Podcasts about nrs

Empowering Small Retailers: NRS Plus Revolutionizes Independent Store Success https://NRSplus.com/ About the Guest(s): Elie Katz is the President and CEO of National Retail Solutions (NRS), a company dedicated to empowering independent convenience stores, liquor stores, tobacco shops, and gas stations across the U.S. With extensive experience as an executive in diverse industries, Ellie utilizes his strong leadership and organizational skills to drive NRS since its inception, under the subsidiary of IDT. NRS provides an advanced point of sale, network, and credit card processing ecosystem servicing over 35,000 retail locations. Elie Katz is also involved in managing real estate and food establishments, showcasing his deep understanding of business growth and investment. Episode Summary: In this episode of the Chris Voss Show, Chris hosts Elie Katz, President and CEO of National Retail Solutions. Elie Katz’s journey in establishing NRS as a beacon for small retailers is explored in depth, alongside discussions on how NRS provides advanced solutions to help independent retailers compete effectively. From revolutionary point of sale systems to integrations with platforms like DoorDash and Uber Eats, Elie Katz outlines how his organization facilitates digital transformation for small businesses in an increasingly competitive market. Listeners are offered a firsthand understanding of how NRS’s tailored solutions are leveling the playing field for independent retailers across the United States. Elie Katz elaborates on NRS’s latest initiatives, including the expansion of premium features and AI product recommendations that streamline operations and enhance consumer engagement. The discussion also dives into security innovations like the company’s patented panic alarm and strategies for digital transformation, which are not just theoretical but ingrained into the ethos at NRS. Elie Katz’s insights into focus and execution in leadership highlight pivotal lessons that are not only applicable to existing retailers but inspiring to aspiring entrepreneurs as well. Discover the evolving dynamics in retail and learn how to remain relevant and successful through adaptive strategies in this engaging episode. Key Takeaways: NRS empowers over 35,000 independent retailers across the U.S. with state-of-the-art POS systems and service integrations. Elie Katz’s leadership philosophy emphasizes understanding pain points, focus, and execution to drive company growth and customer satisfaction. NRS’s AI product recommendations help retailers optimize inventory and pricing, vital in today’s economy. Partnerships with major companies like DoorDash and GrubHub expand customer reach for neighborhood retailers. Innovations like the panic alarm showcase NRS’s commitment to retailer security and business continuity. Notable Quotes: “Small retailers have to stay in the game, especially in today’s economy.” “Focus and get it done. You can’t pay your bills with excuses.” “We’ve got to keep up with the AI transformation, or you risk being left behind.” “Digital transformation isn’t just necessary—it’s vital for survival in today’s competitive market landscape.” “Every feature we add aims at one goal: helping small businesses become more efficient.”

Today on the Advancing Nitrogen Smart podcast we speak in-depth about the recently-revised Minnesota Nutrient Reduction Strategy with Matt Drewitz from the Minnesota Pollution Control Agency. What are the goals of the MN Nutrient Reduction Strategy, and how are they being addressed specifically? Are we on track to meet our objectives? How have environmental changes over the years affected our progress? How have wastewater treatment plants contributed to the effort, and what have we learned from them? What kinds of other practices can be leveraged to meet the goals of the NRS, and how should farmers approach these ideas? Who's a farmer's point of contact with questions about adopting these practices? All of this on today's episode, recorded on the road from the recently held Nutrient Management Conference in Mankato, MN.Guests:Brad Carlson, Extension educator (Mankato)Matt Drewitz Minnesota Pollution Control Agency, (St. Paul)Additional resources:Minnesota Nutrient Reduction StrategyOne Watershed, One PlanAddressing nitrate in southeastern MinnesotaThe state of Minnesota's soil health: How many farmers are doing no-till, cover crops, and moreEdge of field N and P reduction strategies: What to know about conservation drainage practicesVideos of the 2026 Nutrient Management and Nitrogen Conference presentations are now available---For the latest nutrient management information, subscribe to the Nutrient Management Podcast. And don't forget to subscribe to the Minnesota Crop News daily or weekly email newsletter, subscribe to our YouTube channel, like UMN Extension Nutrient Management on Facebook, follow us on X (formerly twitter), and visit our website.If you have questions or comments, please email us at nutmgmt@umn.edu.Advancing Nitrogen Smart is proud to be supported by the farm families of Minnesota and their corn check-off investment through Minnesota Corn.

This podcast is the audio version of the Gear Garage Live Show, where Zach answers submitted questions and talks all things whitewater. In this episode, Zach dives deep into river safety "rants," analyzes rescue videos, and discusses the importance of professional training for both private boaters and aspiring guides. Zach begins the show by announcing new one-day rescue clinics offered by Northwest Rafting Company. These clinics are designed as a "palatable" way for private boaters to gain experience in specific areas like mechanical advantage and throw bags without committing to a full three-day course. He also shares a personal "safety rant," emphasizing that while some may call him a "safety squirrel," his access to non-public incident reports drives his passion for teaching rescue techniques. A significant portion of the episode is dedicated to video analysis. Zach reviews footage of a "pushing move" gone wrong, explaining why aggressive maneuvers can leave boaters exposed and sideways to obstacles. He suggests that many situations are better handled by pulling or using a "ferry" to maintain control. He also reviews a rescue scenario in flat water, cautioning against the reflexive use of throw ropes which can create dangerous tangles in the water. The discussion also touches on gear essentials, particularly PFD selection. Zach notes that while many kayakers prefer low-profile vests for agility, rafters—especially larger individuals—benefit from higher flotation models like the Astral Indus or specific NRS rescue vests. He concludes with a reminder that professional growth in the industry requires "time on the water," recommending programs like the Class III Rowing School for those looking to build a solid foundation. Topics and links that Zach talked about in this episode Training: Northwest Rafting Company Rescue Clinics and Class III Rowing School. Gear: PFD selection and the dangers of ropes in flat water rescues. Safety: Using your voice as a rescue tool (Speech, Reach, Throw, Row, Go).

Elie Y. Katz, Founder, President & CEO of National Retail Solutions (NRS), joined Doug Green, Publisher of Technology Reseller News, for a wide-ranging conversation about what's changing right now for independent convenience stores—and why technology partners should be paying attention. Katz opened with a candid, real-world story from home that set the tone for the episode: small-business life is relentless, unpredictable, and personal. “I'm here, ready to roll… and tell them about National Retail Solutions and how we could help them make more money and put more money in their pocket,” he said—framing NRS as both a technology provider and a support system for business owners who are often juggling everything themselves. NRS serves the “onesies, twosies” of retail: independent convenience stores, bodegas, and similar single-operator businesses. Katz said NRS has deployed more than 40,000 point-of-sale registers across the U.S., supporting stores that compete daily against national chains with far deeper resources. The discussion highlighted how these stores—often located at street level in dense neighborhoods—are increasingly becoming the preferred option for shoppers who want convenience, familiarity, and a sense of safety. A key theme was how consumer behavior shifts can quickly reshape revenue. Katz noted that many NRS-supported stores are seeing strong growth in e-commerce and delivery, enabled by POS integrations that connect store inventories to their own websites and to marketplaces like DoorDash and Grubhub. In his view, this is a repeatable pattern: during COVID, convenience stores went from shutdown panic to becoming essential community hubs, and those that embraced digital ordering surged. “The ones that were smart enough to be hooked into online ordering and the marketplaces… they thrived,” Katz said. Green and Katz also explored what Katz called a “quiet revolution” inside these neighborhood businesses—moving from cash-first operations to modern payment methods, loyalty programs, and digitally enabled workflows. Katz argued that the next generation of customers expects to order, pay, and interact through mobile experiences, and retailers that resist change risk getting left behind. “If you don't want to embrace the technology… you're going to wake up like Blockbuster, Kodak, Yahoo,” he warned. The conversation also covered safety and risk reduction, especially for stores operating in high-crime environments. Katz pointed to a patented feature built into NRS registers: a “panic alarm” workflow that can silently alert police in the event of a robbery while opening the cash drawer to comply with demands. “We have a patented alarm system embedded in our point of sale register… the drawer opens up and a silent alarm goes to the police department,” he said. Beyond POS, Katz positioned NRS as a broader financial and operational services provider for small businesses, including credit card processing, cash advance services to help with cash flow, and payroll services. His message to the channel was direct: technology resellers already have trusted relationships with Main Street businesses, and those relationships can translate into new revenue streams. “They're leaving money on the table by not taking advantage of the fact that they're trusted already by their customer,” Katz said. Finally, Katz emphasized that NRS wraps these capabilities with what he described as “white glove, back-of-house assistance,” helping store owners navigate programs, compliance issues, and operational setup—critical for owners who are often, as he put it, “the employee of the month, the pot washer, the HR person, head of legal, head of purchasing.” To learn more, visit https://nrsplus.com/. Katz also noted there is a “contact the CEO” option at the bottom of the site for direct outreach.

We're kicking off the New Year for Equine Affaire with a little visit on the Western Side of things! Today, we're chatting with Zoe Woodland, a cutting horse & cow work trainer, and Jason Brooks, vice president of marketing for National Roper's Supply. Zoe will be presenting as part of Cowtown in Cooper, sponsored by Western Life Today, and NRS will be exhibiting with us in the Bricker Building! Horses in the Morning Episode 3863 - Show Notes & Links: Hosts: Allison Rehnborg and Glenn the GeekTitle Sponsor: Equine AffaireGuest: Zoe Woodland of Zoe Woodland Performance Horses | FacebookGuest: Jason Brooks of NRS | FacebookTo subscribe, search Horses in the Morning OR Equine Affaire in your favorite podcast player!Equine Affaire on FacebookHorses In The Morning on FacebookTIMESTAMPS:12:40 - Zoe Woodland27:28 - Jason Brooks

We're kicking off the New Year for Equine Affaire with a little visit on the Western Side of things! Today, we're chatting with Zoe Woodland, a cutting horse & cow work trainer, and Jason Brooks, vice president of marketing for National Roper's Supply. Zoe will be presenting as part of Cowtown in Cooper, sponsored by Western Life Today, and NRS will be exhibiting with us in the Bricker Building! Horses in the Morning Episode 3863 - Show Notes & Links: Hosts: Allison Rehnborg and Glenn the GeekTitle Sponsor: Equine AffaireGuest: Zoe Woodland of Zoe Woodland Performance Horses | FacebookGuest: Jason Brooks of NRS | FacebookTo subscribe, search Horses in the Morning OR Equine Affaire in your favorite podcast player!Equine Affaire on FacebookHorses In The Morning on FacebookTIMESTAMPS:12:40 - Zoe Woodland27:28 - Jason Brooks

 Welcome to ROADSIDE presented by Zwift!    In today's episode, Tom and Jet catch up with Jayco AlUla climbing star, Ben O'Connor. The boys discuss Ben's World Tour career and the different hurdles that were presented to him along the way. Ben details the moment he knew he could be one of the best riders in the world and what goes through your mind when your about to win your first Tour de France stage. The boys also chat Netflix, NRS, Boxing Day Papas and the upcoming 2026 Aussie Summer.   Zwift Mailbag: Send in your questions, hypotheticals, takes and everything in between to jet@roadsidepod.com and we will read the best ones out in the next episode!   -  -    The Roadside Cycling Show is presented by Zwift   Need a trainer? Try the all-new Zwift Ride - zwiftinc.sjv.io/55gL11 Head to https://www.zwift.com/ to start your free 14-day trial today. The Roadside Cycling Show is also supported by FE Sports, the home of premier cycling brands and products such as Wahoo, Pirelli, 100%, Campagnolo and more. Check out their range now - https://www.fesports.com.au/Shop/c_230/Products 

Doug Green, Publisher of Technology Reseller News, sat down with Elie Y. Katz, Founder, President & CEO of National Retail Solutions (NRS), to discuss how payments, telecom, and point-of-sale technology are converging to reshape small and independent businesses. Katz explained how NRS, incubated within IDT, was created to give independent convenience stores and small merchants the same tools and insights long available to large national chains. At the center of NRS's success is its integrated point-of-sale platform, now deployed in more than 38,000 locations nationwide. Katz described how NRS combines POS, credit card processing, payroll, cash advance services, and telecom products into a single system. “We didn't just build a register,” Katz said. “We built a platform that lets independent merchants compete with corporate America.” The conversation highlighted the accelerating shift away from cash toward cards, mobile wallets, and peer-to-peer payment apps such as Venmo and Zelle—especially among younger consumers. Katz noted that safety, efficiency, and cost are driving merchants toward cashless or low-cash environments. “The phone has become the bank,” he said, pointing to how mobile payments are now central to everyday commerce. Katz also outlined the opportunity this shift creates for telecom channel partners, MSPs, and resellers. By leveraging existing customer relationships, partners can expand into POS, payment processing, payroll, and cash advance services through NRS. “If you didn't pivot, you went out of business,” Katz said. “Our platform gives channel partners a new stream of recurring revenue using relationships they already have.” Finally, Katz detailed NRS's growing ecosystem of integrations, including DoorDash, Grubhub, and NationsBenefits, which help independent merchants increase revenue and compete more effectively. With offerings like NRSPay and flexible, no-penalty credit card processing, NRS is positioning itself as a long-term partner for small businesses navigating the transition to a digital, cashless economy. For more information, visit https://nrsplus.com/.

