Podcasts about musculo

Nuestro HOMENAJE a FRANCISCO,que su alma descanse en PAZ, GRACIAS por su GRAN EJEMPLO de LIDERAZGO MASCULINO,que AVANZA, derribó muros del miedo desde el CORAJE, AMOR,PAZ, FE, que invitó a la UNIDAD,respetando la diversidad..Desnudó miserias humanas, de los abusos a menores, y los abusos económicos internos. Y realizó SU MISIÓN en esta Tierra.que invitó a HACER LIO.para seguir derribando paradigmas limitantes, fuera del AMOR REAL. ese que te TRANSFORMA en tu MEJOR VERSIÓN. “La vida es peligrosa, no por la gente que hace el mal, sino por la que se SIENTA A VER LO QUE PASA “ ALBERT EINSTEIN. “Cosas mayores que yo haréis “ dicen las escrituras… Juan 14.12. Te invito a CONECTAR con tu PAZ, LUZ , BIENESTAR ..desde nuestra Embajada de Paz. UNESCO ESPERANZA ARGENTINA. Radial saludable. Desde el 2002, brindándote herramientas VALIOSAS para TU BIENESTAR. Junto a EXPERTOS reconocidos por su trayectoria de EXCELENCIA académica y GRANDEZA INTEGRAL QUE MERECÉS Desde el 09.11.2011, somos Embajada y Embajadora de Paz.distinción y misión divina, recibida de Fund.Mil Milenios de Paz (asoc.UNESCO) “Locura, es creer: si haces lo mismo, vas a obtener diferentes resultados “ ALBERT EINSTEIN. SABADO 26.04.25, a las 11 am de Rosario. Argentina. LA BANDERA de la PAZ, no sólo un símbolo, reconocido a nivel internacional, sino además representando un PACTO INTERNACIONAL, ROERICH,que este 15.04.25. se conmemora el 90 ANIVERSARIO de su firma, y un camino a manifestar desde la LUZ, y en UNIDAD. EN el MES de la SALUD y del INVESTIGADOR/A CIENTIFICO. 1.- MÉTODO HIPOPRESIVOS Otra forma de OPTIMIZAR TU TIEMPO, REJUVENECER, ACTIVAR FAJA ABDOMINAL , TONIFICAR PISO PELVICO, MEJORAR SEXUALIDAD, CONCIENTIZAR PRESIONES INTRAABDOMINALES Y TORACICAS, AMIGARTE con tu MUSCULO de la FELICIDAD: el DIAFRAGMAAA,,! Estaremos junto a un Investigador, disrruptivo, MAESTRO, EXPERTO reconocido a nivel INTERNACIONAL LIC.PITI PINSACH. @pitipinsach Lic.en Ciencias Actividad Fisica y Deporte. Cofundador. Wellness Coaching y Low Pressure Fitness.desde España- 2.- NEUROCIENCIAS BÁSICAS. para TU BIENESTAR Estaremos junto a una genia, EXPERTA en NEUROCIENCIAS BÁSICAS. DRA. SILVIA KOCHEN. Investigadora del CONICET. Nos invitan al CONGRESO INTERNACIONAL de CÁÑAMO INDUSTRIAL Y CANNABIS MEDICINAL. @unaj_oficial “Defiende tu DERECHO A PENSAR ,que por más que erres, es MEJOR que no pensar “ HIPATIA de ALEJANDRIA. “Educa al niño, y no será necesario, sancionar al adulto “ PITÁGORAS. “La vida es peligrosa, no pro la gente que hace el mal, sino por la que SE SIENTA a VER LO QUE PASA “ EINSTEIN. TE ACOMPAÑAMOS RADIALMENTE los SABADOS a las 11 am.Rosario Arg. En VIVO. FM 88.9 + www.radiogranrosario.com.ar + APP MOVIL.homonima +LUEGO desde TU CANAL de PODCAST PREFERIDO #MARISAPATIÑOENTREVISTASPARATUBIENESTAR en diversas plataformas internacionales:Spotify + Ivoox + Apple + Amazon Music ,etc. ) Sembrando PAZ, ENTUSIASMO y VIDA. en todo el mundo COMPARTI con AMISTADES.. ! ABRAZOTES de PAZ. MARISA PATIÑO. Fundadora,CEO,productora.www.esperanzaargentina.com.ar Embajadora de Paz Designada Parlamentaria Mundial de Educación. Mentora Neurociencias Aplicadas para EmpoderARTE. Autora #NeuroEmpodeHADACuantica, basada en labor de tesis Certificada en Empoderamiento Femenino Univ.Salamanca. Certificada Bienestar y Salud Mental en el trabajo.Fund.INECO. Certificada Instructora Internacional Método Hipopresivos para Tu Bienestar AMAIP. Certificada Conferencista Internacional por Red Mundial Conferencistas Certificada Internacional cómo Coach en Nutrición y Salud OEIP. www.marisapatinoambassador.com

Tous les jours, du lundi au jeudi, la France Bouge prend des nouvelles d'entrepreneurs qui sont déjà passés dans l'émission. Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

Tous les jours, du lundi au jeudi, la France Bouge prend des nouvelles d'entrepreneurs qui sont déjà passés dans l'émission. Distribué par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

Hoy en día podemos ver en los medios de comunicación como famosos de la talla de Elon Musk, Oprah Winfrey, Cristina aguilera, Kim kardashian, Luis Miguel, Lady Gaga y decenas de actrices de Hollywood, o ricos de Sillicon Valley… comentan que han perdido mucho peso y sin esfuerzo, gracias a un medicamento Unos hablan de ozempic, otros de wegoby y otros de mounjaro…. Otros comentan sus principios activos, liraglutida, semaglutida o tirzepatida Pero prácticamente nadie se ha parado a explicar los razonamientos fisiológicos que hay detrás de todo esto… Y para ello os traigo a Alfredo Andreu, farmacéutico , nutricionista y autor del libro, Ozempic & Co: Apagando el Ruido de la Comida, Perdiendo Peso y este es su web: https://www.habitonutricion.com/ Hablaremos de: Que es impacto tienen la insulina y el glucagón en la perdida de grasa y sensación de hambre y saciedad Que es el GLP 1 y que son los análogos de GLP 1 ) agonista del receptor del péptido similar al glucagón tipo 1 (GLP-1): Acciones en cerebro; hipotálamo nervio vago / pancreas: aumenta insulina y baja glucagón / tracto gastrointestinal vaciamiento gastrico tipos de medicamentos Agonistas duales GLP-1/GIP) Novo Nordisk: Produce Ozempic, Wegovy, Rybelsus, Victoza y Saxenda. Eli-Lilly: Trulicity y Mounjaro., Mounjaro es el primer agonista dual de GLP-1 y GIP, con potencial superior en la pérdida de pes Elimina grasa vs perder apetito…. Musculo y hueso Mi comparación : sueño y descanso ---- esteroides Efectos secundarios corto plazo (estomacales, Reducción de acetilcolina, lo que puede afectar la motilidad intestinal y la contracción muscular, hipoglucemias) medio plazo (posibilidad pancreatitis, cancer de tiroides…) largo plazo (rebote, perdida de masa muscular) Realmente quien debería ser candidato… ultima bala antes de operación en obesidad mórbida? Recuerda su web: https://www.habitonutricion.com/

¡Hola!En el podcast de hoy os cuénto todo lo relacionado con la hormona insulina.Qué funciones tiene la insulina y por qué es una hormona clave para la vida.Por qué el problema no es la hormona insulina en si mismo sino la perdida del equilibrio y un EXCESO derivado de una resistencia celular a la insulina.Qué factores pueden llevar a que tengamos resistencia. a la insulina y, por tanto, nuestro pánreas tenga que producir un exceso de insulina.Qué sintomas y signos se asocian a una resistencia a la insulina.Cómo medir la resistencia a la insulinaQué podemos hacer para mejorar la sensibilidad a la insulina: tener musculo, consumo de fibraSuplementos que pueden potenciar habitos saludables: berberina, gymnemma sylvestre, silimarina, creatina, myoinositol, chiro inositol, picolinato de cromo, zinc, extracto de melon amargo...Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario Mi TikTok @isabelvinabas En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.com

Chaque vendredi, nous traitons d'un sujet de santé au féminin, de manière pratique. Cette semaine, nous parlons des troubles musculo-squelettiques. Ces douleurs se manifestent par des gênes dans les mouvements et sont localisées au niveau ou autour des articulations comme le poignet, le coude ou encore le genou. Une rhumatologue répond aux questions des auditrices : Dr Awa Cheikh Ndao, médecin interniste, rhumatologue à l'Hôpital Aristide Le Dantec et maître de conférences agrégé à l'Université Cheikh Anta Diop de Dakar au Sénégal. La palabre au féminin de Charlie Dupiot.Programmation musicale :► Singuila feat. Youssoupha – Rossignol ► Imany – Wonderful life.(Rediffusion)

Chaque vendredi, nous traitons d'un sujet de santé au féminin, de manière pratique. Cette semaine, nous parlons des troubles musculo-squelettiques. Ces douleurs se manifestent par des gênes dans les mouvements et sont localisées au niveau ou autour des articulations comme le poignet, le coude ou encore le genou. Une rhumatologue répond aux questions des auditrices : Dr Awa Cheikh Ndao, médecin interniste, rhumatologue à l'Hôpital Aristide Le Dantec et maître de conférences agrégé à l'Université Cheikh Anta Diop de Dakar au Sénégal. La palabre au féminin de Charlie Dupiot.Programmation musicale :► Singuila feat. Youssoupha – Rossignol ► Imany – Wonderful life.(Rediffusion)

!Hola!  En el episodio del podcast de hoy vuelvo a contar con la maravillosa ayuda del Doctor Juan Viña, Médico, Catedrático de Bioquímica y Biología Molecular en la Universidad de Medicina de Valencia y encima lo mas VIP, mi padre :) En el episodio de hoy aprenderemos:¿Qué diferentes tipos de fibras musculares tenemos y cuáles son sus principales características bioquímicas que justifican su existencia? ¿Se pueden modificar los tipos de fibra muscular o el porcentaje de cada tipo que tenemos?¿En qué se diferencian las fibras musculares del músculo esquelético (como el bíceps o el cuádriceps) de las fibras musculares del corazón a nivel metabólico?Hay marcadores bioquímicos en sangre de daño muscular cuándo, por ejemplo, sufrimos un infarto? Y si es así, cuáles son, por qué se elevan y cual es su utilidad.Espero que os guste y cualquier duda extra ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQ  Y los suplementos formulados por mi https://ivbwellness.com

El día de hoy en nuestro segmente del cuerpo habla lo que la boca calla, tenemos un excelente tema que te va a ayudar a poder gestionar de la mejor manera esos dolores lumbares. Déjame tus comentarios y siguenos en nuestras redes. Gracias por tus 5 estrellas

Hola!En el episodio del podcast de hoy os explico qué componentes integran el gasto energético total como son:-Gasto metabolico basal-Gasto energético asociado a las actividades fisicas diarias-Gasto energético asociado al ejercicio físico-Efecto termico asociado a los alimentos-Termogénesis adaptativaAdemás, os cuénto qué hormonas influyen en el gasto metabólico basal y cómo podemos, si queremos optimizarlas.Espero que os guste :)Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.com

