home and escape that, well maybe except for that occasional phone call that they would get or something, but they were really able to, you know, go back home and remove themselves from it. But with social media it became their, you know with the evolution of technology also became the evolution to bully, and so kids were vulnerable to bullying 24 hours a day, and I think that that was one of the reasons that bullying really was put on kind of that national dialogue and also there was a recognition that kids because of things like self-harm, things like depression, anxiety, we began to recognize that there was medical things happening with our kids that were the result of being bullied, and also their you know, the suicide ideation, and suicide attempts, became part of the dialogue as well. So those two things really kind of started to put bullying much more in the public radar and also, they turned a lot of those stereotypes around and we recognize that bullying was a very serious issue for our kids. Jeff: You mentioned in the beginning that educating parents and giving them tools to deal with some of the stuff that comes with, I mean mostly parents in my situation that I know, they didn't choose to become a parent of a child with disabilities, and where do they go for that so, that's what PACER was basically built on. Julie: Absolutely and Jeff I'll just share too that I am the parent of a young man who was born with Down syndrome, who was also nonverbal, he has a feeding tube, a pacemaker, some really significant medical issues and so, it was David who, he was three when I started here at PACER, and he's now 21, and it was thinking about those vulnerabilities of kids that really inspired our, my work here, and also the work of others, in that so much of bullying happens because someone is not able to defend themselves against it, and so it was about how do we educate parents to raise kids who are self-advocates? How do we educate parents to be advocates for their own children? You know and I think back, and again I'll just reference back to 2000, so often when kids would tell their parents that they were being bullied, I think the first response from parents from majority of parents was, oh just ignore it, it'll go away, and you know, and that came from a really good place, and I think parents hoped that by ignoring it, it would stop, but we know from history that just ignoring it does not make a go away, in fact it usually gets worse, and and I remember kids, there was some kids who jokingly when we were talking to them for the focus groups and everything else and they said, well what if I would tell my parents to just ignore their annoying boss? Would that be a solution to the situation? And I remember there was another kid he said, What if I told my parents just to ignore their bills? Would their bills just go away? And so, you know we'd say that, and we realized that, how ineffective that response was, but that was the only thing we had at that time, and we know now that there's so many more solutions. And since 2000 now, every state across the nation has a law about bullying, and bullying prevention in schools, and legislators focused on the school environment when creating those laws. So, we now know that parents and kids have rights and within every state about what can happen if they're being bullied and those weren't in place before, and we also teach parents just how they could be supportive of their child. So instead of being that dismissive, just ignore it, we help them understand how important it is to talk through it and let them know that they're not alone, that we're getting, that you're gonna as a parent, you're gonna be there to help them learn how to advocate their way through it, and I would say to Jeff, that you know, I think for my own son even, self-advocacy skills were so important for him and being a child who's nonverbal, one of the things that we taught him how to do is, if, if you're not feeling comfortable, first thing we want you to do is find a teacher, and we had that written into his IEP, and even from there we continued developing more strategic options for him. Jeff: So, when I was on the website for the National Bullying Prevention Center, I noticed there's some videos and it just wasn't a collection of videos, they were broken down into young children, teens, and you know it even led to what you're talking about educating adults. Can you tell us a little bit about those videos? They really impacted me because it brought me back to the realization that, I may have been part of, not may have, I was part of bullying a little bit and I was bullied, and it just it doesn't go away really, because it all came back to me pretty vivid, pretty, it was all there. Child 7: It makes me cry after school. Child 8: We are different in many different ways, size, shape, and color. Child 9: I have been bullied so I know how it feels to everyone going through a hard time out in the world. Several child voices: Tall, short, skinny, or round, tall, short, skinny, or round, you have a voice, so make a sound. never meant to be the same. Child 10: You have to care because there are other people in the world besides you that have feelings. Child 11: Bullying can prevent good in the world and make the bad go in the world. Child 12: It's not nice to bully, it's better to be a friend. Julie: Yeah absolutely, and you bring up such a good point to Jeff in that, one of the decisions we made very early on was to recognize that any student within the same day can play multiple roles in what we call a bullying situation, and that you may be that young person, you're on a bus riding to school and someone might be throwing, you know, wads of paper at the back of your head over and over and everybody's laughing. So you're that person that's targeted by bullying on the bus and so you can imagine how that feels, that vulnerability, you're on the bus and you get to school and there's all sorts of emotions you're feeling, you're, you know you might be feeling anger, you might be feeling fear, you might be feeling sad, and then you get off that bus and you walk into school and you see a kid by a locker and for whatever reason you just decide to push that kid because you know that you can, and you you push that kid, you've now taken on that role of the kid who's doing the bullying. The next hour you might be witnessing a similar situation you know, in your own classroom, and so to just be labeling kids as a bully, or as a victim, or as you know, somebody who sees it, it wasn't strategic for us. We realized that this is the root of all bullying, it's a social issue. It's a very social issue and by us allowing the behavior to continue to happen without anybody saying anything about it is why it was perpetuated for so long, and I think it's about, we say bullying is about behavior, and so our kids, they're about behaviors, they're not about labels, and what we really want to do is be educating them, and Jeff you mentioned those videos and I think that, again in today's culture, and our evolution, the way we absorb information, we thought it was so important to be offering everybody a variety, so everything from being able to read information, to listen to information, to have access to videos, and you know, and we do a lot of interactive stuff as well. The video series we wanted to touch a parent audience because we want to be giving them a little bit different information than what we would give our kids. So, we actually do have three different websites. We have the National Bullying Prevention Center which we consider our portal page, and that's really for our adult audience, and then we also have two age-appropriate websites. One is called Teens Against Bullying and that is for middle and high school students, and the second is called Kids Against Bullying, which is for elementary school students, so we present to information that that's age-appropriate on those sites through a variety of dissemination, so everything from reading, to interaction on the website, to videos. Jeff: Yeah that was really interesting because I think the ones for kids had animated drawings, it actually described what was going to be on there and said drawings that the kids did, and then their voices, so it really brings it home, and when you witness, or you hear that kids voice, and the tones in their voice, it really like, you can feel it and you mentioned something about everyone's kind of a participant in it. Either your bullying, your target, or you're a bystander. Julie: Yeah and you know, bullying doesn't affect just that kid who's being bullied because when we think about, we like to talk about bullying on a continuum, so if you take a hundred students and you'd line them up, there's gonna be ten students who are frequently targeted by bullying, there's gonna be ten students who maybe are doing the bullying, but that leaves these eighty kids in-between who probably you know might experience bullying a little bit, or might participate in groups, but they're also that 80 percent that sees it happening and you know Jeff I'll tell you universally from talking to kids for, for the past almost twenty years, that group doesn't like it, they don't like what they see, but what they've never had in the past is that they didn't feel empowered to do something about it. You know it goes back to maybe one of those kids in that group was the one that went and told a teacher when they saw a bully and when they were met with, don't be a tattletale, you know what does that do, it shuts them down, they're not going to go back again and say something about it, and so again, it's about making that cultural shift to really engage that 80% to be what we call advocates. It goes back to our PACER model of advocacy, and we say it's advocacy for self, and advocacy for others, and so really giving that that group the dialogue and the tools about, what do you say if you see a bullying situation? And I think that 80% is so important for our kids with disabilities to because the majority of bullying is happening outside the adult's world, and so it's happening in places like a bus where there's not adults, you know, the one person who's on a bus is the bus driver, and what are they doing, they're facing the other way of where all these kids are sitting behind them. And so bullying also happens online, in places where adults aren't, you know that's why so many social media sites that adults are using, kids aren't, because they want to be in a world of their own choosing, and interacting with each other. And so if you think about it, it becomes extremely important for this peer group, this, these bystanders to be empowered to do and say something about bullying, and especially for those who aren't able to stop it on their own. And there's also a really powerful statistic that almost 60% of bullying situations will stop when a peer intervenes and that peer invention becomes so much more powerful than anything in an adult could ever do because just as kids who bully have a lot of power, the peers can take that power away in that situation by saying, you know, we don't accept this, this is not what our school is about, we're better than this, and we've found that that it's extremely effective. [Music] Jeff: It's cool to be kind. [Laughter] Julie: Yeah you know you want to say something, it's cool to be kind sounds really cool to us as adults, but we like to frame it a little bit different for kids and, and especially you know, I think our elementary school students, things like that still resonate with them, you can go with that, some of those really very simple messages. Life gets a lot more complicated for our middle and high school students and how that empathy is, how do you tap into that natural empathy that kids have, because most people don't want to see another person be hurt, but they don't want to put themselves in that situation where they themselves might next become the target, or they get in trouble for sometimes intervening, and so you, you want to really make the payoff, you want to make the trade-off worth their investment of intervening and taking that risk. Jeff: Yeah that group mentality, those eighty students, is it cool to be part of the cool group, that the group is doing this, or is it cool, and I think because of PACER and you know the states passing the laws about bullying that the youth now is starting to realize that it's okay, and cool, those to step out step in, and be part of the conversation part of the solution to bullying. Julie: Absolutely, and Jeff again, my son David, I remember when he was going into middle school and again, you know everybody has their individual vulnerabilities and for him, it was not being able to tell us if he was in a bullying situation he just he wouldn't have that ability to do that and we wouldn't know, and so one of the things that we wrote into his IEP at that time was about training kids to be his advocates. So, at that time, we selected four young people who I knew were already allies of David and these weren't popular kids, they weren't the student council kids, they were they were kids I just knew who had empathy and who cared. We gave them the training to look out for David because we knew that they would know about bullying long before any of the adults would and those students were amazing, and they had such incredible, just their own self-worth and their self-confidence was brought up so much by learning those advocacy skills for David that they shared it with friends and they told people how much you know, this meant to them being part of you know, being delegated with this responsibility, and so that model quickly expanded within my son's school, that advocacy model and they became known as peer advocates. And so, what we did is we continued to train students about what to do if they saw somebody in a bullying situation, how they could intervene, what kind of support they could provide for David, and we also provided an adult mentor that they could go to. So that they could you know, share if there was something that was beyond what they could handle. And that model was incredibly effective, and it became known as the peer advocacy model, and it's still in place at that school today and I know we also have information about it on PACER's website. Yeah there's a great video on there, there's the toolkit, there's statistical data, and there's also a way that you can start it within your own school as well. Jeff: And that's what that toolkits about right? Julie: We have several toolkits on the website, but there's a peer advocacy toolkit on the website that really explains that model in more detail. Jeff: In my world of disability with the blindness and vision loss and difficulty in reading the printed word, self-advocacy is an important skill to develop because typically the parents are what becomes a personís advocate to make, ensure that they're receiving services, or they seek, come to PACER's to learn how to be their advocate in a sense, but then there's a point where the parent will assign chores, or wean them into responsibilities and self-advocacy because they're going to transition from high school to college to the workplace and having that skill set is very important. I was glad to see in the bullying that you guys mentioned self-advocacy. Julie: Yeah, I would say with self-advocacy in bullying, the one important nuance there, is that, we want to make sure that we're not putting full responsibility upon the student to stop it themselves because if they could have stopped it themselves they would have already done that. But what we do say is that self-advocacy is very important and that'll help you get your power back in this situation because I think so much about being bullied, you start to feel powerless, you start to feel like you don't have any options, so in doing that self-advocacy piece is really powerful, and in the world of disability too, it's important to note a couple things, that you have either your IEP, or your 504 that you can be writing those goals and objectives right into, and we've seen parents and teachers get incredibly creative with that. So everything from identifying an adult that a young person can go to if they need help in a bullying situation, and, and that advice, because that isn't always readily available in the school, and so writing that right into your plan is very important, or you know, we've seen other situations where students can leave class five minutes early just because if a hallway is really busy and they're getting bumped around you know, quote-unquote by accident, when we really know it's not by accident that it's on purpose, you know maybe for a short period of time they want to leave class early just to make sure that, that it's not happening, but ultimately we want that behavior to stop in the hallway and for it not to be happening so that they can be included with their peers. But the other important piece is that there's not a federal law about bullying, so every state has a law, but at the federal level there's a law on harassment. So, the distinction between that is that if the bullying is based on an individual's disability, or their race, or their religion, or their gender, or their national origin, then it reaches a threshold of harassment, and at that time the Department of Education as well as the office for civil rights are looking at those scenarios too, so there are some protections in place when the bullying is based on an individual's disability. Child 13: I push myself and yet it is never enough. Child 14: It's never enough. Child 13: And it's hard to ask for what I need. Child 15: I wish others could see that I may not be tough on the football field. Child 16: Or deal with social events very well, but I am a dependable friend. Child 17: It is hard to be understood. Jeff: You mentioned harassment and bullying and you thinking about all the definitions as they're defined in whether a dictionary, you know Webster would say, but it seems like they all blur together, it's a little blurry like conflict harassment, bullying, can you talk just a little bit about that? Julie: Sure I'll give a quick 101 on a definition of bullying, and again Jeff, you know like you say it's, it's somewhat nebulous, and so I'll go back to, if you're listening to this, this recording in the state of Minnesota, Minnesota's definition of bullying in the schools might be much different than how California legislation defines it, or legislation in Pennsylvania, but there are some common hallmarks that I'm gonna mention as far as what defines bullying. So, the first would be that there has to be the intent to hurt, harm, or humiliate, and that can be either emotionally or physically. So, everything from a push, a shove, to name-calling/gossip, so there's that intentionality to hurt, harm, humiliate. The second is is that, the act is typically repeated, instead of you know, but often you know, if it's of significance it can be a one-time act, and I'll use the illustration of say for example if somebody's on social media and they say something really inflammatory and it reaches the an audience of a thousand people immediately, to me that may be a single act, but because it's reaching a thousand people it would definitely hit that threshold of bullying. The third is there's this power imbalance, and again this is, this is I, you know, the imbalance of power up, with that in quotations because it sounds very lofty, but what it is is when a person has either more physical or social power, so everything from you know, so a larger person being much more intimidating to someone else, to a person of smaller stature, but it can also be social power you know, so often we hear it's the quote-unquote the cool kids who are bullying, and so they have much more social cachet then the person that they're bullying. But that imbalance of power can also be about groups, because so often with bullying there's a group mentality and you know, against one person, and it's awfully hard to have power in that situation as an individual versus a group. And the fourth one is that the person is not able to defend themselves, because we see a lot of times people act inappropriately, but it's when, when that person is, feels vulnerable, and they're not able to stop what is happening to them without the help of someone else. The distinction between bullying conflict and harassment then, so with harassment, it has all those hallmarks of bullying, but it's also, and again we're looking at the legal definitions based on legislation, and so the distinction with harassment is that it has all the hallmarks of bullying, but it's also based on an individual's disability, gender, race, religion, national origin, and so the legal, that's the legal definition. And at the interesting nuance to is just to understand what the difference is between conflict and bullying because I think that's very important with our kids, is that we want to let them know, that to have a disagreement, to have an argument, that's a natural part of just life, and it's going to happen through through life, and the distinction of when conflict crosses over into that threshold of bullying is when one person feels unsafe, they no longer feel safe in that disagreement, and also that most conflict will stop when the person realizes how much they're hurting the other person, and so those are really those those distinctions. Jeff: Yeah, I remember there's something saying, guided by empathy that someone does then, retreat or realize they're doing, they're harming someone, they actually realize it, and some people just don't. Julie: Yeah and they'll usually though, they'll be an apology or just an acknowledgement of, hey I guess you know, we've, we've crossed a line here that's not comfortable for someone, for the other person. Jeff: I think the, one of the biggest things you know I, I knew I was coming here to talk about bullying and so I you know, looked at the website and I talked to a couple people about it, and I reflected some things in my past, and I just am grateful that the children today in schools and stuff have the opportunity to be part of the conversation that you and PACER are doing, the bullying prevention, are doing, that there is a conversation that people can join in on. Julie: Yeah one of the I think important parts about our websites is that we wanted to make it not only educational, but we also want it to be aspirational and inspirational and you do that through the sharing of stories, and so if you do go on our website, one of our primary hub and navigation just lists stories, and that's true in all three of our web sites, whether it's for our kids, teens, or adults because we need to understand that impact that bullying has, and I think it's so, it's so easy to say, oh you know it's horrible what happened to somebody, but when you read their their personal story, and you understand the impact that it had for that person, literally about them maybe not wanting to get up and go to school because they couldn't face another day, it's important to know that, and it's those stories and the sharing of stories that really changes lives. And so we wanted to have a way that people could interact and so story sharing is one of those, we also have a nice feature called I care because dot dot dot, where individuals can go on there and fill out why this topic matters to them, and again those are very poignant, and very telling, and also just that kind of that aspirational piece is that, we want the opportunity for anyone to get involved and we realized that we're a small staff so PACER overall has a staff of almost seventy people but on our bullying prevention project there's only three of us, so there's three of us within PACER and we obviously have an infrastructure that supports us, but one of the things that we knew is that the only way we could make change with such a small staff was to really have people who wanted to get invested within every community and that's really what we found is whether it's kids, whether it's parents, or teachers, or even community members, we want to give them tools so that they could be part of the conversation. I think an important evolution you know, what you've heard me talk about what bullying was like in 2000 and where we are now in 2018 is that when we started in 2000 we really needed to be educating people about why do you need to care about this topic of bullying, and then you know, and the reasons were is because it had such a negative impact on her kids, everything from them not wanting to go to school, to also having these physical symptoms of depression and anxiety. You know I think the majority of our society now understands that, that bullying is is not acceptable, but now we need to beware. What are we going to do about it and what behaviors do we want to replace it with and so our conversation has continued to evolve to, we are together against bullying but we're also United for attributes such as kindness, because again you can't go wrong with kindness, and the world just needs a lot more of it. But we also started talking about the concepts of inclusion and acceptance, and we chose those two very purposefully. Inclusion because so often our students with disabilities are not included, you know traditionally they're not included in a classroom setting, they're not included in peer groups, they're not included in friendships, and so to be having active conversations about that we felt was really important. And the other values of kindness, inclusion, and acceptance, and I think so often bullying is about people's differences and in thinking about it, so often what somebody is bullied about is really what makes them unique and valuable to society and I'll just use my own that I, I'm five-eleven now, and I think I was five-eleven back in sixth grade and though I was teased about height and, but really that's what I value, and I think in blind or visually impaired community, and again Jeff, you can probably speak to this, but it's probably your uniqueness that you value about yourself. And so one of the things that we want to do is to say that acceptance is about who somebody is and things that they cannot change, but it's also probably what really they value most about themselves as well, and even my son with Down syndrome, I think what people value about him is his disability because of what he brings to a community, because of his uniqueness, and how he approaches life because of this disability. Jeff: I'm so glad to be part of this conversation because I'm just reflecting back and you talked about acceptance, like when I first lost my eyesight there was a period of time there where I was like, hmm, I didn't know what I didn't know, and I was like kind of lost, so vulnerability at that point until I was able to accept my blindness, my visual impairment, then I could deflect comments or just things like that so, Julie what suggestions would you have for someone who may be experiencing bullying? Julie: Sure, and I'm gonna look at this through the lens of we really focus on students in K through 12, and the first thing I always want to tell anyone who's in that age range and/or their parents is to know that, especially if you are experiencing bullying, that you're not alone, and and I say that Jeff because, one of the things we so commonly hear from individuals is that they feel like they're the only ones that are