Podcasts about Normal

Have you recently left your doctor's office feeling more confused than when you walked in?  Or finally worked up the courage to share the brain fog, crushing fatigue, or unexplainable mood swings—only to get brushed off with: “It's just part of getting older”?  I see you—because I was you—and I know how frustrating and lonely it can feel to navigate midlife changes when so few doctors truly understand what's happening in your body.  In this empowering episode, we dive into how to be heard at the doctor's office during perimenopause and menopause, what to track before your appointment, the right questions to ask, and the signs it might be time to find a new provider.  You deserve answers. You deserve care that sees the whole you. And you deserve to walk out of your appointments with clarity and a plan to feel your best.  Tune in to this episode to reclaim your voice and your power in this beautiful season of life! IN THIS EPISODE Navigating the knowledge gap in women's health care  Tips for confidently advocating for yourself to your doctor  Addressing common symptoms in midlife and menopause Questions to ask your doctor and labs you should test for  Finding a functional medicine doctor who will hear you out  My FREE perimenopause survival guide and more about my upcoming book: The Perimenopause Revolution  QUOTES“Even today, the average woman waits 7 to 10 years for a proper diagnosis of conditions like Hashimoto's and other autoimmune issues.” “If you feel dismissed, it's okay to find another provider. I know this can feel daunting, but your health and your quality of life is on the line. You deserve a provider who listens.” “There are so many doctors and providers out there like me who care deeply, who understand what it's like to be going through this transition, what it's like to be a woman navigating the world, particularly the healthcare system, and what it's like to struggle with symptoms, and you just desperately want answers to feel better again.” RESOURCES MENTIONED Grab the FREE Thriving in Perimenopause Guide HERE!  Preorder my new book: The Perimenopause Revolution HERE and get instant access to over $500 worth of bonuses! Try Qualia Senolytic and use code DRMARIZA to get 15% off RELATED EPISODES  #319: Red Flags: 10 Ways We Gaslight Women in Medicine Today #650: Unlock Your Health: The Ultimate Biomarker & Lab Blueprint to Thrive in Midlife and Beyond #541: Why Functional Labs Are a Game Changer for Your Health with Dr. Kela Smith 579: Hormone Replacement Options and Hormone Testing for Women in Midlife + Self Advocacy for Optimal Health with Esther Blum

Ken and Anthony talk about Devin Booker's extension with the Suns, what that could mean for a player like Donovan Mitchell, and whether or not NBA contracts are going to start being bigger than NFL contracts.

Dr. Nicole Rivera breaks down the real root causes behind the diabetes epidemic and why simply “managing numbers” isn't enough. She exposes the hidden dangers of processed foods, the limitations of conventional bloodwork, and shares what it actually takes to heal pancreatic function and reclaim your energy, mind, and long-term health. This is a wake-up call for visionary families and leaders who want to create generational health—by getting proactive, not just reactive.   #DiabetesPrevention #PancreaticHealth #IntegrativeMedicine #GenerationalHealth #RootCauseHealing #BloodSugarBalance #FunctionalMedicine #WellnessLeadership #RealFoodRevolution #LiveLimitless   3 Key Takeaways:   Most “normal” bloodwork is missing the full picture.Glucose and even A1C aren't enough—you need a comprehensive look at insulin, amylase, and lipase to truly assess pancreatic health and diabetes risk. Processed foods and chemical additives are sabotaging your pancreas. It's not just about sugar; it's about the hidden chemicals in your everyday foods that disrupt your body's natural ability to regulate blood sugar. You can heal and even reverse blood sugar issues—if you address the root cause. Sustainable results come from real food, lifestyle shifts, and understanding your unique biology—not just popping a pill or chasing “magic” solutions.  Quotes:  “Don't be the person that sits around saying, ‘My glucose has been great,' but you feel like shit. If you relate to the energy crashes, the cravings, the brain fog—there's an opportunity to actually do something about it.” “Are we just manipulating numbers so you feel better about the situation, or are we more interested in solving the root cause and expressing true health so that we don't have to fear disease and dysfunction?”   Find Integrative You Radio On: Website Youtube  Apple Spotify   2 Doctors Committed to Innovating the Healthcare Experience. Integrative You Radio is hosted by husband-and-wife duo, Dr. Nicole Rivera and Dr. Nick Carruthers. With their voracious curiosity for Integrative Medicine, the Human Mind, Aligned Parenting, and Entrepreneurship, they bring a fresh perspective to the table. They aim to debunk the BS that is holding you back in your health, your relationships, and your life. Each episode is designed to challenge your thinking, push boundaries, and inspire you to see your life through a new lens. Dr. Nicole and Dr. Nick share transformative insights that have revolutionized their lives and the lives of their clients at Integrative You. This is raw. This is real. This is Integrative You Radio— where we blow shit up for the sake of human innovation.   Links: Website: Integrative You Instagram: Dr. Nicole Rivera & Integrative You Book a Consult [yes, it's free] with our Concierge Coordinator & Dr. Nicole  We are fanatical about relationships. Working on your health, your mind, and essentially your life is the best thing you can do for yourself [and the people you love]. This is why we want to get to know you and make sure we are aligned so we can build a relationship rooted in trust and partnership for growth. If anything, you can at least use this call for clarity on your best move even if that is not working with us. We are here to provide value in this world, so just book the call: https://www.integrativeyou.health/onboarding Got questions? You can call or text us at 732-810-1084.

Eddie shared a story about times that famous people tried to do normal people things, and it went terribly wrong. Bobby revealed what is going on with his brain and the 3 sessions he has been to after being gifted the treatment by Amy. Listeners called out Lunchbox for making his wife use the bathroom on the side of the road. Amy thinks Bobby gave her money by accident. Bobby talked about should we normalize baby showers for men? Bobby and Amy shared what inventions they thought of recently and were devastated to find out they already existed.See omnystudio.com/listener for privacy information.

This week on The Mommy Labor Nurse Podcast, I'm joined by my friend and fellow podcaster Dr. Mona Amin to chat about those quirky, confusing, and totally normal things newborns do in the early days. Dr. Mona is a board-certified pediatrician and parenting expert who's all about helping new parents feel calm, confident, and informed. Inside this episode, we're unpacking: Why your baby's hiccups are nothing to worry about What's going on with day/night confusion How much (or little!) your baby really needs to eat in those early days And 7 more newborn behaviors that might surprise you! If you're a first-time parent or you just want a little reassurance, this episode is full of validation and real talk from two mamas who've been there

Welcome to Season 2 of the Orthobullets Podcast.Today's show is Podiums, where we feature expert speakers from live medical events. Today's episode will feature ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Dr. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thomas Edwards⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠and is titled⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ "⁠Can We Restore Normal Anatomy in Total Shoulder Arthroplasty."⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In this episode of "Normal World," Dave Landau, 1/4 Black Garrett, and Angela dive into the FBI and DOJ's newly released memo on Jeffrey Epstein. After combing through explicit material and over 10,000 images and videos, officials somehow concluded there's no client list, no credible blackmail, and no reason to charge anyone else. Problem solved, right? The crew isn't so sure — especially after reviewing 10+ hours of surveillance footage from Epstein's cell, complete with a suspicious glitch. They unpack the twisted logic of trafficking victims to nobody, the DOJ's laughable search tactics, Pam Bondi's “it was on my desk” moment, and Trump's visibly irritated reaction when the topic came up during a Cabinet meeting. From Clinton and Trump to the unnamed pilots, island staff, and missing JFK files, the team questions whether we'll ever see real accountability — or if this is just another cover-up dressed in official language. Then it's on to the bizarre new lawsuit against Diddy, in which allegations include ketamine, Biggie's old clothes, and a disturbing incident involving a shirt and zero shame. It's graphic, surreal, and somehow fits right into the week's theme of elite absurdity. Today's guests on "Normal World" are Mike Imbasciani and Derek Cahill. Sponsors Blue Chew As always, get your first month of BlueChew FREE. Just use promo code NORMAL at checkout at https://bluechew.com/ and pay $5 for shipping. That's it! Miracle Made Go to www.trymiracle.com/NORMAL and use the code NORMAL to claim your FREE 3-PIECE TOWEL SET and SAVE over 40%. Learn more about your ad choices. Visit megaphone.fm/adchoices

