Podcasts about nsaids

Recognizing that osteoarthritis (OA) isn't just a disease of “old dogs” is transforming how veterinary professionals care for their canine patients. Yet, in the fast pace of clinical practice, performing a full orthopedic exam on every patient isn't always feasible. This episode of the VetFolio Voice podcast offers practical strategies to help you screen patients and identify those who would benefit most from a more thorough orthopedic evaluation. Learn how to communicate with clients on detecting early-onset OA, when to escalate to diagnostics, and how to tailor multimodal, long-term management strategies using a combination of NSAIDs, surgery and newer options—because every dog deserves to move comfortably at every stage of life.

Dr. Deb Muth 00:00:09 Hi there, how are you? Bob Miller 00:00:10 Excellent! Pedaling as fast as humanly possible, but doing okay. Dr. Deb Muth 00:00:14 Good, good. Well, I’m looking forward to our conversation today. This should be amazing. Bob Miller 00:00:20 Yeah, it should be a lot of fun. Dr. Deb Muth 00:00:22 Yeah, anything that’s off-limits for you in, our conversation? Bob Miller 00:00:28 No. Dr. Deb Muth 00:00:29 Okay, anything you want me to make sure we cover for you? Bob Miller 00:00:33 Well, I mean, is it okay if we put a little plug-in for our software? Dr. Deb Muth 00:00:35 Absolutely. Bob Miller 00:00:36 Yeah. Dr. Deb Muth 00:00:37 Absolutely. Bob Miller 00:00:36 Yeah. Dr. Deb Muth 00:00:37 Absolutely. Bob Miller 00:00:38 Hey, can we… can we do a screen share? Yes, we can. Yeah, because I want to show you some maps, and… Dr. Deb Muth 00:00:43 Okay. Things like that, yeah, so… Perfect. So just let me know when you want to do screen share. Bob Miller 00:00:48 Okay. Dr. Deb Muth 00:00:49 And yeah, feel free to plug your software wherever you want to. Bob Miller 00:00:53 Okay, well, good. Let me pull up a, a slide for that, and give me one second, I just want to shut the door to my office to get the noise down. Dr. Deb Muth 00:01:01 No worries. Bob Miller 00:01:16 And, how should I refer to you? Dr. Debb? Dr. Muth, what do you like? Dr. Deb Muth 00:01:18 Dr. Deb is great, or Deb, either way, I’m pretty informal, so… Bob Miller 00:01:22 Yeah, and… Bob is fine for me. Okay. Yeah. Yeah, there you go. Why people feel like they need this, son. Special name, it’s like, seriously. Dr. Deb Muth 00:01:33 Right? I agree. Bob Miller 00:01:35 When I work with my clients, it’s like, Dr. Millison, just, just bop, just, just bop. Dr. Deb Muth 00:01:41 Yep, that’s how I am, too. Just call me Deb, it’s good. Dr. Deb Muth 00:01:44 They feel a little awkward with that, you know? They’re not used to that, but… Bob Miller 00:01:48 Alright. And you’re a naturopath, medical doctor. Dr. Deb Muth 00:01:52 A nastropathic doctor and a nurse practitioner. Oh, nice. Yeah, so I got the best of both worlds, right? Bob Miller 00:01:58 Yeah, damn. Okay. Alright, so here we go… There we go. Alright, so I got that ready, and then I will do a, I will do a screen share. I think you’re gonna really, appreciate what we’ve come up with. We’ve come up with the concept of, Cellular CPR. Dr. Deb Muth 00:02:23 Oh, nice! Bob Miller 00:02:24 And that is, construct the cell membrane, Protect the cell membrane. And restore it if it’s damaged. Dr. Deb Muth 00:02:32 Love that. Bob Miller 00:02:34 I love that. Yeah, so that’s what we’re focusing on, and then how, You know, we want to get to the point that, you know, most people think of genetics, they think of, like, 23andMe or Ancestry. Dr. Deb Muth 00:02:44 Yeah. Bob Miller 00:02:45 And then you have the professional geneticists who are looking at, you know, odd things that could create a disease. We’re looking at functional genomics. Dr. Deb Muth 00:02:54 Which is so much better. Bob Miller 00:02:56 Yeah. Are you familiar with what we do here, or… Dr. Deb Muth 00:02:58 A little bit, a little bit. So, it’ll be new to me, too, so I’m excited. Bob Miller 00:03:03 And how much time do we have? Dr. Deb Muth 00:03:04 We have an hour, give or take a little bit on either side. Do you have a hard stop anywhere? Bob Miller 00:03:10 No, no, I put a, I moved my clients around, and I don’t have anybody till, 3.30, so we’re good. Okay. Dr. Deb Muth 00:03:16 Perfect. Alright. Bob Miller 00:03:18 It’s like we’re getting started early as well, so… Dr. Deb Muth 00:03:19 Yeah, we’re getting started a little bit early, so that’s good. Bob Miller 00:03:22 Yeah, I just got my office cleaned up, so… Dr. Deb Muth 00:03:23 Okay, good. All right, are you all set to get started? Bob Miller 00:03:28 I’m good to go, my friend. Dr. Deb Muth 00:03:29 I’m gonna just record a little intro and a little bit of a, hook for people, and then we’ll get started. I’ll ask you to kind of tell us a little bit about yourself, and then we’ll just take this conversation wherever it’s supposed to go. Bob Miller 00:03:39 Okay, you got it. Dr. Deb Muth 00:03:40 Alright, sounds good. So what if the reason you’re not healing isn’t your diet, your supplements, or your labs, but it’s actually your genes? Dr. Bob Miller is uncovering how genetic variants, when combined with modern toxins, explain why some of us stay sick no matter what we try. Today, we’re talking genetic pathways, detox blocks, and the new science every wellness warrior needs to know. Welcome back to Let’s Talk Wellness Now, the show where we uncover the root causes of chronic illness, exploring cutting-edge regenerative medicine, and empower you to heal from the inside out. I’m Dr. Deb, your medical detective, and today, our guest, Dr. Bob Miller, is a true pioneer in functional genomics. He’s a board-certified traditional naturopath and the founder of Neutrogenetic Research Institute. And he’s the leading groundbreaking research on how genetic variants influence chronic illness, inflammation, and detoxification. His work has been recognized on international stages, uncovering links between genetic expression and conditions like Lyme disease, mast cell activation, or MCAS, and mitochondrial dysfunction. I’m so excited to talk to Dr. Bob today. He is gonna reveal some things that even I don’t know about, so I’m excited to learn alongside of you guys. So… Dr. Bob, let’s get started. Tell us a little bit about yourself, and kind of how you got on this journey. Bob Miller 00:05:04 Well, that’s, that’s interesting. I was sort of like a mid-career coming to the natural health field, because in my early 30s, I found myself with a severe case of ulcerative colitis. Bob Miller 00:05:15 And I was in the hospital for 21 days. probably within hours of death, pleading to death. And they told me I’ve got one option, and that is cut out the colon and wear a bag. Didn’t sound like a lot of fun. Dr. Deb Muth 00:05:27 Not an option I would want. Bob Miller 00:05:29 So, you know, the medical folks wasn’t real happy with me, but I said, yeah, I’d like to explore some alternative things.Never thinking that I’d get into this field, and then I just, you know, worked with some herbalists and things that I found absolutely fascinating. So, that’s how I got into this around 30 years ago. And, haven’t looked back since, and just having a… having a blast as we now move into how our genetics impacts things. So, that’s what we’re gonna… that’s what we’re gonna talk about today. Dr. Deb Muth 00:05:58 I’m excited to talk about this genetic thing. When you started over 30 years ago, what kind of patience and problems first inspired you to dig deeper into that root cause healing and kind of get into the genetic piece of it? Bob Miller 00:06:10 Sure. Well, you know, as a… now, I’m in a part of the country called Lancaster County, Pennsylvania, where there’s a lot of Amish and Mennonite, and they gravitate towards these things.So, this is their first thing to do, and that doesn’t work, then they’ll go other routes. So, you know, back then, we just saw typical, you know, a little tired, constipation. You know, a little bit of fatigue, arthritis, those kind of things. But things have changed dramatically over the years, as people are now getting more chronically sick. You know, it’s worse than it’s ever been. And what we’re finding is the, the culprits Primarily is mold exposure and Lyme disease. When people get those two together, they’re just… it’s an inflammatory cascade that nobody can seem to unravel. So that’s where we spend a lot of our time. And we’re also spending a lot of time looking at mental health, like ADD, ADHD. And, we give… this year I’ll be speaking at three autism conferences. And we can dig into that a little bit as to why we think we’re seeing such a dramatic increase. And aside from autism, that used to be 1 out of 1,000, now it’s 1 out of 33, or 23. You know, we’re also seeing dramatic increases in ADD, ADHD. People are stressed out. And today, I think we’ll have the time to actually go through and show how environmental factors combine with genetics to cause that to happen. So we’ll… we should have a fun visit here today. And today, I think we’ll have the time to actually go through and show how environmental factors combine with genetics to cause that to happen. So we’ll… we should have a fun visit here today. Dr. Deb Muth 00:07:37 This should be a fun visit. We can cover lots of topics. I am so excited. So, you founded Nutri Genetic Research Institute in 2015. What did you hope to accomplish, and what kind of surprised you in your findings so far about that? Bob Miller 00:07:51 Well, you know, let’s back up at what, you know, genetics is used for. Everybody’s familiar with 23andMe and Ancestry that, you know, tells you where your ancestors came from. Then you have your professional geneticists. I mean, these are people with a degree in genetics. And they’ll look for, you know, very odd sort of things that are prone to relate to a disease. So there are disease-related genetics. Well, in functional, we don’t look at either of those. We look at For example, how you’re breaking down your fats and utilizing them. How you’re recycling your glutathione. How you might be handling your iron. And none of those are disease-causing on their own.And none of those are disease-causing on their own. But when they pile up on you, and then combine that with environmental factors, that’s when things start to go south on us. So, that’s what we’re doing, we’re looking at patterns. And our first foray into this was, we did studies on Lyme disease. And our first foray into this was, we did studies on Lyme disease. So, we looked at, like, I think 50 people with Lyme disease. We looked at their genome. So, we looked at, like, I think 50 people with Lyme disease. We looked at their genome. And we found patterns that were more evident in those with Lyme. Now, this doesn’t… these genetics don’t mean you get Lyme, it just means if you get Lyme, you react worse to it. And we found patterns that were more evident in those with Lyme. Now, this doesn’t… these genetics don’t mean you get Lyme, it just means if you get Lyme, you react worse to it. So, as you know, some people get Lyme, they go on a round of antibiotics, and they’re done. So, as you know, some people get Lyme, they go on a round of antibiotics, and they’re done. Others have a little more struggle, and then others are struggling terribly for years. So there’s an old adage of genetics loads the gun, environment pulls the trigger. Dr. Deb Muth 00:09:14 Yeah, that is so true, and I think when we’re talking about Lyme and mold and things like that, we forget sometimes that our genetics can predispose us to be more sensitive to those things, and if we have genetic pathways where we don’t clear things properly, it’s harder for us to get them out of the body. And then you add on that whole rain barrel effect that we’ve always used as a functional medicine term, right? If the barrel’s half full, you’re okay. If it’s full, and now it’s spilling over, it’s a bigger problem. Have you guys found, too, that some of these environmental things actually are changing the genetics of people, or how they’re processing their own genetics? Bob Miller 00:09:53 Well, let’s go back to, Genetics 101. But we’ll go back a little bit further. So, what an interesting mechanism, what a miracle the body is. Bob Miller 00:10:03 Fats, carbohydrates, proteins, drink water, breathe air, expose the sunlight, and somehow everything gets made. I mean, when you just step back and think about that, it’s like, It’s pretty darn amazing. Dr. Deb Muth 00:10:15 I always tell women, you know, the fact that we get pregnant and we have healthy pregnancies and births is a miracle, because if we had to try to control that, that wouldn’t work so well. Bob Miller 00:10:25 Right. Well, that’s another miracle. These microscopic sperm and egg, human being, 9 months later, it’s like. But even inside of us. We are making our hair, our skin, our nails, our blood vessels, our ATP, our energy, it’s all being created. Well, that gets created by enzymes. So, enzymes take one substance, combine it with something else, and make something new. Then another enzyme comes along and does the same thing. Your DNA is the instructions on how to make the enzymes. So, when we are conceived. If it’s a, if it’s a female, of course, it’s the XX, the two chromosomes. You know, we’ve… everybody’s seen those… the genetics that… Listed pair. So, if it’s a female, the father donated the X enzyme. And the mother has no choice but to give the eggs, so that’s female. If the father donates the Y, you have a male that’s in chromosome number 1. Then 2 through 23 is the rest of the instructions on how to make enzymes. So, what can happen? We can get what are called SNPs, single nucleotide polymorphisms. And SNPs just mean that the instructions to make the enzyme’s not quite as good. So, if one parent gives a SNP on the making of an enzyme, The enzyme’s fine. It works. But, general rule of thumb, It may only work at 70-80% of efficiency. Now, a good analogy is think of an 8-cylinder and a 6-cylinder car. If parents give you good information, that’s like having an 8-cylinder car. If one parent gives you that snip, it’s like having a 6-cylinder car. Now, is a 6-cylinder car a fine car? Sure. It’ll get you from point A to point B, but it’s just going to have the power of an 8-cylinder. Then if both parents give you a SNP on the same enzyme, it may be 30-40%, and that’s like having a 4-cylinder car. Sits in the driveway, looks the same, puts gas in it, everything. But if you’ve got a 4-cylinder car. Probably not a good idea to go cross-country pulling a trailer behind you up and down mountains. Dr. Deb Muth 00:12:29 This is true. Bob Miller 00:12:32 So… We can get an 8-cylinder, 6-cylinder, or 4-cylinder enzyme. Now, if it’s not under a lot of stress, if that 4-cylinder car is just taking you to the bank and the grocery store. It’s just as good as an 8-cylinder car. But if you gotta pull that trailer, and there’s a lot of stress on it, being mountains, it’s gonna struggle. Now, there’s one other little caveat to this, and that is some genetic mutations are gain-of-function. They actually work faster. Now, we have enzymes that do all kinds of things. We have enzymes that make and recycle our antioxidants, but we also have enzymes that make inflammation. No, that’s a good thing, because if we get a virus or bacteria, if you didn’t make inflammation to kill it, well, we’d all die of infection. So, you know, we tend to think of free radicals as bad, antioxidants as good. They both play an important role. But interestingly, some of the major enzymes that make inflammation, they can be overactive. They can be turbocharged. And when they’re stimulated by environmental toxins, they overreact. Bob Miller 00:13:40 And therein lies the problem. When they overreact, we have a problem. Bob Miller 00:13:46 So, if we have genes that overreact when stimulated. And then the enzymes that take care of inflammation are underactive. Then you’re gonna be more inflamed. You know, the majority of people that, you know, come for functional medicine Or naturopathic help, or… Inflammation that they can’t seem to get under control. Dr. Deb Muth 00:14:06 Right. Bob Miller 00:14:07 And we will be, you know, during this hour, we’re going to look at some of the pathways that make that happen. So, what we can do then, we can’t change our genetics. When you’re conceived, that’s the hand you’re dealt. When your life would be over, if someone would take some tissue and measure, it’d be exactly the same as conception. Does it change. Bob Miller 00:14:28 The enzyme’s ability to do its job may be compromised. Because remember I said there’s a, the enzyme takes a cofactor. So an enzyme takes substance A, cofactor, make substance B. Well, if that cofactor’s not there, the enzyme’s not going to work either. So, you could have an 8-cylinder car, and if there’s no gas in it, it’s not going anywhere. So… It’s the strength of the enzyme, it’s the cofactor to do the A to B conversion. And that’s what we’re going to get into. So, many people say, well, where did these SNPs come from? Nobody knows for sure. Sometimes they’re what’s just called de novo, when the sperm and egg go together, the instructions get mixed up a little bit. We do believe a lot of it came from a long time ago, when we were almost wiped out by sexually transmitted diseases. And those STDs were altering the genes when the conception, in other words, when the sperm went into the egg, the STDs were interfering. And causing the problem, so… I often joke, if you want to blame somebody. Blame your great-great-great-great-great-great-great-grandparents for, being a bit promiscuous, so… Dr. Deb Muth 00:15:31 Yeah, for being… having a little too much fun, right? Bob Miller 00:15:35 So, we don’t know for sure, but, you know, there are some that, But most of the SNPs that we get inherit from our parents. So, if you look at a child. And you look at the SNPs. 99.9% of the time, it came from one of the parents. Dr. Deb Muth 00:15:50 In identical twins, do they have the exact same identical makeup? Bob Miller 00:15:54 Yep, Dr. Deb Muth 00:15:56 But not in fraternal twins, correct? Bob Miller 00:15:59 No, no, those could be different, Jeff. Dr. Deb Muth 00:16:00 It could be different because they have different sacs, they’re not sharing that same genetic makeup. Bob Miller 00:16:04 Yeah, so keep in mind, both your mother and your father have, you know, the two And so you get one from one parent, one from another. Dr. Deb Muth 00:16:13 So… Bob Miller 00:16:14 Interesting situation. I had, 3, 3 boys. And, we were looking at an enzyme related to breaking down oxalates. Now, the mother and father each had one SNP, and that’s called heterozygous. Three boys, and they all come together, they’re Amish boys, they’re a lot of fun. And I looked at their genomes, and the one boy didn’t have any SNPs at all. And one had won. And the other one had two. Dr. Deb Muth 00:16:41 Interesting. Bob Miller 00:16:42 So, we don’t quite know how these things get handed off, but with the parents each having one, you could have a child with none, one, or two. So, the one, his ability to break down oxalates, which is fine. The other one was slightly impaired, and the other one was dramatically impaired. So, you can have 3 children, and it all depends what the parents have. Now, if a parent has a homozygous, or 2 copies. And the other parent has nothing. Every child will have one. Okay. If both parents are homozygous, that they both have two, Every child will have two. Dr. Deb Muth 00:17:19 too. Bob Miller 00:17:20 Yes, so that’s the way it works, but, you know, but it’s somewhat rare that both parents are homozygous on an enzyme, but it can happen. Dr. Deb Muth 00:17:27 Do we think that infections today, like Lyme disease or mold exposure, things like that, if the parent, the woman, primarily, I’m thinking, is pregnant, and she actively has these infections. Can those infections affect the genetics, kind of like a past sexual transmission did where we thought back in the day? Bob Miller 00:17:47 Yeah, I… I mean, I’m not that much of a geneticist to answer that for sure, but my thought would be no, that at conception, the pattern’s made. Dr. Deb Muth 00:17:55 Okay. And then that’s… that’s the hand you’re dealt. Bob Miller 00:17:58 Yeah. So, I tell people we have good news and bad news. The good news is we can compensate for the weakness. The bad news is we can compensate for the weakness. Dr. Deb Muth 00:18:09 That is so very true. Bob Miller 00:18:11 Yeah, we can’t, because I often get asked, so we’ll do some things now, and we’ll check my genes again, and they’ll be better. It’s like, nope. Dr. Deb Muth 00:18:18 Oh, – – Bob Miller 00:18:19 You gotta play the hands you’re dealt, so… Dr. Deb Muth 00:18:21 That’s right. Bob Miller 00:18:22 You can test your genetics… if you’re looking at the same enzyme, you can test it every year. It’s not gonna change. It’s like the blueprint. Dr. Deb Muth 00:18:30 It’s good and bad, right? It’s the one test you only have to do once in your lifetime. Bob Miller 00:18:34 No, unless, you know, like, our. Dr. Deb Muth 00:18:36 All the time. Bob Miller 00:18:37 Yeah, now our test looks at, called the Functional Genomic Analysis Test of your genomic Resource. We look at 220,000 steps. Dr. Deb Muth 00:18:46 Wow, that’s a lot. Bob Miller 00:18:47 That’s not all of them. Dr. Deb Muth 00:18:49 Right. Bob Miller 00:18:50 So, maybe in the next year, we’re gonna come out with our third version of the chip. And then, if someone wants to get those new things that weren’t on it, they’d have to repeat. But whatever we measured is gonna stay the same. Dr. Deb Muth 00:19:03 That’s a lot of SNPs to look at. Bob Miller 00:19:05 Keeps us busy. Dr. Deb Muth 00:19:06 But there’s still, but there’s still SNPs that we. Bob Miller 00:19:09 That we’d like to have that we don’t have, so… Bob Miller 00:19:11 We started out with version 1 on our genetic test, then we worked with version 2, and we’re already compiling a list of what version 3 would look like. So if somebody has our version 2, And we’re saying, you know what, it’d be nice if we could see these, well, then you’d repeat, but it won’t change what you already know, so… Dr. Deb Muth 00:19:29 Got it, got it. So, when you started out, and you started looking at the research of Lyme disease and chronic infections, which detox pathways are most important for people who struggle with those conditions? Bob Miller 00:19:43 Okay. You know what might make sense as we do a screen share, and I’ll actually show you the pathway. Does that make sense? Bob Miller 00:19:48 Alright, so… let’s see if I… let me just press the share… Dr. Deb Muth 00:19:52 Yep, you should just be able to press share. Bob Miller 00:19:54 And… number 2. Okay. Are we seeing the screen there? Bob Miller 00:20:01 Okay. Dr. Deb Muth 00:20:02 So, this is a map that we made. Bob Miller 00:20:05 And by the way, this is not… All-inclusive of all the things we look at, but we believe this is a core issue. So, where we’re going to start here, there’s something called the microglia. And the microglia are glial cells. They’re in the brain and the central nervous system. And they’re very interesting little creatures, because most of the time, and this is just a drawing of what they sort of look like. Most of the time, they’re in what’s called the M2 anti-inflammatory mood. What that means, these little guys pick up dirt, debris, Recycle them. Turns on an enzyme called interleukin-10 that’s anti-inflammatory. And just kind of does general housekeeping. And just kind of does general housekeeping. However, when a trigger comes along. However, when a trigger comes along. They… it’s the same glial cell, but it moves over to a very pro-inflammatory enzyme. A pro-inflammatory glial cell. And it triggers these 3 enzymes, Actually, these four. That are pro-inflammatory. Tumor necrosis vector alpha, Interleukin-6. NF Kappa B, Inos. Now, these create inflammation. So you might think, well, why is that good? Well, if you have some foreign invader, virus, bacteria coming in, parasite. If you didn’t have these guys coming to the rescue, you would just die of infection. So, these guys are your friend unless they’re your worst enemy. Because TNFA, and we’ll show you when we actually do a demo account, TNFA can be overactive. So, in other words, it over-responds. Interleukin-6 can be overactive. And if Kappa-B can be overactive. The INOS, and I’ll explain each of these as we go through a demo, can be overactive. Now, what that means is, you’re very good at killing virus and bacteria. But this is where autoimmune disease comes in, and just inflammatory conditions. Now, this is just speculation, but we think what happened is, as you know. Thousands of years ago, we didn’t have refrigeration, we didn’t have sewer, we didn’t have pure water, and we didn’t have antibiotics. So, if you made it to 40, you were an old-timer, because everybody was dying of infection. So, what we believe happened is, by what’s called natural selection, Having these overactive. A thousand years ago was to your advantage. Dr. Deb Muth 00:22:31 Hmm. Bob Miller 00:22:32 But now… We have pure water, we have refrigeration, we have sewers, we have antibiotics. But now we have environmental factors that are stimulating them. Now it’s to our disadvantage. And we’ll talk about that a little bit as it relates to the hemochromatosis genes and maybe the G6PD. Dr. Deb Muth 00:22:48 Yep. Bob Miller 00:22:49 Now, why are we becoming so inflamed? Let’s look at the triggers. Now, one of my, favorite expressions is. I was born all the way back in 1954. Dr. Deb Muth 00:23:01 And it was a different world back then. Bob Miller 00:23:05 These are some of the triggers. And we’ll get into these, but right now, high fructose corn syrup, And the high-fat diet. High fructose corn syrup only came about in 1968. So now we’re being exposed to high fructose corn syrup. Then… we didn’t have these, these viruses like COVID. Dr. Deb Muth 00:23:26 Yeah. Bob Miller 00:23:27 Now, there’s now pretty strong evidence that COVID Was actually, you know, made as a gain of function. It’s debated, and I’m not taking an opinion on it, but there’s some people who believe Lyme disease was also a part of experimentation. Dr. Deb Muth 00:23:40 Go. Bob Miller 00:23:41 Then we have molds, and it appears as though mold is getting stronger. you know, 20 years ago, when I was seeing folks, mold wasn’t on the radar. I would say 7 out of the 10 folks we speak to today have mold problems. Yeah, 20 years ago, we talked more about mold allergy being an issue versus mold toxicity being an issue. Right. So… I know some folks are, you know, speculating what’s happening, but one of the theories out there is that EMF is strengthening mold. I don’t know if you ever heard that theory, and I don’t… Dr. Deb Muth 00:24:13 I have. Bob Miller 00:24:14 I’m not claiming it’s true, but it’s an interesting theory. Then even, you know, your black mold from water-damaged buildings. Then our air pollution is getting worse. We’re getting more toxic metals. Dr. Deb Muth 00:24:26 You know, if we have a… Bob Miller 00:24:27 You know, we’re gonna look back someday and say, what were we thinking, smearing aluminum into our armpits? The, what were we doing putting mercury in our teeth? Then, you know, glyphosate. When I was a kid, there was no glyphosate. So, all of these herbicides and pesticides. Polychlorinated biphenols, And then EMF. So, we love our cell phones, you know, and I think unless you, or in the middle of the desert, or down in a cave, you’re being exposed to EMF somewhere. So, you know, we have our cell phones with us, we have, We have Wi-Fi, the towers are everywhere. And we don’t know long-term, but we may find that this can… this creates some inflammation. And I don’t know if you get any folks, but do you have any folks that have… are they EMF sensitive? Dr. Deb Muth 00:25:16 Oh yeah, we have a whole bunch of them. Bob Miller 00:25:18 Yeah, and then if you have any TBIs, So, plenty of things here. that will stimulate into the microglia, M1. Now, you could say, well. We’re all pretty much exposed to the same thing. Why do some people get hit harder than others? So here’s where we’re gonna start. There’s an enzyme called Nrf2 and RF2. And Nrf2 is the enzyme that senses when there’s inflammation. And turns on hundreds of anti-inflammatory enzymes. We’ll show when we do the demo, you can have genetic weakness on NERF2. And NERF2 inhibits and slows down microglia M1. supports M2. Now, if it’s not complicated enough, there’s an enzyme called KEEP1. And KEEP1 inhibits NRF2. And you can actually have gain of function on keep 1, that makes Keap 1 stronger. So… A lot of the people who land on my doorstep So… A lot of the people who land on my doorstep Both parents gave a mutation on KEEP1, making it overactive. Both parents gave a mutation on KEEP1, making it overactive. Dr. Deb Muth 00:26:31 Hmm. Dr. Deb Muth 00:26:31 Hmm. Bob Miller 00:26:32 Suppressing Nrf2, nerve 2 might be weak. So, nobody’s putting the brakes on, M1. And by the same token, Nerve 2 supports M2. Then there’s a process called mTOR and autophagy. mTOR stands for mammalian tard of rapamycin, the growth of new cells. And then autophagy, taking our dead cells and recycling them. We need a balance between the two of them. If we didn’t have mTOR, the sperm and the egg would never become the baby, the baby would never become the adult, we wouldn’t make new cells. But our cells are constantly, you know, the old cells dying off. Autophagy is where we take that debris from the cell and recycle it, just like a farmer Plows the crop under at the end of the year. The dead plant then becomes the fuel for the spring, your dead cell becomes the fuel for the spring, and that’s autophagy. So we’re gonna look back someday and say, what were we thinking? We give our animals growth hormones so they get fatter faster. Oh my. So, we consume those animals, and inventory runs faster. Now, for anybody who’s, You know, maybe above 40, 45 years old. Think back when you were 12, and what did girls look like? They were primarily flat-chested little girls. Now they look like 16-year-olds. Because environmentally, we’re jacking up mTOR. So, mTOR stimulates microglia M1, suppresses microglia M2. Probably 80% of the folks we visit with. This is the part of the problem. NRF2 