going through this experience. And you're not alone, in that people are here for you, and if you are being bullied, absolutely as a young person reach out to somebody and let them know, because you have the right to do that, you have the right to be safe at school, you have the right to feel safe online, and so in talking to a parent it's not a show of weakness, it's a show of strength, and I think it takes incredible courage if you are being bullied to just show up to school every day, and so use that courage and translate it into action by talking to an adult and then figure out what you want to do to, to advocate to make it better, and part of advocacy is telling somebody and letting them help you through a plan, and you know whatever that plan may be, make it unique to you, that fits your needs. And for adults, if you find out that your child is being bullied number one listen to them, and let them talk through it because it's a very emotional thing, and you as a parent are going to be experiencing a lot of emotion if you find out that your child is being bullied. Everything from why didn't I know about this before to why didn't they tell me before, but the most important thing you can do is be supportive and the 2nd thing is to go in and find out what your rights are, you know be calling us, or be emailing us, or going online and in finding out what your rights are because your child does have the right to be safe at school, I think that's, that's just of primary importance in of advocate. Jeff: I don't know this one will make the podcast, but as you're talking there I was thinking, do kids who bully ever come forward and wonder why they're doing it? Julie: Yeah absolutely and it's a great question and, and again, I can only speak [inaudible] from the kids that we that we have communicated with, but we've heard where kids go on our website and we actually have a checklist on there especially for our young kids and it's called, do you bully? And they go on there and they read through those behaviors and they, they read through it, and they say, wow I'm doing that, and they don't realize the impact that they've had on another person through their actions, and so we need to be teaching our kids about what appropriate behaviors are, and if you as a parent find out that your kid is, is showing those bullying behaviors, absolutely be having that conversation with them and saying how can we redirect what you're doing? And teaching them how to have empathy for others, such an important piece, and, and I don't think most kids would identify themselves as quote/unquote a bully, and so that's where it's particularly important for adults to be acknowledging those behaviors and saying what can we do to redirect them? Jeff: Once again thank you so much for all this information, there's just a wealth of information that I was able to tap into, I'm going on to the website and talking to you, and you know even this podcast people are gonna be listening, and it's just, sometimes you feel like you're in a vacuum in life, you're isolated from it like, what do I know about bullying in a sense that do I have the answers, but with the conversation going on, and the website and stuff people can get connected to each other and share, especially their parents because they're the ones if they know about it, they're the ones that can do stuff too, and it's just great resource. Can you tell people how they can get to your website? Julie: Absolutely, you go to PACER, again P A C E R, is that acronym that I talked about way back at the beginning and it's PACER.org, and that'll get you to PACER's primary website, and then to reach the National Bullying Prevention Center you would put in PACER.org slash bullying. Jeff: Well that's easy enough, well Julie thank you so much for carrying on this conversation that we all need, and I don't think just because I'm in the blindness community, and bullying doesn't have boundaries, so opening it up to so much, most of our podcasts deal with blindness and stuff but we can't hide from bullying because it it does exist, so thank you very much. Julie: Thank you Jeff and thank you listeners! Child 18: Sometimes we are just told to deal with it. Child 19: Sometimes I don't think I'm any different from other teenagers. Child 20: We kind of all struggle to be understood. Child 21: But yeah, I struggle. Child 22: Emotionally and intellectually, it's sad when people are insulted and made fun of because they have something they're born with and cannot help but have. Child 23: If only others could see, I have so much to offer. Child 24: I would like to encourage kids of my generation... Child 25: Well, really everyone.... Child 26: To be more kind each other.... Child 27: To be more kind to each other...... Child 28: To be more kind to each other. Child 29: Think about how good it feels when someone comes to help you when you least expect it. Child 30: We are all trying to fit in. Child 31: We are all trying to fit in. Child 32: We are all trying to figure life out. Child 33: We are all trying to figure life out. [Music] Jeff: Be sure to check out PACER's Center Champions for Children with Disabilities and PACER's National Bullying Prevention Center on the web at www.pacer.org, and check out State Services for the Blind in Minnesota at www.mn.gov/deed/ssb. Live, learn, work, and play. And a big thank you goes out to Chee Chau and Steven Letnes for their beautiful music. You can find Chee Chau on Twitter at lcheechau, and Stephen Letnes at stephenletnes.com. For more podcast with the blindness perspective, check us out on the web at www.blindabilities.com, on twitter at BlindAbilities, and download the free Blind Abilities app from the app store, and on Google Play, that's two words, Blind Abilities. You can also enable the Blind Abilities Skill on your Amazon device, just say enable Blind Abilities. And from Pacer Center, State Services for the Blind, and Blind Abilities, Thanks for listening, we hope you enjoyed, and until next time, bye bye! [Music]
Job Insights Extra: Adjustment to Blindness - Meet Rob Hobson: College Prep and Success All in One. Transcript Provided Job Insights Extra brings you Rob Hobson, Cordinator for Professional Development and College prep at Blindness Learning In New Dimensions, Inc. Best known as Blind, Inc. located in Minneapolis, Minnesota. Rob tells his story how he overcame the challenges that nearly defeated him when entering his Masters program. He made a decision to improve his Blindness skills and this led him on the journey he continues today. From nearly bailing out to exceeding his own expectations by finishing his Masters degree ahead of time and landing a job in the career he wanted. Rob talks about his job details when he started as an Orientation and Mobility instructor to his duties today as Cordinator of Professional Development and the College Prep program. Join Rob Hobson and Jeff Thompson on this brief look into Rob’s Adjustment to Blindness and how he is helping others adjust to their Blindness today. You can find out more about Blind,Inc and Adjustment to Blindness on the web at www.BlindInc.org You can also contact Rob and Blind, Inc. via email You can find out more about State Services for the Blind on the web at www.MN.Gov/Deed/SSB And to find Services in your state check out the American Foundation for the Blind web site and enter your State’s name in the, “Find Local Services” section. Thank you for listening! You can follow Job Insights on Twitter @JobInsightsVIP Send the Job Insights Team and email and give us some feedback and suggest some topics you would like to see us cover. Job Insights is part of the Blind Abilities Network. You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Get the Free blind Abilities App on the Google Play Store. Job Insights Extra: Adjustment to Blindness - Meet Rob Hobson: College Prep and Success All in One. Transcript Provided [Music] Rob: When I started that semester, I soon realized that the skills I used in college from my undergrad weren't gonna work in grad school. Jeff: That's the voice of Rob Hobson, Coordinator of Professional Development and College Prep at Blindness Learning in New Dimensions. Rob: Set up an interview and came up here in early December of 2008 and I was offered a position and I accepted. Jeff: Rob talks about the challenges that he faced when transitioning from college to his master's degree program, and how adjustment to blindness training gave him the skills and confidence to succeed. Rob: We use structure discovery which utilizes the environment as a teaching tool and if you only just know one specific route, that can be really debilitating because that's all you know. Jeff: And you can find the Job Insights podcast on blindabilities.com, part of the Blind Abilities Network with host Serina Gilbert and myself Jeff Thompson, and you can contact us by email at JobInsights@blindabilities.com, and join us on the job insight support group on Facebook, on Twitter at Job Insights VIP. Rob: Get that adjustment to blindness training because it is vital for you to be able to compete out there with your sighted peers. Keep an open mind because there is a lot of life after blindness. [Music] Jeff: I went down to South Minneapolis to the historic Pillsbury mansion, the home of Blind Incorporated and that's where we met up with Rob Hobson, we hope you enjoy! [Music] Welcome to Blind Abilities I'm Jeff Thompson and today we're down at Blind Incorporated in Minneapolis we're talking to Rob Hobson and he's the Coordinator for Professional Development and College Prep. How are you doing Rob? Rob: I'm doing well on yourself Jeff? Jeff: Doing good thanks, Rob thanks for taking the time to coming on the Blind Abilities and sharing a little bit about your journey through blindness and your job that you have. Rob: Oh thank you I'm happy to be here. Jeff: Well Rob, can you tell a little bit about what your job is like here? Rob: Well working here at Blind Incorporated, it's a lot of fun, we have a great team and we work together as a team to provide adjustment to blindness training to college-age students, to adults, to seniors, and we have transition programming, and we even have a buddy program which covers 9 to 13 year olds. Jeff: You cover the whole gauntlet? Rob: Yeah we do, it's, it's great, it's, it's a lot of fun. [Bass guitar sound effect] Jeff: Now you did not start out as a Program Coordinator? Rob: Well when I started at Blind Incorporated, I started in 2009, but I should go further back, actually, it's actually a little journey. In 2006 I started grad school at Southern Illinois University in Carbondale to get a master's degree in public administration, on paper that sounds great, when I started that semester I soon realized that the skills I used in college from my undergrad weren't gonna work in grad school. The bar was a lot higher, note takers were hard to get, because I utilized their services through disability services through the campus and I realized that my skills weren't up to par because I just couldn't keep up. Every time I thought I did great, I was still further behind. What really hit it for me was when I took this budgeting class and I thought I got all the points possible, and in that class it was zero to five, five was like the max of points you can get, so I thought hey, I might have gotten a four or five, and I got my grade and it was a 1.5, and the words that really changed my view was, well I felt bad, so I just gave you a 1.5. And that really hurt, it really set, threw me back a loop, you know, it's like wow, I've never had that happen to me before. I called some friends who are in the NFB and I talked to them about, you know, maybe it's time for me to get some adjustment to blindness training. I knew it would be a process because getting Illinois, because that's where I lived at the time, to pay for it was a process. I've heard horror stories that sometimes it could take two years but I was pretty confident that it wouldn't take that long. So in August of 2006 I met with a counselor, I convinced her to start the process and I had an O&M evaluation. I wrote a letter stating why I needed this training and what it was going to do for me, so I had an O&M evaluation, through the letter I was able to convince them to provide me the opportunity to go to the Louisiana Center for the blind in Ruston Louisiana. I started my program at the end of March of 2007, and that's when I started my journey in blindness training. Now to be fair, my goal was to get through the program, go back to Southern Illinois University in Carbondale, and complete my Master's in Public Administration Degree. Well while I was in the program, it was suggested to me that I should consider the Louisiana Tech O&M program and I considered it for about 1/2 a second and I thought no that's not me. As they say it, it put the seed there and throughout the summer of 2007 I realized that hey, you know I might actually like this. I started the process in the fall to go into Louisiana Tech, in the end of November I started my first classes as a Louisiana Tech student in grad school. Jeff: Now Rob, could it be that winter was coming and.... Rob: I'm not gonna lie, that was true, I thought that was a good benefit but really I was excited to start this program because I knew that, you know at the end of this program I would be able to get a job, and believe it or not, throughout that year it took me a year, end of November of 2007, and by November 19th of 2008 I walked away with a college degree, a graduate degree, from Louisiana Tech. It was a rough year, they say that a master's degree generally is a year and a half to two years, I did it in a year, it was probably the hardest year of my whole life at that time. Jeff: Congratulations! Rob: Thank you. I soon talked to Sean Mayo who was the Executive Director of Blind Incorporated, set up an interview and came up here in early December of 2008 and I was offered the position and I accepted. In January of 2009 I started as a Blind Incorporated employee, and to be fair, I only planned to be here year after about a month of working here because it was so cold, but I soon liked it, teaching cane travel was a lot of fun, it took me a while to get into my zone, you know because when you come to a new city you have to learn how to navigate the streets and learn the grid, the outline, you know all of the names of the roads, and I knew I had the skills to teach, it was a matter of learning the environment so I could teach and understand how to relate that information to my students. Jeff: So did you do a lot of exploring in your off time and just try and navigate the city and learn it? Rob: I did, I spent a lot of time learning south Minneapolis, I spent some time with Zach Ellingson who was the full-time cane travel instructor at the time, and we talked a lot, he really helped me gain the information necessary to teach. I spent some time observing him just to see how he taught because you know, when you're still a new teacher, you still like to get other teaching styles and I knew Zach was really successful at what he was doing and it was a good resource to work with. I spent a lot of time on weekends going out to other places in the city but at the time I really focused on south Minneapolis because I knew majority of my instruction was gonna be during that time. I later throughout the years, I gained knowledge in Northeast Minneapolis, Southeast Minneapolis, St. Paul, I know some of St. Paul, I don't know a lot of it but I know enough to to be able to teach it. Jeff: Now learning the areas that you did, it's pretty much transferable skills the way you teach here right? Rob: It is, the skills are transferable but you know it's like anything else, when you want to teach someone you have to still know what you're teaching, does that make sense? Because we also teach how to navigate the area via some of the names, so I needed to know those names so I can you know pass that information along, learn bus routes, I learned a lot of the bus routes, but yes, the skills I learned in Ruston Louisiana were transferable once I figured out the grid system and for an example, Hennepin Avenue is your divider between north and south Minneapolis, and the river, the Mississippi River divides southeast Minneapolis and northeast Minneapolis from north and south Minneapolis, and anything more than that you get a little complicated because it depends on where you are further south in the city, you actually have the river divider between St. Paul and Minneapolis. [Bass Guitar Sound Effect] Jeff: There's always been a debate about people sometimes teaching route travel compared to teaching skills that will allow you to explore other areas and use the same set of skills. Rob: That is true, in our format we use structure discovery which utilizes the environment as a teaching tool. We do start off with students in the beginning giving them simple route assignments so that they learn to gain that confidence and gain those problem-solving skills so that they're able to change those routes, make a diversion if need be, I mean because, well if you've walked in Minneapolis in the summer, you know that, maybe every, about every few blocks there's construction, or they tear up a sidewalk to put in a new one, or whatnot, you have to be able to problem solve in that and if you only just know one specific route, that can be really debilitating because that's all you know, and how are you gonna be able to get through that situation. Jeff: Yep I graduated from Blind Incorporated and I remember the whole thing, the only thing Zack always got upset was, I grew up here so, when he was trying to fool me or something, I'd hear a church bell. Rob: Oh, and that gave it away didn't it? Jeff: I could identify the church, so he would be more creative next time you know, just knowing that I had a few cues that other people didn't have so it was always interesting. Now in your new position, what do you do for Blind Incorporated? Rob: Currently I set up all of our activities, I coordinate from beginning to end. For an example last year we went camping for the first time in I don't know how many years, at least since I've been here we've never gone camping up to that point, and we actually went camping, we stayed in tents and that was a long process to put that together because there's a lot of details involved. It's not like we all just got in a van and drove up to Duluth area and pick the camping site and just went camping. There's a lot of details involved when you take 30 people, 30 of your closest friends and students up to, up to go camping. So there's logistics because you have to work on you know the amount of food, how many tents, how many people per tents, just a lot of logistics. I coordinate all of the logistics to make sure everything falls in line, all of our activities from camping to just going rock climbing at vertical endeavors. Starting last year we started putting together professional development for the staff and students, some of the highlights, we had Kevin O'Connor come in, who is a renowned professional speaker who came in and talked to our staff and students on basically just professional development, working with each other, and what does it mean to be professional, and covered all of those components. We also had somebody come in and do a multicultural training, we had somebody come in and talk about cognitive disabilities, we've done some first aid CPR, so we've done a lot of different programming, but we've done it before but not to this caliber, so we really have a professional development piece about every three months or so for the staff and we started incorporating the students in that as well because it's important I think for our students to be able to have that information, they can put it on their resume, and I think it makes them even more employable. [Music] Jeff: You also had a program called Blind and Socially Savvy, can you tell us a little bit about what that is? Rob: So Blind and Socially Savvy really covers the soft skills, starting in conversation with somebody, proper way to introduce somebody, etiquette, so they have an etiquette meal where they actually sit down, a full meal and they learn how to conduct themselves in a professional environment because I'm sure you know Jeff that there are always interviews, sometimes those interviews are sitting down with a meal with your future employer, so it's a great opportunity to be able to conduct yourself professionally, it makes it even more likely for you to get that job. Also it's good to be professional and to have that proper etiquette because you're going to be amongst peers, whether they're your fellow co-workers, or friends, family, maybe you volunteer in an organization, it's great to have that etiquette because it puts you even higher up on the bar of success. Jeff: I attended something very similar to that and I remember they said, your bread is not a mop and turn your phone off, and pay all your attention to the person, it's not about the food mostly, it's about the interview so to say, or the person that you're attending with. Rob: That is correct. Jeff: And then they went through, start from the, just like on the Titanic, start with the outside silver and wake work your way in, so there's a lot of information there that people are kind of expected to know, but if you haven't had the opportunity to learn it, Blind and Socially Savvy that you guys provide here, is awesome! Rob: Yeah and we didn't do it ourselves, we did it along with State Services for the Blind, we worked well with them and Sheila Koenig who's the coordinator for transition for SSB, she worked really well with Dan Wenzel the executive director here, and Michelle Get, who coordinates our transition programs. Jeff: And you do have a lot of programs here and opportunities that you mentioned early and it's really neat to see all the stuff that's happening from the summer to prep to like I said you cover the whole gauntlet here. Rob: Yep we also are starting a new program, it's our College Programming or I like to call it College Prep and what it is is students come in maybe they don't want to do a full six to nine month program but they want to come in and get some of those non-visual adjustment to blindness skills. So they'll come in for a summer, get that training, and if they're new to going to college we actually have a college class component that would start in the fall where they could take a class and still continue to get some adjustment to blindness skills, we would work with them on navigating a campus, and specifically that campus, and we would also work with them on study skills, note-taking skills, all of the the skills necessary to be successful in college. I know when I first started college I was absolutely terrified and I think even now with, with the technology being the way it is, back then you know if you had a computer you were lucky, but nowadays there's phones, there's Braille displays, there's lots of different technology out there that we would be able to work with students on so that they are fully competent and capable to be successful in college so that they can be employable in the future. Jeff: And being able to use that equipment on day one! Rob: Exactly, I mean that's, I think that's a really good point Jeff, you don't want to start, get your technology September first when you start at the class in late August and then have to learn how to use it while taking classes at the same time. We like to work with students early so that they have those skills when they start the college class, that they are able to know how to use their technology, take the best notes possible so that they can be self-sufficient. [Music] Jeff: Rob Hobson thank you very much for what Blind Incorporated does here in Minneapolis and across the nation because other students come from other states and you guys give them an opportunity to succeed, give them skills and the confidence to do so. What advice would you give to someone who has recently become blind visually impaired or has trouble reading the printed word, and what advice would you give them as they start that journey? Rob: I would say keep an open mind, blindness is probably the one of the most terrifying disabilities out there, and really it's because of the unknown, it's a sighted world out there, people perceive through what they see, but keep an open mind because there is a lot of life after blindness. I lost my vision I, I wasn't fully sighted but when I did have some vision I lost it pretty quickly due to a retinal detachment and, and that's a long journey itself, but I know what it's like, it's tough, but what I can tell you is working with State Services for the Blind, figure out your options, whether it's Blind Incorporated, VLR, or Duluth Lighthouse, get that adjustment to blindness training because it is vital for you to be able to compete out there with your sighted peers and really that adjustment to blindness training is what's going to put you on that same platform for success. Learn those skills, know how to cook, clean, learn to read Braille, technology, cane travel, because you got to be able to get there on your own. You can always use Uber and Lyft but I can tell you that stuff's expensive, I know I look at my bank account every month, not that I use it every day but I use it just for quick things, it's expensive, so you're not going to be able to do that all the time, so you've got to pick up those, you know learn those non-visual skills that you can travel independently. Remember that blindness is not a tragedy. I like to say blindness is what you make of it, you can look at it as a tragedy, or you can look at it as, you know what, this is a new challenge, and I'm here to overcome it. Jeff: So Rob, if someone want to get a hold of you or Blind Incorporated, do you have any contact information? Rob: Sure do, you can call our main number 612-872-0100, and ask for Jennifer Wenzels, she handles our intake. You can also ask for me, I'm happy to talk to you if you have any questions, my extension is 220, and Jennifer's extension is 251. We also if you like email, you can send an email to info@blindinc.org. Jeff: info@blindinc.org, well Rob thank you once again for taking the time, sharing your story, sharing your experience with the listeners and, really appreciate it. Rob: Oh you're welcome Jeff, it was a pleasure. [Music] Jeff: Yes it was a real pleasure talking to Rob Hobson, and if you want a contact Blind Incorporated, send them an email at info@blindinc.org, on the web at blindinc.org, and to find out more about State Services for the Blind check us out on the web at www.mn.gov/deed/ssb, and to find services in your state check out American Foundation for the Blind's website at AFB.org. And Thank You Chee Chau for the beautiful music and you can follow Chee Chau on Twitter at lcheechau. Once again, thank you for listening, we hope you enjoyed, and until next time bye-bye [Music] [Multiple voices] When we share what we see through each other's eyes, We can then begin to bridge the Gap between the limited expectations and the realities of Blind Abilities. Jeff: For more podcast with the blindness perspective, check us out on the web at www.blindabilities.com, on twitter at BlindAbilities, download our app from the app store, Blind Abilities, that's two words, or send us an email at info@blindabilities.com, thanks for listening.