Join Matt and me for Episode 140 as we catch up with our friend, fellow Shenandoah University alum, and Broadway star J. Robert Spencer! You may know him from Jersey Boys and Next to Normal, but today he's here to talk about hosting the upcoming Shenandoah Summer Music Theatre benefit concert on August 3rd.Plus, we'll let you know how you can score two FREE tickets to the show!Don't miss this fun conversation with one of Broadway's finest—stream it now wherever you listen to podcasts.Get tickets to the SSMT Benefit here:https://tickets.su.edu/25-ssmt-special-events/25-08-ssmt-benefit-concertSupport The Conner & Smith Show on Patreon here:https://www.patreon.com/ConnerandSmith?utm_campaign=creatorshare_fan

 Normal pressure hydrocephalus (NPH) is a clinical syndrome of gait abnormality, cognitive impairment, and urinary incontinence. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features. In this episode, Katie Grouse, MD, FAAN, speaks with Aaron Switzer, MD, MSc, author of the article “Radiographic Evaluation of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Switzer is a clinical assistant professor of neurology in the department of clinical neurosciences at the University of Calgary in Calgary, Alberta, Canada. Additional Resources Read the article: Radiographic Evaluation of Normal Pressure Hydrocephalus 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 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 Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr. Switzer: Thanks so much for having me, Katie. I'm a neurologist that's working up in Calgary, Alberta, Canada, and I have a special interest in normal pressure hydrocephalus. So, I'm very happy to be here today to talk about the radiographic evaluation of NPH. Dr Grouse: I'm so excited to have you here today. It was really wonderful to read your article. I learned a lot on a topic that is not something that I frequently evaluate in my clinic. So, it's really just a pleasure to have you here to talk about this topic. So, I'd love to start by asking, what is the key message that you hope for neurologists who read your article to take away from it? Dr. Switzer: The diagnosis of NPH can be very difficult, just given the clinical heterogeneity in terms of how people present and what their images look like. And so, I'd like readers to know that detailed review of the patient's imaging can be very helpful to identify those that will clinically improve with shunt surgery. Dr Grouse: There's another really great article in this edition of Continuum that does a really great job delving into the clinical history and exam findings of NPH. So, I don't want to get into that topic necessarily today. However, I'd love to hear how you approach a case of a hypothetical patient, say, where you're suspicious of NPH based on the history and exam. I'd love to talk over how you approach the imaging findings when you obtain an MRI of the brain, as well as any follow-up imaging or testing that you generally recommend. Dr. Switzer: So, I break my approach down into three parts. First, I want to try to identify ventriculomegaly and any signs that would support that, and specifically those that are found in NPH. Secondly, I want to look for any alternative pathology or evidence of alternative pathology to explain the patient's symptoms. And then also evaluate any contraindications for shunt surgery. For the first one, usually I start with measuring Evans index to make sure that it's elevated, but then I want to measure one of the other four measurements that are described in the article, such as posterior colossal angle zed-Evans index---or z-Evans index for the American listeners---to see if there's any other features that can support normal pressure hydrocephalus. It's very important to identify whether there are features of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, which can help identify patients who may respond to shunt surgery. And then if it's really a cloudy clinical picture, it's complicated, it's difficult to know, I would usually go through the full evaluation of the iNPH radscale to calculate a score in order to determine the likelihood that this patient has NPH. So, the second part of my evaluation is to rule out evidence of any alternative pathology to suggest another cause for the patient's symptoms, such as neurodegeneration or cerebrovascular disease. And then the third part of my evaluation is to look for any potential contraindications for shunt surgery, the main one being cerebral microbleed count, as a very high count has been associated with the hemorrhagic complications following shunt surgery. Dr Grouse: You mentioned about your use of the various scales to calculate for NPH, and your article does a great job laying them out and where they can be helpful. Are there any of these scales that can be reasonably relied on to predict the presence of NPH and responsiveness to shunt placement? Dr. Switzer: I think the first thing to acknowledge is that predicting shunt response is still a big problem that is not fully solved in NPH. So, there is not one single imaging feature, or even combination of imaging features, that can reliably predict shunt response. But in my view and in my practice, it's identifying DESH, I think, is really important---so, the disproportionately enlarged subarachnoid space hydrocephalus---as well as measuring the posterior colossal angle. I find those two features to be the most specific. Dr Grouse: Now you mentioned the concept of the NPH subtypes, and while this may be something that many of our listeners are familiar with, I suspect that, like myself when I was reading this article, there are many who maybe have not been keeping up to date on these various subtypes. Could you briefly tell us more about these NPH subtypes? Dr. Switzer: Sure. The Japanese guidelines for NPH have subdivided NPH into three different main categories. So that would be idiopathic, delayed onset congenital, and secondary normal pressure hydrocephalus. And so, I think the first to talk about would be the secondary NPH. We're probably all more familiar with that. That's any sort of pathology that could lead to disruption in CSF dynamics. These are things like, you know, a slow-growing tumor that is obstructing CSF flow or a widespread meningeal process that's reducing absorption of CSF, for instance. So, identifying these can be important because it may offer an alternative treatment for what you're seeing in the patient. The second important one is delayed onset congenital. And when you see an image of one of these subtypes, it's going to be pretty different than the NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. Clinically, you may see that the patients have a higher head circumference. So, the second subtype to know about would be the delayed onset congenital normal pressure hydrocephalus. And when you see an image of one of these subtypes, it's going to be a little different than the imaging of NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. And there are two specific subtypes that I'd like you to know about. The first would be long-standing overt ventriculomegaly of adulthood, or LOVA. And the second would be panventriculomegaly with a wide foramen of magendie and large discernomagna, which is quite a mouthful, so we just call it PAVUM. The importance of identifying these subtypes is that they may be amenable to different types of treatment. For instance, LOVA can be associated with aqueductal stenosis. So, these patients can get better when you treat them with an endoscopic third ventriculostomy, and then you don't need to move ahead with a shunt surgery. And then finally with idiopathic, that's mainly what we're talking about in this article with all of the imaging features. I think the important part about this is that you can have the features of DESH, or you can not have the features of DESH. The way to really define that would be how the patient would respond to a large-volume tap or a lumbar drain in order to define whether they have this idiopathic NPH. Dr Grouse: That's really helpful. And for those of our listeners who are so inclined, there is a wonderful diagram that lays out all these subtypes that you can take a look at. I encourage you to familiarize yourself with these different subtypes. Now it was really interesting to read in your article about some of the older techniques that we used quite some time ago for diagnosing normal pressure hydrocephalus that thankfully we're no longer using, including isotope encephalography and radionuclide cisternography. It certainly made me grateful for how we've come in our diagnostic tools for NPH. What do you think the biggest breakthrough in diagnostic tools that are now clinically available are? Dr. Switzer: You know, definitely the advent of structural imaging was very important for the evaluation of NPH, and specifically the identification of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, in the late nineties has been very helpful for increasing the specificity of diagnosis in NPH. But some of the newer technologies that have become available would be phase-contrast MRI to measure the CSF flow rate through the aqueduct has been very helpful, as well as high spatial resolution T2 imaging to actually image the ventricular system and look for any evidence of expansion of the ventricles or obstruction of CSF flow. Dr Grouse: Regarding the scales that you had referenced earlier, do you think that we can look forward to more of these scales being automatically calculated and reported by various software techniques and radiographic interpretation techniques that are available or going to be available? Dr. Switzer: Definitely yes. And some of these techniques are already in development and used in research settings, and most of them are directed towards automatically detecting the features of DESH. So, that's the high convexity tight sulci, the focally enlarged sulci, and the enlarged Sylvian fissures. And separating the CSF from the brain tissue can help you determine where CSF flow is abnormal throughout the brain and give you a more accurate picture of CSF dynamics. And this, of course, is all automated. So, I do think that's something to keep an eye out for in the future. Dr Grouse: I wanted to ask a little more about the CSF flow dynamics, which I think may be new to a lot of our listeners, or certainly something that we've only more recently become familiar with. Can you tell us more about these advances and how we can apply this information to our evaluations for NPH? Dr. Switzer: So currently, only the two-dimensional phase contrast MRI technique is available on a clinical basis in most centers. This will measure the actual flow rate through the cerebral aqueduct. And so, in NPH, this can be elevated. So that can be a good supporting marker for NPH. In the future, we can look forward to other techniques that will actually look at three-dimensional or volume changes over time and this could give us a more accurate picture of aberrations and CSF dynamics. Dr Grouse: Well, definitely something to look forward to. And on the topic of other sort of more cutting-edge or, I think, less commonly-used technologies, you also mentioned some other imaging modalities, including diffusion imaging, intrathecal gadolinium imaging, nuclear medicine studies, MR elastography, for example. Are any of these modalities particularly promising for NPH evaluations, in your opinion? Do you think any of these will become more popularly used? Dr. Switzer: Yes, I think that diffusion tract imaging and MR elastography are probably the ones to keep your eye out for. They're a little more widely applicable because you just need an MR scanner to acquire the images. It's not invasive like the other techniques mentioned. So, I think it's going to be a lot easier to implement into clinical practice on a wide scale. So, those would be the ones that I would look out for in the future. Dr Grouse: Well, that's really exciting to hear about some of these techniques that are coming that may help us even more with our evaluation. Now on that note, I want to talk a little bit more about how we approach the evaluation and, in your opinion, some of the biggest pitfalls in the evaluation of NPH that you've found in your career. Dr. Switzer: I think there are three of note that I'd like to mention. The first would be overinterpreting the Evans index. So, just because an image shows that there's an elevated Evans index does not necessarily mean that NPH is present. So that's where looking for other corroborating evidence and looking for the clinical features is really important in the evaluation. Second would be misidentifying the focally enlarged sulci as atrophy because when you're looking at a brain with these blebs of CSF space in different parts of the brain, you may want to associate that to neurodegeneration, but that's not necessarily the case. And there are ways to distinguish between the two, and I think that's another common pitfall. And then third would be in regards to the CSF flow rate through the aqueduct. And so, an elevated CSF flow is suggestive of NPH, but the absence of that does not necessarily rule NPH out. So that's another one to be mindful of. Dr Grouse: That's really helpful. And then on the flip side, any tips or tricks or clinical pearls you can share with us that you found to be really helpful for the evaluation of NPH? Dr. Switzer: One thing that I found really helpful is to look for previous imaging, to look if there were features of NPH at that time, and if so, have they evolved over time; because we know that in idiopathic normal pressure hydrocephalus, especially in the dash phenotype, the ventricles can become larger and the effacement of the sulci at the convexity can become more striking over time. And this could be a helpful tool to identify how long that's been there and if it fits with the clinical history. So that's something that I find very helpful. Dr Grouse: Absolutely. When I read that point in your article, I thought that was really helpful and, in fact, I'm guessing something that a lot of us probably aren't doing. And yet many of our patients for one reason or other, probably have had imaging five, ten years prior to their time of evaluation that could be really helpful to look back at to see that evolution. Dr. Switzer: Yes, absolutely. Dr Grouse: It's been such a pleasure to read your article and talk with you about this today. Certainly a very important and helpful topic for, I'm sure, many of our listeners. Dr. Switzer: Thank you so much for having me. Dr Grouse: Again, today I've been interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. 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.