is weak. mTOR is strong. Environmental factors come along. And this guy gets carried away. He doesn’t do that burst and move back. Stays here. We’re calling that How environmental factors create a locked-in, pro-inflammatory. and neurotoxic phenotype. In other words, once it starts, it just keeps… Feeding upon itself. Alright, so what happens now when microglia is overactive. it triggers these 3 enzymes, TNFA, N of kappa B, And interleukin-6. Each one of these can have genetics that make them run stronger. Then it stimulates an enzyme called NLRP3, Which makes what are called inflammasomes. Now, guess what inflammasomes can be? Your best friend or your worst enemy? Because they will, if you’ve got, again, a virus or bacteria, or possibly even some bad cells in the body. They will zap them. Well, that’s good. Unless it’s overactive. Unless it’s overactive. And then what it does, through interleukin-1 beta, makes excess glutamate. And then what it does, through interleukin-1 beta, makes excess glutamate. Anxiety, gut inflammation, OCD, ADD, autism. And, you know, glutamate, we’ll talk about that a little bit, but glutamate makes you intelligent, highly motivated go-getter. but can also be excitatory. And then, look what it does. Let’s see, do I have the drawing tool here? Yes, I do. Okay. So, it comes down through here, Makes the glutamate. Comes back up through here. through the ADORA 2A enzyme, Then we’ve got a feedback loop that feeds upon itself. Then, through interleukin-18, we make histamine. and mast cells. And then through histamine receptor site number 1, we come back and spin it. And now you’ve just got this spinning feedback loop. So, the glutamate will make you anxious, the histamine will give you allergies and make you anxious. And you’re allergic to everything, and you’re feeling horrible. Now, it doesn’t end there, Dr. Dad. It then goes on to make something called gast dermins that creates pyroptosis, where it actually starts punching a hole in the cell membrane. And you’re only going to be as healthy as your cells are. Just a little background. You know, we’re made up of trillions of cells, and each one of them has what’s called a lipid bilayer, made from lipids, which comes from fats. And you’re only going to be as healthy as those membranes are. So that’s why we coined an interesting phrase. Cellular CPR. Construct the cell. Protect the cell. And restore the cell membrane. And we believe that’s going to be revolutionary in the functional medicine world. So… It’s not hard to figure out that if you start punching holes in the cell membrane, that’s not a good thing, okay? Bob Miller 00:31:22 Now… There’s an interesting molecule called NAD. Thicotide adenoside dinucleotide. And anybody who’s in the, you know, listening to the health podcasts and things, they’re… They’re, they’re learning about NAD. And I’m going to show you a chart later, all the good things that NAD does, but For the most part, it helps what’s called sirtuins. And sirtuins are quite interesting. If anybody’s looking at longevity. The sirtuins is where they’re looking at.Because sirtuins turn on good things. Turn off bad things. And I’ll show some charts on that later. So for right here, this sirtuin uses NAD, to slow down NF-kappa-B. CERT 2 uses NAD to slow down an ORP3. So, if we’ve got genetic weakness on these, or we don’t have enough NAD, We don’t hold this pathway back. Make sense? Dr. Deb Muth 00:32:24 Yeah, makes perfect sense. Bob Miller 00:32:25 Now, I’ll show this a little bit later. So, people are like, oh, well, I’m gonna start taking some NAD. Dr. Deb Muth 00:32:31 Right. Bob Miller 00:32:32 And there’s functional doctors who give NAD intravenous. It was just this morning, I was talking to a woman who said, Oh my gosh. I went and got intravenous NAD, and it took me a month to recover from that. Dr. Deb Muth 00:32:45 Hmm. Bob Miller 00:32:46 what happens is, and I’ll show this in a little more detail, there’s an enzyme called CD38, that’s stimulated by NF-kappa-B. And it takes NAD, To make intracellular calcium. that stimulates NLRP3 and actually makes things worse. So, if we have this guy upregulated, and I’ll show a chart what does that. taking NAD will make you worse. Again, when I go into the software, I’ll show you that whole pathway, so… I would encourage people, you know, just don’t go out and start taking massive amounts of NAD, you know, stick your toe in the water, see how you do. Because everything you’ve heard about, how good it is, is true, unless this guy says, oh, thank you very much, let me make more inflammation. Now, this might be part of our innate immune system, that if we have some pathogen that’s gonna kill us. By golly, we want that to happen. But if this is happening by environmental factors, Then it’s detrimental. So the immune system that protected us a thousand years ago now might be turning on us because of the environmental factors that we showed earlier. All right. Then there’s an enzyme called PARP that’s NAD-dependent, and that actually repairs strain breaks in your DNA. Now, the next thing that happens… is there’s an enzyme called NADPH oxidase that gets stimulated. and something called INOS. Now, I’m sure most people know about nitric oxide. It’s a gas that dilates your blood vessels. That’s why sometimes they’ll even give people drugs, nitroglycerin, to boost their nitric oxide. That’s why people are doing beetroots and other things to boost their nitric oxide. But there’s an OS3 enzyme that makes the nitric oxide that’s good for blood flow. But there’s an INOS That makes nitric oxide to kill pathogens. probably might be the third or fourth time I’ve said this. That’s a good thing, unless it isn’t. So, if it’s killing some pathogen, great. It was just misfiring. it combines… With superoxide that’s made by this enzyme, and makes something called peroxynitrite, which is one nasty free radical that chews you up and spits you out. So, the NOx enzyme, NADPH oxidase, uses NADPH, To make this free radical called superoxide. If we have time, we’ll get into it. NADPH is what your body needs to recycle your antioxidants.So, I coined the phrase, the NADPH steel. Where the NOX enzyme takes this very important NADPH, And rather than being useful, makes superoxide. Now, again, is that fine if you’ve got some bacteria to kill? Of course. But if it’s just chronically running, it’s just making all this chronic inflammation. Then it makes something called hydrogen peroxide. And we need to clear hydrogen peroxide by 3 enzymes, catalase, thyroid reduction. And glutathione peroxidase. If we have genetic issues on here, or we don’t have the cofactors. There’s something called the Fenton reaction, discovered in 1895 by Dr. Fenton. Where hydrogen peroxide combines with iron to make what are called hydroxyl radicals. And guess what they do? They create lipid peroxides, That damages your cell membranes. Now, again, the body’s pretty darn amazing. We have glutathione, And here’s where your body’s taking glutathione and recycling it. But look who’s needed to recycle it. NADPH. So, if this guy up here is chewing it up, We don’t recycle our glutathione. And then an enzyme called glufon peroxidase 4, Takes this damaged lipid and repairs it. So, here we’ve got this protecting, we want to protect it by not having this happen. But then we also need this guy to do the restoration. So, there’s a lot that can go wrong in here, Dr. Deb. Dr. Deb Muth 00:37:07 There’s a lot that could go wrong. And I can imagine some of my listeners are thinking that lipid peroxidase, is that the same thing as what they’re thinking of when we talk about lipids and cholesterol? Is that the same process that’s happening there? Bob Miller 00:37:22 Well, no, no, the lipids can be used to make cholesterol, but here we’re talking about where they’re going to build the cell membrane. And they’re being… and they’re being, destroyed. If anybody would like to see a visual representation of this, just go on YouTube. And type in, ferrooptosis Animation. cool little video, it’s about 3 minutes long, and it shows the lipids coming over, being oxidized, and now GPX4 fixes them, so… YouTube, Pharaoptosis Animation, cute little video. It’s just that really… Shows vividly what we’re… what we’re talking about here. Now, this is… Dr. Deb Muth 00:37:59 And so this is very common, too. Like, a lot of people do hydrogen peroxide IVs. Dr. Deb Muth 00:38:04 And so, if somebody doesn’t know their genetics, they could have a problem with doing those, just like they could doing the NADHIVs, correct? Bob Miller 00:38:13 Sure, yeah, yeah, yeah. So, I’ve talked to so many, you know, of course, the hydrogen peroxide kills pathogens. I mean, that’s what it does. So… but I’ve spoken to so many people that said. I had one client that said they’ve never been the same after having one hydrogen peroxide infusion. Dr. Deb Muth 00:38:30 Interesting. Bob Miller 00:38:31 Yeah. So… it can be… I see why people use it, because it. Bob Miller 00:38:36 pathogens, But on the other hand. And now’s a good time to speak about… I don’t have it on here, but there’s a, there’s an enzyme called the HFE gene. And that is what causes you to absorb iron. And there’s mutations in it that cause something called hemochromatosis. Were you overabsorb iron? Now, true hemochromatosis is when both parents give you a mutation. But there’s now growing evidence even a heterozygous can cause a little bit more iron absorption, not to the human chromatosis point, but overabsorption. So, if you overabsorb iron, And you have too much hydrogen peroxide that’s not cleared, All kinds of inflammation. Now, what’s happened is sometimes this inflammation Will damage the red blood cells. And some well-meaning doctor says, oh, you need some iron. And they take iron and it makes it worse. So, can’t tell you how many people I’ve said, you’ve got the overabsorption of iron, and they say, well, that can’t be right, because I’m low in iron. Well, that could be because it’s being chewed up here. Dr. Deb Muth 00:39:40 Sure. GPX1 and TXN turn it into, to water. The, catalase turns it into water and oxygen. Dr. Deb Muth 00:39:58 Now, I see a lot of my clients who have mutations or SNPs on that GPX gene, on that glutathione gene. And they really struggle to clear a lot of their toxins. Bob Miller 00:40:12 Sure. Dr. Deb Muth 00:40:14 Yeah, absolutely. Well, GPX4. Bob Miller 00:40:18 is what, repairs, but you can see GPX1 Is what uses glutathione. To turn hydrogen peroxide. So, but it all depends upon having enough glutathione. Dr. Deb Muth 00:40:30 Yeah. Bob Miller 00:40:31 Well, guess who controls making a glutathione? Dr. Deb Muth 00:40:34 Nerf 2. Bob Miller 00:40:37 So, if you have a keep one weakness, or strength to two… I’m sorry, keep one is too strong. Nrf2 is too weak. You don’t make glutathione. So, when a lot of people do that, it’s like, well, I’m gonna take glutathione. Dr. Deb Muth 00:40:51 Right. Bob Miller 00:40:52 And some do great, and some do poorly. You know, because… and I’ll show this on one of the other charts. You can see here that the, The glutathione has to be recycled. And if we don’t recycle it, it actually turns into superoxide free radical. So… NADPH are the cofactors, For taking the oxidi… here’s oxidized glutathione, here’s reduced. So, this is a good glutathione. After it does its job, you can see it becomes oxidized.We need to recycle it. Well, if we have weakness on the enzyme that does that, or a weakness in Nrf2, or not enough NADPH. The oxidized glutathione never gets recycled. So, I’ve talked to a lot of people who said, oh, glutathione made me so sick, and say, well. Dr. Deb Muth 00:41:43 Yeah. Bob Miller 00:41:44 You need it, but you need to recycle it. Dr. Deb Muth 00:41:46 Can you speak for just a brief moment, too, about MTHFR? That is a very popular gene, it’s all over social media as the major gene, but can you speak to a little bit about that, and how that fits into this whole process of things? Because it is just such a small piece. Dr. Deb Muth 00:42:04 understanding genetics. Bob Miller 00:42:06 Yeah, to be honest, it drives me nuts. Dr. Deb Muth 00:42:08 Me too. Bob Miller 00:42:11 Alright, so… You know, there are people on social media I won’t say what I think, I’ll be kind. But… But the, And, you know, they might mean well. But they talk about, if you have MTHFR and COMT and PEMT, that’s… oh my goodness, that’s horrible, and we’ll fix that for you, and you’ll be fine. Bob Miller 00:42:36 it just irritates me to no end. And it really could get anybody who’s doing this legitimately in trouble. I mean, I’m afraid someday, you know, there might be some cracking down on this kind of nonsense. Now, to answer your question about MTHFR. Dr. Deb Muth 00:42:51 I mean, it really is, but I’ll tell you what, why don’t we hold that thought until I go to another map and I can actually… Okay. Bob Miller 00:42:56 But the real… the cliff notes is the MTHFR puts a methyl group on your folate, which is needed, but it has gotten way, way, way too much attention. And people learn they have MTHFR, and they start taking a multivitamin with methylfolate, then they take a B vitamin with methylfolate. Dr. Deb Muth 00:43:13 And they’re pushing it too hard. Bob Miller 00:43:15 Yeah. So I can’t tell you how many people I’ve helped by saying, stop it. Dr. Deb Muth 00:43:20 Yeah, take less of it. Bob Miller 00:43:21 Take less of it, yeah. So, yeah. Yeah, there’s a… If somebody, say, ranked the enzymes at their level of importance, MTHFR might be 40 or 50 on a scale of 100, you know. Keep one Nerf two. big deals. Dr. Deb Muth 00:43:40 deals. Bob Miller 00:43:41 NQO1 that I didn’t even talk about yet, NQO1, takes your, NA… your NAD goes into NADH, To make electrons for the electron transport chain. you need NQ01 to bring that back. If that’s not working, and I’ll show you on the NAD map how disastrous that can be. Now, the next piece is here, and I think You know, if you talk to any school teachers and say, if you’ve taught for more than 10 years, how are the kids today? Every one of them says, more ADD, ADHD, more autism. Just look at human beings, we’ve never been so agitated. You know, everybody, and it might be a social media thing, but people take a position on something, and if anybody doesn’t share that position, they view them as the enemy. Dr. Deb Muth 00:44:29 And it’s kind of scary what’s happening to us. Bob Miller 00:44:33 So, we can’t agree to disagree anymore. We see anybody who has a differing opinion as the enemy. And, you know, there was… there’s people that didn’t have Christmas dinners together, because they had political differences, like… Dr. Deb Muth 00:44:44 Excuse me. Bob Miller 00:44:45 can’t you put your political differences aside to have Christmas together, you know? Dr. Deb Muth 00:44:49 Right? Bob Miller 00:44:50 become that, you know, no matter what your position is, and I’m not saying anyone’s right or wrong, I’m just saying. You know, in the old days, they used to say that the Republicans and Democrats in Congress would argue policy and then go have dinner together. And now everybody’s all up in arms, angry. Dr. Deb Muth 00:45:05 Yeah. Bob Miller 00:45:06 So… There’s likely multiple reasons for that. But let me show you one of them. That, you know, to what degree this is… very important, we don’t know, but I think We’re beginning to believe this is very important. So, there’s something… there’s a neurotransmitter called GABA. And God buys the don’t worry, relax, be happy. Chill. Okay. Dr. Deb Muth 00:45:31 Nobody has enough of that anymore. Bob Miller 00:45:33 Well, yeah, you’ll be surprised what I’m gonna show you. So, let me see if I can find a, Let me see if I can find the right slide here. Let me look for it here. So, there’s something called a GABA receptor site. And here you can see… This is a neuron, and this is where you, The neuron normally is excitatory. However, there’s normally low chloride in the neuron. Dr. Deb Muth 00:46:09 Hmm. Bob Miller 00:46:10 So, GABA itself is neither relaxing. For excitatory, all GABA does, it opens up what’s called a chloride channel. And then chloride, which has a negative charge, will flow into the neuron. Follow me there? Dr. Deb Muth 00:46:26 Yep. Bob Miller 00:46:27 And as it does, it changes this from a positive charge to a negative charge, And it’s relaxing. and inhibitory. Dr. Deb Muth 00:46:34 Hmm. Bob Miller 00:46:36 Now, on the other hand, there’s enzymes called NKCC1, That will push chloride in. and KCC2 that will bring chlor… oops and bring chloride out. And then there’s a sodium channel. And, sodium has a positive charge. And glutamate will push that in. So, as long as this is happening. And GABA says, receptor sites, open, chloride goes in, Chill. However, If NKCC1 Pushes extra chloride in. KCC2 doesn’t pull it out. and GABA hits the receptor site, the GABA comes flowing out, Sodium comes in, And now it’s excitatory. So Gabba didn’t change. GABA just opened the receptor site, that’s all it does. Dr. Deb Muth 00:47:33 Yeah. Bob Miller 00:47:34 But it’s the chloride balance that’s going to determine whether this is relaxing or not. Now, these are the things that go along with when they lose that KCC2 or gain NKCC1. Pain and sensitivity, burning electrical, neuropathic pain. Normal touch hurts. Sound and light sensitivity. Tinnitus can flare. Headaches and migraines. Seizure tendency. Body jolts. Spasticity, cramps, stiffness, startle reflex. Trouble falling asleep, non-restorative sleep. Anxiety, stress, reactivity, that’s what we have now. Hyperarousal, panic-like surges, irritability, racing thoughts. Brain fog, slowed processing, working memory slip-ups. Mental fatigue. Episodes of racing hearts, sweaty palms, guts on edge. Those are all the things that happen when this GABA switch occurs. Now, here’s what happens, and this is what I’m going to be presenting at an autism conference. When you have a newborn, they need that NKCC dominant to develop. By early childhood, it should… or, sorry, early adulthood. we should move over to the KCC dominant, that’s the taking the chloride out. Nice-looking 25-year-old boys, functioning very well. However, when we get microglia M1 upregulated. Because of environmental toxins, processed foods, Tylenol, aluminum. they stay in NKCC1 dominant, and there’s ADD, ADHD, Autism, the whole spectrum. because… They’ve not moved over to the… They’ve not moved over to the KCC2. And again, this is caused by… Environmental factors. Stimulating the microglia. And then, interleukin-1, interleukin-18 weakens KCC2, interleukin-1 beta, Strengthens NKCC1. high chloride. We open up the chloride channel, In Rebell Excitatory. So, I think when, When the pediatricians get ahold of this, they’re going to be very excited to know that This could be why we’re seeing such a rise, and not just autism, but ADD, ADHD, anxiety, the whole shit mess. Dr. Deb Muth 00:49:58 thing. Bob Miller 00:49:59 Yeah, so… and you can see NF-kappa-B stimulates that. These stimulate it, and I think that’s why everyone’s getting so anxious. Now, there’s a little bit more to it, and we’ll get into this when we look at some of the maps, but… The, the glutamate, Which is excitatory. will stimulate the NMDA receptor, make more glutamate, And glutamate will inhibit KCC2. And then we also need an astrocyte To, take both ammonia And glutamate, and… Turn them back into glutamine. And I’m going to talk to you a little bit about arachidenic acid, and if we have too much arachidenic acid. or TNFA is upregulated, that doesn’t happen. Ammonia goes up, and there may be multiple reasons for this, but this is a reason why some of the autistic kids do flapping. Dr. Deb Muth 00:50:49 Hmm. Bob Miller 00:50:50 Because they’re not clearing their ammonia. And you can tell if somebody has high ammonia by… they get that old person smell, you know. Dr. Deb Muth 00:51:00 Yup. Bob Miller 00:51:01 your vehicle cycle’s not taking out the, the ammonia. Now, last pathway here. There’s growing interest in mast cell activation. So, back here, we talked about peroxynitride. And that will stimulate mast cells, and those are white blood cells that are your best friend, unless they’re your worst enemy. Then it’ll make histamine. And there’s enzymes called histidine decarboxylase that’ll make more. Dr. Deb Muth 00:51:28 I’m sure everybody’s heard of DAO, the enzyme that degrades histamine. Yep. Bob Miller 00:51:31 We can have genetic weakness, we don’t make that. There’s an enzyme called histamine and methyltransferase, That, That breaks down the histamine. Then if we don’t do that, it’ll get stuck in the histamine receptor site. And then it’ll make something called, renin. Which will cause angiotensinogen to turn into angiotensin. One, that turns into angiotensin II,And that’s where people make aldosterone, where they’ll get the, The swollen ankles and high blood pressure. But interestingly, there’s an enzyme called ACE2, that takes this guy and turns it into angiotensin 1-7, Which is anti-inflammatory and also inhibits… TNFA. Now, you can have weakness on ACE2, But… and anybody’s saying, that sounds familiar? Dr. Deb Muth 00:52:25 That’s where COVID comes in, using ACE2. Bob Miller 00:52:28 And now we just found there’s literature that if you get COVID long enough, it can actually make ACE2 not be able to work as well. So look what it does. It comes down here, stimulates the NADPH oxidase, More superoxide. More peroxynitrite. And we’re on a cycle here. We’ve actually named this the Home Cycle Hypothesis, the proposed feed-forward loop. That just keeps feeding on itself. All being caused by… Primarily, The environmental factors. But hitting those who have genetic weakness the hardest. That’s why. Dr. Deb Muth 00:53:08 To the people. Bob Miller 00:53:09 Don’t live in a moldy house. One person is sick as can be, and the other person says, well, you must be imagining things, because I don’t feel anything. Dr. Deb Muth Yeah. Same thing with long haul, right? Two people can both get sick, one gets sick and never seems to recover, and somebody else gets sick, and they have absolutely no problems with it at all. Bob Miller 00:53:30 Sure. Well, think about it, if you get COVID, and ACE2 is weak, and some of this other stuff is going on. This thing just starts feeding upon itself. Dr. Deb Muth 00:53:38 Keep creating more inflammation, more complications, nothing’s calming down. Bob Miller 00:53:43 Yeah. Now, you, you ask about, MTHFR. So, this is the, this is the, the software called Functional Genomic Analysis. There’s a demo report we have. So, let’s talk a little bit about, MTHFR. So, we actually have a map called a methylation map. Now, what happens is, when you do your saliva test, you, you know, you spit, you put some saliva. in a collection kit, goes to a lab, takes out the DNA data, sends it to the computer, and now you can actually see it visually. Okay. So, it’s gonna take a second for this, data to load up, it’s, and each of these Circles, each of these ovals, is an enzyme. And the data gets loaded up to see where it is. So, until it gets loaded up here, I didn’t preload this. There it goes. So… The primary thing about methylation is There’s a nasty substance called homocysteine that, if it’s too high, can really be detrimental. The body takes methylfolate, and combines with methyl B12, To bring this back up to methionine. And then through the MAT genes, we make SAMI, S-adml methionine. Which is involved in so many processes. Then after it does its thing, it turns back into homocysteine. And this thing needs to keep spinning around. That’s why, you know, it’s a good idea to keep homocysteine at, do you have a number that you’d like? 7, 8? What do you like for a number? Dr. Deb Muth 00:55:24 Yeah, I like mine below 7. Bob Miller 00:55:26 Yeah. So if the homocysteine goes too high. It, caused all kinds of problems. So, here’s where you ask about the MTHFR. So, here you can see on this individual. I click on MTHFR, and you can see it comes up here, here’s the C677. And you can see here where it says, variants. I’ll… I’ll draw in case somebody’s having a hard time seeing that. So, you can see there’s nothing in there. That means there’s no genetic mutations. If one parent would have given a mutation, there’d be a 1. If both parents did, there’d be a 2. Now, here’s why Yes, methylation is important, I’m not saying it isn’t important, but look at this MTHFRC677. In my software. Only 42.5% of the population does not have a mutation. 44.7% have won. 12.9 have 2. So, this isn’t some rare, oh my god, I’m gonna die… Kind of thing, yeah. Dr. Deb Muth 00:56:27 Right. Bob Miller 00:56:28 So, And then what happens is that, and again, I’m not dismissing methylation, I… we could do a whole show on methylation. Bob Miller 00:56:36 get it. But I think that what people are doing is they’re, they’re learning about MTHFR, they get it measured, they panic. They start taking massive amounts of methylfolate, which many times is to their detriment. Dr. Deb Muth 00:56:50 Well, it’s… and isn’t it true, too, with MTHFR, like, you have to also look at MTR, MTRR, and the more we stack up of those, the more complicated than MTHFR can be. It’s not… it’s not as simple as just saying MTHFR 677 versus 1298. It’s more complex than that, kind of like what you’ve already shown with some of the other things. There’s more to it than just that one little sliver. Bob Miller 00:57:17 Oh, sure, well, let’s take a look. So, remember I said there’s a cofactor? One of the cofactors is called FAD. Just a Bob Miller observation, that’s all. But when people have trouble with their riboflavin and they don’t have enough FAD, They’re doing much worse than people who have just a C677. So, right here, you could have perfect C677th. And if you don’t have the cofactor, it’s not gonna work, okay? Dr. Deb Muth 00:57:48 And as you said, there’s an MTR enzyme. Bob Miller 00:57:51 that takes methylfolate and methyl B12, to spin it around. So, here on this individual. here’s your… here’s your B vitamins, or I’m sorry, your B12s. There’s an enzyme called TCN1 that takes it from the stomach into the blood. Then there’s other enzymes that take it from the blood into the tissue. And if you’re having trouble here. Well, then you’re not going to have this working, so… Even if you don’t have MTHFR, And you have MTR, like this, no, I’m sorry, this person doesn’t. But they have the MTRR, and then they don’t have enough B12, this isn’t gonna work, aside from that. And then there’s a middle pathway. And then there’s enzymes called the MAT1. they take the methionine to the salmon. If that’s not working, we stick… we get stuck in methionine. So, it’s, it’s not just an MTHFR. And then, one of the things that people forget about. is through these CBS enzymes and CTH, We make cysteine, which is needed to make glutathione. The master antioxidant. So, it really is that… I call it the, The 3D chess game played underwater. Dr. Deb Muth 00:59:07 It really is. I mean, I see people who have CVS, COMT, glutathione, MGHFR genes. And some of them function just fine. Like, they have Like, I look at this person and I’m like, oh my gosh, I don’t know how they’re functioning because they’re double mutated on so many pathways, but yet they don’t have a lot of symptoms, they don’t have a lot of complications. Somehow their body has figured out a way to adapt to what it has so it can stay alive and it can function at a high functioning level. Bob Miller 00:59:36 Yeah, and they may be, you know, eating right? Yeah. Staying out of a moldy house. reducing stress. So, it’s diet, it’s stress, it’s genetics, environmental factors. So, yeah, we can’t just say somebody’s gonna be good or somebody’s gonna be bad. You know, some people get scared, oh, I got all these, it’s like, well… Bob Miller 00:59:56 Are you living in a moldy house? You know, and if you live in a moldy house and your glucuronidation pathway doesn’t do well, or if you’re, you know, a smoker, or you’re constantly eating junk food, I mean, all. Bob Miller 01:00:07 things come together. Although, you know, when we focus on genetics, we’re well aware that this is just a piece of it. You know, you could have identical twins, Genetically, and if one… Is exposed to mold and smokes and drinks and stressed out. They’re gonna be a whole lot sicker than their sibling. Bob Miller 01:00:28 Yep. Dr. Deb Muth 01:00:29 Yeah, it’s that concept of taking twins, and one gets raced with one family, and one gets raced with another family, and they don’t have the same… problems that… that each other have, you know? It’s a very unique situation, we don’t think about that enough. Bob Miller 01:00:44 Alright, so again, genetics loads the gun, environment pulls the trigger. So, if you’ve got a loaded gun, but you don’t have the triggers, you’re okay. Dr. Deb Muth 01:00:53 Yeah. Bob Miller 01:00:54 Yeah. So, remember I said I was going to talk about NAD? So, here’s NAD, and what it does, it turns into NADH. And what NADH does, it, Comes down this pathway, what’s called the electron transport chain. And that makes your ATP, that’s your energy. So, if this wasn’t working, we wouldn’t be alive, because we wouldn’t have energy. So it donates an electron, that’s why it’s called electron transport chain. So, we need NAD, To make this, to make the energy. But remember I said that NQ01, this would probably be, like, on my top 10 list of… Bob Miller 01:01:36 Much more important than MTHFR. This one takes NADH back to NAD. If we’re stuck over here, We’re low in this NAD+, But what happens is, NQO1 also provides CoQ10. And CoQ10 Is what’s needed for the electron transport chain to flow. So if we get too many electrons up here. And they don’t turn them into energy. They make a nasty free radical called superoxide. Okay. Now, NAD plus also makes NADPH, And that is needed. Remember I said we need to recycle our antioxidants. So, if we have a problem with FAD from riboflavin. Yeah, we don’t have enough NADPH, Glutathione’s not getting recycled, and you’re gonna be inflamed. And you take glutathione, you’ll feel worse. There’s another enzyme called thimoredoxin. Same thing, needs NADPH and FAD. And same way with your nitric oxide, there’s an enzyme called NOS3, That makes the nitric oxide that dilates your blood vessels. And if we don’t have enough NADPH or fat, You’re gonna make superoxide. Rather than nitric oxide. Now, remember