Job Insights #4: Apps With Productivity in Mind for Education and in the Workplace. Transcript Provided Welcome to the 4th episode of Job Insights with Serina Gilbert and Jef Thompson. We focus on Employment, Careers, enhancing opportunities and bringing you the latest innovations from across the Vocational Rehabilitation field to ensure your choices lead you down the career pathway that you want and succeed in gainful employment. From getting started with services, to assessments, Individual Plan for Employment (IPE) to gaining the skills to succeed and tools for success, Job Insights will be giving you tips and tricks to help your journey to employment and break down the barriers along the way. On this 4th episode of Job Insights Hope Paulos joins Serina Gilbert and Jeff Thompson in the studio and they talk about productivity apps and software. From the classroom to the workplace, these apps are geared towards making your daily challenges a bit more manageable, efficient and productive. Hours Tracker, Black Board, Drafts, Files, SeeingAI, Dictionary Thesaurus Pro, KNFBReader and Bookshare’s Read To Go app are all mentioned with some great discussion about how we use these apps. A great little Scan Stand named Foppidoo makes the scene and a conversation on Lift and Uber gets quite a chat as well. You can check out the Meet Me Accessibly book from Jonathan Mosen and learn about Zoom on the PC. Join the Job Insights crew and download some apps and give them a whirl. Hey, productivity rocks! We hope you enjoy this Job Insights episode and you can send your feedback and suggestions to the Job Insights team by email at JobInsights@BlindAbilities.com Follow the Job Insights team on twitter @JobInsightsVIP Job Insights is part of the Blind Abilities network. A big Thank You goes out to CheeChau for his beautiful music! Thank you for listening! You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Job Insights #4: Apps With Productivity in Mind for Education and in the Workplace. Transcript Provided [Music] Female voice: I feel like I'm getting a lot better education so yeah, I think, I think the online learning is an equalizer. Jeff: Job Insights, a podcast to help you carve out your career pathway and enhance the opportunities for gainful employment. Female Voice: But sometimes I require KNFB Reader when I have more than one page that I want to kind of read continuously. Jeff: Learn about resources for training education and employment opportunities. Female Voice: Blackboard, that is a learning management system and a lot of universities are using them as well for classes. So this particular app is available on Android, iOS, and PC, and Mac of course. Jeff: We will hear from people seeking careers, employment, from professionals in the educational field, teachers, and innovators in this ever-changing world of technology to help you navigate the employment world and give you Job Insights and enhance the opportunities to choose the career you want. Male Voice: Fopydo people sounds good and I actually at that time asked my son, and I, it was actually a play on the on Scooby-doo. Jeff: And you can find the Job Insights podcast on BlindAbilities.com, part of the Blind Abilities Network with hosts Serina Gilbert and myself Jeff Thompson, and you can contact us by email at JobInsights@BlindAbilities.com, leave us some feedback, or suggest some topics that we cover. On Twitter at Job Insights VIP, and check out the Job Insights support group on Facebook where you can learn, share, advise, and interact with the Job Insights community. [Music] Female Voice: Lift also released an update to their service dog policy saying that an allergy or fear of animals is not a valid reason to not pick up an individual with the service animal. Jeff: But hey it's a good learning tool, because it's just repetitious and pretty soon it just starts coming to you, mm-hmm, so I dug right in, when I saw they had flashcards I went Wow! [Music] Jeff: And now please welcome Serina Gilbert and Jeff Thompson with Job Insights. [Music] Jeff: Welcome to Job Insights and this week we're talking about apps, apps that you'll use in school, at the workplace, and these are productivity type of apps, and with me today of course is Serina Gilbert how are you doing? Serina: I'm good Jeff, how are you? Jeff: I'm just doing great and we got a guest today all the way from Maine. Hope Paulos, how are you Hope? Hope: I'm doing great, how are you? Jeff: I'm doing good, we're all doing good, so that's good. Today we're gonna talk about apps, you know some of these apps are mostly productivity type of things, stuff that you'll use to, you know get things done and that's, that's what we're, we're all about here on Job Insights. So Serina, last podcast you said you were holding out on us from what you're gonna tell us, is the cliffhanger over or are you gonna tell us? Serina: Oh we've got a little bit of a wait cuz we have to talk to Hope first, we have a guest. Jeff: How about you Hope, what do you got? Hope: I certainly don't have a cliffhanger. [Laughter] Serina: We set her up there Jeff! Jeff: yeah. Hope: Yeah you did! [Laughter] Jeff: So Hope, how's it going out and Maine? Hope: It's going well, the weather is nice finally, when I talked to you and Pete last time, it was March, and it was in the 20's, 20 degrees. Now we are in about the 60's, 70's, so I am absolutely loving it, birds are chirping, the guide dog is going for walks, he's enjoying it, Jeff: Is he bringing you with? Hope: Oh yeah of course! [Laughter] Jeff: That's great! Serina: But Jeff needs to know if you planted any Apple trees? Hope: No. Serina: Only PC trees? Hope: Only PC trees. [Laughter] Jeff: Oh that's the running joke isn't it? So when it comes to productivity type of apps, Hope what did you bring to the show today? Hope: Sure, so I have a couple of them. I don't use this particular one very much right now because I do work for Apple, and Apple has me on a strict schedule so I don't need this particular one, but for people who are freelancing, the name of the app is called Hours Tracker, it's a free app and basically it allows you to track your hours of course, hence the name, but it also allows you to track your earnings, and it will deduct the taxes as well. So it will tell you how much is deducting for taxes. So it's great for individuals who are freelancing. The second app that I have brought to the show is Blackboard. That is a Learning Management System and a lot of universities are using them as well for classes, so this particular app is available on Android, iOS, and PC, and Mac of course. This will allow you to do your classes online literally anywhere and actually a couple of the blindness organizations were working in tandem to get this particular app accessible. It's extremely accessible, there was only one thing that I commented on a couple weeks ago and I sent feedback in to the iOS developers and they fixed it. They're very very good about fixing issues that people might have. The other app that I brought, that I brought to the show is Learning Ally. This is an app that will allow you to download books and it's also good for individuals who are dyslexic and who have low vision because I believe it will allow you to magnify the print in the actual book so you can read along with the narrator which is quite helpful. That's more University as well, University-type app, Productivity app and of course the last app would be the Bookshare app. The Read2Go, this allows you if you have a membership to Bookshare, which I believe most students can get for free, it allows you to read the books on your phone be it Android or iOS. Jeff: Now on the Hours Tracker, is that what it's called? Hour Tracker? Hope: Hours Tracker yeah. Jeff: Hours Tracker. So when you're doing the setup, your presets, do you put in your wage, and then it just calculates it and are you able to output that anywhere, or is it just something you read? Hope: Absolutely, so this particular program allows you to put in the wage, and it allows you to put in whether or not taxes are withheld, so technically even if you were, you know not freelancing, if you working a job as an employee, a W2, you could use it as well. Basically it allows you to put in your breaks and your lunches and things like that, and it lets you know when to go on the break, and when to go to lunch, and when to clock out, and when to clock in. [Music] App Voice: Sample Job, 0.05H today, 0H button, clock out now or long-press for extras menu, button, next clock out now, button, cause now, button, break now button, break now, sample job 0 H on break 8:10 a.m., 0.02H button, end break or long press for extras menu button, end break. Hope: It also will let you know, like you can, you can set a reminder to have it automatically clock in when you get to work, and yes you can send it, I think it's a CSV file, or CV file, something like that, a database file, and it will put it in an Excel spreadsheet I think as well, so that you can show it to your employer. Jeff: That's kind of neat. Serina: That's pretty cool I like that. Hope: Yeah it's a it's a pretty neat app for sure. Jeff: Intuit the makers of QuickBooks and various tax applications has a program and it might be part of their bundle and I believe you can buy it separately, I believe it's called Self-Employed, but that sells on a monthly subscription for 7 to 8 dollars a month. Hope: Yeah this is free and I think, I'm trying to think if I paid for anything, I think I did just because I was freelancing at the time and I wanted them more, more, so it has a lite version and it has a full-featured version, but even the full-featured version wasn't some really really, you know cheap price. Jeff: A one-time fee? Hope: A one-time fee yeah. Jeff: That makes perfectly good sense, economically I can track that pretty good. [Laughter] [Music] Jeff: You can download Hours Tracker free from the App Store or the Google Play Store. Hourlys Tracker is free for up to 21 days of time entries and if you upgrade to the pro or professional, you get rid of all the ads, unlimited amount of entries that you can make, the only difference between the professional and the personal is you can have unlimited amount of jobs in the professional, and you can upgrade to the professional or the personal in the in-app option. The professional will run you $9.99 and the personal will run you $5.99. Once again, a one-time payment, I was really intrigued when I heard about Hours Tracker, I downloaded to my iPhone, and started using it right away, I named a job, I started the time, and when I was completed I stopped the time. I also had the option to input the time that I wanted it to start or input the time that I wanted to stop, otherwise you could do it in real time and that works out really nice. There's also an option that you can take notes and keep them with that job. I found that the accessibility on Hours Tracker on my iPhone was second to none, all the buttons were labeled and the intuitiveness was what I expected for when I have started logging the job, putting in the hours, getting out of the job, putting notes in, was just exactly how I expected it would work and it did work that way. Another small part of the accessibility, it lets you cancel a pop-up or dismiss the pop-up that comes up, and I really like that because if you've ever had a pop-up pop-up and not be able to get rid of it, that's not good. So after kicking around Hours Tracker on my iPhone for one job, I personally recommend this for anybody who is self-employed or someone who works on projects and just wants to have better records of the time they spend on their projects and jobs. [Music] Jeff: So on the Blackboard, I remember I have not experienced Blackboard yet, but I remember going to college and I was at the mercy of every professor that was experimenting by putting stuff on the web and accessing it through a link they give you, and if it was accessible you got lucky, so Blackboard is a collective effort to make it accessible for everyone. Hope: Absolutely, so it all depends on the type of class you're taking obviously right, if people don't know I'm going back to school to become a teacher of the blind and visually impaired and so all of the courses need to be accessible to me. So the professor's will tag their images so that I can know what's going on, their quizzes are all accessible, obviously the discussion boards are all accessible, and I use a combination of the two apps, so I use the combination of Blackboard and I use Learning ally to be able to do my classwork, and literally like I said, I can do it anywhere. With the phone if I have a Braille display and/or a Bluetooth keyboard I can do my homework on the beach or in the park you know, so literally anywhere and that's huge compared to when I was going back to school to get my undergrad degree, like you know 2009, that's when I graduated so it's, it's huge it's a huge step up. Serina: Yeah I remember using Blackboard when I was doing my master's degree which would have been gosh, probably around the same time as you are doing your undergrad, so I finished in 2010 and so, I don't know, 2007, 2008, somewhere around there's when I started it and they used Blackboard for everything. My program was pretty much 100% online, we didn't have the app back then, we just had the website, but even back then the website was pretty accessible. I rarely had any difficulties with it and I was going for the rehabilitation counseling so the professors were a little bit more cognizant of accessible media and documents and things like that. I loved using blackboard because it is easy to log on to, you know if I was on a break at work or whatever, or at home trying to get a discussion posted or something like that. Hope: Yeah it is really easy to use extremely easy to use. Jeff: Is that why you opted to do your classes online, not that you're on an island out off the shore of Maine, but..... [Laughter] Hope: Yeah I think, I think it's easier because I've done classes on site to, not having to do as my masters, but having to do with my undergrads degree. I find the digital world to be a lot more accessible, I just remember going to classes on site and didn't have a lot of input from the professor. The professor was teaching to a lecture hall full of I don't know, a hundred students, I just felt like I was kind of left out and wasn't getting all the notes that I needed to get, whereas here taking the classes online and using, again the combination of Blackboard and Learning Ally, I'm able to take the notes that I need, I'm able to contact my professors if I need to. I have peer to peer interaction as well. I feel like I'm getting a lot better education, so yeah I think, I think the online learning is an equalizer. Jeff: Mm-hmm. Hope: Of sorts. Jeff: Yeah that's great because you know everyone has to do what works for them and if you found a good way of doing it that's great, having those two apps makes it all accessible. Hope: For the most part yeah everything is accessible, even from registering for classes, I go to Missouri State University, so using Missouri State's website is accessible. It's just huge, it's what we're able to do as people who are blind and visually impaired with a digital world, it's absolutely huge. Jeff: So is that something you looked for when you were looking for an online course that they did use Blackboard? Hope: Not really, I didn't know what they used, I contacted them, I did ask them in the beginning when I was registering for the program what they used and I could have used Moodle, Moodle was another application, another learning management system that I'm familiar with and either one I would have been fine with. I looked online and and saw the collaboration between the two blindness organizations regarding Blackboard and I'm like okay this is going to be fine, this is gonna be great, I know it's gonna be accessible, I contacted my professors beforehand and gave them my accommodations and all that and said I need extra time and because it's a digital world they can input my time-and-a-half for quizzes and allow me to have that time and you know they can input that in Blackboard and all is good. I can't speak enough good things about accessibility and digital stuff. Jeff: So let's see, there's Learning Ally, we will put that in the show notes, we'll put Blackboard in the show, we'll put all these in the show notes so people can click on them and go right to the App Store or the Google Play Store and we'll have the links there, so back to the cliffhanger. [Laughter] Jeff: Hi Serina. Serina: And I thought of one like while we were sitting here, so even you'll be surprised Jeff. Jeff: Ooo. [Laughter] Serina: My absolute number one favorite app and I see it all over all of the groups like iPhone and iPad apps, and the assistive technology group, all of them, a seeing AI, I don't think it's any surprise there. That app allows me to be a lot less dependent on a human reader to just go through what's in my mailbox that I get at work. Now I can just kind of okay, yeah I need someone to finish reading that to me, or oh, this is just something that needs to go in the file, it's cut down on how much time I have to spend with somebody sitting at my desk with me going through stuff, and it's free, which is amazing to me because I remember reading gosh, I think it was like two years ago when Microsoft had their hackathon and they had released a video about seeing AI and they were showing a demo of it and I was like, well that's cool but it'll never come out and if it does it'll be super expensive. And then all of a sudden there's a link, and it's free, and it works, like amazingly and it, I can't thank Microsoft enough for that, that actually was a big surprise for me. Jeff: Yeah, you just open it up and boom, short text is reading. Serina: Yeah, from across the room right Jeff! [Laughter] Jeff: Yeah, that happened to me and, I shouldn't say it but I was that Orcam demonstration when they were having the little issues, and I was reading the wall that had their sign on it, so I was like wow, this is already talking, just out of the box, just turn it on and there it is. Male Voice: I use seeing AI all of the time to determine what's in my medicine cabinet, for documents you know I use seeing AI for short text. [Music] Female Voice: I use the document reader all the time, not gonna say it's as good as KNFB Reader because it's not. I did a test between reading my mail with it and with KNFB Reader and I found KNFB Reader to be far more stable, but I still like the app, I use it a lot, I'm glad that it's one of the tools in our toolbox. Female voice: For reading and stuff I used to go to KNFB Reader all the time but it just seems like Prizmo go and seeing AI is so much easier that I tend to go to them more. Male Voice: Seeing AI is my main go-to app and I use that, the short text channel mostly if I can't identify an item with that I will switch to the product channel if it has a barcode. A lot of the apps like [Inaudible] and Aipoly Vision and [inaudible], I've deleted most of those off of there because I can accomplish the same thing with seeing AI [Music] Male Voice: Jeffrey I see apps like Aipoly Vision, [Inaudible], Identifee, of course the KNFB Reader, I think seeing AI is becoming the main tool in the toolbox. Jeff: And you know, all the other channels that they have on their to four options but that's the one I use all the time because, you open it up it works. Serina: Yeah there's a handwriting one too that I've tried only a couple of times, but it surprisingly did recognize the handwriting enough for me to figure out at least what the note was generally about cuz sometimes my clients will stop in and I can't see them, and they'll leave a handwritten note at the front desk and obviously it's probably dependent on the individuals handwriting but I was at least able to get the name of the client and know, okay I'll just call them and see what they needed. Jeff: Hmm, well that's good. Serina: That one's in BETA I think. Jeff: Yeah you always wonder when they have a little feature that's in there and they tag the word BETA after it's like, you better use it now because it may not be there! Serina: Or it's like the disclaimer don't trust this feature. It might not work right! Jeff: Mm-hm try it on a doctor's prescription. [Laughter] Serina: Oh gosh. Jeff: That's the to test. Serina: This is totally not productive but when seeing AI first came out, we were playing with it in my office to see how old it thought everyone was. [Laughter] So all of my co-workers were like changing their hairstyles or putting on glasses or taking off glasses to try to trick it to make it think that they were younger. Jeff: That's a great use of state-funded money. [Laughter] Serina: Hey! Jeff: I know everyone's been doing that, it's kind of a novelty thing and that's like artificial intelligence to me when they're built into apps to me, it's like you know when you go to the carnival, you know, they'll guess your age and you win the whistle or something but you know, I'm not into the novelty stuff but that really does work. Serina: Hope, do you use seeing AI for any of your school work, or since it's mostly digital do you not have to use it a lot? Hope: Yeah I use it sometimes, I use it for work actually to find out whether or not my Mac, my work Mac is gonna turn on correctly. We have so many policies in place at Apple that sometimes voice-over doesn't turn on correctly and so I use either seeing AI or I also use AIRA for that, but most of the time I just grab my phone and you seeing AI. Speaking of the, or how old people were, I actually did that last weekend I think it was on my grandmother's 93rd birthday. I went up to her and took a picture of her and had