Podcasts about mri

Today, I am delighted to connect with Dr. Elisa Port, a talented breast surgeon with a passion for helping women better understand breast cancer, breast health, and the science behind screening, diagnosis, and treatment. She's the chief of breast surgery for Mount Sinai Health System in New York, a professor of surgery at Mount Sinai's Icahn School of Medicine, and the author of The Breast Advice. In our conversation, we explore breast cancer risk factors, various screening mechanisms and their impact on dense breasts, and the role of diagnosis and pathology, including DCIS. We also discuss menopause symptom management, anti-hormone and targeted treatments, immunotherapy, de-escalation, and why a personalized approach to breast cancer treatment is so important.  Stay tuned for a truly informative conversation with Dr. Port. With her infectious optimism, she has a wonderful way of translating the science and the research in her book, making it accessible and putting the statistics into context so the information feels far less scary than it otherwise might. IN THIS EPISODE, YOU WILL LEARN: How 90% of women diagnosed with breast cancer have no family cancer history How body weight and alcohol can influence breast cancer risk Why Dr. Port recommends annual mammograms beginning at age 40 for most women Dr. Port may disagree with recommendations against breast self-exams Why women with dense breasts may benefit from supplemental ultrasound or MRI in addition to mammography Unvalidated breast screening tests may lead to false positives, unnecessary testing, procedures, anxiety, and expense. What DCIS is, and how it influences treatment decisions Why an individualized approach is essential when using SERMs, SERDs, and aromatase inhibitors How Oncotype testing helps to identify women who may safely avoid chemotherapy Bio: Dr Elisa Port Dr. Elisa Port, MD, is chief of breast surgery at Mount Sinai Health System, which encompasses seven different breast centers. Her team performs over a thousand breast surgical procedures each year. She is also the director of the Dubin Breast Center, a state-of-the-art breast center in Manhattan that opened in April 2011. She personally consults with thousands of patients and performs hundreds of operations each year. Dr. Port is a trusted voice in the media and a sought-after speaker. She has been featured in The New York Times, NPR, CBS, Today, Mornings with Maria, and Pix11. In addition to her media presence, Dr. Port regularly speaks at public events and is invited to present at conferences and panels across the country. She lives in Manhattan with her husband and two dogs. Connect with Cynthia Thurlow   Follow on X, Instagram & LinkedIn Check out Cynthia's website. Submit your questions to support@cynthiathurlow.com  Join other like-minded women in a supportive, nurturing community: The Midlife Pause/Cynthia Thurlow.  Purchase Cynthia's book, The Menopause Gut. Cynthia's Intermittent Fasting Transformation Book The Midlife Pause Supplement Line Connect with Dr. Elisa Port On her website On her personal Instagram  Breast Advice MD on Instagram The Breast Advice Substack

The JournalFeed podcast for the week of July 27-31, 2026.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday's Spoon Feed:In this single-center study, advanced imaging utilization increased significantly following the deployment of a Provider-in-Triage (PIT) model. In addition, the rate of negative CT scans in patients with abdominal pain was higher in PIT-exposed patients.Tuesday's Spoon Feed:In this retrospective study, children with reliable physical exam and normal plain T- or L-spine x-rays had 1 missed injury out of 126 children, and 100% had no operative injury.Wednesday's Spoon Feed:A clinical decision support alert shortened the time to stress-dose hydrocortisone administration for patients with known adrenal insufficiency in the emergency department.Thursday's Spoon Feed:FFP-first MTP may have a slight mortality benefit, but this is not a practice-changing study.Friday's Spoon Feed:A structured approach to cervical spine clearance using clinical decision rules, modern CT, and select use of MRI and x-ray in adult and pediatric patients allows us to avoid prolonged collar use, reduce ED crowding, and limit adverse collar effects for patients.

Full episodes notes are on Dr. Aimee's website. In this episode, I'm shining a spotlight on adenomyosis: a condition that's often misunderstood and overlooked, yet can have a profound impact on fertility and overall uterine health. I'm joined by Dr. Armando Hernandez-Rey, a board-certified reproductive endocrinologist and founder of Conceptions Florida, who is at the forefront of treating complex reproductive health issues, including adenomyosis, endometriosis, and recurrent pregnancy loss. Together, we dive deep into what adenomyosis is, how it differs from endometriosis, why it's so frequently undiagnosed, and what it means for those struggling with infertility or recurrent pregnancy loss. Dr. Hernandez-Rey shares his expertise on diagnosis, treatment options (including the latest in minimally invasive therapies) and how patients can best advocate for themselves. Whether you're newly diagnosed or searching for answers, this conversation is packed with insights to empower you on your fertility journey. In this episode we cover: The difference between adenomyosis and endometriosis, and why that distinction matters Why adenomyosis is often missed or misdiagnosed in fertility workups The impact of adenomyosis on implantation, pregnancy outcomes, and miscarriage risk Diagnostic tools: ultrasound vs. MRI and what to ask your doctor Treatment options, including hormonal therapies and emerging minimally invasive procedures like radiofrequency ablation How to advocate for yourself and what questions to ask your fertility specialist Real-world outcomes and statistics from Dr. Hernandez-Rey's clinical experience Resources: Dr. Armando Hernandez-Rey's practice: Conceptions Florida Do you have questions about IVF? Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, August 17 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom.   Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org. Other ways to connect with Dr. Aimee and The Egg Whisperer Show: Subscribe to my YouTube channel for more fertility tips!Subscribe to the newsletter to get updates

When an MRI revealed a small mass in her right lung, Shira Boehler, by her own admission, ignored it. A...

A methods-focused episode about how muscle and body-composition measurements can mislead you when reading the research. The main event is a new Balshaw and colleagues paper concluding that ultrasound muscle thickness is a poor index of MRI-measured muscle growth. Trexler and Helms argue this shouldn't be read as "throw out all ultrasound research" — the real culprit is that muscle thickness is a crude one-dimensional snapshot with measurement error large enough to swamp the small changes seen in typical short studies, whereas MRI captures growth in more dimensions with better fidelity. They walk through why comparing across different dimensions and different devices matters, what researchers can do about it (bigger doses, larger samples, multiple measurements), and use the famous "sleep restriction kills your gains by 60%" study as an example of over-reading a tiny difference in ten people. The second half turns to DEXA. Prompted by someone confused that DEXA fat mass didn't line up with the 3,500-calorie rule, they explain DEXA's three-compartment model, why it measures fat mass rather than adipose tissue, and why lean soft tissue readings are so sensitive to hydration. The practical upshot: don't build your worldview on a kilogram of day-to-day DEXA noise, be cautious using DEXA to estimate energy status, and understand that flattening a three-dimensional body into a two-dimensional scan introduces real limits. They close with an extended, tongue-in-cheek bit about trademarking "muscle journey" dimensions. Iron Culture is proudly presented by the MASS Research Review. Mostly because Helms and Trex are co-owners. massresearchreview.com If you're in the market for some new (ultra-high-quality) gym gear or apparel, be sure to use code "MRR10" for a 10% discount over at elitefts.com If you'd like to submit a question for a future episode, head over to: massresearchreview.com/ironculture Chapters 0:00 Intro 5:57 The paper: is ultrasound a poor muscle-growth measure? 18:04 What muscle thickness actually captures 25:38 Measurement error vs. a tiny signal 31:16 Different dimensions, different devices 37:52 What researchers should do about it 39:26 Case study: does sleep loss "kill gains"? 47:28 On to DEXA: where this started 53:26 How DEXA works & why fat mass ≠ adipose tissue 1:02:15 Why methods don't always agree 1:11:06 Water weight & the whooshing scale 1:16:43 Estimating energy status from DEXA 1:19:36 Wrap-up

Patrick opens with excitement over advancements in cancer treatment, describing how MRI-guided cryoablation freezes tumors with stunning precision and brings hope. He moves from medical discovery to lively conversations about the "Keep Going" album, weaving in questions about Church teaching on scripture, debates over Peter as the rock, the procession of the Holy Spirit, and differences between Catholicism and Eastern Orthodoxy. Answers come alongside practical exchanges on confession, cremation, judgments about the afterlife, and the tangled history behind church practices, all threaded together with warmth, humor, and challenge. Good News: A revolution is happening in cancer treatment: https://x.com/2stefanmoore/status/2081764352039047469?s=46&t=m_l2itwnFvka2DG8_72nHQ (00:41) Jonathan - I contest that the Gospel of St. Thomas was inspired? (06:45) Rich - 1 Corinthians 10:4. How is Christ the Rock here and not Peter? (08:35) Kurt - Can you tell me more about the Schism of 1054? Why does the Eastern Orthodox call themselves the one true church? (20:02) John - Should we say the Act of Contrition before we go to Confession? (30:52) Mary - I have a neighbor who is keeping her son's ashes in a box. (42:47)

CardioNerds Dr. Rohit Nathani, Dr. Atefeh Ghorbanzadeh, and Dr. Mariam Riad, discuss Obesity-related Heart Failure with Preserved Ejection Fraction (HFpEF) with Dr. John Ostrominski.  This episode was produced as part of the CardioNerds Academy curriculum by House Jones under the guidance of House Chief, Dr. Mariam Riad and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This episode highlights the diverse clinical phenotypes and complex, multifaceted pathophysiology of HFpEF. We take a deep dive into the therapeutic advances that represent paradigm shift in metabolic modulation aimed at improving outcomes in patients with HFpEF and metabolic syndrome. Audio editing by CardioNerds intern Pacey Wetstein. Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls HFpEF is a constellation of symptoms often with different underlying pathophenotypes; cardiometabolic type is rising in incidence. Diagnosis is predominantly based on the clinical scenario along with supporting evidence from imaging modalities such as echocardiogram, cardiac MRI, and right heart catheterization. Cardiometabolic HFpEF is a complex syndrome characterized by dysregulated lipid metabolism, systemic inflammation, and hemodynamic abnormalities, all of which contribute to exercise intolerance and frailty. Lifestyle interventions, comorbidities management, and HFpEF therapeutics go hand in hand for comprehensive HFpEF care and offer opportunities for multispecialty collaboration to achieve optimal patient outcomes. References Ostrominski, J, Højbjerg Lassen, M, Butt, J. et al. Adiposity-Related Anthropometrics and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Participant-Level Pooled Analysis of Randomized Clinical Trials. JACC. 2025 Nov, 86 (20) 1760–1777.https://doi.org/10.1016/j.jacc.2025.08.012  Packer, M. The Adipokine Hypothesis of Heart Failure With a Preserved Ejection Fraction: A Novel Framework to Explain Pathogenesis and Guide Treatment. JACC. 2025 Oct, 86 (16) 1269–1373.https://doi.org/10.1016/j.jacc.2025.06.055 Ahmed, N., Dalmasso, C., Turner, M.B. et al. From fat to filter: the effect of adipose tissue-derived signals on kidney function. Nat Rev Nephrol 21, 417–434 (2025). https://doi.org/10.1038/s41581-025-00950-5 Alicic, R.Z., Neumiller, J.J. & Tuttle, K.R. GLP-1 receptor agonists and next-generation metabolic hormone therapies in chronic kidney disease. Nat Rev Nephrol 22, 265–282 (2026). https://doi.org/10.1038/s41581-025-01036-y Ostrominski, J, Harrington, J, Claggett, B. et al. Anthropometric Measures, Cardiovascular Outcomes, and Treatment Effects of Finerenone in Cardiovascular-Kidney-Metabolic Disease: Pooled Participant-Level Analysis of 3 Global Trials. JACC. 2025 Nov, 86 (20) 1781–1801.https://doi.org/10.1016/j.jacc.2025.08.039

If you're a woman with multiple sclerosis (MS) and you've noticed your fatigue, brain fog, or word-finding trouble getting worse in your 40s or 50s… you're not imagining it. And you're not alone in this. In this episode, I sit down with Dr. Rhonda Voskuhl, a leading MS neurologist and menopause researcher from UCLA, to talk about something the MS community rarely hears explained clearly: what menopause is actually doing to your brain, and why it can look and feel so much like an MS flare. Here's the part that surprised me most. Your MRI can come back completely clean… no new lesions… and you can still feel like your cognition is slipping. That doesn't mean nothing is happening. It means we need to look at what's happening at the cellular level, not just the lesion level. Here's what we cover

The SEC is still living in 2005 and so is everyone around here...we discuss. What will an ARDOT podcast sound like? Plus Zach dances during an MRI. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

As wildfires tear through B.C., more than a thousand firefighters are battling the flames. And while they're managing to extinguish some, new ones are popping up.Also: Some turbulence has formed between the Ontario and federal governments over the proposed expansion of a downtown Toronto airport. Ottawa pulled its support for the project last week, and CBC News has learned Ontario didn't see that coming.And: Alberta is about to become the only place in Canada where you can get a medical diagnostic test, like an X-ray or an MRI, without a doctor's referral.Plus: Both Israel's and Ukraine's leaders visit the White House, fires in France and Spain, vats of putrid, rotting fish sauce are finally being removed from a plant in Newfoundland, and more.

An elevated PSA often leads to an important question: should you have a prostate biopsy right away, or is an MRI the better first step? In this episode of Intellectual Medicine, Dr. Stephen Petteruti explains why multiparametric MRI has become an essential tool in evaluating men at risk for prostate cancer before proceeding to biopsy.Dr. Petteruti discusses how MRI helps identify suspicious areas within the prostate, the role of the PI-RADS scoring system, and why imaging can provide valuable information that guides decision-making. He also explains the limitations of prostate biopsies, including sampling error and the challenge of drawing broad conclusions from a relatively small tissue sample.The conversation explores how PSA trends, MRI findings, and clinical judgment work together to determine the most appropriate next steps. Dr. Petteruti also discusses active surveillance and emphasizes the importance of patients understanding their diagnostic options so they can make informed decisions in partnership with their physician.Timestamps(00:00) Elevated PSA: What's the next step?(00:55) Why MRI often comes before biopsy(01:45) What a prostate MRI can reveal(02:20) Understanding the PI-RADS scoring system(03:15) Why targeted biopsies have limitations(05:20) What a biopsy can and cannot tell you(07:20) Understanding Gleason scores and cancer grading(09:15) When active surveillance may be appropriate(11:10) Monitoring PSA and MRI over time(12:20) Becoming an informed patient and making confident decisionsEnjoy the podcast? Subscribe and leave a 5-star review on your favorite platforms.Dr. Stephen Petteruti is a board-certified physician specializing in longevity-focused, integrative medicine. He works with men navigating prostate cancer, testosterone, and hormone health, aging, and performance using proactive, evidence-informed strategies grounded in real clinical practice. His approach prioritizes preserving function, strength, and quality of life while helping patients make clear, informed decisions beyond reactive, fear-driven care.

Send us Fan MailIn this systematic review and meta-analysis, Nim and Adrianne dig into just how common brain injury really is in neonates with critical congenital heart disease. Pooling 31 studies spanning two decades, the authors found that nearly 70% of these babies show some form of ischemic brain injury, split roughly between pre-operative and post-operative timing. Counter to what most clinicians would predict, kids who went to surgery earlier (days 4-6) had higher rates of white matter injury than those who waited longer. MRI remained the most sensitive tool for picking up these lesions, well ahead of ultrasound or CT. But the data stops well short of proving these findings predict long-term outcomes, and Nim pushes back on the idea that an abnormal scan alone should steer decisions about whether to operate.----Prevalence of Ischemic Brain Injury in Neonates With Congenital Heart Disease: A Systematic Review and Meta-Analysis.Kim C, Chetan D, Kazazian V, Alzamil J, Chau V, Seed M, Miller SP, Selvanathan T.Neurology. 2026 Feb 10;106(3):e214569. doi: 10.1212/WNL.0000000000214569. Epub 2026 Jan 9.PMID: 41512205Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

In this SRNA “Ask the Expert” episode, GG deFiebre spoke with Dr. Michael Levy and Dr. Benjamin Greenberg about optic neuritis and how it is most often linked to multiple sclerosis but can also be idiopathic or associated with MOGAD and NMOSD. They compared differences across these conditions (including age patterns, bilateral involvement, severity, exam findings, and typical recovery), outlined diagnostic workups such as MRI, antibody testing, and spinal fluid studies, and reviewed acute treatments [03:14]. The discussion also covered emerging therapies like Pivikto for neuroprotection and efgartigimod alfa to lower IgG as a potential alternative to plasma exchange, and examined challenges in remyelination and stem-cell delivery approaches like Q-Cells while cautioning against unproven stem cell clinics [11:57].Benjamin M. Greenberg, MD, MHS is a Professor and the Cain Denius Scholar in Mobility Disorders in the Department of Neurology [https://utswmed.org/why-utsw/departments/neurology/] at UT Southwestern Medical Center in Dallas, Texas. He currently serves as the Vice Chair of Translational Research and Strategic Initiatives for the Department of Neurology. He is also the interim Director of the Multiple Sclerosis Center [https://utswmed.org/locations/aston/multiple-sclerosis-and-neuroimmunology-clinic/] and the Director of the Neurosciences Clinical Research Center. In addition, he serves as Director of the Transverse Myelitis and Neuromyelitis Optica Program and the Pediatric Demyelinating Disease Program [https://www.childrens.com/specialties-services/specialty-centers-and-programs/neurology/demyelinating-disease-program] at Children's Medical Center. Prior to his recruitment to UT Southwestern in 2009, Dr. Greenberg was on the faculty of the Johns Hopkins Division of Neuroimmunology, serving as the Director of the Encephalitis Center and Co-Director of the nation's first dedicated Transverse Myelitis Center. Dr. Greenberg splits his clinical time between adult and pediatric patients at William P. Clements Jr. and Zale Lipshy University Hospitals, Parkland, and Children's Medical Center. His research focuses on better diagnosing, prognosticating, and treating demyelinating diseases and nervous system infections. He also coordinates clinical trials to evaluate new treatments to prevent neurologic damage and restore function to affected patients. Michael Levy, MD, PhD is a recognized neurologist with over 15 years of clinical and research expertise in rare neuroimmunological disorders. He established the Neuroimmunology Clinic and Research Laboratory at Massachusetts General Hospital and is the Research Director in the Division of Neuroimmunology and Neuroinfectious Disease. Previously, Dr. Levy was on the faculty at Johns Hopkins University and was the founding Director of their Neuromyelitis Optica Clinic. Clinically, Dr. Levy cares for patients with MOG antibody disease (MOGAD), neuromyelitis optica spectrum disorder (NMOSD), and idiopathic transverse myelitis (TM). Dr. Levy is also the principal investigator (PI) on numerous patient studies and drug trials for new and improved treatments for these disorders. In 2022, Dr. Levy became the lead principal investigator for the two worldwide clinical trials in MOG antibody disease. In the lab, Dr. Levy's research focuses on the development of animal models of NMO and MOG with the goal of tolerization as a sustainable long-term treatment. Dr. Levy has more than 200 peer-reviewed research articles, reviews and editorials, and 3 patents covering NMO tolerization therapy, TM diagnostics, and stem cell regeneration approaches.00:00 Welcome01:02 Optic Neuritis Basics02:27 Causes and Percentages03:14 MS vs NMO vs MOG06:07 Workup and Testing07:51 Acute Attack Treatment09:30 Recovery and Vision Measures11:57 Pivikto Neuroprotection15:30 Efgartigimod vs Plasma Exchange17:59 Repair vs Remyelination20:15 Q-Cells and Stem Cell Delivery22:22 Closing

Have you observed an asymmetric feeding artery on prostate MRI? Alan Gao, MD, discusses the study by Zeynep et al. exploring the finding's potential role in detecting clinically significant cancer. Full article: Prostate Feeding Artery on MRI: Association With Clinically Significant Prostate Cancer Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social Threads: https://www.threads.com/@ajr_radiology

