Podcasts about neurologists

Dr Fred Wininger is a Veterinarian and Founder of the Animal Neurology Center. He joins Chris and Amy in-studio, marking a year since his practice opened in St Louis,...the only single-specialty animal hospital of its kind in the nation. He says he started as a Professor of Veterinary Medicine at Mizzou, then moved to St Louis to a multi-discipline practice. His office now deals exclusively with problems with the brain and spine in animals.

Chris and Amy welcome Dr Fred Wininger to the studio, he's opened a veterinary practice that deals with neurological issues in pets; would you date Jason Bourne?; what about the AI scams that target the elderly?; Amy has returned at the listeners are happy.

In the second installment of this three-part series, Dr. Stacey Clardy and Max Goldman discuss neuroscience research and the BRAIN Initiative.  Stay updated with everything related to Neurology on the Hill. Show transcript:  Dr. Stacey Clardy:  Hi, this is Stacey Clardy. We are going to continue with our three-part series today about the top advocacy issues covered at Neurology on the Hill 2026 in Washington, DC. Again, as many of you know, this is the AAN's annual advocacy fly-in event. Neurologists come from all over the US to Washington and meet with elected representatives to discuss issues of high importance to allow us to continue providing high-quality care to patients in the US with neurological diseases. In the first minute, we discuss the topic of Medicare, and I have with me again, Max Goldman, director of Congressional Affairs from the AAN legislative team, to talk to us about issue number two, which is neuroscience research, and specifically the BRAIN Initiative. Max, what are we going to discuss about neuroscience research? What do we need to happen in order to continue doing high-quality research? Max Goldman: So, this one is so important, and there's this wonderful program at the NIH called The BRAIN Initiative. This was founded in 2013, really reinforced in 2016 with the 21st Century Cures Act. It's just funding for basic research into how the brain works, right? And the idea behind this is that if we can understand how the brain works, we can find the next generation of treatment or cures for neurological conditions, psychiatric conditions, and issues that go through the brain. This year, we are in a precarious position. Mandatory funding for this program is expiring, and so we're going to lose a lot of money and a lot of opportunities to provide more grants to people to figure out how the brain works. So, what we are doing on Neurology on the Hill is we're asking members of Congress to support $468 million in funding in fiscal year 2027 for the BRAIN Initiative, so we can keep up the good work and keep working towards the next generation of treatments and cures for neurological conditions. Dr. Stacey Clardy: So important. Thank you, Max. To learn more about this issue and the other two issues, you can go to AAN.com. Click on advocacy. And stick with us for the third Neurology Minute, where we will get to the final issue to be discussed, telehealth. 

A doctors' union says a neurologist shortage is the perfect case study in what's going wrong across our health system. Association of Salaried Medical Specialists executive director Sarah Dalton spoke to Corin Dann.

A neurologist shares her top 5 migraine tips: track your headaches, treat early, know your triggers, limit overuse, and consider preventative medications. Sounds helpful, right? But if you've followed this exact advice and ended up with more frequent migraines, worse medication dependency, and a longer list of triggers you can't avoid, you're not alone. This episode breaks down why standard neurologist recommendations, though well-intentioned, often lead to a cycle of worsening symptoms, increased medication use, and ultimately preventative drugs. You'll learn why tracking without a real plan demoralizes you, why taking meds at the first "uh-oh moment" robs you of your body's natural resilience, why chasing triggers is a fool's errand that leaves you bubble-wrapped and anxious, and how suppressing symptoms without addressing root causes guarantees your body will fight back harder. The real answer isn't more medication or stricter trigger avoidance, it's restoring the resilience and vitality that keeps your internal needle out of the migraine zone, even in the face of stressors like sunlight, food, dehydration, or a delayed meal. If you're trapped between a rock and a hard place, white-knuckling through medication reduction, or sitting in your neurologist's office in tears because nothing is working, this episode will help you understand why the standard path fails and what you can do instead. If you're experiencing 8+ migraine days per month and ready to address the root cause instead of just managing symptoms, schedule a free consultation below: https://www.drlesliecisar.com/apply Free Training: 5 Proven Steps to Being Migraine Free (Even if you think you've already tried everything.) https://www.drlesliecisar.com/5SHMN Connect with us: Website: https://www.drlesliecisar.com/ Free Facebook Group: Healing Migraines Naturally, with Leslie Cisar, ND Ready to try something radically different that actually works? Read more about my approach here: https://www.drlesliecisar.com/map In health,Dr. Leslie Cisar

Patients say they're waiting months to see neurologists - as research shows we're facing a long-term workforce shortage. Health correspondent Kate Green reports.

There's a call for urgent government investment in specialist neurologists to treat the growing number of people with Multiple sclerosis. Amanda Rose is the National Manager at Multiple Sclerosis New Zealand, and spoke to Corin Dann.

The country has far fewer neurologists than it needs to treat conditions like Alzheimer's disease and stroke, and it's a problem that's only getting worse. Dr Anna Ranta spoke to Corin Dann.

Join Sandra and enjoy this week’s show as you listen to the medical testimony of Dr. Adam Rizvi. He discusses everything from patients staying alive with near zero blood pressure to the room darkening or brightening when a soul departs.See omnystudio.com/listener for privacy information.

Join Sandra and enjoy this week’s show as you listen to the medical testimony of Dr. Adam Rizvi. He discusses everything from patients staying alive with near zero blood pressure to the room darkening or brightening when a soul departs.See omnystudio.com/listener for privacy information.

An Auckland Neurologist says he is seeing increasing numbers of people suffering side effects from huffing nitrous oxide, with some users ingesting enormous quantities on a daily basis. Community leaders say there needs to be tighter regulation around who is able to buy and trade the product that can easily be bought in large thermos sized cannisters with the equivilent of hundreds of hits. Professor of clinical neurology at Auckland University, Dr Alan Barber spoke to Lisa Owen.

Heart health is brain health. High blood pressure, high cholesterol, and blood sugar don't just affect your heart—they can also increase stroke risk and impact memory and long-term brain function.In this episode of Baptist Health Talk, host Sandra Peebles speaks with Dr. Marcus St. John, interventional cardiologist, and Dr. Nestor Beltre, neurologist and movement disorder specialist, about how shared risk factors connect heart disease and cognitive health. They explain why keeping blood pressure in a healthy range may lower the risk of cognitive impairment, why exercise is truly “fertilizer for the brain,” and how the Mediterranean lifestyle supports both heart and brain health.The doctors also address common misconceptions about supplements and explain how stress and depression can mimic memory problems—often mistaken for early dementia. Learn practical, evidence-based steps you can take today to protect both your heart and your brain.Host:Sandra PeeblesAward-Winning JournalistGuests:Marcus St. John, M.D.Interventional CardiologistBaptist Health Miami Cardiac & Vascular InstituteNestor Beltre, M.D.Neurologist and Movement Disorders SpecialistBaptist Health Miami Neuroscience Institute

Neurologist Dr. Vinit Banga explains stress, sleep, stroke symptoms, brain health, and the effects of pollution on the brain in this powerful podcast episode with Gaurav Arora.This episode covers:•Stress symptoms and how chronic stress damages the brain•Deep sleep and why sleep is essential for brain repair•Stroke warning signs (FAST symptoms) and why minutes matter•Brain fog, memory loss, cognitive decline, early dementia signs•Delhi pollution / AQI effects on brain ageing and intelligence•Migraine triggers, headaches, and dangerous neurological red flags•Doctor-patient trust, Practo ratings, healthcare commercialization in India00:00 Impact of Delhi's Pollution on Brain Health00:37 Stress and Its Effects on Health01:39 Air Quality and Brain Aging03:24 Blood-Brain Barrier and Pollution06:03 Memory Issues and Aging07:04 Understanding Memory Formation12:20 Sleep Disorders and Brain Health13:35 The Importance of Deep Sleep16:09 Stress: The Silent Disruptor46:38 Doctor-Patient Trust and Ethical Concerns55:14 Commercialization in Healthcare01:04:15 Concluding Thoughts and GratitudeDr. Vinit Banga is Director & Head of Neurology & Neurovascular Intervention at Fortis Escorts, and shares life-saving insights on preventing stroke, protecting brain function, and understanding modern neurological risk factors.Keywords: neurologist podcast, brain health India, stress and stroke, sleep and brain, stroke symptoms, stroke warning signs, Delhi pollution brain damage, brain fog, dementia signs, migraine, Fortis neurologist, Dr Vinit Banga, Gaurav Arora podcast.#Stress #Stroke #BrainHealth #Sleep #Neurology #Podcast #DrVinitBanga

Join Jay Gunkelman (500,000+ brain scans analyzed), clinicians Joy Lunt (RN, BCN; Past President ISNR; hundreds of autism cases), Dr. Mari Swingle (author of i-Minds), John Mekrut (The Balanced Brain), Joshua Moore (MA, LMHC, BCN; Alternative Behavioral Therapy), Anthony Ramos, and host Pete Jansons for a full live Q&A on neurofeedback's impact on autism spectrum disorder—from severe non-verbal kids to life-altering changes, plus broader insights on epilepsy, sensory issues, dissociation, and more.✅ Topic 1 Explained: Neurofeedback often transforms autism symptoms (behavior, communication, family life)—~95% of Joy's cases see major gains, like one child whose school forgot his diagnosis.✅ Topic 2 Deep Dive: Not too young—even 5-year-olds benefit with careful protocols; early work prevents years of struggle by gently guiding brain development.✅ Topic 3 Insights: Intake via detailed interviews > rigid QEEG; adjust real-time based on behavior—avoid disrupting compensations for best results.✅ Additional Topics:

In this special episode, recorded live at the 2025 Genomics England Research Summit, host Adam Clatworthy is joined by parents, clinicians and researchers to explore the long, uncertain and often emotional journey to a genetic diagnosis. Together, they go behind the science to share what it means to live with uncertainty, how results like variants of uncertain significance (VUS) are experienced by families, and why communication and support matter just as much as genomic testing and research. The panel discuss the challenges families face when a diagnosis remains out of reach, the role of research in refining and revisiting results over time, and how collaboration between researchers, clinicians and participants could help shorten diagnostic journeys in the future. Joining Adam Clatworthy, Vice-Chair for the Participant Panel, on this episode are: Emma Baple – Clinical geneticist and Medical Director, South West Genomic Laboratory Hub  Jamie Ellingford – Lead genomic data scientist, Genomics England  Jo Wright – Member of the Participant Panel and Parent Representative for SWAN UK  Lisa Beaton - Member of the Participant Panel and Parent Representative for SWAN UK  Linked below are the episodes mentioned in the episode:  What is the diagnostic odyssey?  What is a Variant of Uncertain Significance?  Visit the Genomics England Research Summit website, to get your ticket to this years event. You can download the transcript, or read it below. Sharon: Hello, and welcome to Behind the Genes. My name is Sharon Jones and today we're bringing you a special episode recorded live from our Research Summit held in June this year. The episode features a panel conversation hosted by Adam Clatworthy, Vice-Chair of the Participant Panel. Our guests explore navigating the diagnostic odyssey, the often-complex journey to reaching a genetic diagnosis. If you'd like to know more about what the diagnostic odyssey is, check our bitesize explainer episode, ‘What is the Diagnostic Odyssey?' linked in the episode description. In today's episode you may hear our guests refer to ‘VUS' which stands for a variant of uncertain significance. This is when a genetic variant is identified, but its precise impact is not yet known. You can learn more about these in another one of our explainer episodes, “What is a Variant of Uncertain Significance?” And now over to Adam. -- Adam: Welcome, everyone, thanks for joining this session. I'm always really humbled by the lived experiences and the journeys behind the stories that we talk about at these conferences, so I'm really delighted to be hosting this panel session. It's taking us behind the science, it's really focusing on the people behind the data and the lived experiences of all the individuals and the families who are really navigating this system, trying to find answers and really aiming to get a diagnosis – that has to be the end goal. We know it's not the silver bullet, but it has to be the goal so that everyone can get that diagnosis and get that clarity and what this means for their medical care moving forwards.    So, today we're really going to aim to demystify what this diagnostic odyssey is, challenging the way researchers and clinicians often discuss long diagnostic journeys, and we'll really talk about the vital importance of research in improving diagnoses, discussing the challenges that limit the impact of emerging research for families on this odyssey and the opportunities for progress. So, we've got an amazing panel here. Rather than me trying to introduce you, I think it's great if you could just introduce yourselves, and Lisa, I'll start with you. Lisa: Hi, I'm Lisa Beaton and I am the parent of a child with an unknown, thought to be neuromuscular, disease. I joined the patient Participant Panel 2 years ago now and I'm also a Parent Representative for SWAN UK, which stands of Syndromes Without A Name. I have 4 children who have all come with unique and wonderful bits and pieces, but it's our daughter who's the most complicated. Adam:  Thank you. Over to you, Jo. Jo:  Hi, I'm Jo Wright, I am the parent of a child with an undiagnosed genetic condition.  So I've got an 11-year-old daughter. 100,000 Genomes gave us a VUS, which we're still trying to find the research for and sort of what I'll talk about in a bit.  And I've also got a younger daughter. I joined the Participant Panel just back in December. I'm also a Parent Rep for SWAN UK, so Lisa and I have known each other for quite a while through that. Adam:  Thank you, Jo.  And, Jamie, you're going to be covering both the research and the clinician side and you kind of wear 2 hats, so, yeah, over to you. Jamie:  Hi, everyone, so I'm Jamie Ellingford and, as Adam alluded to, I'm fortunate and I get to wear 2 hats. So, one of those hats is that I'm Lead Genomic Data Scientist for Rare Disease at Genomics England and so work as part of a really talented team of scientists and engineers to help develop our bioinformatic pipelines, so computational processes. I work as part of a team of scientists and software engineers to develop the computation pipelines that we apply at Genomics England as part of the National Health Service, so the Genomic Medicine Service that families get referred to and recruited to, and we try to develop and improve those. So that's one of my hats. And the second of those is I am a researcher, I'm an academic at the University of Manchester, and there I work really closely with some of the clinical teams in the North West to try and understand a little bit more about the functional impact of genomic variants on kind of how things happen in a cell. So, we can explore a little bit more about that but essentially, it's to provide a little bit more colour as to the impact that that genomic variant is having. Adam: Great, thank you, Jamie. Over to you, Emma. Emma: My name's Emma Baple, I'm an academic clinical geneticist in Exeter but I'm also the Medical Director of the South West genomic laboratory hub, so that's the Exeter and Bristol Genomics Laboratory. And I wear several other hats, including helping NHS England as the National Specialty Advisor for Genomics. Adam: Thank you all for being here. I think it's really important before we get into the questions just to ground ourselves in like those lived experiences that yourself and Jo and going through. So, Lisa, I'm going to start with you. The term ‘diagnostic odyssey' gets bandied around a lot, we hear about it so many times, but how does that reflect your experience that you've been through and what would you like researchers and clinicians to understand about this journey that you're on, essentially? Lisa: So I think ours is less an odyssey and more of a roller-coaster, and I say that because we sort of first started on a genetic journey, as it were, when my daughter was 9 weeks of age and she's now 16½ – the half's very important – and we still have no answers. And we've sort of come a bit backwards to this because when she was 6 months old Great Ormond Street Hospital felt very strongly that they knew exactly what was wrong with her and it was just a case of kind of confirmation by genetics. And then they sent off for a lot of different myasthenia panel genes, all of which came back negative, and so having been told, “Yes, it's definitely a myasthenia, we just need to know which one it is,” at 4 years of age that was removed and it was all of a sudden like, “Yeah, thanks, sorry.” And that was really hard actually because we felt we'd had somewhere to hang our hat and a cohort of people with very similar issues with their children, and then all of a sudden we were told, “No, no, that's not where you belong” and that was a really isolating experience. I can remember sort of saying to the neuromuscular team, “Well is it still neuromuscular in that case?” and there was a lot of shrugging of shoulders, and it just…  We felt like not only had we only just got on board the life raft, then we'd been chucked out, and we didn't even have a floaty. And in many ways I think I have made peace with the fact that we don't have a genetic diagnosis for our daughter but it doesn't get easier in that she has her own questions and my older children – one getting married in August who's already sort of said to me, you know, “Does this have implications for when we have children?”  And those are all questions I can't answer so that's really hard. Adam:  Thank you, Lisa. Yourself, Jo, how would you describe the odyssey that you're currently experiencing? Jo: So my daughter was about one when I started really noticing that she was having regressions. They were kind of there beforehand but, I really noticed them when she was one, and that's when I went to the GP and then got referred to the paediatrician. So initially we had genetic tests for things like Rett syndrome and Angelman syndrome, which they were all negative, and then we got referred on to the tertiary hospital and then went into 100,000 Genomes. So we enrolled in 100,000 Genomes at the beginning of 2017, and we got our results in April of 2020, so obviously that was quite a fraught time. Getting our results was probably not as you would want to do it because it was kind of over the phone and then a random letter. So, what I was told in that letter was that a variant of uncertain significance had been identified and they wanted to do further research to see if it might be more significant. So we were to be enrolled into another research project called Splicing and Disease, which wasn't active at the time because everything had been put on hold for COVID, but eventually we went into that. So, I didn't know what the gene was at that point, when I eventually got the form for going to get her bloods done…  So that went off and then that came back and the geneticist said, “That gives us some indication that it is significant.” So, since that point it's been trying to find more information and research to be able to make it a diagnosis. There have been 2 sort of key things that have happened towards that but we're still not there. So one of the things is that a research paper came out earlier this year so that's kind of a little bit more evidence, it's not going to give us a diagnosis but it kind of, you know, sits there. And the other thing is that my geneticist said, “Actually, yeah, it looks like it's an important change.”  That's as far as we've got. So we've still got work to do to make it a diagnosis or not.  Obviously if it is a diagnosis, it is still a one-of-a-kind diagnosis, so it doesn't give me a group to join or that kind of thing. But now I've got that research paper that I've read and read, and asked ChatGPT to verify that I've understood it right in some places, you know, with the faith that we put into ChatGPT (laughs), I've got a better understanding and I've got something now that I can look back on, the things that happened when my daughter was one, 2, 3, 4 and her development was all over the place and people thought that I was slightly crazy for the things I was saying, that “Actually, no, I can see what's happening.” So, it's like the picture's starting to come into focus but there's work to do. I haven't got a timeframe on that, I don't know when it's going to come together. And I always say that I'm a prolific stalker of the postman; ever since our first genetic tests you're just constantly waiting for the letters to drop through the door. So a diagnostic odyssey to me is just waiting for random events. Adam: I think what you've both kind of really clearly elaborated on is how you're the ones that are having to navigate this journey, you're the ones that are trying to piece this puzzle together, and the amount of time you're investing, all whilst navigating and looking after your child and trying to cope with the daily lived experience as well. And something you've both touched on that I'd love to draw out more is about how exactly was the information shared with you about the lack of diagnosis or the VUS or what's going on, because in our case you get this bit of paper through the post that has all these numbers and it's written in clinical speak and we had no conversation with the geneticist or the doctors. You see this bit of paper and you're reading it, scared for what the future will hold for your child, but I'd love to know like how were you communicated whilst all this is going on, how did you actually find out the next steps or any kind of future guidance. Lisa: So I think in our case we kept sort of going onto neuromuscular appointments, and I think for probably the first 5 years of my daughter's life I kind of had this very naïve thought that every time we turned up to an appointment it would be ‘the one' and then…   I think it would've been really helpful actually in those initial stages if they had said to us, “Actually, we don't know when this is going to happen, if it's even going to happen, you need to kind of prepare yourself for that.” It sounds fairly obvious to say but you don't know what you don't know. And in some ways we were getting genetic test results back for some really quite horrible things and they would tell us, “Oh it's good news, this mitochondrial disorder hasn't come up,” and so part of you is like, “Yay!” but then another part of you is thinking, “Well if it's not that what is it?” And we've very much kind of danced around and still don't really have an answer to whether it's life-limiting. We know it's potentially life-threatening and we have certain protocols, but even that is tricky. We live in North Yorkshire, and our local hospital are amazing. Every time we go in, if it's anything gastro-related, they say to me, “What's the protocol from Great Ormond Street?” and I say, “We don't have one” (laughs) and that always causes some fun. We try to stay out of hospitals as much as we absolutely can and do what we can at home but, equally, there's a point where, you know, we have to be guided by where we're going with her, with the path, and lots of phone calls backwards and forwards, and then is it going to be a transfer down to Great Ormond Street to manage it. And actually the way I found out that nothing had been found from 100,000 Genomes was in a passing conversation when we had been transferred down to Great Ormond Street and we'd been an inpatient for about 6 weeks and the geneticist said to me, “So obviously with you not having a diagnosis from the 100,000 Genomes…” and I said, “Sorry?  Sorry, what was that?  You've had the information back?”  And she said, “Well, yes, did nobody write to you?” and I said, “No, and clearly by my shock and surprise.” And she was a bit taken aback by that, but it happened yet again 2 years later (laughs) when she said, “Well you know everything's been reanalysed” and I said, “No.”  (Laughs)  And, so that's very much, it still feels an awful lot like I'm doing the heavy lifting because we're under lots of different teams and even when they're working at the same hospital they don't talk to each other. And I do understand that they're specialists within their own right, but nobody is really looking at my daughter holistically, and there are things that kind of interrelate across.    And at one of the talks I attended this morning they were talking about the importance of quality of life, and I think that is something that has to be so much more focused on because it's hard enough living without a diagnosis, but when you're living with a bunch of symptoms that, I think the best way I can describe it is at the moment we've got the spokes of the umbrella but we don't have the wrapper, and we don't know where we're going with it. We can't answer her questions, we can't even necessarily know that we're using the most effective treatments and therapies for her, and she's frustrated by that now, being 16, in her own right, as well as we are. And I'm panicking about the navigation towards Adult Services as well because at the minute at least we have a clinical lead in our amazing local paediatrician but of course once we hit and move into that we won't even have him and that's a really scary place to be, I think. Adam: Jo, is there anything you wanted to add on that in terms of how you've been communicated to whilst all this is going on? Jo: Yeah, so I think part of what makes it difficult is if you're across different hospitals because they're not necessarily going to see the same information. So obviously it was a bit of a different time when I got our results, but I got our results on a virtual appointment with a neurologist in one hospital, in the tertiary hospital, and because he could see the screen because it was the same hospital as genetics, and he said, “Oh you've got this” and then the letter came through later. When I had my next appointment with the neurologist in our primary hospital, or secondary care, whatever it's called, in that hospital, he hadn't seen that, so I'm telling him the results, which isn't ideal, but it happens quite a lot. What I think is quite significant to me is the reaction to that VUS.  I have to give it, the doctors that look after my daughter are brilliant, and I'm not criticising them in any way but their reaction to a VUS is “I'm so grateful for the persistence to get to a diagnosis.” Neurologists are a bit more like “Oh it's a VUS so it might be significant, it might be nothing.” Actually, as a patient, as in a parent, you actually want to know is it significant or not, “Do I look at it or not?” And, I mean, like I said, there were no research papers to look at before anyway until a few months ago so I didn't have anything to look at, but I didn't want to look at it either because you don't want to send yourself off down a path. But I think that collective sort of idea that once someone gets a VUS we need a pathway for it, “What do we do with it, what expectation do we set the patients up with and what is the pathway for actually researching further?” because this is where we really need the research. Adam:  Thank you, Jo. So, Emma, over to you in terms of how best do you think clinicians can actually support patients at navigating this odyssey and what's the difference between an initial diagnosis and a final diagnosis and how do you then communicate that effectively to the patients and their family?   Emma: So I think a key thing for me, and it's come up just now again, is that you need to remember as a doctor that the things you say at critical times in a patient's or parent's journeys they will remember – they'll remember it word for word even though you won't – and thinking about how to do that in the most sensitive, empathetic, calm, not rushed way is absolutely key.   And there are some difficulties with that when you're in a very high-pressure environment but it is absolutely crucial, that when you are communicating information about test results, when you're talking about doing the test in the first place, you're consenting the family, you're explaining what you're trying to do and those conditions, you balance how much information you give people.    So, you were talking earlier about “So you haven't got this diagnosis, you haven't got that diagnosis,” I often think it's…  We're often testing for numerous different conditions at the same time, I couldn't even list them all to the parents of the children or the patient that I'm testing. It's key to try and provide enough information without overwhelming people with so much information and information on specific conditions you are just thinking about as a potential.  Sometimes very low down your list actually but you can test for them.    Because people go home and they use the internet and they look things up and they get very, very worried about things. So, for me it's trying to provide bite-sized amounts of information, give it the time it deserves, and support people through that journey, tell them honestly what you think the chance of finding a diagnosis is. If you think it's unlikely or you think you know, sharing that information with family is helpful.   Around uncertainty, I find that a particular challenge. So, I think we've moved from a time when we used to, in this country, declare every variant we identified with an uncertain significance. Now, if we remember that we've all got 5 million variants in our genome, we've all got hundreds and hundreds… thousands and thousands, in fact, of variants of uncertain significance in our genetic code. And actually, unless you think a variant of uncertain significance genuinely does have a probability of being the cause of a child's or a patient's condition, sharing that information can be quite harmful to people.    We did a really interesting survey once when we were writing the guidelines for reporting variants of uncertain significance a few years ago. We asked the laboratories about their view of variants of uncertain significance and we asked the clinicians, and the scientists said, “We report variants of uncertain significance because the clinicians want them” and the clinicians said, “If the labs put the variant of uncertain significance on the report it must be important.” And of course, if you're a parent, if the doctor's told you the variant is a variant of uncertain significance of course you think it's important.    So, we should only be sharing that information, in my opinion, if it genuinely does have a high likelihood of being important and there are things that we can do. And taking people through that journey with you, with the degree of likelihood, the additional tests you need to do and explaining to them whether or not you think you will ever clarify that, is really, really key because it's very often that they become the diagnosis for the family.  Did I cover everything you think's important, both of you?  Lisa: I think the one thing I would say is that when you are patient- or parent-facing, the first time that you deliver that news to the parent… you may have delivered that piece of news multiple times and none of us sit there expecting you to kind of be overcome with emotion or anything like that but, in the same way that perhaps you would've had some nerves when, particularly if it was a diagnosis of something that was unpleasant, you know, to hold onto that kind of humanity and humility. Because for those patients and parents hearing that news, that is the only time they're ever hearing that, and the impact of that, and also, they're going on about with their day, you don't know what else they're doing, what they're juggling.    We're not asking you all to be responsible for kind of, you know, parcelling us up and whatnot but the way information is imparted to us is literally that thing we are all hanging our hats on, and when we're in this kind of uncertainty, from my personal experience I'm uncomfortable, I like to be able to plan, I'm a planner, I'm a researcher, I like to sort of look it up to the nth degree and that, and sitting in a place without any of that is, it's quite a difficult place to be. And it's not necessarily good news for those parents when a test comes back negative, because if it's not that then what is it, and that also leaves you feeling floundering and very isolated at times.  Adam: Yeah, and you touched upon the danger of like giving too much information or pushing families down a particular route, and then you have to pull them out of it when it's not that.   You talked about the experience you had, you felt like you'd found your home and then it's like, “Well, no, no, sorry, actually we don't think it's that.” And you've invested all of your time and your emotion into being part of that group and then you're kind of taken away again. So it's to the point where you have to be really sure before you then communicate to the families, and obviously in the meantime the families are like, “We just need to know something, we need to know,” and it's that real fine line, isn't it?    But, Jamie, over to you. Just thinking about the evolving nature of genomic diagnosis, what role does research play in refining or confirming a diagnosis over time?  Jamie: So it's really, really difficult actually to be able to kind of pinpoint one or 2 things that we could do as a community of researchers to help that journey, but perhaps I could reflect on a couple of things that I've seen happen over time which we think will improve things. And one of that's going back to the discussion that we've just had about how we classify genetic variants. And so, behind that kind of variant of uncertain significance there is a huge amount of effort and emotion from a scientist's side as well because I think many of the scientists, if not all, realise what impact that's going to have on the families.   And what we've tried to do as a community is to make sure that we are reproducible, and if you were to have your data analysed in the North West of England versus the South West that actually you'd come out with the same answer. And in order to do that we need guidance, we need recommendations, we need things that assist the scientists to actually classify those variants.  And so, what we have at the moment is a 5 point scale which ranges from benign to likely benign, variant of uncertain significance, unlikely pathogenic variant and pathogenic variant. It's objective as to how we classify a variant into one of those groups and so it's not just a gut feeling from a scientist, it's kind of recordable measurable evidence that they can provide to assist that classification.   So in many instances what that does is provide some uncertainty, as we've just heard, because it falls into that zone of variant of uncertain significance but what that also does is provide a framework in which we can generate more evidence to be able to classify it in one direction or another to become likely pathogenic or to become likely benign. And as a research community we're equipped with that understanding –– and not always with the tools but that's a developing area – to be able to do more about it.   What that doesn't mean is that if we generate that evidence that it can translate back into the clinic, and actually that's perhaps an area that we should discuss more. But kind of just generating that evidence isn't always enough and being able to have those routes to be able to translate back that into the hands of the clinicians, the clinical scientists, etc, is another challenge. Adam:  And how do you think we can drive progress in research to deliver these answers faster, to really try and shorten those diagnostic journeys, like what are the recommendations that you would say there? Jamie:  So being able to use the Genomics England data that's in the National Genomic Reference Library, as well as kind of other resources, has really transformed what we can do as researchers because it enables teams across the UK, across the world to work with data that otherwise they wouldn't be able to work with.   Behind that there's an infrastructure where if researchers find something which they think is of interest that can be reported back, it can be curated and analysed by teams at Genomics England and, where appropriate, kind of transferred to the clinical teams that have referred that family. And so having that pathway is great but there's still more that we can do about this. You know, it's reliant on things going through a very kind of fixed system and making sure that clinicians don't lose contact with families – you know, people move, they move locations, etc. And so, I think a lot of it is logistical and making sure that the right information can get to the right people, but it all falls under this kind of umbrella of being able to translate those research findings, where appropriate, into clinical reporting.   Adam:  Thank you. And, Emma, is there anything you would add in terms of like any key challenges that you think need to be overcome just to try and shorten the journeys as much as possible and find the answers to get a diagnosis?  Emma: I think trying to bridge that gap between some of the new technologies and new approaches that we've got that we can access in a research context and bringing those into diagnostics is a key area to try to reduce that diagnostic odyssey, so I really want to see the NHS continuing to support those sorts of initiatives.   We're very lucky, as Jamie said, the National Genomic Research Library has been fundamental for being able to reduce the diagnostic odyssey for large numbers of patients, not just in this country but around the world, and so trying to kind of look at how we might add additional data into the NGRL, use other research opportunities that we have in a more synergistic way with diagnostics I think is probably key to being able to do that.    We are very lucky in this country with the infrastructure that we've got and the fact that everything is so joined up. We're able to provide different opportunities in genomics for patients with rare conditions that aren't so available elsewhere in the world.  Adam: Great, thank you. I think we're it for time, so thank you very much to the panel. And I'd just say that if you do have any further questions for ourselves as participants then we're only too happy to pick those up. Thank you for lasting with us ‘til the end of the day and hope to see you soon.  -- Sharon: A huge thank you to our panel, Adam Clatworthy, Emma Baple, Jo Wright, Lisa Beaton and Jamie Ellingford, for sharing their insights and experiences. Each year at the summit, the Behind the Genes stage hosts podcast style conversations, bringing together researchers, clinicians and participants to discuss key topics in genomics.  If you're interested in attending a future Genomics England Research Summit, keep an eye out on our socials. If you'd like to hear more conversations like this, please like and subscribe to Behind the Genes on your favourite podcast app. Thank you for listening.    I've been your host, Sharon Jones. The podcast was edited by Bill Griffin at Ventoux Digital and produced by Deanna Barac.