What comes first - a peace deal or a peace prize? The war rages on in Gaza - another 40 Palestinians were killed overnight in Israeli airstrikes, but Israel's Prime Minister Benjamin Netanyahu has been unable to thrash out a ceasefire deal despite two days of talks in Washington, though he did nominate Donald Trump for the Nobel peace prize. Meanwhile in Gaza families continue to struggle for food and water amid the constant bombardments and with an aid system that is failing to deliver. Israeli officials say they are working with the UN and other bodies to “ensure necessary aid crosses the border”. So who is to blame for this catastrophe? And what needs to be done to alleviate it? In this episode of The Fourcast, Cathy Newman speaks to James Elder, global spokesperson for UNICEF, the United Nations agency providing humanitarian aid to children worldwide. He is just back from Gaza - his fifth visit to the territory since the war between Israel and Hamas began in October 2023.

‘Painful periods are common, but not normal'

Looking for the signs.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Amy is joined by historian and author, Dr. Philippa Gregory, to discuss her newest book, Normal Women, exploring 900 years of women's stories including the origins of the gender wage gap, the history and normality of women loving women, where our abortion laws began, and much much more.Donate to Breaking Down PatriarchyPhilippa Gregory is one of the world's foremost historical novelists and non-fiction writers. She wrote her first ever novel, Wideacre, when she was completing her PhD in eighteenth-century literature and it sold worldwide, heralding a new era for historical fiction. Her flair for blending history and imagination developed into a signature style and Philippa went on to write many bestselling novels, including The Other Boleyn Girl and The White Queen.Now a recognized authority on women's history, Philippa graduated from the University of Sussex and received a PhD from the University of Edinburgh, where she is a Regent and was made Alumna of the Year in 2009.

Coach Scott McNally - Ask Me Anything 5 2:20 The 5 Levels of Steroid Enhancement 3:00 Therapeutic 8:30 Optimized 10:25 TRT + 13:00 Enhanced 15:00 Nucular 19:00 “optimal” total and free test to build muscle 22:00 Blood Pressure Machines to monitor at home 25:45 Hot Take on BAM15 28:35 Blood Pressure on Smart Watches? 32:15 Test EQ ratio 34:20 Planning gear on a rebound 41:30 Controlling Gyno 48:20 Cardarine VS SLU-PP-332 52:00 DADA 55:30 Summer Cycle- Month to month plan 1:07:00 Coming back after 7 years off bodybuilding 1:12:15 Higher doses in off season or diet phase 1:17:20 Dose of GH for fat loss 1:19:40 cycle after losing 70 lbs 1:24:00 Build muscle in a fat loss phase 1:27:30 Baseline Labs Before Starting First Cycle 1:28:45 Cycles for Arm Wrestling 1:31:30 Max added calories in a reverse diet 1:34:25 Healing From A Bad Shot 1:39:00 GLP meds not working along longer 1:40:50 When to Finish A Cut and shift to muscle gain 1:47:40 Is Pharma GH that important 1:50:30 Fat loss while still using alcohol 2:00:00 Water weight on Primobolan 2:06:00 Methylene Blue Follow Scott on IG : https://www.instagram.com/scottmcnally1/ Amazon Affilate Links to Products Scott will talk about : Normal to Large Size BP Cuff : https://amzn.to/44Nnikd Keto Mojo Kit : https://amzn.to/4lGvg4p Keto Mojo Test Strips : https://amzn.to/44zI2uz ✅ Coach Scott McNally hangs with you guys and talks shop. Reach out for coaching or show sponsorship at : mcnallydiets@gmail.com ✅ ✅ Modern Aminos New Peptide and Research Chem Affiliate : https://tinyurl.com/y4nts94n ✅ ✅Code THINKBIG ✅ Parabolic Peptides Great Research Tabs and Peps https://tinyurl.com/ycpnbjzd ✅ ✅Code THINK

Jóse Rafael Guzmán celebra el cumpleaños de Silvia Patricia, compartiendo anécdotas de la fiesta y la preparación de la comida. Se discuten temas familiares, relaciones, y el humor en situaciones cotidianas, mientras se bromea sobre la vida y la muerte. También se menciona un próximo viaje a Canadá y la importancia de la comunidad en Patreon.