seeing AI tell her how old she was, now again she's 93 right, so it said a 65 year old woman is smiling, or looks happy or something like that and she's like, wait, did it say 65? [Laughter] Hope: Shes like, I like that! So it made her day. Serina: Yeah. Jeff: I actually think for women they do have a built in algorithm that knocks off a couple years just to you know, keep the customers happy. Serina: No it added 10 years to mine, no matter what it says 10 years. Hope: Oh really. That's funny! [Laughter] Jeff: The algorithm breaker! Serina: Gosh. [Laughter] The other one that I use is obviously very similar to seeing AI but sometimes I require KNFB Reader when I have more than one page that I want to kind of read continuously. To my knowledge I don't know that you can scan multiple pages in seeing AI and if you can, somebody let me know, cuz I actually like it a little bit better. But sometimes when I'm working from home and I don't have access to my flatbed scanner but I need to read some printed like medical documents or things like that, I'll take out KNFB Reader and just scan a whole bunch of pages all at once and then read it, through it continuously, so that's very helpful, and then also you can save on KNFB Reader in their file system, and I think I saw on the latest update that now they can sync with Google Drive and Dropbox now to, so that's kind of a really cool feature that they've integrated in there now. Jeff: Yeah I like the KNFB Reader when I have like, I might have 10 pages of something to read and I don't want to take a picture of each of them so I put it on double sheet and then batch mode and when I turn the page it'll sense that, so you know you got the page turning then ch-ch-ch. KNFB Reader Voice: Manual picture button, automatic picture, picture from ste..., alert, please place your device on an empty document stand and align the camera with the aperture, okay, button, flash off, button, multi-page mode off, button, multi-page mode on. [Camera Sound Effect] Serina: Do you have a stand that you use with it? Jeff: Yeah I do, its the Fopydo and it was designed by Thomas Wardega, and here he is. Thomas: Fopydo sounds good, and I actually at that time asked my son, and it was actually a play on the on Scooby Doo. So basically this was designed from the ground up for people who are blind and visually impaired and along that process I learned to work with people who are blind so I went through a couple of revisions of the stand before I even started selling it just to make sure that people are happy with using it and that it fulfills whatever is needed from a scanning stand for people who are blind and visually impaired. [Camera Sound Effect] Jeff: It comes with a set of instructions that you can scan, you can put it together, once you got it together it just folds right up and you can put it in a suitcase, it takes up very little real estate. Serina: Oh I need one, and does it work with any phone or? Jeff: Well back when I talked with him he said it would handle, if you balanced it right, and iPad Mini, so I, I guess your your beast of a phone, your iPhone X may work. [Laughter] Serina: Yeah and put the link in the show notes cuz I've been, I thought, I had somebody looking for one before and they were like $50, I'm like mm-hmm, I'll just hold it up, you know. [Laughter] Jeff: Having the batch mode on the KNFB Reader really makes it viable product for someone that's in school that may have to be scanning a lot of pages. Serina: I definitely need one of those. Jeff: Yeah we'll put the link in the show notes and I believe he sells it on Amazon and if you have Amazon Prime, there you go, ten, twelve bucks. Serina: Primes getting expensive though it's like $120.00 starting this year. Hope: I think there's a discount for students. Serina: It's half off for students cuz I had that for a couple of years, and then they got smart and realized that I'm not a student anymore because my school let me keep my student email address for years, and I don't even think I have it anymore now. Now they make you verify by sending in like a schedule. Hope: Oh really? Serina: Yeah. Hope: Similar to Apple music, they do the same thing. Serina: Yeah, and I think Spotify does the same thing too. Hope: Yep. Serina: They got smart. Jeff: So we'll have to put the link in there for Amazon Prime half off for students, that's good news. Serina: Yeah that's it, and half off of Apple music and Spotify, not that those are, those could be productivity apps because if you need music to stay focused. Hope: Technically yeah, exactly, that works! Jeff: Or books. Hope: Yeah. Jeff: Amazon still sells books. Serina: Who orders books anymore? Jeff: Does anybody use Audible for books? Serina: I do not, I totally looked at it, but every time I looked at it I just can't, like I think it's thirteen ninety-nine a month for so many credits and one, the amount of credits you get for that amount is equal to downloading one book, and I haven't found that it's better than just using BARD, because they usually have especially if it's a best-seller what I want anyway. Jeff: Mm-hmm and the BARD app is totally accessible too. Serina: Yeah it's, it's a little old school sometimes, it has its glitches but it gets the job done. Hope: It can be yeah, exactly. Jeff: But it's, it's something that if you do send in a report and stuff like that they'll fix it? We can hope for the best right Hope? Hope: Yeah exactly, yeah sure, I'll write them, I'll give them a good report! Jeff: There you go. Hope: Sure. [Laughter] Serina: Well and it's hard because I know, I think that's run by the Library of Congress so that probably takes like an act of Congress just to get a glitch fixed you know. Jeff: Oh good one! Serina: I didn't mean it to be all cheesy but it's kind of funny. Jeff: Yeah it is, it is, it's nice when things work and you know, you were talking about seeing AI when you open it up short text just starts. I got an app called Drafts, just like the seeing AI, when you open it up it just works the short text is working, do you open it up and the cursors waiting up in the upper left-hand corner and you can start typing, you don't have to open up a new file. The neat thing is if you're in a meeting and you're taking notes and you can set it for certain increments of minutes that pass by and then next time like you open your phone, say it closed, it'll start a new file automatically. Serina: Well that's cool. Jeff: So you're not adding to your recipe you wrote two days ago that's still sitting there, do you want to save it, you don't know if you should save it, it automatically, so if you set it up for 10 minutes, if 10 minutes goes by, it saves it, and opens up a new one, just ready to go, so it's like a new sheet of scratch pad for you, can actually do some markups on it, yeah share it anywhere you want, it's really cool. I do the cut and paste and then just pop it into an email, bang! Serina: I like that, is that a free up too? Jeff: Yeah Drafts is free, I think it's called Drafts 5, there is a professional upgrade, a pro version and that is $20 a year or two dollars a month, but you can do a lot with just the Drafts app. I just love that because when you just want to take down a note, I don't like going into, I use pages because it syncs up with my apple orchard but when I'm at someplace where the meetings starting and I open up pages, you know it has to load up, it goes to the recent, and it seems like, you know all the gears have to spin around five times before anything happens, but this one opens up just bang, it's ready to go. Serina: I especially have that problem using the native Notes app on the iOS devices. Ever since they made it where you've got some notes on your iPhone, some on iCloud, some on Google Drive, or Dropbox or wherever, it's so hard for me to figure out where my notes are anymore that I just don't use that app anymore. Jeff: And that's my second app that I was going to talk about, it's the files app in iOS platform on the iPhone. Files, if you don't know where it went because it says, oh it's stored on the iCloud, or on the desktop in the iCloud, or on the iCloud Drive or wherever, and you start hunting around, but if you go to files and go to most recent, it'll check all those files, all those different drives, all the different places on your phone and everything, but if you go to recent and then if you click up on top you can go back and actually go specifically only to one area where you think it is, but if you put it on all, its checking all those drives that you have synced up with it and you can usually find it, so when I get lost for a second I just open up files and go to the most recent and there it is. Serina: That's a good tip, I didn't know that. I never really knew the point of the files app. Jeff: Yeah check it out, open it up and just see, and you'll see what you've been doing lately. Seirna: So I have one more that you do not know that is my favorite apps to use, any guesses? Jeff: Hope, what do you think it is? Hope: Hmmm, Uber, no it's not productivity, nevermind. [Laughter] Serina: Well technically it is, I do use Uber and Lyft a lot for work actually because I have to go as part of my job, I have to be at high schools and things like that and I am almost an exclusive Lyft user personally. Jeff: And why Lyft over Uber? Serina: I just have found just with my personal experience in the city that I live in that I've had better luck with Lyft drivers as far as friendliness and I have a service animal so, I've never been rejected on Uber, I'm actually, the only place I was was actually on Lyft. I found that the cars have been cleaner and the drivers just seem friendlier and with Uber I specifically am NOT a fan of the, if we wait more than two minutes, we're gonna charge you policy. Hope: Oh that's not good. Serina: Yeah that's a newer policy, maybe in the last six months and that policy just really bothers me especially when you're visually impaired. Drivers will say they're there and you're like where? You know, and if they're automatically gonna charge you, I think it's, I don't, I guess it's maybe like five dollars, if the driver has to wait I believe it's more than two minutes, like that's stressful, it's already nerve-racking like being like, hey I've got a service animal, are they gonna drive right past me, are they gonna pick me up, and then to know they're also gonna charge me an extra five bucks if I can't find them. And then they also tend to do the walk here and meet your driver thing. Jeff: Oh yeah. Serina: And I've never had that happen with Lyft no matter, I've been in downtown Denver and that's not happened before, but Uber will send you up a random parking lot or something to meet your driver. Hope: Oh wow! No thank you. Serina: Yeah so that's more why I'm Lyft exclusive, and then on the driver side I'm not quite sure how it breaks down, I don't remember how much the drivers get but I know with Uber it's not like a set percentage that the drivers get as far as, like I think it with Lyft the drivers get 75% of the fares With Uber, nobody really knows what percentage of the fare they get because they can, I've had drivers say like, yeah I've done rides Denver to you know, the DIA Airport and sometimes I get 60, sometimes I get a hundred, like there's no, I guess transparency with it. Jeff: Mmm-hm. Serina: And I can only speak to you know what I'm told, but I just personally feel better about using Lyft and for those who don't know, Lyft also released an update to their service dog policy saying that an allergy or a fear of animals is not a valid reason to not pick up an individual with a service animal and I feel like that's a very strong policy, and that's telling you where they stand on that very clearly, and I'm not, I'm not sure if Uber has come out as strong as they did. But that's all for a whole another podcast, you have to use all that when we talk about transportation. [Laughter] Jeff: No that's, that's good information because in my neck of the woods my wife uses Lyft, I use Uber and yet, I've been noticing that at certain peak times the price goes way up and other times it's low, and the waiting time changes, but you know, if it were two minutes, it's sometimes it's as low as thirty seven cents, but other times it's higher, you know, so things, I think it's the area you're in that really has, it makes a difference between which one you use, it is productivity because you got to get places and it's nice to know you can get there. Serina: And on time and on your own time. Jeff: Good. Serina: But that was a really good guess that brought on a whole another discussion, I liked it. [Laughter] Serina: But honestly we're on the app right now. Jeff: Ahh, zoom zoom. [Laughter] Serina: But part of my job is to train other people and to hold conference calls and things like that, and to my knowledge as far as like a true training platform where you can record and share your screen and things like that, I found that Zoom is the most accessible system out there that's also used by like companies all over the place. I know Skype is out there, but I don't know if Skype lets you like record the calls and things like that, I don't, like independently, not by pushing it through a different software but just right in the program recording it and having that access to be able to share your screen and still use your PowerPoint effectively and things like that. Jeff: Mm-hmm, and we're doing a neat thing for the first time here and we didn't know if we could do it but Hope sat beside us waiting patiently for us, but we figured it out and we're recording on two ends right now. Serina: Unless I pushed the wrong button again which is very possible. [Laughter] Jeff: Another cliffhanger, stay tuned next week when we find out! Serina: That will be our opener next week. Guess what I actually did it right! Jeff: You know, I'm starting to like Zoom because it's like I can't even tell you, you guys are here, because typically when we're using Skype in my headphones, I have this hiss when other people aren't talking so there's continuous hisses going on and then in the editing phase. So Zoom's really good and I really like the feature where you can send an email and people can just click on the link and they connect right up. Serina: Yep, it makes it really really easy. Hope: So a question I have, you mentioned sharing your screen, how accessible is that with voiceover? I heard through the grapevine that the voice-over will read actually what's on the screen. I don't know if it's true or not? Serina: So I haven't had a chance to test that because at work we don't use any Max, and then when I'm on a Zoom call and I am a participant I'm not usually on my iPhone. Hope: Right. Serina: So if you are leading the meeting and you're sharing your screen, it's actually pushing through a video of your screen, so it's almost like, I just imagine like a webcam watching your screen or whatever. Hope: Right, so I would assume it's not accessible then. Serine: Correct, but and I don't remember the keystroke, maybe Jeff knows, but I know in the latest major update to the OS on the Macs and iOS, you can have it essentially perform an OCR on the screen like live, with the software on the Mac, but I haven't had a chance to truly test that out just because I'm not usually on Apple devices when I'm participating. The way that I work around that, because I do have to present to individuals that use screen readers as well sometimes, is I usually will send my PowerPoint out ahead of time so that they can follow along while they're listening to the meeting, but then they also have access to the chat panel and everything else, it's just the visual of the video that they're not quite having access to but I, I just send it out ahead of time. Jeff: Yeah I haven't dug too deep into this, but Serina told me about Jonathan Mosen's book, and he did a full fledge book on using Zoom for calls and meetings and stuff like that, and yeah, I believe you can get that on Mosen's consulting on the website, and we'll put a link to that in the show notes. Serina: Yeah the book is called "Meet Me Accessibly" and it's very current based on, because I listen to maybe four or five chapters so far, and it sounds like he recorded it maybe in June of 17 and he does a really good job of letting you hear the screen reader and how it interacts with everything and going through all the different settings and explaining what exactly it is that they all do. Jeff: Yes he does he has quite a few books on Mosen's consulting so when you get there, just look around and he has tutorials on a lot of different topics, he's into the Mac, he's into, no not the Mac as much anymore, but he's into the PC, Microsoft. Serina: All these plugs Jeff, you're going to need to get some royalties! [Laughter] Jeff: Hopefully I get their name right and their website right. Another app that I have that I use and some people laugh at this, I use Dictionary Thesaurus Plus, and if you get the dictionary you can upgrade and you get, its a combination of Dictionary and Thesaurus Plus and I get the word of the day, and I'm just waiting to get that specific word to send Serina because she laughed at me when I talked about this app before. But it's just kind of neat because in there, they have flashcards and I'm on the bottom, they're not labeled but I figured out what two of them are, flashcards, so I took insight today just when I was skipping around there and I made a flashcard so on one side it says insight, on the other side it says the definition, so someone could actually go through there if they have a 10 word list that need to know or learn, like they're in school and they could actually input the word, get the dictionary, and there's also a button that says go to page, so if you want more definition you can just click on it, brings it right to the dictionary page and it's just kind of a neat resource if you're into that you know. If you want to know what words mean. Serina: Well that could you, I mean you just brought up a good point though, that could be a really good study aid for somebody if you're in a class where there's a lot of maybe theories, or specific definitions you need to know, you could load all those in there and while you're on the bus or whatever kind of be going through those, probably a more fun way than just reading the book. Jeff: Yeah and that's why I did it, like when I took Spanish, I made, I made note cards. I took these note cards and I brailled on one side, and then on the other side I had some other Braille, the translation in English to what it was, so I could just go through, and people were like joking with me like, Oh flashcards, it's like it's something for the kids or something, but hey, it's a good learning tool because it's just repetitious and pretty soon it just starts coming to you. Serina: Mmm-hmm. Jeff: So I dug right in when I saw they had flashcards, I went wow! So I really like that and it's, uh I think there's a fee for the upgrade, might be a few dollars but you can get download at all for free and test it and then in the in-app you can upgrade. Serina: Nice! Jeff: Well I think we got a handful of apps here that you know through experience we, we've been trying, we've been using and stuff. Some of these apps if you find them useful click on the show notes, download them, check them out, and if you have any feedback or suggestions on the apps that you want us to do on our next show, give us a jingle, drop us an email at JobInsights@blindabilities.com, on Twitter at Job Insights VIP, and uh, let us know what you think. Serina: What are we talking about next tiem John....John? Wow! Sorry! [Laughter] Jeff: Well Sarah! [Laughter] Jeff: What will our next one be on? Serina: I don't know, we have so many topics, normally I'm like, let's take this, let's let Hope pick the next topic, no pressure! Hope: No pressure yeah right mm-hmm! Let's do transportation since we kind of talked a little bit about it in this one, that would make sense. Serina: Getting to work. Hope: Yeah, absolutely. Serina: Perfect. Jeff: Getting to work, school, college. Hope: Yeah. Jeff: There you go Sarah! Serina: Stop it! [Laughter] Jeff: And if you want to contact Hope, she's on Twitter. Serina: If you want people to have it? Hope: Yeah my Twitter is Fidelco, capital F as in Foxtrot, I, D as in Delta, E, L, C, O, 4, the number four, ever. My email address is hopepaulos@gmail.com, so hopepaulos@gmail.com. Jeff: Well Hope thank you very much for coming on to Job Insights, it's really neat to have you and we're gonna have you back as soon as possible here for our next round table. Hope: Thank you so much Jeff and Serina, it was wonderful being here. I appreciate it! Serina: Yep, you have a great day! Hope: Thank you! Jeff: Do you know it's nearly midnight and you said have a great day? Serina: Well this will come out during the day. [Laughter] [Music] Jeff: It was a real pleasure having Hope Paulos join us on the show today, all the way from Maine, and next week when we're talking about transportation all the way from New York we'll have Joe De Niro, so stay tuned to the next episode of Job Insights. And a big shout-out to Chee Chau for his beautiful music and you can follow him on Twitter at lcheechau, as always thank you for listening, we hope you enjoyed, and until next time bye-bye [Multiple voices] When we share what we see through each other's eyes, We can then begin to bridge the Gap between the limited expectations and the realities of Blind Abilities. Jeff: For more podcast with the blindness perspective, check us out on the web at www.blindabilities.com, on twitter at BlindAbilities, download our app from the app store, Blind Abilities, that's two words, or send us an email at info@blindabilities.com, thanks for listening.