Lecanemab arrived in Canada in January 2026 as an anti-amyloid therapy meant to slow Alzheimer disease. A new practice article in CMAJ, "Lecanemab use for early Alzheimer disease in Canada," lays out key challenges with the drug including narrow eligibility, a modest effect that may not be clinically meaningful, and a resource-intensive path to treatment.Dr. Sophie Weiss, a co-author of the article and a third-year internal medicine resident at the University of Toronto, walks through eligibility and effect size of this novel treatment. Qualifying is a multi-step process of confirmed amyloid on a PET scan or lumbar puncture, genetic testing and a baseline MRI. However, the Clarity AD trial slowed decline by 0.45 points on a standard dementia scale, short of the roughly 1-point difference considered clinically meaningful. Patients eligible and interested in pursuing the therapy, in spite of its modest benefit, will need to pay $35,000 to $40,000 a year which presents one more barrier to treatment.Dr. Vivian Ewa, a care of the elderly physician in Calgary and a clinical associate professor at the University of Calgary, describes the drug's limited role in her practice. She is unable to prescribe it as this is restricted to a small number of specialized prescribers. She says biweekly infusions and urban-only diagnostics put it out of reach for rural and remote patients. For the many who will not qualify, she points to the 2024 Lancet Commission finding that 45% of dementia cases are potentially preventable by modifying 14 risk factors, through such interventions as physical activity, socialization, vascular risk management and hearing correction.For some patients, lecanemab may offer hope for a devastating condition lacking effective disease-modifying treatments. Physicians should be clear about the potential barriers, modest effect size and significant cost. At the same time, primary care physicians should emphasize the impact of reducing identified risk factors.Comments or questions? Text us.Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.You can find Blair and Mojola on X  @BlairBigham and @DrmojolaomoleX (in English):  @CMAJ X (en français): @JAMC FacebookInstagram: @CMAJ.ca The CMAJ Podcast is produced by PodCraft Productions

The first oral PCSK9 inhibitor, another study finding safe MRI scanning in patients with nonconditional CIEDs, the PFA-SHAM trial, and the curious case of orthopedic injuries in cardiology are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic   I Enlicitide Approved First Oral PCSK9 Inhibitor Welcomed for Potential Primary Care Impact https://www.medscape.com/viewarticle/first-oral-pcsk9-inhibitor-welcomed-potential-primary-care-2026a1000own Dr Gregory Katz Substack https://gregorykatz.substack.com/p/are-we-sure-mercks-new-cholesterol CORALreef Lipids Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511002 CORALreef HeFH Trial https://jamanetwork.com/journals/jama/fullarticle/2841258 CORALreef Outcomes Trial https://clinicaltrials.gov/study/NCT06008756 II MRI Scans in Non-conditional CIEDs Specialized Nurse Practitioners Safely Manage MRI in Patients With Cardiac Implantable Devices https://www.medscape.com/viewarticle/specialized-nurse-practitioners-safely-manage-mri-patients-2026a1000ozt Nurse Practitioner-Led CIED Monitoring During MRI 10.1016/j.hroo.2026.04.031 External Link MRI in Nonconditional Pacemakers and ICDs https://academic.oup.com/europace/article/22/2/288/5717383 Heart Rhythm Society Consensus Document 10.1016/j.hrthm.2017.04.025 External Link III PFA-SHAM trial PFA-SHAM Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.079484 SHAM-PVI Trial https://jamanetwork.com/journals/jama/fullarticle/2823283 IV Orthopedic Injuries in Cardiology What Will It Take to Make Fluoroscopy Labs Safer? https://www.medscape.com/viewarticle/what-will-it-take-make-fluoroscopy-labs-safer-2026a1000ox6 Expert Consensus Statement on Enhanced Radiation Protection https://www.jacc.org/doi/10.1016/j.jcin.2026.06.011 'Shed the Lead' and the Injuries. Should Cath Labs Go Lead-Free? https://www.medscape.com/viewarticle/shed-lead-and-injuries-should-cath-labs-go-lead-free-2024a1000hnb Health Hazards of Working in the Interventional Laboratory https://doi.org/10.1016/j.jacc.2014.11.056 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Editor-in-Chief Cecelia E. Schmalbach, MD, MSc, is joined by senior author Jennifer L. Spiegel, MD, and Associate Editor Jacob Hunter, MD, to discuss the significance of advanced standard software tools for cochlear implants that allows a detailed analysis, as outlined in the paper "Angular Insertion Depth for Cochlear Implantation: A Comparative Analysis on Precision of CT, MRI, and x-Ray" which published in the July 2026 issue of Otolaryngology–Head and Neck Surgery. Click here to read the full article.

Michael Nader is a behavioral neuropharmacologist with research interest in the areas of drug abuse, impulsivity, brain dopamine receptor function and nonhuman primate models of human disease. He has been working with catheterized nonhuman primate models for nearly 35 years and with brain imaging (PET and MRI) for over 25 years. His research examines individual differences in drug effects, highlighting sex differences, social rank and drug history as important organismal variables that influence outcome. Read more about Dr. Nader's work at https://school.wakehealth.edu/research/labs/michael-nader-lab

Everyone Has the Same AI Tools Now. So where's the Moat?In this episode of Tank Talks, host Matt Cohen sits down with Jacob Jackson, partner at Julian Capital and founder of Deep Checks. A physicist turned SaaS founder turned deep tech investor, Jacob brings a unique perspective on the shifting landscape of venture capital. He shares his personal journey from developing MRI techniques at UBC to founding MedStack, and why he made the full-circle pivot back to backing companies building real, hard technology.Jacob offers a frank assessment of the defensibility crisis in software, explains why AI is democratizing superpowers across every industry, and makes the case that deep tech offers faster exits and higher unicorn density than its reputation suggests. He also breaks down how Julian Capital supports founders with growth and go-to-market muscle, and why the team behind the idea matters more than ever in today's market.Whether you're a founder building hardware, an investor looking for the next generation of venture returns, or just trying to understand where technology is headed, Jacob Jackson delivers the kind of straight talk that cuts through the hype.Why Software's Moat Is Gone (04:00)* Jacob's firsthand experience building MedStack, where Amazon, Google, and Azure built competing products almost overnight* Why the defensibility crisis in SaaS is making it harder than ever for new companies to get off the ground* The shift from competing on product to competing on capital and go-to-marketRedefining Deep Tech: What Everyone Gets Wrong (06:44)* The biggest misconception: that deep tech requires 20-year fund cycles* How SpaceX-style private market liquidity proves milestone-based exits work* Why the hottest sector of the year is never where the biggest company gets seededHow AI Accelerates Hardware Development (08:23)* AI as a democratizing force that makes everything faster and more competitive* From CAD design to patent strategy: how AI is becoming a founder's essential tool* The commoditization of vertical robotics and what it means for defensibilityBuilding Moat in Deep Tech: Talent, Networks, and Network Effects (10:30)* Why network effects and talent density matter more than patents alone* How to pull the “ladder up” behind you as you scale* Incumbents vs. upstarts: why everyone has access to the same tools nowThe Rise of Deep Checks (18:01)* How Deep Checks became the world's largest network of deep tech founders and VCs* The platform that helps founders run a tight, accelerated fundraising process* Over $100 million deployed and 5,000+ founders submitted in just two yearsWhat Jacob Looks for in Founders (24:50)* The 50/50 split between team and idea* Why obsession and speed matter more than business experience* How to spot the founders who will learn to sell, recruit, and negotiateFrontier Tech vs. Deep Tech (29:20)* Why Julian Capital backs “picks and shovels” companies in spaces like fusion and quantum* The importance of market pull and meaningful near-term milestones* Why a 20-year fund cycle makes financial math nearly impossibleThe Data That Surprised Everyone (32:58)* Deep tech exits are 25% faster with more unicorns per dollar invested* Why historical data shows deep tech outperforming software* The role of capital flooding and dilution in venture returnsAbout Jacob JacksonJacob Jackson is a partner at Julian Capital and the founder of Deep Checks, the world's largest network of deep tech founders and VCs. A physicist by training, Jacob pivoted from academic research to founding MedStack, a privacy and security SaaS platform, before returning to his engineering roots as an investor. He now backs founders building hardware and tackling the world's hardest problems. Jacob is known for his data-driven approach, obsession with team quality, and candid takes on the future of venture capital.Connect with Jacob Jackson on LinkedIn: https://www.linkedin.com/in/jonlovekingsett?originalSubdomain=caVisit Julian Capital's website: https://www.julian.capital/Submit to Deep Checks: https://www.deepchecks.vc/Connect with Matt Cohen on LinkedIn: https://ca.linkedin.com/in/matt-cohen1Visit the Ripple Ventures website: https://www.rippleventures.com/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit tanktalks.substack.com

Disclaimer: This article is for educational purposes only and is not a substitute for individualized medical advice. Talk to your own physician before making decisions about cancer screening, testing, or treatment.TL;DR* A healthy 58-year-old gets a routine full-body scan, finds a “cancer” that would never have hurt him, and ends up with permanent incontinence from unnecessary treatment. This is more common than most people realize.* Dr. H. Gilbert Welch, a Dartmouth-trained cancer epidemiologist, spent 30 years documenting overdiagnosis — the discovery of cancers that meet the technical definition but would never have caused harm. His estimate: roughly 60% of PSA-detected prostate cancers and 25% of mammography-detected breast cancers fall into this category.* The “5-year survival rate” you hear cited as proof screening saves lives is often distorted by lead-time bias — finding a cancer earlier can make survival numbers look better without adding a single day to anyone's life.* Not all screening is suspect. Colonoscopy, low-dose CT for high-risk smokers, and cervical cancer screening (Pap/HPV) have strong randomized-trial evidence behind them.* The piece conventional screening misses: metabolic health. A 2026 Nature Communications study using machine learning on UK biobank data linked insulin resistance to increased risk across at least 12 cancer types — independent of body weight — and standard checkups rarely test for it.* Want a personalized look at your own metabolic terrain? Book a Metabolic Audit Call — link in show notes, spots limited weekly.The Test That Didn't Save His LifePicture a 58-year-old man. Healthy weight, active, doesn't smoke, feels completely fine. He goes in for a routine total-body scan — the kind now available at imaging centers with no doctor's referral required. Two hours later, a radiologist flags a small spot on his prostate.Six months, two biopsies, and one surgery later, he has a diagnosis: permanent incontinence. And the cancer itself? “Clinically insignificant.” It almost certainly would never have caused him harm. He would have lived out a full life and died of something else entirely, never knowing it was there.The test didn't save his life. It changed it — for the worse.This scenario happens thousands of times a year, and it's exactly what Dr. H. Gilbert Welch — a general internist, cancer epidemiologist, and senior researcher at Brigham and Women's Hospital — spent his career warning about. His book, Should I Be Tested for Cancer?, makes a case that runs against decades of public health messaging: more testing is not automatically better testing, and early detection does not automatically mean lives saved.This article unpacks what Welch got right, where his argument leaves a gap, and what a more complete, proactive approach to cancer risk actually looks like.The Cancer Reservoir: Why Finding More Doesn't Mean Saving MoreFor decades, the operating assumption in medicine has been simple: catch cancer early, save the life. No asterisk, no nuance.Welch's research complicates that. His central idea is the cancer reservoir — the observation that most people carry small clusters of abnormal cells somewhere in their bodies right now. In the prostate, thyroid, breast, or lung. Under a microscope, these cells look like cancer. But many of them will never grow, never spread, and never threaten a life. A person could carry one for thirty years and die at 87 of heart disease, never knowing it existed.The problem is that increasingly sensitive tools — full-body scans, PSA tests, low-dose CT — are very good at finding these dormant clusters. And once something is found and labeled “cancer,” the medical system is built to treat it.Welch's numbers, drawn from randomized trial data, are striking: approximately 60% of PSA-detected prostate cancers are overdiagnosed, meaning they meet the technical definition of cancer but would never have caused symptoms or death. For mammography-detected breast cancers, the estimate is around 25% — meaning roughly one in four women treated for a screen-detected breast cancer may never have needed that treatment: the chemotherapy, the radiation, the surgery, the fear, the financial cost.This isn't an anti-medicine argument. It's a call for a conversation that rarely happens: here's the case for this test, and here's the case against it — here's what we might find that helps you, and here's what we might find that sets off a chain reaction you'll spend years managing. For most patients, that conversation never occurs.The 5-Year Survival Stat Is Misleading YouFive-year survival rates for cancer are often cited as evidence that screening works — and they sound like exactly that. But Welch shows why the number can be deceptive, and it comes down to lead-time bias.Here's the mechanism. Imagine a woman whose cancer will kill her at 65, regardless of when it's found. If screening catches it at 62, she lives three years with the diagnosis before dying at 65 — a five-year survival rate under five years. But if that same cancer isn't found until symptoms appear at 64, she lives one year with the diagnosis and dies at 65 — a five-year survival rate of zero.Same woman. Same cancer. Same date of death. But the version of her found earlier through screening appears, statistically, to have “survived longer.” Screening didn't add a single day to her life — it just moved up the start date of her diagnosis. It's the equivalent of claiming a win in a race because someone moved your starting line 200 meters ahead of everyone else's: you didn't run faster, you just started earlier. The finish line never moved.Now layer in overdiagnosis. If 1,000 people are diagnosed with cancers that would never have hurt them, and all 1,000 are alive five years later — which they would have been regardless — the survival statistics look dramatically better without a single life actually being saved. Welch's research shows that 5-year survival rates can climb while actual cancer death rates stay flat. More survivors on paper. Same number of people dying.None of this means medicine isn't making genuine progress in some cancers — colon cancer being a clear example, discussed below. It does mean that 5-year survival statistics, on their own, are not proof that a screening program is saving lives.Where the Evidence for Screening Is Actually StrongIt would be a mistake to leave this discussion thinking all screening is suspect. Welch himself is careful to draw a distinction, and there are tests with solid, randomized-trial evidence behind them.Colonoscopy for colorectal cancer is arguably the strongest case for screening that exists. It's unique because it doesn't just detect cancer — it can prevent it, by removing precancerous polyps before they ever become malignant. Colon cancer incidence and mortality have both dropped measurably in populations with high screening rates. If you're 45 or older, or have a family history, this is worth a serious conversation with your doctor.Low-dose CT for lung cancer, in high-risk individuals specifically, showed a 15–20% reduction in lung cancer deaths in the National Lung Screening Trial — but only among heavy smokers (roughly a pack a day for 20+ years). The risk-benefit math works because the baseline risk in that population is high.Cervical cancer screening — Pap smears and HPV testing — is a genuine public health success story. Rates have dropped dramatically since routine screening began, because cervical cancer has a long, slow, detectable precancerous stage that can be caught before it turns invasive.The common thread: these screenings either catch a long, slow precancerous process, or they target a population where the risk is already high enough that the math clearly favors testing. That's the question worth bringing to your doctor: given my specific risk factors, does the math on this test work in my favor?By contrast, the evidence is much weaker for consumer-marketed total-body scans, full-body MRI as a general “optimization” tool, universal PSA screening in all men over 50, and mammography in average-risk women in their 40s. These aren't mandates — they're conversations, and informed consent means understanding both sides before deciding.The Harms Nobody Talks AboutHealthcare marketing tends to present testing as one-sided: test early, catch it early, save your life. Welch's research catalogs the costs that rarely make it into that pitch.False positives. A mammogram flags a shadow. It isn't cancer — but you don't know that yet. Six weeks of follow-up imaging, maybe a biopsy, and the stress hormones flooding your body during that stretch are a real physiological cost, even when the final answer is “you're fine.”Unnecessary treatment. When a cancer that would never have caused harm is treated anyway — with surgery, radiation, or chemotherapy — the harm is real and the benefit is zero.The cancer label itself. Research shows that being labeled a cancer patient, even for a cancer that's never actively treated, changes a person's psychology, relationships, insurability, and life trajectory. Welch identifies this as a form of harm medicine rarely accounts for.Radiation exposure. Repeated CT scans carry cumulative radiation risk. A full-body scan can expose a person to the radiation equivalent of hundreds of chest X-rays — a real risk added to the body in pursuit of a cancer that may never develop.Welch's central reframe: the question isn't “should I get tested,” it's “given my risk factors, my age, my family history, and my values, does the math on this specific test work in my favor?” That's informed consent — and most people never get that conversation.The Missing Piece: Your Metabolism Is an Early Warning SystemWelch's work is thorough on what not to do. Where it leaves a gap is the proactive question: if blanket screening of healthy people isn't the answer, what is?The answer lies in the years — sometimes decades — before a tumor ever forms. Cancer doesn't appear overnight. The cellular environment that allows it to take root and grow develops gradually, and it leaves metabolic fingerprints long before any scan could detect a tumor.The clearest evidence for this comes from a 2026 study published in Nature Communications, which used machine learning on a massive UK database and linked insulin resistance to a significantly increased risk of at least 12 types of cancer. Pancreatic cancer risk was elevated by roughly 29%, colon cancer by 18%, and breast cancer by 13% — and critically, this risk showed up independent of body weight. A person at a healthy weight can still be carrying the metabolic dysfunction that drives cancer risk, and a standard annual physical would miss it entirely, because most doctors check fasting glucose, not fasting insulin. By the time glucose is elevated, insulin regulation has often been off for years.Layer in chronic inflammation (measured by hs-CRP), elevated ferritin, low vitamin D, rising homocysteine, and a poor triglyceride-to-HDL ratio, and what emerges is a picture of a metabolic environment that is increasingly hospitable to cancer. Think of it as soil: a healthy garden doesn't grow weeds easily, but depleted, imbalanced soil invites them. Cancer is the weed. Metabolic dysfunction is the depleted soil. The strategy, then, is to work on the soil rather than wait to spot the weed.What to Actually Do About ItPath A: Testing to ask your provider forThese tests build a real metabolic picture — the kind that shows soil quality before any weed appears.* Fasting insulin + HOMA-IR — not just fasting glucose. This is likely the single most important test most doctors aren't ordering.* Hemoglobin A1c — your 3-month blood sugar average.* hs-CRP — a high-sensitivity marker of systemic inflammation.* Full lipid panel, including TG/HDL ratio — a ratio above 3 is a strong metabolic red flag.* Ferritin — elevated levels are increasingly linked to inflammatory cancer environments.* Vitamin D (25-OH) — low levels are associated with higher cancer risk across multiple types; optimal is 60–80 ng/mL, not just “in range.”* Homocysteine — a methylation marker that, when elevated, signals oxidative stress.* LDH (Lactate Dehydrogenase) — rises when cells are under metabolic stress.For a deeper look, consider a comprehensive nutrient and organic acids panel (NutrEval), a gut microbiome panel (GI-MAP) — the gut-cancer connection is real — and a full hormone panel including cortisol, estrogen, testosterone, and SHBG.Path B: Lifestyle changes to start today* Eat in this order: protein and fat first, vegetables second, starches last. This alone can meaningfully blunt post-meal blood sugar spikes.* Cut refined sugars and seed oils — the two most direct dietary drivers of insulin resistance and inflammation.* Move daily. At minimum, 150 minutes of moderate activity per week, resistance training twice a week, and even a 10-minute walk after meals to improve glucose metabolism.* Prioritize sleep. Poor sleep disrupts glucose metabolism after a single bad night. Seven to nine hours is non-negotiable for metabolic health.* Manage stress. Chronic cortisol elevation drives insulin resistance — this is biochemistry, not soft advice.You don't need to do all of this at once. Pick one test to ask for at your next appointment, and one lifestyle change to start this week.Summary & Next StepDr. Welch's research makes an uncomfortable but important case: early detection is not automatically synonymous with lives saved, the 5-year survival statistic can be misleading, and testing healthy people carries real costs — false positives, unnecessary treatment, radiation exposure, and the psychological weight of a cancer label. At the same time, some screenings — colonoscopy, cervical cancer screening, low-dose CT for high-risk smokers — have strong evidence behind them and are worth pursuing for the right person.What's missing from that picture is a proactive strategy, and that's where metabolic health comes in. Insulin resistance, chronic inflammation, and blood sugar dysregulation show up years before cancer does, and unlike a full-body scan, they're both measurable and fixable.If you want a clear picture of where your own metabolic terrain stands — and what your highest-leverage next steps are — book a Metabolic Audit Call. It's a complementary 45-minute session where we review your current labs, symptoms, health history, and goals together. Spots are limited each week; the link is in the show notes.References* Welch, H.G. Should I Be Tested for Cancer? Maybe Not and Here's Why. University of California Press.* National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening.* Nature Communications (2026). Machine learning analysis of UK biobank data linking insulin resistance to increased risk across 12 cancer types, independent of body weight.* Thrive 120 Podcast, Episode 126: “Should I Be Tested for Cancer? What Dr. Welch Got Right — And What He Missed,” This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit tripleplaydoc.substack.com/subscribe

A medical imaging machine Whakatane has been waiting years for has ended up instead in Masterton. Eastern Bay of Plenty locals needing an MRI scan still have to trek toTauranga to use one of its seven MRI machines, all privately owned. Phil Pennington reports.