!Hola! En el podcast de hoy, aprenderás todo sobre la vitamina B12, una vitamina esencial para nuestro cuerpo que juega un papel crucial en la síntesis de ADN y ARN, así como en el metabolismo de los ácidos grasos. Vamos a explorar las cuatro formas principales de la vitamina B12: metilcobalamina y 5-deoxiadenosilcobalamina, que son las formas activas en nuestro organismo, y cianocobalamina e hidroxocobalamina, que se encuentran comúnmente en suplementos.  También os contaré cómo la B12 ayuda a convertir la homocisteína en metionina, lo cual es fundamental para la producción de S-adenosilmetionina (SAMe), una molécula clave para la síntesis de carnitina, dopamina, melatonina, y para la producción de mielina que protege nuestros nervios.Hablaré sobre los efectos de la deficiencia de B12 en nuestra salud neurológica y hematológica, y cómo ciertos medicamentos y condiciones pueden afectar su absorción. Además, te explicaré por qué es importante medir los niveles de B12 y homocisteína en el cuerpo para evitar problemas de salud.  Ojala os guste :) Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQY los suplementos formulados por mi https://ivbwellness.com

Hola!En el episodio de hoy contesto a tus dudas sobre cómo ganar y optimizar tu masa muscular.Entre las preguntas que contestaré están:¿Mas proteina = mas musculo?Mejores suplementos para aumentar masa muscular sin incrementar el % de grasaMejor Rutina para ganar masa muscular ¿Hay alguna relación entre estrógenos y masa muscular en mujeres y hombres?¿Con mancuernas de 1kg, cintas y peso corporal se puede aumentar masa muscular?Tengo resistencia a la insulina, hago ejercicio de fuerza y aún asi noto que me cuesta ganar masa muscular, ¿qué hago?Isa, me he roto la rodilla y ahora estaré un mes sin moverme, ¿qué puedo hacer para minimizar la perdida de masa muscular?Para mas información ya sabéis que me tenéis en mi instagram @isabelvina dónde te comparto contenido diario En mi canal de YouTube https://www.youtube.com/channel/UC-dfdxLBcvfztBvRAKZSXGQ Y los suplementos formulados por mi https://ivbwellness.com  

Instagram: @Luis_Villasenor_kg⁠⁠⁠ ⁠⁠⁠Instagram de Christian Assad: @MedHacker⁠⁠⁠ ⁠⁠Instagram: @SinPelosEnElCactus⁠⁠⁠ En este episodio explosivo de "Sin Pelos en el Cactus", me acompaña Luis Villaseñor, conocido por su capacidad para transformar cuerpos blandengues en máquinas de musculatura pura. Juntos, nos sumergiremos en el revoltoso mundo de la flexibilidad metabólica y el desarrollo muscular, desglosando cómo el ejercicio y una buena dosis de proteínas pueden ser la clave maestra para optimizar tu carcasa de carne y hueso. ¿Te sientes más cansado que el móvil de un abuelo? ¿Tu rutina de ejercicio parece sacada de un manual de tortura medieval? Pues bien, prepárate para una sacudida de realidad con Luis y yo, donde exploraremos desde los mitos más arraigados hasta las verdades más dolorosas sobre la salud y el fitness. Este no es un episodio para los delicados de corazón que prefieren un yogur light antes que un buen filete; aquí hablamos duro y sin filtros, porque en el camino hacia el templo del músculo, los débiles se quedan en la primera estación. Así que, si estás listo para dejar de ser parte del club de los eternamente adoloridos y quieres empezar a entender realmente cómo funciona tu cuerpo, no te pierdas este episodio. Conéctate, aprende y, quién sabe, quizás hasta te motives a levantar algo más pesado que tu control remoto. ¡Dale play y transforma esa flacidez en fortaleza!

Chaque vendredi, nous traitons d'un sujet de santé au féminin, de manière pratique. Cette semaine, nous parlons des troubles musculo-squelettiques. Ces douleurs se manifestent par des gênes dans les mouvements et sont localisées au niveau ou autour des articulations comme le poignet, le coude ou encore le genou. Une rhumatologue répond aux questions des auditrices : Dr Awa Cheikh Ndao, médecin interniste, rhumatologue à l'Hôpital Aristide Le Dantec et maître de conférences agrégé à l'Université Cheikh Anta Diop de Dakar au Sénégal. La palabre au féminin de Charlie Dupiot.Programmation musicale :► Singuila feat. Youssoupha – Rossignol ► Imany – Wonderful life.

Chaque vendredi, nous traitons d'un sujet de santé au féminin, de manière pratique. Cette semaine, nous parlons des troubles musculo-squelettiques. Ces douleurs se manifestent par des gênes dans les mouvements et sont localisées au niveau ou autour des articulations comme le poignet, le coude ou encore le genou. Une rhumatologue répond aux questions des auditrices : Dr Awa Cheikh Ndao, médecin interniste, rhumatologue à l'Hôpital Aristide Le Dantec et maître de conférences agrégé à l'Université Cheikh Anta Diop de Dakar au Sénégal. La palabre au féminin de Charlie Dupiot.Programmation musicale :► Singuila feat. Youssoupha – Rossignol ► Imany – Wonderful life.

En el episodio de hoy hablaremos sobre la masa muscular y la importancia de tener una base sólida de ella antes de los 50 años si quieres ser alguien longevo.Suscríbete gratis a mi nuevo newsletter "Domina Tu Camino" y recibe directamente en tu bandeja de email una dosis de desafíos diarios para inspirarte a actuar: https://gustavovallejo.com/newsletterSupport the show

En España se diagnostican cada año alrededor de 300.000 nuevos casos de cáncer,  y a pesar de todos los avances que existen hoy en día en ciencia e investigación… La incidencia no hace otra cosa más que avanzar en todo el mundo, en 2020 se diagnosticaron unos 18 millones de cáncer, y se calcula que en 2040, se llegue a los 27 millones en todo el planeta… Hay datos que pronostican que 1 de cada 2 hombres tendrá cáncer y en mujeres el dato es todavía peor, 2 de cada 3 mujeres sufrirán cáncer a lo largo de su vida Además la edad y la mortalidad del cáncer, también tienen datos que asustan, ya que cada vez hay más casos en personas menores de 50 años Hasta hace poco, solo se hablaba de genética, de herencia o de suerte… pero hoy en día parece que la ciencia, destaca en papel crucial que tiene el estilo de vida en la prevención y el tratamiento de esta enfermedad Y en estos hábitos, sin duda, parece que la actividad física puede ser la herramienta número 1 para combatir el cáncer, situando al ejercicio como la barrera más fuerte y eficaz. Y para hablar de ello, os traigo nada más y nada menos que a los chicos de FISACC, Adrián Castillo y Pedro Valenzuela, que acaban de sacar un librazo, llamado precisamente: El EJERCICIO, UN MURO CONTRA EL CÁNCER… HÁBITOS SALUDABLES PARA COMBATIR LA ENFERMEDAD Hablamos de estos 15 puntos: 1. ¿Qué es el cáncer?2. Que % es genético y que % es por hábitos o epigenética, Bissell3. Cáncer y estilo de vida, causalidad o causalidad… Otto Warburg: escuchado – criticado- admirado4. Teoria del suelo y la semilla, la importancia del contexto metabólico de Paget  5. Inactividad física, Sedentarismo y obesidad, cuanto ayuda a desarrollar un ambiente adecuado para el cáncer6. Y el tabaco, alcohol y estrés?7. Glucosa, Lactato y mitocondrias, que papel juegan a favor y en contra8. Se puede prevenir? Cardio, fuerza o vida activa… y el efecto cóctel de los 39. Musculo y cáncer:  sarcopenia y caquexia10. Oppenheimer y la explosión de energía, entendemos los beneficios del ejercicio físico? Cómo el EF vuelve infértil el suelo para el cáncer, en cantidad y en velocidad de desarrollo11. La importancia de la Glutamina: ¿ O al músculo o al tumor?12. Aporte de oxígeno al tumor y creación de vasos sanguíneos, bueno o malo?13. Paciente oncológico y EF… igual o más que para prevenir?14. El timming, antes, durante o después de quimio15. Inmunoterapia y futuras investigaciones See omnystudio.com/listener for privacy information.

Es más común el objetivo de bajar de peso que subir masa muscular, sin embargo aumentar masa muscular puede ser un elemento importante que te puede apoyar a tener menos fluctuaciones en tu peso y mantener un peso saludable por más tiempo, incluso a bajar más rápido de grasa corporal. En este episodio comparto cuales son los factores que influyen en la ganancia muscular y mitos en relación a la alimentación y ejercicio Más información: Hábitos Inteligentes ¡Síguenos en instagram! 

Dr. Olivier Pourquié is the Frank Burr Mallory Professor of Pathology and Professor in the Department of Genetics at Harvard Medical School. His work focuses on the segmentation clock and the development of muscles and vertebrae. He talks about studying somitogenesis in vitro and his work on brown fat development.

Hola!En el episodio del podcast de hoy os desgrano el mineral Magnesio al detalle:Cuales son las funciones del Magnesio en nuestro cuerpoPor qué el Magnesio puede ser la clave para conseguir adecuados niveles de vitamina DPor qué en la actualidad los alimentos han dejado de ser una fuente rica en MagnesioFarmacos y condiciones que aumentan el riesgo de deficiencias de Magnesio¿Como medir de manera fiable los niveles de Magnesio?Signos y sintomas de la deficiencia de MagnesioTipos de Magnesio, cuales son los mejores para mantener nuestro status de magnesio intracelular.Espero que os guste, y cualquier duda extra me teneis en mi instagram @isabelvinaLa linea de suplementación IVB esta en la web https://ivbwellness.com y en numerosas farmacias colaboradoras.Un besito enorme :)

Primera etapa en el Dakar 2024. Comienza fuerte el Dakar en 2024 con una super etapa de 540 kilómetros de recorrido. Esta etapa transcurrirá entre Al-Ula y Al Henakiyah, un nuevo lugar paso en el Dakar. De los 544 kilómetros de esta jornada nada menos que 414 serán cronometrados. Comenzara en un lugar fantástico para los aventureros y pilotos del Dakar, entre cañones, también habrá fuera pista para, y para finalizar entraran en una zona pedregosa donde los pinchazos pueden empezar a ser protagonistas. A todo esto, esta etapa atravesara valles espectaculares con volcanes inactivos. No puedes, ni debes perderte, esta etapa junto a nosotros. El equipo que interviene en esta tertulia-analisis es el siguiente: Nacho Salvador @_NachoSalvador Diego Durruty @diegodurruty Javier Quilon @JaviviQuilon Fernando Rivas @rivasportauto Jose Lagunar @JoseLagunar Antonio Rodriguez @Antortxa AutoFM es el programa de radio del motor más escuchado de España. Somos lideres en el formato podcast y estamos presentes en iVoox, Spotify, Amazon Music, YouTube, iTunes, TuneIn, Radios de España... En AutoFM analizamos las últimas novedades del mundo del motor, probamos y opinamos sobre los nuevos automóviles que llegan al mercado. #podcast #podcastdecoches #podcastmotor #videopodcastcoches #coches #automovil #motor

My guest today is Chris Kitson of 'Rockstar Runners', a musculo-skeletal therapist and performance coach. We talk about the mechanics of how people get injured and what they can do to rehab an injury but also delve into the mindset side too. Chris has so much empathy and experience in this area and it's really refreshing to hear him talk about us as individuals with our own reasons for running and how we need to deal with the psychological impact of running injuries. He encourages us to take a higher level view of our lives and ensure that we have things that can fill the void of running when we are injured but also helps us to understand that the mind is a vital component of getting back to performance too. To find out more about Chris and his coaching and therapy sessions check out: https://www.instagram.com/rockstar_runners/ If you want to improve in your next race and want personalised help in training, nutrition and mindset designed to get you faster, further and stronger straight away, message me at www.instagram.com/therunningrules or see ⁠⁠⁠⁠www.therunningrules.com/coaching --- Send in a voice message: https://podcasters.spotify.com/pod/show/therunningrules/message

Que es y Porque es un Musculo tan Importante

Qué tan necesario es el aumento de músculo en las mujeres? Qué tan grande se puede poner una mujer por entrenar con pesas? Es importante el aumento de músculo para la disminución de grasa corporal o solamente podemos disminuir la grasa corporal sin necesidad de aumentar el músculo? Vamos a romper con estos mitos en este podcast.#spostspsycologist #mycoacheli #gorillazbarbell #eliarevalopodcast #nutritioncoach #powerlifting #catracho #muaythai #jcfit #MetCon #indianapolis coacheli.indy@gmail.com gorillazbarbell.com

Neste episódio da série Seguindo os Guidelines, convidamos os especialistas Marcelo Cabrini, Fabrizio Messetti e José Henrique Santiago para abordarem o tema: "Câncer de bexiga musculo invasivo não metastático".