In this Q&A episode, I answer questions about how to train for varied competitive distances without getting pulled in too many directions, explain my compelling stance on avoiding coffee (and NSAIDs), and give a plug for Dr. Doug McGuff’s “Big 5” total-body workout—a simple, highly effective way to stay strong with just one workout per week. I also share thoughts on how corporations like Whole Foods Market and PF Chang’s continue to sell plenty of crap despite their healthy reputations, discuss the magic of Zone 1 walking for building awesome aerobic fitness, and explain one of the best ways to tell if you’re doing too much strength training. Hint: you shouldn’t be getting sore. These are practical, everyday insights you can use right away to simplify your training, improve your health, and avoid some common mistakes. TIMESTAMPS: Jack, age 60, asks about his running goals. He says he is confused about what Brad says the parameters should be. [01:11] Jack has another question about coffee. Is having that stimulant in the morning helpful for your overall well-being as an athlete? [07:38] Another listener asks: Should I take my high intensity interval training, my strength training like Dr. Doug McGruff's Big Five and a basically walking approach to races? [15:45] Some comments from YouTube include this with Brad's comment: How long should you sprint to achieve all the health benefits? Brad's answer: All your entire life. [17:56] Monica initiates a discussion on the industrial seed oils being used rather than butter in restaurants and even Whole Foods and P.F. Changs. [18:50] Anthony asks about building up aerobic fitness by walking. Brad's response is thatthe aerobic base is built at the lower exercise intensities where your body has sufficient oxygen to develop and fine tune your mitochondrial function [27:00] Chad experiences soreness after trying to complete body weight exercises every other day to failure. Brad answers: If you have recurring soreness from your strength training regimen, you are most certainly overdoing it. [30:48] Dr. Doug McGruff's book, Body by Science, has a great regimen of five big workouts to do once a week. [32:22] Chad is also asking about his schedule for training. You want to have ebbs and flows in your schedule such that you have built in downtime and you always respect the importance of intuition and adjusting on the fly. [37:37] LINKS: Brad Kearns.com BradNutrition.com - 20% OFF Your First Order! B.rad Superdrink – Hydrates 28% Faster than Water—Creatine-Charged Hydration for Next-Level Power, Focus, and Recovery NEW: B.rad Real Rad Gummies - Creatine + Nootropics for Focus, Motivation, Performance, and Recovery! B.rad Whey Protein Superfuel - The Best Protein on The Planet! Brad’s Shopping Page BornToWalkBook.com B.rad Podcast – All Episodes Peluva Five-Toe Minimalist Shoes - Save 10% Body by Science We appreciate all feedback, and questions for Q&A shows, emailed to podcast@bradventures.com. If you have a moment, please share an episode you like with a quick text message, or leave a review on your podcast app. Thank you! Check out each of these companies because they are absolutely awesome or they wouldn’t occupy this revered space. Seriously, I won’t promote anything that I don't absolutely love and use in daily life: B.rad Nutrition: Premium quality, all-natural supplements for peak performance, recovery, and longevity; including the world's highest quality whey protein! Get 20% OFF your first order! Peluva: Comfortable, functional, stylish five-toe minimalist shoe to reawaken optimal foot function. Use code BRADPODCAST for 15% off! Jaspr Air Scrubber: Ultra high-performance air purifier - blows other air filters away! Save $200 on your unit with code BRAD. Get Stride: Advanced DNA, methylation profile, microbiome & blood at-home testing. Hit your stride the right way, with cutting-edge technology and customized programming. Save 10% with the code BRAD. Online educational courses: Numerous great offerings for an immersive home-study educational experience Primal Fitness Expert Certification: The most comprehensive online course on all aspects of traditional fitness programming and a total immersion fitness lifestyle. Save 25% on tuition with code BRAD! #bradpodcastSee omnystudio.com/listener for privacy information.