"I have recorded over 500 deaths in my journal... and I can tell you, the room gets crowded when we pass." Join Sandra for a moving interview with Dr. Adam Rizvi, a Critical Care Physician and Neurologist who has spent decades on the frontlines of the ICU. Dr. Rizvi began keeping a "Death Journal" to process the grief of losing patients, and what he discovered changed his view of reality forever. In this episode, Dr. Rizvi shares the unexplainable phenomena he witnesses at the bedside. He tells the incredible story of a dying father whose blood pressure was so low he should have been unconscious, yet he stayed awake and conversing until the exact moment his son walked in the door. He also discusses the medical evidence for the afterlife, sharing cases where patients had zero brain activity yet woke up with clear memories of what happened. This is a powerful conversation about the "Crowded Room" phenomenon, the power of True Forgiveness to heal decades of estrangement, and the visual proof that something leaves the body when we die. In this episode: * The Death Journal: Lessons from witnessing 500+ transitions. * The Impossible Goodbye: How a dying man held on against medical odds for his son. * The "Crowded Room": Why the room feels "standing room only" when someone dies. * Visual Phenomena: Dr. Rizvi describes seeing a ball of light leave a patient's forehead. * Medical Proof: Consciousness exists even when the EEG is flat. * Healing Estrangement: A moving story of a father and daughters reuniting after 30 years. Get Dr. Adam Rizvi's book "Love Does Not Know Death": https://amzn.to/3ZjDPc9 Website: https://lovedoesnotknowdeath.com/ *Connect with Sandra Champlain: * Website (Free book by joining the 'Insiders Club, Free empowering Sunday Gatherings with medium demonstration, Mediumship Classes & more): http://wedontdie.com *Patreon (Early access, PDF of over 800 episodes & more): Visit https://www.patreon.com/wedontdieradio  *Don't miss Sandra's #1 "Best of all things afterlife related" Podcast 'Shades of the Afterlife' at https://shadesoftheafterlife.com