Job Insights #3: Mastering the Elephant in the Room - Disclosing a Disability in the Job Interview Process. Transcription Provided Full Transcription Below Welcome to Episode 3 of Job Insights with Serina Gilbert and Jef Thompson. We focus on Employment, Careers, enhancing opportunities and bringing you the latest innovations from across the Vocational Rehabilitation field to ensure your choices lead you down the career pathway that you want and succeed in gainful employment. From getting started with services, to assessments, Individual Plan for Employment (IPE) to gaining the skills to succeed and tools for success, Job Insights will be giving you tips and tricks to help your journey to employment and break down the barriers along the way. In this episode we take on the White Elephant in the Room, that is, the job interview room. With guest voices answering the question, “Do you disclose your disability during the job interview process, and if so, when do you disclose?” Hosts Serina Gilbert and Jeff Thompson take a good look at this Million Dollar question from all points of view and leave you with information that will better prepare you for your job interview process. There may not be one set way and being prepared for the job interview gives you an advantage that may help you land the career you want. Check out episode 3 of Job Insights and send us your feedback and topic suggestions by email. mailto:jobinsights@blindabilities.com Follow the Job Insights team on twitter @JobInsightsVIP http://www.twitter.com/jobinsightsvip Job Insights is part of the Blind Abilities network. Thank you for listening. You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Get the Free Blind Abilities App on the Google Play Store. Full Transcription [Music] Female voice: And most of the people that worked there did not know that I had any sort of vision impairment or anything like that, and at that time I was not comfortable walking around with my cane. Jeff: Job Insights, a podcast to help you carve out your career pathway and enhance the opportunities for gainful employment. Female voice: Because an interview is not just the employer figuring out if they want to hire you, it's you figuring out if you want to work for the employer as well. Jeff: To help you navigate the employment world and give you Job Insights and enhance the opportunities to choose the career you want. Selling yourself, you want to be the best box of cereal on the shelf because when people come down they're looking at all the colors all the things, what makes them pick a certain box? Is it the toy inside, is it the fancy colors? So you had to start selling yourself and be the one they pick. Female voice: If you have more of a obvious disability, you want to make sure that you kind of address that in a way that makes it so that they're not thinking about that, they're thinking about your skills, that's what their inner monologue isn't about you, it's about what they think that you can't do in their bias. Jeff: And you can find the Job Insights podcast on Blindabilities.com, part of the Blind Abilities network, with host Serina Gilbert and myself, Jeff Thompson. And you can contact us by email at Job Insights@BlindAbilities.com, leave us some feedback or suggest some topics that we cover. On Twitter at Job Insights VIP and check out the Job Insight support group on Facebook where you can learn, share, advise, and interact with the Job Insights community. [Music] Female voice: I didn't catch them off guard by showing up with a cane, and I found that that approach worked really well for me. [Music] Jeff: Learn about resources for training, education, and employment opportunities. Female voice: I think sighted people just like since video calls exist, they, that's what they use, so it's definitely becoming, it's going to be a type of interview than most people will have I think. Jeff: And now please welcome Serina Gilbert and Jeff Thompson with Job Insights. Hey Serina! Serina: Hey Jeff! Jeff: To disclose or not to disclose, that is the question I ask of thee. Serina: Have you been reading Shakespeare? Jeff: No, but I have been reading the Job Insights support group page. There's been a topic going on there about disclosure. Serina: Yeah it seems like a lot of people have some different opinions on, do I talk about my disability in the job interview, do I not? [Sound Effect] Female voice: I have a very disability in that I use a cane, and I can't make eye contact and so I find that usually, and this is the same thing that I did after the phone interview but before the in-person interview, I disclosed. [Sound Effect] Female voice: Do I talk about it when I'm doing my cover letter or my resume or not? [Sound Effect] Male voice: If you're applying for a position and it involves using some kind of accommodation, then it's probably wise to disclose it. [Sound Effect] Serina: And I really wanted to see if we could talk about that a little bit today get some different opinions. [Sound Effect] Female voice: If I need to than I do, if I don't need to I don't. [Sound Effect] Serina: Just get it all out there, I know this will be a pretty divisive topic, everyone has some pretty strong opinions on disability disclosure. We're here to offer you some tips on what might help you in the job interview process, when might be a good time to disclose and work to your advantage in a job interview, and maybe when might not be a great time to bring that up in a job interview. Jeff: And when to know the difference, that's um, I think the most important thing. Serina: Exactly. Jeff: Some of the topics that came up really shocked me like, I do my own accommodations a gentleman said, and that just made me cock my head and I had to think about that for a little bit, and yeah I get that, or someone says how dare you can you show up and shock them by showing up with a cane, you didn't tell them, and I'm thinking, like in some situations the resume does not have a spot for that, they may be able to dissect it out of the some of the positions you've held, or some of the companies who worked for, but I think mostly it's one of those situations that you're prepared for either way. Serina: Well and it's interesting that you brought up the I provide my own accommodations piece of the equation. I respect anyone who wants to step up and say here's what I need, I already have it, that's great, but in a lot of systems you can't install your own programs onto computers without having some significant permission. For example I work for a government agency, there's no way they're gonna give me an administrative password and all kinds of leeway to install any programs that I want because who knows what they could do to their network. Of course I know that JAWS is safe and I know that they know that JAWS is safe, but they still have to have some sort of system for managing the programs that are on their server and other network because what if you install a pirated piece of software then what, not saying that you would, most employers unless it's a real small company, it is their legal responsibility to provide you with that reasonable accommodation so why not take them up on it as opposed to using your hard-earned money to purchase those licenses and keep that up on somebody else's computer. Jeff: So having JAWS, having accommodations, and talking to them about accommodations that to, to read the screen, you can even have a person come in to do evaluation of what kind of software they're using, what kind of databases they're using, the see if you can gain access, and further down the line some scripts could even be made to help these specialized programs that they utilize just so you can overcome that hurdle, and it might be just a button that you have to get past. Serina: Exactly. Jeff: So there's some great services that are out there when you're trying to get a job, especially when you're into the job field, it seems like State Services has a whole arsenal of people that are help at that point, or if you're trying to retain a job too. Serina: That's a really good point, yes if you maybe already have a job, gosh I didn't even think about that Jeff, if you, if you already are working, I've seen that and quite a few of the support groups on Facebook, I'm working, I'm losing my vision, I don't think I can work anymore, and just remember that if you are having vision difficulties at work, you are still able to go apply for services at vocational rehabilitation and see what kinds of things they might be able to put place so that you can keep your job. I'd hate to see somebody that has 20 or 25 years in a career and you're just that close to retirement and feeling like you have to give up because your vision is changing with all the technology that's out there now, not saying it's gonna be easy, there's gonna be some learning curves for sure, but the sooner you start getting those services, the sooner you can get back to working in the job like you used to. Jeff: Yeah and that job retention it's a lot, I'm not gonna say it's a lot easier, but what it does is, you're gonna go into some specifics you know, you're just gonna do this to bridge this, to bridge that, to shore up what you're not able to do because it's obvious right away, rather than if you leave the job you go back home then you get to start from scratch like, I want to learn how to cook, I wanna, you know so it's interesting at different points when people are losing their vision, but when we're talking about disclosure, is that's a unique point too. I suppose because I've been blind for so long that to me I can live within my skin, and I think the difference is people who are trying to, especially high partials, or partials, they're either around blind people, there the sighted person around sighted people or they're the blind guy, or the blind person. Serina: Mm-hmm. Jeff: But at a job interview, there's a quandary there, do they use their cane or not use their cane and bump into things or do they bring their cane? Serina: You just brought up a really interesting point because I just thought back to when I was 19 and I started getting cane training from vocational rehabilitation, and at that time I was a cashier at a retail store, and most of the people that worked there did not know that I had any sort of vision impairment or anything like that, and at that time, I was not comfortable walking around with my cane. I'd rather bump into somebody then be seen as the blind girl. So at the age of 19 I would have absolutely said, no way I am not disclosing my disability, I can do it just as well as anyone else. I will just work twice as hard, and struggle at times, but now gosh, 20 years later ish, I think totally differently I, I could never personally see an instance where I would not want to disclose that because I don't want it to be the elephant in the room, when I'm being interviewed. Jeff: Mm-hmm. [Sound Effect] Rob Hobson: It's really up to the individual, some people like to not say a thing, show up to the interview, surprise I'm blind, you know, granted they don't say that. I think to the interviewer that, that's a surprise, but if you want to go that route, that's totally fine it's entirely up to you. But I want you to think about something when you go in for that interview, blindness is that, the white elephant in the room, if you don't address it, you're left to whatever conceptions they have a blindness, positive or negative, but if you address it as in a positive way, you bring up the fact that you are blind, and that you utilize accessible technology via you know whether it's JAWS or NVDA, or a system access, whatever it is you use, explain to that employer why you're the best candidate for the job. The long answer is, it's up to the individual, but if you don't address the fact that you're blind, I think it puts you at a disadvantage. Jeff: And that was Rob Hobson, he's the director of programs at Blind Incorporated in Minnesota. [Sound Effect] Jeff: And that's what it is, it's that the elephant in the room, and if you don't squash that, they're gonna paint their own picture as big as a an elephant any way they want to. Serina: Well and the reality is is that every employer knows that they can't come out and say, what's your disability, they can ask, do you require any reasonable accommodations to perform the essential duties of this job, which is a roundabout way of still figuring it out obviously. But if you're coming to an interview and you're using a service animal, or you have a cane, it's right out there and then they're just wondering, well how on earth is she going to be able to do this, or how is he going to be able to spellcheck documents for me, or access the computer? Because the technology that we use is not mainstream, most people don't even understand what a screen reader is unless they know somebody who has a visual impairment. Jeff: Mm-hmm, yeah and that's the point where you have the opportunity to educate them and sell yourself with the skills that you do have. Serina: Exactly, one of the other panelists did bring up a really good point. If it's a phone interview, that's totally different, they don't see you, they have no clue what you look like, what your abilities and capabilities are, and then what you're selling to them. I don't think I would mention it in that interview type of setting, what about you Jeff? Jeff: No I really don't think so, I think the phone call is a situation where they're just starting to get a good feel of how you, you know your social skills, they want to find out if you're a good fit for the team, for the company. Serina: Correct, because we talked about this a little bit on our very first podcast, if you got the interview then they have already determined that you're qualified for the position, they're just trying to see if you're a good fit for the office but, whether that be the culture, or some more specific questions that they weren't able to flush out in the application process, by not discussing your disability when you have a visible disability, you're almost causing the employers to only focus on the fact that you just walked in with a service dog, or with your cane, and is human as people want to be, and is empathetic and understanding as they claim to be, that's still going to be in the forefront of their mind especially if they're not familiar with your disability. Jeff: That's where Daysha the employment specialist brought up a very good point about where you're just talking about and she called it the internal monologue that the hiring person will be creating. [Sound Effect] Daysha: When you do talk to somebody, especially if it's an interview, you're gonna get that tell me about yourself, you could even get that when you just meet an employer at a job fair or an internship fair, tell me about yourself. You want to make sure especially if you have more of a obvious disability, you want to make sure that you kind of address that in a way that makes it so that they're not thinking about that, they're thinking about your skills. A lot of people make the mistake of never seeing anything and then an employer, the whole time that they're talking is thinking, well because they don't have any experience with vision loss, so they're thinking to themselves, I don't know that I could do that if I couldn't see right, I'm not sure that they're gonna be able to do that, that's what, their inner monologue isn't about you, it's about what they think that you can't do and their bias. Tell how you do things, go into it with confidence, know what your skills are ahead of time, know what you have to offer an employer, and just go into it that way. [Sound effect] Serina: Exactly they start putting those doubts in their mind. I don't know if they'll be able to do this, what about safety concerns? That's a really big one, is my workers compensation insurance going to go up because I have this individual in my office who's presumably, whether correct or incorrect, going to be causing more workplace incidents or accidents. Which we all know if you've gotten your orientation and mobility training in your personal adjustment training, your always more safe than the people who are sighted in the office, because you're not walking around on your cell phone or distracted. [Laughter] Jeff: We'll have to put in ramps and handrails, we'll have to label everything and yeah, but you can control that, and I think at that point, you know you're coming in with a cane and you know they don't know it yet, so that's your opportunity right there, that's your opportunity to call out the white elephant in the room in your favor. You can address it and you can tell them exactly like we said, selling yourself, you want to be the best box of cereal on the shelf, because when people come down, they're looking at all the colors, all the things, what makes them pick a certain box? Is it the toy inside, is it the fancy colors? So you have to start selling yourself and be the one they pick. Serina: It's interesting that you mentioned when you come to the interview, let's say with your cane or your service animal, I have seen situations where individuals do have a visual impairment that warrants the use of a cane and they opt to not bring that to the job interview, and I have seen that cause some problems, because when you don't have your cane or your service animal that could create some super awkward situations when you're trying to interview with the employer. As an example, the employer comes out to the lobby to get you, and maybe your vision is not adjusted or whatever the case may be to that particular office environment, and you're walking not so steady, or unsure about yourself, just think of the assumptions that they're putting in their mind now with the individual that's interviewing for the job, but not walking appropriately in their office, or not making eye contact, or not quite getting the handshake. Jeff: Mm-hmm, yeah and that's very important because myself, I have no central vision, and I can pick up some peripheral stuff, but in an interview you're probably trying to make the best eye contact you can, and I was just in an interview, this was a podcast interview and I told the person right off the get-go, don't think I'm looking over your shoulder or something behind you because that's how I sometimes pick things up by looking away from what I'm really looking at, so I actually made them feel more comfortable than them trying to talk during the interview wondering, what's behind me he keeps looking at, or something like that. Serina: Exactly, yeah. Jeff: In reality I, whatever I'm looking at I can't see anyways, so you can control the situation. They're going to start working this white elephant up in the room, they're gonna start, and not even hearing what you're talking about, all the stuff you're talking about, so you have to get control of the conversation a little bit and that's where you can start saying that, how you overcome doing job details that they want like word document that you use because you use JAWS, or how you can use other type of apparatuses or tools for success that get you to the point where you can compete against anybody that they hire. [Sound Effect] Miranda: I say no because I feel like with as much misunderstanding as there is in the world with with blindness, it's easy for a employer or potential employer to look at your resume and see that you're blind and see all these other resumes that he's got to go through that are just as educated, just as qualified as you are, and to simply just let that one go, like alright, I'm not gonna deal with that. I mean because you're you're talking about them having to deal with ADA and all this, all that other kind of stuff, walk in there confident and stuff, don't disclose before you go in, and just be like, hey this is what I can offer your company. If you made it in there, if they invited you in then that means you're qualified and you should have a shot at it just as everybody else. Jeff: You're listening to the voice of Miranda Brandenburg, she's a certified personal trainer and nutritional specialist. Miranda: The vast majority of people out there have never dealt with a blind person or encountered someone, especially one that is out there making waves, that's out there leading the charge, that's out there willing to work and get in there and travel and do this and do that and get out on the mat and fight and compete with sighted peers on every single level that they can. [Sound Effect] Serina: And it doesn't have to be the first thing you talk about you know, it can be something that, because I've never been an interview that didn't say at the end, do you have any other information like to offer me, or do you have any questions for me, I don't, what about you Jeff? I've never not been asked that? Jeff: Every time and have that question, because they want to know something, so I suggest before you going into an interview, go online, read their mission statement, see what company they are, see what they're all about, what, what's their key words, and that's something that you might want to integrate into your dialogue with them, and then when they come with that question, ask that question, like do you have any questions about my ability to do this job? Serina: And the way that I've approached it, I've only had to do it once, because one was I was applying for a County job at a local Workforce Center, and the second interview was using a white cane, was at the division of vocational rehabilitation. So it could not be more of a comfortable environment. I didn't even have to address it there, but the first one I did come in, I had my white cane, towards the end they said, do you have any more information you'd like to share with me? And I said well, you know, you obviously know I have a visual impairment, I just wanted to give you some information on the technology that I use in order to get things done, and I had gone as far as to print out some real short tip sheets on, at that time I was using a portable CCTV, and JAWS, so that they knew I had already thought about the types of things that I might need on the job and was already skilled in that, so that they didn't have to worry about, okay, obviously I'm gonna have to train her on our procedures, but is she also going to have to get training on her technology needs. Jeff: Mm-hmm, and that's a good point to come in there and let them know how you're gonna access the material that they have. Serina: Mm-hmm, now I have seen some questions in our support group about, do I disclose in the application process? A lot of applications are automated and they, some of them do ask if you have a disability. So I wanted to talk a little bit about that because, yes they might be asking if you have a disability, but if, unless they're breaking the law, that information is not to be passed on to the hiring manager or the individual that's reviewing your application. Typically when they're asking if you have a disability or require reasonable accommodation, that information is used for one of two things. The first would be that there is a program called Work Opportunity Tax Credit which allows employers to have taxes reimbursed to them to offset hiring expenses and things like that for hiring individuals in a variety of situations including those that have a disability, as well as those that are on public assistance, or they're using it because they know that they have some sort of testing that all the applicants have to do, and they really truly are trying to reasonably accommodate anybody that might need those accommodations. So I wouldn't hesitate to answer that personally because that could put you in an awkward situation down the road should you have to take, for example if you're applying at a call center, should you have to take one of their tests and all of a sudden you're asking for an accommodation when on the application you said that you don't need accommodations or don't have a disability. Jeff: And the same thing in Minnesota our Governor passed two years ago, he passed the proclamation that 7% of all employees in the state jobs, they'll hire people with disabilities to fill that 7% goal that they want to have, and so in some applications, some situations, there is a checkbox for that, and that way companies that do want to hire people can have that choice too. Serina: And that brings up another good point, the federal government also has a mandate that they have to hire a certain percentage of individuals with disabilities, and in fact, if anyone has been through that federal hiring process, it's a nightmare to say the least. If you do not check that you have a disability, then you're not going to be considered in any of the priority categories which means that your application might never even get looked at for open position. Jeff: Yeah it's a tough area and a lot of us, like I said on the last podcast, a lot of us aren't fully up on everything that there is to know about blindness when you probably, if you weren't born blind, or you just became blind, there's a lot to learn and there's lots of people that are offering suggestions and no one's really wrong, but I think the best fit is the best fit that you feel most comfortable with because if you're uncomfortable they'll know you're uncomfortable with it so, that's why in Minnesota here at the state agency, they do tutoring on job interviews, mock interviews, where you do get the situation that you know, mister mister boss might ask questions or make you feel awkward in a sense just so you can understand that every interview that you go to, you're gonna get a different person that has different preconceived ideas and it's gonna be in a different situation each time. So if you have an opportunity to try a mock interview, that'd be really great experience. Serina: Well and frankly I remember reading an article, I think it was last year, people are actually scared of blindness, they would rather have cancer than be diagnosed with being blind or visually impaired. So imagine that fear then being put into the situation of, oh my gosh how could I possibly hire somebody that has this visual impairment? If you don't address how you do things in the workplace. Jeff: Mm-hmm that's a great point, another great point is to remember they want to hire someone who can get the job done. Bottom line, get the job done. Susan Robinson, an entrepreneur out in New York and a TEDx speaker, and visually impaired by the way, she told me that she has never terminated a person because they were sighted. Serina: Hmm, that's an interesting way to put that. Jeff: Mm-hmm, she has a job that she needs to get done, she wants to hire the person that could come in and do that job, that's it. Serina: Wow, look at you getting all philosophical over there! [Laughter] [Sound Effect] Female voice: To me it was no different than anyone else doing the same thing with the exception of letting people know during an interview process what I might need from them. So again it was the same sort of self-advocacy to use your wonderful term as I did in college, so in an interview process, the first interviews is sort of getting to know each other, do I think I like working for this person? Because an interview is not just the employer figuring out if they want to hire you, it's you figuring out if you want to work for the employer as well. Once we got to maybe a level 2 or level 3 conversation in the interview process, at that point when it seemed to be a little bit more concrete that the position possibly could be mine, I would disclose and I would say, I just want to let you know I have a visual impairment, it may not be obvious to you, but what that means is I'm gonna bring everything that we've already talked about, my, all of the skills and characteristics that we've discussed, but I am going to need a large monitor for my computer so that I can see things you know enlarged a little bit, and generally people were very receptive to that because again I'm letting them know which is what every potential employer wants to know, can you do the job, are you willing to do the job, and are you going to be a good fit? [Sound Effect] Jeff: Serina, when we had our conversation with Cindy Bennett, a researcher out in Washington and a former intern at Microsoft, she mentioned something that we hadn't even considered, and that was, an interview via videoconference. [Sound Effect] Cindy: I think if I had a video interview I would probably disclose, but I would frame it something like, I'm actually blind so, I might be like, hey does the camera look okay, okay cool, like just like that, just really quick. I do practice if I do a video interview, I always like first of all clean my apartment and look nice. [Laughter] Second of all, I set up my computer on a table in front of my couch and call someone I know, like I video call someone I know and they tell me okay this is good. I found that just like a quick little thing at the beginning of the video interview, I'm like, oh by the way I'm blind, I just wanna make sure that you can see me okay in the camera. If it's an old-fashioned audio phone interview, then usually the person emails me and says we'd like to invite you for an in-person interview and I say thank you and confirm the dates and say, oh just for your information, I'm blind, here's what I need. Jeff: Were you excited when we asked for a podcast that you didn't have to clean your house? [Laughter] Cindy: Yeah [Laughter mixed with inaudible talking] I don't want to do a video call ........ I think they are important things to think about, like I honestly with a lot of my colleagues now that I'm comfortable with them, I'm just like, can we just do audio because then I can just set my phone down beside me and we can go on with our business, but I think sighted people just like, since video calls exist, they, that's what they use. So it's definitely becoming, it's going to be a type of interview that most people will have I think. Serina: I honestly didn't even think about how the video interview, how that would be impacted by the visual impairment, so I'm glad you brought that up because I haven't had an interview for a job since 2010 and it was definitely not when people were doing video interviews or anything like that, so that's definitely something to think about. [Sound Effect] Jeff: It's really great that so many people came on board and shared their experiences, the way they handle disclosing a disability during an interview and the people leaving comments on Job Insights support group page on Facebook. And to sum it up, here's Rachel Hastings, she just got done running the marathon, the Boston Marathon and she's a music therapist. [Sound Effect] Rachel: I've done it both ways, so I've done it one time I didn't tell them that I was blind until I got there and I think it kind of caught him off guard. I mean part of me is like deal with it, but the other part of me is like, well you know, there's no harm in telling them over the phone. After they invite you to an interview, and so because I kind of felt like I made it awkward, so the next time I was first offered a phone interview and I told them over the phone, I'm like, by the way I want to let you guys know that I'm legally blind, but I'm very independent and that, that was after they invited me for an in-person interview. So it's like there was no way they could turn me down but yet I didn't catch them off-guard by showing up with a cane in person, and I found that that approach worked really well for me. [Sound Effect] Jeff: So Serina, next week we're gonna be talking about some apps. Apps for the workplace, apps for productivity, apps for a school. Serina: Yep, I know that I have my favorites. Jeff: Hmm, you gonna save them, you're gonna make us wonder till next week aren't you? Serina: You guys will have to wonder till next week. Jeff: The cliffhanger strikes again. [Laughter] Serina: So I'd like to thank everyone for listening to our show today. As always if you have any questions or topics that you'd like us to follow, you can give us a message on Twitter, that's at Job Insights VIP, or on our Facebook page which is Job Insights, and we also have a brand new job insight support group on Facebook, just search Job Insights support group, see you next time. [Music] Jeff: Thank You Chee Chau for your beautiful music, that's lcheechau on Twitter. We really hope you enjoyed this podcast, thanks for listening, and until next time bye-bye! [Music] [Multiple Voices] When we share what we see through each other's eyes, we can then begin to bridge the gap between the limited expectations and reality of blind abilities. Jeff: For more podcasts with the blindness perspective check us out on the web at www.blindabilities.com, on Twitter at Blind Abilities, download our app from the app store, Blind Abilities, that is two words, or send us an email at info@blindabilities.com. Thanks for listening.