Normal, Rate, and Overshare lead us to Normal, IL an other fun town names, early 2000's TV, rating things online, Cher, and more.New episodes every Tuesday.Editing by: Julia WD HarrisonTheme by: Arne Parrott Logo by: Casey BordenSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode I'm joined by Dr. Maria Sophocles to break the silence around painful sex, vaginal atrophy, menopause, and the damaging scripts of ‘duty sex'. Dr. Sophocles shares:Why so many women endure painful sex silentlyThe difference between vaginal atrophy, vulvodynia, and other causes of painHow treatments like vaginal estrogen, lubricants, and dilators can helpWhy sexual pain should never define your worth as a partnerThe importance of communication with doctors and partnersHer upcoming documentary HOT! exploring midlife women's sexualityHer personal definition of sex: joy, curiosity, and humorThis episode is a must-listen for any woman wanting to understand her body, break free from shame, and embrace a sex life defined by her own needs and desires.Timestamps:00:00 – Intro & Guest Welcome02:10 – The Reality of Painful Sex Globally05:50 – Dr. Maria Sophocles' Work & TED Talk Impact09:20 – Mercy Sex, Duty Sex, and The Bedroom Gap14:00 – Why Women Feel Obliged to Endure Pain17:50 – Common Causes of Painful Sex in Midlife21:40 – Treatments: Vaginal Estrogen, Lubricants, Dilators26:10 – How To Talk To Your Doctor About Sex31:30 – Communicating With Your Partner About Pain & Pleasure38:00 – The Importance of Sexual Check-Ins43:20 – Dr. Sophocles' Upcoming Documentary HOT!47:10 – Her Personal Definition of Sex49:00 – Closing Thoughts & Next StepsKaren Bigman, a Sexual Health Alliance Certified Sex Educator, Life, and Menopause Coach, tackles the often-taboo subject of sexuality with a straightforward and candid approach. We explore the intricacies of sex during perimenopause, post-menopause, and andropause, offering insights and support for all those experiencing these transformative phases.This podcast is not intended to give medical advice. Karen Bigman is not a medical professional. For any medical questions or issues, please visit your licensed medical provider.Looking for some fresh perspective on sex in midlife? You can find me here:Email: karen@taboototruth.comWebsite: https://www.taboototruth.com/Instagram: https://www.instagram.com/taboototruthYouTube: https://www.youtube.com/@taboototruthpodcastAbout the Guest:Dr. Maria Sophocles has been a leader in women's healthcare for nearly 30 years, specializing in menopause management and female sexual health. She founded Women's Healthcare of Princeton, a progressive gynecology practice, and has been a visiting professor and NIH researcher in Switzerland. A board-certified ob/gyn and Menopause Society Certified Practitioner, she has pioneered innovative treatments, including CO2 laser therapy for vaginal atrophy. She serves as CMO of EMBR Labs, Director of Women's Health Services for Curia Health, and is an advocate for women's health policy. Dr. Sophocles is also an author, TEDWomen2023 speaker, and frequent media contributor on women's health topics.Connect with Dr. Maria Sophocles:Website: https://mariasophoclesmd.comInstagram:

Pirates' broadcaster Neil Walker joins Adam Crowley and Dorin Dickerson on The Fan Hotline to discuss Paul Skenes in the upcoming MLB All-Star Game, Ben Cherington's recent comments and more!

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Normal people do not rush to assign blame to politicians. Normal people do not rush to examine the political ties to a natural disaster. The ghouls seek to find political advantage. Learn more about your ad choices. Visit megaphone.fm/adchoices

Normal people do not rush to assign blame to politicians. Normal people do not rush to examine the political ties to a natural disaster. The ghouls seek to find political advantage.

Normal people do not rush to assign blame to politicians. Normal people do not rush to examine the political ties to a natural disaster. The ghouls seek to find political advantage.

Local 10 anchor and reporter, Clay Ferraro, reacts to the Miami Heat trading for Norman Powell and discusses what he expects the team's ceiling to be as currently constructed.

This voicemail had me fully sweating. A teacher casually drops that a full SWAT team showed up at her school… and the kicker? It wasn't even a drill. We're talking lockdowns, military gear, weapons drawn, and a group of students who were just trying to get to lunch. And the reason they showed up? Ohhhh, you are not ready. I spiral through the possibilities, ask all the wrong questions, and react in real-time to what is possibly the most over-the-top, under-explained escalation in school discipline history. If you've ever wondered what it feels like to go from supervising recess to being in the middle of a tactical operation, this one's for you. Takeaways: A voicemail about a SWAT team storming a school sends me into a full-body spiral, because the reason? Unhinged. Another caller shares what happened when a vending machine break-in led to a full-on student confession… and some unexpected admin energy. We talk about what happens when the punishment doesn't match the crime and whether schools are just winging it at this point. I try to get serious (briefly) about boundaries, blame, and how kids process consequences even when the adults aren't getting it right. And for anyone trying to survive this week intact, I drop a resource that might actually help you feel like a human again. — Join our Book Club: www.patreon.com/thosewhocanread Don't Be Shy Come Say Hi: www.podcasterandrea.com Watch on YouTube: @educatorandrea A Human Content Production Learn more about your ad choices. Visit megaphone.fm/adchoices

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Cycling used to be about skill — race craft, resilience, knowing when to attack. Now? It's about looking good. Style has overtaken substance, and nowhere is that clearer than with Pas Normal Studios. In this episode, we dive into how the Copenhagen-based brand transformed high-end kit into a status symbol. It's not just clothing — it's a cultural signal. €300 bibs, curated café stops, matching socks and frame paint… Pas Normal didn't just sell apparel, they redefined what it means to “look like a cyclist.” But at what cost? We explore whether this shift elevated the sport — or hollowed it out. If you've ever felt underdressed at a group ride, this one's going to hit home.Surfshark - Online security starts with a VPN and I trust Surfshark. Go to⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://surfshark.com/roadman⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and use code roadman at checkout to get 4 extra months of Surfshark VPN.NOMIO is clinically proven to:Lower lactate levels, Reduce oxidative stress, Improve training adaptations And deliver a noticeable boost from the very first dose. Go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.drinknomio.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and check out this game changing supplement. 4iiiiReady to elevate your cycling game? Trust the 4iiii PRECISION 3+ Powermeter—precision, performance, and peace of mind, all in one.Learn more by visiting http://www.4iiii.comBIKMO Whether it's theft, damage, crashes, racing or travel, Bikmo's got your back. Their in-house claims team makes the process fast and painless, and here's the kicker — with 50% off multi-bike cover, you can protect all your bikes, and even your family's or mates' bikes, under one simple policy.Make sure you're covered - check the details in your policy docs. T&Cs apply.Head over to https://bikmo.com/uk/ and use the code ROADMAN to get covered & save money.REAPCustom Carbon Composition Bikes made in the UK. REAP's gravel bike is set to redefine gravel riding with 50mm+ tyre clearance https://reapbikes.com/

Is it normal to hold your breath when someone around you sneezes or coughs?