Removing all animal foods from your diet usually causes unfavorable health consequences, studies suggest. Let's discuss ways to avoid the micronutrient deficiencies that my be present on a plant-based diet. Related: Support your Workout Sessions and Healthy Hydration with the Electrolyte + Creatine Combo by MYOXCIENCE: Use code podcast to save 15% Link to video, images and articles: https://bit.ly/43PdfaX Show Notes:   01:28 Deficiencies from these diets cause hair loss (for women too), hormonal changes, skin issues, hypothyroidism, sarcopenia (muscle loss) osteoporosis, and bone fractures. 06:45 Professional medical organizations are promoting vegan and plant-based diets, despite evidence to the contrary. 09:33 There are 5x more former vegans or vegetarians than current ones. 10:00 Plant-based diets do not signify a reduction in all-cause mortality. 11:20 Linked with anxiety, neurologic dysfunction, cognitive impairment, Musculo-skeletal, and immunological issues. 12:00 Supplement with B12, zinc, omega 3 fats, selenium, iodine, and protein. 12:15 Depressive disorders are significantly more common in vegans and vegetarians. 13:30 Eating disorder occurrences are higher in vegans and vegetarians. 16:20 Humans are omnivores. 18:10 Vegans/vegetarians may be more health conscious, which overestimates the health benefits of the diet when compared to other diets. 19:20 Nose to tail eating. 22:25 Supplementing with collagen, organic bone meal, omega 3 fats, and glycosaminoglycan chondroitin may be helpful. 22:50 Processed, overcooked, or burned meat is harmful. 23:20 Fermented foods are more digestible. 25:30 The scientists promote a plant forward omnivorous diet.  

Les troubles musculo-squelettiques (TMS) Se repérer dans l'épisode  Présentation du format de cet épisode qui sera divisé en 2 parties.  Dans le premier épisode, nous découvrions les facteurs d'apparition et de développement des TMS.  Dans cette seconde partie, nous allons découvrir comment prévenir troubles musculo-squelettiques. Vous comprendrez pourquoi certains collaborateurs développent des TMS et d'autres non. Cet épisode sera animé par Daniela MARGITICAN, experte risques professionnels et Gilles SCETBON, médecin expert employeur. Après une formation en médecine générale et une expérience dans la médecine d'urgence. Gilles s'intéresse à la prévention en médecine qui l'amènera à explorer les voies de la médecine d'expertise.  Existe-il des caractéristiques physiques propices aux TMS ?  Existe-t-il un lien entre les troubles psychosociaux et les TMS ? Si oui, comment cela se traduit-il ?   En quoi la formation permet d'atténuer les TMS ?  L'hygiène de vie permet-elle de réduire le risque de développer des TMS ?  Comment préserver la qualité du travail dans un contexte de rallongement de la durée du travail (cf : réforme sur les retraites) ?  Existe-il des évolutions dans la médecine préventive (ergonomie) permettant de réduire les TMS ?  Merci à nos deux intervenants, Daniela MARGITICAN et Gilles SCETBON.   Vous avez aimé cet épisode ?   Ce n'est que le début de l'aventure la voix des RH.    Nous espérons que vous avez aimé cet épisode de la voix des RH. N'hésitez pas à partager vos commentaires et avis.   CRÉDITS : La voix des RH est un podcast de l'entreprise AYMING Réalisation : L'agence Les Années Folles    Bonne écoute. —---------- Chaque semaine nos experts en Ressources Humaines sont invités à partager leurs expériences, astuces et méthodes afin de vous aider à améliorer vos performances. Avec une approche novatrice, dynamique et pragmatique, ce podcast explore les clés de la gestion des RH en vous donnant des conseils concrets et applicables. La voix des RH est un podcast de l'entreprise Ayming, votre partenaire de confiance dans l'amélioration de la performance de votre entreprise. ✨ ------ À propos d'Ayming :   Présent dans une quinzaine de pays et fort de 1.300 employés, le groupe Ayming regroupe des experts en amélioration des performances, en matière de ressources humaines, finance et innovation. Pour ses 15.000 clients, le groupe permet chaque année de réaliser 300 millions d'économies RH, 50 millions d'économies fiscales et génère des capacités de financement supplémentaires d'un milliard d'euros.  Ayming accompagne en particulier la fonction RH sur ces principaux défis, dans sa transformation stratégique, opérationnelle et digitale.  Conseil en Performance RH | Découvrir nos expertises RH : https://www.ayming.fr/expertise/ressources-humaines/  Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

In Part 2, Dr. Marco Belizaire dives deeper into the importance of the nervous system and spine. Is your health at optimal function? Do you struggle with obesity or heart disease? Have you tried chiropractic care in your health routine? In this episode, you will learn about experiences with pregnant women and children. Get on top of your health with these wisdom tips shared with a world-renown Olympic athlete and a highly admired pillar in the chiropractic care community – Dr. Marco Belizaire. Listen as he shares his wealth of knowledge and expertise for whole body health and optimization of the nervous system.   Dr. Belizaire specializes in Sports performance optimization. He has worked with a great deal of world and Olympic Champions, and world record holders in track and field as well as NFL and NBA athletes -making a positive impact in their performance.   As an Olympic level athlete, He is able to translate the knowledge and expertise of a keen understanding of bio-mechanical functions of the human body as it relates to increased peak performance from a neuro musculoskeletal point of view to work with the best athletes at all levels. He has the skill set necessary to assess and deliver effective neuro-Musculo-skeletal treatment for: Accelerating Healing from Injury Optimizing Human Performance Predicting and Preventing Injury     In this Episode you will learn: How the nervous system and spine work together How Chiropractic care finds root causes to eliminate health challenges The benefits for pregnant women The benefits for children Reversing unhealthy habits through diet, hydration, activity, mobility and adjustments to lower heart disease and risks associated with obesity   Connect with Dr. Marco Belizaire Website: https://www.athleticsdc.com/ Instagram: https://www.instagram.com/athleticsdc/ Twitter: https://twitter.com/DrMarcoDC     Please share Your Voice Must Be Heard with friends, family and others that you believe would benefit. And please take a moment to rate us on whatever platform you listen to your podcasts.       Connect with Marquita Email: voicemustbeheard@gmail.com Instagram: @yourvoicemustbeheardpodcast  

Dans ce nouvel épisode, nous allons donc parler des troubles musculo-squelettiques . Cet épisode sera animé par Daniela MARGITICAN, experte risques professionnels et Gilles SCETBON, médecin expert employeur. Après une formation en médecine générale et une expérience dans la médecine d'urgence. Gilles s'intéresse à la prévention en médecine qui l'amènera à explorer les voies de la médecine d'expertise.    Dans cette première partie, nous allons découvrir ce que sont les TMS :    Tout d'abord comment décrire les troubles musculo-squelettiques ? Quels sont les chiffres clés dans les TMS ?  Quels sont les TMS les plus fréquemment observés ?  Comment se manifeste ces TMS ? Comment identifier ces premiers signaux et comment les soigner ? Existe-t-il des stades différents ?  Quels sont les facteurs qui entrent en jeu dans la prévention des TMS ?  Quel rôle peut avoir la prévention des risques au sein des entreprises ?  Comment sont traités les TMS au sein des entreprises ? Comment-est-il possible, pour un salarié, de retrouver la pleine utilisation de ses capacités physiques ?   Merci à nos deux intervenants, Daniela MARGITICAN et Gilles SCETBON.   Vous avez aimé cet épisode ?   Ce n'est que le début de l'aventure la voix des RH.  Nous vous invitons à écouter la suite de ce premier épisode et nous y parlerons des facteurs d'apparition et de prévention des TMS Nous y aborderons notamment les questions suivantes :    Existe-t-il un lien entre les troubles psychosociaux et les TMS ? Si oui, comment cela se traduit-il ?  L'hygiène de vie permet-elle de réduire le risque de développer des TMS ?  Le mieux c'est encore d'écouter le prochain épisode.    Nous espérons que vous avez aimé cet épisode de la voix des RH. N'hésitez pas à partager vos commentaires et avis.   CRÉDITS : La voix des RH est un podcast de l'entreprise AYMING Réalisation : L'agence Les Années Folles    Bonne écoute.   —---------- Chaque semaine nos experts en Ressources Humaines sont invités à partager leurs expériences, astuces et méthodes afin de vous aider à améliorer vos performances. Avec une approche novatrice, dynamique et pragmatique, ce podcast explore les clés de la gestion des RH en vous donnant des conseils concrets et applicables. La voix des RH est un podcast de l'entreprise Ayming, votre partenaire de confiance dans l'amélioration de la performance de votre entreprise. ✨ ------ À propos d'Ayming :   Présent dans une quinzaine de pays et fort de 1.300 employés, le groupe Ayming regroupe des experts en amélioration des performances, en matière de ressources humaines, finance et innovation. Pour ses 15.000 clients, le groupe permet chaque année de réaliser 300 millions d'économies RH, 50 millions d'économies fiscales et génère des capacités de financement supplémentaires d'un milliard d'euros.  Ayming accompagne en particulier la fonction RH sur ces principaux défis, dans sa transformation stratégique, opérationnelle et digitale.  Conseil en Performance RH | Découvrir nos expertises RH : https://www.ayming.fr/expertise/ressources-humaines/ Hébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