Send us a textMikey sits down with Craig Caudill of Nature Reliance School live at the Georgia Bushcraft Fall Gathering and queries Craig about his childhood, the pillars of NRS and his catalog of work!https://www.naturereliance.org/https://ltwrightknives.com/https://www.woodsmonkey.com/Support the showSupport the show

“Hard to get a customer — but once you have that customer, sell them something else.” — Elie Y. Katz, Founder, President & CEO, National Retail Solutions (NRS) In this Technology Reseller News podcast, Doug Green, Publisher of TR Publications, speaks with Elie Y. Katz, CEO of National Retail Solutions (NRS), about how NRS is helping small businesses compete with national chains — and why telecom resellers and MSPs are perfectly positioned to benefit from a new wave of retail technology opportunities. NRS, a division of IDT, began as a mission to modernize small, independent convenience stores through affordable, easy-to-use point-of-sale (POS) systems. A decade later, NRS has more than 38,000 units deployed nationwide, helping merchants streamline sales, manage operations, and now — expand digitally through DoorDash and Grubhub integrations. What started as a POS platform has evolved into a full suite of business services — including NRSPay for transparent, no-contract credit card processing, NRS Purple Payroll for affordable payroll solutions, and cash advance programs that help small businesses stay liquid and grow. Katz is now calling on telecom resellers and channel partners to leverage their trusted customer relationships and add new, high-margin offerings. “Every one of your customers needs credit card processing, payroll, or better cash flow. We make it simple, transparent, and profitable — for you and them,” he explained. With NRS, partners can expand beyond telecom into broader small-business enablement — reaching industries from convenience stores and retailers to medical, dental, legal, and service-based businesses. “The hardest part of sales is building trust. Our resellers already have that trust — now it's time to build on it,” Katz added. To learn more about partnership opportunities, visit SellNRS.com or explore NRS solutions at NRSPlus.com. Software Mind Telco Days 2025: On-demand online conference Engaging Customers, Harnessing Data

Vi snakker med Jon Nordby ("Head of Data Science" i Soundsensing) og Lars Henry Berge Olsen (forsker på NR): Hvordan utvikler Soundsensing prediktiv feildeteksjon for næringseiendommer? Og hva er egentlig forskjellen på avviksdeteksjon og feildeteksjon? Dette jobber vi med i "EarOnEdge" – som står for "On-Edge Anomaly Detection in Machinery Using Sound as a Data Source". EarOnEdge er et såkalt Innovasjonsprosjekt i Næringslivet (IPN) og finansiert av Norges forskningsråd. Prosjektet utvikles i direkte samarbeid med brukergruppen med Malling & Co AS som kompetansepartner for drift og forvaltning av bygg. I prosjektet jobber NRs forskere med kompetanse på maskinlæring og statistisk modellering sammen med Soundsensing for å utvikle bedre algoritmer for feildeteksjon for næringseiendommer. EarOnEdge kan bidra til at Soundsensing får et stort internasjonalt marked om noen år.Sannsynligvis VIKTIG er en serie om KI og digitalisering av Norsk Regnesentral, Anders Løland er programleder, gjesteopptreden av Sigurd Rønning. Produsent: Elin Ruhlin Gjuvsland.Musikk: Ivan Ohanezov, pixabay.comhttps://nr.no

"At RX, we celebrate failure, which is kind of a strange thing to say," said RX CEO Hugh Jones on the November 2025 edition of Trade Show Talk.  Why?   "Failure is actually a part of the executive process and making great choices," he said In this episode, Host Danica Tormohlen delves into this topic and more with Jones, who shares the company's recent growth and strategic bets in the trade show industry.   Jones discusses a broad range of topics, including RX's expansion into Saudi Arabia, digital product development, and the importance of celebrating failures to drive innovation and leadership.   For context: RX, a division of public company RELX and ranked No. 2 on the Stax Top 20 Exhibition Organizers List (by revenues), produced 282 face-to-face events in 25 countries in 2024, and these events served 41 industry sectors and attracted more than 6 million participants, according to its 2024 Annual Report. Some of RX's flagship events include New York ComicCon, JCK, ISC West, and FIBO Global Fitness. In its most recent earnings report in August, RX saw 8% growth year over year for the first half of 2025.  The episode also features interviews with Legends Global GM Rodney Falk on the Cincinnati convention center's reopening in January 2026 and Exhibitions and Conferences Alliance Executive VP Tommy Goodwin on the U.S. government shutdown's impact on the industry.  00:00 Introduction to Trade Show Talk  00:34 Meet Hugh Jones, CEO of RX  01:22 Sponsorship Message from Legends Global  02:08 Hugh Jones' Background and Philosophy  04:17 Interview with Hugh Jones Begins  04:24 The Importance of Taking Risks  07:16 RX's Expansion and Acquisitions  08:36 Digital Transformation at RX  11:39 Innovative Approaches in Trade Shows  15:16 Navigating the Pandemic and Strategic Changes  20:25 Value-Based Selling and Customer Focus  29:08 Advocacy, Sustainability, and Talent in the Trade Show Industry  37:40 The Importance of Standardization in Events  40:30 Digital Innovation and Future Trends  44:42 Real-Time Matchmaking and Industry Trends  46:08 AI in Trade Shows: Strategy and Implementation  49:41 Personal Insights: Monday Morning Routine  52:24 Upcoming Events and Travel Plans  54:35 Hobbies and Family Life  55:55 Worst Business Advice Ever Received  58:25 Cincinnati Convention Center Update  01:14:27 Advocacy Update with Tommy Goodwin  01:22:03 Conclusion and Upcoming Episodes    This episode is brought to you by Legends Global.   Legends Global is the premier partner to the world's greatest live events, venues, and brands. Legends Global delivers a fully integrated suite of premium services—from feasibility and consulting to venue management, sales, merchandise, hospitality, partnerships, content and booking. The company's white-label approach keeps partners front and center while leveraging the power of their global network with more than 450 venues, 20,000 events, and 165 million guests annually. Learn more at LegendsGlobal.com.     Guest bio: Hugh Jones   Chief Executive Officer   Every executive has to place bets in order for the value propositions to remain relevant to the customers, but not every bet has to work. Hugh believes that executives learn by both our successes and our failures. That philosophy has served Hugh well over the years since joining RELX in 2011, following the purchase of Accuity where he was Chief Executive Officer. In addition to leading Accuity to become one of the world's largest and most significant companies in the payment routing and Anti Money Laundering sectors, Hugh has also led Fircosoft, NRS, I.C.I.S, Estates Gazette (EG) and Cirium; and before joining RX he was Global Managing Director within the Risk and Business Analytics Division.   Hugh's philosophy has seen him lead large scale acquisitions and subsequent integrations of many companies that now reside and prosper within the RELX portfolio. Hugh joined RX as CEO at the start of 2020, bringing with him plenty of experience in public company protocol and all facets of business management including P&L oversight, talent development, forecasting, sales execution, technology innovation and product discovery, launch and growth.   Hugh's experience has been invaluable in navigating RX's response to challenges and his strategic understanding of technological innovation has accelerated the use of digital and data products and services across RX events, as an ongoing core component of RX face to face events. Passionate about building a culture of collaboration, exploring, risk taking, accountability and courage, Hugh champions the creation of a psychologically safe and inclusive workplace for all.  versed in public company protocol and all facets of firm management including P&L oversight, talent development, forecasting, sales, technology and product innovation, discovery, launch and growth.   A mélange of exceptional investment and overall management qualifications, combined with superior analytical leadership. Accustomed to and effective in high-profile executive roles, making high-stakes investment decisions with world-class clients and customers. Versed in leading investor forums at a publicly traded firm, commercializing data streams, contributing forward-thinking vision and overcoming complex business obstacles.   More than two decades of experience building corporate value by creating rich data streams that provide new solutions to difficult corporate challenges. Successful at developing and coaching top executive teams, leading sales efforts, and negotiating complicated corporate and functional business deals with financial institutions, corporations and governmental agencies.  • Member of the Young President's Organization (YPO) since 2009 • Served on numerous Boards for the benefit of Private Equity firms • Winner of the 2013 Ernst & Young Entrepreneur of the Year Award in Financial Services for the Midwest Region • Holds a BA in economics from Yale University cum laude and an MBA from the University of Michigan  Guest bio: Tommy Goodwin is Executive Vice President for the Exhibitions & Conferences Alliance (ECA), the advocacy association for the business events industry. In this role, he leads ECA's work on behalf of the interconnected ecosystem of exhibitors, event and meeting organizers, suppliers, venues, and destinations that comprise the global business events landscape.     Prior to joining ECA, Tommy spent more than 20 years leading social impact, member value, public affairs, and international engagement efforts for several globally recognized associations and corporations, including Oracle, AARP, and the Project Management Institute (PMI). Additionally, he was a research fellow at Harvard Business School focused on the international political and legal environment in which businesses and social enterprises operate.     Tommy has a B.B.A. from The George Washington University, an M.B.A. from Auburn University, and a Postgraduate Diploma in European Union Law from King's College London. He also holds several certifications including a Project Management Professional from PMI, a Certified Meeting Planner from the Events Industry Council, and a Certified Association Executive from the American Society of Association Executives (ASAE).     Recognized by The Hill in its list of association "Top Lobbyists" every year since 2020, Tommy was also named a "Leading Association Lobbyist" by CEO Update/Association TRENDS in 2023. He has also been elected as a Fellow by ASAE (2022), named an "Association Innovation Leader" by DCA Live (2022), received the "Industry Support Award" from Trade Show News Network (2022), and recognized as an events industry "Changemaker" by MeetingsNet (2022).     Tommy currently serves on the advisory boards of Factum Global and The Iceberg. He is also a past president of the National Institute of Lobbying & Ethics and a past chair of ASAE's Executive Management Professionals Advisory Council and Advocacy Council.    Host bio: Danica Tormohlen    Meet Danica Tormohlen, a dynamic force in the trade world who's been telling compelling stories for more than 30 years. As VP of Group Content at Informa, she's the mastermind behind Trade Show News Network, bringing the pulse of the industry to life. When she's not crafting engaging content, you'll find her behind the microphone hosting the Trade Show Talk podcast, where she chats with industry movers and shakers.    A proud Mizzou Journalism School grad (go Tigers!), Danica has left her mark across the events industry landscape, from SISO to Trade Show Executive. Her trophy shelf sparkles with journalism awards, but what really gets her excited is breaking new ground for women in the industry. As a founding member and current president of the Women in Exhibitions Network North America, she's passionate about lifting others up while climbing the ladder herself.    When she's not reporting on trade shows and events, you'll spot Danica pounding the pavement as an enthusiastic runner or rolling up her sleeves with the National Charity League, proving that giving back is always in style. Her secret sauce? A perfect blend of journalistic integrity, industry insight, and boundless energy.     Catch Danica's latest thoughts on LinkedIn and X, where she's always sharing industry insights with a personal twist.   

In paddling and in life, nothing is wasted — every stroke counts, and every experience is money in the bank moving you toward your goal. In this episode of The Discomfort Zone Podcast, Anna Levesque sits down with longtime paddler, coach, and storyteller Anna Bruno — a six-time member of the USA Freestyle Team and current Marketing Communications Manager at NRS. From pre-competition nerves that literally send her running for the bushes, to redefining her relationship with ego and identity in paddling, Anna Bruno shares the raw and relatable side of navigating discomfort. Together, Anna and Anna dive into:

Heidi Gunderson has had a whirlwind futurity year with Wonder If Im Lucky - starting with the BFA Juvenile World Championship. This isn't her first big time winner however, and we had the chance to talk to Heidi about the horses that have made her career. This year, Heidi took a leap of faith and retired from her 20+ year career as a teacher to train full time, and her story and mindset change about chasing your dreams can be an inspiration to all. A wife, a mom, a teacher, and now a full time futurity trainer, she has worn a lot of hats and we are thankful for the time she spent with us to share her story! This week's episode is brought to you by NRS. NRS has everything you need from boots, hats, apparel, bits and spurs, saddles, ropes, feed and more! NRSworld.com

Elie Y. Katz, President & CEO of National Retail Solutions (NRS) that operates the leading point-of-sale (POS) terminal-based platform and NRS Pay credit card processing … Read more The post NRS strives to present the most innovative technologies to help retailers survive and thrive appeared first on Top Entrepreneurs Podcast | Enterprise Podcast Network.