Normal na siguro sa magkakapatid ang paminsan-minsan na pag-aaway pero kung palaaway pa rin ang isa kahit tumanda na, parang may problema na ata. Mula pagkabata, mapang-asar at mapagkumpara na talaga si Natalie. Buti na lamang ay mapagpasensiya sina Oliver at Shanel. Sa tatlong magkakapatid, si Natalie lang ang ayaw mag-ambag sa kanilang tahanan. Hindi naman sana isyu iyon pero masyado niyang kinakalaban ang lahat dahil sa kagustuhan niyang umangat. Pakinggan ang kwento ni Shanel sa Barangay Love Stories. 

We're doing something a little different this episode: Jon got in touch with comedian Emily Wilson about her special, and got to live his Oprah fantasy and interview her about the making of her special, her time on The X Factor, and somehow kept his composure the whole time (not really).Emily's Website: https://www.therealemilywilson.com/Podcast Socials -Email: butasongpod@gmail.comFacebook: @butasongpodInstagram: @butasongpodThreads: @butasongpodNext episode: Next to Normal (2024 West End Production)!

From the vault  ✨ Feeling like you're behind in life, growing out of a friendship & why nights in are usually better than a night out, we share the things we forget are normal in our 20s (or any age). Plus, we answer an Advice With The Chicks submission that has us asking to we believe in: “the right person, wrong time”?Enjoy & we'll be back with fresh episodes for ya ear holes very soon! 

07-04-25 - Stacy Emails That Her Husband Likes Massages From Seedy Looking Places And Asks If It's Legit Or Normal - BOSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

We got real about parenting from fear, trusting your gut, and why not every kid needs therapy. It was honest funny, and a little all over the place - just how we like it.

07-04-25 - Stacy Emails That Her Husband Likes Massages From Seedy Looking Places And Asks If It's Legit Or Normal - BOSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Why are everyone's parents so weird? What happened before the moon was in our orbit? And how do we commit class war in a way that complies with Terms Of Service? We talk about these ideas and more in today's Drew & Natalie Have A Normal Conversation.• natalie & drew This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.garbagebrainuniversity.com/subscribe

Self-care podcast Exploring Female Pelvic Floor Health, Overactive and Normal Bladder Function & Sexual Health & Pelvic Floor Exercises With Kristin Parise TOPICS:: ** Exploring Female Pelvic Floor Health (10:59). ** Overactive and Normal Bladder Function (15:25). ** Sexual Health & Pelvic Floor Exercises (23:40).   NOTES:: Show notes: amberapproved.ca/podcast/589 Leave me a review at amberapproved.ca/review Email me at info@amberapproved.ca   Sign up for The Body Brilliance Workshop: https://amber-romaniuk.mykajabi.com/body-brilliance    Subscribe to newsletter: https://amber-romaniuk.mykajabi.com/newsletter-sign-up    SHOW LINKS: Coaching Savings: Save $1000 off 6-month and $2000 off 12-month Private Coaching Programs for the month of July! Click below to schedule a 30 minute Complimentary Body Freedom Consultation https://amberapproved.ca/body-freedom-consultation/  Take my free Emotional Eating Quiz here: http://amberapproved.ca/emotional-eating-quiz Listen to Episode 291 about what it's like to work with me here: http://amberapproved.ca/podcast/291/ Follow me on Instagram www.instagram.com/amberromaniuk Youtube Channel: https://www.youtube.com/@amberromaniuk/  ABOUT MY GUEST: Kristen Parise has been a physiotherapist for more than 23 years, with a graduate degree in Exercise Physiology and a Bachelor of Health Science in Physiotherapy from McMaster University. She owns Blueberry Therapy, a pelvic health and pediatric therapy clinic in Dundas, Ontario. In 2020, she received the Women of Distinction Award in the Small Business category from the YWCA. Kristen has extensive experience working with children and adults in various settings like hospitals, children's treatment centers, outpatient clinics, and home care. She is deeply committed to research and evidence-based practice, continuing to teach at McMaster University to keep up with evolving trends. Kristen specializes in pelvic health rehabilitation, treating both adults and children with issues like incontinence, pelvic pain, and sexual dysfunction. She has grown Blueberry Therapy from a small clinic into a thriving practice with many services. Passionate about meeting clients' needs, Kristen recently launched an online store offering pelvic health products. She also started The Hole Shebang Podcast, discussing topics related to pelvic health. Additionally, Blueberry Therapy has expanded with the Blueberry Nest, a space for group programs such as prenatal yoga, Blueberry Core and Floor, and Perimenopause and Yoga. In 2025, the clinic will host courses and conferences, including The Pleasure Principle: Advancing Women's Sexual Health Together Conference. Keep up with Blueberry Therapy's latest updates on Instagram @blueberrytherapypelvichealth and Facebook @blueberrytherapy.  www.blueberrytherapy.ca  @blueberrytherapypelvichealth (Instagram) MY PARTNERS: One of the things I've been working on improving is my sleep. Sleep is extremely important for many different functions in the body, yet sometimes we can have trouble falling or staying asleep. That's why, I've not only ensured my sleep hygiene practice is supportive, I have a herbal ally that I have by my bedside at night in case I wake up and am having trouble falling back to sleep. And that my friends is WishGarden Herbs Sleepy Nights which includes passionflower, skullcap and hops. It helps calm my system and helps me fall back to sleep if I wake.   Crafted for rapid absorption, WishGarden's remedies provide swift and potent benefits that you'll feel in minutes. With no fillers, gums, binders, or sugars, they harness the full strength of botanicals in their purest and most effective form.    I add a few pumps of Sleepy Nights to my water and keep it by my bedside. They also have a wide array of other amazing herbal allies to help with mood, women's hormones and MUCH more. Discover the natural power of their legendary blends by visiting WishGardenHerbs.com/NoSugarcoating  or using code NOSUGARCOATING for 20 percent off your order.