Visceral fat, subcutaneous fat, Prenuvo MRI scans, and the truth about belly fat Your gut and your face are telling on you. This episode reveals why the fat under your skin might be protecting you while the fat around your organs is quietly wrecking your metabolism, heart, and longevity, and exactly what to do about the difference. Get $300 off your next Prenuvo MRI scan: https://prenuvo.com/?discount=Dave Host Dave Asprey sits down with Dr. Sean O'Mara, a former undercover narcotics agent, criminal prosecutor, emergency medicine physician, and retired U.S. Army Colonel who assisted the White House and Senior Executive Service, treating Vice President Dick Cheney, former President Bill Clinton, and Secretary of State Colin Powell. Today he's recognized as the world's most experienced physician in eliminating visceral fat and epicardial adipose tissue (EAT), the inflammatory fat now linked to nearly every major chronic disease and accelerated aging. He founded Influence Medicine, a specialty built around helping senators, heads of state, and top executives optimize their biology so they can perform and lead at the highest level. Dave and Dr. O'Mara break down the real difference between visceral fat and subcutaneous fat, why a visible six-pack might signal hidden disease, and how MRI scans reveal what your mirror never will. They dig into the biohacking strategies that actually shift your body composition: fasting protocols that build beneficial fat instead of burning it away, microbiome optimization for fat metabolism, and the supplements and functional medicine tools Dr. O'Mara uses with his highest-performing clients. They also cover the gut-hormone connection driving modern metabolic dysfunction, why political leaders are quietly getting scanned, and what your face reveals about your visceral fat levels before you ever step on a scale. You'll Learn: The real difference between visceral fat, subcutaneous fat, and why one protects you while the other kills you Why a six-pack might be hiding disease your MRI would catch How a 72-hour fasting protocol can build the good kind of fat through adiponectin signaling What your face reveals about your visceral fat and longevity risk The gut-hormone connection driving testosterone, metabolism, and inflammation Why senators and world leaders are getting scanned for hidden fat How microbiome health, fasting, and functional medicine work together for fat loss and longevity Thank you to our sponsors! - Beyond Wonderland Conference | Oct 13 - 14, 2026. Get your ticket now at wonderlandconference.com. - Suppgrade Labs | Get real restorative sleep with Quiet Mode. Use code DAVE15 at shopsuppgradelabs.com. - Puori | Use code DAVE at puori.com/DAVE to get 32% off your first Puori CP1 Pure Collagen. Order when you start a subscription. You save more than $26 - LMNT | Right now you can get a free 8-count Sample Pack of LMNT's most popular drink mix flavors with any purchase at drinkLMNT.com/dave Dave Asprey is a four-time New York Times bestselling author, founder of Bulletproof Coffee, and the father of biohacking. With over 1,000 interviews and 1 million monthly listeners, The Human Upgrade brings you the knowledge to take control of your biology, extend your longevity, and optimize every system in your body and mind. Each episode delivers cutting-edge insights inhealth, performance, neuroscience, supplements, nutrition, biohacking, emotional intelligence, and conscious living. New episodes are released every Tuesday, Thursday, Friday, and Sunday (BONUS). Dave asks the questions no one else will and gives you real tools to become stronger, smarter, and more resilient. Keywords: visceral fat vs subcutaneous fat, how to reduce visceral fat, best fat for longevity, MRI body scan benefits, Prenuvo full body scan, what is epicardial fat, skinny fat TOFI explained, why is my six pack unhealthy, 72 hour fasting benefits, fasting and testosterone, how to build subcutaneous fat, biohacking visceral fat, Sean O'Mara doctor, influence medicine, fecal microbiota transplant benefits, gut microbiome and fat loss, Dave Asprey, biohacking, longevity Resources: • Learn More About Dr. O'Mara's Work At: https://drseanomara.com/ • Get $300 Off Your Next Prenuvo MRI Scan: https://prenuvo.com/?discount=Dave • Get My 2026 Clean Nicotine Roadmap | Enroll for free at https://daveasprey.com/2026-clean-nicotine-roadmap/ • Dave Asprey's Latest News | Go to https://daveasprey.com/ to join Inside Track today. • Danger Coffee: https://dangercoffee.com/discount/dave15? • My Daily Supplements: SuppGrade Labs (15% Off) • Favorite Blue Light Blocking Glasses: TrueDark (15% Off) • Dave Asprey's BEYOND Conference: https://beyondconference.com • Dave Asprey's New Book – Heavily Meditated: https://daveasprey.com/heavily-meditated • Join My Substack (Live Access To Podcast Recordings): https://substack.daveasprey.com/ • Upgrade Labs: https://upgradelabs.com Timestamps: 00:00 – Trailer 00:58 – Intro 02:38 – Fat Type Basics 04:19 – Reviewing Dave's Scan 08:04 – Good Fat vs. Bad Fat 16:49 – Fertility & Pregnancy 19:47 – Personality & Health 21:51 – Wealth & Health Neglect 30:32 – Insurance Incentives 39:29 – Microbiome & Disease 40:41 – FDA & Fecal Transplants 42:57 – Viome & Biomarker Data 45:40 – Skinny Fat & Appearance 49:44 – Building Subcutaneous Fat 52:57 – Fasting Protocol 58:37 – Closing See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

A bone biopsy can reach the target and still miss the diagnosis. In this episode of the BackTable Podcast, host Dr. Neil Jain is joined by Dr. Peter Thurlow to discuss how lesion selection, imaging review, trajectory planning, and device choice determine whether a targeted bone biopsy produces a useful sample without compromising future treatment. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported byVarian https://cancercare.siemens-healthineers.com/products/interventional-oncology/musculoskeletal/omnibone --- Timestamps 00:00 - Introduction04:17 - Approaching Focal Bone Lesions06:17 - Differentiating Lesions and Pain Management13:13 - Settling on Bone Biopsy Imaging16:55 - Understanding Pre-Op Imaging from Lesion Characteristics 21:50 - Maintaining Communication Across Specialties24:21 - Which Devices To Select and Navigating Challenges32:28 - Trajectory Paths and Surgical Considerations35:30 - How to Avoid and Mitigate Biopsy Complications41:30 - Wrap Up --- More about this episode The conversation begins with a systematic approach to evaluating focal bone lesions, including the likelihood of malignancy, lesion location, number of lesions, and selection of an appropriately sized sampling device. Dr. Thurlow reviews anesthesia and pain-management strategies for both superficial and deeper osseous targets, as well as the respective roles of MRI and CT in procedural planning. For challenging lesions, he explains why needle-guidance technology may be preferable to adjusting gantry tilt and outlines how imaging findings and biopsy strategy should be tailored to lesion type, with particular attention to the difficulties associated with blastic lesions. The doctors also discuss the importance of communication with pathology, surgery, oncology, and other collaborating specialties before proceeding. Dr. Thurlow shares his preferred biopsy devices, considerations for selecting a safe trajectory, and ways to account for potential future surgical approaches. The episode concludes with practical strategies for avoiding complications, minimizing tissue injury, and obtaining an adequate diagnostic sample. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

一、【20260717人間菩提】 【無量義 法髓頌】 以善以愛照亮全球經藏演繹，即將於11月中旬展開，志工們彼此從陌生到熟悉，用真誠的心在學習，舉手投足無不都是法，讓師父看得很歡喜。 一場經藏演繹，是因為有眾人的互相配合，把握因緣齊聚一堂，還有慈悅師姊也在其中承擔了重要的推手，才能共同成就這一大盛事，更將愛的能量持續擴散。 大家共同演繹、背誦《無量義經》時，上人也叮囑大家，在訓練時六根都要用到，仔細去聽、去看、也去開口，除了要調整好氣息，也要謹記舉手投足間，都要將法入心，並勤加練習，讓我們變得沒有擔憂，心就會很輕安、自在，這也叫做修行。 二、健康100分~手麻、走路不穩別輕忽！洪祥益醫師談頸椎脊髓病變：把握黃金治療期，避免終身遺憾 花蓮慈濟醫院神經脊椎微創外科主任洪祥益醫師表示，許多人以為拿筷子不穩、扣扣子困難、寫字變醜、走路不穩只是年紀大或老化造成，其實這些都可能是「頸椎脊髓病變」的早期警訊。脊髓是連接大腦與四肢的重要神經通道，一旦受到壓迫，大腦傳遞控制運動、感覺及反射的訊號就會受到影響，因此除了肩頸痠痛、手麻之外，更可能出現精細動作退化、步態不穩，甚至不自主抖腳等症狀。 洪醫師指出，造成頸椎脊髓病變最常見的原因包括椎間盤突出、骨刺增生造成椎管狹窄、外傷，以及東亞族群較常見的「後縱韌帶骨化症」。部分患者平時症狀並不明顯，直到神經學檢查或核磁共振檢查，才發現脊髓已受到嚴重壓迫。尤其原本已有退化的人，即使只是跌倒、滑倒、撞到頭，甚至搭乘雲霄飛車，都可能因脊髓缺乏緩衝空間而造成嚴重損傷。 診斷方面，醫師會先透過神經學檢查、反射測試判斷是否為脊髓病變，再依需要安排核磁共振（MRI）確認病灶位置。若確定脊髓受到壓迫，治療重點就是及早減壓。洪醫師表示，目前頸椎顯微微創手術已相當成熟，利用高倍率顯微鏡與精密器械，在狹小空間內安全移除骨刺或壓迫組織，大多數患者手術後即可下床活動，住院時間短，傷口小、恢復快。 洪醫師也提醒，脊髓病變若延誤治療，可能因長期壓迫導致脊髓萎縮、肌肉無力，即使手術後恢復效果也會打折扣，嚴重者甚至因一次輕微跌倒造成四肢癱瘓。因此，若出現手部精細動作變差、走路像踩棉花、容易跌倒等症狀，應盡快至神經外科或神經內科接受專業評估，把握黃金治療時機。 平時保健方面，應避免長時間低頭滑手機、維持正確坐姿、多做核心肌群與頸部肌力訓練，減少頸椎負擔。洪醫師也鼓勵民眾培養運動習慣，增加肌肉力量，就像投資健康一樣，讓肌肉穩定支撐脊椎，才能降低退化與受傷風險，維持良好的生活品質與行動能力。