47 When evening came, the boat was out on the sea, and he was alone on the land. 48 When he saw that they were straining at the oars against an adverse wind, he came towards them early in the morning, walking on the sea. He intended to pass them by. 49 But when they saw him walking on the sea, they thought it was a ghost and cried out; 50 for they all saw him and were terrified. But immediately he spoke to them and said, "Take heart, it is I; do not be afraid."51 Then he got into the boat with them and the wind ceased. And they were utterly astounded, 52 for they did not understand about the loaves, but their hearts were hardened. (Mark 6:47-52 NRS)

47 When evening came, the boat was out on the sea, and he was alone on the land. 48 When he saw that they were straining at the oars against an adverse wind, he came towards them early in the morning, walking on the sea. He intended to pass them by. 49 But when they saw him walking on the sea, they thought it was a ghost and cried out; 50 for they all saw him and were terrified. But immediately he spoke to them and said, "Take heart, it is I; do not be afraid."51 Then he got into the boat with them and the wind ceased. And they were utterly astounded, 52 for they did not understand about the loaves, but their hearts were hardened. (Mark 6:47-52 NRS)

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

The results of the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure for lateral osteochondral lesions of the talus (OLTs) are unknown. Therefore, the present prospective study aims to assess the numeric rating scale (NRS) of pain during walking at 2-year follow-up. Secondarily, the aim is to assess other clinical, radiologic, and safety outcomes. In conclusion, in the first 7 prospectively followed patients who underwent the TOPIC procedure for large osteochondral lesions of the lateral talar dome, an improvement of the NRS of pain during walking from median 5 preoperatively to 1 at 2-year follow-up was observed. Click here to read the article.

43 After sternly warning him he sent him away at once, 44 saying to him, "See that you say nothing to anyone; but go, show yourself to the priest, and offer for your cleansing what Moses commanded, as a testimony to them."45 But he went out and began to proclaim it freely, and to spread the word, so that Jesus could no longer go into a town openly, but stayed out in the country; and people came to him from every quarter. (Mark 1:40-45 NRS)

43 After sternly warning him he sent him away at once, 44 saying to him, "See that you say nothing to anyone; but go, show yourself to the priest, and offer for your cleansing what Moses commanded, as a testimony to them."45 But he went out and began to proclaim it freely, and to spread the word, so that Jesus could no longer go into a town openly, but stayed out in the country; and people came to him from every quarter. (Mark 1:40-45 NRS)

Elie Y. Katz Talks NRS Innovations for Small Retail Success Nrsplus.com About the Guest(s): Elie Y. Katz is the President and CEO of National Retail Solutions (NRS). Seven years ago, Elie brought his extensive experience from various industries to establish NRS, focusing on empowering independent retailers with essential business tools. His past involvement includes managing multiple real estate investments and food establishments. Under his leadership, NRS has grown to service close to 30,000 independent retailers across the U.S. with a robust ecosystem of point-of-sale networks and credit card processing solutions. Elie's vision revolves around providing cutting-edge technology to small businesses to help them compete against larger corporate entities. Episode Summary: In this episode of The Chris Voss Show, host Chris Voss welcomes back Elie Y. Katz, the dynamic President and CEO of National Retail Solutions (NRS). They explore the transformative impact of technology on small businesses and how NRS is spearheading innovations for independent retailers. Elie shares insights from his vast experience in creating tools that allow small businesses to thrive in a competitive market dominated by major retailers. Together, Chris and Elie delve into NRS's mission to support these businesses with state-of-the-art solutions. This episode takes a deep dive into the world of retail solutions, highlighting how NRS's products and services are game-changers for small retailers. With a focus on enhancing efficiency and profitability, Elie discusses NRS's wide array of offerings, from point-of-sale systems tailored for various industries to innovative credit card processing services. The conversation also touches on the importance of adopting technology to meet modern business challenges, the role of AI in improving operational efficiency, and exciting future expansions. Chris and Elie make a compelling case for why technology is indispensable for the growth of small businesses in today's economy. Key Takeaways: Empowering Small Retailers: National Retail Solutions offers an extensive range of tools, including point-of-sale systems and credit card processing, aimed at enhancing the operational efficiencies of small, independent retailers. AI and Technology Integration: NRS is integrating AI to assist retailers with product pricing and inventory management, ensuring they remain competitive and informed. Safety and Security: NRS has developed a patented panic alarm feature in their POS systems, which can silently alert authorities during emergencies, thus improving store safety. Expansion and Growth: NRS plans to expand its offerings into the restaurant industry while also aiming at serving international markets, leveraging its technology-backed solutions. Community Impact: Elie Katz emphasizes NRS's commitment to helping small business owners succeed, highlighting the entrepreneurial spirit that fuels independent retailers. Notable Quotes: "Our point of sale register is the brain. It has all the items… and it's ready to go." "Technology rules the roost… if we don't embrace the technology change, then you better embrace the fact that you may be out of business soon." "With our point of sale register, you're standing there… and that's why these brands love us." "We are gonna be hot and heavy going into the restaurant point of sale register business." "I know the struggles… it makes me proud to help business owners be successful with their business."

We are always honored when we can sit down with a veterinarian to discuss their specialty and passion and that was just the case with Dr. John Janicek. Dr. Janicek specializes in wobbler surgery and neurological diseases as well as having a very long resume in orthopedic surgery, soft tissue surgery, and sports medicine. From the causes, how to diagnose, treatment, rehab, recovery, outcomes and more we really got the opportunity to learn about Wobblers disease and its impact in our industry. Knowledge is power when making the best decisions for your horses and early diagnosis of Wobblers leads to a better outcome - and we are thankful to have the chance to share this knowledge with our listeners! As always when we bring a veterinarian on the podcast, remember - there is no way to cover everything in an hour and an audio podcast does not replace a trip to your veterinarian. If you have concerns about your equine athlete, consult your personal veterinarian!This week's episode is brought to you by NRS. NRS has everything you need from boots, hats, apparel, bits and spurs, saddles, ropes, feed and more! NRSworld.com

Katie Veteto is a river guide with quiet calculated confidence and a sharp eye for water. Within a few years she was navigating one of the most difficult crafts on the river—the massive sweep boat. NRS's new film Driving Sweep, directed by River Radius Contributing Host Greg Cairns, follows her journey of learning, doubt, and determination as she takes on a role historically dominated by men. Through her story, the film offers a powerful reflection on resilience, mentorship, and making space in wild places.GUESTSKatie VetetoKatie Veteto was born in Southern Utah, raised in the Missoula Valley, and now spends her time in Missoula, MT and Salmon, ID. She grew up seeing the rivers of the West through the joyful lens of community and recreation and continues to guide on rivers in Montana and Idaho. Katie is an elementary school teacher. During Katies time off, you'll find her romping in the woods with her dog Tuck, swing dancing, knitting hats, writing, or bumping around on a bike. In the Summer you'll find her somewhere on the Middle Fork of the Salmon.Greg CairnsContributing Host & Film Creator SPONSORSNRS@nrsweb Valley Nissan@valley_nissan WATCH THE FILMYouTube linkRead about the film GIVEAWAYEnter Here@riverradiuspodcast  THE RIVER RADIUSWebsiteRunoff signup (episode newsletter)InstagramFacebookApple PodcastSpotifyLink Tree

Evo Japan announcements, Tekken DLC reception, and the NRS curse come for MK1.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode Answer Questions Middle Fork Trip Planning Blog Some of the Questions that Zach covered in the Q&A section of this episode Topic: Oar Length (For a Specific Situation) What's the best oar length for running Class II rapids in a 15'6" long Stryker inflatable boat? The boat has a 60-inch span, a 6'2" wide beam, and a 160-pound outboard motor on the stern. I plan to use it occasionally as a drift boat. For longer, deeper, easy-going sections, I'll use the motor to go back upstream and re-fish, or to get through slow, deep, unfishable water. Thanks! Topic: IK for Extended Trips I've been using an Aquaglide touring IK for Class III/IV trips—our last was on the Lower Salmon—and after spending days sitting in water, I know it's time for an upgrade. I recently picked up a Star Outlaw II for my son, but so far it's only seen flatwater. We've got some whitewater trips planned for June and July, and I'd love some advice for my new IK. I'm super torn between a few options. In order of interest: Star Outlaw II — I like the 5 chambers, drop-stitch floor, and the price point, plus the reviews are solid. But I hate the lack of anchor points for gear—had to glue some on for my son. AIRE Outfitter II — Tons of great reviews, nice bow kick, and it has good gear loops. But it's pricey, and I'm worried I'll be sitting in water again with that floor. AIRE Lynx II — Same pros and cons as the Outfitter. Corran Tandem — I like that it handles big water, but I think I'd hate it on flatwater. RMR Taylor vs Animas — The price is right and what I've found so far is positive, but reviews are way fewer compared to NRS stuff. I'm 6'2”, around 300 lbs (currently cutting weight), and I need an IK that can support me on a 5-night trip. Also curious about the NRS Riffle—it looks durable and capable.

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about in this episode GoRafting.com Maps Answer Questions May 4th Illinois Trip Today's Questions: Topic: Raft Pressure I'd love to hear your thoughts on air pressure for rafts. How do you know when it's right? What do you think about those digital air pressure caps, like the TRiB brand ones NRS sells? I know you should let some air out when driving over mountain passes or when the boat's sitting in the sun to prevent blowouts. But other than that, how important is it to get the air pressure just right on the water? Thanks, and keep up the good work! Topic: Tech Support Hi Zach! Love the show, great content! I'm filming our Main Salmon trip this year with a GoPro. What do you use—or what have you heard of—to merge and edit GoPro clips into one seamless video with text and music? I need something old-guy friendly, since I'm not super tech-savvy. Got any tips or tricks you've learned from your own experience? Thanks! Topic: Dish Bucket Water Love the show, thank you for keeping this up. I always look forward to the Tuesday show and any other reviews, testing or other topics you cover. For getting rid of dish water, different rivers have different rules. My understanding is that for high-volume rivers, it's better to dispose of strained dishwater into the river. For smaller rivers (Smith, MFS), you're supposed to disperse the water above the high water line and away from camp. For low use camps, I guess this could make sense, that eventually the rain will do it's thing and it'll soak into the ground. For desert trips or popular camps, this just seems like a recipe for attracting pests. Even if you could strain every bit of food, there's still going to be oils and dissolved sugars which will get tossed on the ground. Maybe my concept of how much oil/sugar/small stuff gets left behind is wrong. I'm assuming these rules have science/research behind them. Any thoughts or ideas on this?

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Ask a question on the next live show Some of the Questions that Zach covered in the Q&A section of this episode Topic: 40k Rogue Hi, Zach. Hope things are well How was the Wind Race? Some AW staff and Board and families were planning to paddle the Rogue April 6-8 after the Board meeting. But it looks like the flow forecast shows 40k. Thoughts on the Rogue at high flows? Topic: High Float PFD Hope you are well. Not sure you remember me, I have done a Rogue rowing school and a regular Rogue trip with NWRC (though it was some time ago). You have also been kind enough to answer a couple of questions for me and I think my son, Nathan, has been in touch with you once or twice. I have another question, if I may. Many years ago you answered my question on a recommendation for a PFD, you recommended the Kokatat Maximus. I have had two of them and since I am typing this email they have both done their job perfectly! Sadly both the second Maximus and I are getting long in the tooth. I think it may be time to up my flotation. Doing a bit of looking, there seem to be two out there that have 22 lbs of floatation, NRS big Water Guide and the Astral Indus. I vaguely recall you were not a big fan of NRS PDF's (I could be 100% wrong on that and please feel free to correct me if I am) and I do seem to prefer the Astral. Though the rescue harness is a little unnecessary for me to have since I could not imagine any situation being improved by me being live bait. If you have any thoughts on these two or any others it would be greatly appreciated. Topic: Mustang Dry Suit I saw your video on dry suits and I'm curious what you think about Mustang's newish neoprene necked drysuit? They seem to claim that it's dry, I have issues with tight neck gaskets and am considering giving it a shot. Curious if you have tried it or have any thoughts. Topic: River Trip Roster One idea for a future YouTube segment: How to assemble the right crew for your next private river trip. Personalities, skills, chores, kids/no kids, shared goals, etc. I've been fortunate to be on some great Grand Canyon and Salmon trips and it's been thanks to strong vision and leadership from permit holders / trip leaders.

Welcome to episode 232 of the Women's Running podcast. I'm your host Esther Newman and she's your other host Holly Taylor. On this podcast we talk about health, politics, stuff on TV and what we ate last night. Occasionally, we talk about running.This episode is sponsored by Coopah, the running app. Use the code WOMENSRUNNING when you sign up for 2 free weeks and a further 20% off for a whole year.Marathon trainingWe're talking training, and we're talking pop psychology – two of our most favourite things. See if you can figure out what's going on with our deeply troubling psyches. Speaking of which, Holly tries to persuade me to watch The Traitors – if you also avoid reality TV, let us know if she manages to persuade you. We also talk about looking forward to going to the NRS this weekend – if you're coming along, do please pop by to our stand and say hi!Coopah supportWe have another Jordan segment this week, as she checks in to see how our training is going using the Coopah training app. She explains how our training is like a sandwich, and we're very keen to find out what constitutes the pickle. And we're also very keen to find out if anyone cheats the plan! Do let us know!Lovely extra bitsThis episode is sponsored by Coopah. Coopah are offering all pod squadders a 2-week free trial of their app and then giving 20% off their standard annual subscription price. Just download the Coopah app and use the code WOMENSRUNNING when you sign up. Or visit coopah.com/womensrunning where you can find all of these details.·      Subscribe to Women's Running – and you'll save 50%Setting up your own podcast? Try Zencastr – we've been using it for ages and LOVE ITDownload a FREE mini mag to help you run 5K! Go to womensrunning.co.uk/runBuy a Pod Squad t-shirt!Do join us on Patreon so you can come and chat in our new Pod Squad community on Discord! Go to patreon.co.uk/womensrunningEmail us at wrpodcast@anthem.co.uk with any questions or running stories Get bonus content on Patreon Hosted on Acast. See acast.com/privacy for more information.