Are you currently struggling with chronic back pain, migraines,  neck stiffness, sciatica, or burning neuropathy? If you absolutely love how your pain is shaping your daily routine, this episode is definitely NOT for you.In this episode, we take a completely sarcastic, tongue-in-cheek look at the "benefits" of staying miserable. If you've been putting off getting help, playing the "wait and see" game, or masking your symptoms with endless prescription bottles, we are calling you out today—with love, but directly.Inside this episode, we break down:The "Groan Routine": Why a chiropractor will completely ruin your morning ritual of hobbling to the kitchen like a 90-year-old.The Pill Bottle Collection: How finding the root cause of your pain might ruin your hobby of lining up muscle relaxers and NSAIDs.The "Wait and See" Gamble: Why pretending a bulging disc or compressed nerve will magically fix itself is a high-stakes game.Taking One for the Team: Why staying stuck on the couch and missing out on golf, vacations, or the grandkids lets everyone else have the spotlight.The Pain Identity: Why feeling great, moving freely, and sleeping through the night can be downright terrifying if you're used to complaining at the water cooler.All jokes aside, if you are tired of temporary chemical band-aids and ready to actually fix the underlying structural breakdown, it's time to stop making excuses.At Core Health Darien, we use advanced, non-invasive technology to get to the source of your pain so you can live life on your terms.Don't let another week slip away to preventable suffering. Listen in, laugh at the excuses, and then take action.