Job Insights Episode 2 - Vocational Rehab 101: Demystifying the Myths and Planning For Employment Welcome to the second episode of Job Insights with Serina Gilbert and Jef Thompson. We focus on Employment, Careers, enhancing opportunities and bringing you the latest innovations from across the Vocational Rehabilitation field to ensure your choices lead you down the career pathway that you want and succeed in gainful employment. From getting started with services, to assessments, Individual Plan for Employment (IPE) to gaining the skills to succeed and tools for success, Job Insights will be giving you tips and tricks to help your journey to employment and break down the barriers along the way. In Episode 2 of Job Insights Serina and Jeff break down Vocational Rehab services from eligibility, intake, personal adjustment training, training centers, and your responsibilities as well. Navigating the services may seem daunting at first but with a little bit of information and explanation you will soon fine your pathway to gainful and meaningful employment does not have to be a solo journey. Your Voc-Rehab team wants you to succeed and is their for you all the way. Full Transcript Below We hope you enjoy this Job Insights episode and you can send your feedback and suggestions to the Job Insights team by email at JobInsights@BlindAbilities.com Follow the Job Insights team on twitter @JobInsightsVIP Job Insights is part of the Blind Abilities network. A big Thank You goes out to CheeChau for his beautiful music! Thank you for listening. You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Transcription: Job Insights Episode 2 - Vocational Rehab 101: Demystifying the Myths and Planning For Employment Serina: I know sometimes that a lot of individuals can be a little bit overwhelmed by applying for services with vocational rehabilitation and we'd like to hopefully demystify some of the myths and help you learn a little bit more about the process. Jeff: Job Insights, a podcast to help you carve out your career pathway and enhance the opportunities for gainful employment. Serina: Helping you with independent living skills, helping you get around town, helping you with cooking, money management, all those things that you need in order to be successful on a job. Jeff: Learn about resources for training, education, and employment opportunities, to see what best suits you to see if you're prepared to move on to the next step. Serina: Correct. Jeff: Thus it's an assessment. Serina: Correct, it helps the counselor out and it helps you out too. Jeff: We will hear from people seeking careers, employment from professionals in the educational field, teachers and innovators in this ever-changing world of technology to help you navigate the employment world and give you Job Insights, and enhance the opportunities to choose the career you want. Serina: We would hate to see you move forward with an employment goal that you thought you would absolutely love, only to find out maybe three months into the job that you obtain, that you really don't like it so much, so it helps us save a little bit of time and prepare you for realistic expectations on the job. Jeff: You can find the Job Insights podcast on BlindAbilities.com, part of the Blind Abilities Network, with host, Serina Gilbert and myself, Jeff Thompson. And you can contact us by email at jobinsights@blindabilities.com, leave us some feedback, or suggest some topics that we cover, you can also follow us on Twitter at Job Insights VIP, and check out the job inside support group on Facebook where you can learn, share, advise, and interact with the Job Insights community. [Music] Serina: Sometimes it might be getting more evaluations done with an orientation and mobility specialist, or a vision rehabilitation therapist to see what kind of personal adjustment training you might need. Jeff: And now please welcome Serina Gilbert and Jeff Thompson with Job Insights. Serina: Hi Jeff how are you? Jeff: I'm doing good how are you Serina? Serina: I'm doing great, how was your week? Jeff: It was good, it was good, the sun has come, spring is finally here. Serina: I don't know, I think you might get some more snow. It's not May yet. Jeff: We're just so glad to have it, I already got the patio furniture out, so I'm excited, I'm excited. Serina: You gonna be barbecuing for me? Jeff: We did that yesterday. Serina: Nice! Jeff: And I didn't even let you know did I? Serina: No you didn't even invite me, even though I'm, I don't even know how many miles away from you. [Laughter] Jeff: I'll waft the barbecue smell west. Serina: Send it over with an Amazon drone you know. Jeff: There we go. I wonder what that sound will be? Serina: They'll probably have like a special Amazon Prime sound for us all. Jeff: Oh yeah so it's recognizable. Serina: Everyone's jealous because we got something from Amazon. Jeff: The dogs will whine just a little bit, it is exciting though when a package comes. Serina: So I heard that we got a ton of positive feedback on our very first introductory episode to Job Insights? Jeff: Yes we did, it did not come by drone, but we got so much positive feedback, it's really exciting. Serina: I think that's great. I know today we were talking about vocational rehabilitation 101, and we'll chat a little bit about the process, what to expect. I know sometimes that a lot of individuals can be a little bit overwhelmed by applying for services with vocational rehabilitation and we'd like to hopefully demystify some of the myths and help you learn a little bit more about the process. And I know, as I talked about on the previous podcast, I was also a client of vocational rehabilitation and I believe you were as well right Jeff? Jeff: Yes I did, but unlike yourself Serina, my ophthalmologist did not send me there, so getting started with State Services was interesting. Serina: At least you got connected, that's that's the biggest part. Jeff: Mm-hmm. Serina why don't we start out by telling the listeners a little bit about what it takes to qualify for services, and if it's a federal or state standard that they go by. Serina: So it's a federal mandate, the eligibility requirements for vocational rehabilitation systems, in general, you have to have a documentable disability that poses some sort of barrier towards you entering into employment, keeping employment, or advancing in the current position that you have. You also have to be able to basically benefit from the services and that's a presumption that most agencies make. Jeff: A presumption? Serina: A presumption of eligibility. Jeff: Hmm? Serina: Another eligibility criteria that helps is, I believe if you receive SSI or SSDI then you are automatically eligible for vocational rehabilitation services. Jeff: So that's usually a process when you go there for services then you probably have to get it to go to a doctor so it's documented. Serina: Well, you can go to a doctor, but if you do not have documentation of your disability, vocational rehabilitation can actually either send out for the records, or send you for evaluations in order to obtain that documentation. Jeff: And that's just one of the steps of the intake process. Serina: So that first step is your intake appointment, which your counselor will go over a ton of different paperwork with you, you'll sign some releases of information for them to be able to talk to necessary individuals that might be working with you on the case, or to obtain medical records, or again refer you for those necessary evaluations, and from that time frame of the first date that you officially apply for services your counselor has up to 60 days to determine you are eligible for services. It can take that long depending on the counselors caseload, but sometimes it's faster, it just depends on the documentation that you already have, and what that counselors caseload looks like. Jeff: Is that the same for when agency is on order of a selection? Serina: Correct, they still have the same 60 days eligibility determination requirements, even if they do have a waitlist or order of selection. Jeff: So if they determine on the intake that you're in, then what's the next step? Serina: The next step is what's called the comprehensive assessment. What happens in this stage is you and your counselor are working together to identify a reasonable and suitable employment goal and also identify the necessary services that might be provided to you in order to help you achieve that employment goal. Sometimes this process could include you trying out work, doing what's called a situational assessment, and that would involve you going to a worksite and trying out the job to see if you like it, see that the duties are something that work well with your personality, in your disability, and also to help you with networking. Sometimes it might be getting more evaluations done with an orientation and mobility specialist, or a vision rehabilitation therapist to see what kind of personal adjustment training you might need. Jeff: Serina, personal adjustment training, can you break that down for our listeners? Serina: Definitely, personal adjustment training might include helping you with independent living skills, helping you get around town, helping you with cooking, money management, all those things that you need in order to be successful on a job. Jeff: And typically you could be sent to a blindness training center or a vendor of the agency? Serina: It depends on this state, some agencies do use the blindness centers, some do have in-house service providers that work specifically for DVR, or third-party vendors like you mentioned, and then I'm not sure about other states, but here in Colorado we do actually have a center based program that the vocational rehabilitation program staffs as well. Jeff: And in Minnesota were fortunate to have three adjustment to blindness training centers, Vision Loss Resource in Minneapolis, Blind Incorporated in Minneapolis, and in Duluth we have the Lighthouse for the Blind, plus State Services for the Blind, and various vendors that will provide specialized services as well. You mentioned doing a situational type of thing where you go to an employer and they do an evaluation, would that be set up with your employment specialist to see if this is an interest of theirs or to see if they like it? Serina: It can be set up through an employment specialist if the state that you work in is structured in that manner, sometimes it's your vocational rehabilitation counselor that's setting it up, and sometimes it can even be a third party vendor that you're working with that is providing that assessment service for us. Jeff: And this is all in an attempt to see what best suits you to see if you're prepared to move on to the next step. Serina: Correct. Jeff: Thus it's an assessment. Serina: Correct, it helps the counselor out and it helps you out too because we would hate to see you move forward with an employment goal that you thought you would absolutely love, only to find out maybe three months into the job that you obtained that you really don't like it so much, so it helps us save a little bit of time and prepare you for realistic expectations on the job. Jeff: So if you do need some soft skills, if you do need some technology skills, and it's determined that you should go to a blindness training center of some sorts, that might set you back six to nine months or whatever it takes right? Serina: That's correct, the blindness training centers are not super short programs, I think the shortest program that they have is the summer youth program for those that are still in either high school or college perhaps, and I believe that's even eight weeks. Jeff: And that's basically like a step program to bridge you into college preparedness? Serina: Correct. Jeff: And if you're planning on going just straight into the workforce then a training center might give you the skills that are needed to help gain employment. Serina: Correct, they work on every skill that you can possibly think of from independent transportation, orientation and mobility, independent living, I do believe they do some self-advocacy training, as well as working on basic social skills because you are living on campus with lots of other people and there's gonna be times when you disagree and you're gonna have to use those conflict resolution skills which will help you for sure once you start working. Jeff: I know we talked about transition aged students quite a bit, but there's also other people adults that have vision loss and they want to get their employment back and so these training centers do adult programs as well. Serina: And it can be quite helpful because I know last time we talked a little bit about an individual maybe who's coming in that has lost sight a little bit later in life but still really wants to work, that's a hard transition coming from having a driver's license and being able to independently transport yourself and work on a computer, to all of a sudden not having those skills anymore and abilities, and those centers and also other field based programs through vocational rehabilitation can certainly help with that transition, and also help you connect with different support groups and things like that so that you can start networking with individuals who've maybe been there as well. Jeff: However, before you move on to this step you must set up an individual plan or employment. Serina: That is correct, and all of the individualized plans for employment can only have services on it that the counselor and you agree are necessary and appropriate, and then they are always purchased at the least possible cost. So there might be times when there's certain products that you really really would like, but the counselor has to follow certain policies and purchase things at the lowest possible cost that is still appropriate for what you need the items for. Jeff: But typically the items will get you to your destination? Serina: Exactly, like as an example, there's lots of different types of computers now, we have our personal computers that maybe would run a screen reader or screen magnification software, and we have our Mac books that also have that same type of software built into it. Typically vocational rehabilitation is going to look at purchasing personal computers more so because we're looking down the road at employment and most employers still use personal computers, so it makes the most sense to get you used to using that type of a technology if you're going to be working in an office environment down the road. Jeff: And when you're saying personal computers, you're talking about Microsoft based platform. Serina: Correct, like a Windows computer. Jeff: Mm-hmm, Serina, can you tell us how flexible and IPE, individual plan for employment is? Serina: Yes, it's a plan, yes it's written on paper, but that doesn't mean that it can't be changed. So it's really important to communicate with your counselor if you feel that something's not going the way that you want it to go, or that you want to try something different, because that plan can definitely be amended, it's actually quite rare that we have the exact same plan from start to finish. Jeff: Okay someone goes through the process and they get their training, making progress, and you're checking the list and moving forward and now they're going to college and they are succeeding, according to the plan, and it comes time to where they start thinking about the job and job resumes, and job interviews, and all that, is there any services for that type of area? Serina: Definitely, it can be considered part of vocational counseling and guidance, which is on every single plan for employment across the country, I don't think there's any plans that don't have that, but it's also part of what we call job seeking skills training, which would be, you either working with your counselor, or perhaps a third party vendor to develop that resume, develop a general cover letter, and also start doing mock interviews, and begin talking about how do you want to handle the interview, how do you want to disclose your disability, if you want to do that at all, and how do you advocate for yourself during that interview. For example if you need an accommodation for testing and things like that as part of the interviewing process. Jeff: Now when it comes to disclosure, there's so many debates about it, and there I don't think there is any one answer, one fits all for this topic. Serina: Correct and I know we're probably gonna talk about that, maybe that'll be our next episode, because that's a hot topic of how do I disclose my disability, and what when and where, am I going to get discriminated against, things like that, I know people are very fearful of that, that definitely will warrant a full episode. Jeff: And that's a big one, so is writing your resume, because a resume is a work in progress, because if you're looking at one job, looking at a next job, it has to form to the job, the keywords and everything, so it's a good skill to have and a good thing to have a template to be able to adjust it for the job you're seeking. Serina: Exactly, we call it tailoring your resume because if you're not putting in specific keywords, a human's not even going to see your resume because there's so many electronic ways that they use, optical character recognition, and scanning the resume that you've submitted either online or even email, where they just scan to see specific keywords and skills and if it doesn't meet that, then it automatically gets denied. Jeff: Optical character recognition, it was such a gift and now it's working against us. Serina: Yep, sound familiar though right? Jeff: Mm-hmm, Serina with all your experiences, what tips would you have for someone who's receiving services and working with the counselor? Serina: So during the vocational rehabilitation process it's really important that you stay in close contact with your vocational rehabilitation counselor. There will be a lot of times when they're going to be asking for tons of paperwork that you might find cumbersome or even redundant. I promise you they wouldn't be asking you for it if they didn't need it because we get a lot of paperwork, if we didn't need it, we wouldn't be asking for it for you. So especially if you're on/in a plan for employment that includes training, every semester we're going to be looking at what grades did you get, what classes are you registering for next semester, do you need any books, did you apply for your federal financial aid? All of those things are things that are required before we can say yes we will pay for your tuition this semester at the school. If your counselor sends you an email asking for something, the quicker you reply the quicker things can move, and just know that sometimes things can't move overnight, if you call us and for specific piece of technology, we might not be able to get that for you immediately, especially if it's not included on your plan for employment, there might be some paperwork things that have to be done and ordering processes and things like that. So we ask that you're a little bit patient with us, but also the more you communicate with us, the better service provisions you will have. Jeff:And staying ahead of the game is the whole thing. Serina: Exactly. Jeff: Yeah, being on the State Rehab Council I get a lot of documents about this it's agencies and I see that one of the highest percentage of closures is because of lack of communications by the client back to the agency. Serina: That's probably actually pretty accurate because especially with my caseload I work with a lot of young adults, so they're still learning how to keep in touch so I do give them quite a few chances but it never fails that as soon as I close a case because I haven't heard from them despite multiple attempts on my end, about two weeks later is when they call me back and say, well I didn't know that you were gonna close my case. And obviously yes you can go back through the process and we can open it again but it's much more efficient even if you just send me a text message saying, everything's all right, I'm still out here, and that'll keep things going for you, but we have to remain efficient and show that the people that were working with are making progress in order to meet our goals and outcomes. Jeff: Serina, this is a lot of great information for someone who is going through vision loss, what advice would you have for someone who is seeking services from their division of vocational rehab or their State Services for the Blind? Serina: If you are a transitioning student and you're at least 15 years old and you are definitely starting to think about employment and what's next and actually some states that's as little as 14, but most states is about 15 or 16, but if you're starting to think about employment, I would say do not hesitate to contact your local vocational rehabilitation, talk to them about services, even if you call and you meet with them and it's not quite the right time, you are at least ahead of the game and knowing what to expect when you do decide that it's the right time for you. If you're an individual that's lost sight a little bit later in life or maybe have never heard of vocational rehabilitation and you're struggling with some vision difficulties, pick up the phone and give them a call, especially if you're looking into employment. All of our services at vocational rehabilitation are for sure geared towards employment now, so any services that we provide do you have to be tied to an employment goal with an eventual goal of being employed in the long-term. Jeff: You know Serina when I first lost my eyesight, I was skeptical you know, I was like worried about what's gonna happen and I didn't know, I didn't know where the blind were, I didn't know anything and I kind of felt like State Services, the agency was kind of a safety net, so I was gonna go out there and forge my own path and if I failed I would head towards the agency and get services, but now today, the more I know about it, it seems like it's a vehicle towards a future, and I've said this many times, but it is, it's it's, it's a resource, it's a place to go to learn about the pathways that you can take towards employment. Serina: And I'm curious what was your experience on the client side? I know you're on the state rehab Council and things like that, but do you remember being your very first experience when you first applied for services? Jeff: You know this is a great question for me because my experience was quite unique I think because when I first lost my eyesight I sold my pickup truck and I bought a brand new computer, I bought jaws and I started doing things the way I thought was best, I did things my own way. I did not understand that State Services for the Blind with an IPE, an individual plan for employment would have set up something of the nature to provide me the tools for me to succeed according to the plan and my goals, and once I understood that there were services as such, I then meticulously figured out what I would have to do for myself, and what they could do for me, and together we could reach the goals that we both set up. So I think part of the demystification of this is, they won't buy you everything, it's not a toy store, but they will assist you in succeeding, and those services do range from, you know, picking the right college that best suits your field, the technology that you'll need to succeed in college or in the workplace, there's so many services that are available there, you just have to make that call, like you said Serina, make that call and find out what they can do for you, and what you have to do as well. Serina: Well and that, someway just popped a thought into my head, I know that some individuals, most you know, most likely receive SSI or SSDI, some sort of Social Security benefits and it can be a little nerve-racking wondering, what if I start work and then it doesn't work out, how are my benefits impacted, there's lots of different rules related to social security and work. So I'm thinking that might be a really good idea for another future topic as well. Jeff: Absolutely, and when a person is going through vision loss it doesn't mean that they're totally educated on all the intricacies that are involved from your State Services, from your DVR, from the government, from Social Security, all these things have to be learned and dealt with and that's why talking with your counselor to learn, to educate yourself, so you can better be prepared for the opportunities that are ahead of you, and I think calling your State Services is one of the best things that a person can do, and that's why they call it a informed choice. Serina: Exactly, so many topics Jeff, we're never gonna end. [Laughter] Jeff: Hmm, that's job security huh? Serina: For sure, how insightful. [Laughter] Jeff: Speaking of something that never ends, I thought winter was the same way around here, but we got grass out back now and the trees are starting to bud, I could feel that a little apple trees with the little buds on them. Serina: That's awesome, you'll start sneezing pretty soon here. Jeff: Mm-hmm, I'm just glad I planted apple trees because I don't think they make PC trees. Serina: Ba dump bum[Imitating comedic snare drum] [trumoet sound effect] Well that concludes today's podcast, but next week we will be tackling that tough topic of disability disclosure, and the job interview. If you have questions you can email us at: Jeff: JobInsights@BlindAbilities.com. Serina: Or follow us on twitter: Jeff: at Job Insights VIP. Thank you CheeChau for your beautiful music, that's @LCheeChau on Twitter. [Music] We really hope you enjoyed this podcast, thanks for listening, and until next time bye-bye. [Music] [Multiple voices] When we share what we see through each other's eyes, we can then begin to bridge the gap between the limited expectations and realities of blind abilities. Jeff: For more podcasts with the blindness perspective check us out on the web at www.blindabilities.com, on Twitter at Blind Abilities, download our app from the app store, Blind Abilities, that is two words, or send us an email at info@blindabilities.com. Thanks for listening!