Do you need a better quality of life? Is your overall health at optimal level? Get on top of your health with these wisdom tips shared with a world-renown Olympic athlete and a highly admired pillar in the chiropractic care community – Dr. Marco Belizaire. In this episode, Dr. Marco Belizaire will share is wealth of knowledge and expertise for whole body health and optimization of the nervous system.   Dr. Belizaire specializes in Sports performance optimization. He has worked with a great deal of world and Olympic Champions, and world record holders in track and field as well as NFL and NBA athletes -making a positive impact in their performance.   As an Olympic level athlete, He is able to translate the knowledge and expertise of a keen understanding of bio-mechanical functions of the human body as it relates to increased peak performance from a neuro musculoskeletal point of view to work with the best athletes at all levels. He has the skill set necessary to assess and deliver effective neuro-Musculo-skeletal treatment for: Accelerating Healing From Injury Optimizing Human Performance Predicting and Preventing Injury     In this Episode you will learn: About Dr. Marco Belizaire as the Athlete and Sports Performance Chiropractor His story about finding his purpose and call Alternative medicine with chiropractic care and how beneficial it can be for your health Ways the body can self-heal and self-regulate Crash course in human anatomy as it pertains to Central Nervous System and Neuro-musculo-skeletal treatment How to find root causes to your pain and how to prevent them   Connect with Dr. Marco Belizaire Website: https://www.athleticsdc.com/ Instagram: https://www.instagram.com/athleticsdc/ Twitter: https://twitter.com/DrMarcoDC     Please share Your Voice Must Be Heard with friends, family and others that you believe would benefit. And please take a moment to rate us on whatever platform you listen to your podcasts.       Connect with Marquita Email: voicemustbeheard@gmail.com Instagram: @yourvoicemustbeheardpodcast

GUESTS: Sandra Witzel, CMO SkedGo, and Baroness Tanni Grey-ThompsonABOUT THIS EPISODE"Mobility for all" is an oft-used and well-intentioned phrase – but images of urban mobility and new mobility solutions rarely feature people with impaired mobility, or anyone living with a disability, raising questions about the concept of mobility for all.People living with disabilities face any number of challenges in the quest to get around, whether that's related to urban planning, physical barriers and obstructions, infrastructure issues, ageing transport networks, poorly designed solutions, untrained transit support staff, or personal safety – to name but a few...According to UN data, around a billion people worldwide live with disabilities - nearly 15% of the global population, and that rises to nearly 20% in low- and middle-income countries. The World Health Organization says around 75 million people worldwide need a wheelchair, but only 5-15% have access to one.But accessibility in mobility is about so much more than wheelchairs – it's about the many more hidden disabilities; it's about reduced mobility, impaired vision and hearing, provisions for the elderly and infirm - and about planning for inclusive mobility, rather than making it an afterthought. ABOUT THE GUESTSPrior to taking up a seat in the House of Lords, Baroness Tanni Grey-Thompson represented Great Britain as a wheelchair racer at five Paralympic Games, winning a total of 16 medals: 11 gold, four silver and a bronze; at the World Championships, she won six gold, five silver and two bronze; and she won the London Marathon six times.Connect with Baroness Tanni Grey-Thompson on LinkedInSandra Witzel is an advocate for mobility as a service; she's the co-founder of Women in Mobility UK; and she's a frustrated public transport user, with impaired mobility caused by life with Musculo-skeletal issues. Chief Marketing Officer and board member at mobility app SkedGo, she's also a certified and award-winning health coach. Connect with Sandra Witzel on LinkedInSHOW NOTESUp Down London Lift status at Transport for London stationshttps://www.updownlondon.com/Step-Free LondonStep-free map and future accesshttps://stepfreelondon.uk/map/ Briometrix Mobility MapsEffort-based Mobility Maps which display colour-coded footpath networks, indicating the degree of difficulty for a person in a wheelchair to traverse the pathway.https://briometrix.com/HandimapRoute planning app that takes into account the accessibility of sidewalks, crossings and paths, as well as obstacles (urban furniture, works...)https://www.handimap.fr/You can subscribe to Ride: The Urban Mobility Podcast wherever you get your podcasts. Feel free to share it, like it, give it a rating, sign up to the Ride LinkedIn page, and check out our website, ridemobilitypodcast.com.

Y en este episodio, hoy hablamos sobre 15 suplementos que puedes comprar en la tienda de vitaminas que te van a ayudar a tener una mayor recuperación y aumento de tu masa muscular si estás haciendo ejercicios de entrenamiento de fuerza o de aumento de volumen con hipertrofia en el gimnasio, te explico en qué momento debes de consumirlo y cuáles son los que no deben de faltar en tu suplementación Búscanos en redes sociales en Instagram y en Facebook @comunidad_dietaflexible y @pepeles_perez

Inspirados por el tweet de Justin Welsh con nada más y nada menos que 47 aprendizajes de sus 4 años emprendiendo por su cuenta y al ver que había muchas cosas en común con nuestras experiencias, hemos querido crear este formato fresco del que esperamos puedas sacar algunas cosas útiles para tu propia vida.Links mencionados:El tweet de Justin.Programa DOCE, nuestro espónsor principal.

Shaman King regresa con su secuela por todo lo alto para el próximo año, aquí te contamos lo que necesitas saber y las continuaciones que hemos tenido con los hijos de los protagonistas. Hablamos de la nueva película de Mario Bros, con miras a muchos premios y las mentes geniales detrás de ella. Regresa Kid Musculo por su aniversario, hablamos de la historia del personaje y lo que significa para su público, además metemos sazón con la polémica por recientes declaraciones de Ben Affleck hacia James Gunn, cerrando con unos problemas que esta teniendo la nueva temporada de “The Mandalorian” ¡Dale Play!

Hall, J. E., Hall, M. E., & Guyton, A. C. (2021). GUYTON & HALL TRATADO DE FISIOLOGIA MEDICA 14a ED. ELSEVIER. --- Send in a voice message: https://podcasters.spotify.com/pod/show/las-poderosas-celulas-nk/message

Ce jeudi 17 novembre, a solution proposée par Doado pour aider à soulager les troubles musculo-squelettiques (TMS), a été abordée par Noémie Wira, Alexandre Spriet, président de Doado, et Hadia Ripoll, directrice général de Doado, dans la chronique La pépite, dans l'émission Good Morning Business, présentée par Stéphanie Coleau et Christophe Jakubyszyn, sur BFM Business. Retrouvez l'émission du lundi au vendredi et réécoutez la en podcast.

Bettina Guisa es entrenadora certificada en ejercicio funcional, barre, cardio yoga e Hipopresivos por Low Pressure Fitness, tema del que hablamos en este episodio para entender qué son los Hipopresivos, por qué están de moda y lo más importante ¿por qué debería de importarnos? Pues resulta que estos ejercicios abdominales reducen la presión del abdomen al momento de realizarlos, logrando que se protejan los órganos y músculos de esta zona ¿el resultado? mejor digestión, postura y vida sexual. No te pierdas este episodio y descubre como puedes sentirte mejor con esta técnica.Suscríbete para apoyar al podcast y comparte tus episodios favoritosSiguenos en YouTubeSiguenos en InstagramSiguenos en FaceBookSigue a Pau Feltrin Sigue a Val BenavidesDESLINDE DE RESPONSABILIDAD: El contenido en este podcast es meramente informativo y no pretende sustituir la atención diagnóstico o tratamiento médico profesional. Siempre consulta con tu doctor o profesional de la salud certificado para cualquier duda o pregunta respecto a una condición médica o de salud. Nunca ignore el consejo médico profesional ni demores en buscarlo por algo que hayas escuchado en este podcast.

Si eres de las personas que cree que lo único importante en la nutrición hablando del tema muscular es la proteína… estás en un grave error, la proteína claro que es importante, pero sin los correctos carbohidratos y grasas puede ser que no veas ganancias musculares, recuperación, desempeño en el entrenamiento, etc. no todo es la proteína… Búscanos en redes sociales en Instagram y en Facebook @comunidad_dietaflexible y @pepeles_perez