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED. Hosts: Brian Gilberti, MD Avir Mitra, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK Epidemiologic Risk Profiles Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew. Peak demographic manifestation concentrated within the 30–60 age band. High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window. Mineralogical Composition Vectors Calcium oxalate crystals represent the predominant structural matrix. Struvite configurations (magnesium ammonium phosphate matrix) account for 1–2% of cohorts. Struvite stones function explicitly as infection-driven configurations secondary to upper tract proliferation; higher distribution index noted in female cohorts. Etiological & Modifiable Relational Dynamics Profound systemic dehydration or low baseline fluid throughput states. High-sodium diet structures and heavy animal-protein consumption loads. Positive genetic/familial history variables. Relative risk modulation: Each variable independently operates to expand baseline risk by a factor of 2x to 3x. Pathophysiologic Symptom Complexes Acute, sudden-onset, maximum-intensity (10/10) unilateral flank pain. Classic structural radiation vector tracking downward toward the ipsilateral groin/genitourinary dermatomes. Distinctive behavioral marker: Renal colic pacing/writhing behavior with zero antalgic position availability. Concomitant autonomic triggers: Nausea and emesis manifest in 50% of acute presentations. Physical Exam Discordance Metrics Severe subjective distress contrasted with a characteristically soft, completely non-tender abdominal palpation exam. CVA tenderness is completely variable and lacks reliable negative predictive value. Atypical Presentation Classifications Vague, poorly localized abdominal pain presentations occurring in up to 20% of active cases. Isolated lower urinary tract irritative signs including acute frequency or severe urgency. Incidental & Asymptomatic Dynamics Silent intrarenal or ureteral stones found incidentally. Longitudinal tracking demonstrates up to 33.3% of initially asymptomatic cohorts convert to fully symptomatic renal colic within a multi-year tracking window. 2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS Vascular Mimics: AAA rupture/expansion. This is a mandatory exclusion pathway in elderly cohorts presenting with acute flank or back pain. Physical tracking requires active exploration for an expansile, pulsatile abdominal mass. Gynecologic Emergencies: Ruptured ectopic pregnancy. Demands universal screening protocols via rapid beta-hCG testing in all female patients of childbearing potential presenting with lower abdominal/pelvic localization. Infectious Upper Tract Decompensation: Acute uncomplicated pyelonephritis. Differentiated via persistent high spikes, high fevers, systemic shaking chills, and profound pyuria. Genitourinary Structural Crises: Acute testicular torsion. Mandates a thorough, explicit scrotal/testicular structural exam if the flank pain radiates into the scrotum. Gastrointestinal and Adnexal Torsional Confounds: Acute appendicitis variants, acute mesenteric/bowel ischemia, and ovarian torsion syndromes. 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION Urinalysis Interpretation Nuances Microscopic or gross hematuria presents in approximately 66% to 90% of acute cases. Critical Pathological Caveat: Complete absence of hematuria documented in 20% to 33.3% of confirmed, acute obstructing ureteral stones. Diagnostic rule: A pristine urinalysis with zero red blood cells is entirely insufficient to exclude acute ureterolithiasis. Urinary pH as a Composition Clue Consistently low urinary pH parameters (pH < 5.5) point strongly toward a uric acid crystalline composition. Elevated urinary pH parameters (pH > 7.5) indicate the presence of urease-producing microbial pathogens, pointing toward a struvite infection stone. Infectious Screening Metrics Active tracking for marked pyuria, positive leukocyte esterase, and bacterial nitrites to rule out an obstructed, infected upper urinary tract system. BMP Immediate quantification of baseline serum creatinine to establish accurate eGFR values. Targeting detection of post-renal AKI from bilateral obstruction, unilateral obstruction in a single functioning kidney, or severe volume depletion. CBC Evaluation for marked leukocytosis. Physiologic Nuance: Mild-to-moderate white blood cell count elevations frequently represent non-specific stress demargination driven by severe pain and repetitive vomiting. High-grade white blood cell shifts demand immediate exclusion of systemic bacteremia or an infected, obstructed urinary system. Adjunctive Lab Pathways Rapid qualitative urine hCG testing. Reflex urine culture execution whenever urinalysis metrics display significant inflammatory profiles or clinical suspicion of UTI is high. 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION Non-Contrast CT Diagnostics Gold standard; diagnostic sensitivity and specificity parameters exceed 95% for stones >2 mm. Provides precise quantification of stone diameter (mm), exact localization (proximal, mid, or distal ureter), and degree of secondary hydronephrosis. Excellent structural visualization for detecting or ruling out alternate retroperitoneal, vascular, or intra-abdominal pathologies. Contrast-Enhanced CT Protocols Indicated when alternative intra-abdominal surgical pathology is highly suspected over isolated renal colic. Retains diagnostic capability to identify urinary tract stones >3 mm even within contrast-enhanced phases. NCCT Structural Architecture Limitations Standard stone protocol CT scans are executed in a prone position without IV contrast enhancement. It does not opacify the ureteral lumen. Presents a cumulative radiation exposure penalty when utilized serially across recurrent ED presentations. POCUS / Radiology Ultrasound Direct stone visualization capabilities are modest, operating at approximately 50% to 60% sensitivity, and is highly dependent on anatomical positioning at the extreme proximal ureter or the UVJ. Secondary obstruction tracking: Demonstration of hydronephrosis operates at a high sensitivity of approximately 80%. POCUS Clinical Utility Metrics Eliminates ionizing radiation exposure and allows immediate, rapid real-time execution directly at the patient’s bedside. Confirmation of significant hydronephrosis within a classic clinical presentation yields high post-test probability for stone presence while lowering suspicion for vascular catastrophes like a AAA. KUB Radiography Extremely poor overall diagnostic sensitivity, hovering around 57%. Fails to image radiolucent configurations (pure uric acid matrices) or small stones measuring

Contributor: Aaron Lessen, MD Educational Pearls:  Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including constipation, respiratory depression, and hypotension. NSAIDs carry a risk of GI bleeding and worsening kidney function with chronic use. A randomized clinical trial assessing the effects of acupuncture on low back pain took 800 adults aged 65 and older with chronic low back pain and placed them into one of three treatment arms: Usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus usual medical care Standard acupuncture consisting of 8–15 treatment sessions over 12 weeks, plus 4-6 maintenance sessions during the next 12 weeks, plus usual medical care Using the Roland-Morris Disability Questionnaire (RMDQ) score, they assessed disability at 6 months and 12 months. The study found that those who had undergone treatment with acupuncture had significantly greater improvements in disability related to low back pain compared to the group that was only treated with usual medical care. Acupuncture is not used in the ER, but could represent a relatively safe adjunctive therapy for patients who are not responding to standard medical therapy alone.   References:  American College of Surgeons Committee on Trauma. Best practices guidelines: geriatric trauma management. American College of Surgeons; 2023. Accessed May 27, 2026. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf DeBar LL, Wellman RD, Justice M, et al. Acupuncture for chronic low back pain in older adults: a randomized clinical trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

Most people assume that if a drug sits on the shelf at Costco or Walgreens, it must be pretty safe. But what if some of the most common over-the-counter (OTC) medications are among the riskiest drugs in America? On this vintage episode of Vitality Radio, Jared exposes the hidden dangers behind everyday pain relievers, sleep aids, and heartburn drugs—medicines that cause thousands of deaths every year when misused or taken long-term. You'll learn how a drug becomes “OTC,” what happens when pharmaceutical companies push for that switch, and why the FDA's approval process might not tell the whole story. Jared dives into the startling realities of PPIs like Prilosec, NSAIDs like ibuprofen, and acetaminophen (Tylenol)—uncovering their risks to the liver, kidneys, bones, and brain. He also discusses how marketing convinces consumers these drugs are harmless. Finally, Jared offers a resource for safe, natural alternatives for reflux, pain, inflammation, sleep, and immune support—options that nourish the body instead of depleting it. This episode will change the way you look at “harmless” OTC drugs and help you take real control of your health.Additional Information:#341: Your Digestive Health Supplement User's Guide. From IBS to Acid Reflux - Learn How to Balance Your Gut Health With Natural Products. #522: Q&A Show #5 - Jared Answers Your Questions About Energy and Sleep!#471: Boosting Your Immune System Ahead of Winter #553: Boswellia & Curcumin: Nature's Dream Team for Pain & Inflammation with Dr. Lexi LochVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

Why Your Immune System May Be Attacking Its Own Tissue (The Gut Connection) | Podcast #477