This episode is a continuation of my two-part interview with Professor of Neurology and author Dr. James Noble. We continue discussing his book, "Navigating Life with Dementia," how dementia is diagnosed, what can be done about it, and much more.

Welcome back to our weekend Cabral HouseCall shows!   This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track!   Check out today's questions:    Sheena: Hi Dr C! Hope you and your team are well. I've been hearing a lot about colostrum lately and it piqued my interest. Can you speak a little about it? Do you use it? Is there a brand you would recommend? Is it safe for anyone? Who should avoid it? Side effects? I take a probiotic everyday, can colostrum replace this?? Looking forward to hearing your response. Thanks in advance!                                                                                                                                                         Frankie: Hi Stephen, My name is Frankie Im 21 years old, and I wanted to follow up from Episode 3382, where you mentioned my symptoms could be connected to gut issues, low vitamin D, magnesium, metals, or GERD. Since then, I followed a strict LPR diet for about two months  no gluten, coffee, alcohol, peanuts, oats, onions, garlic, broccoli, beans, etc. My LPR symptoms improved by around 70%, and while I still have some mucus in my throat, its nowhere near as potent as before. During and after the protocol, I focused on rebuilding my gut with some gut-rebuilding supplements and slowly reintroducing foods. Its now been about three months since finishing the protocol, and Ive gained around 14 pounds. I also still deal with loose stool almost every day, which hasnt improved much. It’s honestly shocked me because Im very dialed in with both my food and workouts, yet the weight gain and digestive changes still happened. I wanted to get your thoughts on what direction to take from here. I havent run the Big 5 protocol since Im based in Canada, and it would end up costing quite a bit more with shipping and exchange rates. Also, I just wanted to mention its surprising how many young people my age are struggling with digestive and gut related issues. Its becoming way too common. Thanks again for all the work you do, and I hope you have a great day I listen to you every morning. Frankie     Gary: Hi Dr. Cabral. Im 49, male & over the last 4 years taken a deep interest in my health. I had cerebral malaria (2003) & as a result developed essential tremor both hands. Listened to 2 podcasts & working on noticeable triggers like ltd caffeine & alcohol. It hasnt got worse, but really is there any way to reverse it? Neurologist says surgery has no guarantee.  I would value the truth & if it were your wife what you would do please. So much life ahead 🙏 (PS. Partner is an IHP so DESTRESS at the heart of our approach) we want to do EVERYTHING we can. Thank you     Sienna: Hi Dr. Cabral - so excited about your new Pea Protein, got great feedback from the support team, however would love your response. Pea Protein safe for kids? Since DNS is I would approach it in same way, Dr. AI says generally kids get enough from food so not recommended… Do you give this to your daughters in same way you have it? Ie a little more protein in smoothies *daily* or just in baked goods like pancakes occasionally. Thank you! Happy holidays      Anonymous: What are some ways to improve gut motility, I'm already on a supplement program and ginger tea. Any thoughts on massage abdominal, hot stones, any other physical techniqes?     Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community's questions!      - - - Show Notes and Resources: StephenCabral.com/3634 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

My guest is a Professor of Neurology at Columbia University, and author of the book "Navigating Life with Dementia." We talk about the book, what dementia is, different types of dementia, and much more.

In this episode of the Smarter Not Harder Podcast, Dr. Melissa Jones joins Dr. Scott Sherr for an insightful and groundbreaking conversation about pediatric neurology, inflammation, and the integrative treatment of conditions like PANS, PANDAS, autism, and dysautonomia. Dr. Jones shares her journey from conventional pediatric neurology to functional and integrative care, breaking down how chronic infections, gut health, mold toxicity, and inflammation play a critical role in neuropsychiatric disorders in children — and how these issues can often be reversed. Join us as we explore: • What PANS and PANDAS really are — and why they're often misdiagnosed • Mold, mycoplasma, and Lyme: stealth infections affecting kids' brains • Why gut health, mitochondria, and detox pathways matter in autism • The power of lifestyle, sleep, diet, and supplements to reduce neuroinflammation This episode is for you if: • You're a parent or clinician curious about the root causes of neuropsychiatric symptoms • You're looking for integrative strategies to address autism, OCD, anxiety, and more • You want to understand how mold, toxins, and chronic infections impact kids' brains • You believe in treating the whole child — not just the symptoms You can also find this episode on…   YouTube: https://youtu.be/g2HDDtQGhnQ Learn more about Dr. Melissa Jones: Website: https://aiopwellness.com/ Find more from Smarter Not Harder: Website: Smarter Not Harder podcast Instagram: https://www.instagram.com/troscriptions HOMeHOPe Virtual Symposium 2026: https://homehope.org/homehope-virtual-symposium-2026 Get 10% Off your purchase of the Clinical Metabolomics module with code PODCAST10 at https://www.homehope.org/ Get 10% Off your Troscriptions purchase with code POD10 at https://www.troscriptions.com/ Get daily content from the hosts of Smarter Not Harder by following @troscriptions on Instagram.

Eye pain can be a source of serious concern for patients, bringing worries about their eyesight. While uveitis is far from the only source of ocular pain, in many presentations of the condition it is a feature. In this Editors' Choice podcast, ophthalmic surgeon Mr. Harry Petrushkin¹ ² and neurologist Dr. Ruth Dubson³ join forces to explain a comprehensive approach to uveitis treatment. Host Dr. Amy Ross Russell leads the way through a refresher on eye anatomy and the spectrum of uveitis patients neurologists are likely to encounter. These are often the more serious of patients, requiring good working relationships across disciplines. They also speak of the overlap with neuroinflammatory presentations, and the eye manifestations seen in conditions like multiple sclerosis and sarcoidosis. Read the paper: Uveitis for Neurologists (1) Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK (2) Rheumatology Service, Great Ormond Street Hospital NHS Trust, London, UK (3) Blizard Institute, Queen Mary University London, London, UK Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production by Amy Ross Russell and Brian O'Toole. Editing by Brian O'Toole. Thank you for listening. 

You leave your neurologist's office with another prescription. You thought they'd finally dig into why you're getting migraines. Instead? Another medication to try. Here's what most people don't understand: Medical doctors aren't looking for root causes. They're confirming a diagnosis and following a checklist called "standard of care." Once the diagnosis is made, the doctor follows an algorithm: Try this medication. If that doesn't work, try this one. Keep moving down the list. They're not trained to believe your body can heal. Allopathic medicine operates from the belief that once you develop a chronic condition, it's broken and defective. You can only suppress the symptoms. But you know intuitively that if you could figure out what your body needs, it would heal. And you're right. Your body needs three things to stop generating migraines: nutrient delivery, waste clearance, and cellular resilience. The mismatch happens when you expect a root-cause investigation and get a prescription instead. If you believe your migraines can be healed, work with someone who shares that understanding. Schedule your free consultation here: https://www.drlesliecisar.com/apply Free Training: 5 Proven Steps to Being Migraine Free (Even if you think you've already tried everything.) https://www.drlesliecisar.com/5SHMN Connect with us: Website: https://www.drlesliecisar.com/ Free Facebook Group: Healing Migraines Naturally, with Leslie Cisar, ND Ready to try something radically different that actually works? Read more about my approach here: https://www.drlesliecisar.com/map

As Idahoans endure weeks of wildfire smoke each summer, a neurologist is warning that what we breathe doesn't just irritate our lungs — it may be harming our brains as well. 

Learn more about neurologist Dr. Carolyn Larkin Taylor and purchase her book, Whispers of the Mind A Neurologists Memoir at her website.Sign up for Michelle Redo's newsletter The Redo at michelleredo.comListen to more of Phil Redo's music at Bandcamp or find him on Spotify or Apple Music

Scientists are expanding our understanding of MS at an unprecedented pace. This week, Dr. Leorah Freeman discusses why, as new discoveries and medications enter clinical practice, neurologists and MS specialists should ask themselves 3 important questions when considering a patient's treatment plan. Dr. Freeman is the Director of the Multiple Sclerosis and Neuroimmunology Center at Dell Medical School at the University of Texas at Austin, where she also leads the MS and Neuroimmunology fellowship program and the MS Imaging and Outcomes Research Laboratory.  We'll also tell you about study results that reveal two distinct biologically-informed MS subtypes. We're explaining some of the confusing background to the FDA's decision not to approve a disease-modifying therapy that achieved positive results in its Phase 3 clinical trial. And did we really need a study to tell us that people living with MS fear experiencing a relapse or disease progression? Well, yes. We'll explain why. We're also reminding you to mail your insurance premium payments and other important documents earlier than you have in the past.  And we're sharing details about the two clinical trials that received $4.1 million in funding as part of the International Progressive MS Alliance Experimental Medicine Trial Awards. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: 3 questions your neurologist should be asking themselves  :22 Public Service Announcement: How the new rule about postmarks could affect your healthcare  1:16 FDA says it's not ready to approve Tolebrutinib  3:16 Study identifies two biologically-informed MS subtypes  6:29 Study results remind us that people with MS fear relapse and progression  10:09 The International Progressive MS Alliance invests $4.1 million in two clinical trials  14:04 Dr. Leorah Freeman discusses why neurologists need to ask themselves 3 important questions when considering a patient's treatment plan  17:18 Share this episode  33:16 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/436 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com The Multiple Sclerosis Insider https://themultiplesclerosisinsider.substack.com STUDY: Combined Magnetic Resonance Imaging and Serum Analysis Reveals Distinct Multiple Sclerosis Types https://academic.oup.com/brain/article/148/12/4578/8321558 STUDY: Fear of Disease Progression and Relapse in Multiple Sclerosis: A Systematic Scoping Review https://frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1680781/full JOIN: The RealTalk MS Facebook Group https://facebook.com/groups/realtalkms REVIEW: Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 436 Guests: Dr. Leorah Freeman Privacy Policy

Psychologist and Neurologist, Ian Robertson, joins sean to discuss and explore a counter-intuitive idea for the new year: that boredom isn't something to fear, but something we urgently need to relearn. He argues that our constant urge to scroll and stay stimulated is eroding our ability to think, feel and create freely. Ian makes the case for boredom as a temporary relief from “mental slavery”, a state that allows the mind to wander, emotions to surface, and creativity to re-emerge.