  Episode: 140 RAISING PPA assessment and treatment from the Ground Up: In Conversation with Jeanne Gallée     In this episode you will discover: · Assessment and Intervention Aren't Separate — Conversation itself can double as both. By listening closely and responding to what a client offers, in a "more art than science" way, clinicians gather meaningful data and provide support at the same time, rather than treating these as two distinct phases of care. · Rigid Testing Can Erase the Person Behind the Diagnosis — Traditional standardized assessments often serve the goals of an institution or research protocol more than the person being assessed. Frameworks like RAISE and the PACT scale shift the focus toward strengths, natural conversation, and what someone can still do, rather than repeatedly measuring decline. · PPA Needs Its Own Identity and Training Path — Because primary progressive aphasia sits uneasily between post-stroke aphasia care and traditional dementia care, clinicians often receive little formal training in it. A global survey found major gaps in education and confidence, underscoring the need for dedicated resources, like Dr. Gallée's PPA roadmap, built specifically for this population. Do you ever wish you could step back in time and undo the missteps and errors of the past? What if you had the opportunity to build something from the ground up? Certainly, knowing what you know now, you could begin in a better place. But of course, there's always pitfalls with new beginnings, even with the knowledge of lessons from the past. You could, however, make a positive impact on that new beginning. Welcome to the Aphasia Access Conversations podcast. I'm Jerry Hoepner, a professor from the University of Wisconsin Eau Claire, and co-facilitator of the Chippewa Valley Aphasia Camp, Blue Gold Brain Injury Group, Mayo Brain Injury Group, Young Persons Brain Injury Group, Brain In-Cog, and Thursday Night Poets. I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas about their aphasia care through a variety of educational resources. I'm privileged to introduce today's guest, Dr. Jeanne Gallée, who is a clinical scientist in the Department of Medicine at the University of Washington. Dr. Gallée is a licensed speech language pathologist practicing in the greater Washington state area. She completed her Bachelor of Arts in Cognitive and Linguistic Sciences at Wellesley College in 2016 and Doctor of Philosophy at Harvard University in Speech and Hearing Bioscience and Technology in 2021. She has been recognized as a Distinguished Early Career Professional by ASHA and a Distinguished Scholar by the Tavistock Trust for Aphasia. Her work is dedicated to improving assessment practices and functional outcomes for individuals living with aphasia and neurodegenerative conditions. Jerry Hoepner: Jeanne, it's really nice to see you again today, and to have this opportunity to have a conversation with you as a recent recipient of the Tavistock Scholar Program, and to talk about your work with individuals with primary progressive aphasia. So, thanks for being "on" today for the conversation. Jeanne Gallée: Thank you so much for having me, Jerry. I'm really honored to be here. Jerry Hoepner: Likewise, I'm really excited for this conversation, and as I just alluded to, I wanted to congratulate you on being awarded the first Tavistock Scholar with an emphasis doing work in primary progressive aphasia, and I thought maybe I could get your thoughts on being selected as a Tavistock Scholar. Jeanne Gallée: Thank you. It feels honestly incredibly remarkable in the sense that I think it represents a shift in how we're thinking about the separate diagnoses of progressive aphasia versus an aphasia that's due to an acute injury. And I'm really honored to be a part of that. I think there have been many discussions growing over the years, and I think we're seeing that shift in how we do think about addressing assessment and intervention and general care for people across the aphasia continuum. Jerry Hoepner: Agreed, I think there's been so much growth in the last five years in that area. I can remember at the outset of the pandemic, having discussions about "What do we do with people with primary progressive aphasia who were a part of our aphasia group? Should they be a part of our aphasia group? How do we pivot to that in an online context?" and it feels like we've come so far in our conversation about where primary progressive aphasia fits in in all of those different contexts. Jeanne Gallée: Right, I entirely agree, and I think the journey of my own work has already evolved in so many ways that I couldn't have imagined, like you say, five years ago I completed my doctoral work March 2021 and just seeing the phenomenal amounts of change that have really taken place since then has been incredible, and I feel very lucky to be part of that momentum right now. Jerry Hoepner: Absolutely, it's exciting to see these things move forward. And one of the differences that I see is primary progressive aphasia started out within the Life Participation Approach, just soundly from day one, as opposed to a lot of aphasia care, which has kind of evolved from this medical model, and how refreshing it is to see something built from the ground up. Done right, so to speak. I don't know if you have thoughts on that piece… Jeanne Gallée: No, I do. I think that's a really interesting point. I think I might be part of the camp that at times feels like progressive conditions get a little bit lost in the rehabilitation space, but I think you're absolutely right. I think the absence of pharmacological treatment, or a cure that has long standing effects for these progressive conditions has made rehabilitation specialists much more attuned to focusing on quality of life, life participation, maintaining autonomy, and so forth. So, I think I forget that perspective sometimes. Perhaps from the space that I work in, I tend to be in a more interdisciplinary environment where I feel on the opposite end. I'm often asked for justification for providing these types of services, and that fits in nicely with our previous discussion on how we do see that differentiation and how people with aphasia due to a progressive condition may be siloed from people who have the more quote unquote traditional aphasia symptoms. Jerry Hoepner: Yeah, that's a really good point. And you know, referring to those previous conversations we discussed that need for primary progressive aphasia to have a space of its own. It's tricky because it doesn't fit into post-stroke aphasia quite right, and it doesn't fit into the Alzheimer's and dementia world quite right. So, yeah, it's nice to see this developing in the Life Participation kind of context, really excited about Anna Volkmer's conference dedicated to primary progressive aphasia. Yeah, what an excellent point, that even though we feel like it's great to build it from the ground up, there's still people in that interdisciplinary context, who are very much looking at this, like,"Justify this. How is having conversations and doing activities with someone justifiable, as a, you know, as a skilled intervention?" Jeanne Gallée: Right. I think a lot of it comes back to misunderstandings about the scope of our profession. So, coming from the speech language pathology standpoint, we may have a perspective that other providers may not. And it's interesting, particularly when that confusion or disconnect happens in conditions that are communication led, where we see the symptoms primarily touching upon our ability to interact verbally or non-verbally to communicate. And it's fascinating, and I think speaking to that silo, we see PPA having been a relatively new and still considered very rare condition, but there's so much overlap with other conditions, right, in the kinds of symptoms that we see and there's so much where, as any speech pathologist with experience in acquired neurogenic communication disorders, we can see that we can apply our skill set, but again, likely due to the terminal nature of the condition, we end up seeing providers taking it a different route, or saying either there's only the pharmacological route, or we just let it lie or let it be as is, which we wouldn't do with any other condition. We wouldn't say that for someone with ALS. We would want to provide them the supports, even if they're temporary, to improve quality of life. So, it is an interesting, almost cultural phenomenon as well. I think. Jerry Hoepner: Yeah, that I think it's really fascinating, and I'm so glad you brought that up. It reminds me of kind of the phrase, the company we keep, right? It's easy to be amongst, you know, people who are in the [Life Participation Approach to Aphasia] LPPA world, who think the way that we think, and who do the way that we do. And I do a lot of work in the area of cognitive communication disorders with acquired brain injuries, and so forth, and there's been a remarkable shift in the last five years there as well towards a more Life Participation bio psychosocial approach, and some of the work that I've been passionate about for years has been more and more accepted. So you feel like when you're in that company of all of your people that everything's all good, but it also reminds me of something that my friend Natalie Douglas always says, which is that "We need to be out there amongst others who need to understand the importance of this kind of a perspective, and sharing that." And when you talked about those other professionals, I really didn't think about that until you said that. Right, really important to get them on the same page, and to help them understand why this is so important. Jeanne Gallée: Right? And I think that's where the conference that you mentioned, the first PPA only conference that's taking place this summer in London, is so special because one of the reasons why we were so motivated to have this type of a conference is that there wasn't really the space at the typical aphasiology conferences, and then the larger neurology-based conferences, or more broadly dementia-based conferences, also didn't quite feel like a home. I think, especially their studies of quality of life, in particular, we're really not seen as rigorous in those contexts. So, this conference, what's nice is that we have that uniting force of everyone being focused on PPA, but it's super interdisciplinary, and that I think will really promote some fantastic conversations. Jerry Hoepner: Wow, that's really encouraging and exciting to see that move forward. I'm not in the primary progressive aphasia world, although when we're at aphasia camp and things like that, certainly that's a part of my role. But as soon as I saw the call for papers come out, I'm, you know, texting and messaging all of my PPA folks to say, "Did you see this? This is great. Are you doing something?" It's very exciting. So, I'm excited to see where that moves in the future and to hear how things go this time around. That's great. Jeanne Gallée: Likewise, I'm really excited, and I do really believe it will lead to a whole future cascade of collaboration. Jerry Hoepner: Yeah, amazing. Well, before we delve into your amazing work, I've been reading your articles, and it's been just a pleasure to read it. I'm always impressed with how certain themes of importance can come across in different areas of our field, and it's been fun to see that. I wonder, because I'm looking at the list of collaborators, just some incredible collaborators on that list, in those papers, I'd love to hear a little bit about your mentorship, both in primary progressive aphasia and kind of thinking about the Life Participation quality of life kind of context as well. Jeanne Gallée: Yeah, I think in hindsight my mentorship experience seems more linear than it did in the moment. And I think it goes back to my original journey in my doctoral program. The program I was in, the Speech and Hearing Bioscience and Technology program at Harvard was a little bit different from others, where we didn't apply to work with a specific mentor, but truly just to get into the program. And they encouraged a pretty extensive shopping period to work with a variety of mentors to get a feel for topic area, mentorship style, and so traditionally first year students didn't even have any experiences, they just focused on the very time-intensive and rigorous coursework. I came in and started my first experience with Evelina Fedorenko at Massachusetts Institute of Technology, who had worked with an undergrad. And that I think from the get-go gave me a very holistic view. I think, of the ways in which we could think about language, and in particular, the language network. So, there I was working on MRI studies of what activations do we see in the language network. In response to linguistic stimuli. And we were working with undergrads at MIT who were all healthy between the ages of 18 through 30, and I just felt at a certain point that I had this growing interest towards thinking about what happens when something goes wrong. So when it's atypical processing of language. I first thought I might be interested in pediatric population, so I was all over the place, but through the partnership that my program had with the MGH Institute of Health Professionals, I ended up having this amazing opportunity to be mentored by Evelina Federenko, as well as Sophia Vallila Rohter at the Institute of Health Professions, as well as the Frontotemporal Disorders Unit at Mass General Hospital, through my actual clinical training. So I had this quite hefty consortium of mentors, and I think that has its own set of challenges, right? It's a little bit less mentor-directed and more on the student to say, "This is exactly what I want to work on." But I think that allowed me to build a network of experiences and mentors, and that just has bled into every experience I've had since then. I also think the pandemic, you brought that up before, had a huge role in this, and all of a sudden people were very, very open to virtual meetings and connections and wanted connection. I think everyone felt very stuck at home and wanted to find more people and to find meaning and Anna Volkmer and I had the opportunity to meet at the Academy of Aphasia in Macau in 2019. And honestly meeting her in our connection has been also one of those launching pads for me to really jump out into the world of international collaboration. So all that to say, I think a lot of chance encounters and just a lot of plunging into possible conversations head first has led to this phenomenal mentorship team. And a lot of people who I collaborate with now I see as my inadvertent mentors, and that includes Anna, that includes Maya Henry at UT Austin, Amy Mooney in Oregon, just people who have consistently volunteered their time to mentor me in ways in which I can only say I would have never expected. Jade Cartwright and I have had such a phenomenal collaboration over the past few years as well, where we just had the same interests, and Zoom allowing, we were able to build on those. Jerry Hoepner: That's really an amazing answer to that question. I love the term inadvertent mentors, because I just think that those are the best mentors, where you're as much a mentor to them as they are to you. And it's just this really reciprocal relationship, but it's also built on this organic, like passion and interest for the same kinds of topics. Where it's not forced and that's a really nice kind of look back on your entire process. I was also struck by the term "mentor shopping", or "mentor shopping period", whatever. And I think that's really great that you had an opportunity for that not to be so mentor-led, and I mean it clearly shows through when you talk about your clinical experience and how that was connected to your research experience, and kind of all used to create this amalgamation of who you are. I mean, it's clear in talking with you, it's clear in reading your work that you have that strong, multi prong kind of basis. It's not just research, it's not just this specific area of research, it's really broad and the clinical connection is there, so that makes a lot of sense when I hear you talk about that, for sure. Jeanne Gallée: Oh, thank you. Yeah, I think in hindsight, again, it seems more linear, and in the moment it sometimes felt a little wild, I will say, in terms of just wrangling what do I actually want to pursue, and how. And I'm still figuring that out. But I think this community of collaborators and mentors is truly what has kept me in the field and as well. Jerry Hoepner: Yeah, I think when you can connect with other people who are passionate about the work that you're doing. I can't imagine sitting at alone in my office doing a project, and I mean it's just so much more fun when you're doing it with other people. And other people who can expand the way that you think, which I'm sure everyone that you've mentioned on that list really does, when you can say, "Well, I think we should do it this way" and someone says, "Have you thought about…" and it just completely wrecks your world in a good way, "Like, oh my gosh, I didn't think about that, that's so exciting!" and then you just get into this back and forth. Yeah, very fun to hear about that. And again, it clearly shows through in the work that you do. In our previous conversations, you also mentioned this idea, and this again built on those clinical foundations that your initial mission was really to help develop interventions for people with primary progressive aphasia, and then you kind of got not off track, but inadvertently focused on working on assessments. You mentioned that there's just such a need, and this is so common in a lot of areas, but there's a need for more person-centered, ecologically valid strength-based assessment, and that the traditional measures just don't tell us enough. So, I'm really excited to talk about the work that you're doing on assessment, and how that brings us closer to what we need from an intervention standpoint, too. Jeanne Gallée: Yeah, so that really is at the heart of what has been my experience. Also, right from the get-go, we started talking about the differences, or the possible differentiation that the field has historically taken in thinking about post-stroke aphasia versus primary progressive aphasia. One of my first real PPA projects in my doctoral work was meant to be a naming treatment study for people living with PPA, and one of the roadblocks I kept hitting was also my mentors and reviewers telling me that I was trying to add too many things. And in that process I realized I don't think just using something that exists for post-stroke aphasia is going to be the best way to address the patients I'm seeing right now. And it's not because there's something wrong with that treatment. That treatment was not designed for these individuals. And that led to many more rabbit holes, and you know me really just feeling this existential crisis of "Well, why are we working on the stimuli that we are, and why are we asking questions about these ones?" And I have so much respect for the assessments that exist, and the individuals behind them, and the time they invested in making them. I am also of the belief that we can move forward and improve our processes. There are certain assessments that may be widely used and have so much again power behind them. You know, we have best associated certain assessments with characterizing a diagnosis, but what I ended up seeing in my placements and throughout my clinical work is that many assessments serve more of a mission of an institution or a research protocol than the person being assessed. And in the face of a person with a terminal condition who is using their precious time to serve you in that space, I just think it's so much more important, or that much more important, to really consider what is most functional for them. What will serve them? And how we, how can we give back to that person? And again, part of that emotion, I think, comes from having worked in many research-centered spaces, where someone might not get intervention afterwards, or they might not understand why they are participating in up to five hours of assessment, and I think that's where that passion for focusing on reprioritizing the patient or the client really came from. Jerry Hoepner: I think that attention to "what's in it for them", is really important and clearly based in kind of where your heart is at and where your clinical mindset is at. Because it's easy to go in and say, "Well, we need this data. We need all the data that we get." but to what end, right? Like, how is it going to help? And how is that going to give us any more information about how to help this person, then what they can't do, right? So, I appreciate that mindset a lot, you know. It makes me think, and this is a little off track, and we didn't talk about this question earlier, but what a shift it will be clinicians working with people with primary progressive aphasia, and how they'll be able to shift from using kind of the existing tools that were out there for other purposes to moving towards tools that are designed specifically for people with PPA, and maybe just a snapshot of your thoughts about that piece. Jeanne Gallée: So I think it's really important to know where the field comes from, the work in which it was grounded in. So, I think it, it makes sense to talk about standardized assessment scores. It makes sense to talk about, you know, the specific assessments that can help us quickly differentiate presentations or needs, right? So, using the symptom-led approach, can we identify specific behaviors really quickly in a standardized way? I think the issue comes in when we stop being dynamic in how we use them. It's very easy to use an assessment in a way that feels rote. It feels just like a test, and it's like you said, "just collecting data for the purpose of collecting data." And lose that aspect of humanity. And maybe I'm putting words in other clinicians' mouths, but especially when a certain condition is rare, like PPA is. You may not have very much experience with seeing someone with PPA, or any type of progressive condition, and feel really stuck and needing to be in the motivation of being really professional, sticking to a certain set of tests. "This feels right." Right, this is what someone told me to do. I can fill this out, and there's something very potentially vulnerable or scary about just going with your gut in those moments. And what Anna Volkmer and I have spoken about so often is just the power of having a conversation with someone, and seeing what you can learn from that conversation, not only about the person themselves, but their communication behaviors. And how you can get so much from that conversation, including the trust and comfort of the client in front of you. Jerry Hoepner: Absolutely, yeah. One of the things that I think about when you're talking about that is, in working with people with acquired brain injuries and traumatic brain injuries one of the things I've learned is they will tell you, or they will ask, right? They'll say, "What is this? "What kind of information is this giving you?" "Why do we have to do this stupid test?" And I think that's good. I think that's a mindset that we should have when we're thinking about all of the assessments that we do. Why are we doing this? Is this really necessary? And they're very willing to say, "If it's necessary, that's fine, I'll do it, but are you getting something from this that I'm not seeing?" Right, I love that question, and I think it speaks to what you just said, right? Like, there's so much information that we can gather from conversations, from our interactions with people, we should be thinking about getting that, and if we're doing something else, we should have a why directly following, yeah. Jeanne Gallée: Yes, the why is so important, and you're right. Sometimes we do just need to get certain information. I think for me, one of the most striking moments early on in my training was having small talk. You know, just conversation with a person with semantic variant primary progressive aphasia, and thinking, "Wow, this all feels quite typical. I'm curious about why they're here? What their testing will look like…" and then moving on to the Boston Naming Test and immediately seeing the challenges that came. That dichotomy is really helpful to have in those moments, but again, there's the argument of why are we asking about the name abacus, right? Why are we using that right now, and how does that represent how someone is performing functionally in their everyday life? Jerry Hoepner: Absolutely, yeah, totally. I agree. Can you share a little bit about the RAISE framework, which I really love, because it relates to the way that I think about assessment from the standpoint of counseling, like you build on relationships and connections. William Miller is famous for saying, "The last thing you should ever do at the beginning of a session is assessment." You're beginning of a relationship with someone, don't assess first thing. So, I love that piece, and then thinking about the pact, and I'll let you kind of expand those, but I'll let you unpack them – ha ha- but how that starts to move us towards intervention. Jeanne Gallée: Right. So the RAISE assessment framework was really built out of those conversations, and I guess realizations on my own part about that discomfort with the really rigid end that assessment can…I'll restate that. The rigidity that assessment can have, so again speaking to really, really standardized sets and rigid protocols of specific measures that someone uses, and like you said, having the experience of multiple research participants, as well as patients, asking "Why are we doing this? I know I'm not good at this. Why are we doing it again and again?" And in those moments, not feeling like I had the power to really justify exactly why we were doing everything, apart from, "Oh, this is important for the research study." Which it was, but just feeling like there was that aspect of humanity that was missing, and coming up with my own toolkit in those moments to fill in those blanks. So right after the completion of my PhD, Anna Volkmar and I started speaking a lot more about the power of conversational assessment. And then that led into conversations where we worked with Anne Whitworth, Deborah Hersh, and Jade Cartwright, where again, through the power of Zoom across all times. I was pregnant with my first, and meeting everyone usually at midnight my time. I already was nocturnal at that point!  Where we would just be discussing all of these issues, and what was amazing about this is that, particularly Anne and Deb come from more of the post-stroke aphasia world, and had these amazing principles grounded in those populations where Deborah Hersh had also really come forward with the concept of therapeutic assessment. So as you had said assessment and intervention shouldn't be separate, they belong together and coexist at all times if we're smart about it. And what we ended up doing, first informally and then formally through the more official Delphi process is coming up with a set of principles as a framework for assessment. So, to take a step away from, "Oh, it's just Lucy Goosey, we're having a conversation and chit chat." What we're actually promoting is a pretty structured set of principles to guide the ways in which we can cultivate assessment for individuals with PPA and their loved ones. Jerry Hoepner: Yeah, absolutely. I was kind of scanning on my computer, I was trying to think of the name. I love this name of the article, where it says, 'Please don't assess me to death, or something like that. Jeanne Gallée: Yes, yeah. Jerry Hoepner:  Yeah, and, and thinking about that whole entire process from beginning to end as a relationship, as you know, not discreetly assessment, not discreetly intervention, I think it's just really important. Can you talk a little bit about the PACT and kind of where that has moved things in terms of the assessment piece, but also kind of set a set up for intervention and what that looks like? Jeanne Gallée: Great, so the PACT the Progressive Aphasia Communication Toolkit kit builds off of what we put forth with the RAISE assessment framework. So with RAISE we promote that the relationship might be temporary, it might be a single interaction, or it might be long term, and we cultivate that through conversation and then the PACT is a set of scales that leverages that conversation, we take that natural or as natural as can be interaction and use it to come up with a concrete framework of communication strengths. So that might all sound very esoteric. To make that more concrete, there are four scales to the PACT. They're all clinician ratings, where the clinician is asked to look at a pre-recorded conversation that would occur naturally in a clinical or research context, and then on a scale from four to zero, rate the person speaking's strengths. So within the domains of speech and voice, as well as language and social pragmatics, as well as discourse, and the point or the purpose of that was to really anchor a person's communicative ability in one of these more natural environments with a provider. We collect so much phenomenal qualitative data, but at times it can feel challenging to quantify it and the hope with the PACT is that we can quantify our very real, possibly subjective evaluation of a person's communication at a certain moment in time. Jerry Hoepner: Yeah, and what I love about that, and you might have a slightly different thought about this, because you're deeper into it, but from an assessment standpoint, you can then do that all the way through. You can say, "Here's where they are this year, here's where they are next year, here's where they are the year after that, or you know, two years ago, or whatever your lens is at that point." You can do that without kind of this constant repeating of, "Okay, let's see how bad you are today compared to a year ago, or compared to two years ago." Just a very different mindset. And I love the focus on "What can you still do? What what's working? And how can we leverage what's working to really help you to actually communicate today?" As opposed to saying, "Oh boy, the ship is sinking." which is kind of the typical approach. Jeanne Gallée: Yes, that exactly what you're saying. The tendency tends to focus on what's no longer there. And while that might be helpful in clinical trials to characterize a person's performance diagnostically and the trajectory of a diagnosis over time. It really does not serve the person who goes home after the assessment, nor their loved ones to help them maintain that autonomy and quality of life, and also caregiver burden. And that is actually one of the points I really love about the PACT, is it builds on that RAISE aspect, that final tenant of evolution or adaptation over time. There's no repeat measure conflict here, where you know something might seem familiar. One of the unique parts of the PACT is that the clinician doesn't fill out the scale while they're talking to the person, they're really just recording them talking, so it is on the clinician side where, as often as they'd like to, they could implement the structured prompts of the PACT and then fill out the scale and see how performance might vary over time. They might see effects of context of the conversation, or the environment, or maybe the time of day, you know, phase of life, but it remains a way to use that really important information you gather through these conversations without recreating a testing environment frequently. Jerry Hoepner: I really love that framework. I think there's a lot of room for that to be used in other contexts as well. I just think it's really a wise way of thinking about it. I also, you just mentioned caregivers and caregiver burden in this context, and how does that fit into this entire RAISE framework, the PACT, and so forth. Jeanne Gallée: I think for both the RAISE assessment framework as well as the PACT the carers play an essential role in the sense that if they are available and present in the patient's life, then they are involved in the process. And so within the RAISE framework, the care partner is involved to provide feedback or to be given feedback, and in the PACT the same occurs, where if they are present at the time of the conversation, they are involved in the conversation. What I tend to do in the people I have piloted the PACT, I say come in as you would naturally, but then also take a step back. Let the person that with PPA that we're talking to take the lead, but I want you to interact as you would naturally. And then they're separately also asked to comment on the strengths that the person with PPA has. Their feedback is so integral because if they are present in a person's life, they play an essential role in promoting anything that we do work on in speech therapy. Jerry Hoepner: Absolutely, yeah, really well said. And I wanted to dig in, partly because I have envy of this figure, the roadmap figure for PPA, and I think it really sets up well for as we think about professionals out there too, like what's the roadmap, not just for the person and their partner, but what's the roadmap for clinicians, future clinicians, all of that. Maybe you can talk a little bit about that figure. Jeanne Gallée: I'd be delighted to. So, this was one of those, I would say classic for me moments where I had an idea and went to PowerPoint and started playing around with a visual of what I was thinking. The roadmap paper in no way is meant to be the only guide for how we can work with a person with PPA, but was really born out of discussions with Amy Mooney, as well as Zoe Ezzes, and Kristin Schafferr Mendez through the National Aphasia Association about the possible gaps in education or preparation a person might experience when first working with people living with PPA.  There are so many ways in which we could say, "Oh, just work on this exact task. Work on these.." and that can feel so lost and unanchored, unmoored moreover. And I wanted to provide the clinical toolkit that I've been using to help me think about my broader approach. So to not get lost in the weeds, but just generally think about what's my purpose here, what's my journey, and so at the center of this road that I created is the tenant of providing that person-centered care, like we aim to with the RAISE assessment framework, so really bringing it back to establishing that honest and holistic and person-centered relationship with your client and their care partners. And focusing on creating a journey that's unique to the client that I think can feel hard when there are so many unknowns with a condition like PPA, where you're always working with an interdisciplinary team. Which you may or may not have contact with. So the first part of this roadmap is really defining your role. Who are you as a professional, and what kinds of support can you provide, and part of defining your own role includes defining your role relative to the rest of the interdisciplinary team. How can you provide a different approach from the neurologist or the neuropsychologist who play vital but very different roles in a person's care journey? Part of that definition also includes advocating across professions, so a classic conundrum that people with communication-led disorders face is that they may not have certain challenges in other domains, but their communication results in a domino effect of difficulties. And so, as the speech language pathologist, coming up with ways in which you can provide supports to other providers or your client to improve their communication can be essential for that comprehensive care. That might include coming up with a communication notebook that has a single page related to specific questions or common topics when talking to the neurologist or the physical therapist or other providers. And then part of this roadmap includes referring out. So having the humility and confidence to say I can't help with this in the ways that you may need. I will either refer you to a specialist within our field or outside of our field to help with these specific aspects, and I think that's just responsible care. Jerry Hoepner: Absolutely. Really well described, and such a perfect. A segway to my next question. I always tell my students, assessment isn't just the first and last session that you're working with someone, and the same goes for intervention, right? It's not excluded from the beginning and the end, right? Like, you can't do intervention on day one, you can't do it on the last day, right? I think we kind of silo those things as well, you know, we assess and we intervene every day side by side. Can you share a little bit of your perspectives on this? And, and how that relates to kind of what we just talked about in terms of that roadmap? Jeanne Gallée: Yeah, I think part of the challenge with some of these concepts is that it's very helpful to have experience in working with individuals, whether it is through formal speech therapy or elsewhere, to feel comfort with the unknown. Because a lot of it relies on your ability to listen and to respond to what you notice. You may inadvertently put in assessment by asking follow-up questions to a point a person made when you were talking about their commute. Ad you may offer different technological supports or just visual supports to your client in that conversation in a way to build up supports to see, "Oh, do we see a difference in how they're responding to what I'm saying? And how I provide support? Or when I dial it back, do we see a completely different direction?" So, it is this beautiful, possibly more art than science approach of responding to what a person is giving you. And there are so many individual differences in all of us.  I always joke about how when I used to collect data on the picture description using both age match controls and people with PPA, I would almost burst out laughing when some of the controls provided responses, because I would get one to two sentences sometimes because see the difference in motivation. A person who does not have a communication concern, does not see the need to show exactly what they can do. And would benefit from some encouragement to show exactly how much they can say, whereas a person with PPA, who might have an Aphasia Quotient that recognizes their aphasia, might speak for five to 10 minutes to show exactly everything that they can accomplish. And so I think having that in your back pocket is really important when it comes to thinking about coming up with your recipe of all the ingredients of your assessment and intervention approach and counseling approach. So, I think that's where most of my work comes from, is that there is no one size fits all, but there are certain ingredients or components that we need to apply, and the exact ratios depend on the person you're working with. Jerry Hoepner: That is such a good description of dynamic assessment and intervention and how that I agree, probably more art than science. And that's hard for people who want a black and white answer, like "Step one…" but it's so true, and, and being effective in working in this context, that really moves us nicely into a recent paper that you did, those global perspectives on the management of PPA, and I was struck by the numbers here. Only 40% of respondents said that they had received training in primary progressive aphasia at their university, and they identified all of these needs, right, like online instruction, sample tools, and activity dealing with end of life care and trainings for end of life care. When you mentioned counseling, that totally relates to what we're up against in terms of counseling, right? No one feels confident or has very good self efficacy. Tey don't know if what you know the lines are, what part is theirs and what part is someone else. And I think just really important to like I said, lay out a roadmap and help people to understand what we were just talking about in terms of that art and science of how do you navigate this space when it has to be individualized for every person, and that can feel uncomfortable for a lot of people. So, I'd love to hear more of your thoughts on that, and kind of what you learned from that context. Jeanne Gallée: Yeah, so this research study. Was really an amazing endeavor on part of everyone who was involved. It felt like a grassroots effort to find the speech language pathologists around the world who aren't associated with a particular institution who do work with primary progressive aphasia. So of course it will never be a fully representative sample of every clinician who does so, but I do think we worked very hard to cast a wide net. So we used a snowball method. I contacted almost 40 institutions and governing bodies to find speech language pathologists who do have experience with PPA, because while more and more non-specialist providers will be seeing this patient population, we wanted to hear from the people who currently are in the field and creating their own expertise and toolkits to work with these individuals. So, what we found is that a lot of people are out on their own creating their own wheels, so to speak. And it just really led to that beautiful conclusion of now with the power of our globalization of education and sharing of resources, we can come up with a resource that's shared worldwide. Of course, there will be adaptations to fit different contexts, cultures, languages, but one of the issues has been that the systems of care for PPA have often relied upon very specific individuals. And that's reflected in the educational level. Even I was in the master's program between 2017 and 2019, I didn't hear about PPA formally in my coursework, and if it was mentioned we did not go into any of these aspects of specialized care. Part of that might have been because I didn't take very specific courses that then you know were optional or precluded, so I might have missed it, but I really didn't receive that education in the classroom. I received it through my clinical training, which I would argue is possibly even more valuable, right? You have that experiential training. But I think for clinicians who might want to transition in their careers, or you know, inadvertently in their place of work, are transitioning based on who shows up, that is a huge disservice. Jerry Hoepner: Yeah, agreed. And it's a complex issue, right, because I can remember actually teaching about this back before Tom [Sather] was in my department. I taught the aphasia class and the acquired cog class, and I was thinking, like, where do I talk about primary progressive aphasia? Do I talk about that in acquired com? Do I talk about that in aphasia? Do I do it in both? Where do I talk about end of life care, and like, how does that fit in, because that's, you know, at that point I was teaching dysphasia, too. Believe it or not, and I'm like, it's kind of there, it's kind of here, it's kind of, it's kind of in counseling, it's all right. So that makes it tricky to have kind of a uniform message when it's all over the place. And love to just get your thoughts on that too. Like, where do you put that stuff? Like, it's it's PPA, it's end of life care, it's aphasia, it's right, it's counseling, it's so many things at once. Jeanne Gallée: It is so many things at once, and I do think that speaks to the fact that it may well need its own class as part of progressive conditions. Jerry Hoepner: Yeah. Jeanne Gallée: But I do think a large part of what we share there is that understanding of we may also need to shift the identity of who we think about when we think about life care. And when we think about a progressive condition. Since a huge flavor, so to speak, of PPA is the fact that it is early onset, and especially with our cultural shifts, and you know, people starting families later in life. The face of a person with PPA looks very different from, at least in my childhood, of what looked like typical Alzheimer's disease dementia. And it's a younger, possibly more dynamic working person, possibly with little kids at home. And I think that's where that symptom-led approach has been most beneficial for my practice. Where we think about "What are you experiencing and how is it impacting your life?", rather than saying "This is the diagnosis, let's put you over here in this box." Jerry Hoepner: Yeah, the idea of putting it in a box and siloing things really resonates in this context, and I love what you said about identity, right? The identity - what we all have in our mind's eye when we think about end of life care is not the typical person with primary progressive aphasia. Like I can remember as an elementary school student visiting the nursing homes and singing to the residents and things like that, and this was not, this was not the group of people that we were thinking about in that context. Very, very different, and I just think that's a really good mindset shift to recognize how actually broad that is. I'm sure there's people listening to this who work in, you know, end of life pediatric care who want to slap me in the face right now, but right, we have such a different mindset when we're thinking about end of life care, and that reset that you just made super important. Jeanne Gallée: Yeah, yeah, and easier said than done, I think, As well as just seeing who shows up to the University of Washington support groups, and just the own perspectives that individuals bring there. But I think we can do it. I think, as a field, that will be the way in which we can become the best generalist provider, so to speak, where we take general principles of addressing symptoms or situations, and then apply those to diagnoses across the spectrum. Jerry Hoepner: Absolutely, really well said, and a great place to kind of wrap up our questions, but I want to give you the opportunity, are there points that you want to share before we kind of close our conversation? Things that we missed. Jeanne Gallée: I think the general thread throughout our conversation has just spoken to the power we do have as providers or researchers working with patients with primary progressive aphasia or related conditions, I think when we feel that our expertise in the newest theories or approaches might be lacking, we can always rely upon our empathy and full body listening, just to bring in elements that go across the lifespan, and that in of itself can lead to so many honest and transparent choices in our clinical care that can best serve our communities. I think we are much more empowered than we think we are. Jerry Hoepner: Absolutely, that's a really important thread through many places where clinicians feel uncomfortable. They've got it there and they just have to gain that confidence, and being empowered to step into those moments. Well said. Well, Jeanne it's been just a really fun conversation. I'm sure we could talk all afternoon, but I look forward to catching up to you at future conferences and things like that. It's been my pleasure to have this conversation. So, thank you for being a part of it. Jeanne Gallée: Right back at you, Jerry. Thank you so much. This has been a really fun conversation, and like you said, I hope to meet in person in the near future. Jerry Hoepner: Agreed. On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access, and to access our growing library of materials, please go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at info at aphasia access.org Thanks again for your ongoing support of Aphasia Access.   Resources and Readings 1) The RAISE Assessment Framework: Gallée, J., Cartwright, J., Volkmer, A., Whitworth, A., & Hersh, D. (2023). "Please Don't Assess Him to Destruction": The R.A.I.S.E. Assessment Framework for Primary Progressive Aphasia. American journal of speech-language pathology, 32(2), 391–410. https://doi.org/10.1044/2022_AJSLP-22-00122  Gallée, J., Volkmer, A., Whitworth, A., Hersh, D., & Cartwright, J. (2024). Applications of the R.A.I.S.E. Assessment Framework to Support the Process of Assessment in Primary Progressive Aphasia. American journal of speech-language pathology, 33(5), 2280–2290. https://doi.org/10.1044/2024_AJSLP-24-00085 2) A roadmap for clinicians just starting to work with PPA: Gallée, J. (2023). A Roadmap to enhance care for people living with primary progressive Aphasia: What Can Be Done Now?. Perspectives of the ASHA Special Interest Groups, 8(5), 847-862. https://doi.org/10.1044/2023_PERSP-23-0002  3) Aspects of language functioning in early and late-onset Alzheimer's disease dementia: Gallée, J., Gibbons, L. E., Choi, S. E., Lee, M., Scollard, P., Trittschuh, E. H., Mez, J., Saykin, A. J., Foldi, N. S., Mukherjee, S., & Crane, P. K. (2025). Facets of language performance in early-onset and late-onset Alzheimer's disease dementia. Alzheimer's & dementia : the journal of the Alzheimer's Association, 21(9), e70705. https://doi.org/10.1002/alz.70705 4) The Progressive Aphasia Communication Toolkit (in production at Alzheimer's & Dementia, but here is the preprint): Gallée, J., Cartwright, J., Henry, M. L., Mooney, A. R., Stark, B. C., Volkmer, A., Dietz, A., Nakano, C., Battista, P., Beales, A., Beber, B. C., Cadório, I., Caldwell, M., Davies, K., Ezzes, Z., Gauch, M., Graney, T., Grobler, S., Haley, K. L., Hausmann, A., … Crane, P. K. (2025). The Progressive Aphasia Communication Toolkit (PACT): A Strengths-Based Approach to Multidomain Evaluation for Intervention. medRxiv : the preprint server for health sciences, 2025.11.25.25340904. https://doi.org/10.64898/2025.11.25.25340904 5) A global survey on SLP perspectives on the management of PPA: Gallée, J., Cartwright, J., Grasso, S., Jokel, R., Lavoie, M., McGowan, E., Pozzebon, M., Beber, B. C., Duboisdindien, G., Montagut, N., Norvik, M., Sugimoto, T., Townsend, R., Unger, N., Winsnes, I. E., & Volkmer, A. (2024). Global perspectives on the management of primary progressive aphasia. Scientific reports, 14(1), 19712. https://doi.org/10.1038/s41598-024-70156-5 6) Aspects of language functioning in early and late-onset Alzheimer's disease dementia: Gallée, J., Gibbons, L. E., Choi, S. E., Lee, M., Scollard, P., Trittschuh, E. H., Mez, J., Saykin, A. J., Foldi, N. S., Mukherjee, S., & Crane, P. K. (2025). Facets of language performance in early-onset and late-onset Alzheimer's disease dementia. Alzheimer's & dementia : the journal of the Alzheimer's Association, 21(9), e70705. https://doi.org/10.1002/alz.70705