The episode explains that inflammation is a necessary survival mechanism, with acute inflammation supporting healing, while chronic inflammation drives chronic disease. It outlines major contributors to chronic inflammation including visceral fat (with fasting insulin as a proxy for insulin resistance), poor sleep and sleep apnea, ultra-processed foods, sedentary behavior, overtraining, chronic psychological stress, poor oral health, gut dysbiosis/barrier issues, smoking, alcohol, pollution, autoimmune disease, and chronic infection. The host reviews biomarkers to discuss with a physician such as high-sensitivity CRP, ESR, ferritin, WBC and neutrophil-to-lymphocyte ratio, fasting insulin, ApoB, omega-3 index/omega-6:omega-3 ratio, and homocysteine. Chronic inflammation is linked to cardiovascular disease, depression/anhedonia, brain fog, autoimmune disease risk, cancer mechanisms, skin aging, erectile dysfunction, and chronic pain. Treatment focuses on lifestyle (notably treating sleep apnea, sleep optimization, fat loss, exercise, oral health, omega-3 intake, sauna, stress regulation, circadian rhythm), selected supplements (vitamin D if deficient, curcumin, boswellia, ginger, garlic, olive oil polyphenols, sulforaphane, magnesium/glycine, taurine, NAC, quercetin, probiotics, creatine), and brief discussion of drugs including GLP-1 agonists, colchicine, NSAIDs, corticosteroids, and biologics.   Chronic inflammation https://www.ncbi.nlm.nih.gov/books/NBK493173/ C-reactive protein test https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/ ESR blood test https://medlineplus.gov/lab-tests/erythrocyte-sedimentation-rate-esr/ Ferritin blood test https://medlineplus.gov/lab-tests/ferritin-blood-test/ Homocysteine test https://medlineplus.gov/lab-tests/homocysteine-test/ ApoB test https://my.clevelandclinic.org/health/diagnostics/24992-apolipoprotein-b-test Insulin resistance https://www.ncbi.nlm.nih.gov/books/NBK507839/ Obstructive sleep apnea https://medlineplus.gov/ency/article/000811.htm CPAP therapy https://medlineplus.gov/ency/article/001916.htm Sleep hygiene https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html Physical activity guidelines https://www.cdc.gov/physical-activity-basics/guidelines/adults.html Ultra-processed foods https://pmc.ncbi.nlm.nih.gov/articles/PMC10831891/ Gum disease https://www.cdc.gov/oral-health/about/gum-periodontal-disease.html Gut microbiome https://www.nccih.nih.gov/health/gut-microbiome-what-you-need-to-know Fiber https://www.hsph.harvard.edu/nutritionsource/carbohydrates/fiber/ Autoimmune diseases https://medlineplus.gov/autoimmunediseases.html Inflammation and heart disease https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/inflammation-and-heart-disease Inflammation and depression https://pmc.ncbi.nlm.nih.gov/articles/PMC4566946/ Cancer and chronic inflammation https://www.cancer.gov/about-cancer/causes-prevention/risk/chronic-inflammation Omega-3 supplements https://www.nccih.nih.gov/health/omega3-supplements-what-you-need-to-know   Show Notes 00:00 Welcome to the Hart2Heart Podcast 00:58 Inflammation Basics 01:24 Acute Versus Chronic 03:29 Chronic Disease Link 03:52 Visceral Fat Driver 06:06 Sleep And Apnea 12:33 Food And Movement 16:02 Stress And Oral Health 18:17 Gut And Fiber 21:17 Toxins Autoimmune Infection 26:05 Inflammation Biomarkers 27:13 Inflammation Blood Markers 28:37 Ferritin Iron Balance 30:07 Metabolic Cardio Labs 32:08 Omega 3 Index Insights 34:07 Homocysteine Risks 34:58 Why Inflammation Matters 41:07 Lifestyle Fixes 46:24 Supplement Options 54:36 Medication Overview 57:36 Final Takeaways   The Hart2Heart podcast is hosted by family physician Dr. Michael Hart, who is dedicated to cutting through the noise and uncovering the most effective strategies for optimizing health, longevity, and peak performance. This podcast dives deep into evidence-based approaches to hormone balance, peptides, sleep optimization, nutrition, psychedelics, supplements, exercise protocols, leveraging sunlight, and de-prescribing pharmaceuticals — using medications only when absolutely necessary. Beyond health science, we explore the intersection of public health and politics, exposing how policy decisions shape our health landscape and what actionable steps people can take to reclaim control over their well-being. Guests range from out-of-the-box thinking physicians such as Dr. Casey Means (author of "Good Energy") and Dr. Roger Sehult (Medcram lectures) to public health experts such as Dr. Jay Bhattacharya (Director of the National Institutes of Health (NIH) and Dr. Marty Mckary  (Commissioner of the Food and Drug Administration (FDA) and high-profile names such as  Zuby and Mark Sisson (Primal Blueprint and Primal Kitchen). If you're ready to take control of your health and performance, this podcast is for you.We cut through the jargon and deliver practical, no-BS advice that you can implement in your daily life, empowering you to make positive changes for your well-being. Connect with Dr. Mike Hart Instagram: @drmikehart Twitter: @drmikehart Facebook: @drmikehart

AABP Executive Director Dr. Fred Gingrich is joined by Dr. Cassandra Tucker, professor at the University of California-Davis.  Tucker discusses that there have been changes over the past decade with how disbudding is done with caustic paste becoming more common vs. cautery methods that were previously more common. There is also the belief that caustic paste does not cause pain. The AABP guideline on disbudding and dehorning calves states that all methods of disbudding and dehorning cause pain, and providing analgesia is the standard of care. The misperception is that caustic paste causes less pain because the onset of pain is delayed vs. the immediate reaction of the burn from a cautery iron.  Veterinarians should provide protocols and training for providing analgesia for disbudding that includes both local anesthesia and a non-steroidal anti-inflammatory (NSAID). Tucker discusses the failure rate of a cornual nerve block and methods to decrease failure rate and check the block before applying the iron or paste. The block provides loss of sensation for 1-2 hours, and therefore, an NSAID should be provided. We also discuss providing more than one dose of an NSAID. Wound healing is also a critical part of evaluating a disbudding method. Tucker discusses a research trial where it showed that cautery iron wounds heal in 6-7 weeks while paste wounds take 14-18 weeks. Wound size and healing for paste was dependent on dose of the paste and shaving or not shaving the horn bud prior to application. Tucker walks through a summary of comparing cautery iron vs. caustic paste method of dehorning on the ability to control pain, wound healing, regrowth rates, damage to non-target tissue, and applicability to social or group housing. Veterinarians should consider these variables when developing a method of disbudding and an analgesic protocol for farms. Veterinarians should also provide training for caregivers to perform these procedures under proper local anesthesia and NSAIDs.  Tucker also mentions an organization she co-founded that focuses on research, grants and training for elevating the welfare of animals in food production. Find more information about Kinder Ground at this link.  The history and future of the cornual nerve block for calf disbuddingDavid B. Sheedy, Sharif S. Aly, Cassandra B. Tucker, Terry W. LehenbauerJDS Comm, July 2024, https://doi.org/10.3168/jdsc.2023-0506 Wound characteristics after disbudding: Part I - Effects of caustic paste dose and presence of hairAlycia M. Drwencke, Sarah J.J. Adcock, Cassandra B. TuckerJ Dairy Sci , October 2025, https://doi.org/10.3168/jds.2025-26688 Wound characteristics after disbudding: Part II – Comparing cautery and caustic paste methodsAlycia M. Drwencke, Sarah J.J. Adcock, Cassandra B. TuckerJ Dairy Sci, October 2025, https://doi.org/10.3168/jds.2025-26687

Could the pain reliever you take every month be secretly delaying your ovulation?If you're trying to conceive but still relying on over-the-counter medications like ibuprofen or naproxen, this episode uncovers how these common habits may be interfering with your body's natural ovulation process—without you even realizing it.In this episode you'll...-Understand how NSAIDs disrupt prostaglandins and block follicle rupture-Learn why timing during your cycle can make or break your chances of conception-Discover natural alternatives to manage pain while supporting fertilityPress play now to uncover how to protect your ovulation and boost your chances of getting pregnant naturally.

Why does chronic diarrhea continue even when testing is normal?In this episode, we walk through a case of microscopic colitis and how to approach persistent gut symptoms that don't respond to standard treatment. We break down what microscopic colitis is, why it's often missed on routine colonoscopy, and how it can present as long-standing, non-bloody diarrhea.We also explore how medications like PPIs, NSAIDs, and SSRIs may contribute, and how overlapping factors like dysbiosis, inflammation, and even constipation can complicate the clinical picture.In this episode, we discuss:- Chronic diarrhea and when to look beyond IBS- What microscopic colitis is and how it's diagnosed- Why colonoscopies can miss key findings- The role of medications in gut inflammation- Treatment approaches, including budesonide, bismuth, and bile acid binders- Functional medicine perspectives on persistent gut symptomsMusic provided by Blue Dot.

In this must-listen episode, Dennis sits down with Dr. Jon Andrews—former 5th and 20th Group Special Forces medic turned Duke-trained anesthesiologist (pediatric & cardiac fellowships)—to tackle one of the biggest headaches in austere medicine: you have a tiny box of opioids and ketamine, a long mission, and a patient who needs to stay alive AND comfortable.They break down exactly how to stretch every milligram using real OR strategies adapted for prolonged field care: patient-specific planning, smart titration, multimodal synergy, regional blocks, ketamine myths, and when (and how) to layer non-narcotics without crashing your patient or your supply.Why this episode matters: Acute pain becomes chronic pain. Chronic pain leads to opioid dependence, PTSD, and worse outcomes. In the field, your choices today shape your patient's tomorrow—and whether you still have meds left when the next casualty shows up.Key TakeawaysStart low, titrate smart. Cut your first dose in half on sick or unstable patients. You can always give more—never the other way around.Multimodal is mission-critical. Hit pain from every angle (blocks + ketamine + acetaminophen + judicious NSAIDs) to dramatically reduce opioid requirements and prevent chronic pain pathways.Ketamine IS an analgesic. It's not just dissociation—it's an NMDA antagonist that blunts central sensitization and has proven opioid-sparing effects.Schedule your non-opioids. Acetaminophen (1 g IV/PO/PR q6h) and longer-acting adjuncts form your baseline; use fentanyl or morphine only for breakthrough.Blocks beat everything—if you can do them. Pre-emptive regional anesthesia (when feasible) is the single highest-yield move before surgical stimulus hits.Monitor like your life depends on it. Heart rate, blood pressure, and respiratory rate are your best pain score when the patient can't talk.Plan for worst-case evacuation. Bring more than you think you'll need and dose for the opioid-naïve or opioid-tolerant reality in front of you.Why treating hypertension in the OR (or field) almost always starts with fixing pain firstThe “start low, see response, add more” mantra every austere provider needsWhy Tylenol often performs as well as morphine in blinded ED studies (and why your patients still doubt it)Real talk on ultrasound-guided blocks in 2011 vs. today—and why proficiency still mattersThe dangerous synergy of opioids + benzos + ketamine on respiratory driveWhy you must get comfortable decreasing doses, not just ramping them upChapters01:55 – The austere reality: limited narcotics and why your favorite med won't last forever03:37 – OR planning vs. field reality: opioid-naïve vs. chronic users05:57 – Multimodal analgesia explained (blocks, ketamine, Tylenol, NSAIDs, dexmedetomidine)08:28 – Patient & mission factors that should drive your loadout12:23 – Golden rule: start low, titrate to effect, monitor vitals15:05 – Sick-patient hack: cut your mental dose in half16:01 – Is ketamine actually an analgesic? (NMDA, opioid-sparing, PTSD data)19:12 – Extending your supply: bolus vs. infusion, redosing strategy24:27 – First-line multimodal choices in the field27:43 – Juggling multiple agents: timing, scheduling, and longer-acting blocks30:15 – Regional anesthesia timing—pre-emptive is king (post-injury limitations)32:48 – Ultrasound & blocks in the current PFC world35:08 – Safety considerations for adjuncts (liver, kidneys, bleeding, alcohol)36:59 – Bang-for-buck data on Tylenol vs. morphine38:55 – Practical integration: layering Tylenol/ketamine with fentanyl titration41:54 – Getting comfortable titrating down (and why pain scores can lie)42:53 – Final wisdom: use everything you're comfortable with.For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Osteoarthritis is the most common form of arthritis in humans and in dogs, and the most common source of chronic pain in dogs. 1 in 4 dogs will be diagnosed with arthritis!!! And don't miss the following topics that Terry will also discuss on this show: Fix Your Swollen Feet and Ankles, Stressed at Work? Try Red Ginseng!, 2 New Studies on Dementia Causes and Prevention, Male Infertility, Solutions for Back Pain.

The ACOG recommends a multimodal approach to postoperative pain that includes nonsteroidal NSAIDs, acetaminophen, and opioids. Ketorolac is a favored NSAID for postop pain control. However, the optimal dose of ketorolac after cesarean delivery has not been determined. In this episode, we will summarize a brand new randomized, controlled, single-blind trial of pregnant women undergoing cesarean delivery under regional anesthesia at a large academic medical center between June 2022 and October 2023. Enrolled participants were randomized to receive an initial loading dose of 60 mg (intervention) or 30 mg (control) of intravenous ketorolac in the operating room at the end of surgery.1. Pharmacologic Stepwise Multimodal Approach for Postpartum Pain Management: ACOG Clinical Consensus No. 1. Obstetrics and Gynecology. 2021.2. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstetrics and Gynecology. 2020.3. Eid, Joe MD; Caplan, Madeleine MD; Goel, Nidhi MD; Poirier, Marie-Veronique MD; Montaine-O'Brien, Skyler MS; Rood, Kara M. MD; Costantine, Maged M. MD. Two Perioperative Ketorolac Dosing Regimens After Cesarean Delivery and Opioid Use: A Randomized Controlled Trial. O&G Open 3(2):e159, April 2026. | DOI: 10.1097/og9.0000000000000159

Your immune system isn't just fighting off colds. It's the foundational system that influences all 14 hallmarks of aging — and when it declines, everything downstream accelerates. In this episode, I sit down with Courtney Van Bussum, COO of Longevity Launch Labs, to dive deep into immunosenescence — the aging of the immune system — and why it starts far earlier than most people realise. We unpack what Stanford's landmark 1000 Immunomes Project revealed about the real driver of biological aging, why your supplement stack might be missing the most important piece, and how we built Re:juvenate Pro (Cell Restore in the US) to target immune aging at its root. We get into the fire station analogy that makes the immune system finally make sense, why 70-80% of your immune system lives in your gut and what that means for barrier health, the science behind four synergistic ingredients — Immune Defense Protein, Immunel colostrum extract, carnosic acid from NZ rosemary, and kawakawa — and why standard colostrum supplements aren't cutting it. We also cover why NSAIDs are impairing your recovery, what CXCL9 is and why most practitioners have never heard of it, Isobel's lymphocyte count recovery story, the immune age calculator app, and why "boost your immune system" is the wrong approach — modulation is everything. This is not another colostrum product. This is upstream immune intervention. Links: Shop Re:juvenate Pro (NZ): https://shop.lisatamati.com/pages/rejuvenate Aevum Labs: https://aevumlabs.co.nz Cell Restore (US practitioners): https://aevumlabs.us Cell Restore (US patients): https://ohphealth.com Longevity Launch Labs: https://longevitylaunch.com Lisa's books: https://shop.lisatamati.com/collections/books Longevity newsletter: https://www.lisatamati.com/lisa More episodes: https://www.lisatamati.com/ptl-podcast/                