Dr. Dean Sherzai, co-director of Loma Linda University's Alzheimer's Prevention Program, reveals how lifestyle changes can prevent up to 90% of dementias.

Dr. Derek Stitt and Drs. Joseph Safdieh and Matthew S. Robbins discuss subspecialization's impact on patient care, why preserving a core neurologist identity matters, and how training can reinforce it. Show citation: Safdieh JE, Robbins MS. Opinion & Special Articles: The Core Identity of the Neurologist. Neurology. 2025;105(9):e214265. doi:10.1212/WNL.0000000000214265 

Dr. Derek Stitt talks with Drs. Joseph Safdieh and Matthew S. Robbins about subspecialization's impact on patient care, why preserving a core neurologist identity matters, and how training can reinforce it. Read the related Resident & Fellow Section article in Neurology®. Disclosures can be found at Neurology.org. 

Drs. Greg Cooper, Natalia Rost, and Behnam Sabayan discuss preventive neurology and the need for neurologists to move beyond diagnosis and treatment toward proactive strategies for brain health.  Show citation: Sabayan B, Boden-Albala B, Rost NS. An Ounce of Prevention: The Growing Need for Preventive Neurologists. Neurology. 2025;105(1):e213785. doi:10.1212/WNL.0000000000213785 Show transcript:  Dr. Greg Cooper: Hi, this is Greg Cooper. I just finished interviewing Behnam Sabayan and Natalia Rost for this week's Neurology® Podcast. For today's Neurology Minute, I'm hoping you can tell us the main points of your paper, An Ounce of Prevention, the Growing Need for Preventative Neurologist. Dr. Behnam Sabayan: We are living in a very exciting time for the field of neurology where we are not just getting very good at diagnosis and treatment of neurological condition, but also we are stepping one step back, and that means that we will find the root causes of neurological conditions. We would act as preventive specialists and we would decrease the burden of neurological conditions, not just at the individual level, but also at the population level. And this paper calls for thinking about playing roles at different levels and stages from our offices and our rounds all the way to the community to be brain health advocates and helping other fields and disciplines to reduce the burden of neurological conditions. Dr. Greg Cooper: Well, thank you for that summary and for all of your work on this topic. Please check out this week's podcast to hear the full interview or read the full article published in Neurology®, An Ounce of Prevention: The Growing Need for Preventative Neurologists. Thank you.

Imagine sitting at home and then all of a sudden you hear a men's choir belting out “The Star Spangled Banner.” You check your phone, computer, radio. Nothing's playing. You look outside, no one's there. That's what happened to neurologist Bruce Dobkin after he received a cochlear implant. He set out to learn everything he could about the condition, called musical hallucinosis.In a story from August, Host Ira Flatow talks with Dobkin about his decision to publish his account in a medical journal and why the condition is more common than he realized.Guest: Dr. Bruce Dobkin is a neurologist at UCLA Health.Transcript is available at sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Dr. Greg Cooper talks with Drs. Natalia Rost and Behnam Sabayan about the emerging field of preventive neurology, emphasizing the need for neurologists to shift from traditional diagnostic and treatment roles to a more proactive approach that includes prevention and brain health optimization.  Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

Send us a textC4 Leaders – the ONLY nonprofit to utilize the pizza making process to create space for our companions to be seen, heard, and loved.   We work with businesses, sports teams, hospitals, churches…anyone looking to RISE TOGETHER.  We also write children's books and use the most amazing handmade, hand-tossed, sourdough pizza to bring out the best in each other.   Please check out c4leaders.org to support our important work. Season 5 Episode #26 Dr. Fawad Mian is coming from Denville, New Jersey (inform, inspire, & transform)You can find Dr. Mian via his website prolohealing.com or advocareneurowellnessmd.comAbout our guest: Dr. Mian is not just a physician—he is someone who's lived the very pain he now helps others overcome.  Dr. Mian is a board-certified neurologist and regenerative medicine specialist, working with active adults 55+ who are tired of being told that pills, surgery, or “just living with it” are their only options. After years of dealing with chronic pain and facing a future of invasive procedures, he chose a different path—and discovered what traditional medicine often misses: that the body can heal, when given the right tools and support.  Dr. Mian's expertise is in helping high-performing individuals reclaim their strength, mobility, and freedom through precision diagnostics, regenerative therapies like PRP and stem cells, and custom movement protocols. Dr. Mian's approach is deeply personal, because he knows what it's like to be dismissed, misdiagnosed, and stuck. That's why he treats the whole person—not just the symptom—and guides his patients with the same care he'd offer his own family.One motto at Dr. Mian's clinic is, we don't just mask pain—we resolve it. Because healing isn't a hope. It's a plan.Dr. Mian, thanks for sharing your many gifts and talents with people all over the world, thank you for seeking alternatives that help people who live with chronic pain, thank you for having the courage to write your book (Getting to Pain Free…#1 best seller on Amazon) and thanks for being our guest on Life's Essential Ingredients, welcome to the show.TOTD – “At the end of life, most of us will find that we have felt most filled up by the challenges and successful struggles for mastery, creativity, and full expression of our dharma in the world.   Fulfillment happens not in retreat from the world, but in advance – and profound engagement.”                                                                                                                       Stephen CopeBuild a habit - to create intention - to live your purpose!In this episode:What was life like growing up?What are your life's essential ingredients?Neurologist by trade…NYU for residency and Emory University for your neurophysiology/sleep medicine fellowshipStressExerciseSleepPRP after injuryDifferent treatments for joint stiffness/painChronic pain relief and IV therapySustained Energy and Focus – any supplements or even better natural ways to stay on top of your gameStem Cell TherapyGood fat vs. bad fatSkin Care Insulin Resistance and what is itIntermittent FastingElectronic devices – light exposure Congrats on your book – Getting to Pain Free #1 best seller on AmazonBooks you recommend?Legacy   

In this episode of Living Well with MS, we're sharing highlights from our Ask Aaron webinar – originally recorded as a live Overcoming MS webinar and now edited for the podcast to bring you the key insights, questions and takeaways in one place. Our guest is the dynamic and much-loved Dr Aaron Boster, a board-certified neurologist specialising in multiple sclerosis. Dr Boster answers a wide range of thoughtful, practical questions from the OvercomingMS community. From medications and MRI contrast scans to foot drop, vision changes, supplements and the latest research developments, he brings clarity, warmth and energy to every topic. If you've ever wished you could sit down with a neurologist who truly understands MS, this episode is for you. Watch this episode on YouTube. Topics and timestamps 05:08 Exciting developments in MS research 10:54 Subcutaneous injections of Ocrevus 14:27 Remyelination drug trials 22:02 Addressing fatigue in MS patients 30:14 Managing fatigue: strategies and treatments 31:04 Navigating disease-modifying therapies 31:04 Supporting loved ones with MS 35:09 Understanding MRI and gadolinium contrast 38:21 B-Cell depletion therapies and MS progression 40:42 Exploring functional mushrooms and supplements 44:35 The importance of vitamins and nutrition 52:15 Understanding neurofilament light chain 58:28 Foot drop solutions 59:29 Finding the right doctor 01:00:29 Hope for the future of MS More info and links Listen to other episodes featuring Dr Boster Check out Dr Boster's popular YouTube channel covering all aspects of MS New to Overcoming MS? Learn why lifestyle matters in MS – begin your journey at our ‘Get started' page Connect with others following Overcoming MS on the Live Well Hub Visit the Overcoming MS website Follow us on social media: Facebook Instagram YouTube Pinterest Don't miss out: Subscribe to this podcast and never miss an episode. Listen to our archive of Living Well with MS here. Make sure you sign up to our newsletter to hear our latest tips and news about living a full and happy life with MS. Support us: If you enjoy this podcast and want to help us continue creating future podcasts, please leave a donation here. Feel free to share your comments and suggestions for future guests and episode topics by emailing podcast@overcomingms.org. If you like Living Well with MS, please leave a 5-star review.