What if AI could help clinicians move beyond detection and make breast cancer treatment more precise and personalized? In this episode of Entrepreneur Rx, host John Shufeldt sits down with Stacey Stevens, CEO of SimBioSys, to discuss her career in medical technology, healthcare AI, women's health, and precision oncology. Stacey shares how her experience at Philips Healthcare, iCAD, and her own women's health advisory company shaped her path to leading SimBioSys. The conversation explores Stacey's early work helping bring some of the first AI tools in breast imaging to market, the long road to healthcare adoption, and why clinical evidence, trust, reimbursement, and enterprise-grade security all matter when selling AI into healthcare. Stacey also explains how SimBioSys is taking AI beyond breast cancer detection and applying it to treatment planning. The company's platform uses breast MRI data to create interactive 3D visual models of the breast and tumor, helping surgical oncologists better understand tumor location, volume, and whether a patient may be eligible for breast-conserving surgery. John and Stacey also discuss SimBioSys' next frontier: using image-based AI to help assess a patient's risk of breast cancer recurrence and support more personalized treatment decisions. Beyond the technology, the episode covers startup leadership, fundraising, the realities of building in regulated healthcare, and why trust, transparency, and patient impact must come first. About Stacey Stevens: Stacey Stevens is the CEO of SimBioSys and a healthcare technology executive with deep experience in medical imaging, AI, women's health, commercialization, fundraising, and strategic growth. Before joining SimBioSys, she held leadership roles at Philips Healthcare and iCAD, where she helped introduce early AI technologies in breast imaging. She also founded Ellevate, a women's health strategic advisory company focused on accelerating the adoption of meaningful scientific breakthroughs in women's health. About SimBioSys: SimBioSys is developing a precision medicine platform initially focused on breast cancer, with technology designed to support clinicians and patients across the cancer care journey. Its platform uses AI and spatial biophysics to turn breast MRI data into interactive 3D visual models that can support surgical planning, treatment decisions, and more personalized cancer care. About Xcellerant Ventures: Xcellerant Ventures is a venture capital firm that invests in innovative companies across healthcare, technology, defense, and other emerging industries. Through multiple funds and investment vehicles, including the Jetstream Venture Fund ($5,000 minimum interval fund), the firm partners with visionary founders, provides strategic guidance, and helps connect investors with opportunities in the private markets. Its portfolio includes companies developing solutions that have the potential to transform industries and improve lives.

It wasn't easy, but Thomas Goode managed to survive Stage III multiple myeloma, a rare form of blood cancer that originates in bone marrow.  When he first experienced pain in his left shoulder, it was misdiagnosed as bursitis.  Then he underwent a stem cell transplant no less than three times, with his oldest brother donating the bone marrow for the final two procedures.  Thomas has achieved Minimal Residual Disease status and says his physical health is roughly 70 percent of what it was, pre-diagnosis.   In 2005, Thomas Goode was leading an active lifestyle.  It included bicycle riding and working out.  But when he was on vacation with his family, he went to the gym and suddenly experienced acute pain in his left shoulder.  He went to his family doctor who said Thomas had bursitis and prescribed pain pills.  Thomas was skeptical of this diagnosis because it came because no scans were performed.   He sought a second opinion and went to his orthopedic surgeon.  The doctor called for an MRI and it revealed a tumor near his shoulder and said it was the source of Thomas' pain.  He had the tumor biopsied and it showed a plasmacytoma, cancer that progress to become multiple myeloma.  Thomas underwent six weeks of radiation treatment.  The pain went away, but it returned.    Thomas' multiple myeloma specialist suggested a stem cell transplant, an option Thomas accepted.  It began with induction therapy, backed by doxil, vincristine and dexamethasone, aimed at bringing his white blood cell down to a number that would allow for a stem cell transplant.  However, the procedure didn't work.  The specialist recommended a second stem cell transplant.  Thomas learned his oldest brother was a perfect for a bone marrow transplant.    The second stem cell transplant included compath, fludarabine and melphalan.  It also didn't work, so a third one was performed with velcade, doxil and vorinostat.   Thomas followed this with eight days of radiation.   His care team proclaimed Thomas is Minimal Residual Disease-negative.    Thomas Goode says his health is about 70 percent of what it was before his diagnosis.  He can still work out but acknowledges he will always have some level of back pain.   By way of advice, he would tell anyone diagnosed with multiple myeloma that the disease is not a death sentence.  He says that's because there are more treatment options and better treatment options than when he was diagnosed. Additional Resources: Thomas' Support Group: Triangle Area Myeloma Support Group    

In this empowering episode of the Optimal Body Podcast, Doc Jen and Doctor Dom tackle the realities of aging head-on with research-backed insights. They debunk common fears around MRI findings like disc bulges and osteoarthritis, explaining—using research-backed evidence—that many are normal age-related changes, not reasons to stop moving. From research-backed benefits of weighted vests for improving strength and posture, to the critical role of strength training for bone density and joint health, the hosts emphasize that movement is medicine. Whether managing osteoporosis, herniated discs, or arthritis, a proactive, guided approach to exercise can help you age with strength, confidence, and independence. Zulu Weighted Vest: Upgrade your everyday movement with the ZULU Weighted Vest — designed to increase calorie burn, naturally engage your core, and improve posture with every step. Perfect for walks, workouts, and daily errands. Use code OPTIMAL for 20% off at checkout. Lifting for Longevity Discount: Check out our NEW movement longevity course -> Lifting for Longevity! Build your Strength, Mobility, Power, Balance and more regardless of what stage or age you're at! Podcast listeners get a bonus discount with code OPTIMAL20 We Think You'll Love: Lifting for Longevity Jen's Instagram Dom's Instagram YouTube Channel What You'll Learn: 1:54 The Truth Behind Aging 3:42 The Power of a Provider's Words 6:07 Misconceptions About Aging and Exercise 7:13 Understanding MRI Findings 11:07 Knee Osteoarthritis and Exercise 14:21 Running with Osteoarthritis 15:45 Osteoporosis and Heavy Lifting 18:23 The LIFTMOOR Trial for Osteoporosis 20:58 Herniated Discs and Fear of Movement 25:47 Red Flags for Back Pain 27:11 Four Pillars of Healthy Aging 28:19 Pain Monitoring Rules for Exercise For the full show notes and resources visit https://jen.health/podcast/470 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Back pain affects almost everyone at some point, but why do some people recover while others deal with chronic pain for years?Dr. Nicholas Rolnick joins Ralph Sutton and Marcus Antebi to break down the biggest misconceptions about physical therapy, why movement is often the best medicine, and how blood flow restriction training is changing the way athletes and everyday people recover from injuries.They also dive into weight cutting in combat sports, bodybuilding, flexibility versus strength, posture, sitting all day, spinal mobility, and why MRI results don't always explain your pain.Whether you're dealing with nagging aches, trying to stay active as you age, or simply want to move better, this episode is packed with practical advice you can actually use.0:00 Welcome & introducing Dr. Nicholas Rolnick1:06 How Zac Amico led Ralph to today's guest3:33 Dr. Rolnick's journey into physical therapy6:09 What is blood flow restriction training?8:16 Is blood flow restriction actually safe?9:14 Weight cutting, bodybuilding & combat sports12:48 Why chronic back pain is so difficult to treat15:04 The biggest mistakes physical therapists make18:34 Should you exercise through pain?20:06 Why spinal mobility matters more than most people realize23:45 Marcus shares his recent back injury26:07 How Dr. Rolnick diagnoses pain without relying on imaging29:14 Why MRI results don't always tell the whole story33:28 Is sitting causing your lower back pain?36:14 Final thoughts & where to find Dr. RolnickTEXT us your questions at 718-306-3906!The goodsugar store is the epitome of cool, nestled at 3rd avenue + 69th street!