One of the most common questions chiropractors ask is, “How much should I be spending on marketing?” Unfortunately, there's no one-size-fits-all answer. Your marketing budget depends on your goals, experience, available time, and financial situation. In this episode of the Rocket Chiro Podcast, Jerry Kennedy breaks down what chiropractors need to consider when setting a smart, sustainable marketing budget. What's Normal? Most small businesses spend 5–10% of gross revenue on marketing. Growth-focused businesses often spend 10–20%. Chiropractors? Usually far less. Many operate with 2–3%, and some don't spend anything on external marketing at all. However, even if you think you're not spending on marketing, you probably are. Website hosting, domain names, print materials, business cards—it all counts. The real difference is whether you're intentionally investing in marketing or passively coasting. Why Chiropractors Often Underspend Chiropractors—especially new ones—typically have limited budgets. There's often pride in “doing it all yourself” or “growing by referral,” but this mindset can hold you back. Ironically, the time you most need to invest in marketing (early in practice) is when you usually have the least money and the least experience making smart marketing decisions. Jerry shares his own experience of starting out with a large loan. While the money helped him get set up, it also created false security and delayed asking for help. Too much money, too soon, without a strategy, can lead to poor choices. So, What Should You Spend? There's no exact number. Your marketing budget should be based on: Your practice goals Your available time and money Your marketing skills Your current momentum Don't make zero spending the goal. At the same time, don't fall for high-ticket gimmicks that promise the moon. Be intentional and strategic. Budgeting Basics for Chiropractors Do: Invest in low-cost, high-impact strategies if you're tight on funds. Understand that marketing takes either time or money—often both. Prioritize foundational strategies first (see below). Spend money when it saves you meaningful time. Don't: Gamble on expensive marketing hoping it'll “just work.” Spend money you don't have or overcommit time you can't spare. Lie to yourself about your situation. Be honest so you can plan wisely. Start with the Essentials Before jumping into fancy ads or shiny marketing campaigns, focus on your foundational marketing: A professional, patient-focused website Local SEO and Google Business Profile optimization Generating and managing online reviews Community outreach and networking Custom social media content (if you're willing to create it) These strategies are more affordable, sustainable, and effective over time. Big-ticket ads, print campaigns, and radio spots can come later—if they make sense for your goals and budget. Time vs. Money As your practice grows, your available money increases and time becomes more limited. That's when outsourcing makes more sense. For example, a new chiropractor might build their own website, while a seasoned doc is more likely to outsource that task to save time. Social media tip: Avoid paying for canned content. If you want results, you'll need to share your own personality, voice, and expertise. You can create simple content and pass it off to someone for editing and posting—but generic content won't move the needle. Short-Term vs. Long-Term Strategy Understand the type of marketing you're doing: Short-term marketing (like Google Ads or in-person networking) can generate fast results. Long-term marketing (like SEO or relationship building) builds momentum over time. Ideally, your strategy should include both. Just be clear about your goals so you can match your budget and efforts accordingly. Avoid the Comparison Trap Don't compare your marketing budget or practice stats to other chiropractors without context. Chiropractors often exaggerate their numbers. Even if the numbers are real, you don't know the whole story. Jerry shares a story about a friend with a big, multi-doc practice who grossed 3–4x what Jerry did. But after expenses, the friend only brought home a few thousand more per month—and carried far more stress. Bigger isn't always better. Final Thoughts There's no magic number. The right marketing budget for your chiropractic practice is the one that fits your situation, supports your goals, and delivers a positive return on investment. Start with foundational strategies. Be realistic about where you are. Invest smart, not just big. Don't spend money to impress anyone—especially not other chiropractors. Smart chiropractors make intentional decisions, track ROI, and stay focused on long-term success—not short-term ego boosts.   Want Help Growing Your Practice? Jerry offers business coaching, website design, SEO, and Google Ads services specifically for chiropractors. If you're ready for less stress and more momentum, visit RocketChiro.com. Free Website/SEO Review: https://rocketchiro.com/chiropractic-practice-assessment Best chiropractic websites: https://rocketchiro.com/best-chiropractic-websites Chiropractic SEO: https://rocketchiro.com/chiropractic-seo Coaching for Chiropractors: https://rocketchiro.com/join

Despite what influencers might be spouting on social media, bloating - like PAINFUL bloating - is NOT normal. Of course we all grow a little bit when we eat food or drink liquids (cause it has to go somewhere!), but if you're suffering from painful bloating, uncomfortable gas, constipation, or diarrhea, that is most certainly not normal. And if you listened to this episode and thought "yup, that sounds like me," head to bit.ly/rockthebloat to get started on my Rock the Bloat Minicourse! --- Show Notes: Sign up for a 1:1 Discovery Call Join the Imperfectly Paige Wellness Community Join the Compass Method DIY Program Jump inside my Rock the Bloat Minicourse Get my Core-Gi Workout Program with the exclusive listener discount! Join my Brain Rewiring Masterclass You can learn more about me by following on IG @imperfectlypaigewellness or by checking out my blog, freebies, and offers on my website: https://imperfectlypaigewellness.com Please share with #PaigeTalksWellness to help get the word out about the show - and join the Imperfect Health Fam over on Facebook.

Is your fatigue actually normal? What about that monthly mood swing, that bloating after meals, or the constant joint pain you've started to joke about? In this direct, no-nonsense episode, Dr. Danielle challenges the cultural lie that “common” means “normal.” You'll discover how these everyday annoyances are your body's early warning signals — signals you can't afford to ignore if you want to prevent bigger health problems down the road. Dr. Danielle shares patient stories, breaks down what true root-cause care looks like, and offers practical next steps you can take today. Don't settle for a band-aid approach to your health — listen in and learn how to finally demand better for yourself.SERVICES & MEMBERSHIPS:$7 Mentorship: How to Fix Your Energy, Cravings, and Mood in Just One Day

In this week's sermon, Pastor Nate dives into the life of David—not just the giant-slayer, but the shepherd, warrior, worshipper, and flawed king with a heart after God. From battlefield bravery to backroom blunders, the Book of David shows us that God uses imperfect people to fulfill His perfect plans. There are plenty of "did that really happen?" moments as we uncover what makes David's story so relatable and powerful today. Sean is out so Nate and Adam keep the ball rolling for the Normal everyday Christian. ▶️ Nate's Message on YouTube: https://tinyurl.com/ytp4e3df