00:10.29 Dr_ Placebo Welcome back to Monday mornings with max and Mike Today we're going to talk about Mike's funny glasses and we're gonna continue to cut through the Bs where we see it and then we're gonna add some BS. of our own Mike what's up and what's up with the glasses. 00:33.17 mikebledsoe Absolutely only the most helpful BS in the world. So ah, you know I had to get the we've already used that title. Ah. 00:38.00 Dr_ Placebo Oh can we call this episode constructive lives fuck. Okay I Guess that's really all there is is that all language Anyway, whatever right. 00:48.14 mikebledsoe ah ah I mean the enlightened folk out there I think I would tell you that. So yeah, the glasses are to solve ah a problem that was created by trying to solve a problem that we're trying to solve a problem. So. Ah, basically well these are blue light blocking glasses. So these are not my I still have twenty I'm forty years old 2020 vision to this day I ah I have to acknowledge my parents for their good genetics. 01:19.73 Dr_ Placebo Quit bragging. 01:26.50 mikebledsoe And ah and and my own personal work of doing a lot of things outdoors. No but ah, it's funny because I did start getting some floaters in my eyes and but not I mean I don't even notice them unless I'm like staring at the blue sky you know type of thing. But I. 01:37.10 Dr_ Placebo E. 01:46.21 mikebledsoe Was somebody asked me about their floaters and I go I go you know I'm not really sure what it is but I'm sure that if your body is incredibly healthy and doesn't carry a heavy toxic load and a lot of inflammation your eyes are probably eye health overall is going to do well. But so um. Was like you know what? and it's funny after that conversation I started noticing I was like oh when I'm looking at screens all day. My eyes I can tell like there's I go from being in my living room and then I sit down I have this I have a really big screen at my desk and I got the screen. 02:22.70 Dr_ Placebo Um. 02:23.68 mikebledsoe To improve my posture. So if you if you've got a tiny screen you're more likely to be hunched over trying to look at it and your head's gonna jut forward. But if you have a big screen. It's positioned right? You actually have to like sit back a little bit your chin tucks and you go into a much better posture. So I got this big screen and then I. 02:33.46 Dr_ Placebo Yep. 02:42.81 mikebledsoe Realize that my eyes are just getting blasted by a ton of blue light when I'm looking. There's artificial light I'm just staring right at it for hours and hour hours and hour hours and hours a day and I was like oh I need to get some blue light blocking glasses. So these are like my daytime I have some that. 02:47.24 Dr_ Placebo And. 03:01.32 mikebledsoe When the sun goes down I just swap it out with something that's more heavy duty. Ah and when I wear these glasses my eyes like my nervous system. Overall it's not just my eyes. My nervous system tends to be calmer throughout the day so looking into the blue light all day without anything to block it. Yeah. It was frying me. So yeah, we'll see. We'll see if. 03:21.60 Dr_ Placebo I Smell a sponsor. 03:30.11 mikebledsoe You got to be on my email list be on my email list. You might get links to the you know these products these magical products. 03:31.34 Dr_ Placebo Ah, ah, um, man and ah, all right all right I like it. You know I noticed um because I play tennis and. I Don't know if you know but you really need to be able to see quite well to play tennis at a distance in a variety of light scenarios and I noticed a couple times when I was on the computer a bunch before it Just absolutely. Put my ability to see the tennis ball in the basement. It was really rough. So I try to think of it like you know, um, like rpgs like role-playing video games and some you know you're you're going around. Maybe you're fighting monsters or some shit. But occasionally you find yourself. 04:10.54 mikebledsoe Here. 04:28.90 Dr_ Placebo A little console and I kind of think of ah life that way a little bit. It's a role-playing game and I try to be really mindful of how much time I'm spending at the console.. There should be a really compelling Reason. To use the screens basically and we we really we really don't know what the total cost is um, certainly there's the old ah example of the accountant becomes nearsighted and the farmer becomes farsighted. Right? And so I think the cycling between is the key. 05:06.54 mikebledsoe Yeah, yeah, dude I I agree this is a I love we're talking about this because Ashley and I oh my my mistake, my fiance and I forget her name. Ah yeah. 05:21.39 Dr_ Placebo Jennifer should come up with a fake name. 05:23.75 mikebledsoe Do that now I'm gonna be in trouble. Ah, she'll be the last person listen to this show. She she hears me rant enough. Ah the we we were having date night last night and one these little fancy blind bars. We had bread and accoutrements. 05:34.68 Dr_ Placebo Oh. 05:41.63 mikebledsoe And i't know what that word means but I know when I order it I Love the food that's put in front of me So the ah the oh yeah, the charouty as well. 05:53.29 Dr_ Placebo Charcotery is what I like I can say feed me meat and cheese in like 10 languages. 06:00.81 mikebledsoe Yeah I mean that's that's that's the necessary skills to have any travel. So. It's basically food and and bathrooms. But ah ah we were talking about Myopia and so I had I. Talked about ah I saw a study there day and said there's a huge rides in Myopia and that is nearsightedness that means that people can see just fine something that's in the room with them but something that they try to see far away appears to be blurry and um. You know it's attributed to the fact that everyone's looking at things really close but hardly ever looking at anything very far away and ah that that had me thinking about a concept and I don't know where I picked this up but I I didn't invent it myself. 06:45.19 Dr_ Placebo Edit. 06:56.68 mikebledsoe Which is ah basically the idea is that the more time you spend looking close if you're in a room and all that your your brain actually has a hard time conceptualizing very far out into the future your ability to project. Further out your ability to consider more is hindered and so your eyes are basically just like your your brain is reaching out in front to try to capture some sense of the world and ah if you spend a lot of time. 07:29.63 Dr_ Placebo A. 07:34.42 mikebledsoe And a small space. You're probably gonna think small thoughts. You're gonna have there's gonna small thinking your ability to think into the future is gonna be minimized and you know what? what? Mate. What I thought about next is you know the last two and a half years people spent. There's a 2 wo-year period where a lot of people probably the most people most people who were already indoors way too much now decide to lock themselves inside a house and stare at screens instead of. 07:52.34 Dr_ Placebo Um. 08:08.21 mikebledsoe Instead of looking at somebody who's ten feet away they're always eighteen inches away and if you're on your phone dude it's it's like it's one foot away from your face. So now you have an entire population of people who are near so ah near sighted they're they're myopic their thinking becomes myopic. So. 08:09.71 Dr_ Placebo M. 08:27.38 mikebledsoe As above so below. So whatever's happening in your physical world is going to dictate how your internal world is if you're living in a messy chaotic space your mind is likely gonna be a little messy and chaotic. So this I remember back to when I was living in California and remember. You remember my house and had that big window that was just dude I spent most of my time like I would wake up and walk in the backyard and look over the cliff into the expanse of the ocean and all that and at any time I could leave my computer and put my eyes out there. And it was all it was really nice to be able to get that that contrast and I and it felt good now. You had the practice of looking across the way and trying to spot little boats or a house down the way and to help with my eyesight and. 09:14.56 Dr_ Placebo A. 09:23.80 mikebledsoe And it got me thinking about just my ability to operate in business if I'm in front of a computer screen all the time you know how does that hinder my ability to plan for the future to see greater opportunities or am I going to be able to just see what's in front of me right now. 09:42.42 Dr_ Placebo Man I love what you said there starting about ah 2 two and a half minutes ago in case, anyone wants to timestamp this for later ah, because as soon as you said myopia I was thinking ah visual and psychological right? You get totally locked in. 09:54.20 mikebledsoe Yeah. 10:00.19 Dr_ Placebo Your your world literally shrinks your peripheral vision goes away and from just a more mechanical standpoint your muscles in your eyes and just outside your eyes are going to learn to stay frozen. In that certain area. You know most people are looking between twelve inches and twenty four inches away from their face all the time and if you want to do that. That's fine, but just understand there are going to be tremendous costs to this behavior right. The muscles on the inside of your eyes and outside of your eyes are going to start to freeze into that position because remember your body is always and exactly adapting to whatever you do so just the same way if you sit in a chair all the time your body is going to go. Okay, we sit in a chair a lot How do we make sitting in a chair easier. So if you're looking at a screen that's right in front of you or even papers that are right in front of you which I would argue is a little healthier for you to not have light emitting straight at you but instead have it be bouncing off a page but. Ah, you know before there were screens people were still damaging their ability to see further away by honing in on something really close like a scholar or an accountant or something like that. 11:32.78 Dr_ Placebo Going to get really good at looking at little spreadsheets but they're not going to be very good at seeing far away and it kind of reminds me once again of specialization. It's so useful to have you know 1 person counting the beans. They're locked away in an office all day. And then you have the visionary who never has to look at a spreadsheet in his life. He just looks up from the highest tower to survey the whole situation and lets someone else take care of the details and probably the best. Progress I've made in my life was when I had a clear um separation between those activities. So someone who was really specialized in those minor details. Would take care of that while I was able to see more like the big picture and connecting all these different ideas. So the ah connection between your vision. Ah,, let's call it physically. And your vision psychologically is completely interlinked and there are even um, different physiological responses to the position of your eyes even just looking up for a while. 13:02.96 Dr_ Placebo Been playing a little volleyball recently and so of course I've I've tried to break down all of the volleyball shots and the stances that you find yourself in and sort of like deconstruct volleyball because I don't like to be bad at Sports I like to be good enough to really enjoy them. And I was just thinking how in volleyball you're basically looking straight ahead or up the entire time and I was like wow this would probably be 1 of the best things for people to do just force them to look up and extend. If they're spending tons of time looking. Let's say down at a 30 to sixty degree angle now they're looking up at a 30 to sixty degree angle and everything is up and the hand-eye coordination. Everything is pointed upwards so that. Ah, equal and opposite force could be really beneficial. So just not only the um the distance away from the object and certainly being able to track an object in and out is one of the more fundamental visual skills but also just the angle. Of your eyes has a big influence on your nervous system. You know you snap your eyes up. You should be going into extension. You snap your eyes down. You should be going into flexion so like a fetal position so the position of your eyes and the distance away. 14:33.56 Dr_ Placebo Is going to have a big influence on your nervous system Vision's really complex. So one of the most complex things to understand. 14:37.96 mikebledsoe Yeah, the the other thing is is I mean if you study any body language like I I watched a bunch of videos by this guy who worked for some intelligence agency where he was. Talking about? Well you can you know their eyes do this. It's a tell right? and then I got into a little bit of Nlp and it's you and you can you can watch people when you're talking to them now and you'll I'll ask somebody a question and they'll start looking up into the right or up into the left. 15:00.00 Dr_ Placebo E. 15:08.26 Dr_ Placebo Oh. 15:14.15 Dr_ Placebo Right. 15:16.38 mikebledsoe And then if I ask them how they're feeling and if they're going to be honest with me a lot of times they'll look down like their eyes will will settle straight ahead into my eyes or they'll drop down or they'll they'll want to close their eyes and so yeah, well the the idea the idea that I'm thinking about. 15:30.00 Dr_ Placebo Submissive. 15:35.59 mikebledsoe Is is when the eyes go up a lot of times they're searching for something in the mind they're looking for a memory right in some people say I don't know how accurate this is up into the right you know is more creative processes are going and that part of the brain up into the left is a little more linear thinking more organized. 15:40.36 Dr_ Placebo E o. 15:55.40 mikebledsoe And so I mean I've watched people as I ask them questions and be in conversation. They're looking up and then they're looking to the right and up to the left and I can I can like I can actually see them searching for the information they're looking for. 15:57.51 Dr_ Placebo I. 16:09.28 Dr_ Placebo That's why I always just roll my eyes whenever you talk so you can't get a read on. 16:14.86 mikebledsoe Um, but yeah, ah I mean try try looking up and looking down and see how that impacts. 16:15.40 Dr_ Placebo But but. 16:23.73 mikebledsoe Your experience in that moment. I mean anyone can try this right now just look down or close your eyes see what happens look up see what goat happens and to me for me. It does it shifts I can I can watch my awareness. Go up into my head or my awareness fall into my body. 16:43.60 Dr_ Placebo Well, that's amazing I Think a good example is the connection I'll just bring it back to movement because that's sort of my thing still I Guess if you want to like mellow yourself out. You would basically take a lightweight and do some Romanian Deadlifts and you would look down you would you would you would look down. 17:18.10 Dr_ Placebo You would kind of bend over so you're folding into that fetal Position. You wouldn't stand all the way up and that's going to bring you down that's going to take your nervous system way way down and then um, the opposite would be. You're doing something where you're looking up. And exploding upward whether that's throwing a medicine ball or a sandbag in the air. Um, ah, jumping all that kind of stuff you go up explosively man you are going to jack your nervous system up big Time. So. 1 of the things I've noticed is you can use the eye position as a way to influence the nervous system. Especially if you sync it up with ah synergistic movements along those lines is really powerful. Yeah, you take someone in the very beginning of a session. 18:01.19 mikebledsoe I Like that. 18:08.51 Dr_ Placebo And they're all lethargic and you have them throw a medicine ball up overhead as high and far as they can and snap their eyes upward and within a few repetitions they're they're just absolutely bringing up the level into more sympathetic which is where you're going to get a little more aggression. And then at the end if you want to bring someone back down, you just have them do something kind of eyes down and I'll just say fetal Ish position. Yeah. 18:38.65 mikebledsoe Interesting I like that a lot I like that a lot um are you familiar with Paul check's totem. 18:47.15 Dr_ Placebo No, ah no. 18:51.21 mikebledsoe Basically has a hierarchy of of what dictates the health of the body. So at the bottom of the totem pole is the Musculo skeletal system and then you have the organs and then you have ah ah I think breath. And then you have ah your jaw basically your ability to masticate and then you go up level the stibular system and then you go to the ocular system which is the eyes and then above that is consciousness and all of all of like. 19:12.31 Dr_ Placebo Oo a. 19:26.83 mikebledsoe The idea is consciousness as we were talking about last week is what if something's off in your consciousness. It's going to filter down into your ocular vestibular your jaw your breath your organs and your musculoskeletal system. So if you end up with an injury. It may not just be 1 thing so ah say more. 19:47.18 Dr_ Placebo It reminds me of the neural hierarchy. That's what I've heard which is visual vestibular and propriepptive so visual is the highest vestibular is second inropriacceptive which is your your body and your stuff is third and I've had. Lots of firsthand experience where improving someone's ability to see whether that's just moving their eyes or tracking an object through space has had a really significant difference I mean it feels like Voodoo almost. The fact that some people can have a pain in their back or their shoulder. We do something with their eyes and then it resolves itself and the the criticism of stuff like that is they're like oh well, it won't maybe it won't stay that way but I I would say that anything you can do. To get someone out of the fire basically and into a situation where they can move. Well again is really valuable. So I've seen how that neural hierarchy has played out to be true. You know if someone's got a visual problem. And they don't know that they have a visual problem and their leg hurts. You can do leg circles forever. But it doesn't resolve the root cause which is higher up on the hierarchy just like you know if you. 21:20.50 Dr_ Placebo Give someone liposuction but you'd never repair their relationship with food. They're just going to get fat Again, you know what I mean so it's about addressing things at the root cause of it and the neural hierarchy is a top-down understanding I mean that's why I say vision is so complex because. 21:24.84 mikebledsoe Um, yeah. 21:39.70 Dr_ Placebo Our whole frame of the world is based on our ability to distinguish 1 thing from another and being able to label those things so when you see something it's fucking insane. But is actually really going on like we talk about all the different words that the eskimos or inuits have for snow a lot of different words for green and all of it has to do with being able to distinguish 1 thing from another and initially it was just ah like which way is up. Ah, is this thing going to eat me or not in fact, the evolution of the eye is a really interesting thing. There's a book ah by Isaac Asimov who I thought was just a sci-fi writer but he was also a science writer and it's called the human body structure and operation and it talks about. 22:33.29 Dr_ Placebo Evolution of an eye which started out just as a few um photosensitive cells that could basically just detect photons so you know on the body of some organism. They can detect light or no light and then it turned into a little cup. So It could take in a little bit more light and then this eyeball evolved over time and that's also why like a lot of sea creatures are black on the top and white on the bottom so they are camouflaged against the surrounding environment. If You're an orcca whale and you're above something you're coming out of the they're coming out of the light so you want your belly to be light colored and if you're lower, You're going to be coming out of the darkness so you want the top to be darkly colored and a lot of fish are colored that way specifically. So It's a. Quite an interesting game of cat and mouse between vision and camouflage. Really interesting. 23:33.73 mikebledsoe Yeah, yeah, just goes back and forth. Yeah I think I was watching one of these dock 2 series on like a planet earth or something like that and they were talking about the evolution of the eye and how basically. The the basic functions of our eyes are the same as the a fish and just kind of basically well really. 24:00.33 Dr_ Placebo I think I was saying that last week. Yeah, maybe to you maybe to someone else I talk about that all the time because um, that's there's more similar than there is different. With animals and the fact that a fish eye in your eye are so crazy similar is that blows my mind really because that's a very different creature but in a lot of ways you know they eat or get eaten. 24:27.13 mikebledsoe It's tripping. 24:35.48 Dr_ Placebo Shit stuff out and they have to see what's going on and we're not that different fundamentally. Of course we have all this other ah different stuff like language and metaphor and symbolism and arguably more complex relationships. But even a lot of very simple creatures. Have eyes I mean even ah tardigrades which are like the little water bears. Um, there are really really tiny microorganisms that can survive the. 25:02.68 mikebledsoe Are they that that like the smallest are they the smallest living Organism or. 25:11.15 Dr_ Placebo They no no, no, no, no, they're really weird. They have like 6 legs they're they can survive the vacuum of space they can turn into a crystal if there's not enough water it can survive like radiation. They're really weird. Ah they're. Called water bears but the real name is a tardigrade and they have tiny little eyes. It's a single cell little black spot here and here just in the same place that you would imagine an eye should be and even they have these little eyes. It's it's really trippy. It's it's a huge advantage in the primordial soup to be able to see a little bit further and we talk about ah projection on this show quite a lot and so being able to see further literally with your eyes. And then being able to see further. Let's say ah philosophically or symbolically with like your third eye and being able to project and plan into the future goes right in line with what you were saying before about that myopia of we could call it a. Mindopia like myopia of the mind. Basically that is ah synchronous with the myopia of the vision and once again, it's it's fine because that's how we get the comparative advantage of having someone who's purely focused on a few details. 26:25.82 mikebledsoe Ah. 26:42.81 Dr_ Placebo While someone else can be focused on the big picture and not bother with those details so much. 26:57.23 Dr_ Placebo It's like having a lookout on a ship. Their job is to see and the Captain's job is to choose what to do about that. 27:03.46 mikebledsoe Very specialized. 27:08.14 Dr_ Placebo That's that's the name of our game. We specialize you you go kill the stuff I'll cook it I don't know why I made myself the lady in that example, right? there but but that's what it is specialization. Yeah no. 27:21.87 mikebledsoe Ah I'll be the dude I'll be the dude I okay well at the end of the conversation I had with my fiancee last night was you know what do we do because you know I did go we but we both left. 27:25.38 Dr_ Placebo No, one's going to believe that though. 27:38.90 mikebledsoe California we're living in Texas and there you know, depending on where you live you may have some views that you can look out really far but where we live that's not really the case so spend a lot of time indoors especially because it gets so hot and we get outdoors quite a bit but. If I were to look at the amount of time I spend indoors and looking at screens versus out in nature and looking far away. The ratio is skewed a bit so we've made a commitment to spend more time outdoors my birthday. We're going to go backpacking. We'll be in tahoe next week um 28:16.85 Dr_ Placebo Ah, nice. 28:17.90 mikebledsoe You know? So we'll be so we're doing that and spend a lot of time in nature. Go hiking every day and yeah, so I think that I mean the way I I typically run my life is and ah you know just a sequence of extreme events and it's like. Extreme smallness in my my office and then going out and being nature for 3 4 or five days and then come back to the office for a week and then back and forth which I think is okay for a period of time but the overall goal is to live somewhere where I can regularly. Exercise my vision and and yeah and have that balance. 29:00.98 Dr_ Placebo Yeah, maybe take up bird watching probably some birds down there in Texas really you have a little journal. 29:06.50 mikebledsoe Dude I did so much bird watching when I was in California I ah I you know I lived on that lagoon and I had those I had those? no but I would go out there and I I could I got to where I could predict. No. Every month there was a different type of bird that was coming into the trees these trees in the backyard and they'd be migrating and coming through and then these birds would come hang out for February and then they would disappear and then in April another different type of bird would be hanging out in the same trees. Ah, and. 29:24.50 Dr_ Placebo Ah. 29:28.93 Dr_ Placebo O. 29:38.11 mikebledsoe Yeah I spent a lot of time out there just checking the birds out. 29:44.63 Dr_ Placebo Yeah that's a really ah engaging activity. Actually it's really weird. It's kind of like ah I had this idea that if you see a shooting star. It's lucky, but really. Is it lucky because you are making a wish on the shooting star because if you are that's cool. You're setting an intention. But also if you just happen to be outside looking at the night sky enough that you see shooting stars then that already means like you're bringing that luck. Into your life like that's a healthy behavior and you know it's not like ah this is good and this is bad kind of thing but you know if you are looking at something like straight. Ah you know eighteen inches in front of you ah getting that tunnel vision versus. Actually laying outside and looking at the stars. It's a very different kind of experience. So even if you don't make a wish you just happen to put yourself in a situation where you can see some some shooting stars. It's like you already did the thing that sets you up. For a little bit more peace of mind and relaxation. 30:57.64 mikebledsoe Yeah, how often do use Stargas I don't do it hardly at all anymore it it only happens when I'm traveling and I'm out of the city because the city really messes it up. 31:08.20 Dr_ Placebo Um. 31:13.30 Dr_ Placebo Um, ah the last few weeks of having puppies I've done very little I've done more helping them chase crickets so ah, looking down I'll like find 1 and point it out and then let them go like try to catch it. 31:21.52 mikebledsoe Perfect. 31:30.91 Dr_ Placebo At night but I would say at least once a week I was ah laying outside at night. Um, and just looking up and it's it's ah another one of those really soothing experience it and it's not for everybody like I mean you don't have to do any of that shit it just. Can be a ah nice way to sort of temper the constant ah dopamine buffet that we have available to us. 31:59.24 mikebledsoe All right? This is probably the first time I mean since the invention of the light bulb is you know the last hundred hundred and fifty years I mean really for the average person hundred years the first time that star gazing was not a thing. 32:16.28 Dr_ Placebo M. 32:18.67 mikebledsoe Sun goes down. Everyone's hanging out there's little to do after dark. Maybe you got some candlelight but the stars I mean when you know when you go out into the country you get away from the city. The the stars are so much easier to see it's It's something worth looking at. But if you're. 32:22.37 Dr_ Placebo Oh. 32:30.35 Dr_ Placebo And. 32:36.30 mikebledsoe And L a and you're trying to look at the stars. Good luck. 32:40.86 Dr_ Placebo Right? I mean you'll still see stars. You just won't see as many and I would argue that you're better off to to look up at least a little bit I mean should we just call that ah call this episode look up even. 32:42.61 mikebledsoe Yeah, yeah. 32:57.26 Dr_ Placebo Even that the metaphor of look up is ah synonymous with having a positive attitude right? You can you can look up. You can also look down on somebody. That's a pretty ah unhealthy behavior I would argue you. 33:11.24 mikebledsoe Look up to look down on. 33:15.53 Dr_ Placebo Look up to somebody yeah look up to look down on. Yeah, it's It's pretty big. 33:18.41 mikebledsoe You know. 33:35.10 Dr_ Placebo Ah, do you do any? ah exercises for your vision. 33:39.25 mikebledsoe Ah, there's one I don't do it frequently enough. But um one I like to do is I wrap a towel around my head um Criss Crosss it to basically keep my head from being the thing that turns basically stabilize that and then take my eyes I got a mandala. 33:50.92 Dr_ Placebo And. E. 33:56.77 mikebledsoe Hangs in my garage gym and I circle the mandala with my eyes and I'm I'm really focused on going slow and smooth and then if I find an area where my eyes want to skip which everyone will find some area. It's like oh down and to the right. 34:13.19 Dr_ Placebo E. 34:16.27 mikebledsoe My eye kind of jumped from here to here. Can I go back smooth it out and then keep going and if you can if you can go each way you know from right? you know, clockwise and counterclockwise around the mendala smoothly then you're going to be in a pretty good space. Ah. 34:18.90 Dr_ Placebo In a. 34:36.36 mikebledsoe That's also one way that they're able to see if you had a concussion in the past is if you're if you're either unable to I remember I was I being worked on once and I couldn't look up to the right I think it was. 34:40.10 Dr_ Placebo He. 34:52.91 mikebledsoe Was having trouble looking up to the right? they were doing an eye test on me and they were like oh did you have a concussion and you know where were you hit now. Of course I don't know which concussion they're talking about ah but the the ah. 35:05.10 Dr_ Placebo So. 35:10.14 mikebledsoe They they said oh yeah, a lot of times people they were hit up and to the right, their nervous system remembers that it basically thinks it's still happening and then it's that reaction to try to you know your eyes lead the way and you and you get away from whatever. Ah. 35:19.74 Dr_ Placebo 6 35:29.69 mikebledsoe Force was coming at you and having maybe having some damage to the brain in that area keeps your eyes from being able to go back up and so one of the ways to help heal. The brain is through vision. 35:47.54 Dr_ Placebo Absolutely I think being able to or not being able to but doing a few um circles with the eyes closed and then with the eyes open really smooth is a very simplified and good way to. Improve your ah overall ability to interact with your environment and then another good thing to add is throwing a ball against a wall with some letters drawn on it and calling out the letter that you see right before you catch it. So You're really tracking something in space I would say. 36:21.42 mikebledsoe So you got letters on the wall. Oh on the ball. 36:24.80 Dr_ Placebo Those are probably 2 of the biggest ones on the ball so you take a tennis you take a tennis ball and if you imagine the tennis ball is a cube you draw a letter or a number on each of the 6 faces of the cube. So whatever, whatever you see last you call that out. And do you have to draw anything on it. No, but if you do you're going to track it a little bit longer. So it's going to make you a little more attentive to staying focused on the ball. So even if that was all you did I mean I've written tons of stuff. About vision. It's in a lot of the programs that I've made. But if you just did some ah eyes closed circles and then eyes open circles and then throw a ball against a wall and track it through space that is going to go a really really long way. To improving your overall eye ability and if you do find a spot that's difficult. Um, you know, hold those 8 cardinal directions up up to the right, right? down right down down left left up left and back through. 37:20.00 mikebledsoe I Like that a lot. 37:38.57 Dr_ Placebo And what's interesting is if you do it with the eyes closed. You can focus a lot more on the extra ocular muscles because you're not receiving a lot of input about like oh I'm trying to look at this or that you can really just focus on the movement of the balls in the sockets. 37:54.41 mikebledsoe You can feel it more. 37:57.16 Dr_ Placebo Actually some of the yeah, it's some of the fastest muscles blinking is the fastest thing but your eyes can move really fast, pretty pretty fascinating that we can like look and cover so much distance. Like you can cover way more distance by looking and moving your eyes than you can by moving your body So It's a huge huge advantage. A lot of creatures don't have eyes and they figure it out just fine. They basically have to sniff and bump into stuff. 38:21.90 mikebledsoe From. 38:30.63 mikebledsoe Yeah I was ah I was watching a ah documentary on hunting and they were talking about they they were with these tribes people who had basically um. They would find an animal. They want to hunt and then they would basically creep up on it and then chase it until it ah was exhausted and they would kill it persistent hunting and um it was. 38:59.10 Dr_ Placebo And persistence hunting. 39:06.97 mikebledsoe Really interesting because I mean the the human body is made for that endurance. It's able to endure whereas an animal. Maybe some of these animals may be really fast but they can't cool off fast enough ah like a cheeah like you chase it long enough. It's going to tuck her out. 39:16.74 Dr_ Placebo Yeah, like a cheetah. Yeah. But dude Cheetahs have absolutely shit endurance like they can they can They can hum their motor for like cats in general but Cheetahs especially they can rev it really high but they just can't go very long and. 39:26.22 mikebledsoe So yeah I think that's cats in general. 39:41.27 mikebledsoe Yeah, yeah. 39:45.30 Dr_ Placebo I I talk about this all the time actually because if you look at the human body ah compared to a lot of other animals. It's It's so fucking flimsy it's were. We're Squishy. We're Squishy. We don't have Claws. No armor, no poison. No Venom We're not particularly Fast. We're not particularly Strong. We don't have a lot of offspring. It's It's like really sad but we have Thumbs. We have neocortex and by working together. That's basically good enough that we can have these like. 40:17.39 mikebledsoe Yeah, yeah. 40:21.50 Dr_ Placebo Squishy Bipedal bodies and just dominate every other animal. 40:24.90 mikebledsoe Yeah, yeah I mean one of the things about the persistent persistence hunting the two things that stood out to me was one is we as humans can keep our bodies cooler for long distance than than a lot of these animals and then. 40:42.28 Dr_ Placebo Sweating. 40:42.68 mikebledsoe Yeah, just being able to sweat versus you know, most perspiration coming through the mouth through a lot of these maybe an antelope or something like that that they're chasing down or a buffalo and the other thing is ah if you look at the anatomy of a lot of apes. 40:51.57 Dr_ Placebo That's why dogs pant and. 41:01.81 mikebledsoe They I don't remember the exact like joint it is That's in the neck you may know that allows us to stabilize our vision on the horizon while we run So ah, a typical ape wouldn't actually okay. 41:16.72 Dr_ Placebo It's a vestibular ocular reflex. So that's one of the drills I have people do in Primal Athleticism is to keep your gaze fixed on a spot on the wall. You can draw a spot or put a Post-it note and you move your head left and right you tilt it left and right. 41:20.74 mikebledsoe Is this a. 41:25.58 mikebledsoe They have. 41:34.22 Dr_ Placebo And you nod up and down and you can stay focused on the spot over there. You can do figure eights and if I do figure eights I can still see you crystal clear and that's that's pretty wild. Yeah yeah, this yeah. 41:45.58 mikebledsoe I Like that just doing it with you for the people who are only listening which is everybody. Ah. 41:52.23 Dr_ Placebo You're really missing out on our funny head movements while we stare into each other's eyes. 41:53.79 mikebledsoe Yeah, yeah, yeah, so it really stood out to me is the the thing that really the the 2 things that allowed humans to consume more meat and more what I would imagine be enough fat. To to sit well 2 things. The fat helps build the brain and gives you the ability to sit and think because you you get a ton of calories for you know you expend some calories you kill the animal. But now you have a lot of calories to sit around. And consider things or to build something whereas ah most animals I think they spend their days finding the food chewing. Well a lot of apes I know it's chewing. Yeah. 42:36.28 Dr_ Placebo It's chewing chewing and it's just chewing. They're just chewing all fucking. How do you get to be a giant gorilla with huge muscles and you're a vegetarian you have to be chewing all fucking day. You're just chewing all day. 42:50.13 mikebledsoe All day. 42:55.61 Dr_ Placebo And we have these vertical bodies So We're also not encumbered by gravity the same way like if you imagine just how much less work you have to do by stacking your entire mass like a pillar. Instead of like a bridge. You know if you're a quadruped you're basically doing a plank all fucking day. So you're constantly expending energy just to to stand. Let alone walk. You're expending even more energy. So The fact that we can use our Skeleton to support our structure in. 43:17.83 mikebledsoe Yeah. 43:33.36 Dr_ Placebo Perfect alignment with gravity more or less with these nice Arches through the neck and the spine and the hips and of course our hips are highly optimized for ah, walking and running especially walking. It allows us to cover a lot of ground much slower. But a lot more ground with a lot less energy expenditure. It's incredible and see further. It's like we're in a constant ah prairie dog position where we're up being able to see further along the horizon right. 43:53.59 mikebledsoe Yeah, what. 44:05.48 mikebledsoe Yeah, the do you have any exercises for working peripheral vision specifically it seems like the the figure 9 might help a bit. 44:18.91 Dr_ Placebo Yeah, ah, um, so if you're doing it yourself. You bring your arms all the way out to the side and you start. Ah, you point your Index fingers straight up and you look straight ahead and you start wiggling your fingers and slowly. Bringing your arms forward until you can see your wiggling fingers and what's interesting is um I can't remember which book I wrote it in but the eye loves movement. The eye is attracted to Movement. So if you um, try to see something in your peripherals. That's. 44:38.37 mikebledsoe No. 44:56.17 Dr_ Placebo Still,, you're probably not going to see it because what ends up happening is you only see like a small field of vision of your focal vision. It's called versus your peripheral and your brain fills in the rest. This is what this is why vision gets so fucking Crazy is. You see stuff and then your brain fills it in based on what it thinks is supposed to be there. But if you have like wiggling objects come in from the outside of your periphery you're going to see them a lot easier because your eye is attracted to movement and of course that's ah, an evolutionary advantage. That you want to see any shit that's moving way more than stuff that is ah, not moving right? Another another thing you can do for a peripheral vision is if you have like ah a partner to do that for you coming in. 45:38.58 mikebledsoe Yeah, something I want to kill or avoid to be killed by. 45:54.54 Dr_ Placebo From the peripheral or even throwing a ball over your head in front of you So you're waiting your partner is behind you and he tosses a ball ah over the back of your head into your field of view and you try to catch the ball. As it goes from your peripheral and to your focal vision. Yeah yeah,. But even if you just do the the the finger wiggling thing that'll give you something and it kind of reminds me of that. 46:10.95 mikebledsoe I Like that a lot that sounds fun. 46:28.92 Dr_ Placebo Ah, martial Arts Soft eyes where you try to diffuse your focus like the lantern versus the laser like we talk about. 46:44.47 Dr_ Placebo Right? No, we haven't talked about that I'm getting getting and getting a lot of silence over here. 46:48.56 mikebledsoe Um, totally I yeah I'm having a you know I didn't get a lot of sleep last night is two weeks in a row I'm just I now I know you. 46:56.87 Dr_ Placebo Here We go with the fucking excuses you son of a bitch I don't want to hear that shit just fake it. 47:04.97 mikebledsoe Um, just having I'm having I'm having a time in my life. You're gonna have to carry me a little bit I think we're gonna We're gonna be okay max. 47:10.11 Dr_ Placebo Um, fake it like your wife cinnamon. Your wife's name is cinnamon Cinnamon cinnamon. 47:17.35 mikebledsoe Oh yeah, cinnamon cinnamon cinminnamon in oh I think we covered a lot of good ground here. A lot of practical ah advice things for people to do go outdoors. 47:31.10 Dr_ Placebo Are. 47:35.70 mikebledsoe Ah, make sure you're looking far I don't think anyone needs to be told to look close I think we're getting plenty of that just make sure you're getting some type of balance there move your eyes around ah circles are great. Ah, what else you say we got. Ah. 47:43.68 Dr_ Placebo Um. 47:54.25 Dr_ Placebo So you have ah visual tracking so being able to track a ball coming in at you. Um, there's way more. But for the sake of simplicity. Yeah, even if you just did the eyes closed ah circles and holds. 47:56.58 mikebledsoe Yep. 48:10.71 Dr_ Placebo Eyes open circles and holds and then tossed a ball against a wall preferably like twenty Ish feet away and then the other thing I would say is whenever you sit down at a console set a fucking timer. We have. These magic rectangles and one of their functions is that you can set a timer just don't get frozen in any single position. You know you want to have the farmer vision and the accounting vision. You want to have the lantern and the laser and it's the Alternating. You know another thing I have people do um in the primal athleticism program I do nearf far drills which is you basically put a post it on the wall twenty thirty feet away and you draw something on it a letter a number something that you have to really be able to focus on. And then you hold another one in your hand like let's say twelve inches away so you have something that's twelve inches or twenty inches away in your hand and then you have something that's about 20 to thirty feet away on the wall and you basically try to see how quickly you can cycle between focusing on each one so you know let's say I have a written in the post it in my hand and I have b written in the posted on the wall and I'm going to try to cycle between a and b back and forth as quickly as I can and of course you can move the post it around. 49:42.29 Dr_ Placebo And have it be down a little lower but the main thing is that you're just changing the distance of your focal point because if you're focused on the post it in your hand. You're not going to be able to see what's written on the posted on the wall and if you wanted to you know?? um. Upgraded a little bit. You could write like love on the wall and courage in your hand or something like that. So you have more of like a psychological thing going On. It's you know a little bit sterile to be like ah look at a and then look at B Ah so as long as you're going to do that You might as well. 50:16.36 mikebledsoe I think you should put Mike and max on these postcards that that you know, ah if you if you go to if you go to the website and there's a lead. 50:20.78 Dr_ Placebo Right? perfect. 50:31.58 mikebledsoe Well, there's a pdf over there. Ah. 50:35.95 Dr_ Placebo This is getting weird I love it. But basically you just cycle back and forth see how quickly and use a metronome if you have 1 available to you get free app on your phone and cycle between the close and the far vision. 50:37.18 mikebledsoe A. 50:52.20 mikebledsoe But the you introduced me to using the metronome with training for all sorts of different things that was incredibly useful for me appreciate that I Highly recommend it? yeah. 50:54.93 Dr_ Placebo So that's another thing you can do. Ah. 51:05.90 Dr_ Placebo Oh my god yeah, it's ah it's an absolute game changer people are so focused on how much mass is being moved versus how much acceleration is happening. And 1 of the most fundamental physics. Equations is force equals mass times acceleration and I think it's hilarious. This perverted obsession. We have with mass and this complete neglect of acceleration when in actuality. Um, people care way more. 51:25.36 mikebledsoe Yeah. 51:41.50 Dr_ Placebo About how fast they can move rather than how much stuff they can move and the people who have the best longevity are the ones who retain their ability to be able to move quickly and in fact, that's the athletic attribute that deteriorates more rapidly. Which is why ah sprinters you know tend to peak before age 30 but power lifters tend to peak often in their 40 s late 40 s fifty s so ah, way too much focus is spent on. The amount of mass that is being moved versus the amount of force that is being generated which includes the acceleration and a metronome improves your coordination. It proves your rhythm and it also is a way to very easily ah increase the force. By increasing the acceleration as opposed to just increasing the mass really powerful stuff. I mean there's a lot of other eye Exercises. You could do with it. But yeah for sake of simplicity ah eyes closed make Circles eyes open make circles throw a ball against the wall. 52:37.81 mikebledsoe Yeah, love it. 52:54.80 Dr_ Placebo And then try that near far drill and then use a timer so you're not stuck ah on any 1 ah console for too long. You know there's like the twenty Twenty rule every 20 minutes look twenty feet away for at least 20 seconds that's fine ah a little bit longer would be better though. You know so every 15 minutes or so look at something further away for a little while it'll make a big difference. 53:20.89 mikebledsoe Yeah, so we call it is anything else. You want to leave him with feel like got some Yeah, everyone's got homework to do. Don't go back and put these things into practice. 53:31.80 Dr_ Placebo Ah. 53:37.52 Dr_ Placebo Do do some drawing and doodling do doodling is better than dawdling is what I say so if you're if you're stuck like draw dry it out. You know, a lot of ah. 1 of the big advantages we have is being able to draw symbols and shapes and connect different ideas together. So if you're if you're not sure just start just start drawing shapes and ah connecting words and ideas with lines so you can see it all. Big picture and I think this is probably one of the things that I do best because sometimes I have difficulty staying engaged with details but I will often get out a piece of paper and just draw down some ideas but I'll connect them with ah shapes and lines and diagrams. And I'll try to make some math equations there too but getting your ideas. Ah not only down on paper in words but also connected together in shapes and symbols and lines is really powerful and so you will be able to improve your ability to visualize. And ah envision the future if you use some symbols on the paper. So ah I'll just I'll close with that. Thank you guys. You can see me Maxshank.com Mike Bleso you can find him on his new newsletter where you can get. 54:53.15 mikebledsoe That hurt. 55:04.61 Dr_ Placebo Hot Fresh ah wisdom delivered to your inbox and then also blue light blocking glasses I think you can learn the secret as well. 55:16.90 mikebledsoe Yep yep, just go go go find on the newsletter. Maybe one day I'll yeah I mean if you actually there's if you Dm me I can get you on the newsletter. But right now I don't have anywhere. 55:19.50 Dr_ Placebo Where can they find that strong coach. What where do I sign up for your newsletter dude right. 55:33.76 mikebledsoe For anyone to sign up so I'm ah. 55:34.84 Dr_ Placebo Yeah, how convenient it's like it's like a secret club with no sign on La door. 55:43.42 mikebledsoe I Got I've got a I got my email list that people that got in or get my messages. The people who want in are confused. It's okay I'm I'm rebuilding some things. Ah. 55:56.86 Dr_ Placebo Ah I like it so send you a dm Mike Underscore blood so if you want to get in on it I like it. 56:00.74 mikebledsoe Yeahp Yeah I'll I'll add you and yeah I like to keep it tight I Only want to be talking to people who really want to be talking to me. So yeah, yeah. 56:08.70 Dr_ Placebo All right? nice. Keep it keep a clear vision until next time folks. Thanks Mikey! Love you buddy. 56:15.61 mikebledsoe Love you lady y'all.