If you've spent any time at all living with or caring for someone with multiple sclerosis, you know that medical textbooks and information-filled websites can give us facts, figures, and symptoms, but they rarely capture the sometimes messy, sometimes overwhelming, and sometimes darkly funny reality of what it actually feels like to get a diagnosis of MS and realize your life has suddenly shifted under your feet. Our guest, Liat Shalom, was diagnosed with MS in 2021, at the age of 30. Instead of letting that diagnosis define her, Liat picked up her pen and created Unravelled—a groundbreaking graphic memoir that refuses to sugar-coat the MS experience.   For about five years, we've known that the Epstein-Barr virus (EBV) triggers MS. We'll explain what biologists just discovered about how EBV triggers MS, and what that could mean for future treatments. We're sharing evidence from an important study that shows a simple blood test is as accurate as MRI in determining whether someone is experiencing a relapse or a pseudo-relapse. We're sharing details of a study showing that virtual reality (VR) therapy is effective in treating MS-related brain fog. And if you're a woman between the ages of 45 and 60 and you're experiencing perimenopause, we'll share an easy way for you to participate in MS research without leaving home. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: Unravalled, Liat Shalom's darkly humorous graphic novel about her MS journey  :22 Scientists discover how the Epstein-Barr virus triggers MS  1:53 A simple blood test can determine whether someone is experiencing a relapse or a pseudo-relapse  4:08 It's time to support the National MS Society's $119.6 million active investment in MS research   6:58 Virtual reality therapy can improve MS-related brain fog   9:16 An opportunity to participate in MS research for women between 45-60 who are experiencing perimenopause  11:41 Liat Shalom discusses her journey to an MS diagnosis that led her to create Unravalled, a darkly humorous graphic memoir  13:11  Share this episode  30:32 Next week  30:52 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/464 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes at www.RealTalkMS.com Unravelled: The Story of an MS Warrior by Liat Shalom https://unraveledgraphicnovel.com STUDY: CD4+ T-Cells Reactive to Epstein-Barr Virus Late Lytic Antigens are Enriched in Individuals with Multiple Sclerosis https://www.science.org/doi/10.1126/scitranslmed.adz6566 STUDY: Utility of Multi-Analyte Protein Assay to Distinguish Multiple Sclerosis Clinical Relapse from Pseudoexacerbation https://link.springer.com/article/10.1007/s40120-026-00984-2 STUDY: Effectiveness of Immersive and Non-Immersive Virtual Reality Interventions on Cognitive Function in People with Multiple Sclerosis: A Systematic Review https://www.mdpi.com/2077-0383/15/12/4534 PARTICIPATE IN RESEARCH: Perimenopause and Multiple Sclerosis https://www.nationalmssociety.org/news-and-magazine/news/ms-study-alert-perimenopause-survey STUDY: Effectiveness of Immersive and Non-Immersive Virtual Reality Interventions on Cognitive Function in People with Multiple Sclerosis: A Systematic Review https://www.mdpi.com/2077-0383/15/12/4534 SUPPORT: National MS Society Research https://nationalmssociety.org/research JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on X, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 464 Guest: Liat Shalom Privacy Policy

New research reveals that moderate static magnetic fields—the kind produced by MRI machines and certain consumer devices—can alter the electrical signaling in your nerve cells, with effects that persist even after exposure ends. In this episode, I break down a recent study from Japan that examined how eighteen hours of magnetic field exposure reduced the function of voltage-gated potassium channels in sympathetic neuron-like cells. The researchers identified thirty-seven genes whose expression changed in response to the magnetic field, suggesting your nervous system activates protective pathways when exposed to these fields. In This Episode How magnetic fields affect the ion channels that control nerve cell excitability Why the effects persisted even after the magnetic field was removed What this means for people with medical implants or frequent MRI exposure One practical step you can take to reduce unnecessary magnetic field exposure Featured Study Read the full study: Effects of moderate static magnetic fields on voltage-gated potassium ion channels in sympathetic neuron-like PC12 cells See all studies at shieldyourbody.com/research

Mr. Jones from the We Got A Thing podcast called in to talk all about having prostate cancer, losing his erections and then swinging again years later. Tune in to hear how he found out he had prostate cancer despite having zero symptoms, why routine bloodwork and PSA testing probably saved his life, what his MRI, biopsy and Gleason score revealed, why he decided on surgery vs. radiation, what recovery was really like, how long he had to wear a catheter, when he regained bladder control, how and why he lost penis length after surgery, why he could no longer ejaculate, how prostate removal affected his erections and orgasms, why Viagra and Cialis didn't work for him, how Bimix helped him get his sex life back, what it was like returning to the swinging lifestyle after prostate cancer, why communication with his female partners became more important than ever, what every guy should know about PSA testing and prostate cancer screening, plus a whole lot more. To get in touch with him and join his mens only community you can email him at  mr.jones@wegottathing.com ir find them here: https://wegottathing.com GET A COPY OF THE STRICTLY ANONYMOUS BOOK! Strictly Anonymous Confessions: Secret Sex Lives of Total Strangers. A bunch of short, super sexy, TRUE stories. GET YOUR COPY HERE: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/4i7hBCd⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  or Pre-order audiobook version ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠   To see HOT pics of my female guests + hear anonymous confessions + get all the episodes early and AD FREE, join my Patreon! It's only $7 a month and you can cancel at any time. You can sign up here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.patreon.com/StrictlyAnonymousPodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and when you join, I'll throw in a complimentary link to my private Discord! To join SDC and get a FREE Trial! click here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.sdc.com/?ref=37712⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or go to SDC.com and use my code 37712 Want to be on the show? Email me at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠strictlyanonymouspodcast@gmail.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.strictlyanonymouspodcast.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and click on "Be on the Show." Want to confess while remaining anonymous? Call the CONFESSIONS hotline at 347-420-3579. All voices are changed.   Sponsors:  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://beduc.at/pd2626-anonymous⁠⁠⁠⁠ Click here to take the quiz and  get your personalized SUMMER roadmap to sexual happiness ⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://Rythm.Health/STRICTLYANON⁠⁠⁠⁠⁠⁠ ⁠⁠for 15% OFF your first month  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://VB.Health⁠⁠⁠⁠⁠⁠⁠ - To get 10% off DRIVE BOOST by VB Health, use code: STRICTLY   ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://bluechew.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ — Buy 2 months of Bluechew GOLD and get the third month FREE! Use code: STRICTLYANON⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Follow me! Instagram  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/strictanonymous/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ X  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://twitter.com/strictanonymous?lang=en⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Website  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.strictlyanonymouspodcast.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Everything else: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/Strictlyanonymouspodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

In episode 381 of The Physical Performance Show, host Brad Beer — sports and exercise physiotherapist — sits down with Pogo physiotherapist Tim Studley for the first instalment of a two-part mini-series on shin pain and tibial bone stress injuries, following on from their earlier three-part bone stress injury series. This episode is essential listening for runners, coaches, and clinicians alike, unpacking how to tell the difference between medial tibial stress syndrome (MTSS/shin splints) and a true tibial bone stress injury — two conditions that can feel identical but require completely different management. Brad and Tim walk through the physiology of bone loading, the palpation tests that separate a "safe to keep running" diagnosis from one requiring an MRI, and the loading tests used to stress-test the tibia safely in clinic. Show Sponsor: Pillar Performance continues to lead the way in sports nutrition through micro-nutrition innovation, now expanding into the Performance Health range. One of their newest releases, Collagen Repair, was developed with Gelita Laboratories (Germany) using a clinically trialled collagen peptide (Tendofort) to support tendon and ligament health in conditions like hamstring tendinopathy, Achilles tendonitis, shin splints, and patellofemoral pain. Head to pillarperformance.shop (or thefeed.com for North American listeners) and use code PHYSICALPERFORMANCE for 15% off your first purchase. Pogo Physio also offers online Telehealth Consultations for endurance athletes managing bone, tendon, or joint issues — book online at https://pogophysio.com.au. Listen in as we delve into the following: The prevalence of tibial bone stress injuries and why the shin is the most common bone stress site in runners Why bone stress injuries occur: workload errors, loading frequency vs. magnitude, and individualised risk factors The continuum from "happy bone" to stress reaction to frank stress fracture Why pain magnitude doesn't reliably predict injury severity The heterogeneity of bone innervation and why the periosteum is key to understanding pain Differentiating MTSS from tibial bone stress injury — and why the management is entirely different The 10cm palpation rule: a clinical prediction rule for when to suspect bone vs. soft tissue Why the anterior (front) shin is a higher-risk, non-union-prone injury site The loading-test ladder: double leg calf raise → single leg calf raise → single leg hop → side-to-side hop → forward hop The role of muscle-bone synergy: how calf strength and girth influence tibial bone stress risk Recovery timelines by injury grade, and why MRI matters for prognosis and athlete buy-in A real case study: a triathlete's navicular injury, deconditioning, and return to tibial bone stress injuries Quotes "You can go from hero to zero really quickly with bone."  "Higher levels of pain don't necessarily mean a worse injury."  "Muscle loads bone."  Timeline 00:00 – Introduction & sponsor: Pillar Performance 02:15 – Introduction to Tim and Brad's conversation 02:27 – Prevalence of tibial bone stress injuries 03:56 – Why bone stress injuries occur: workload and biomechanics 05:22 – Symptom patterns: bone stress injury vs. other shin pain 07:42 – Heterogeneity of bone innervation and pain variability 10:10 – Why pain severity doesn't predict injury severity 11:07 – MTSS vs. bone stress injury: two schools of thought 12:06 – Brad's clinical experience and personal injury history 13:59 – Cardinal signs and symptom progression in MTSS 15:23 – The three-legged stool: history, physical exam, imaging 16:19 – The 10cm palpation rule explained 19:43 – Applying the rule in practice 20:42 – Anterior shin pain: a higher-risk presentation 21:39 – Loading tests: from calf raises to forward hopping 24:07 – Individualising the loading-test progression 26:03 – Does the 10cm rule apply anteriorly? 26:55 – History as the biggest predictor of reinjury 27:53 – MRI, prognosis, and grading via the Fredericksons scale 29:15 – Reading hesitancy and movement quality in loading tests 31:10 – Why bone stress injuries aren't purely about vertical impact 33:03 – Calf girth and bone stress risk correlation 34:56 – Case study: a triathlete's navicular injury and recovery 35:58 – Episode close & sponsor mentions THE TEAM: Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online at pogophysio.com.au. Your Hosts:

Six days before he sat down for this conversation, he ran a marathon. Then he explained what the race did to his brain. When you run 26 miles and your glycogen runs out, your brain still needs energy, so it starts stripping the fatty myelin off its own neurons and burning it for fuel. MRI scans caught a 20% drop in myelin up to two months after a marathon, and cognitive testing showed real impairment for about a month. In this episode, Louisa sits down with Brady Holmer, exercise physiologist, 2:24 marathoner, and author of VO2 Max Essentials, for one of the most practical conversations on aerobic fitness, brain health, and longevity the show has recorded. They cover why "marathon brain" is real but temporary, the menopause parallel where a starved brain catabolizes its own white matter, and whether pre-loading ketones or omega-3s can protect your myelin through a hard endurance effort. Then Brady breaks down VO2 max the way almost nobody does: not as a heart-and-lung number, but as a five-step oxygen cascade running from your lungs to your mitochondria, and why the bottleneck moves from your heart to your muscles as you age. You will learn the exact VO2 max floor below which everything becomes a maximal effort, the "50 at 50" target, and why women should aim for 40 to 50. Brady also lays out how the brain itself gates your fitness through myokine signaling, why the one to two hours after training may matter more than sleep for adaptation, and the truth about "non-responders" and the IGF binding protein biology behind trainability. Then the protocols: why the Norwegian 4x4 beats Tabata for VO2 max, how sauna and post-exercise ketones amplify the same session, why sleep consistency beats sleep duration, and the single weekly workout Brady says everyone should be doing for both VO2 max and brain health over the next decade. Reduce your risk of Alzheimer's with my science-backed protocol for women 30+: https://go.neuroathletics.com.au/youtube-sales-page Subscribe to The Neuro Experience for evidence-based conversations at the intersection of brain science, longevity, and performance. TOPICS DISCUSSED 00:00 Intro: Marathon Brain and the Number That Predicts How Long You Live 00:40 Does Running a Marathon Really Damage Your Brain? 01:04 The Study: 20% Myelin Loss on MRI After a Marathon 02:16 Impaired Cognition for a Month, Then Full Recovery 03:28 Why It Happens: The Brain Burns Its Own Myelin for Fuel 04:44 The Menopause Parallel: Brain Glucose Starvation and White Matter 05:57 Can Ketones and BHB Protect the Brain During a Marathon? 06:42 How Marathon Runners Should Fuel to Protect Cognition 08:22 VO2 Max: The Strongest Predictor of Mortality and Longevity 09:00 The Oxygen Cascade: What VO2 Max Actually Measures 11:08 Why VO2 Max Matters More As You Age 12:10 The VO2 Max Floor for Frailty and Daily Living 13:11 VO2 Max as a Brain Metric: Averages by Age and Sex 14:20 The "50 at 50" Target and What Women Should Aim For 15:09 The Female Masters Athlete Study and the VO2 Max Bank Account 16:01 How Your Brain Knows It Is Getting Fitter: Myokines 17:41 Mouse Studies: Block the Brain Signal, Lose the Adaptation 18:37 The Post-Workout Recovery Window That Drives Adaptation 19:53 What Kind of Rest Actually Works After Training 20:50 KetoneIQ: Clean Fuel for the Brain 21:50 Qualia Magnesium: Recovery and Deep Sleep 22:45 The Mission: Why Science Is the New Breaking News 27:25 Attacking VO2 Max From a Different Angle: What Is Your Bottleneck? 28:06 Central vs Peripheral: Heart, Muscle, and Mitochondria 30:20 Spotting Mitochondrial Dysfunction With a Simple Lactate Test 33:18 Training Each Link in the Oxygen Cascade 34:41 Targeting the Lungs: Inspiratory Muscle Training 36:19 Iron, Hemoglobin, and Heat as an Altitude Mimic 38:56 Exercise Hemolysis: Why Runners Break Down Red Blood Cells 39:59 Why Investors and CEOs Are Chasing VO2 Max 40:42 What Is Good for the Heart Is Good for the Brain 42:02 Exercise Snacks vs Deliberate Training as You Age 44:41 HIIT for Stroke Volume: Why the Norwegian 4x4 Works 45:43 4x4 vs Tabata and the 2 to 8 Minute Interval Sweet Spot 46:57 Using Heart Rate and Exertion to Train VO2 Max 48:02 Where AI Is Entering Endurance Coaching 49:14 Timeline Mitopure: Powering Your Mitochondria 50:16 Cozy Earth: Better Bedding, Better Sleep 51:04 Responders vs Non-Responders and the IGFBP Biology 55:35 How to Amplify Adaptation From the Same Training Load 56:39 Heat, Post-Exercise Ketones, and Getting the Basics Right 58:14 Sleep Consistency Beats Sleep Duration 01:00:24 The One Weekly Workout for VO2 Max and Brain Health Thank you to our sponsors KetoneIQ: https://ketone.com/NEURO for 30% OFF Qualia: https://qualialife.com/NEURO for 50% off Timeline: https://timeline.com/NEURO for Mitopure Cozy Earth: https://cozyearth.com use code NEURO for 20% off I'm Louisa Nicola - clinical neurophysiologist - Alzheimer's prevention specialist - founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention. If you're committed to optimizing your brain- reducing Alzheimer's risk - and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0  Instagram: https://www.instagram.com/louisanicola_/  Twitter : https://twitter.com/louisanicola_ Learn more about your ad choices. Visit megaphone.fm/adchoices

Every sports physical therapist remembers the first time they handed a young, anxious athlete an MRI report filled with terms like "partial-thickness tear," "labral fraying," or "degenerative changes." It is a defining moment in a clinician's career. Instantly, the psychological landscape of the rehab process shifts. The athlete, who might only have mild, intermittent symptoms, suddenly views their joint as a ticking time bomb. As a clinician, it is incredibly easy to let that piece of paper dictate your entire treatment plan, leading to over-protection and a fear-avoidant rehab environment.The reality of dealing with overhead athletes—especially baseball pitchers—is that structural abnormalities on an image are often just the cost of doing business. If you scan enough high-level shoulders, you are going to find fraying and partial tears in completely asymptomatic arms. The real skill lies in balancing those structural findings with the actual human being sitting on your treatment table. How do you maintain clinical objectivity when the scan says one thing but your manual muscle testing and special tests say another?On this episode of the podcast, we answer a great question from a listener struggling to navigate this exact scenario with a collegiate pitcher. We discuss how to educate a freaked-out athlete, when to respect the structural pathology, and how to ensure you are treating the functional deficits rather than just chasing a clean image. Check out this week's episode for our full breakdown and clinical pearls on mastering the physical exam.To see full show notes and more, head to: https://mikereinold.com/stop-treating-the-mri-and-start-treating-the-athlete/Learn our proven system for sports PTs who want to master ACL rehab, confidently progress patients, and guide athletes safely back to high-level sport.Click here to learn more Click Here to View My Online CoursesWant to learn more from me? I have a variety of online courses on my website!Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the show_____Want to learn more?  Check out my blog, podcasts, and online coursesFollow me:  Instagram  |  Twitter  |  Facebook  |  Youtube

Can focal therapy truly “thread the needle” between active surveillance and radical prostate cancer treatment? In this episode of BackTable Urology, host Dr. Tiwa Akinsola is joined by Dr. George Schade from the University of Washington to explore focal therapy as a middle ground between active surveillance and radical treatments. Dr. Schade reviews non-radiation energy modalities including HIFU, TULSA/HI-DU, cryotherapy, and irreversible electroporation, highlighting patient selection, institutional experience, technical nuances, and quality-of-life outcomes from recent trials. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps00:00 - Introduction02:09 - Overview of Focal Therapy Modalities04:46 - Deciding Between HIFU and IRE06:56 - Evidence and Trials09:40 - Counseling Patients on Outcomes12:09 - Building a Focal Therapy Program16:12 - Navigating Insurance and Appeals21:48 - Managing Large Glands And TURP25:12 - Preop Workup Essentials and OR Workflow32:32 - Overcoming the Learning Curve35:52 - PostOp Recovery and Surveillance39:04 - Options for Managing Recurrence42:44 - Challenges with Repeat Ablation44:56 - Final Takeaways --- More about this episodeThe conversation covers candidate selection and confirmatory biopsy, perioperative technique and recovery, and ongoing surveillance with PSA, MRI, and biopsy. Dr. Schade also discusses challenges with insurance approvals, building a focal therapy practice, and options for managing recurrence, including repeat ablation, surgery, or radiation. The episode examines how to balance cancer control with quality of life and reviews the evolving evidence base supporting focal therapy's role in prostate cancer treatment. --- Resources Irreversible Electroporation for Prostate Tissue Ablation in Patients with Intermediate-risk Prostate Cancer: Results from the PRESERVE Trial:https://www.sciencedirect.com/science/article/pii/S030228382500346X Focal therapy of localized prostate cancerhttps://pubmed.ncbi.nlm.nih.gov/35996758/ Focal Therapy for Prostate Cancer: Available Technologies, Patient Selection, Follow-Up Protocols and Reported Outcomeshttps://pubmed.ncbi.nlm.nih.gov/41339218/ --- BackTable Urology is the go-to podcast for urologists, urologic oncologists, and urogynecologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

Struggling to break through your keto or low carb plateau? Book a free consultation call with Robert Sikes here: https://www.ketobodybuilding.com/callYour love handles are not just stubborn fat. They are a warning sign of the visceral fat hiding deep inside your body, and it could be quietly making you sick. In episode 901 of the Savage Perspective Podcast, host Robert Sikes sits down with Dr. Sean O'Mara to break down what MRI scans really reveal about visceral fat, deep subcutaneous fat, and the fat around your heart. Dr. O'Mara shares how one man reduced his heart fat by 60 percent in just five days, why fasting and sprinting beat long cardio, how gut bacteria and fermented foods change your body, and why your blood work may be lying to you. If you care about fat loss, longevity, and looking and performing your best, watch the full episode now.Follow Dr. O'Mara on IG: https://www.instagram.com/drseanomara/Get Keto Brick: https://www.ketobrick.com/Subscribe to the podcast: https://open.spotify.com/show/42cjJssghqD01bdWBxRYEg?si=1XYKmPXmR4eKw2O9gGCEuQChapters0:00 - The MRI Experiment: Scanning a Natural vs. Enhanced Bodybuilder2:00 - Natty vs. Steroids: What Do MRI Scans Actually Reveal?3:35 - Do Steroids Cause Visceral Fat? A Doctor's Prediction4:37 - What Are Love Handles Really? The Deep Subcutaneous Fat Problem7:46 - Why Fascia Is a Bigger Deal Than Your Doctor Told You9:32 - Good Fat vs. Bad Fat: The Membrane That Separates Them11:54 - Why the Future of Healthcare Is Trainers, Not Doctors12:55 - Superficial vs. Deep Subcutaneous Fat: What Drives Each?14:21 - The Longevity Molecule Bodybuilders Are Starving Themselves Of15:53 - How To Burn Deep Subcutaneous Fat (Without Losing the Good Kind)18:06 - The Muscle You've Never Trained: Why Blood Flow Beats Hypertrophy20:38 - Can You Have Low Visceral Fat But Stubborn Love Handles?22:17 - How Fast Does Heart Fat Disappear? An NFL Player's Scan24:15 - The 60% Heart Fat Reduction in Just 5 Days26:23 - The 39-Hour Body Transformation That Shocked a Doctor29:06 - The Secret Probiotics That Supercharge Fat Loss30:57 - A Word on Keto Brick31:43 - Do You Need Fermented Foods on a Carnivore Diet?32:35 - How Gut Bacteria Create Natural GLP-1 (Ozempic Alternative?)34:00 - The Probiotics That Gave Him "Superhuman" Senses41:22 - The "Living Diet": Why You Should Chew Meat With Ferments43:05 - Why the Government Now Recommends Fermented Foods45:00 - DEXA vs. MRI: Which Is Accurate for Visceral Fat?47:09 - Why an MRI Scan Changes Your Life (And a Number Doesn't)53:03 - Why Blood Work Lies: The Case for Structural Health Markers58:07 - The Danger of Extreme Fasting (And How To Do It Right)1:00:31 - Why You Should Only Work Out in a Fasted State1:02:37 - Where To Find Dr. Sean O'Mara

Dr. David Chernoff, Chief Medical Officer of Setpoint Medical, discusses electrically driven vagus nerve stimulation (VNS) as a “neuroimmune modulation” approach to autoimmune and inflammatory disease. Chernoff explains the vagus nerve's sensory role in monitoring organs and signaling the brainstem and spleen to regulate immune responses, and how precise stimulation can reduce pro-inflammatory cytokines without immunosuppression. Setpoint's miniaturized, wireless, MRI-compatible implant is placed in an outpatient 45-minute neck procedure and delivers one minute of daily stimulation titrated to an upper comfort level; long-term safety is supported by prior surgical experience and a 242-patient blinded RA study with two-year data, leading to FDA approval for rheumatoid arthritis. The discussion covers add-on use with medications, potential steroid tapering, reimbursement, and research in Crohn's disease, relapsing MS (vision and remyelination), and other conditions, including psoriatic arthritis, lupus, and neurodegenerative diseases.