Job Insights Extra Meet Ivan Delgado: Being Your Own Boss Is Hard Work and Worth It All (Transcript Provided) Welcome to Job Insights Extra, part of the Job Insights Podcast with Serina Gilbert and Jeff Thompson, a podcast focused on the world of employment, career pathways and gainful and meaningful employment. The Job Insights Extra podcasts are success stories, interviews and demos that enhance the experience of reaching that career you want. On this Job Insights Extra we talk to Ivan Delgado, a Business Enterprise Program Operator from Las Vegas. How he got his start into the BEP and what being a business owner has done for him. We hope you enjoy and if you have any questions for Ivan, you can send him an email. If you are interested in becoming your own boss and want to run your own business, contact your state services, your Devision of Vocational Rehabilitation and see what opportunities they have for you. Full Transcript Below Thank you for listening. You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Transcript [Music] Jeff: Welcome to a job insights extra where we will be talking to business enterprise program operator Ivan Delgado. [Music] He's from Las Vegas and that's where the Blind Abilities team went to get this interview at the Randolph Sheppard Vendors of America Sagebrush convention. What is the business enterprise program? It is a operation part of the Randolph Sheppard act that allows you to own an operate your own business. Check out your State Services, your DVR, and find out more about the business enterprise program. [Music] Job Insights is a podcast that is helping you find careers and gainful employment through innovations and opportunities and you can find the Job Insights podcast on Blindabilities.com, part of the Blind Abilities network, and as part of the Job Insights podcast, we will be bringing you the job insights extra, consisting of interviews, demonstrations, and news surrounding employment, careers, and jobs, with hosts, Serina Gilbert, and myself Jeff Thompson, and you can contact us by email at jobinsights@blindabilities.com. Leave us some feedback, or suggest some topics that we cover. You can also follow us on Twitter at JobInsightsVIP. Right now, please welcome Ivan Delgado. Welcome to Blind Abilities, I'm Jeff Thompson, and I am at the Sagebrush convention in Las Vegas and I ran into a fairly new vendor here amongst the senior vendors. I'm talking to Ivan Delgado. How are you dong? Ivan: Alright man, how about yourself? Jeff: Good, good, just enjoying the convention and all of the busy lights and stuff, and noises I should say out there. Ivan: Nice city huh? Jeff: Yeah, and you're from Vegas? Ivan: Yeah man, welcome to Las Vegas, if anybody is listening, come and enjoy Vegas, we love your guy's money. [laughter] Jeff: I noticed that! [laughter] So what got you interested the business enterprise program? Ivan: So about 3 or 4 years ago man, finishing up, not finishing, taking a break from college for certain reasons, whether it was lack of assistive technology or books not being ready for me, I decided to take a break and my lady actually told me about this program. She had a few friends that have done it in California and other states, and she told me, you like to boss me around so you might as well boss people around and try to make money. Yep, a couple years later man, I have been fortunate enough to finally get my own site and I started, originally I started the program. I got my BEP license about 2 years ago. My first site opened February 1st of last year, we just had our one year anniversary, before that we had vending machines at the location I am in. We just, it took a while for the location, the actual location to open up. Jeff: Is there training involved when you first join? Ivan: Yeah, when I first joined, now it's a lot different man, but when I first joined it was pretty intense, what I think is intense man. It was, I want to say 9 months man, and don't quote me on that. Classes started in March and the first three months were strictly just books and learning bi-laws, and how to do PNL's, and marketing, it was pretty awesome man, for someone like me that, you know never had a business, don't have an idea, i was just used to working 9 to 5s. It was very helpful. We did a couple of course through Hadley, Hadley School for the Blind online. We did that and then we did a couple of ServSafe tests here, customer service exams that we had to get. I am fortunate and I could brag about it man, because again, I am blessed man, and I think I am one of the only vendors here in Nevada that does his own profit and loss statement. You have vendors that are paying 200 to 300 dollars to, for people to input simple numbers and again, thanks to those classes, thanks to those three months of actually putting in work man, and understanding PNL's, and little Bi-laws, and stuff like that is definitely helpful man. Jeff: You are your own accountant. Ivan: Yes sir, thank God man! Jeff: You gotta keep the profits up right? Ivan: Right right, that is one way of doing it man, saving money man, all you gotta know is how to work. We know how to work man, it doesn't matter if you are disabled or not man, it's ambition, as humans we hunger for that ambition man. We have it, it is just a matter of if we want it or not man, and a lot of the times we don't want it man, and that sucks, but we are our own worst enemies and our own best friends man, and only we can get what we want man. Jeff: So what suggestions would you have for someone who is interested in getting into the business enterprise program? Ivan: A lot of patience. A lot of patience, hard work. Here in Nevada the process is a little longer due to the lack of operators we have, you know we kind of have to prove ourselves and that is fair I think. But a lot of patience and , just because you're disabled doesn't mean that stuff is going to be handed to us, especially here in the business world man, we have just as much of a responsibility as anybody else. Just keep your head up and be strong. That's it, just stay positive and stuff could be worse and if we are here and you are listening to this podcast, obviously we have gotten this far and the sky is the limit after here. Jeff: So what does Sagebrush bring to you? Ivan: A lot of a lot of information. A lot of people like Mr. Jeff, sorry if, I am bad at names, I think that's your name [laughter] Jeff, but yeah, this man, that working, as a blind community we have to become close man and I'm, the best example man, I don't go out a lot and I don't network but it hasn't changed man, I don't believe in NFB's, and NCB's, and ACB's, I wish there was only one. I don't see for this separation between organizations when really we're all just one, and that's blind. We're all blind so I would love for us to stick together and become one. I think if we become one a lot of people would be aware of both our disabilities, of our business and the Randolph Sheppard Act, again if we advocate be strong, stay positive and network, go out to these kinds of meetings, kind of conferences, I think this could very well be accomplished. There is a lot of older gentleman and ladies that are in the program and it's time for younger generations to step up and I think this is the time. Jeff: There is a lot of wealth of information, they have been in it, they have seen it change, and that is the bigger thing that things have changed and now here you are paving your way, you know, you're two years in, pretty soon you'll probably be leading the show here. Ivan: Absolutely, and those are the plans man, and absolutely, we always have to be grateful to the people that have, that started this man you know, and we've gotten a long ways man, I mean from selling newspapers at Post Offices to you know, having places at Hoover Dam's or at airports, you know that's a huge accomplishment, and that couldn't have been done without the people that you know, are moving on or retiring now. And that is a huge gratitude to you guys, we thank you. Jeff: Well, Ivan Delgado thank you very much for taking your time away from the karaoke. You gonna sing out there? Ivan: No we already did man, I need two more shots, I think these last two shots were on you. [laughter] Jeff: Do you have an email? Ivan: Yeah man, that's ivan.delvilla@gmail.com. Jeff: Alright, well thank you very much for taking the time and just speaking on Blind Abilities. Ivan: Yes sir, have a good day! [Music] Jeff: So if you are interested in the business enterprise program, becoming your own business owner, entrepreneur, check it out with your division of vocational rehab, your State Services for the Blind and see what they can do for you. If you want to find out first hand from Ivan what it is like to be 2 years in, in the business enterprise program, shoot him an email, check it out. Links are in the show notes. So we hope you enjoyed this Job Insights extra, thanks for listening, and until next time, bye bye. [Music] [Multiple voices] When we share what we see through each other's eyes, we can then begin to bridge the Gap between the limited expectations and the realities of Blind Abilities. For more podcast with the blindness perspective, check us out on the web at www.blindabilities.com, on Twitter at BlindAbilities, download our app from the app store, Blind Abilities, that's two words, or send us an email at info@blindabilities.com, thanks for listening.
Take Full Advantage of Transition Services: Enhancing Opportunities for Success - Meet Kylee Jungbauer (Transcript Provided) Kylee Jungbauer is a rehabilitation counselor at state services for the blind. Her concentration is transition age students. We talked to Kylie about what services they provide for students. Transitioning from high school to college and to the workplace. State services for the blind has a Transition Unit that facilitates a path for students, providing guidance and opportunities for success. From assessments to training, the transition Team offers as much or as little help as needed while promoting self advocacy and independence along the way. Kylee talks about the importance of Summer Programs and how the Transition Team provides opportunities with employment, career exploration and access to training on the tools that will help bring about a successful transition. Full Transcript Below Check out below for a list of Summer opportunities and programs. Check out your State Services by searching the Services Directory on the AFB.org web site. State Services for the Blind of Minnesota We offer tools and training for employment and for helping seniors remain independent and active. As Minnesota’s accessible reading source we also transcribe books and other materials into alternative formats, including audio and braille. We assist Minnesotans who are blind, DeafBlind, losing vision, or who have another disability that makes it difficult to read print. I hope you find what you need here. We've also created a Tips for Using Our New Website page. If you’d like to apply for services, learn more, or have more questions, just give us a call. You’ll find contact information for all of our offices on our contact page, or you can call our main office at 651-539-2300. 2018 Summer Opportunities for Teens Learning skills related to blindness, low vision, and DeafBlindness The programs listed below are of varying lengths during the summer. They offer training in independent living and job readiness skills. The program descriptions that follow are taken from each organization’s website. If you’d like to pursue any of these opportunities, please speak with your SSB counselor: BLIND Incorporated (Blindness: Learning in New Dimensions) offers an 8-week Post-secondary, Readiness, Empowerment Program (PREP) designed to prepare students for academic, employment, and social success. The PREP curriculum is designed to empower blind youth with the alternative techniques of blindness they will need to be successful in the college and the career fields they choose, and to give them the confidence and belief in themselves they need to find and keep a job. Additionally there are three one-week summer programs focusing on independent living, post-secondary success, and navigating the world of work. Career Ventures, Inc . offers resources in: Job Seeking Skills training, Volunteer opportunities, Paid-work experiences, Job Shadows, Internships (on a case by case basis), Job Placement, and Job Coaching. Contact Wendy DeVore at wdevore@careerventuresinc.com for more information. Courage Kenny SHARE Program is a resource that provides people of all ages and abilities the opportunity to achieve physical and emotional fitness - and just have some fun. SHARE is a service of Courage Kenny Rehabilitation Institute, part of Allina Health, but our list of services includes those offered by other organizations. It's a one-stop shop for activity listings and registration details in Minnesota and western Wisconsin. Duluth Center for Vision Loss offers summer camps designed to sharpen skills needed for success, including Workforce Readiness, College Readiness, Self-advocacy, Mobility, Technology, Independent living, and much more. Students will learn core workforce readiness and adjustment to blindness skills. They will also be given the opportunity to socialize with peers from across the state and to participate in a wide array of recreational activities. The Lighthouse Transition Program is built on the understanding that “now is the time” that youth need to be developing certain core skills that are essential for their future Helen Keller National Center offers programs to students who are DeafBlind which enable each person who is deaf-blind to live and work in his or her community of choice. HKNC offers individualized evaluation and training which will assist students in achieving their own definition of success. The emphasis for the student in the program is to participate in learning opportunities which will lead to successful employment and a full, enriched and independent life in the community. The philosophy of the Center is one of self-determination for all. Minnesota State Academy for the Blind (MSAB) offers Summer School programming for elementary, Middle school and high school age students. Elementary School programs focus on elementary level academics as well as individual goals identified in student IEP’s. Middle and High school students will participate in activities encompassing the three areas of transition (postsecondary, employment, and independent living). National Federation of the Blind offers of variety of local and national opportunities. The NFB BELL Academy is designed to provide intensive Braille instruction to blind and low-vision children during the summer months. EQ is a week-long learning opportunity that gets blind students excited about STEM by offering hands-on learning experiences. Visit www.nfb.org and www.nfbmn.org for more information. Stone Arch Employment Solutions, Inc. Email Cori Giles at cori.giles@comcast.net for information. Summer Transition Program (STP) provides experiences to address the specific transition needs of students who are Blind, Visually impaired or DeafBlind. STP complements each student’s core curriculum at their local school by providing individualized opportunities in the three transition areas identified in their Individualized Education Program (IEP). These unique transition activities, as part of the Expanded Core Curriculum, give each student the opportunity to increase independence in their school, home, community and work environments. Dates for 2018 are June 13-25. Email Julie Kochevar at julie.kochevar@ahschools.us for information. Thank you for listening. You can follow us on Twitter @BlindAbilities On the web at www.BlindAbilities.com Send us an email Get the Free Blind Abilities App on the App Store. Transcript Take Full Advantage of Transition Services: Enhancing Opportunities for Success - Meet Kylee Jungbauer (Transcript Provided) Kylee: State Services for the Blind can be included in on that plan but then we will also have an employment plan for the students as well. Jeff: Kylee Jungbauer, Rehabilitation Counselor for Transition Age Students. Kylee: We like to keep our students busy during the summer, that's what I tell all of my students so yep, if you're working with us we expect that you're working your plan and obtain that job goal. Jeff: Voices from the success stories of transition age students. Student 1: State Services for the Blind played a role in helping me figure out, for one thing what I wanted to do after high school, and then where I wanted to go to college, and then also they assisted me with helping me find a job. Student 2: Training in stuff relating to technology and all your use of computers and phones, what's the best way that works for you. Student 3: So I was very lucky to have an IEP team that was familiar with working with a blind student. Jeff: Learn about the transition unit at State Services for the Blind. Kylee: I think another way a parent can be involved is just to have that expectation of their student that they will work, and have that expectation that okay yes, they need to learn how to cook, how to do their own laundry, how to clean because the parents aren't gonna be around forever right. Jeff: Kylee is part of a team at State Services for the Blind in their transition unit. Be sure to contact your State Services and find out what their transition team can do for you, and for more podcasts with the blindness perspective, check us out on the web at www.blindabilities.com, on Twitter at Blind Abilities, and download the free Blind Abilities app from the app store, that's two words, Blind Abilities. Kylee: But I think more importantly, is taking a step back and saying, okay, do you have the skills to actually go to college, do you have you know, the advocacy skills, do you have the technology skills, do you have the technology that you actually need? Jeff: Kylee Jungbauer. Kylee: Yep. Jeff: Is that right? Kylee: Yep, yep. Jeff: Welcome to Blind Abilities, I'm Jeff Thompson. Transitioning from high school to college to the workplace, it's a journey that most of us have taken, or some of us are looking forward to, and we'll be talking to Kylee Jungbauer. She's a transition counselor at State Services for the Blind. Kylee is going to talk about the services that you can receive to enhance your opportunities whether in college or gaining employment in the workplace. She's going to talk about the transition unit at State Services which will help you navigate your transition journey and make available all the resources, training, and skills, and confidence that you'll need for the journey. Kylee welcome to Blind Abilities how are you doing? Kylee: I'm great, how are you? Jeff: I'm doing good thank you. I really appreciate you taking the time to come down to the studios to share with us what you do for clients of State Services for the Blind. Kylee: Yes of course. Jeff: So Kylee, what is the transition unit at State Services for the Blind? Kylee: We work with youth about 14 to all the way up to 24, so college students as well, and we help them move through their transition from high school to either college or high school to just starting off with their first couple of jobs, we look at what their job goal is, or if they don't have a job goal, bringing them to that, with looking at different interest, inventories, or getting different work experiences so they can try different jobs and see what they really like. Jeff: When you say 14 to 24, so 14 you're talking about students who are in high school? Kylee: Correct yep, so when they're in high school we work with in conjunction with their schools and their TBVI's to supplement what they're already getting or maybe give suggestions, expose them to some different technology, and things that maybe they aren't getting in their school. Some schools provide a lot of adjustment to blindness training, and some schools do little, so we like to supplement especially during the summer when they're out of school. Jeff: And why is that? Kylee: Just to get them prepared for life, like I said transitioning out of education, you know high school, a lot of the services are provided for them, they aren't really having to advocate hopefully too hard for those services versus when they're an adult, they're kind of on their own and they have to learn how to do those things and advocate either in college or in their first jobs. Jeff: And what kind of options are there for the summer? Kylee: We have a lot of summer programming that some of it we provide, a lot of it the various vendors provides anywhere from more social to adjustment to blindness training, where, you know learning Braille, learning orientation mobility skills, a lot of Technology in Duluth, since it's so far away they have some online courses where you can work with them remotely I guess from anywhere in within Minnesota, so there's a lot of different options. Jeff: When you were talking about the TVI's teachers for the visually impaired, you're talking about the district teachers? Kylee: I don't know if they're considered district teachers or not but the district's hire them, yeah the schools provide that service. Jeff: And that's