Neurologists are privileged to act as guides for patients as they navigate the complex course of serious neurologic illnesses. Because of the impact on quality of life, personhood, and prognosis, neurologists must be able to conduct serious-illness conversations to improve rapport, reduce patient anxiety and depression, and increase the likelihood that treatment choices agree with patient goals and values. In this episode, Teshamae Monteith, MD, FAAN speaks with Jessica M. Besbris, MD, author of the article "The Approach to Serious-Illness Conversations" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Besbris is an assistant professor of neurology and internal medicine, and the director of the neuropalliative care, at Cedars-Sinai Medical Center in Los Angeles, California. Additional Resources Read the article: The Approach to Serious-Illness Conversations Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @JessBesbris Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. How are you? Dr Besbris: I'm doing great. Thank you so much for having me here today. Dr Monteith: Well, thank you for being on our podcast. Dr Besbris: My pleasure. Dr Monteith: Why don't we start off with you introducing yourself? Dr Besbris: Sure. So, my name is Jessica Besbris. I am a neurologist with fellowship training in palliative care, and I am currently at Cedars Sinai Medical Center in Los Angeles, where I am the director of our neuropalliative care program. Dr Monteith: Excellent. So, how did you get involved in that? Dr Besbris: Like, I think, many neurologists, I always knew I wanted to be a neurologist---or, I should say, from the moment I decided to be a doctor I knew that that was the type of doctor I wanted to be, a neurologist. So, I went into medical school with the aim of becoming a neurologist. And very quickly, when I started my clinical years, I was exposed to patients who were living with very serious illnesses. And I found myself really drawn to opportunities to help, opportunities to make people feel better, opportunities to improve quality of life in situations that on the face of it seemed really challenging, where maybe it seemed like our usual treatments were not necessarily the answer or were not the only answer. And so, I pretty quickly recognized that taking care of patients with serious illness was going to be a big part of my life as a neurologist and that palliative care was the way I wanted to help these patients and families. Dr Monteith: And you mentioned you're leading the group. So, how many colleagues do you have in the program? Dr Besbris: We have a very large palliative care group, but within neuropalliative care, it's myself and one other physician, a nurse practitioner, and a social worker. Dr Monteith: Okay, well, I know you guys are busy. Dr Besbris: Yes, we are very happy to be busy. Dr Monteith: Yes. So, let's talk about the objectives of your article. Dr Besbris: Sure. So, the goal of this article is to impress upon neurologists that it really is all of our jobs as neurologists to be having these conversations with our patients who are affected with serious illness. And then, in most areas of neurology, these conversations will come up. Whether it's giving a life changing diagnosis, or talking about treatment choices, or treatment not going the way that we had hoped, or even sometimes progression of disease or end-of-life care. These topics will come up for most of us in neurology, and really, we're hoping that this article not only makes the case that neurologists can and should be having these conversations, but that there are skills that we can teach in this article and with other resources to improve the skill level and sense of confidence that neurologists have when they enter into these conversations. Dr Monteith: Great. I read that there are some developments in the field, on organizational levels, about really making these skills part of standard of care in terms of education. So, can you speak to that? Dr Besbris: Yes. So, there have been a couple of really landmark papers and changes in the educational landscape that I think have really brought neuropalliative care in general, and serious illness conversation in particular, to the forefront. So, there were the position statements released by the American Academy of Neurology in 1996 and 2022, both of which really said, hey, all neurologists should be doing this and receive training on how to have these conversations and provide this care. And the ACGME, the Accreditation Council for Graduate Medical Education, also requires neurology residency programs to learn how to communicate with patients and families, assess goals, and talk about end-of-life care. So, there's a real structural imperative now for neurologists to learn early on how to have serious illness conversations with their patients. Dr Monteith: Great. If there's anything for our listeners to get out of this conversation, what are the essential points? Dr Besbris: If you only take away one or two things from this conversation, I hope that they're that this is an awesome responsibility to be in a moment with a patient going through something challenging, to meet them in that moment with thoughtful, honest, empathic conversations about who they are and what's important to them. And that, just like any other procedure, these are skills that can be taught so that you can feel really confident and comfortable being in these moments. Dr Monteith: Excellent. Wow. Okay, I feel your energy and your empathy already. And so, why don't we just talk about skills? What is the best way to deliver tough news? I read this wonderful chart on SPIKES protocol. Dr Besbris: Yeah, the SPIKES protocol is one really well-known way to deliver serious news. And what's nice about SPIKES is it gives a mnemonic. And as neurology learners, we all love a good mnemonic to help you really center yourself when you're entering into these conversations so that you have a structured format to follow, just like with any procedure. So, the SPIKES protocol stands for Setting: so, making sure you have the right environment; Perception, or assessing what your patient or surrogate decision maker knows already so that you know where to begin; receiving an Invitation to deliver serious news. And then K stands for Knowledge, delivering in a clear and concise way the information that you want to make sure the family or patient walk away with. E for exploring Emotion; and S for really Summarizing what's been discussed and Strategizing on next steps. I think that having these kinds of conversations, it's just like being expert in anything. When you first start learning, it's helpful to have a set of very concrete steps you can follow. And you might even think through the mnemonic as you get ready to walk into that room. And as you become more expert, the flow becomes more natural. And maybe what you do before walking in to prepare is just honing what is that headline? What is that concise statement that I'm really going to give? And the rest may start to feel more natural and less protocolized. Dr Monteith: And there are a few other mnemonics. There's the NURSE mnemonic, which I like. You know, there's a balance between saying things and sounding kind of… you know, sometimes they're like, well, how could you understand what I'm going through? Have you been through something like this? And people shy away, and they're afraid to kind of be a part of these conversations. So how do we approach that with this, a NURSE mnemonic in a way that's kind of sincere? Dr Besbris: Absolutely. So, the NURSE mnemonic, unlike SPIKES, is not a step-by-step protocol. So, NURSE is a mnemonic, but you don't go through each letter and sort of give a naming statement and then an understanding statement and then a respecting statement and so on. Nurse is really a toolkit of different types of statements that we can give in response to emotions so that when you find yourself in a situation where a patient or family member is tearful, is scared, is angry, is expressing feelings, you have some phrases ready that feel authentic to you and that you feel are going to meet the moment and allow you to empathically respond to those emotions. Because until we do that, we really can't move further in this conversation with our patients and families feeling heard and respected. So, that NURSE mnemonic, those Naming, Understanding, Respecting, Supporting and Exploring statements, are really examples of statements that we can use to meet that moment with empathy and understanding and without implying that we have walked in their shoes. We want to avoid being presumptuous and really focus on just being present and empathic. Dr Monteith: So, let's just kind of run through, I think it's really important. Let's run through some of these examples. Maybe if someone's crying hysterically, how would we respond to that? Dr Besbris: So, this is an opportunity for Naming. And I made this one, I think, in the chart, a little bit obvious, meaning that we recognize when someone is crying that they are feeling probably very sad. This is an opportunity for us to name and thus normalize that emotion. I just think something as simple as, I think anyone would be really sad hearing this. These responses are not intended to fix this emotion. I'm not trying to get someone to stop crying or to, you know, necessarily not feel sad. It's really just to say, yeah, it's normal that you're feeling sad. It's okay. I'm here with you while you're feeling sad. And I'm going to be with you no matter what you're bringing to the table. Dr Monteith: Yeah. Let's go through just a couple of others. I mean, these are really good. Dr Besbris: Sure. Maybe Respecting. Dr Monteith: Yeah. So, my Dad is a fighter. Only God, not doctors, can know the future. Dr Besbris: Yeah. So, I love giving these examples with our learners because these statements, things like my Dad is a fighter or God will bring me a miracle or you don't know the answer. Only God knows what's going to happen, I think that they give a lot of doctors a feeling of confrontation, a feeling of anxiety. And I think there are a few reasons for that. And I think one of the main ones is that they're statements that imply that we as doctors are not all-powerful and it's our patients or families sort of looking for a different locus of control, whether it's internal fortitude or a higher power. They're looking to something other than us, and maybe that makes us feel a little bit uncomfortable. And I think that sometimes physicians think that these statements imply that someone doesn't even understand what's going on. But maybe they're coming to this from a place of denial. And I would argue that when someone comes to you with a statement like my dad is a fighter or, you know, I'm looking to God to bring me a miracle or to show me the future. I think that what they're really saying is, wow, I'm really hearing that things are serious, so much so that I'm reaching for these other resources to give me strength and hope. I don't think anyone asks for a miracle if they think that a miracle is not needed, if the problem is easy to fix. And so, rather than come to these types of statements from a confrontational place of I'm the doctor and I know best, I think this is a great opportunity to show some respect and give some respecting statements. Your dad is a fighter. I don't think he could have come this far without being a fighter. Or, you know, I am so grateful that you have your faith to lean on during times like these to give you strength. These are also nice opportunities for exploring statements. For example, I'm so grateful to learn more about your dad. Can you tell me what it is that he has been fighting for all of this time? Dr Monteith: I love that. It's like a follow-up, and also validating. Dr Besbris: Yeah, it's validating. And it allows us to learn a little bit more about this person and to learn, well, is he fighting for a life that we can still achieve with our interventions to lead into the next part of a conversation? Or, is God is going to bring me a miracle? Well, tell me what a miracle looks like for you. I can't tell you how many times I thought someone was going to tell me that a miracle would be cure. And sometimes that is what comes up. But other times I hear, a miracle would be, you know, my loved one surviving long enough for the rest of the family to gather. And, you know, that is certainly something we can work towards together. Dr Monteith: So, why don't we talk a little bit about approach to goals of care discussions? They are tough, and let's just put it into perspective to the critical care team. It's time, the person's been in the ICU, the family wants everything thrown at medically. And it's to the point that the assessment is that would be medical futility. Dr Besbris: Lots to unpack there. Dr Monteith: I wanted to make it hard for you. Dr Besbris: No, no, this is good! I mean, this is something- I work in a, you know, almost one thousand-bed hospital with a massive critical care building. And so, these are not unusual circumstances at all. First of all, I would just say that goals of care conversations are not only about end-of-life care. And I make that point a few different times in the article because I think when people imagine goals of care, and one of the reasons that I think clinicians may sometimes shy away from goals of care discussions, is that they think they have to be sad, they have to be scary, they have to be about death and dying. And I would argue that, really, goals of care discussions are about understanding who a person is, how they live their life, what's most important to them. Most of these conversations should be about living. How are we going to together achieve a quality of life that is meaningful for you and treatments that are going to fit your needs and your preferences? But there is a little slice of that pie in the pie chart of goals of care discussions that is in the arena of end-of-life care. For example, ICU care with, really, the highest levels of intensity of care, and having to talk about whether that still is meeting the moment from the perspective of goals as well as the perspective of efficacy. So, from the goals standpoint, I approach these conversations just like any other goals of care conversation. Usually at this point, we're speaking to family members and not our patients because in a neurocritical care unit, if someone is that sick, they probably are incapacitated. And so, it's a moment to really sit down with family and say, please tell me about the human being lying in that bed. They can't introduce themselves. What would they tell me about themselves if they could speak right now? What kinds of things were important to them in the course of their treatment? What kind of a life did they want to live or do they want to live? So that then we can reflect on, well, can our treatment achieve that? And this process is called shared decision making. This is really where we take in data from the family, who are experts in the patient, and then our own expertise in the illness and what our treatments can achieve, and then bring all of that information together to make a recommendation that aligns with what we believe is right for a particular patient.  So, in the example that you gave, the extreme circumstance where someone is receiving maximal intensive care and we're starting to reach the point of futility, I think that we need to first really understand, well, what does futility mean for this particular patient? Is it that we as healthcare providers would not value living in the state this person is in? Or is it that the treatments truly cannot physiologically keep them alive or meet their stated goals? If it's the first one, that I wouldn't want to be on machines unconscious, you know, at the end of my life, well, I have to set that aside. It's really about what this patient wants. and if the family is telling you they valued every breath, every moment, and if we have care that can achieve that, we should continue to offer and recommend that care. And as healthcare providers, it is so important that we do explain when treatments are not going to be able to physiologically meet a patient's needs or achieve their goals. And that's where we can say, I'm going to continue to do everything I can, for example, to, you know, keep your loved one here for these meaningful moments. And we are at a point where performing CPR would no longer be able to restart his heart. And I just wanted to let you know that that's not something that we're going to do because I have an obligation not to provide painful medical treatments that will not work. So, my approach to futility is really different than my approach to shared decision-making because in the context of objective futility, it's not about necessarily- it's not about decision-making, it's not about shared decision-making as much as it is explaining why something is simply not going to work. Does that make sense? Dr Monteith: Absolutely. And what I love in your article is that, you know, you go beyond the skills, but also potential communication challenges---for example, patients' neurologic status, their ability to understand complex communication, or even cultural differences. So, can you speak about that briefly? Dr Besbris: Absolutely. In the world of neurological serious illness, it is incredibly common for our patients to face challenges in communication. That might be because they are aphasic, because they have a motor speech deficit, it might be because they're intubated, it might be because their capacity is diminished or absent. And so, there are a lot of challenges to keeping patients in these conversations. And in the article, I summarize what those challenges can look like and some strategies that we can use to continue to engage our patients in these conversations to the greatest extent possible and also turn to their surrogate decision makers where the patients themselves are no longer able to participate or participate fully. In terms of cultural considerations, I mean, there could be an entire article or an entire Continuum just on cultural considerations in neurology and in serious illness communication. And so, the key points that I really tried to focus on were exploring from a place of cultural humility what the beliefs and practices of a particular patient and family are in their cultural context, to ask questions to help you understand how those cultural differences may impact the way you approach these conversations. And being sensitive to folks with limited English proficiency, to ensure that we are using medical interpreters whenever possible. Dr Monteith: Excellent. Well, there's so much in the article. There's already so much that we just discussed, but our listeners are going to have to go to the article to get the rest of this. I do want to ask you to just kind of reflect on, you know, all the different cases and experiences that you have, and just, if you can give us a final remark? Dr Besbris: I can think of a number of cases that I've seen in my work as both an inpatient and outpatient neuropalliative provider where I've seen patients after strokes in the hospital with uncertain prognosis, whose families were struggling with a decision around feeding tubes. And where we have made a determination based on goals; for example, to pursue what's called a time-limited trial, to say let's place a feeding tube, let's meet again in the clinic in a few months after some rehab and let's just see, is this meeting this patient 's goals and expectations? I have been pleasantly surprised by the number of patients who have walked into my office after a period of rehabilitation who have regained the ability to eat, who are living an acceptable quality of life, and who have expressed gratitude for the work that I did in eliciting their goals, helping support their families. And some of whom have even come in and said, now that I'm doing better, I'd really like to do an advance directive to better guide my family in the future. People asking for more goals of care discussions, having seen how successful and helpful these conversations have been. Dr Monteith: Great. That's really life-altering for that patient, the family, so many people. Thank you so much for the work you do and for writing this great article and sharing all of this that we really need to learn more about. Dr Besbris: It's been a privilege. Thank you so much for talking with me today. Dr Monteith: Today I've been interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Dr. Wilner would love your feedback! Click here to send a text! Thanks!Many thanks to neurologist and author Dr. Carolyn Larkin Taylor for joining me as a guest on “The Art of Medicine with Dr. Andrew Wilner.” Dr. Taylor recently published “Whispers of the Mind,” a collection of essays that describes the extreme challenges faced by her patients, poignant moments, and, finally, a concession to the fragility of life —a concession that, frankly, is difficult for many physicians. Dr. Taylor was in the first class of women who graduated from Notre Dame. After graduation, she trained as an optometrist for four years and then practiced for three years. She realized she wanted to do more and decided to go to medical school to become an ophthalmologist. She attended Hahnemann Medical School in Philadelphia, PA. But when she rotated on neurology, she “fell in love with it.”  Dr. Taylor ditched ophthalmology and completed her neurology residency at the University of Pennsylvania. She recently worked as a neurologist in Seattle and flew to Alaska a couple of days a month to offer neurology clinics there. Currently, she works at the VA and performs disability evaluations for veterans who have suffered traumatic brain injury.  Dr. Taylor stated that her book “chronicles myJourney and growth as both a neurologist and human being.”  Dr. Taylor always kept a journal, which allowed her to illustrate her patient anecdotes with incredible detail, both physical and emotional. Despite the gravity of her subject matter, she found many of her patients' stories inspiring. She also shares stories of her golden retriever, Prancer, who accompanied her to work and had a knack for comforting patients.  We had a fascinating 40-minute discussion. To learn more or to contact Dr. Taylor, please visit her website: https://www.carolynlarkintaylorauthor.com #fiction #memoir #medicine #humanities Please click "Fanmail" and share your feedback!If you enjoy an episode, please share with friends and colleagues. "The Art of Medicine with Dr. Andrew Wilner" is now available on Alexa! Just say, "Play podcast The Art of Medicine with Dr. Andrew Wilner!" To never miss a program, subscribe at www.andrewwilner.com. Follow me on Instagram: @andrewwilnermd X: @drwilner linkedin.com/in/drwilner Please rate and review each episode. To contact Dr. Wilner or to join the mailing list: www.andrewwilner.com This production has been made possible in part by support from “The Art of Medicine's” wonderful sponsor, Locumstory.com, a resource where providers can get real, unbiased answers about locum tenens. If you are interested in locum tenens, or considering a new full-time position, please go to Locumstory.com. Or paste this link into your browser: https://locumstory.com/?source=DSP_directbuy_drwil...