How many MRI's have you had this year? Well, Joshita Majumdar, a graduate student in electrical and computer engineering, she's had 107… and counting. No, Joshita isn't sick or injured, she's just researching the effects of a nightly sleep on a person's performance the next day by utilizing the Auburn University Neuroimaging Center's one-of-a-kind 7T MRI scanner. So, no need for ear plugs as you enter this MRI, as Joshita already has you covered.

Intracerebral hemorrhage carries high morbidity and mortality, but growing evidence highlights meaningful opportunities for prevention, risk reduction, and long-term recovery. This episode covers key strategies, including blood pressure management, interpretation of neuroimaging markers, and individualized decisions around antithrombotic therapy. It also emphasizes the prolonged recovery timeline and the importance of a holistic, patient-centered approach to improving outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Wendy C. Ziai, MD, and Vishank A. Shah, MD, coauthors of the article "Intracerebral Hemorrhage" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Ziai is a professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Shah is an assistant professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Intracerebral Hemorrhage Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @VishankShah3 Full episode transcript available here Dr Albin: A patient has suffered an intracerebral hemorrhage. They're taken to the neuro ICU, and they fortunately survive. But the journey does not end there. In fact, in some ways, the journey has just begun. Join us today as we unpack holistic care for ICH patients.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello to our audience. This is Dr. Casey Albin. Today, I'm interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I am so delighted that both of you are joining. To begin, let's just do a brief introduction of who you are and, and a little bit of how you got interested in the topic.  Dr Ziai: Hi, I'm Wendy Ziai. Thank you for having me on this podcast. I am a professor of neurology at Johns Hopkins. I am a neurointensivist, and I think I got primarily interested in this topic through clinical trials that I have been a part of since my fellowship days.  Dr Shah: Hi, everyone. I'm, uh, Vishank Shah. I am also, uh, very thankful for being invited to be a part of this podcast. I'm also a neurointensivist at Hopkins and the fellowship program director here for neurocritical care, and I'm interested in recovery after ICH, and that's why I'm a part of this work.  Dr Albin: Welcome to you both. It is such a treat for me to get to interview fellow neurointensivist, particularly those who have such a wealth of experience. So, I am delighted to dive into this. All right. So, to set the stage for our audience, intracerebral hemorrhage has long been approached with pessimism. But your article really highlights that there are meaningful advantages in prevention and risk stratification and long-term recovery for these patients. Though you both are neurointensivist, this article really emphasizes primary prevention and the holistic long-term care for the survivors. And so, to begin, Dr. Shah, can you just lay out a little bit for our listeners the scope of intracerebral hemorrhage and its community impact?  Dr Shah: Yeah. So, you know, ICH is the second most common type of stroke. There are more than three million new cases of ICH globally each year, and it accounts for thirty percent of all stroke types, but it is the one that has the highest mortality, with more than forty to fifty percent of the patients dying in the first thirty days, and then continued long-term impact on both functional as well as outcomes, as well as survivorship after the early period. And it also disproportionately impacts lower socioeconomic, and then minority races like Blacks, Asians, as well as Hispanic ethnicity. And so, there's a lot of work that needs to be done to reduce the burden of this disease.  Dr Albin: Absolutely. I mean, these can really be devastating for families, and I really am appreciative of your highlighting that there's a lot of disparities, and there's a lot of work to be done to really increase equity to these patients. I think a lot of this goes into really the AAN's focus on brain health and trying to improve some of what we're doing to maintain brain health. And I really wanted to kind of drill down on this because for ICH, there's a lot that can be done upfront as we think about how do we counsel patients who may walk into the office about strategies to prevent ever becoming an intracerebral hemorrhage patient. So, Dr. Shah, can you walk us through a little bit about what neurologists in the community need to be doing to make sure that no one ends up with us in the neurointensive care unit?  Dr Shah: Yeah, sure. So, I think, you know, one of the most important risk factors is, of course, hypertension and long-standing uncontrolled hypertension. And so really recognizing the need for early onset screening with regular blood pressure monitoring at a very early age, particularly in the races that I discussed earlier. And then I think another big part, obesity, metabolic syndrome, and type two diabetes. And I think there's a lot of interesting new work that with the GLP-1 agonist, you know, in a large multicenter cohort studies showing that patients receiving these had a significantly lower reduction risk of ICH. And so, this might be a really important part that, you know, clinicians need to start increasingly recognizing and using in their practice. And then, of course, other risk factors that are common include smoking, diet high in sodium, exposure to air pollution, both indoor as well as outdoor. And so, mitigating all of these risk factors can also reduce the burden of ICH.  Dr Albin: Absolutely. And I really want to highlight that hypertension plays such an important role and that we as neurointensivist, as community neurologists, really need to be creative about ways that we can help people meet those blood pressure target and meeting people in the community where they are, making sure that they're not suffering from side effects from their medication that would prevent them from sticking with it long term. Dr. Ziai, anything else to add about what we can do in the community?  Dr Ziai: So, we really want to emphasize, even in the acute phase, that patients moving forward need to have targeted interventions to reduce blood pressure, smoking, enhance their physical activity, have a diet that is high in fruits and vegetables and low in alcohol and salt, and then promoting weight loss, of course.  Dr Albin: And Dr. Ziai, I'm gonna ask you a little bit about one of the things that maybe not all of our listeners have heard about is this APOE2, APOE4 genetic risk for intracerebral hemorrhage. What's going on there and, and should clinicians be testing for that? Dr Ziai: That's a great question, and it is not one that we currently test people for at least acute ICH presentation. APOE2 and A4- E4 alleles, these give patients a two to three times higher risk of ICH by increasing cerebral amyloid deposition. And if you happen to have APOE2 carrier ship status, then along with other risk factors like white matter disease and vascular risk factors, these predict the onset of new microbleeds even during very short follow-up periods of about two years. And as we know, having cerebral microbleeds are associated with an increased risk of all strokes, ischemic and ICH, but they are one of many MRI markers of small vessel disease, which along with cortical superficial siderosis, does significantly increase future ICH risk. And so even in people who've never had an ICH, if they happen to have an MRI, it may be reasonable to look at the MRI and incorporate this burden of small vessel disease, and especially these hemorrhagic markers into, uh, decision-making about interventions.  Dr Albin: That's a really excellent point. And so, I think that your article did a really beautiful job of thinking holistically about the patient, incorporating clinical markers of their risk for having ICH, but also those radiographic markers. I'm just gonna ask you to summarize those again one more time because not everyone will be familiar with these. So, when you're looking at an MRI, what are the things that you're particularly clued in on that would increase the patient's risk of future ICH?  Dr Ziai: In the past, what we're looking for really is markers of cerebral amyloid angiopathy, which significantly increase a person's risk for lobar hemorrhage in particular. And so, we have a set of criteria called the Boston Criteria, and there's a new version of these, version 2.0. And these, um, incorporate a number of imaging markers that provide a very high sensitivity and specificity to diagnose CAA after an ICH. But even if someone's never had an ICH, and they evaluate that risk-benefit ratio for different cardiovascular prevention strategies. And so, the markers that we're specifically interested in are, of course, microbleeds. But not just having microbleeds, but are they lobar or are they deep? Lobar having a higher risk for lobar ICH. How many microbleeds are there? Is it greater than five, or is it just one or two? Also, cortical superficial siderosis is a marker, a hemorrhagic marker, that does portend a significant increased risk of recurrent ICH, along with having a lobar ICH. And now we have these new markers, which are the white matter hyperintensity multi spot pattern, which requires these hyperintensities on flare imaging in the subcortical area, having greater than at least ten of these multi spots, and also having enlarged perivascular spaces in the centrum semiovale, and having at least twenty of those. And finally, white matter hyperintensities, which can be measured with the physica score or just by visualizing them. We can look at white matter hyperintensities as well as being a measure of small vessel disease.  Dr Albin: Got it. And so just to summarize, we're looking for small vessel disease markers because that puts our patients at higher risk of ongoing future bleeds. And then we're also looking for markers of particularly small vessel disease that's caused by cerebral amyloid angiopathy, which again, because it's having that protein deposition, that puts the patient at risk of those leptomeningeal very small vessels, putting the patient at risk of lobar ICH. Just confirming I've summarized this all correctly.  Dr Ziai: Yes. That was perfect.  Dr Albin: Amazing. Dr. Shah, I'm gonna go back to you. Let's say we have a patient. Let's say this is a sixty-five-year-old man who comes in and they want follow-up and they're... And you're trying to think about they've had an ICH in the past, and they are also at risk for ischemic disease. Let's say they, they have hypertension, they've had a smoking history. They have some risk for ischemic events. And you're trying to think about how do you balance those. Let's say the patient needs to be on aspirin but does have some of those high-risk features on their MRI. Is there any guidance on how we think through preventing them from having a recurrent bleed if they're a high-risk patient, also preventing them from having an ischemic event, which they might be at high risk for as well?  Dr Shah: Yes. So, I think, you know, the first step is of course trying to understand what was the type of bleed. I think that has a very important role, like you mentioned. If it's a lobar hemorrhage versus a deep hemorrhage, the risk of recurrent ICH and ischemic events is very variable. So lobar hemorrhages, there's obviously a higher risk of recurrent hemorrhage events, whereas deep hemorrhage is actually at or behaves sort of like small vessel ischemic strokes and have a higher risk of recurrent arterial ischemic events. So that distinction in itself can help you gauge which patients would be safe and would benefit from these therapies. To begin, and of course, looking for some of these markers on MRI that were mentioned by Dr. Ziai for recurrence of hemorrhage risk. In terms of antiplatelet, the, there is a lot more data now to guide treatment, and we have the RESTART as well as the ESTART trial that showed that starting an, a single antiplatelet after intracerebral hemorrhage did not increase the risk of hemorrhage recurrence. They were very variable in the timing when aspirin was started, and so that remains still a question about what is the safest time point to start aspirin. For example, in the ESTART trial, they started them very early, within the first three days, whereas in  the RESTART it was all the way up to two months after the hemorrhage. And so... But in general, the risk of recurrent ICH was very low with a single antiplatelet agent. And so, if it's needed for ischemic prevention, it's relatively safe broadly across all types of hemorrhages.  Dr Ziai: Yeah. I would just mention that there was also a subgroup analysis of the RESTART trial using MRI. And so, this more than likely included patients with CAA, since 40% of the hemorrhages were lobar in that study, and therefore seeing that there was no increased risk of recurrent ICH in RESTART, it is thought that putting patients back on their antiplatelet therapy is safe.  Dr Albin: That's a really huge takeaway pearl for our listeners, that regardless of whether it's a lobar bleed or a deep bleed, if there is a strong indication, you know, this is not just, oh, because someone gave them aspirin 81, but truly that there is a reason that they need to be on a single antiplatelet agent, it probably benefits them to be on that agent, and there's good data that there's not a huge increase in risk. Summarizing all of that?  Dr Ziai: Great.  Dr Albin: Now, things are gonna get a little bit tricky here, because what if the patient, what if they need to be on dual antiplatelet therapy? Or what if they need to be on anticoagulation? Dr. Ziai, I'll, I'll throw that to you. How do you tackle that patient population?  Dr Ziai: Yeah, the safety of dual antiplatelet therapy hasn't really been studied in patients who've had a prior ICH. Although, in people who've had previous strokes, putting them on dual antiplatelets doesn't seem to increase the risk of ICH, but it does increase extracranial hemorrhage. And so there may be other reasons not to put patients on dual antiplatelet agents. Patients who have cancer and also cardiovascular or cerebrovascular disease, putting them on dual antiplatelet therapy does seem to increase the risk for intracranial hemorrhage. So, I think there is enough of a bias against DAPT therapy in patients who have had an ICH that we would not recommend DAPT for patients with a prior ICH.  Dr Albin: Absolutely. And, and then what about, let's say they have atrial fibrillation, and you know that they have a high CHA2DS2-VASc score, and they are at very high risk of ischemic events, but they've also had a prior intracerebral hemorrhage. Walk us through a little bit, how should we approach that patient? Dr. Ziai, I'm gonna start with you again.  Dr Ziai: Sure. So again, looking at the MRI, which all patients with ICH should have nowadays. If patients do have these hemorrhagic findings, a lobar ICH, evidence of CSS, cortical superficial siderosis, especially if it's disseminated, and also lobar microbleeds, especially if there are greater than five, if they're multiple, then anticoagulation should really be avoided in those patients.  Dr Albin: Absolutely. So, I'm really hearing that when we have a patient with ICH, it is just critically important that we understand is this a hypertensive bleed or is this a lobar bleed that is probably related to cerebral amyloid angiopathy? And getting to that distinction is going to play a major role in our deciding whether or not the patient can be on DAPT or can be on anticoagulation. And then what are some of the strategies for patients that you're referring them to if they really cannot tolerate being on anticoagulation, but they have atrial fibrillation, and they do need some sort of ischemic stroke prevention?  Dr Shah: There's still a lot of controversy, even in non-lobar hemorrhages, about resuming anticoagulation and when that would be safe. HAF trial, there was a reduction in ischemic stroke recurrence, uh, but a significantly higher increase in hemorrhage recurrences. I think that trial included both deep and lobar hemorrhages. So, we still need more data, and I think the ASPIRE trial and maybe a meta-analysis would answer that eventually. But in the meantime, if a, specifically for lobar hemorrhages, which are, uh, thought to be CAA related, if they, uh, and the patient has AFib, you know, where anticoagulation would be contraindicated, a watchman device or, you know, AFib ablation may be some of the other strategies that can be looked into for those patients specifically.  Dr Albin: Right. I think that's a really important point to emphasize, that we don't just don't give up and say, "Oh, you're not a candidate for anticoagulation," but we really reach out to our cardiovascular friends and say, "Hey, what other procedures can you offer that will minimize the risk of recurrence?" You know, we don't want them to have an ischemic event, but we also know long-term that there would be a real risk of anticoagulation. Just reminder to our listeners that there are new procedures, and our cardiology colleagues are always doing new trials and new devices, and so we should really leverage their expertise here. I am in the final minutes gonna just switch gears a little bit from talking about sort of the nitty-gritty of secondary ischemic prevention and secondary hemorrhagic stroke prevention and thinking about there has been this degree of pessimism around ICH patients, and that, you know, they have a much more severe outcome than our patients with ischemic strokes. I think that that is probably a myth that we need to do some debunking around, and I think maybe we need to reframe in terms of thinking about just the trajectory. So, Dr. Shah, walk us through a little bit about what we can expect about the recovery trajectory in ICH compared to those patients who have an ischemic stroke. Dr Shah: Yes. From some newer data and studies, it is becoming clear that recovery after ICH is much slower than we expect. In general, for ischemic stroke, recovery is measured within the first few weeks to up to 90 days. But in ICH, we now know that patients can keep recovering all the way up to six months and even beyond. In general, from just a, a study of heart recovery that occurs after ischemic stroke, there's a steep recovery in the first seven days, and then sort of after that, patients still continue to recover, but it, it starts plateauing where up to 90 days. Whereas with ICH, there is not much recovery in the first 7 to 30 days, but after that, there is a recovery that occurs significantly between day 30 and day 180, and then some patients continue to recover all the way up to one year. The more severe the hemorrhage, the slower the recovery, but there's still some evidence to suggest that even severe hemorrhage patients can recover all the way up to one year out and beyond. This is, of course, in terms of functional recovery.  Dr Albin: I think that's a really important point for our audience. Many of the listeners are residents, they're fellows, they're seeing these patients in the hospital, and they may not see a whole lot of improvement over even 30 days. But to keep in mind that just because the patient has not had a dramatic recovery within that first month that they may be in the ICU and then on the floor does not mean that that patient will never have recovery, and that we reset our expectations that recovery is possible, it's just gonna be slower. And I think that that's not only important for the healthcare team to take in mind, but also for patients and their families to know there is hope here. It's just gonna be slower. Dr. Ziai, looking ahead, what developments in this are you most excited about that you think will move the needle for care for the long-term outcomes and the prevention for these patients? What's ahead in, in ICH?  Dr Ziai: Yeah, I think the research that's going on is very exciting at the moment. We just saw the presentation at the World Stroke Organization conference in the fall of the TRIDENT trial, Triple therapy prevention of Recurrent intracerebral Disease events, meaning strokes. And these investigators found that a single pill, a fixed dose of three blood pressure-lowering agents actually was successful in significantly reducing the risk of recurrent stroke in patients who have had a history of ICH and have just normal or low-grade hypertension. So rather than having patients on multiple antihypertensive agents, it may be possible to have them on a single pill, and may dramatically reduce their stroke risk. So that's exciting. There is also a trial ongoing, ASPIRING, testing whether antiplatelet monotherapy after 24 hours only can reduce the risk of all serious vascular events in ICH survivors. So very early antiplatelets. The SATURN trial, we didn't talk about statins yet, but it is comparing continuation versus discontinuation of statin therapy in ICH patients. And then we have ongoing epidemiological studies that are really needed to understand this interaction between the cardiovascular prevention strategies, the antithrombotic use, the blood pressure targets, and these high-risk neuroimaging markers for ICH. And I think that's gonna be key, personalizing the interventions for these patients.  Dr Albin: So, I love that. And what I'm hearing is that it's really important to think about the personalized approach as well as how do we simplify things. We know that blood pressure control is critically important to the primary and secondary prevention of ICH, but we have to make it easy for patients to do so. Dr. Shah, I want to end with kind of understanding, you know, this was an unusual topic for neurointensivists to talk about. This was really about prevention. It was about long-term survivorship. It was about not what's happening in the neuro ICU. How did you guys get interested in sort of that aspect of care?  Dr Shah: Yeah, so that's a great question. Dr. Ziai has been my mentor since I was in fellowship, so now about eight years that I've been working with her, and this was a project that I started in fellowship with under her mentorship, looking at long-term recovery in ICH patients, and specifically severe patients. Happy that work has received a lot of recognition. It was published in JAMA Neurology. We looked at patients with severe intracerebral and intraventricular hemorrhage, those that survived with an mRS of four and five at day 30, and what happened to them over the course of the year. There was really not much data on recovery after ICH. And we were very surprised to see that up to 40% of patients that were an mRS of four and five, so really, really severely disabled at day 30, recovered to an mRS of zero to three by one year. About one-third of that group that recovered actually achieved functional independence with an mRS of zero to two, which was very surprising, really breaking the myths around the pessimism with ICH. We found that a lot of the baseline comorbidities like diabetes, white matter disease, as well as what happens to them during the acute hospitalization, were adding all of that information to the severity of the hemorrhage significantly improved our ability to predict long-term recovery after ICH. And so that's kind of how we got interested in this work, looking at how factors in the care that we provide in the ICU, as well as what the patients come in with, how all of that could be modified to promote recovery in these patients that are often been forgotten.  Dr Albin: I think that there's one takeaway to our listeners is that this is really a place where there's a lot of hope for recovery, and that the nihilism that has really surrounded ICH is a thing of the past, and we have to move forward with thinking about how do we proactively impact the recovery and counsel the patients and give them hope. Because just as your research shows, there really is the ability that they can attain that functional independence, which is absolutely astounding. It's really amazing. Again, today I've been interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Please be sure to check out Continuum Audio episodes from this and other issues. Please go and check out. They have a wonderful article with lots of tables and figures, so much data. And again, thank you to our listeners for joining us today. Thank you, Dr. Ziai and Dr. Shah.  Dr Ziai: Thanks very much.  Dr Shah: Thank you.   Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Interview starts at 27:50 The Secrets Beneath: New Discoveries in Egyptian Monuments & Cutting-Edge Tech In this episode, Darren Grimes hosts George Howard of Cosmic Tusk to delve into the latest groundbreaking research on the Egyptian Sphinx, the possibility of undiscovered underground chambers, and how modern technology like MRI, satellite imaging, and AI are transforming archaeology. The conversation also explores water level changes, ancient climate events, and the search for Atlantis.   He's deeply embedded in alternative history, cosmic impact research (Younger Dryas boundary hypothesis), and discussions of lost/advanced ancient civilizations. His platform regularly covers topics like Plato's Atlantis, pre-flood knowledge, and suppressed archaeology. He has interviewed or collaborated with researchers on these themes (including recent conversations linking back to Atlantis interpretations with guests like Randall Carlson). https://cosmictusk.com/about-george/ https://www.youtube.com/@cosmicsummit English Translation of the Presentation. https://youtu.be/rUl0G7N2iGk?si=Z2mZ5PGFfx1Gq9Qx   Key Topics: The recent presentation and hypotheses about a second Sphinx hidden beneath the Giza plateau, supported by modern imaging technology The use of satellite imagery, LiDAR, and underground scans to locate buried structures without invasive digging Interviews with experts like Filippo Beyondi and Corrado Malonga, and their role in advancing this research The controversy and skepticism within the archaeological community regarding new discoveries and interpretations The potential evidence for ancient water floods, such as the Younger Dryas impact, water erosion patterns, and the possibility of submerged civilizations The technological leap in geoscience: how tools such as MRI, SAR, and AI are revealing subsurface features at unprecedented detail The implications of these findings for understanding Earth's history, climate change, and ancient civilizations like Atlantis The upcoming expansion of the Cosmic Summit into Titan Network, supporting creators and new scientific revelations The ongoing excavation developments at sites like Hawara, Egypt, and the importance of future physical digs alongside remote sensing   Become a Lord or Lady with 1k donations over time. 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Group A strep in the pediatric ED: from strep throat to invasive disease and toxic shock. Host: Ellen Duncan, MD, PhD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Group_A_Strep.mp3 Download Leave a Comment Tags: Infectious Diseases, Pediatrics Show Notes Background Group A strep = Streptococcus pyogenes — gram-positive organism that colonizes the pharynx, but also the perianal and genital mucosa (worth remembering when the source isn’t the throat). Extremely common. The episode cites an estimated ~289 million cases/yr of strep pharyngitis in children 5–14 (NIH). For a U.S.-specific, verifiable anchor: the CDC estimates strep throat drives ~5.2 million outpatient visits/yr in people