Normal pressure hydrocephalus (NPH) is a clinical syndrome characterized by the triad of gait apraxia, cognitive impairment, and bladder dysfunction in the radiographic context of ventriculomegaly and normal intracranial pressure. Accurate diagnosis requires consideration of clinical and imaging signs, complemented by tests to exclude common mimics. In this episode, Lyell Jones, MD, FAAN speaks with Abhay R. Moghekar, MBBS, author of the article “Clinical Features and Diagnosis of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. 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. Moghekar is an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Clinical Features and Diagnosis of Normal Pressure Hydrocephalus 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: @LyellJ 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 Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Abhay Moghekar, who recently authored an article on the clinical features and diagnosis of normal pressure hydrocephalus for our first-ever issue of Continuum dedicated to disorders of CSF dynamics. Dr Moghekar is an associate professor of neurology and the research director of the Cerebrospinal Fluid Center at Johns Hopkins University in Baltimore, Maryland. Dr Moghekar, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Moghekar: Thank you, Dr Jones. I'm Abhay Moghekar. I'm a neurologist at Hopkins, and I specialize in seeing patients with CSF disorders, of which normal pressure hydrocephalus happens to be the most common. Dr Jones: And let's get right to it. I think most of our listeners who are neurologists in practice have encountered normal pressure hydrocephalus, or NPH; and it's a challenging disorder for all the reasons that you outline in your really outstanding article. If you were going to think of one single most important message to our listeners about recognizing patients with NPH, what would that be? Dr Moghekar: I think I would say there are two important messages. One is that the triad is not sufficient to make the diagnosis, and the triad is not necessary to make the diagnosis. You know these three elements of the triad: cognitive problems, gait problems, bladder control problems are so common in the elderly that if you pick 10 people out in the community that have this triad, it's unlikely that even one of them has true NPH. On the other hand, you don't need all three elements of the triad to make the diagnosis because the order of symptoms matters. Often patients develop gait dysfunction first, then cognitive dysfunction, and then urinary incontinence. If you wait for all three elements of the triad to be present, it may be too late to offer them any clear benefit. And hence, you know, it's neither sufficient nor necessary to make the diagnosis. Dr Jones: That's a really great point. I think most of our listeners are familiar with the fact that, you know, we're taught these classic triads or pentads or whatever, and they're rarely all present. In a way, it's maybe a useful prompt, but it could be distracting or misleading, even in a way, in terms of recognizing the patient. So what clues do you use, Dr Moghekar, to really think that a patient may have NPH? Dr Moghekar: So, there are two important aspects about gait dysfunction. Say somebody comes in with all three elements of the triad. You want to know two things. Which came first? If gate impairment precedes cognitive impairment, it's still very likely that NPH is in the differential. And of the two, which are more- relatively more affected? So, if somebody has very severe dementia and they have a little bit of gait problems, NPH is not as likely. So, is gait affected earlier than cognitive dysfunction, and is it affected to a more severe degree than cognitive dysfunction? And those two things clue me in to the possibility of NPH. You still obviously need to get imaging to make sure that they have large ventricles. One of the problems with imaging is large ventricles are present in so many different patients. Normal aging causes large ventricles. Obviously, many neurodegenerative disorders because of cerebral atrophy will cause large ventricles. And there's an often-used metric called as the events index, which is the ratio of the bitemporal horns- of the frontal horns of the lateral ventricles compared to the maximum diameter of the skull at that level. And if that ratio is more than 0.3, it's often used as a de facto measure of ventriculomegaly. What we've increasingly realized is that this ratio changes with age. And there's an excellent study that used the ADNI database that looked at how this ratio changes by age and sex. So, in fact, we now know that an 85-year-old woman who has an events index of 0.37 which would be considered ventriculomegaly is actually normal for age and sex. So, we need to start adopting these more modern age- and sex-appropriate age cutoffs of ventriculomegaly so as not to overcall everybody with big ventricles as having possible NPH. Dr Jones: That's very helpful. And I do want to come back to this challenge that we've seen in our field of overdiagnosis and underdiagnosis. But I think most of us are familiar with the concept of how hydrocephalus could cause neurologic deficits. But what's the latest on the mechanism of NPH? Why do some patients get this and others don't? Dr Moghekar: Very good question. I don't think we know for sure. And it for a long time we thought it was a plumbing issue. Right? And that's why shunts work. People thought it was impaired CSF absorption, but multiple studies have shown that not to be true. It's likely a combination of impaired cerebral blood flow, biomechanical factors like compliance, and even congenital factors that play a role in the pathogenesis of NPH. And yes, while putting in shunts likely drains CSF, putting in a shunt also definitely changes the compliance of the brain and affects blood flow to the subcortical regions of the brain. So, there are likely multiple mechanisms by which shunts benefit, and hence it's very likely that there's no single explanation for the pathogenesis of NPH. Dr Jones: We explored this in a recent Continuum issue on dementia. Many patients who have cognitive impairment have co-pathologies, multiple different causes. I was interested to read in your article about the genetic risk profile for NPH. It's not something I'd ever really considered in a disorder that is predominantly seen in older patients. Tell us a little more about those genetic risks. Dr Moghekar: Yeah, everyone is aware of the role genetics plays in congenital hydrocephalus, but until recently we were not aware that certain genetic factors may also be relevant to adult-onset normal pressure hydrocephalus. We've suspected this for a long time because nearly half of our patients who come to us to see us in clinic with NPH have head circumferences that are more than 90th percentile for height. And you know, that clearly indicates that this started shortly at the time after birth or soon afterwards. So, we've suspected for a long time that genetic factors play a role, but for a long time there were not enough large studies or well-conducted studies. But recently studies out of Japan and the US have shown mutations in genes like CF43 and CWH43 are disproportionately increased in patients with NPH. So, we are discovering increasingly that there are genetic factors that underlie even adult onset in patients. There are many more waiting to be discovered. Dr Jones: Really fascinating. And obviously getting more insight into the risk and mechanisms would be helpful in identifying these patients potentially earlier. And another thing that I learned in your article that I thought was really interesting, and maybe you can tell us more about it, is the association between normal pressure hydrocephalus and the observation of cervical spinal stenosis, many of whom require decompression. What's behind that association, do you think? Dr Moghekar: That's a very interesting study that was actually done at your institution, at Mayo Clinic, that showed this association. You know, as we all get older, you know, the incidence of cervical stenosis due to osteoarthritis goes up, but the incidence of significant, clinically significant cervical stenosis in the NPH population was much higher than what we would have expected. Whether this is merely an association in a vulnerable population or is it actually causal is not known and will need further study. Dr Jones: It's interesting to speculate, does that stenosis affect the flow of CSF and somehow predispose to a- again, maybe a partial degree for some patients? Dr Moghekar: Yeah, which goes back to the possible hydrodynamic theory of normal pressure hydrocephalus; you know, if it's obstructing normal CSF flow, you know, are the hydrodynamics affected in the brain that in turn could lead to the development of hydrocephalus. Dr Jones: One of the things I really enjoyed about your article, Abhay, was the very strong clinical focus, right? We can't just take an isolated biomarker or radiographic feature and rely on that, right? We really do need to have clinical suspicion, clinical judgment. And I think most of our listeners who've been in practice are familiar with the use and the importance of the large-volume lumbar puncture to determine who may have, and by exclusion not have, NPH, and then who might respond to CSF diversion. And I think those of us who have been in this situation are also familiar with the scenario where you think someone may have NPH and you do a large-volume lumbar puncture and they feel better, but you can't objectively see a difference. How do you make that test useful and objective in your practice? What do you do? Dr Moghekar: Yeah, it's a huge challenge in getting this objective assessment done carefully because you have to remember, you know, subconsciously you're telling the patients, I think you have NPH. I'm going to do this spinal tap, and if you walk better afterwards, you're going to get a shunt and you're going to be cured. And you can imagine the huge placebo response that can elicit in our subjects. So, we always like to see, definitely, did the patient subjectively feel better? Because yes, that's an important metric to consider because we want them to feel better. But we also wanted to be grounded in objective truths. And for that, we need to do different tests of speed, balance and endurance. Not everyone has the resources to do this, but I think it's important to test different domains. Just like for cognition, you know, we just don't test memory, right? We test executive function, language, visuospatial function. Similarly, walking is not just walking, right? It's gait speed, it's balance, and it's endurance. So, you need to ideally test at least most of these different domains for gait and you need to have some kind of clear criteria as to how are you going to define improvement. You know, is a 5% improvement, is a 10% improvement in gait, enough? Is 20%? Where is that cutoff? And as a field, we've not done a great job of coming up with standardized criteria for this. And it varies currently, the practice varies quite significantly from center to center at the current time. Dr Jones: So, one of the nice things you had in your article was helpful tips to be objective if you're in a lower-resource setting. For you, this isn't a common scenario that someone encounters in their practice as opposed to a center that maybe does a large volume of these. What are some relatively straightforward objective measures that a neurologist or someone else might use to determine if someone is improving after a large-volume LP? Dr Moghekar: Yeah, excellent question, Dr Jones, and very practically relevant too. So, you need to at least assess two of the domains that are most affected. One is speed and one is balance. You know, these patients fall ultimately, right, if you don't treat them correctly. In terms of speed, there are two very simple tests that anybody can do within a couple of minutes. One is the timed “up-and-go” test. It's a test that's even recommended by the CDC. It correlates very well with faults and disability and it can be done in any clinic. You just need about ten feet of space and a chair and a stopwatch, and it takes about a minute or slightly more to do that test. And there are objective age-associated norms for the timed up-and-go test, so it's easy to know if your patient is normal or not. The same thing goes for the 10-meter walk test. You do need a slightly longer walkway, but it's a fairly easy and well-standardized test. So, you can do one of those two; you don't need to do both of them. And for balance, you can do the 30-second “sit-to-stand”; and it's literally, again, 30 seconds. You need a chair, and you need somebody to watch the patient and see how many times they can sit up and stand up from a seated position. Then again, good normative data for that. If you want to be a little more sophisticated, you can do the 4-stage balance test. So, I think these are tests that don't add too much time to your daily assessment and can be done with even trained medical assistants in any clinic. And you don't need a trained physical therapist to do these assessments. Dr Jones: Very practical. And again, something that is pretty easily deployed, something we do before and then after the LP. I did see you mentioned in your article the dual timed up-and-go test where it's a simultaneous gait and executive function test. And I've got to be honest with you, Dr Moghekar, I was a little worried if I would pass that test, but that may be beyond the scope of our time today. Actually, how do you do that? How do you do the simultaneous cognitive assessment? Dr Moghekar: So, we asked them to count back from 100, subtracting 3. And we do it particularly in patients who are mildly impaired right? So, if they're already walking really good, but then you give them a cognitive stressor, you know, that will slow them down. So, we reserve it for patients who are high-performing. Dr Jones: That's fantastic. I'm probably aging myself a little here. I have noticed in my career, a little bit of a pendulum swing in terms of the recognition or acceptance of the prevalence of normal pressure hydrocephalus. I recall when I was a resident, many, many people that we saw in clinic had normal pressure hydrocephalus. Then it seemed for a while that it really faded into the background and was much less discussed and much less recognized and diagnosed, and less treated. And now that pendulum seems to have swung back the other way. What's behind that from your perspective? Dr Moghekar: It's an interesting backstory to all of this. When the first article about NPH was published in the Newman Journal of Medicine, it was actually a combined article with both neurologists and neurosurgeons on it. They did describe it as a treatable dementia. And what that did is it opened up the floodgates so that everybody with any kind of dementia started getting shunts left, right, and center. And back then, shunts were not programmable. There were no antibiotic impregnated catheters. So, the incidence of subdural hematomas and shunt-related infections was very high. In fact, one of our esteemed neurologists back then, Houston Merritt, wrote a scathing editorial that Victor and Adam should lose their professorships for writing such an article because the outcomes of these patients were so bad. So, for a very long period of time, neurologists stopped seeing these patients and stopped believing in NPH as a separate entity. And it became the domain of neurosurgeons for over two or three decades, until more recently when randomized trials started being done early on out of Europe. And now there's a big NIH study going on in the US, and these studies showed, in fact, that NPH exists as a true, distinct entity. And finally, neurologists have started getting more interested in the science and understanding the pathophysiology and taking care of these patients compared to the past. Dr Jones: That's really helpful context. And I guess that maybe isn't rare when you have a disorder that doesn't have a simple, straightforward biomarker and is complex in terms of the tests you need to do to support the diagnosis, and the treatment itself is somewhat invasive. So, when you talk to your patients, Dr Moghekar, and you've established the diagnosis and have recommended them for CSF diversion, what do you tell them? And the reason I ask is that you mentioned before we started recording, you had a patient who had a shunt placed and responded well, but continued to respond over time. Tell us a little bit more about what our patients can expect if they do have CSF diversion? Dr Moghekar: When we do the spinal tap and they meet our criteria for improvement and they go on to have a shunt, we tell them that we expect gait improvement definitely, but cognitive improvement may not happen in everyone depending on what time, you know, they showed up for their assessment and intervention. But we definitely expect gait improvement. And we tell them that the minimum gait improvement we can expect is the same degree of improvement they had after their large-volume lumbar puncture, but it can be even more. And as the brain remodels, as the hydrodynamics adapt to these shunts… so, we have patients who continue to improve one year, two years, and even three years into the course of the intervention. So, we're, you know, hopeful. At the same time, we want to be realistic. This is the same population that's at risk for developing neurodegenerative disorders related to aging. So not a small fraction of our patients will also have Alzheimer's disease, for example, or go on to develop Lewy body dementia. And it's the role of the neurologist to pick up on these comorbid conditions. And that's why it's important for us to keep following these patients and not leave them just to the neurosurgeon to follow up. Dr Jones: And what a great note to end on, Dr Moghekar. And again, I want to thank you for joining us, and thank you for such a wonderful discussion and such a fantastic article on the clinical diagnosis of normal pressure hydrocephalus. I learned a lot reading the article, and I learned a lot more today just in the conversation with you. So, thank you for being with us. Dr Moghekar: Happy to do that, Dr Jones. It was a pleasure. Dr Jones: Again, we've been speaking with Dr Abhay Moghekar, author of a wonderful article on the clinical features and diagnosis of NPH in Continuum's first-ever issue dedicated to disorders of CSF dynamics. 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. 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.