Shivam: My name is Shivam Patel and I'm currently a 3rd year medical student from Western university and today we will be discussing Chronic Pain After Cancer with an emphasis on Improving functionality in cancer survivors and how it overlaps with musculoskeletal dysfunction. We will also talk about the management of pain in outpatient settings as well as the role acute rehab units can play in recovery. Arreaza: Before getting into specific considerations, let's start with a framework most clinicians are familiar with, standard, guideline-based management of upper extremity pain. Typical approach of a patient with shoulder or upper extremity pain Shivam: The standard approach for any patient coming in with a musculoskeletal issue is stepwise and conservative first. Initial management includes activity modification, NSAIDs or acetaminophen for pain control, and early referral to physical therapy depending on severity and duration. If symptoms persist, we escalate. That may include imaging—usually starting with X-ray, then MRI if indicated, and consideration of corticosteroid injections, particularly for conditions like subacromial impingement or adhesive capsulitis which are commonly seen especially following breast cancer treatment. Arreaza: Most guidelines emphasize avoiding early imaging unless there are red flags like trauma, neurologic deficits, or suspicion for malignancy or infection. The reason behind this recommendation is that if you image the population of people older than 50 years old, about 40% of people show rotator cuff tears or damage.  Shivam: When I First heard about this statistic as a medical student, I was shocked and it opened my eyes to the potential downsides of overimaging. We also emphasize maintaining mobility. For example, in adhesive capsulitis, early range-of-motion exercises are key, not immobilization. Arreaza: Exactly. “Motion is lotion” (Dr. Uy's mantra). Shivam: And pharmacologically, we're moving toward a multimodal approach. NSAIDs are first line when tolerated. Topical agents like diclofenac can be useful. Neuropathic agents like gabapentin or duloxetine are only considered if there's a neuropathic component. Arreaza: And a key element is that opioids are not first-line for chronic musculoskeletal pain. Shivam: Yes, that's a key point. Current guidelines recommend minimizing opioid use, reserving them for severe, refractory cases, and even then, for short durations with clear treatment goals. Arreaza: Now, let's transition this framework into cancer survivors.  Shivam: The challenge is that many of these patients present with similar complaints. In the upper extremities, for example, they present with shoulder pain, weakness, stiffness, but the underlying causes are more complex. Particularly in cancer survivors, upper extremity pain is often multifactorial. You still have mechanical issues but layered on top are treatment-related effects such as surgical disruption of anatomy, radiation-induced fibrosis, chemotherapy-induced neuropathy, and generalized deconditioning. Arreaza: Let's take an example: THIs a 55-year-old female, s/p left mastectomy and chemoradiation, completed her cancer treatment 1 year ago and now she is presenting with shoulder pain. So, how do we approach this patient? Shivam: This was a specific case I had the pleasure of familiarizing myself with however it is important to acknowledge just how many patients in America share similar experiences due to the incidence of breast cancer. If we approach this as a typical rotator cuff issue, we might miss key contributors that have been seen in cancer survivors like pectoralis tightness from radiation, scapular dyskinesis from surgery, or even early lymphedema. Arreaza: Right, and that changes management. Because if you don't address those underlying contributors, standard treatments may only provide partial or temporary relief. Shivam: Exactly. And this is where we start to see the limitations of a purely symptom-based approach. Let's zoom out again. There are nearly 19 million cancer survivors in the U.S., and that number is increasing due to rapidly improving cancer treatment options. With that, we're seeing more long-term sequelae—especially involving the musculoskeletal system. Arreaza: Some symptoms in cancer survivors are reduced mobility, persistent fatigue, weakness, and impaired return to activities of daily living. And this may lead to chronic pain and reduced quality of life.  Shivam: As a side note, we can also acknowledge the impact of mental and psychological aspects on patients who have cancer or any other chronic condition. If they are depressed or less motivated to be active, participate in therapy, the deconditioning effect can be exacerbated in these patients.  Arreaza: Great point, and also, this is a population that is often under-referred to rehabilitation services. We hope we can increase awareness today. Shivam: Yes, some sources state that only around 30% of those that qualify for acute rehab are referred to it. Which is surprising, because rehabilitation directly addresses many of these issues that cancer patients experience—strength deficits, mobility limitations, and functional decline. Arreaza: Let's talk about pathophysiology for a moment. Why do these patients develop chronic pain? Shivam: A major factor is deconditioning. During cancer treatment, patients often reduce their activity levels significantly. That leads to loss of muscle mass, decreased endurance, and altered biomechanics. Arreaza: I see, sarcopenia plays a role in the development of pain in these patients.  Shivam: And once pain develops, it further limits activity, reinforcing that cycle—pain → inactivity → deconditioning → more pain. On top of that, structural changes, often caused by fibrosis from radiation, reduce tissue elasticity, limit range of motion, and contribute to stiffness and pain. Arreaza: And neuropathic pain from chemotherapy adds another layer—burning, tingling, or hypersensitivity—which requires a different treatment approach. So, given this complexity, how should we as clinicians adjust our assessment of pain in these patients? Shivam: I think it's very important to start with a thorough history to ensure we don't miss any past history of chronic conditions or intensive treatment for prior medical diagnoses. First, we need to broaden the differential. Don't assume it's a single pathology. Second, incorporate function into our assessment. Ask the patient: What can you do? What can't you do?  Additionally, I think it's very important to ask what your patient's goals are for themselves and what they would like to accomplish.  _____________________ References:  Stubblefield, M, Upper Body Pain and Functional Disorders in Patients With Breast Cancer. PM&R, 2014; 6:170 - 183​. https://pubmed.ncbi.nlm.nih.gov/24360839/ Cohen, E, American Cancer Society Head and Neck Cancer Survivorship Care Guideline, Ca Cancer Journal Clin. 2016;0-36​. https://pubmed.ncbi.nlm.nih.gov/27002678/ Stubblefield, M, Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors​. https://pubmed.ncbi.nlm.nih.gov/22108231/ Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA. Cancer rehabilitation and palliative care: Critical components in the delivery of high-quality oncology services. Support Care Cancer. 2015;(23):3633-43.​ https://pubmed.ncbi.nlm.nih.gov/26314705/ Cai, Z, Radiation-induced brachial plexopathy in patients with nasopharyngeal carcinoma: a retrospective study. MuscleNerve. 56; 2017: 1031–1040​. https://pmc.ncbi.nlm.nih.gov/articles/PMC4951337/ Silver, J. K., Baima, J., & Mayer, R. S. (2013). Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA: a cancer journal for clinicians, 63(5), 295–317. https://doi.org/10.3322/caac.21186.  Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Millions of Americans are in pain. Arthritic joints make exercise difficult, even though moving is one of the best things we can do for joint pain. Pinched nerves can cause excruciating, long-lasting pain. The usual treatments, such as NSAIDs, may help ease the pain momentarily, but do nothing to help heal the underlying condition. What […]

Pope Leo XIV's first Easter message, where he called for global peace amidst conflicts like the Russia-Ukraine war and the US-Israeli war on Iran. The "messy" irony lies in the transition from a solemn papal address on world "ravaged by wars" to the interpersonal "messiness" and psychological pathology discussed in the following segments.   The Anti-Inflammatory Power of Basil Basil contains a high concentration of Eugenol. In the world of natural chemistry, Eugenol is a "blocker"—it actually works similarly to over-the-counter NSAIDs (like Ibuprofen) by inhibiting the enzymes (COX-2) that cause swelling and pain in the joint. How it adds to your Aloe-Herb Salve: Adding Basil creates a "Triple Threat" for your severe arthritis: Rosemary: Increases local circulation (brings blood flow to the joint). Lemon Balm: Calms the "angry" sensory nerves around the kneecap. Basil: Acts as the heavy-duty anti-inflammatory to reduce the actual swelling. Savoring the Silence & Protecting the Peace. You can't fix stupid, and you certainly can't fix a narcissist. But you can fix your boundaries. If every time you share a win, you get a grunt, stop sharing the win. Build your 'Silent Resort' and invite people who know how to celebrate. Your joy is too expensive to be spent on someone who is committed to being miserable. Protect that peace! Federation is a hard sci-fi crossover; it functions as a secular Passion play. It tells the story of a man (Cochrane) who suffers through a global apocalypse (WWIII), offers humanity "salvation" through the light of warp drive, disappears (dies to the world), and is ultimately "resurrected" through the grace of an alien entity and the legacy he leaves behind. The Bravo-verse: A Masterclass in Internalized Bias & Bozoma St. John, Gamer Recognized Game. I don't think I am kissing up, I am calling a spade a spade. And Boz St. John is calling 4-a possible- 5, yelling Domino, Uno Reverse-draw 4-Uno on those b@@@chs.      Just when I thought I was going to leave Reality TV commentary to the pros, here comes Ciara Miller and The Boz of it all....While the underfed hippos are snapping in the fake LA swamp, Bozoma is playing the Kobayashi Maru of the C-Suite. She didn't come to win the game; she came to audit the players and then unplug the board. Checkmate. Meeting Adjourned.   Check out my music on Spotify and Apple or wherever you listen to music! The official videos are on YouTube. Stream and stream often! Navigate to https://linktr.ee/tnfroisreading to check out all coffee and book options. Seasonal Affective Disorder Is Treatable and all of us should be about fixing our mental health always.... If you are searching for help and direction in your struggles with depression and addiction Call 1-800-273-8255 Available 24 hours everyday   There is also an online chat feature https://suicidepreventionlifeline.org/chat/   And if Vodka is the problem, call  1-800-662-HELP (4357) for 24/7 help. Please reach out to find joy in this season!

Colorectal cancer is now the No.1 cause of death for people under 50 in the United States. When it is caught early, nine out of ten people survive. When it is caught late, only two out of ten do. Yet most people are not screening, not eating enough fiber, and have no idea how rapidly the gut microbiome is collapsing in modern populations. I sat down with Dr. Karan Rajan, NHS surgeon, gut health expert, and founder of Loam Science, to break down the real biology behind the gut microbiome and why it may be one of the most powerful levers we have for longterm health. We cover the rising colorectal cancer epidemic in young people, why fiber is the single most important thing you can do for your colon, and how the microbiome connects to your brain, heart, hormones, immune system, and even your skin. Dr. Karan also explains how stress, poor sleep, NSAIDs, antibiotics, and proton pump inhibitors silently destroy the gut lining, why the carnivore diet starves your microbiome, the emerging link between gut health and endometriosis, and what the science actually says about microbiome testing, GLP-1 peptides, and supplement quality. Reduce your risk of Alzheimer's with my science-backed protocol for women 30+: https://go.neuroathletics.com.au/youtube-sales-page Subscribe to The Neuro Experience for evidence-based conversations at the intersection of brain science, longevity, and performance. _____ TOPICS DISCUSSED 00:00 Colorectal Cancer Is Now the #1 Killer Under 50 01:24 Why Early Screening Changes Everything 03:19 The Gut Microbiome Explained Simply 05:51 Why Fiber Is the Rent for Your Colon 11:32 The Hadza Tribe and What 100g of Fiber a Day Does 18:45 The Carnivore Diet and What It Does to Your Gut 24:10 Stress, the Vagus Nerve, and Gut Dysfunction 31:20 Sleep, Circadian Clocks, and Your Bowel Health 33:06 The Gut-Cancer Connection 34:12 Cholesterol, the Gut-Heart Axis, and LDL 38:50 Estrogen, Perimenopause, and the Microbiome 43:15 Endometriosis and the Microbiome Trial 48:30 Leaky Gut, NSAIDs, Antibiotics, and PPIs 53:25 GLP-1 Peptides, Semaglutide, and What the Research Says 55:38 Why Supplement Quality Is Mostly Unregulated _______ Thank you to our sponsors Function Health: https://www.functionhealth.com/louisanicola Timeline: http://timeline.com/NEURO Wayfair: https://www.wayfair.com/ Cheers Health: https://CheersHealth.com/NEURO Use code NEURO for 20% off Jones Road Beauty: https://www.jonesroadbeauty.com Use code NEURO BASED Bodyworks: https://basedbodyworks.com/ Use code NEURO for 20% off _______ I'm Louisa Nicola - clinical neurophysiologist - Alzheimer's prevention specialist - founder of Neuro Athletics. My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention. If you're committed to optimizing your brain- reducing Alzheimer's risk - and staying mentally sharp for life, you're in the right place. Stay sharp. Stay informed. Join thousands who subscribe to the Neuro Athletics Newsletter → https://bit.ly/3ewI5P0 Instagram: https://www.instagram.com/louisanicola_/ Twitter : https://twitter.com/louisanicola_ Learn more about your ad choices. Visit megaphone.fm/adchoices