En el programa de hoy vamos a hablar de la mejor manera de comer verduras, hay muchas preguntas a este respecto y en esta capitulo tendrás el mejor consejo Recuerda que puedes tener nuestra asesoría o puedes participar de nuestro reto de transformación corporal online en cualquier parte del mundo, inscirbiéndote en www.transformateonline.com o envianos un correo a mauricecastro@negocioencasa.comnuestro canal de Youtubehttps://www.youtube.com/channel/UCeZOGHEZymqbkymYUnkVLPwEl éxito de cualquier distribuidor independiente Herbalife Nutrition requiere tiempo, dedicación y esfuerzo personal constante. Los ingresos presentados corresponden exclusivamente al expositor y no son típicos o promedio. Para conocer los ingresos promedio consulta la Declaración de Ganancia Bruta Promedio pagada por Herbalife en Herbalife.com y MyHerbalife.com. Las fotos en esta presentación reflejan la historia personal de quien aparece en ellas. Los resultados presentados no son típicos, los resultados individuales varían. Herbalife Nutrition promueve un estilo de vida activo y saludable que incluye una alimentación balanceada, adecuada ingesta de líquidos, actividad física, suplementación o complementación alimenticia y descanso apropiado. Los productos Herbalife Nutrition no tienen el propósito de tratar, curar ni prevenir enfermedad alguna, y han sido formulados y registrados para su consumo por adultos. Antes de consumir cualquier producto Herbalife Nutrition, lee detenidamente su etiqueta.Esta presentación fue desarrollada por un profesional de la salud que interviene en su calidad de asesor, según su experiencia y conocimientos. Al consumir productos de Herbalife Nutrition lea las etiquetas previamente.ENTRENAMIENTO CREADO EXCLUSIVAMENTE POR DISTRIBUIDORES INDEPENDIENTES. HERBALIFE NUTRITION NO ES RESPONSABLE DE SU CONTENIDO