What if you could cheat aging, indulge in life's guilty pleasures, and still thrive? Dr. Sandra Kaufmann, a pioneering longevity expert and fearless explorer of the biochemical frontier, joins Dave to reveal how you can bend the rules of biology to live longer, smarter, and stronger. Forget perfection—Dr. Kaufmann's radically practical approach embraces the human side of longevity, showing you how to optimize your body while enjoying the ride. From downing Diet Cokes to defying traditional medical dogma, she's rewritten the playbook on anti-aging with her Seven Tenets of Aging. Together, she and Dave dive into everything from molecular hacks for outsmarting junk food to unlocking the secret power of your mitochondria, DNA, and circadian rhythms. This episode goes beyond the surface with mind-blowing insights, hilarious moments, and actionable steps to take your health (and your fun) to the next level. What You'll Learn: • The Seven Tenets of Aging and how they'll change your approach to health • Why indulging in “bad” habits doesn't have to sabotage your longevity • Biochemical secrets to combat oxidative stress, glycation, and cellular junk • The real story behind NAD, circadian rhythms, and the tools for better sleep • How to create a personalized health plan that's sustainable, effective—and fun Resources: • Supplement Protocol One-Sheet for this episode: https://www.instagram.com/dave.asprey/?hl=en• 2025 Biohacking Conference: https://biohackingconference.com/2025 • Kaufmann Protocol Website: https://kaufmannprotocol.com • Sandra Kaufmann's Book – Why We Age and How to Stop It: https://www.amazon.com/Kaufmann-Protocol-Why-Age-Stop/dp/0692089047 • Sandra Kaufmann's Instagram: https://www.instagram.com/kaufmannantiaging/?hl=en • Danger Coffee: https://dangercoffee.com • Dave Asprey's Website: https://daveasprey.com • Dave Asprey's Book – Smarter Not Harder: https://daveasprey.com/books • Dave Asprey's Linktree: https://linktr.ee/daveasprey • Upgrade Collective – Join The Human Upgrade Podcast Live: https://www.ourupgradecollective.com • Own an Upgrade Labs: https://ownanupgradelabs.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen – Neurofeedback Training for Advanced Cognitive Enhancement: https://40yearsofzen.com SPONSORS: Leela Quantum | Head to https://leelaq.com/DAVE for 10% off. Timeline | Head to https://www.timeline.com/dave to get 10% off your first order. Timestamps: • 00:00 Trailer • 00:45 Guest Introduction • 02:30 Longevity Insights • 04:22 Personal Stories • 08:00 Pharmaceuticals • 12:26 Diet and Lifestyle • 18:19 Seven Tenets • 22:04 Sleep and Circadian Rhythms • 26:41 NAD and Supplements • 37:46 Blood Sugar and AGEs • 47:09 Microcirculation • 49:08 NRS and Imports • 49:18 Cellbex Medication • 50:03 Cellbex Benefits • 50:41 Alzheimer's and Cellbex • 51:28 Antioxidants • 54:26 Stem Cells and Exosomes • 58:03 Laser Skin Treatments • 01:07:34 Hormones and Longevity • 01:20:03 Lithium for Mood • 01:27:45 Gender and Longevity • 01:32:39 Final Thoughts See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

13 Who is wise and understanding among you? Show by your good life that your works are done with gentleness born of wisdom. 14 But if you have bitter envy and selfish ambition in your hearts, do not be boastful and false to the truth. 15 Such wisdom does not come down from above, but is earthly, unspiritual, devilish. 16 For where there is envy and selfish ambition, there will also be disorder and wickedness of every kind. 17 But the wisdom from above is first pure, then peaceable, gentle, willing to yield, full of mercy and good fruits, without a trace of partiality or hypocrisy. (James 3:13-17 NRS)

13 Who is wise and understanding among you? Show by your good life that your works are done with gentleness born of wisdom. 14 But if you have bitter envy and selfish ambition in your hearts, do not be boastful and false to the truth. 15 Such wisdom does not come down from above, but is earthly, unspiritual, devilish. 16 For where there is envy and selfish ambition, there will also be disorder and wickedness of every kind.17 But the wisdom from above is first pure, then peaceable, gentle, willing to yield, full of mercy and good fruits, without a trace of partiality or hypocrisy. (James 3:13-17 NRS)

This podcast is the audio version of the Gear Garage Live Show, where we answer submitted questions and talk all things whitewater. Topics and links that Zach talked about this episode GoRafting Sponsor Answer Questions Some of the Questions that Zach covered in the Q&A section of this episode Topic: 2nd Boater Without getting into full details, I was in a situation where I was the second boat. We were an eight boat trip. This was the Middle Fork a few years ago. A signal came up the line to stop and eddy out. For some reason the lead boat didn't stop. I stayed with the lead boat and the third boat stayed with us. Again we signaled up to stop and again the lead boat did not try to Eddy out. We were running up on Sulpher and the lead boat went ahead and entered the rapid. I followed and stayed with the lead boat until it finally eddied out before Ramshorn. It turned out a boat in the back had gotten pinned and didn't come off until everyone hiked back and joined together to get it off. My question is was I right in staying with the lead boat when it didn't stop. My gut was telling me to eddy out because someone was in trouble behind us, but I felt a responsibility to the lead boat as I was his safety. The rower on the third boat felt the same. Topic: Oar setup with Tall Torso Hi Zach, Been watching your oar setup video to help dial in my boat this winter. I'm rowing a 13' Otter, 60" wide NRS frame, older 6-7" oar towers (wasn't exactly sure where to measure from), 8'-10" oars, and sitting on the dry box. The geometry has never been fully customized for various reasons. Anyways, I'm hoping you have some thoughts on a couple things and how they relate to oar setup. 1.) I'm fairly tall (6'-1") but most of my height is in my torso (32" inseam). 2.) In the past, I have sometimes been hitting my legs while rowing (probably some operator error involved). I was set on getting newer/taller oar towers to accommodate these issues, but your video inspired me to hit pause and think this through. I appreciate what you do for the boating community, and I want to say thanks for the videos and thanks for any advice you can give on my setup.

Darby McAdams holds many places in the river world: kayaker, film maker & instructor of both kayaking and film work for young paddlers. In November of 2024 her new film NEAR THE RIVER went public. In this episode Darby moves through her kayak path, her film path and talks about NEAR THE RIVER and its story about the people of the Zambezi River in Africa. DARBY MCADAMSNear the River filmIGRiver Roots Film ProductionNRS Dirtbag Diaries:  “Darby McAdams & the Evolution of Passion” by Chandra BrownSPONSORSDenver Area Nissan Dealers@nissanusaOver It Raft Covers@overitraftcoverspromo code, free shipping: riverradius   THE RIVER RADIUSWebsiteInstagramFacebookApple PodcastSpotifyLink Tree

In this episode of The Discomfort Zone Podcast, I sit down with Danny Mongno, a true paddling industry veteran, as he opens up about his journey through the highs and lows of a career in paddle sports. From his passion for teaching to overcoming physical challenges like hip surgeries, Danny shares the resilience it takes to stay active in an ever-evolving outdoor industry. We delve into the impact of e-commerce on small retailers, the growing significance of fitness and personal connections, and how the paddling community is shifting focus toward athletes who lift others up. Discover how Danny, through his work at NRS, is supporting events that are reuniting paddlers, amplifying women's voices, and empowering athletes to make a lasting impact. This episode is a must-listen for anyone passionate about the outdoors, community, and the power of connection in sports.

    Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis  Host David Rosenblum, MD  Episode Date: October 25, 2024 In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).  Featured Article 1:  - Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease - **Authors:** Mohamed Hussein, Tamer Hussein    Key Points Discussed  1. Background:  Correlation between lumbar multifidus muscle dysfunction and chronic low back pain. 2.  Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months. 3.  Outcome Measures:  Significant improvements in NRS and ODI scores, with high patient satisfaction. 4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.  Featured Article 2:  -   Degenerative Lumbar Spinal Stenosis  Authors:*  Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong Qiao  Key Points Discussed  1. Background:  DLSS is a common condition in older adults, often leading to muscle atrophy and disability. 2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity. 3.  Results:     - Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments.    - A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis.    - The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides. 4.  Conclusions:  The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.  Discussion:  Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.  Closing Remarks:  Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.   **Follow Us:** - Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments. - Connect with us on social media [insert social media links]. NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns. References Xia, G., Li, X., Shang, Y. et al. Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 22, 536 (2021). https://doi.org/10.1186/s12891-021-04411-5 Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016 Mar 22;2:12. doi: 10.1051/sicotj/2016002. PMID: 27163101; PMCID: PMC4849261.

    Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis  Host David Rosenblum, MD  Episode Date: October 25, 2024 In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).  Featured Article 1:  - Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease - **Authors:** Mohamed Hussein, Tamer Hussein    Key Points Discussed  1. Background:  Correlation between lumbar multifidus muscle dysfunction and chronic low back pain. 2.  Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months. 3.  Outcome Measures:  Significant improvements in NRS and ODI scores, with high patient satisfaction. 4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.  Featured Article 2:  -   Degenerative Lumbar Spinal Stenosis  Authors:*  Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong Qiao  Key Points Discussed  1. Background:  DLSS is a common condition in older adults, often leading to muscle atrophy and disability. 2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity. 3.  Results:     - Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments.    - A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis.    - The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides. 4.  Conclusions:  The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.  Discussion:  Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.  Closing Remarks:  Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.   **Follow Us:** - Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments. - Connect with us on social media [insert social media links]. NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns. References Xia, G., Li, X., Shang, Y. et al. Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 22, 536 (2021). https://doi.org/10.1186/s12891-021-04411-5 Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016 Mar 22;2:12. doi: 10.1051/sicotj/2016002. PMID: 27163101; PMCID: PMC4849261.

12 Take care, brothers and sisters, that none of you may have an evil, unbelieving heart that turns away from the living God. 13 But exhort one another every day, as long as it is called "today," so that none of you may be hardened by the deceitfulness of sin.14 For we have become partners of Christ, if only we hold our first confidence firm to the end. (Heb 3:12-14 NRS)

Join me as I interview my friend and regular student at NRS, Mr. Jayberry Miller.  Jayberry is a young businessman who has an integrity that surpasses many in the industry. His gear is top notch, as well as his character.  Listen in as we discuss his business strategy, details of how he makes gear and much more.  The NRS Online Membership is THE best way to get the most up to date content for our followers: https://bit.ly/NRSONLINE Please check out our preferred gear provider, Tuff Possum Gear. Use code NATURERELIANCE for 10% off: https://tuffpossumgear.com/ Dont forget to go check out our NRS Online Membership for the best and most up-to-date content: https://bit.ly/NRSONLINEWild Times: Wildlife EducationWildlife mysteries, crazy news, and daring animal stories—listen now!Listen on: Apple Podcasts SpotifyThanks for listening! Follow us at Nature Reliance School.

The stolen documents case is back! Judge Aileen Cannon dismissed the charges against Trump and his goons in July on the theory that special counsels are illegal, and Monday Special Counsel Jack Smith filed his brief to the Eleventh Circuit explaining why she is very obviously wrong. Plus, RFK Jr. dropped out and endorsed Trump. Does that mean he's off the ballot everywhere? Links: Jack Smith 11th Cir Brief https://storage.courtlistener.com/recap/gov.uscourts.ca11.87822/gov.uscourts.ca11.87822.18.0_1.pdf   Trump v. US https://www.supremecourt.gov/opinions/23pdf/23-939_e2pg.pdf 18 USC 599 https://www.law.cornell.edu/uscode/text/18/599 ADLF Complaint re: Trump/Carson https://static.politico.com/83/4d/90f795464ab58210ca25aa3a1af7/adlf-complaint.pdf NRS 293.202 https://www.leg.state.nv.us/nrs/nrs-293.html New Yorker profile https://www.newyorker.com/magazine/2024/08/12/robert-f-kennedy-jr-profile-presidential-campaign Show Links: https://www.lawandchaospod.com/ BlueSky: @LawAndChaosPod Threads: @LawAndChaosPod Twitter: @LawAndChaosPod Patreon: patreon.com/LawAndChaosPod

In this episode, Stuart C. Gordon, MD, FACP, FACG, AGAF, FAASLD; Marlyn J. Mayo, MD; and Brenda Remo discuss strategies for optimizing PBC pruritus care in the clinic setting.Listen to their conversation on how important it is to ask patients about their pruritus, validate their symptoms and feelings, and offer treatment options framed with realistic expectations.Presenters:Stuart C. Gordon, MD, FACP, FACG, AGAF, FAASLDProfessor of MedicineWayne State University School of MedicineDirector, Division of HepatologyHenry Ford Health Detroit, MichiganMarlyn J. Mayo, MDProfessor of Internal MedicineDivision of Digestive & Liver DiseasesUniversity of Texas SouthwesternDallas, TexasBrenda RemoPerson living with PBCDownloadable slides: https://bit.ly/3LHHiufProgram: https://bit.ly/4fBLQ3lTo get access to all of our new podcast episodes, subscribe to the CCO podcast channels on Apple Podcasts, Google Podcasts, or Spotify.