When headaches start shaping your decisions — what you say yes to, where you go, how you plan your day —they're so much more than "just a bad day." They're controlling your life. And you deserve better than living around your pain. Migraines affect 40% of the global population, yet they remain one of the most misunderstood and dismissed health conditions; many sufferers wait YEARS before seeking help, enduring an invisible illness that disrupts work, sleep, relationships, and daily routines — often without validations or answers. If you've tried everything for relief with no lasting results, this episode is for you. Recording this episode between Thanksgiving and Christmas isn't a coincidence. The holiday season—with its disrupted routines, travel stress, and dietary changes—creates the perfect storm for headaches and migraines. But these triggers aren't unique to the holidays; they show up during weddings, graduations, vacations, and any major life event. Understanding them now can help you year-round. In this episode of Get Back to Your Life®, VSI Neurologist and migraine specialist Dr. Ella Akkerman breaks down what's actually happening in your brain during a headache or migraine, why certain types require completely different treatments, and how small daily disruptions can trigger a painful cycle. Drawing on both her clinical expertise and her own experience with migraines, Dr. Akkerman offers clarity, compassion, and a realistic path to relief. You'll learn: The science behind different headache types— tension headaches, migraines, and cluster headaches—and why identifying yours changes everything How hormonal fluctuations (especially during perimenopause and menopause) can amplify migraine patterns Why the holiday season creates the "perfect storm" for headaches—and how to protect yourself Practical prevention strategies beyond medication, from hydration to stress management When it's time to see a neurologist and what treatment options actually work Whether you're dealing with occasional tension headaches or chronic migraines that disrupt your daily life, this conversation offers validation, answers, and actionable steps toward real relief. Key takeaway: You don't have to live with headaches in this era of breakthrough treatments. But the longer you wait, the harder they become to treat. If headaches are interfering with your daily life, expert help is available. Visit VSIspine.com to request an appointment with a neurologist who specializes in diagnosing and treating complex headache conditions.  Subscribe to Get Back to Your Life® for more physician-led guidance on taking control of your health.