What if the biggest barrier to patient retention isn't your care, but the time it takes patients to get answers?  Today's patient wants answers fast.  Today's Chiropractor wants to increase speed, quality of care - and compensation for all of the above.  Technology is the answer.  As patient expectations continue to accelerate, practices that can provide immediate clarity, faster care pathways, and greater certainty create a significant advantage. Dr. Timay sits down with John Conidi from Next Healthcare to explore how in-house radiology helps reduce patient drop-off, improve retention, mitigate medico-legal risk, and create new revenue opportunities for the practice. The conversation unpacks the financial realities of implementing imaging, the critical role of radiologist reporting in protecting both patients and providers, and how emerging AI technology may soon help identify urgent findings faster than ever before. The result is a compelling look at why imaging is becoming far more than a diagnostic tool. It's becoming a strategic driver of better patient experiences, stronger clinical outcomes, and sustainable practice growth.   In This Episode You Will Discover: Why a simple referral outside the practice may be costing far more patients than most realize  The overlooked medico-legal responsibility that comes with every image taken  A revenue opportunity hiding inside a service many practices already recommend  How reducing diagnostic delays can dramatically strengthen patient trust and retention  The emerging AI capability that could identify urgent cases before they reach the top of the reporting queue   Episode Highlights 02:04 - Why the speed of getting answers may matter just as much as the quality of care.  02:41 - A simple referral for imaging may be creating more patient drop-off than most practices realize.  03:37 - The path from diagnosis to care changes dramatically when answers happen immediately.  04:09 - Every X-ray captures more than the spine, creating a level of responsibility many practitioners never fully consider.  05:45 - What if radiology reporting could become a strategic asset instead of simply another expense?  08:24 - The strongest return on an X-ray machine may have less to do with reimbursement than with practice growth.  09:16 - Convenience isn't just good service anymore. It's becoming a competitive advantage.  10:40 - Removing barriers to advanced imaging could dramatically shorten the patient's journey to answers.  15:19 - What if months of waiting for an MRI could become a matter of days?  16:52 - The future of radiology may not be faster reports, but knowing which patients need attention first.  19:05 - One routine image uncovered something nobody expected and completely changed the care plan.  19:36 - Taking the image is only the beginning. The real responsibility starts with everything that comes after. 20:39 - Dan Anticich from Success Partner Twoconnect, joins Dr. Andrew to discuss how chiropractic practices can improve lead conversion, patient reactivation, and operational efficiency through dedicated offshore support. They explore how virtual team members help practices protect marketing investments, strengthen patient communication, reduce administrative workload, and create scalable systems that support sustainable growth.   Resources Mentioned To learn more about the REM CEO Program, please visit:  http://www.theremarkablepractice.com/rem-ceo For more information about Next Healthcare please visit: https://nexthc.com.au/   For more information about Two Connect please visit: https://twoconnect.com.au/ Book a Strategy Session with Dr. Pete - https://go.oncehub.com/PodcastPC Prefer to watch? Catch the podcast on YouTube at: https://www.youtube.com/@TheRemarkablePractice1 To listen to more episodes, visit https://theremarkablepractice.com/podcast or follow on your favorite podcast app.

Dr. Linda Chu speaks with Dr. Eddy Zandee and Dr. Kirk Davis about multidisciplinary expert consensus recommendations aimed at reducing the use of low yield radiographs and improving imaging appropriateness across healthcare settings. They explore which common radiographic exams may offer limited clinical value, when CT or MRI may be more appropriate, and how education and workflow changes can help optimize imaging utilization. Optimizing Radiography Utilization: Multidisciplinary Expert Consensus Recommendations Endorsed by the Society of Academic Bone Radiologists, Society of Skeletal Radiology, American Societyof Emergency Radiology, Orthopaedic Trauma Association, American Academy of Emergency Medicine, and American Rhinologic Society. Zandee van Rilland et al. Radiology 2026; 319(2):e252309.

What Your Mammogram Is Missing, And the Technology That Changes Everything Linda Creed wrote The Greatest Love of All. She wrote it in 1977, and when Whitney Houston released it in 1986 it spent fourteen weeks at the top of the charts. One month after it hit number one, Linda died of metastatic breast cancer. She was Dr. Jenn Simmons' hero. And that loss became the reason Dr. Jenn became Philadelphia's first fellowship-trained breast surgeon — and eventually, the reason she walked away from conventional oncology entirely. Because what she found inside that system wasn't healing. It was pattern recognition, symptom suppression, and a mammography screening program that the American College of Physicians now says offers no survival benefit at any age. In this episode, Dr. Terri sits down with Dr. Jenn Simmons, integrative oncologist, breast surgeon, and founder of PerfeQTion Imaging, for one of the most important conversations in the show's history. They cover what mammograms actually do and don't do, why thermograms are being misused, why stage zero is not cancer, why bioidentical hormones do not cause breast cancer and may actually be protective, and the FDA-cleared technology Dr. Jenn has built that screens for breast cancer without pain, compression, or radiation — with forty times the resolution of MRI. Every woman needs to hear this episode. And so does every clinician still telling women they can't have hormones after a breast cancer diagnosis. What you'll discover: The story of Linda Creed, writer of The Greatest Love of All, and how her death from metastatic breast cancer became Dr. Jenn's life mission [01:53] What the American College of Physicians published in April 2026 about mammogram screening — and why it confirms what integrative medicine has been saying for years [around 20:00] The mammogram math: screen 2,000 women for ten years, potentially extend one life, diagnose ten with cancer they never needed to know about, and subject 200 to unnecessary biopsies [around 22:00] Why thermograms are not a screening tool for breast cancer and what they should actually be used for [29:39] Why stage zero is not cancer — and why the breast cancer world hasn't renamed it the way other specialties have [38:53] The truth about bioidentical hormones and breast cancer: what the data actually shows, and why women who take hormones after a breast cancer diagnosis have better outcomes [42:01] How PerfeQTion Imaging uses sound waves through a warm water bath to create a 3D reconstruction of the breast — no pain, no compression, no radiation, 40x the resolution of MRI [34:29] How breast cancer is a metabolic disease — and why screening for metabolic dysfunction can identify risk years before it ever shows on imaging [34:29] What it means to give every patient a health plan, not just a treatment plan [around 23:00] Breast health is health. And now there's a better way to protect it. The Dr. Terri Show is presented by EVEXIAS Health Solutions.Learn more and find a provider near you at evexias.com Connect with Dr. Terri:

In this episode of the Matthews Mentality Podcast, Kyle Matthews sits down with David Bakhtiari, two-time First-Team All-Pro, five-time Pro Bowler, and one of the greatest left tackles of his generation. Over 11 seasons with the Green Bay Packers, David protected Aaron Rodgers' blind side, helped lead the Packers to consistent playoff runs, and established himself as one of the NFL's premier offensive linemen.David shares his incredible journey from being an overlooked high school recruit to earning a scholarship at the University of Colorado, declaring early for the NFL Draft, and eventually becoming a cornerstone of the Packers franchise. He opens up about draft day, earning Aaron Rodgers' trust, negotiating life-changing contracts, managing wealth, and the devastating ACL injury that ultimately changed the trajectory of his career.The conversation also explores player safety, artificial turf versus natural grass, mental resilience, identity after professional sports, and what it truly takes to compete at the highest level for more than a decade.Topics covered in this episode:David Bakhtiari's journey from Colorado to the Green Bay PackersProtecting Aaron Rodgers and life as an NFL left tackleWhat Aaron Rodgers told him before his first NFL startNFL Draft day, combine interviews, and falling to the fourth roundThe mentality required to become a First-Team All-ProOffensive line techniques, preparation, and consistencyNegotiating NFL contracts and building long-term wealthReal estate investing and financial disciplineBehind the scenes of the Packers' Pitch Perfect 2 cameoThe ACL injury that changed everythingMultiple knee surgeries, rehabilitation, and returning to footballWhy David has become an advocate for player safety and natural grass fieldsCoping with retirement and finding purpose after footballDavid also reflects on the emotional side of professional sports, sharing what it was like to lose the game he loved, the challenges of rebuilding after injury, and the lessons he's carrying into the next chapter of his life.Whether you're an NFL fan, athlete, entrepreneur, or someone navigating setbacks in your own career, this conversation offers an honest look at resilience, discipline, leadership, and what it takes to perform at an elite level.Follow David Bakhtiari:Instagram: https://www.instagram.com/davidbakhtiari X: https://x.com/DavidBakhtiariFollow Kyle Matthews CEO:Instagram: https://www.instagram.com/kylematthewsceo TikTok: https://www.tiktok.com/@kylematthewsceo X: https://x.com/kylematthewsceo LinkedIn: https://www.linkedin.com/in/kylematthewsceo00:00 Don't Get Me Killed 00:54 Meet David Bakhtiari 02:17 Life After Football 04:08 Staying Fit After the NFL 06:42 From High School to College Offers 08:42 Choosing Colorado 11:50 Earning the Starting Job 15:04 Welcome to College Football 17:23 Realizing the NFL Was Possible 18:56 Declaring for the NFL Draft 22:59 NFL Combine Stories 25:34 Draft Day Slide 27:55 The Green Bay Packers Call 30:45 The Beach Meeting 32:10 FIFA with Aaron Rodgers 32:56 Clay Matthews' Welcome 34:19 First NFL Start 37:26 "Don't Get Me Killed" 39:17 Why I Wore #69 41:44 The Elbow Brace 43:01 Pitch Perfect 2 Cameo 49:51 Becoming an All-Pro 52:15 The Mental Side of Offensive Line Play 55:50 Signing a Big Contract 01:00:33 Money Habits & Investing 01:02:27 Tearing My ACL 01:03:10 Turf vs. Grass Debate 01:04:20 Why Turf Feels Different 01:07:09 Stadiums, Money & Player Safety 01:09:47 The MRI 01:12:58 Cartilage Damage & Multiple Surgeries 01:16:30 The Two-Year Rehab 01:17:41 Finding Identity After Football 01:21:58 Missing the Game 01:24:59 Aaron Rodgers Stories 01:26:17 Rapid Fire NFL Questions 01:32:20 Closing Thoughts

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Gayatri Devi is a nationally recognized neurologist specializing in memory disorders, including Alzheimer's disease and related dementias. In this episode, Gayatri explains how to think about dementia as a spectrum—including Alzheimer's disease, vascular dementia, Lewy body dementia, and mixed presentations—while exploring the evolving biology of amyloid, tau, and neuroinflammation and why brain pathology does not always correlate with symptoms. She discusses her approach to detecting subtle cognitive decline in high-functioning individuals, the role of biomarkers and APOE4 testing in asymptomatic patients, the benefits and risks of anti-amyloid therapies such as lecanemab and donanemab, and strategies for minimizing treatment-related complications. Gayatri also examines why some patients may stabilize or even improve with individualized care, the overlap among different dementia syndromes, and the relationship between menopause, estrogen, and cognition—including her concept of menopause-related cognitive impairment. Finally, she discusses how advances in early detection, AI-assisted monitoring, targeted therapies, and precision medicine are reshaping the future of dementia care. We discuss: Gayatri's training and clinical focus, why dementia is a spectrum disease, and how personalized treatment is changing Alzheimer's care [3:45]; How Alzheimer's disease fits within the broader spectrum of dementia: diagnosis, biomarkers, and early pathophysiology [7:15]; The emerging role of neuroinflammation and viral infections in Alzheimer's disease [13:30]; Gayatri's comprehensive approach to evaluating cognitive decline in high-functioning patients [17:45]; Why forgetting names is usually normal and when word-finding problems become concerning [29:00]; Why women are at higher risk for Alzheimer's disease and how menopause influences cognition [33:45]; The promise and limitations of blood-based biomarkers for diagnosing Alzheimer's disease [40:15]; When preclinical Alzheimer's screening is appropriate and how to interpret positive biomarker results [45:00]; Case study: early Alzheimer's prevention in a highly-functional woman in her 50s with two copies of APOE4 [47:15]; Anti-amyloid therapies: balancing clinical benefit with ARIA risk using slow titration [51:45]; The aducanumab controversy, why it was discontinued, and why Gayatri would still choose it [1:00:00]; How anti-amyloid therapies cause ARIA, strategies for detecting and managing these complications, and how future therapies may improve safety and accessibility [1:03:30]; Two patient examples of exceptional responses to anti-amyloid therapy [1:12:30]; A multimodal approach to Alzheimer's treatment: combination therapy, MRI-guided TMS, GLP-1 receptor agonists, and more [1:15:00]; Vascular dementia, Lewy body dementia, and the overlap with Alzheimer's disease [1:21:00]; Lewy body dementia and Parkinson's disease: distinguishing two alpha-synuclein disorders [1:26:45]; Risk factors for Lewy body dementia and what remains unknown [1:36:15]; Treating menopause-related cognitive impairment: hormone therapy, brain rehabilitation, and balancing breast cancer risk [1:38:45]; How biomarkers changed Gayatri's perspective on the potential for Alzheimer's patients to improve [1:47:15]; The future of Alzheimer's care: AI, precision medicine, and personalized treatment [1:49:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Carnitine, with acknowledged muscle and brain benefits, may find a new role in supporting cancer immunity; Calcium and vitamin D's bone-building impact may be limited; Internal visceral fat may accelerate brain aging, MRI study finds; The remarkable benefits of a newly-discovered mitochondrial booster—urolithin A (Mitopure®️).

People in wheelchairs are walking again. A man whose hip bone was disintegrating from infection, told by doctors there was no hope, walked into a meeting three weeks later. The MRI came back: full regeneration, infection gone. What caused it? In this episode, Lance Wallnau sits down with Kat, a woman who personally avoided 7 surgeries. Kat has been sharing this discovery across the US for nearly 7 years, and today she brings the testimonies doctors can't explain: a wheelchair patient whose MRI confirmed his hip regenerated, and a 93-year-old whose kidneys came back to 100% function in 5 days. In this episode: * The wheelchair testimony — walking again after hip disintegration, with MRI proof * 93-year-old avoids dialysis: kidneys restored to 100% in 5 days * Kat's story: 7 potential surgeries, 2 weeks, zero pain Podcast Episode 2172: People Are Walking Again After This Unexpected Breakthrough | don't miss this! Listen to more episodes of the Lance Wallnau Show at lancewallnau.com/podcast