Spyware is discovered on U.S. hotel check in systems. A Microsoft outage affects multiple services. Bitdefender uncovers Unfading Sea Haze. University of Maryland researchers find flaws in Apple's Wi-Fi positioning system. Scotland's NRS reveals a sensitive data leak. Rapid7 tracks the rise in zero-day exploits and mass compromise events. The SEC hits the operator of the New York Stock Exchange with a ten million dollar fine. Operation Diplomatic Specter targets political entities in the Middle East, Africa, and Asia. The FCC considers AI disclosure rules for political ads. N2K T-Minus Space Daily podcast host Maria Varmazis speaks with guests Brianna Bace and Unal Tatar PhD sharing their work on Legal Perspectives on Cyberattacks Targeting Space Systems. Tone-blasting underwater data centers.  Our 2024 N2K CyberWire Audience Survey is underway, make your voice heard and get in the running for a $100 Amazon gift card. Remember to leave us a 5-star rating and review in your favorite podcast app. Miss an episode? Sign-up for our daily intelligence roundup, Daily Briefing, and you'll never miss a beat. And be sure to follow CyberWire Daily on LinkedIn. CyberWire Guest N2K T-Minus Space Daily podcast host Maria Varmazis speaks with guests Brianna Bace and Unal Tatar PhD sharing their work on their paper: Law in Orbit: International Legal Perspectives on Cyberattacks Targeting Space Systems. You can learn more about their work in this post. Check out T-Minus Space Daily for your daily space intelligence.  Selected Reading Spyware found on US hotel check-in computers ( TechCrunch) Microsoft outage affects Bing, Copilot, DuckDuckGo and ChatGPT internet search (Bleeping Computer) Deep Dive Into Unfading Sea Haze: A New Threat Actor in the South China Sea (Bitdefender)  Apple's Wi-Fi Positioning Can Be System Abused To Track Users (GB Hackers)  National Records of Scotland Data Breached in NHS Cyber-Attack (Infosecurity Magazine) Zero-Day Attacks and Supply Chain Compromises Surge, MFA Remains Underutilized: Rapid7 Report (SecurityWeek) NYSE Operator Intercontinental Exchange Gets $10M SEC Fine Over 2021 Hack (SecurityWeek) Operation Diplomatic Specter: An Active Chinese Cyberespionage Campaign Leverages Rare Tool Set to Target Governmental Entities in the Middle East, Africa and Asia (Palo Alto Networks Unit 42 Intel) FCC chair proposes requirement for political ads to disclose when AI content is used (The Record) Acoustic attacks could be a serious threat to the future of underwater data centers (TechSpot) Share your feedback. We want to ensure that you are getting the most out of the podcast. Please take a few minutes to share your thoughts with us by completing our brief listener survey as we continually work to improve the show.  Want to hear your company in the show? You too can reach the most influential leaders and operators in the industry. Here's our media kit. Contact us at cyberwire@n2k.com to request more info. The CyberWire is a production of N2K Networks, your source for strategic workforce intelligence. © N2K Networks, Inc.