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Maisha T. Robinson, MD, MSHPM, FAAN, FAAHPM, who served as the guest editor of the December 2025 Neuropalliative Care issue. They provide a preview of the issue, which publishes on December 2, 2025. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Robinson is the Chair of the Division of Palliative Medicine and an assistant professor of neurology at Mayo Clinic in Jacksonville, Florida. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @neuropalldoc Full episode transcript available here Dr Jones: Most of us who see patients with chronic progressive neurologic disease are aware of the value of palliative care. The focus on symptom management and quality of life is a key aspect of helping these patients. But how many of us are comfortable starting the conversation about palliative care or care at the end of life? Today we have the opportunity to speak with a leading expert on neuropalliative care, Dr Maisha Robinson, about how we can better integrate neuropalliative care into our practices. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Maisha Robinson, who is Continuum's Guest Editor for our latest issue of Continuum on neuropalliative care, and our first-ever issue fully dedicated to this topic. Dr Robinson is an assistant professor of neurology at Mayo Clinic in Florida, where she is Chair of the Division of Palliative Medicine, and she also serves on the AAN Board of Directors as Chair of the Member Engagement Committee. Dr Robinson, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Robinson: Well, Dr Jones, thank you for having me. Really a pleasure to be here. I'm Maisha Robinson at the Mayo Clinic in Jacksonville, Florida. I spent my time as a neurohospitalist, a general palliative care physician, and a neuropalliative care physician. Dr Jones: So, this is a topic that at Continuum, we have heard about from subscribers for a long time requesting a fully dedicated issue to palliative care. And we've titled this neuropalliative Care. So, we want to respond to our subscribers and bring them content that they're interested in. I also think that palliative medicine is a big education gap in our specialty of neurology and something that we have room to improve on. So, let's start with the basics, Dr Robinson. Palliative medicine has been around for a long time, but this concept of "neuropalliative care" feels relatively new. What is neuropalliative care? Dr Robinson: That's a great question. Generally, what I would say is palliative care, first of all, is really just a specialty that focuses on trying to improve quality of life for people that have a serious or advanced medical condition. And neuropalliative care is really palliative care for people with neurologic conditions. And you'll see a number of neurologists doing neuropalliative care, but also there are internists as well, and people from other specialties, who focus on patients with neurologic disease and really trying to improve their quality of life. Dr Jones: Got it. And so, it's really the principles of palliative medicine in a specialty-specific context, which I think is important for us given the prevalence of chronic disease in our specialty. And I was obviously reading through these articles in this issue, and in the really wonderful articles, there are some themes that came up multiple times in various different articles. And one of them was obviously the importance of communication with patients and families. I think, and I'm speaking a little bit from personal experience here, many physicians feel uncomfortable bringing up the discussion of palliative care. And I'm sure that is something that reflects on your practice, too. How often do you have a patient who shows up to clinic and they ask you, why am I here? Dr Robinson: It happens all the time, because colleagues who are referring patients are nervous to tell them that they're sending them to palliative care. But we try to tell people it's really just to normalize it, to say that the palliative care team is going to see you, they're going to help with some symptoms, they're going to help you think about big picture, and they're going to be sort of an added layer of support to your team. And I think if people approach it from that standpoint, then patients and family members will say, that sounds great, I need a little extra support. Dr Jones: So, I think most neurologists have a threshold at which they would feel more comfortable having specialty support, having a palliative medicine specialist to help them in symptom management with the patient. For the palliative care that they provide themselves---and we want our subscribers to read this issue and feel more comfortable with delivering some palliative care on their own---how would you encourage them to begin that conversation? How should they initiate that conversation with a patient about working more toward palliative management of symptoms? Dr Robinson: So, one of the things we recommend is really introducing an approach to palliative care very early in the disease process. So, discussions about big picture and goals of care, discussions about who might help make medical decisions if the person can't make them for themselves. Those kinds of things can be discussed very early on. And in fact, that's palliative care. And then they can talk to patients more about the fact that as the disease progresses, there may be an additional team that can help walk along alongside the neurologist in helping you prepare for what's to come. You know, I think it's very important for patients and family members who feel like you're not abandoning them, but you're adding additional resources. And so, I like the way that we often will suggest to people to say partner or collaborate or bring in extra resources with the palliative care team. I think patients and family members will respond to that. Dr Jones: Yeah. So, by talking about it early, you kind of, at least, help to avoid that problem of the patient perceiving the introduction of palliative care as the quote-unquote "giving-up problem." Is that right? Dr Robinson: Correct. Because we also don't want to see people who are just being referred to us for end-of-life care. Palliative care is about much more than that. But if patients will Google palliative care, they may see hospice come up. And so, introducing the concept early and discussing some palliative topics early will allow the patient and family members to think that, okay, this isn't because I'm at the end of life. This is just because my clinician wants to make sure that I have all the bases covered. Dr Jones: This was also mentioned in several of the articles, the studies that have shown how frequently palliative care is initiated very near the end of life, which is usually, I think, perceived as a missed opportunity, right? To not wait so long to take advantage of what palliative care has to offer. Dr Robinson: That's correct. And the benefit of palliative care is that oftentimes we work alongside an interdisciplinary team, a team that could be quite helpful to patients and their support systems throughout the course of the disease. So, we have chaplains, we have nurses, we often have other clinicians, advanced practice providers as well, who work with us. We have spiritual advisors as well. And the patients and family members could benefit from some of those resources throughout the course of the disease. Who they might need to meet with may vary depending on what the disease is and how they're doing. But there's definitely some benefit to having a longitudinal relationship with the palliative care team and not just seeking them out at the end of life. Dr Jones: So- that's very helpful. So, it'll obviously vary according to an individual provider's level of comfort, right, where they're comfortable providing certain palliative management care versus when they need to have some assistance from a specialist. Are there types of care or are there certain thresholds that you say, wow, this patient really should go see a specialist in palliative medicine or neuropalliative care? Dr Robinson: So, I think that if there are, for instance, refractory symptoms, where the neurologist has been working with a patient for a while trying to manage certain symptoms and they're having some challenges, that person may benefit from being referred to palliative care. If patients are being hospitalized multiple times and frequently, that may suggest that a good serious-illness conversation may be necessary. If there are concerns about long-term artificial nutrition, hydration, or functional and cognitive decline, then some of those patients have benefited from palliative care. Not only the patient, but also the caregiver, because our team really focuses on trying to make sure that we're walking through the course of disease with these patients to ensure that all of the needs are managed both for the patient and the family member. Dr Jones: Got it. And that's very helpful. And I know that we talk about a lot of these decisions happening in an ideal environment when there's good access to the neurologist and good access to a palliative medicine specialist or even a neuropalliative medicine expert. In your general sense, I- and maybe we'll talk a little bit here in a minute or two about the growing interest in neuropalliative care. But in terms of access, in terms of availability of really, truly neuropalliative expertise, what is your sense of how widely available that is in the US? Dr Robinson: There's a shortfall of palliative care clinicians in the United States. Everybody who needs a palliative care clinician won't have access to one. And I think your point about the primary palliative care is so important. That's really what we encourage all clinicians, neurologists, neurosurgeons, even, physiatrists, the neurology care team members need to be comfortable with at least initiating some of these conversations. Because, to your point, not everyone's going to have access to a palliative care physician. But by reading issues such as this one, attending some courses---for instance at the American Academy of Neurology meetings---, doing some online trainings, those types of things can be helpful to bring any neurology clinician up to speed who certainly may not have access to a palliative care physician. Dr Jones: So, I know---and this is in part from my own conversations with patients in my own practice---there are a number of fears that patients have when they have a chronic disease, something that's progressive or something that we don't have a curative treatment for. But I think one of, if not the most common fear among patients is pain, and pain that can't be managed adequately during the course of chronic illness or at the end of life. One of the interesting concepts that I saw mentioned in a few of the articles in this issue is this concept of total pain. So, not just the somatic pain that I think we tend to think of as clinicians and patients tend to think of as patients, but a more holistic definition of pain. Walk us through that and how that relates to palliative medicine. Dr Robinson: So, Dame Cicely Saunders, the modern-day founder of palliative medicine, really described this biopsychosocial model for pain. And so, you're right, it's not just physical pain, but it's psychological pain, it's spiritual pain. And oftentimes when we are taking care of patients with neurologic disease, they may have some physical pain, but a lot of them are thinking about, for instance, the things that they will miss, which may cause some internal discomfort. Things that they're grieving, the life they thought they were going to have, the person that they used to be, the life they used to have, and what they anticipated their life as being. And some of that can cause people to have not only the spiritual discomfort, but also some psychological discomfort as well. And so, when we're thinking about how to provide rehensive care to these patients, we have to be thinking about all of these aspects. Dr Jones: It's really helpful. And I guess the more you can identify those, the more you can either help yourself or find the right expert to help the patient. I thought that was an interesting expansion of, of my view of how to think about pain. And another observation that came up in several of the articles was a lack of high-quality clinical trial evidence to inform a lot of the interventions in neuropalliative care. Some of them are common-sense, some of them are based on clinical experience or expert advice. In your own practice, if there was one key knowledge gap to close---in other words, if there was one pivotal trial that we could do to answer one question in helping patients with chronic neurologic disease---what would you say is the main gap? Dr Robinson: I think the real gap is, who needs palliative care and when? That seems very simple. We have tried things such as automatic triggers for palliative care, for instance, in patients with ALS, or we've said that maybe all glioblastoma patients should see palliative care. But is that true? Are we utilizing the resources in the best possible way that we can? We're not sure. And so, you'll see these practices doing things all a little bit different because we don't have a best practice and it's not really standardized about when people should see palliative care, or why, for instance, they should see palliative care, or who should see palliative care. And I think if we could help drill that down, we can provide some better guidance to our colleagues about when and why and who should see palliative care. Dr Jones: It's a really kind of a fundamental, foundational, who needs the service to begin with or who needs to care. Okay, that's- that is a big gap. So, one of the interesting concepts that I read- and it was in Benzi Kluger's article on neuropalliative care for patients who have movement disorders. I think it's a concept that is interesting, really, maybe in the management of patients with a lot of different chronic, progressive neurologic diseases. And it's this idea of stealing victories or bringing joy to patients. In other words, not just managing or trying to minimize some of the negative aspects or symptoms of disease, but looking for opportunities to bring something positive to their experience or improving their quality of life. Tell us a little more about that, because I think that's something patients would appreciate, but I think neurologists would appreciate that, too. Dr Robinson: Dr Kluger loves to talk about sustaining and finding joy in patients who have really serious or advanced neurologic conditions. He likes to talk about stealing victories, which can relate to the fact that patients and their loved ones can find even some benefit despite having a serious or advanced neurologic condition. Neurologists and neurology clinicians also can steal victories in their patients when they notice, for instance, that they've gained a new skill, and they've lost a skill that they used to love because of the advancing disease. And this is just an opportunity for not only the patients and family members, but also the care providers to recognize that in the midst of decline, there are positive things to be found. Dr Jones: I think it gives patients a sense of maybe reclaimed autonomy when they can say, well, there's maybe nothing I can do to cure this disease in the conventional sense, but I can maybe go on this trip with my family, which has been something I've always wanted to do. Or, I can do these things, so I can attend certain events that I want to. And I think that autonomy and independence aspect of that, I think that I think that was really meaningful and something that I'm going to bring back to my own practice in my care of patients who have ALS, for example. When you think about neuropalliative care---and you've been a leader in this area, Dr Robinson---what do you think the biggest change in neuropalliative care has been over the last few years? Dr Robinson: I think there's a growing cohort of people who are recognizing that there is some benefit in having dedicated specialists who focus on palliative care for patients with neurologic disease. When I said I was going to do neuropalliative care, somebody asked me, why would a neurologist be interested in palliative care? Over the last decade and a half, we've seen that shift. And not only are our colleagues recognizing the benefit, but also patients and caregivers are. Some are even asking for palliative care. I think people are recognizing that not only having their primary neurologist or neurology clinician taking care of them, they have this extra layer of support, and this extra team really focused on quality-of-life issues can be beneficial. Dr Jones: So, one of the things that I think you and I have both seen, Dr Robinson, is a growing interest among neurology trainees in palliative medicine. And maybe that's anecdotal, but in my own practice, I've seen more and more trainees express an interest in this. For neurology residents who are interested in this as a component of or maybe a focus of their career, what would you recommend to them? How should they go about this? Dr Robinson: Yes, it used to be that every neurology resident interested in palliative care would call me or email me or send me a message, but now there are so many that I can't keep up. We're excited about the growing number of people interested in neuropalliative care. What I would say to those people is that you can really try to hone your skills by, for instance, doing a rotation with the palliative care team at your hospital, if there is one. If there isn't one, you might even ask to spend some time with the local hospice agency, which may be helpful to you. If you're attending some of the national meetings---for instance, the American Academy of Neurology meeting---you may want to go to a course and learn a little bit about palliative care. There are a couple that are offered every year. There is an education opportunity for education in palliative and end-of-life care as well. And so, there are a number of resources that you can find in addition to this issue of Continuum as well. Dr Jones: I find it gratifying that trainees ask about this. And I'm sorry, I think I've probably sent a bunch of trainees your way for advice about this, and you've been incredibly generous with your time and expertise. So, I find it very gratifying that our neurology trainees are interested in this area, because it's an important area of medicine. It's also probably a challenging practice just from the cognitive load and the emotional load of caring for patients who are moving through a progressive illness. What is your thinking about how to have a sustainable career in palliative medicine? What is your approach to that? Is it for everyone? Dr Robinson: Yeah, the issue with palliative care is that we do see some very challenging situations, and frankly some very sad situations. But I actually love what I do because I think that we're helping patients and their family members during very, very difficult times. I feel like this is why I went to medical school, to try to be there for people when they need me the most. The way that I think about it is, the patients and family members will be going through this anyway. We're trying to help improve their quality of life as they're going through it. And what you might find interesting is that these patients are so grateful. And their loved ones, they're so grateful. Even if they're nearing the end of life, just to have someone who's helping them see that, for instance, the pain could be better, or that they have more resources for the loved ones to be able to take care of them. And so, I think that helps sustain us, realizing that we are really having a positive benefit on the patients and also their family members. Dr Jones: Well, I think that's a great point to end on. And these are patients who need help. Even if we don't have a curative therapy, they do need support. And that's an important service and a function and an important facet of our profession. So, Dr Robinson, I want to thank you for joining us, and I want to thank you for such a great discussion of neuropalliative care. I learned a lot from our conversation today. I've learned a lot reading the articles and the experts that you put together. This is an important topic. I'm really grateful to you to having assembled this team of expert authors and put together an issue that I think will be really important for not only our junior readers, but also our more experienced subscribers as well. Dr Robinson: Thank you, Dr Jones, for the opportunity. Dr Jones: Again, we've been speaking with Dr Maisha Robinson, Guest Editor of Continuum's most recent issue and first issue fully dedicated to neuropalliative care. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

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