En el programa de hoy vamos a hablar de la dicotomía de control, que fue expuesta por el filósofo estoico Epicteto y que tiene gran utilidad hoy en nuestra vida diaria y por supuesto es importante en nuestra nutrición y bienestar Recuerda que puedes tener nuestra asesoría o puedes participar de nuestro reto de transformación corporal online en cualquier parte del mundo, inscirbiéndote en www.transformateonline.com o envianos un correo a mauricecastro@negocioencasa.comnuestro canal de Youtubehttps://www.youtube.com/channel/UCeZOGHEZymqbkymYUnkVLPwEl éxito de cualquier distribuidor independiente Herbalife Nutrition requiere tiempo, dedicación y esfuerzo personal constante. Los ingresos presentados corresponden exclusivamente al expositor y no son típicos o promedio. Para conocer los ingresos promedio consulta la Declaración de Ganancia Bruta Promedio pagada por Herbalife en Herbalife.com y MyHerbalife.com. Las fotos en esta presentación reflejan la historia personal de quien aparece en ellas. Los resultados presentados no son típicos, los resultados individuales varían. Herbalife Nutrition promueve un estilo de vida activo y saludable que incluye una alimentación balanceada, adecuada ingesta de líquidos, actividad física, suplementación o complementación alimenticia y descanso apropiado. Los productos Herbalife Nutrition no tienen el propósito de tratar, curar ni prevenir enfermedad alguna, y han sido formulados y registrados para su consumo por adultos. Antes de consumir cualquier producto Herbalife Nutrition, lee detenidamente su etiqueta.Esta presentación fue desarrollada por un profesional de la salud que interviene en su calidad de asesor, según su experiencia y conocimientos. Al consumir productos de Herbalife Nutrition lea las etiquetas previamente.ENTRENAMIENTO CREADO EXCLUSIVAMENTE POR DISTRIBUIDORES INDEPENDIENTES. HERBALIFE NUTRITION NO ES RESPONSABLE DE SU CONTENIDO