On December 8th, I hosted a webinar called “What “Do Showrunners Look For In A Script,” where I talked about how to come up with interesting and unique characters, as well as how tapping into your everyday life interactions with people can help with this. This episode addresses questions you asked in our Q&A session that we didn't have time to answer. There's lots of great info here, make sure you watch.Show NotesA Paper Orchestra on Website: - https://michaeljamin.com/bookA Paper Orchestra on Audible: - https://www.audible.com/ep/creator?source_code=PDTGBPD060314004R&irclickid=wsY0cWRTYxyPWQ32v63t0WpwUkHzByXJyROHz00&irgwc=1A Paper Orchestra on Amazon: - https://www.amazon.com/Audible-A-Paper-Orchestra/dp/B0CS5129X1/ref=sr_1_4?crid=19R6SSAJRS6TU&keywords=a+paper+orchestra&qid=1707342963&sprefix=a+paper+orchestra%2Caps%2C149&sr=8-4A Paper Orchestra on Goodreads: - https://www.goodreads.com/book/show/203928260-a-paper-orchestraFree Writing Webinar - https://michaeljamin.com/op/webinar-registration/Michael's Online Screenwriting Course - https://michaeljamin.com/courseFree Screenwriting Lesson - https://michaeljamin.com/freeJoin My Newsletter - https://michaeljamin.com/newsletterAutogenerated TranscriptMichael Jamin:Well, no one cares that you took my course, so zero. No one's going to be. That's why we don't give a diploma out because the diploma is worthless. No one really cares if you went where you studied, who taught you all they care about? Is the script good or not? Does it make them want to turn the page or not? Do they want to find out what happens next or not?Michael Jamin:You are listening to What the Hell is Michael Jamin talking about conversations in writing, art, and creativity. Today's episode is brought to you by my debut collection of True Stories, a paper orchestra available in print, ebook and audiobook to purchase And to support me in this podcast, please visit michael jamin.com/book and now on with the show.Michael Jamin:Hey everyone, welcome to a very special episode of What the Hell is Michael Jamin talking about. I'm here with my guest host Kevin Lewandowski, and he helps out a lot with the podcast, with all my social stuff, and he's actually by trade. He's a writer's assistant script coordinator, which is actually one step higher than writer's assistant, so he's worked on a bunch of shows. Kevin, welcome to the show.Kevin Lewandowski:Thank you for having me. Michael, for those of you, sorry I'm not Phil, I'm just kind of filling in for Phil for a couple days, but I'm excited to be here. And yeah, I hope to tell you all a little bit about script coordinating as well and what that all entails,Michael Jamin:Fill in and fulfill, fillKevin Lewandowski:In and fulfill.Michael Jamin:What shows were you script coordinator on?Kevin Lewandowski:So the big one was Why Women Kill.Michael Jamin:Did we ever figure out why?Kevin Lewandowski:I mean, depending on who you ask, a lot of women will say because of men,Michael Jamin:They kill for ratings.Kevin Lewandowski:Right? Okay, that's better. But yeah, that was, I forgot how long ago that was, but that was, unfortunately we got canceled four or five days before we were supposed to start filming. Our actors had just landed in Canada and then the next day they announced they were pulling the plug on the show.Michael Jamin:Why?Kevin Lewandowski:It could be many reasons. I think a lot of it had to do with we were a little bit behind on scripts and then budgeting and we were still kind of in the midst of covid precautions and things like that.Michael Jamin:Covid, people don't realize, especially new showrunners, you don't mess with the budget. You get things done on time, Ross, you're screwed. What other shows did you work on then?Kevin Lewandowski:So the first show I ever worked on was in 2015. It was the Muppets, and it was funny. I thought if anyone ever caught a break, this is my break. I was like, it's the Muppets, it's going to go on for five or six years and I'm just going to notch up every year. And after 16 episodes, that one got canceled.Michael Jamin:What's Ms. Piggy really like?Kevin Lewandowski:I mean, she is who she is. Difficult. Yeah, she's difficult. She's a bit of a diva. We have to had to cater to all of her needs.Michael Jamin:What about, I'm sorry, and what were the other shows? Screw Miss Piggy. Yeah,Kevin Lewandowski:Screw Miss Piggy. So after that, a bunch of pilots that never got picked up, and then I worked for a show on Netflix called The Ranch with AshleyMichael Jamin:ElementKevin Lewandowski:That was a live audience show and I was there for two seasons. I'm trying to think after that. It's all becoming a blur. I did two seasons of Why Women Kill. Actually the first year I was a line producer's assistant, and so that was interesting to kind of see the financial side of things and see where they decide to put the money in. And then for season three, they moved me to Script coordinator,Michael Jamin:But the Branch was a legit show. That was a big show.Kevin Lewandowski:That was a lot of fun because I'd always wanted to work in the Multicam world. There's just something about show night and it's just kind of a big party for everyone and you get to see the audience's instant gratification. It's just a lot of fun. A lot of fun to work on those shows.Michael Jamin:Yeah. Well now the next thing for us to do is try to get you into one of these jobs so you don't have to co-host with me all the time on thisKevin Lewandowski:Podcast. I don't mind co-hosting with you.Michael Jamin:Oh, all right. Well, we'll see if you feel that way at the end. Okay, that's fair. So we are doing, this is a special q and a. We do these monthly webinars or whatever, every three weeks actually, and we have a lot of questions we can't answer. And so we save 'em for the podcast. And now Kevin's going to feed them to me. He's going to regurgitate them to me. He's going to baby bird them into my mouth, and then I'm going to try to answer them as best I can.Kevin Lewandowski:Early Bird gets the worm or something like that.Michael Jamin:Gross. Kevin Gross.Kevin Lewandowski:And I apologize in advance for anyone's name I might butcher.Michael Jamin:It's okay. They don't need to. I mean whatever if you get 'em wrong. Okay,Kevin Lewandowski:So these first few questions are going to be kind of course related questions. The first one is from Dat Boy, D-A-T-B-O-I. And that person's asking, what are the best tips for making my script shine more than the rest?Michael Jamin:Oh boy. Well, I wish he would. Well, he was already at my free webinar. I wish he would sign up for my course. I mean, that's what the course is. The best tips for making it shine is making sure your act breaks pop, making sure the dialogue feels fresh, your characters are original. I mean, there's no tips. It's not a tips thing. It's 14 hours of, let me tell you how to do it. That boy, I wish. What do you think, Kevin? What's your answer for him?Kevin Lewandowski:I think it's one of the things you always say on your webinars is after taking my course, you'll just hear me yelling in your head all the time about this is your end of act two moment, this is this, this is that. And I can vouch for that and say, anytime I'm looking through a script or even watching a TV show, because of your course and just understanding the story structure, you get those spider senses like, oh, the raising the stake should be coming very soon. Now we're about halfway through the episode, so something better be changing here. And I think it's just, again, everything you say in your course of just knowing those beats when they need to hit how they need to pop will help set your script ahead of amateur writers.Michael Jamin:You're a good student, Kevin.Kevin Lewandowski:Yeah. Thanks.Michael Jamin:Alright, what's next?Kevin Lewandowski:So km phs, when I say I don't have experience, but I have a killer pilot and I took Michael Jamin's course. How much of a difference is the course going to make in terms of being a desirable hire?Michael Jamin:No one cares that you took my course. So zero no one's. That's why we don't give a diploma out because the diploma is worthless. No one really cares if you went where you studied, who taught you all they care about, is the script good or not? Does it make them want to turn the page or not? Do they want to find out what happens next or not? So I wish I could give you a better answer than that, but it's not the degree. The degree isn't worth anything. Hopefully the knowledge is worth something.Kevin Lewandowski:I think the analogy I have in my head of your courses, I look at scripts I wrote before taking your course, and it's like when you look back at high school photos and I had the Frosted tips, the pca, shell, necklace, hoop earring, and at the time it was cool. And now you look back and it's like it's pretty cringe-worthy. It's pretty cringe-worthy to see those photos. And now after taking your course, I feel like it's like now I'm wearing a suit and I don't have the poop hearing and I don't have the frosted tips, and I'm not as cringe-worthy when I look back at some of the scripts I wrote a year or so ago.Michael Jamin:Good, good. All right, good. Very good. Impressing me more and more, Kevin.Kevin Lewandowski:Right? Next question. Ous. I'm butchering that one. Nope,Michael Jamin:Perfectly. That's how he says his name.Kevin Lewandowski:Yeah. What are the most important things an inspiring writer should be aware of while reviewing one script before sending it to an established executive or writer?Michael Jamin:God, it's pretty much the same answer as all the other ones. It's like, do your act breaks, pop? Is it fresh? The dialogue, I'm sorry, but it's the same answer, so I don't really have anything to say. Yeah, yeah.Kevin Lewandowski:Next question, mal. Yay.Michael Jamin:Exactly.Kevin Lewandowski:In a 26 page pilot is page 11 two, late for the first act break, second act break or second act being on page 20.Michael Jamin:On the 26 page script, the first back page is on 11, is that what they said?Kevin Lewandowski:Yeah.Michael Jamin:It's not terrible. I've seen worse things. I'm assuming it's a single space. It's not terrible. Yeah.Kevin Lewandowski:Colin Miller, what is a good system to practice writing every day? I like this question.Michael Jamin:A good system, a good system. I don't know why you like it, because I'm stumped. I mean, I would just say write a good system is to, I'm most creative in the morning, so that's when I want to write and I try to do my busy work in the evening stuff that's easier, but you might be a night owl, but I would just carve out time every day and just sit down at the computer and write. And don't be so precious that no one's going to look at your first draft. That first draft can be terrible, so don't just get it on paper. Yeah.Kevin Lewandowski:Yeah. I think a lot of maybe misconceptions people have is writing every day isn't necessarily open up final draft and typing something. Sometimes it's going on a walk for an hour and a half and thinking about the story you're trying to tell and laying out the beats in, I live in Glendale and there's a outdoor mall. It's fun to kind of just walk around there and people watch a little bit. And sometimesMichael Jamin:The Americana, that's where you go.Kevin Lewandowski:Yep. Right By the Americana.Michael Jamin:Are you in walking distance to thatKevin Lewandowski:Few blocks?Michael Jamin:Interesting. Okay. Alright. You'd like to go on the trolley.Kevin Lewandowski:I've never been on that trolley. I'm always afraidMichael Jamin:You like to ring the bell on trolley, Kevin. Yeah.Kevin Lewandowski:I'm always afraid it's going to hit someone.Michael Jamin:Yeah, I know. I know.Kevin Lewandowski:I think takes up a lot of the bottom of the path.Michael Jamin:Yeah. AllKevin Lewandowski:Right. Next question. So NRS creates, I guess this is a question, it's more of a comment. It said, agreed. The course is changing the way I see all of my stories. Good, great.Michael Jamin:Great.Kevin Lewandowski:Christina Sini, who's a current student, and Michael Jamin's course, we learned to break and structure story well before writing those bits and pieces of a script glued together that we won't have to cling to anyone to make them fit. We basically learned how to build in order. I think that goes back to your analogy of laying the foundation first and doing, starting with the characters in beat sheets and then outlining and eventually getting to the physical writing of the script.Michael Jamin:Yeah, she's doing great, Christina. She's having a good amount of success early on, so I'm impressed.Kevin Lewandowski:Another very active person in the course, Laurie. John Michael's course is amazing. When you take the class, you also become of the Jam and Facebook community. We do table reads and give each other notes twice a month. Writer sprints, Wednesday nights and mock writer's room. So anyone that's thinking about getting the course, we have this private Facebook group and it's a bunch of great people in there and we are all just trying to build each other up.Michael Jamin:It really is. It's impressive because when you look at some of the other Facebook groups, the screenwriting groups or on Reddit or groups, it's mostly people trying to tear each other down. But because this is private, I think they're not like that at all. It's a community, I think.Kevin Lewandowski:Yeah, I think that was a big thing for you because you said you were in some of those groups, and I think you even said you sometimes as a professional working writer, you would say something that people would attackMichael Jamin:You. Yeah. You don't, what are you talking about? Oh, alright. I happened once or twice. I was say, I'm done. Yeah.Kevin Lewandowski:All right. Next question. VV oral, is it worth it? And parentheses story structure is very detailed in your course, so I think maybe it's worth it, not is it worth it? Yeah. I think it's just more people praising about your course.Michael Jamin:Okay.Kevin Lewandowski:Let's see. Okay, now we have some craft questions. Good. From Mal mavey, they, again, is it okay to end a pilot on a cliffhanger?Michael Jamin:Yeah, it's okay, but better not. You're really counting on the fact that anyone's going to care, so you're better. I think what the danger is, you may be writing towards this cliffhanger thinking that everyone's going to be so, oh my God, what's going to happen if you don't write? If all those pages beforehand aren't so great, no one's going to care what happens. And so a lot of people write towards this cliffhanger thinking, oh, aren't you going to be enthralled? And the answer is no, we don't care.Kevin Lewandowski:Yeah. Yeah. I think trying to work backwards from that I think can be a disservice. And I think it's just you definitely don't want that cliffhanger to be more exciting necessarily than your act one break, because that's what we know what we're following. Lex Macaluso, once I have a great script, what are the practical steps to do?Michael Jamin:Well, once you have a great script, write another one for sure. And then you want to make sure you actually do have a great script. And you do that by showing it to people. And it doesn't have to be somebody in the industry. It could be a friend or a mother or someone whose opinion you trust. What do you think? And if they love it and they say, this is amazing, show me something else. You're onto something. But if they say, well, I like this part, or I like when this happened, or This is a good storyline, then that's not a great script. So you have to be honest with yourself. It's really, look, it's really hard to write a great script. Everyone assumes they have it and I don't assume I have it. So when I do my job really well, I might have a good script. A great script is really, you got to really hit it out of the park.Kevin Lewandowski:And I think just that idea of what is a great script, so arbitrary, and I think it's sticking to the story structure of what you teach in your course can help set your script apart from others.Michael Jamin:Yeah. And honestly, it is those things that I'm looking for. All the things that I say that when I'm reading a script, what I'm looking for and what I'm really looking for is I want a really good script. It doesn't even have to be great because a really good script stands out great or amazing is very rare. I mean, how often do you see a movie that's been made or a TV show and you go, this is a great script. Most of the time you're like, oh, this is really good.Kevin Lewandowski:So if you were reading a script, and let's say maybe the structure wasn't where you think it should be, but the characters were very compelling and the characters were witty with what they were saying. Would you still be okay with that? Or vice versa if maybe the characters was a little bit too much speaking on the nose, but the structure and everything was spot on with that.Michael Jamin:Years ago we hired on a show, we were running a show and we were reading a ton of scripts, and we got to one where Act one was really good. Act two was really good, and Act three was not very good. And we hired him anyway because we were thought at that point, I was like, he did the first two parts really well, I could fix, or we could fix Act three, not a problem. And so I think that says a lot. You do act one, walk two. That's a big deal. He's a young writer.Kevin Lewandowski:Do you see a pattern with a lot of writers starting out is Act two where they struggle the most? Or is it act three or is it,Michael Jamin:Listen, I don't make it to act two. If Act one isn't good, I don't read further. I get another script. If I get a stack of scripts, who cares about Act two? Fact One sucks.Kevin Lewandowski:Yeah. Ben Miller, what screenplays are the best to read, to learn from perhaps the West Wing pilot, which I read in a screenwriting class?Michael Jamin:Well, it depends what you want to write. If you want to write drama, then maybe West Wing pilot, I haven't read it, but you can also learn from reading band scripts. You can say to yourself, if long as you're honest, why am I not interested in this? And if you know what to look for, why is the script not compelling? Is the dialogue, is it the act breaks? Do they now you'll know what to look for? And then the trick is to be honest with yourself. There's been times even in my early career where I might pitch something to my partner and he'll say, if you read that in a script and someone else's script, you'd say, that sucks. And I go, really? I thought it was good. He goes, no, no, you would say it sucks. So then at that point, you got to go, okay, you got to back off. And you don't fight for it. You got to be honest with yourself.Kevin Lewandowski:I think another amazing thing in today's world that didn't really exist when you start out is pretty much any show that's out there right now, you can get access to some version of the script, whether it was a writer's draft or a production draft. IsMichael Jamin:That true? How do you find them?Kevin Lewandowski:I mean, if you just go to Google and you type in Breaking Bad Pilot script, there's going to be versions that you can download. It's always interesting to read those scripts and then watch the first episode and see how much did they change? Because I doubt you'll be able to find necessarily the final shooting draft online, but those first couple writer's drafts are available. And it's always interesting just to see you're reading it and you really, really like this part, but then you watch the episode and they took it out. You're like, oh, okay. That's interesting thatMichael Jamin:If you really wanted up your game, you could also watch the pilot of Breaking Bag and type out the script while you're watching it and then read it later and look for what are the act breaks, literally, what are the act breaks? How do they work? What's the dialogue on that? What's the last line of every scene? What's the dialogue? At the last line,Kevin Lewandowski:When I was doing writer's assistant script coordinate stuff, that's what I used to do to type faster just sit and watch TV and just type out the script as it was happening.Michael Jamin:Wow, good forKevin Lewandowski:You. Because in the room, they don't like it when you say, Hey, can you slow down a little bit? Can I hear that again? No, you got to go.Michael Jamin:Yeah.Kevin Lewandowski:Okay. Part, what advice would you offer writers to adapt to the inevitable changes in developments expected in the screenwriting field and then years to come? I'm assuming that's in the context of chat, GPT, ai, that kind of stuff.Michael Jamin:Right now, that stuff is being regulated. I don't know of anybody who's using it in a writer's room. That's not to say I could easily be out of the loop, so I don't know. But right now, as far as I know, chat, GPT wasn't a tool. Any writer that I knew was clamoring for, because we all knew if it works, it's going to put us out of a job. So any changes? I don't know. I really don't know. I would just say maybe I'm naive, but stay the course. Figure out how to write without using a computer program or else, because if you're using the computer program, what do we need you for?Kevin Lewandowski:Right. Have you ever just to see what it would look like, just prompt, Chappie, just to write you a random scene just to see what it would look like, and then compare it to your knowledge you have of being a professional writer forMichael Jamin:Many years. Well, a couple of months ago, my partner decided to put some prompts into chat, GPT to come up with story ideas for Come FD for the show we were on. He just read 'em to me. We were both laughing at how terrible they were. It was like a paragraph of what's going to happen in this episode. And it was interesting how it was able to glean what the show was and what it was like, but it was just such an oversimplification of what the show, it lacked any nuance. It was kind of stupid. It was like, nah, that's not, I know. That's what it was almost like asking a 4-year-old what you think the show is and the four year olds. Yeah. Okay. You're right. It's about firemen. Okay, sure. But other than that, the ideas were terrible.Kevin Lewandowski:Yeah. Another question from NRS creates, what are your thoughts on screenwriting competition websites like Cover Fly and the Blacklist? Is that a good way to get a script into people's hands? Thoughts on one act, scripts, one act plays? Do they have three acts?Michael Jamin:A lot of questions. I think you're the better person to answer the first part.Kevin Lewandowski:Yeah. So I've definitely submitted to some of those contests just to see A, if I would get any more B, what kind of feedback they would give. And a lot of times it's not very helpful feedback. And you've talked about, you have to question who these people are that are giving feedback, because chances are, they're not professional working writers right now. They would not have the time to go through 20, 30 scripts to give feedback. So chances are these could potentially be recent college graduates that are just doing what they think, what they learned in film school. And interestingly enough, I think Phil, he went through one competition. He sent me what the feedback was, and just reading it, I was like, this sounds very Chat, GPT ai. It was just very, because he sent me other ones he got, and I was like, okay, this feels like a person actually read this. This feels like it could have been put in chat, GPT, write a response based on what you think. And then when I said that to him, he was like, you might be right. He's like, you might be right. Interesting.Michael Jamin:Back when I was writing my book and I submitted to some publishers, whatever, a couple wrote back why they didn't like it, why they didn't want to option the book or whatever, and whatever. A couple of them, their feedback was like, no, it's clear to me you barely read it. Which I understand because these were low level publishing types editors. And on their weekend read, they probably had to read a couple dozen books, manuscripts, they're not going to give it full attention. And I was like, so some of the criticism, I was like, okay, that's a fair criticism. But no, but that is not, there's literally no truth in what you're saying there. You just phoned it in because you have to read so much over the weekend. So I don't know. Got to take, no one's going. I mean, it's the same thing for these websites. Are they really going to put their heart and soul into it? No. Why would TheyKevin Lewandowski:Don't care. They just want theMichael Jamin:Money. Yeah. Why would they? Yeah.Kevin Lewandowski:You think about someone in your position giving feedback to a fellow writer that might take you two and a half hours, read the script, think about your notes, and then put 'em in a format to be able to explain them to the writer. And I don't think these people in those competitions are doing that. They probably just read it once and write down what they think. And it's funny how some of them, it's what would you rank the character dialogue on a one to 10, and they write six and a half. It's like,Michael Jamin:Where are you gettingKevin Lewandowski:That from? One is six and half. So then what would've gotten me an eight or an half or a nine?Michael Jamin:One of the things we just started doing on their website, if you have the course, our screenwriting course, I have a couple of friends who are high level writers who are willing to give notes. But here's the thing, you're going to pay. It's not cheap. You're going to pay these people to sit down and read your damn script for two or three hours and they're not getting $10 an hour. That's not what they're going to get. I don't know what you get paid for,Kevin Lewandowski:I guess. So is this a good way to get your script into people's hands? So I think, yeah, mean it's technically people's hands, but I don't know ifMichael Jamin:I don't think they're the right hands.Kevin Lewandowski:Feedback is going to be any valuable. And then thoughts on one X Scripts. One X plays, do they have three x inherently?Michael Jamin:That's an interesting question. Do they have three acts? I would say yes, in terms of the structure, in terms of what makes something compelling, but not necessarily, I guess I've written some stories in my book that don't fall into the traditional three Acts structure, but they come close. They definitely come close to it. And that's just because, well, it doesn't really matter why, but you can't go wrong. You really can't go wrong if you structure something like the way we teach.Kevin Lewandowski:So in your opinion, because heard, sometimes people use a five act structure, and I think for me, I think it's basically the same three act structure, but so act one will be act one, and then Act two isMichael Jamin:ActKevin Lewandowski:Two A and then Act two B. And so it's kind of broken up like that. So for me,Michael Jamin:Well, Shakespeare wrote that way. Yeah.Kevin Lewandowski:And he's all right. He did.Michael Jamin:Yeah. I mean, I just think it's easier not to write. I just think three is easier to get your head around. Yeah.Kevin Lewandowski:Yeah. I think just the thought of hearing the words, so writing five acts, that just sounds like it can be a lot, but if you could be like, oh, three acts, okay, I can do that.Michael Jamin:Yeah. Right. Anyone could do that. Yeah.Kevin Lewandowski:Next topic, breaking in. DJ asked when starting out to obtain that experience, what sort of job should one be searching for, staff, writer, assistant, et cetera?Michael Jamin:You should be searching for the production assistant job anywhere, and eventually, after a season or two, see if you can move to a job that's closer to the writer's room. Physically, let's do what Kevin did. That's what he did.Kevin Lewandowski:And I think there's a staff writer that's obviously not entry level assistant. There's various assistant positions you could do production assistant, you can do showrunners, assistant executive assistant. I think one of the, or the terminologies people may get confused is writer's production assistant and then writer's assistant. And the writer's production assistant is the one that's responsible for getting the lunches, stocking the kitchen, making copies, things like that. And the writer's assistant is the one that sits in the room, types up the notes and the jokes that are being pitched. And they work closely with the script coordinator. And as you've said, many times, the writer's assistant is not an entry level job. It can be very intensive times.Michael Jamin:And for what's worth, I've worked with several