where they start their individual educational plan. Kylee: Yep yep, the TBVI's, they're included in it, the students will also have a case manager that kind of runs the whole thing and makes sure that the goals that are written on the education plan are being obtained or maintained or changed as needed, and State Services for the Blind can be included in on that plan but then we will also have an employment plan for the students as well with their job goal, or if there isn't a job goal then we, we just put something generic while we're exploring different careers. Jeff: So they actually have a simultaneous education plan segueing into a employment plan? Kylee: Correct yep, they'll have an education plan and an employment plan at the same time up until graduation of course, and then it will just be an employment plan with State Services for the Blind, and that will bring them through either their first job or college. Jeff: Well that's a good segue. Kylee: Yeah. Jeff: How does State Services or the transition work with the districts or the Department of Education in Minnesota? Kylee: We like to be invited to all of the IEP meetings so please invite us, that doesn't always happen, just because sometimes they get thrown together really last minute and as long as the parent and the student can make it they kind of just go on with it but, it's good for us to be there so we can see what the school is providing and maybe advocate for more, maybe make suggestions, or see where we can supplement in during this school year, you know sometimes students have time on weekends or after school, or especially during the summer time when they're on break. We like to keep our students busy during the summer that's what I tell all of my students, so yep if you're working with us we expect that you're working your plan and obtain that job goal throughout the school year and then especially during the summer when you're on break and you have that extra time, Jeff: Are there internship programs available to transition-age students in the summer? Kylee: Yes definitely we can work with a vendor but we also have our work opportunity navigator, Tou Yang, and he works with a lot of the students that I'm working with to get them internships, paid summer jobs, if they're interested in working during the school year that's great too, or doing Job Shadows so they can check out different jobs. Some students have this career goal, they know they want to do it but they haven't really talked to somebody who's in the work field actually doing that job, and they may find that oh it looks like it's a lot more data entry and paperwork versus client contact and so maybe they don't want to do that, or maybe they want to be a photographer but they don't want to have to figure out their own taxes or anything like that, so they'll look into working for a company versus going out on their own. So different things that they just don't know because they haven't had that experience. Jeff: Experience that will help them formulate their career goals. Kylee: Right exactly, yep so each career goal on our end has to be looked at, explored, and we have to determine if it's feasible, so if we have a student who wants to be a dolphin trainer for instance but doesn't want to leave Minnesota, that's probably not going to be something that SSB will support just because once they graduate you know, they won't be able to find a job here in Minnesota, so yep. Jeff: Maybe moose training or something but not dolphin training. Kylee: Yes. [Whoosh Sound Effect] Jeff: So if someone wants to explore a career, is there a resource here to help them do that? Kylee: Yep work with Tou, and also we've got a couple different websites that we can either send to our students or sit with them and work one-on-one with them to do some exploration that way, and hopefully the student are getting that in their school as well, hopefully. Jeff: So Tou, you say he's the employment navigator, he actually contacts companies, works with companies to know what they want and educate them on what to expect probably, and then brings people in for opportunities? Kylee: Yep, yep he has a background in working and doing job placement for other companies in the past so he has those employer connections which is great as well, but yep he brings students out to look at people out doing the actual job that they may be interested in so they can see the intricacies of it and still interested in that after learning the ins and outs or if maybe it's not for them and they want to explore other options. Jeff: So Kylee, how do parents get involved, do you have contact with parents of transition students? Kylee: Definitely, parents can be as involved as they want to be of course if their student is a minor, they have to be there for any signing of documentation, but after that they can be as involved as they want to be, kind of feel that out with both the student and the parents. Sometimes I just meet with my students one-on-one during the school day or whatever is convenient for them, but sometimes the parents want to be there, sometimes I can send an email to the parents after a meeting just giving them a recap. If I'm sending internship opportunities or things that need to be filled out with the student and maybe the student isn't the most responsive, I'll just CC the parents on the email just to make sure that everybody saw that it needs to be sent back. But I think another way that parents can be involved is just to have that expectation of their student that they will work, and have that expectation that, okay yes they need to learn how to cook, how to do their own laundry, how to clean, because the parents aren't gonna be around forever right, and they also hopefully won't be following their student to college, so if they need those skills just like any other person. But on the flip side of that, we understand that for a college student, or college bound student it is normal for them not to have those skills. I think college bound students kind of figure out how to do their own laundry once they show up and they dye a white shirt red for the first time and then they're like, okay maybe I need to figure this out, so that's totally normal but I think yeah, for parents to have that expectation that their students work and most people I know had to have a summer job so they could pay for their gas, pay for their the clothes that they want, or the new phone, or you know what have you, so yeah just having that expectation that their student will go on in transition just like any other visual person, so yeah. Jeff: You brought up a good point about you know, the parents are probably their first advocate that they have coming along in life, and there's comes a point in that transition process where a student has to start considering taking over that advocacy, advocating for themselves, like when they don't get a book on time that they can't always depend on their TBI or disability services, they get to a point where they start to have take responsibility for laundry like you said, all that stuff. Kylee: Yep yep, we have a whole Student Handbook that we go through and it has expectations of you know all the documentation that we need before semester starts, but I think more importantly is taking a step back and saying, okay do you have the skills to actually go to college, do you have you know the advocacy skills, do you have the technology skills, do you have the technology that you actually need, the knowledge of the different apps, you know to get your books online, right now it's Jesse that's working with all of our students, but getting our transition tech involved and they come in for a tech assessment to see what they have right now and what they'll need with both technology and technology training. So I have a student right now we're getting her tech package in but also we're planning for the training that she'll need in preparation for going off to college because surprisingly, her typing skills aren't that great, so that's something she knows she really needs to work on because all of those papers that she's gonna be writing, she's gonna need those skills, yeah super exciting, skills that you'll need right. [Whoosh Sound Effect] Jeff: I've seen reports where like colleges said that people are coming in and they're not prepared, and I've also seen where people come in but they end up being like a week or two behind because they're just trying to use this new technology that they don't understand yet and you have to be able to hit the ground running when you enter college. Kylee: Right yes, I talk a lot about that you know, college is high school times ten, you know you don't have a whole week to learn about one chapter in a book, and then have a test on it maybe a week later, it's like five chapters in one week, so you have, yeah right exactly, you have to be able to hit the ground running. So making sure that they're connected with the disability services at their college and they know the ins and outs of how they ask for accommodations, if they need extra time with test taking, anything like that, knowing how to get all that stuff before they go into college. I talked to my students about how some teachers are fabulous with accommodations and some just don't want to deal with it, or they haven't really had to deal with it in the past, so having those advocacy skills are huge. Jeff: Yeah I always suggested when I went in, I learned right away that, send in an email to each teacher, each professor, six weeks in advance if you get that opportunity, to start setting up that communications, and get that underway, rather than trying to set something, because everyone's busy that first week. Kylee: Definitely yeah. I know when I went off to college for the first time, I was terrified to talk to any of my professors, but you don't have that you know option when you need accommodations, you just have to go for it, and feel you know, be comfortable, or maybe you don't have to be comfortable with it, but you have to be able to at least do it, so yeah having those skills is huge. Jeff: Yeah and it does get more comfortable, and as long as you do get comfortable with it, it just puts it back, you just move forward from there. Kylee: Right exactly. Jeff: What words of advice for someone who is transitioning from high school to college to the workplace? Kylee: I would say make sure that you have all of your technology training down, your orientation and mobility, make sure that you're comfortable with that. I think a lot of students are comfortable in their school settings, so some that have some vision may not even use their cane, but I think it's important when you're out in public especially when you're learning new locations to have those orientation mobility skills down, because yeah you will need them. Advocacy skills as well because you need to be able to talk to your employer and let them know what you need and feel comfortable with that, yeah it's very important. Jeff: Yeah because most colleges aren't that one building school. Kylee: Exactly yep, and a lot of the students that I work with we offer orientation mobility skills, multiple semesters so they can learn their new path, you know each time. After a student's been on campus for a couple of years they pretty much know the layout but, I have no problem each semester bringing in orientation mobility, you, just right away so they feel comfortable with where they're going. Jeff: Well that's great, Kylee how does someone get in contact with State Services for the Blind for the first time? Kylee: The best way to do it is to contact, if you're in the metro to contact our St. Paul office, and they will get you connected with Meredith Larsen, and Meredith does all of our orientation and intakes, and orientation is provided twice a month at different times, so you can come in, learn about all of our services and decide if this is the right program for you. If so then she'll meet with you one-on-one and do an intake and have you sign an application at that point and that kind of, your signing saying yes I'm dedicated to this program, and then from there you'll start working with a counselor. If your you're in the metro it'll be either me or Ashlyn, and if you're in Greater Minnesota there's different counselors out in those areas that also work with our transition youth. Jeff: That's perfect, well Kylee, once again thank you so much for taking the time out of your day to come down to the studios here and sharing with us, believe me it's been a wealth of information, so thank you very much. Kylee: Yep, thank you. Jeff: It was a real pleasure talking to Kylee and be sure to check out the show notes where you can find out how to contact State Services for the Blind, and you can find the summer programs that are listed, and some job opportunities you could have for helping out at the summer programs, and to contact State Services in your state be sure to check out AFB.org where they have resources where you can find the services offered in your state. This podcast is produced in part by State Services for the Blind, live, learn, work, and play. [Music] And a big thanks goes out to Chi Chow for his beautiful music, and that's LChiChow on Twitter. Thank You Chi Chow. Once again, thanks for listening, we hope you enjoyed, and until next time, bye-bye. [Music] [Multiple voices] When we share what we see through each other's eyes, we can then begin to bridge the Gap between the limited expectations and the realities of Blind Abilities. For more podcast with the blindness perspective, check us out on the web at www.blindabilities.com, on twitter at BlindAbilities, download our app from the app store, Blind Abilities, that's two words, or send us an email at info@blindabilities.com, thanks for listening.
The translation and localization industry has seen some impressive innovations over the past decade, but in many ways, it has remained stubbornly resistant to change. Today we sit down and talk with Jeff Sandford co-founder of Wovn.io. The Wovn team has developed a way to take the pain out of web localization and translation. They promise to do it all with a single line of code. We talk a bit about the mechanics of web-site localization and state of the industry as a whole, and we also discuss some important but surprising differences between with makes compelling UI/UX design for Japanese and for Western users, and what kinds of tasks machine translation can really be trusted with. Jeff also explains why he decided to start a company with someone he had never meet. It’s a great discussion, and I think you’ll really enjoy it. Show Notes for Startups Why website translation is important but often overlooked Why Jeff chose to start a company with someone he had never met How to combat Japan's "Design by Committee" problem Why you should not trust machine translation for e-commerce When you need to change from a bottom-up to top-down sales strategy The challenges of working with Japanese enterprise customers as a startup Advice for foreign engineers and founders who want to come to Japan Why Japan needs to get uncomfortable Links from the Founder Wovn.io homepage Wovn.io on Twitter Wovn.io on Facebook [shareaholic app="share_buttons" id="7994466"] Leave a comment Transcript from Japan Disrupting Japan, episode 86. Welcome to Disrupting Japan, straight talk from Japan’s most successful entrepreneurs. I'm Tim Romero and thanks for joining me. Today we’re going to talk about something that you and I, and probably everyone else listening right now has struggled with. Translation and localization. It’s been an industry that has both seen some impressive innovations over the past decade, but is also somehow quite resistant to change. Localization is a part of business that almost every firm has to deal with, but almost no one looks forward to. It’s a lot like dealing with lawyers in that way, I suppose. Well, today we sit down with Jeff Sandford, cofounder of Wovn.io who say they’ve developed a one line of code method for taking the pain out of localization and translation. We talk a bit about the mechanics of website localization and the state of the industry as a whole, of course. We also talk about the important and surprising differences between what makes great UI/UX with Japanese and western users. And what kind of tasks machine translation can really be trusted with. And Jeff shares a story of what made him decide to start a company with a cofounder who he’d never even met before. But you know, Jeff tells that story much better than I can. So let’s hear from our sponsor, and get right to the interview. [pro_ad_display_adzone id="1411" info_text="Sponsored by" font_color="grey" ] [Interview] Tim: Cheers. Jeff: Cheers. Tim: So I’m sitting with Jeff, cofounder of Minimal Technologies and the creator of Wovn.io. And thanks for sitting down with me today. Jeff: Thank you very much. Good to be here. Tim: Wovn.io at a high level is simply localization for a website. But it’s more than that. It’s more interesting than that so why don’t you tell us a bit about what it is. Jeff: So often people when you tell them you do website localization, they think translation, which it actually isn’t. Translation is a very integral part of it, but what we focus on is the system of localizing a website. So let’s say you have an English website, and you’ll like to create a Chinese version or Spanish version of that website, we handle all of the details of actually creating those versions, and also managing them and serving them to users. Tim: Now there’s a lot of companies that are doing that,
The Consumer VC: Venture Capital I B2C Startups I Commerce | Early-Stage Investing
My guest today is Jeff Housenbold ( https://visionfund.com/team/jeff-housenbold ) , Managing Partner of Softbank's Vision Fund ( https://visionfund.com/ ) , the world's largest technology-focused venture capital fund, with over $100 billion in capital. Some of Jeff's investments are DoorDash, Compass, OpenDoor, and Whoop. Previously, Jeff was the CEO of Shutterfly. We discuss how he approaches investment themes, how he identifies opportunities on the value chain, and markets that are ripe for disruption. Without further ado, here's Jeff. Also, check out The Consumer VC Summit: February 23-25 about Ecommerce, Retail and Innovation. Full Lineup and to purchase tickets: *Summit.theconsumervc.com* ( https://app.redcircle.com/shows/3af1af78-a3bd-428f-a8f8-947073d6388c/ep/0fb856e1-7f1c-4c67-8a98-4c414cd58645/Summit.theconsumervc.com ) Enter *CONSUMERVC* at checkout for 20% off One book that inspired Jeff: The Fountainhead ( https://www.amazon.com/gp/product/0451191153?camp=1789&creativeASIN=0451191153&ie=UTF8&linkCode=xm2&tag=theconsumervc-20 ) by Ayr Rand I highly recommend following him on Twitter @jtbold. ( https://twitter.com/jtbold ) Here are the questions I ask Jeff - * So in your career it seems like you've done it all as it relates to business. What led you to joining Softbank and be part of the vision fund? * You're part of something that no one else has done - an $100 billion venture capital fund. Now, every fund has their ups and downs across the portfolio, but your fund has far greater AUM than any other fund in the ecosystem. How do you approach risk and portfolio construction? * How do you think about returns? Since it's that large a fund, are you still expecting venture capital type returns or returns more similar to growth stage private equity? * What's your process of deploying capital? What's your average check size? * What criteria do you look for in companies? * I imagine since you are writing large checks, you might have a more intensive due diligence process. If you could walk me through it. * After you invest, how do you think about growth execution? * I know you are a thematic investor and you extensive reports about large industries. How do you go about deciding what industry to focus on and your process creating the reports? * An area that I know you focus on is real estate technology. What are current trends that you are focused on in the space and has COVID changed your perception of that industry? * SPACs have become very popular in the past couple of years and I know Opendoor is going public via Chamath's SPAC. On this show, we've talked about the impact of SPACs when it comes to CPG and food and beverage brands and the impact of those types of businesses, but haven't spoken about SPACs impact on tech businesses. Would love to hear your thoughts on SPACs. * You've been around the dot com boom and bust, the 2008 crash and now this pandemic. Seems for the past ten years or so when the economy was growing, companies optimized for growth, not profitability. Now the tune has changed and seems to have been changing in the past couple of years. How do you think about unit economics, sustainable, and optimizing for growth vs. profitability? * What's one thing that you would change regarding venture capital? * What's your most recent investment and what makes you excited about it? * What's one company that's on your anti-portfolio and why did you pass? * What's the best advice that you've ever received? * What's one piece of advice that you have for founders?
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