En el programa de hoy vamos a hablar de el por qué vivir con una mala condición física es mucho más difícil que decidirse a entrenar, hablaremos de los beneficios de un estilo de vida activo y saludable. Recuerda que puedes tener nuestra asesoría o puedes participar de nuestro reto de transformación corporal online en cualquier parte del mundo, inscirbiéndote en www.transformateonline.com o envianos un correo a mauricecastro@negocioencasa.comnuestro canal de Youtubehttps://www.youtube.com/channel/UCeZOGHEZymqbkymYUnkVLPwEl éxito de cualquier distribuidor independiente Herbalife Nutrition requiere tiempo, dedicación y esfuerzo personal constante. Los ingresos presentados corresponden exclusivamente al expositor y no son típicos o promedio. Para conocer los ingresos promedio consulta la Declaración de Ganancia Bruta Promedio pagada por Herbalife en Herbalife.com y MyHerbalife.com. Las fotos en esta presentación reflejan la historia personal de quien aparece en ellas. Los resultados presentados no son típicos, los resultados individuales varían. Herbalife Nutrition promueve un estilo de vida activo y saludable que incluye una alimentación balanceada, adecuada ingesta de líquidos, actividad física, suplementación o complementación alimenticia y descanso apropiado. Los productos Herbalife Nutrition no tienen el propósito de tratar, curar ni prevenir enfermedad alguna, y han sido formulados y registrados para su consumo por adultos. Antes de consumir cualquier producto Herbalife Nutrition, lee detenidamente su etiqueta.Esta presentación fue desarrollada por un profesional de la salud que interviene en su calidad de asesor, según su experiencia y conocimientos. Al consumir productos de Herbalife Nutrition lea las etiquetas previamente.ENTRENAMIENTO CREADO EXCLUSIVAMENTE POR DISTRIBUIDORES INDEPENDIENTES. HERBALIFE NUTRITION NO ES RESPONSABLE DE SU CONTENIDO

Arrumando a postura, focando musculo fraco e ficando seco

Ce jeudi 12 mai, des solutions de prévention contre les TMS ont été présentées par Lorraine Goumot et Samuel Corgne, président et fondateur d'ErgoSanté, dans la chronique La pépite dans l'émission Good morning business présentée par Sandra Gandoin et Christophe Jakubyszyn sur BFM Business. Retrouvez l'émission du lundi au vendredi et réécoutez la en podcast.

Coach Bala discussed the cardio vascular portion of CVMSMS training   Youtube Link: https://youtu.be/4FE6BP9q7UE

DE REGRESO JUNTOS EN CABINAAAAAAAAAAAAAAA

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Sarcopenia es el nombre medico de la perdida de masa muscular, que no solo se presenta en los adultos mayores si no también en algunos jóvenes. En este episodio hablaremos de como evitarla.

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID's, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state's Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP's to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days' worth are necessary, and rarely more than 5 days' worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient's condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication's potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient's response to opioids. In tolerance, the patient's pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID's in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients' compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. 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