assistants, either writer's, assistant production assistants, who've since gone on to become staff writers have had successful careers. So it's not like many. So Kevin, hopefully you'll be next.Kevin Lewandowski:Yeah, I'm hoping so too. Next question, Sammy. ak. So the best way to get a foot in the door to support and learn the biz write in assistant or pa, we kind of just answer that. Yeah. Production assistant is that entry level. You're kind of just the gopher and you're the whatever they kind of need you go do, and you prove yourself to those people above you. And they notice. Notice people notice when you're either calling it in or you're really going above and beyond to make whoever's ahead of you life a little bit easier. Yeah. All right. Now we got some miscellaneous. Oh, here's a fun question. Tulio, how close are you to officially publishing your book, Michael,Michael Jamin:It's already out tulio. You can go get it. You can find it. Sign copies are available@michaeljamin.com slash book. Or you could search for a paper orchestra on Amazon or Barnes and Noble, or the audio book on Audible or Spotify or Apple. How about that?Kevin Lewandowski:Get the book. Everyone get the book. The comment to address from Jonathan Loudon, real world dilemma. I like this. Can't get experience without getting hired. Can't get hired without experience. That's why, who is such a reality?Michael Jamin:Well, but if you're starting off in an entry level position, you don't need to know anybody. You just have to put yourself out there. And then in terms of knowing someone later in your job, well, now you already know people. Now you broke because entry levels, literally, you have a pulse in a car. So I find that it's a convenient excuse. Put yourself out there, and Kevin, you didn't have any contacts when you broke into Hollywood. None. So there you go.Kevin Lewandowski:You just got to knock on some doors. I think people that work in the industry, they know kind of how it works. Once you break in, you become a pa, and you make those network connections with production coordinators that you've worked with and people on the show, and you build those genuine relationships and you do good. Then when they go to the next show and they're like, Hey, we need someone, then they'll reach out to you andMichael Jamin:They're not reaching out for you because they're as a favor to you. They're reaching out to you because we need to hire someone. And I don't really want to spend days interviewing.Kevin Lewandowski:I already know you can do the job. It's so much easier just to bring you aboard.Michael Jamin:Yeah, right. It's not like a favor to you. It's a favor to them.Kevin Lewandowski:Yeah.Michael Jamin:You are listening to, what the Hell is Michael Jamin talking about? Today's episode is brought to you by my new book, A Paper Orchestra, A Collection of True Stories. John Mayer says, it's fantastic. It's multi timal. It runs all levels of the pyramid at the same time, his knockout punches are stinging, sincerity, and Kirker View says, those who appreciate the power of simple stories to tell us about human nature or who are bewitched by a storyteller who has mastered his craft, will find a delightful collection of vignettes, a lovely anthology that strikes a perfect balance between humor and poignancy. So my podcast is not advertiser supported. I'm not running ads here. So if you'd like to support me or the podcast, come check out my book, go get an ebook or a paperback, or if you really want to treat yourself, check out the audio book. Go to michael jamin.com/book, and now back to our show.Kevin Lewandowski:Next question, all nighters cinema, what makes your script stand out? If it's a book adaptation and the story isn't your original story,Michael Jamin:Well, do you have the rights to adapt? A book is one question. So if you don't, I probably wouldn't adapt it. And that's not to say that when people think you adapt a book, you still have to have these act break pops. These scenes have to unfold. It's not like books are a slam dunk to adapt. I mean, there's definitely some art and craft that has to be applied to turning into a script. So that's how you make it stand out.Kevin Lewandowski:And I think one of the other things you like to say is if you have a book, there might be a few different stories happening throughout that book. And in your paper orchestra, one of the examples you get, oh, I forget what it was called about the swing dance, and I forgot that chapterMichael Jamin:Was called Yes, swing and a Miss.Kevin Lewandowski:Yeah. As you said, there was other stuff happening at that point in your life, but it was just this story was the one you wanted to tell. Of course you were going to work and doing stuff like that, but this was the story you wanted to tell.Michael Jamin:Right. And also, how many times have you seen they've adapted a book, I don't know, a popular book into a TV show movie? And sometimes it's good and sometimes it's bad. It's because it's not as simple as simply typing the book.Kevin Lewandowski:And a lot of times people say the book was even better or the book was better anyways. And I mean, it's hard to take 300 pages of a book and consented toMichael Jamin:An hour and a half movie. Right.Kevin Lewandowski:David Sallow, what if you a show idea that you have done the work on and think it uniquely speaks to the present moment? Are there any shortcuts possible there or noMichael Jamin:Shortcuts to what? You got to write a script. Yeah. There's no shortcuts to write in a good script, and there's no shortcuts to selling it. There's no shortcuts anywhere. Shortcuts. When does shortcuts ever work? I don't know. Where are the shortcuts? Yeah, little Ed riding Hood. Other than that, in real life, you got to put the work in. Right.Kevin Lewandowski:Do you ever watch the, there's a documentary about the South Park creators and how from they, from blank page to delivering the episode, how many days do you think,Michael Jamin:Well, I know they're super fast, so I would say five,Kevin Lewandowski:Six.Michael Jamin:Six.Kevin Lewandowski:Okay. Six days. That's very fast. They are delivering it like a half hour before it's supposed to. Yeah.Michael Jamin:And that's because the animation process is so crude that they can do it so quickly, but that's fast,Kevin Lewandowski:And we've just gotten used to it that way. So I think with them in an interesting way, that's why their shows seem like their current and present, because something could have happened in the news last week, and then that episode could air next week. Whereas other animation shows, and I know you've worked in animation, sometimes it's seven, eight months before that episode,Michael Jamin:Or it could be nine months, nine months animated show. So yeah, you don't do anything top of one within in an animated show, not the ones I've done.Kevin Lewandowski:Yeah. Next question. What if I wrote lyrics to the theme song? Is that okay to include? I think this might be in the context of one of the things you say in your scripts, don't write music cues. Don't write, don't put song lyrics in there, or something like that.Michael Jamin:I mean, if you think you got fantastic lyrics and you're going to really impress the hell out of someone, but you still have to, when I'm reading the script, I have to imagine what the music is, and I'm not going to imagine the music. And I suppose you can write the lyrics and maybe some people will read it and some won't. So it's up to you. Do you really think it's fantastic or not?Kevin Lewandowski:I had a couple scripts that I put part of a song in there and then listening to, I'm like, no, it's coming out, taking it out.Michael Jamin:In my opinion, there's really no, I'm not crazy about reading that.Kevin Lewandowski:Yeah,Michael Jamin:I mean, maybe others are, I don't know.Kevin Lewandowski:Well, I think, I think back to my script, it was I just kind of being lazy. Could I take that three eighths of a page and add something in there that's going to help move the storyline further, or was I just looking for a, what's a funny moment I could have right now?Michael Jamin:Right. Okay.Kevin Lewandowski:Let's see. From Aaron, in terms of recognizing good writing, writing, what is considered too much in terms of providing direction to actors, description of character, thoughts and emotions, et cetera?Michael Jamin:The less the better, in my opinion. You don't want let the actors do their job, and if you feel you can't convey the anger in a scene or the love in a scene with dialogue and you're yelling at the actors, do it this way, then you haven't done your job as the writer do your job. Not everyone else's. As far as action lines go, I am of the camp that the shorter the better because most writers or most people reading do not want to read your action line. I suppose one day, if get, I think when you get more successful, if you're Aaron Sorkin, you can write whatever the hell you want. You're, because he writes his actions line. I imagine poetry, it's probably his action lines are probably just as interesting as his dialogue because he's such a great writer, but don't count on it when you're starting off.Kevin Lewandowski:I was reading something, I forgot who the actor was, but they said, the actor always requested that their script have commas and apostrophes taken out of dialogue because they felt like they didn't want someone telling them how to say things. And I was like, I can respect as an actor, but I was like, that poor script coordinator, they have to go through that whole script again and take everything out.Michael Jamin:That's a little bit much to me. It seems like putting a comma there is like that's just grammar. And if they wanted to take it out, I think they should do it themselves, but whatever,Kevin Lewandowski:From Jonathan Loudon, again, how many feature films have you written, pitched, but never sold?Michael Jamin:Well, we wrote one completely as a spec, and that did not sell, but that got us a producer interested in our writing, and then we wrote two more that did sell as pitches. We pitched them first, then we got paid to write the script. And as far as I can remember, I don't think we wrote any other feature scripts. I think we maybe had some ideas that were batting around, but we never actually pitched or wrote, but we work mostly in tv.Kevin Lewandowski:So do you know, because from what I can recall, you've never sold a feature that actually went into production, correct. Right,Michael Jamin:Right. They they never do.Kevin Lewandowski:Yeah. And how do you think you would feel, because as you say, tv, the showrunner head writer has the final say, and on a feature, it's the director that has the final say. I worked with someone, his name's Steve Rudnick, and he wrote Space Jam and the Santa Clause movies with Tim Allen, and he told me this story how he was at a baseball game and he saw someone walking down the aisle and it had a Space jam cast and crew jacket. And he asked the guy and he was like, can I ask you where you got that jacket? That's a really cool jacket. And he's like, oh, I worked on production. This was all our rap gifts, and Steve never got one because writers usually aren't part of the production aspect onMichael Jamin:Feature, and he was accredited writer on it. Right. That's what an actor thought he was. Yeah. Yeah. I think that's probably common. I don't know why people want to become writers on movies. I mean, it would be cool, but maybe he was heavily rewritten. Maybe he was, I don't know.Kevin Lewandowski:He was so bummed. Yeah.Michael Jamin:Yeah. He wasn't invited to anything.Kevin Lewandowski:Yeah. Right. Geo, could you elaborate on the things not to say to executives or some examples of what the producer said?Michael Jamin:What the producer said? I'm not sure I answered the question.Kevin Lewandowski:So can you elaborate on the things, so I guess as a writer, and maybe you gave your script to an executive and they were giving you feedback or said, Hey, maybe do this, do this. How would you respond to those notes?Michael Jamin:Yeah, you want to be positive. Great. We'll work on that. Thank you. Good idea. Interesting thought. We'll definitely do our best with that, and then later, hopefully you can take 90% of the notes and the ones you can't take, you say, I think we address the spirit of your note. Even if we couldn't address your notes or this one, we couldn't make it work occasionally, but you're doing 90% of the notes. Yeah.Kevin Lewandowski:I think the phrase I would always hear on notes calls is, okay, well, yeah, we'll take a look at it. We'll take a look at that. Yeah,Michael Jamin:We'll take a look at it. Yeah. We,Kevin Lewandowski:Next question from Cody, with short seasons, freelance opportunities have mostly gone away, but are there still opportunities for freelance, and if so, how are writers polled in for those?Michael Jamin:I don't know. That's a good question because that's a question. You'd have to look that up with the Writer's Guild. I don't remember on our last show there, I don't recall ever having those guys doing freelance, giving off freelance episodes to anyone. So it used to be a Writer's Guild mandate if the show was a certain length that they had to give out a certain number of freelancers. And now maybe they don't have to, but I wouldn't either way get it out of your head that you're ever going to sell a freelance episode because it's just so over my 28 years, I think I've sold maybe three freelance episodes and I would do more. It's not a problem. It's just that they're really hard to get.Kevin Lewandowski:And I think a lot of times what happens in writer's rooms is those writer's assistants and script coordinators that have proved their worth for a couple of seasons. If that opportunity comes for them to get a freelance episode, the showrunner helps 'em out with that, and that helps them get into the Writer's Guild and things likeMichael Jamin:That. That's usually a bone you throw those support staff after they've been there a couple of years.Kevin Lewandowski:That's a nice bonus. It's a nice check to get. Next question, David Campbell. Does the creator continue to have involvement or do you teach them on the job?Michael Jamin:If someone creates the show and they are not the showrunner, which just happened on a couple shows we've done. We were not the showrunner and the creator had involved. They were on the writing staff, but they didn't have any say. They didn't have the final say or anything. If we are the showrunner, whoever's the runner has final say. Yeah.Kevin Lewandowski:Next question, nerds and friends, how many writers' rooms are virtual remote nowadays? What is the path to becoming a showrunner? Is it a writer pivoting into that role? I can imagine producing experience helps.Michael Jamin:No, so a showrunner is the head writer. The way you become a showrunner is by being a writer on many shows and being good at writing, and then the producing aspect of the job. You kind of learn on the job as you rise up the ranks. You don't have to take a course or there's no certification, and it's something you can fake.Kevin Lewandowski:For me, I never really understood what the word producer meant. No one in the context of television, because it's working in the industry, you learn, okay, writers can be producers, but then sometimes accountants, if they're high enough, they can also be producers. And not every producer is necessarily like the creative vision. Some of them deal with the money aspect of it.Michael Jamin:Yeah. They're non-writing producers or non-writing executive producers, they'reKevin Lewandowski:Called. Yeah. Next question, K with an asterisk next to it. Are series filmed for streaming services similar to TV regarding creative control for the show runner?Michael Jamin:Yeah. Yes.Kevin Lewandowski:Easy question. Yeah, all-nighter cinema. How different is trying to greenlight a serial TV show versus a mini series?Michael Jamin:It just depends on what the network, usually they're buying series. They're not buying mini series there. Sometimes they're buying limited series. It just depends on the network. And I wouldn't even approach, again, your goal is to write one great script as a writing sample, and it's not to time the market and figure out who's buying what. Can you write a script? Answer that question first,Kevin Lewandowski:Right? If a studio buys your pilot but ends up passing and an exec at another studio is interested, how realistic is it that they'll buy it againMichael Jamin:If the first one will buy it?Kevin Lewandowski:I don't know. I'm wondering if they're asking just because one studio passes on your script, does that mean every studio is going to pass on it?Michael Jamin:No. No. Usually if you're lucky, you pitch to five studios and one buys it. That's how they don't all want to buy it. You're lucky if one wants to buy it. But again, what's frustrating about all these questions that we're hearing is everyone's saying, how do I make money selling a script? And no one's saying, how do I write a good script? Everyone is already assuming that. It's just so damn frustrating. It's like, guys, what do you think? How do you think this is going to work? It's not about the meeting. It's about writing a damn good script. First thing's first. So I don't know, what are you going to do? I yell into the wind. People don't listen to me on this.Kevin Lewandowski:I listen. They'll listen. They'll listen. Yeah. I mean, I think there's almost this weird delusion that people think they're going to move out here within a year. They're going to have their own show. And I was just talking to someone the other day that they're going to USC, and she was talking about kind of her timeline with things, and she said, I want to give myself five years from when I graduate in 2025 to try to get into a writer's room. And when she said that to me, I said, very realistic. That's not too quick that, because there's a lot of luck of, IMichael Jamin:Thought you were going to say have her own show on the air.Kevin Lewandowski:No, no. She was very much, if I can be in a writer's room in five years. So I thought, yeah, because tough, because if you can get on that show that season one, it's not a hit yet, then it becomes a hit that can definitely fast track you a little bit. And my struggle has been, none of the pilots I've worked on have gotten picked up and shows have gotten canceled. And I'd like to believe that's not my fault, but it's hard to look at the No, I'm kidding. I'm kidding.Michael Jamin:But yeah. But it's a little frustrating when people ask these questions sound to me like when I hit a grand Slam, who do I high five first? They're like, dude, can you get on base? Do you know how to get a base hit? What are you talking about? Just get a base hit first. So that's what it sounds like to me. And I wish people would just have more realistic expectations and would take a little more, everyone's assuming they already knew how to do the hard part.Kevin Lewandowski:Yeah. Next question, given that streaming has changed the face of sitcom series writing, how do you feel about the future of the industry? Are there days of having full writer's room and staff over?Michael Jamin:It certainly seems that way, but who knows right now, if you follow what's going on, it seems like, it seems like everything's becoming, we're slowly moving back to the old days. There's going to be fewer streamers. They're going to be consolidation. They're already talking about these big streamers merging. And when that happens, things will change, but we don't really know. Right now, the industry's at a crossroads. They're not picking up a lot of shows. Now. They will pick up start. That will happen. And imagine a couple of, it can't go on much longer. They got to have to start pulling the trigger and start making TV shows again. So we don't know. We're at the crossroads,Kevin Lewandowski:Because I think you said back when you were working on, just Shoot Me In, I think you said King of the Hill, there was more than 15 writers on King. KingMichael Jamin:Of the Hill. We had 20 writers in King of the Hill, and we were do 22 episodes in a season.Kevin Lewandowski:And how many were on Just Shoot Me?Michael Jamin:Well, let's see. In the beginning, I would say it's closer to maybe 10 or so, maybe 12 at some point.Kevin Lewandowski:And in your experience, do you think comedy rooms always have more writersMichael Jamin:Than drama? I don't know. I mean, it just really depends on the budget of the show and how many episodes you're going to be doing.Kevin Lewandowski:I think I was watching something about Breaking Bad, and I think they had six writers.Michael Jamin:Oh, really? That's it.Kevin Lewandowski:Wow. On why Women Kill. We had five.Michael Jamin:The thing about drama is that you don't have to, it is easier in the sense that when you're writing a comedy, you still need to have that structure. You still need to come up with a story that is engaging, but it also has to be funny. But when you're doing the drama, you just need to come up with an engaging story, and it doesn't have to be funny, and you don't have to punch up the lines. And in that sense, I do think it's a little easier, but that's not to say writing Breaking Bad is easy. I mean, what a great show that works.Kevin Lewandowski:Right, right. Next question from maybe, are there tutorials and Final Draft, a proper guide for making your script presentation acceptable?Michael Jamin:What do you think? I don't know. I haven't looked at the tutorials.Kevin Lewandowski:Yeah. I mean, I think the nice thing about Final Draft is they have pre-built templates that you can use. So if you're writing a Multicam, it'll prebuilt that template and everything will automatically be capitalized for you. And same thing with Single Cam. And I think one of the things you always say is when you hand your script to someone, they're not going to know you use Final Draft or one of these other programs to write the script. They're just going to get a printed out version. And I think there's minimal things you need to do, make sure the dialogue is in the middle of the page and certain things are capitalized, and there's a certain format formatting of that. But Final Draft can take care of all that too. So when you're done writing, you just hit file, export as PDF, and that's it. You're done. All the four is done.Michael Jamin:I mean, final Draft, like you said, has those templates, and it'll make your script look like a script, which is great. You got a script, you got something that looks like a script, but does it read like a script?Kevin Lewandowski:Right. Har Draft does not do that for you. Yeah, it won'tMichael Jamin:Do that.Kevin Lewandowski:Michael's course does.Michael Jamin:Yeah. I hope,Kevin Lewandowski:Lorenzo, given your friendship with the late David Bellini, have you got any insights on Italian films, TV industry, in your opinion? Is there any difference? Thank you.Michael Jamin:From what I knew from David. David when he was a lot, the difference is enormous. It's a whole different film structure over there. It's not so much of an industry as it is. I don't know. It sounded like really hard. And he was pretty successful. He worked on a bunch of shows, and he moved to LA to Hollywood because he was like, this is too crazy here. This is just not enough work. So I think it was a miracle that he was as successful as he was there, but it's a whole different ballgameKevin Lewandowski:If the script doesn't have scenes in it. How should it be written? Is it just dialogue and descriptions? Do you have any advice for someone who wants to be a script doctor?Michael Jamin:Okay. The script does have to have scenes in it. It can't be all one scene. That's not going to be acceptable. A script doctor is not really, that's some bullshit that people say on the internet. No one I've ever met ever called themselves a script doctor. We're all screenwriters. And sometimes you sell your own work, and sometimes you're brought in to rewrite somebody else's, and there's no script doctor. You don't get a degree and you don't wear a stethoscope. And that's not a job. It's just sometimes will get paid to rewrite someone else's script, but you'll only get that job if you're a really good writer and you've written some really good scripts on your own. And then when you do, usually you're like, hell, I'll just write. I want to write my own stuff. And you're brought in to change someone else's script because it's like, all right, someone's giving me money and here's a job, and I'm in between jobs, so I'll do it.Kevin Lewandowski:There's no shortcuts. A couple more questions, Aaron. How many followers, subscribers would someone need to have on social media for that to be interesting and asset to a studio or showrunner?Michael Jamin:Literally have no idea. And I'm not sure it would be interesting to a showrunner at all as far as the studio, in terms of being a writer. You're not expected to have a social media following at all. I just happen to have one, but it's not right. No one's, no one ever asked me, no one really cares. The benefit is I can promote my own stuff. I have a following, but for a writer, you don't need that.Kevin Lewandowski:Yeah. And then our last question, is it okay to make the size of the words on the title page a little bit bigger?Michael Jamin:I suppose it is. I don't try to do anything fancy, but I don't know why you want to. It's okay if you want to. It's not desperate, but I don't know. I try to make it, I want my script to look like just an ordinary script. I want the pages themselves, the dialogue to stand out. I'm not really trying to make the cover page stand out.Kevin Lewandowski:Yeah, I think it's like when writing any paper you did in college or whatever the title is, 18 font, and then the stuffy writing is 12 font or whatever.Michael Jamin:Yeah, you can do that.Kevin Lewandowski:Yeah. I think one of the things you said is the title page. No one necessarily cares about that. If you put a fancy image on there, that's not going to, people aren't going to be like, oh, we got to hire this person. We got to hire this person right now.Michael Jamin:Yeah. Don't even give any thought to the title. I mean, really. You're not going to fool anybody. So yeah.Kevin Lewandowski:Well, that is all the questions we have from that webinar.Michael Jamin:Wow. Excellent. Kevin, you did really well. You're a natural here. Thanks. Yeah. Alright, everyone. Thank you. Please continue coming to our webinars. We do 'em every few weeks. To sign up, go to michael jamin.com/webinar. I got a book out. I hope you all get it. Sign copies are available @michaeljamin.com slash book. And if you want to come see me on tour, go to michael jamin.com/upcoming. Kevin, where can people find you?Kevin Lewandowski:I'm on social media, Kevin Lewandowski. Sorry it's a very long last name. It gets butchered a lot, but I'm there. And yeah, I occasionally make appearances with Michael on these webinars and things like that. So yeah. Thank you all for who's been coming to the webinars and checking out Michael's stuff. Just go to michael jamen.com and just start clicking around. There's a bunch of stuff you can get his free scripts, stuff he's written. There's free lessons up there. Every podcast we do gets uploaded there. You can spend hours on that websites. Just go there, click around, buy the book byMichael Jamin:The book. Thank you so much buddy. Alright. You're just going to stick around. Kevin's going to be back next week for another episode. I believe it's next week. We will see when it drops, but he's going to be back around for another one. Alright, everyone, until then, keep writing, keep being creative and all that stuff. Thanks so much.Michael Jamin:Wow. I did it again. Another fantastic episode of, what the Hell is Michael Jamin talking about? How do I do it week after week? Well, I don't do it with advertiser supported money. I tell you how I do it. I do it with my book. If you'd like to support the show, if you'd like to support me, go check out my new book, A Paper Orchestra. It asks the question, what if it's the smallest, almost forgotten moments that are the ones that shape us most. Laura Sanoma says, good storytelling also leads us to ourselves, our memories, our beliefs, personal and powerful. I loved the Journey, and Max Munic, who was on my show says, as the father of daughters, I found Michael's understanding of parenting and the human condition to be spot on. This book is a fantastic read. Go check it out for yourself. Go to michael jamin.com/book. Thank you all and stay tuned. More great stuff coming next week.