David Murphy, RTÉ Economics and Public Affairs Editor, looks ahead to a meeting of the Government Trade Forum.

 Listen to the Show Right Click to Save GuestsTex Arts Bye Bye BirdieFly Unfeathered Divine Carnival What We Talked About   Etoile Evita Balcony Scene Sandy Knox Suff's for High School Masquerade Come back to the five & Dime Jimmy Dean The Bro Show Jynx Monsoon – Oh Mary New Hampshire funding! Jimmys Thank you to Dean Johanesen, lead singer of "The Human Condition" who gave us permission to use "Step Right Up" as our theme song, so please visit their website.. they're good! (that's an order)

I feel like there is this shift in what used to be the habits and routines of “extreme biohackers” or “health gurus” and now those same things have become part of a lifestyle that people are adapting to make it their new healthy normal.    What we eat, how we move, what we focus on, how we approach health & supplements & body recovery, having a low stress lifestyle - all of it.    This is - my opinion - the best ever cultural shift… because it makes us all healthier, happier in our day to day because we feel great and we will live longer and age better.   In this episode I'm breaking down the habits and ideas that play into this new healthy normal.   Whether you're just starting or refining your routine, this is your blueprint for building a healthy lifestyle that feels good and becomes your new normal.     Let's break it down this way...   -What we eat    -How we move    -What we focus on / headspace / love / low stress    -How we approach health & supplements & body recovery     

Hey, welcome to Thumb Cramps, a normal video game review podcast hosted by Joel Duscher and Jackson Baly (Gamers). Like all normal podcasts, it has come to their attention that people have been crying out for an introduction to the podcast that is easy to listen to; so here it is, A Beginners Guide To Thumb Cramps.Thumb Cramps+ has launched! Ad-free podcasts and a bonus monthly episode of Speedrunning Television; a brand new podcast that innovates how to watch television as gamers. Subscribe now on Sanspants Plus OR Apple Podcasts! Email us at ThumbCrampsPod@gmail.com Find us on Instagram;Jackson | Duscher | Thumb CrampsWatch us on Twitch;Jackson | Duscher | Sanspants RadioYou can physically send us stuff to PO BOX 7127, Reservoir East, Victoria, 3073.Join our facebook group here or join our Discord here.Theme music by Benny Davis! You can find all his stuff at his website or check out his YouTube channel. Hosted on Acast. See acast.com/privacy for more information.

In this episode, our hosts dive into the extremes of bodybuilding prep—what's truly ‘normal' and what might actually be a red flag. In a sport known for pushing limits, it can be hard to tell the difference. Tune in as they unpack common themes and shed light on what competitors should accept—and what they shouldn't.

Send us a textIn this special "minisode" of Your Child is Normal, Dr. Jessica Hochman answers four of the most common summer questions she hears from parents:– Is it normal if my kid doesn't drink much water?– Why does my child get constipated when we travel?– What if my child refuses sunscreen?– How do I prevent motion sickness in the car?The goal is to help parents learn practical tips of normal parent concerns to help you feel more prepared during the summer months.Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner. For more content from Dr Jessica Hochman:Instagram: @AskDrJessicaYouTube channel: Ask Dr JessicaWebsite: www.askdrjessicamd.com-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20-To test your child's microbiome and get recommendations, check out: Tiny Health using code: DRJESSICA Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Erin is back in Santa Fe for a limited time, dropping off all her Vancouver luggages, and Bryan is still without a kitchen and has a new eye diagnosis. Bryan covers the recent Supreme Court case United States v. Skrmetti which upheld a Tennessee ban on gender-afffirming care. Erin examines the appeal being brought to the high court regarding New Jersey's First Choice Women's Center and New Jersey Attorney General Matthew Platkin's attempts to find out who is funding these pro-life pregnancy resource centers. For tickets to Bryan's Edinburgh shows visit www.bryansafi.comSee omnystudio.com/listener for privacy information.