National Retail Solutions Offers Innovative Solutions for Independent Retailers NRSplus.com Show Notes About the Guest(s): Eli Katz is the President and CEO of National Retail Solutions (NRS) Plus. With over seven years of experience in the industry, Katz has brought his expertise as an executive in various companies to found NRS. NRS operates the leading point-of-sale terminal-based platform and NRS Pay with credit card processing for independent retailers. With over 27,000 active POS terminals in stores nationwide, NRS provides solutions to help independent retailers compete in the market. Episode Summary: In this episode of The Chris Voss Show, host Chris Voss interviews Eli Katz, the President and CEO of National Retail Solutions (NRS) Plus. Katz shares the story of how NRS was founded and the mission behind the company's offerings. He discusses the challenges faced by independent convenience store owners and how NRS provides them with the technology and insights to compete in the market. Katz also highlights the importance of clean and transparent credit card processing for small businesses. Additionally, he introduces NRS's innovative panic alarm system embedded in their point-of-sale registers, designed to enhance the safety and security of store owners. Katz concludes by discussing NRS's partnerships and future plans to continue improving their product offerings. Key Takeaways: NRS provides independent convenience store owners with a point-of-sale register that offers digital coupon products, credit card processing, and other features to help them compete in the market. NRS's credit card processing solution, NRS Pay, offers a clean and transparent rate with no long-term contracts or hidden fees. The panic alarm system embedded in NRS's point-of-sale registers silently alerts the police in case of emergencies, providing a sense of security for store owners. NRS has partnered with companies like Strata Select, MS Energy Technologies, and Source One Digital Team to offer additional solutions and services to their customers. NRS is committed to continuously improving their product offerings and providing support to independent retailers in various industries. Notable Quotes: "We created the world's greatest point-of-sale register for these independent, convenient liquor tobacco stores." - Eli Katz "Our point-of-sale register offers clean and transparent credit card processing with no hidden fees." - Eli Katz "The panic alarm system gives store owners a sense of security and comfort, knowing that help is just a button away." - Eli Katz "We partner with reputable companies to offer additional solutions and services to our customers, such as signage and canopies for gas stations." - Eli Katz "Our goal is to level the playing field for independent retailers and provide them with the tools they need to succeed." - Eli Katz