When I first met Dr. Mitchell Fleisher, it was clear that his approach to healing goes far beyond conventional medicine. A lifelong advocate for homeopathy and holistic care, Dr. Fleisher shared the story of how a lecture during medical school and a personal health breakthrough cemented his commitment to natural healing. We talked about his innovative Joint Regeneration Therapy (JRT), which combines homeopathic remedies, peptides, and nutritional support to help patients avoid invasive procedures. He also discussed the risks of overusing NSAIDs, strategies for supporting children's health naturally, and the importance of empowering individuals with practical tools for self-care. Finally, Dr. Fleisher walked us through his online platform, Alternative Dr. M Care, which provides hundreds of protocols and resources to guide people in taking charge of their own health. Episode Highlights: 08:38 - First Encounter with Homeopathy 12:35 - The moment theory turned real 15:44 - An Integrated Healing Approach 19:17 - Joint Regeneration Therapy (JRT) 23:39 - Her Knee Pain Disappears 25:46 - Comparing JRT to Stem Cell Therapy 29:35 - Concerns About Anti-Inflammatories 32:31 - Safer Alternatives for Teething 40:59 - Overview of GNHS Services 44:01 - What is Alternative DrMCare? 47:27 - Membership Benefits and Updates 49:13 - How Homeopathy Empowers Mothers 57:16 - Generational Impact of Homeopathy About my Guests: Mitchell A. Fleisher, M.D., M.D.(H), D.Ht., D.A.B.F.M., Dc.A.B.C.T., F.S.S.R.P. Dr. Mitch Fleisher is a double board-certified Family Physician with over 40 years of experience in integrative and regenerative medicine. He specializes in constitutional homeopathy, anti-aging therapies, peptide therapy, stem cell and exosome therapy, advanced musculoskeletal injections, nutritional and botanical medicine, IV therapy, chelation, detoxification, bio-oxidative therapy, and bio-identical hormone replacement. He is the originator of Joint Regeneration Therapy (JRT), a natural, non-surgical approach for repairing joints and relieving chronic pain, enhanced with StemWave therapy. Dr. Fleisher has taught homeopathy and integrative medicine at institutions including the University of Virginia Health Sciences Center and the Medical College of Virginia, and continues to lecture nationally and internationally. He is the author of Alternative DrMCare Natural Medical Self-Care Protocols© and Rapid Reference to the Fundamentals of Vitamin Therapy. He serves as Medical Director of the Center for Integrative & Regenerative Medicine (C.I.R.M.) in Virginia and Global Natural Health Solutions (GNHS), providing expert homeopathic and naturopathic consultations worldwide. Find out more about Dr Mitchell Website https://www.gnhshealing.com/ https://www.alternativedrmcare.com/ https://www.cirm1.org/ If you would like to support the Homeopathy Hangout Podcast, please consider making a donation by visiting www.EugenieKruger.com and click the DONATE button at the top of the site. Every donation about $10 will receive a shout-out on a future episode. Join my Homeopathy Hangout Podcast Facebook community here: https://www.facebook.com/groups/HelloHomies Follow me on Instagram https://www.instagram.com/eugeniekrugerhomeopathy/ Here is the link to my free 30-minute Homeopathy@Home online course: https://www.youtube.com/watch?v=vqBUpxO4pZQ&t=438s Upon completion of the course - and if you live in Australia - you can join my Facebook group for free acute advice (you'll need to answer a couple of questions about the course upon request to join): www.facebook.com/groups/eughom          

On this episode of Vitality Radio, Jared shares his personal approach to natural pain relief after a season of bumps, strains, sore feet, and everyday aches. Instead of relying on NSAIDs, he walks through the natural tools he keeps on hand—including homeopathic T-Relief, curcumin formulas, PEA, CBD, magnesium, and targeted nutrients for nerve and joint support. Jared explains how different types of discomfort—such as bruises, nerve irritation, or joint stiffness—may benefit from different strategies and why experimentation is often key to finding what works best for your body. He also discusses collagen, bone broth protein, and joint lubrication support for long-term mobility, plus a cleaner topical lidocaine option for short-term relief. The goal isn't just masking discomfort—it's building a natural toolkit that supports resilience, recovery, and everyday movement.Products:MediNatura Pain ProductsCuraMed Acute PainPEACBD Products - Call us to order! 801-292-6662BenfotiamineAlpha Lipoic AcidNerve ReverseBaxylMagnesium BisglycinateMagnesium LotionRebuild+ Functional Bone Broth ProteinAdditional Information:#622: Natural Pain Relief: Homeopathy, Arnica, and a Cleaner Approach to Lidocaine with Marie Camille#620: CBD, THC, and Hemp: How to Use Them Wisely for Sleep, Stress, and Pain#472: Could LDN Be Your Answer For Autoimmune Disease? With Dr. Keith BerkowitzVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.

NSAIDs are overused and cause silent damage to joints, heart, and the gut—leading to GI bleeds and even death. #NSAIDRisks #JointHealth #HeartHealth #SafeAlternatives

Chronic Back Pain is probably the least favorite for most clinicians, but it is one of the most reported reasons for office visits. Brent Ness joins the Sports Medicine Broadcast to discuss how Aclarion is helping provide imaging that can identify biomarkers and find where the pain is actually coming from. Brent, recall your earliest interaction with Athletic Trainers. My kids played sports in high school and had injuries that the AT Staff took care of. Give us the highlights of NOCIScan Taking info from an MRI, measures the quantity of different biomarkers within the spine and disc.  Compares the biomarkers to other discs within the patient’s spine. Structural integrity and acid levels Disc material can be filled with acids, which can cause pain  MRI can look normal if these acids are present. Nerves can grow into the disc with a herniated disc or degeneration.  Disc degeneration is not just in “old” people, but also in people in their 20s, 30s, early 40s, and volleyball players Gives the treating physician more information Spectroscopy: same machine as MRI, different sequence that the tech would use. 1.5 or 3 T works Proteoglycans  levels Result reports usually take just a few minutes Currently in 23 markets in the US, still a cash pay service at the moment or done through clinical trials. Working on coming to Houston  How does this apply to the currently active athletic population? Football, hockey, pole vault, volleyball Ben likes to look at all of the options for Athletic Trainers.  Are there any Athletic Trainers currently employed by Aclarion? Always looking for motivated people. Yes  Lower-income high school Athletic Trainer – How do you feel I can best help my patients with back pain?  Start with the traditional treatments, rest, ice, NSAIDs. If very painful for a long period of time, if they move on to get an MRI, ask for MRSpectroscopy or NOCIScan to see more. They get with the imaging center to ensure the tech can get a single voxel spectroscopy setup on the machine. What is keeping more surgeons from adopting this type of MRI? Still new, working on moving into more hospitals. Cash pay vs. insurance is a big roadblock that many surgeons face.  Hopefully, one day we can work toward also being used on the knee $1450 list price (usually discounted as well) – patient pay model on the website, acquire through info@aclarion.com first Contact Us: Aclarion – aclarion.com Brent: info@aclarion.com Ben –  Shelby – Shelbyngaytan@gmail.com Jeremy – info@sportsmedicinebroadcast.com These people LOVE Athletic Trainers and help support the podcast: Frio Hydration – Superior Hydration products. Xothrm – Best heating pad available – Use “SMB” or email info@xothrm.com and mention the Sports Medicine Broadcast Donate and get some swag (like Patreon but for the school) HOIST – No matter your reason for dehydration DRINK HOIST MedBridge Education – Use “TheSMB” to save some money, be entered in a drawing for a second year free, and support the podcast. Marc Pro – Use “THESMB” to recover better. Athletic Dry Needling – Save up to $100 when registering through our link.

In this episode, we review the prevalence of chronic pain in the U.S. and the risks of overusing NSAIDs. Nearly 1 in 5 adults struggle with daily pain, and half of those over 50 report persistent musculoskeletal discomfort. We will discuss natural approaches to help manage pain more safely and holistically. Tune in for a critical look at pain management and safer alternatives.

What if inflammation isn't the enemy? For decades we've been told to suppress it, silence it, and eliminate it as quickly as possible. Anti-inflammatory diets. Anti-inflammatory drugs. Anti-inflammatory supplements. But what if the body is doing exactly what it's supposed to do? In this powerful solo episode, Darin breaks down the biology of inflammation and challenges the modern narrative that inflammation itself is the disease. Instead, he reveals a deeper truth: inflammation is a signal — an intelligent response to disruption in the body's environment. From gut health and modern diet to stress, sleep deprivation, environmental toxins, and movement deprivation, this episode uncovers the real drivers behind chronic inflammation and why suppressing the signal without addressing the cause may actually delay healing. This isn't about rejecting modern medicine. It's about asking a better question. Why is the fire there in the first place?     In This Episode Why inflammation is the body's emergency response system The difference between acute inflammation and chronic inflammation The chemical cascade that activates the immune response How the body naturally turns inflammation off through resolution molecules Why chronic inflammation is often a signal that the trigger hasn't been removed The gut microbiome and the connection between leaky gut and systemic inflammation Why Western diets dramatically alter inflammatory signaling The omega-6 to omega-3 imbalance in modern food systems How refined sugar activates inflammatory pathways in the body Chronic psychological stress and the HPA axis inflammatory response The gut-brain-inflammation connection and mental health Sleep disruption and the immune-sleep "crosstalk" cycle Why skeletal muscle acts as an anti-inflammatory organ Environmental toxins, PFAS, pesticides, and microplastics as immune triggers What ancient systems like Ayurveda and Traditional Chinese Medicine understood about inflammation thousands of years ago The global reliance on NSAIDs and the culture of suppressing symptoms Research showing anti-inflammatory drugs may delay healing The cycle of gut damage and chronic inflammation created by long-term NSAID use Why removing triggers is the real path to resolving inflammation     Chapters 00:00:03 – Opening: Welcome to SuperLife and the mission of building health sovereignty 00:00:33 – Sponsor: Manna 00:02:16 – Introducing the topic: Why inflammation may be widely misunderstood 00:03:00 – The modern obsession with "anti-inflammatory everything" 00:04:14 – Reframing inflammation: the body's emergency response system 00:05:30 – What actually happens inside the body during inflammation 00:07:00 – Breakthrough research on the body's natural inflammation resolution system 00:08:01 – Acute inflammation vs chronic inflammation explained 00:09:14 – Chronic inflammation and its link to major diseases 00:09:45 – Why inflammation is often a symptom rather than the root cause 00:10:40 – The gut microbiome and its role in regulating inflammation 00:11:40 – How ultra-processed foods damage the gut and trigger inflammatory signals 00:12:23 – Sponsor: Our Place 00:14:53 – Omega-3 vs omega-6 fats and their influence on inflammatory pathways 00:15:48 – Sugar, insulin signaling, and metabolic inflammation 00:16:09 – Chronic stress and the inflammatory cascade 00:17:06 – The gut-brain-inflammation connection 00:18:00 – Sleep and the body's nightly inflammatory reset 00:18:31 – Muscle contraction and the release of anti-inflammatory myokines 00:19:16 – Environmental toxins and why the immune system responds with inflammation 00:20:04 – Ancient perspectives on inflammation, including Ayurveda's concept of "Pitta" 00:22:48 – The widespread use of NSAIDs and anti-inflammatory medications 00:23:50 – Research showing suppressing inflammation may delay healing 00:25:05 – The vicious cycle of NSAIDs damaging the gut and increasing inflammation 00:26:15 – Dietary patterns that reduce inflammatory triggers 00:27:18 – Why daily movement acts as natural anti-inflammatory medicine 00:27:50 – A better question to ask your doctor: Why is inflammation present? 00:28:09 – The final perspective: inflammation as communication from the body 00:29:07 – Closing message: inflammation is not the enemy: it's the conversation     Thank You to Our Sponsors Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Manna Vitality: Go to mannavitality.com/ and use code DARIN12 for 12% off your order.       Join the SuperLife Community Get Darin's deeper wellness breakdowns — beyond social media restrictions: Weekly voice notes Ingredient deep dives Wellness challenges Energy + consciousness tools Community accountability Extended episodes Join for $7.49/month → https://patreon.com/darinolien       Find More from Darin Olien: Instagram: @darinolien Podcast: SuperLife Podcast Website: superlife.com Book: Fatal Conveniences     Key Takeaway Inflammation is not a malfunction. It is your body raising the alarm: responding to stress, toxins, injury, imbalance, and disruption. Suppressing the alarm without asking why it's ringing keeps the cycle going. Healing begins when we stop fighting the signal and start listening to what the body is trying to tell us. Your body isn't broken. It's responding to the environment it's been given. Change the environment and the biology follows.  

Joint issues affect pets of all ages—not just seniors—and today's conversation with Jope cofounder, Dr. Christine, dives into what makes their Hip & Joint Dog Chews with undenatured type II collagen (UC-ll) different from traditional joint supplements.  Speaking both as a veterinarian and a pet parent, Dr. Christine, discusses the science of how UC-II works with the immune system, how it supports mobility and comfort as with her own dog, Pepsi, and where it fits within a multimodal joint care plan.If you're a pet parent looking for proactive support—or a veterinary professional exploring new tools for mobility management—this episode delivers practical insight backed by science.

In this episode of the Optimal Body Podcast, physical therapists Doc Jen and Doctor Dom delve into sesamoiditis, an overuse injury that leads to pain in the sesamoid bones beneath the big toe. They discuss the risk factors and symptoms associated with sesamoiditis, highlighting the importance of an accurate diagnosis. The hosts detail conservative treatment options, including offloading, orthotics, medication, activity modification, and physical therapy, while emphasizing a holistic approach that considers the entire lower limb. Surgery is presented as a last resort. Additionally, they introduce their Foot and Ankle Plan, designed to help listeners improve foot health and prevent recurrence of sesamoiditis through targeted exercises and gradual progression. Manukora Manuka Honey: During the winter months, I've been reaching for Manukora Manuka Honey daily. It's rich, creamy, and contains 3x more antioxidants and prebiotics than regular honey, plus MGO for added support. I take one spoonful each morning. Try it at https://manukora.com/docjen to save up to 31% plus $25 in free gifts. Strong Start: Interested in getting started with strength training? Tried starting, but have had aches and pains? Or just feel like you could use a form and technique tune up on your strength training lifts? I created this FREE Strong Start program to help guide lifters at any level in moving confidently and safely through the primary strength movement we should all be doing! Come join for free! We think you'll love: Strong Start Program Free Week of Jen Health Jen's Instagram Dom's Instagram YouTube Channel For full show notes and resources visit https://jen.health/podcast/450 What You'll Learn: 02:24 Discussion of risk factors, activities, and biomechanics that contribute to sesamoiditis. 05:02 Explanation of overuse, repetitive pressure, and specific activities that lead to the condition. 06:16 Details on foot structure, limited toe motion, and other anatomical risks. 08:15 Description of orthotics, rocker shoes, and walking boots for reducing toe pressure. 09:16 Discussion of NSAIDs, corticosteroid injections, and their short-term benefits and limitations. 10:24 Emerging evidence for extracorporeal shockwave therapy and its role in chronic cases. 10:53 Highlighting the need for targeted exercises and PT for long-term improvement. 12:48 Typical timeline and phases of... Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we take a structured, evidence-based approach to the acute treatment of migraine in children and adolescents. From confirming the diagnosis and screening for concerning features to optimizing outpatient therapy and executing a protocolized emergency department strategy, this episode walks through what works. We review the role of NSAIDs and triptans, clarify how IV fluids and ketorolac fit into care, and provide a stepwise framework for dopamine antagonists, valproate bridge therapy, DHE protocols, steroids, discharge planning, and admission decisions. Practical dosing, reassessment timing, and family-centered communication strategies are emphasized throughout. Learning Objectives Recognize the clinical features of pediatric migraine and distinguish it from secondary causes of headache. Implement a stepwise, evidence-based emergency department approach to acute pediatric migraine, including appropriate medication selection and timing of reassessment. Develop safe discharge and follow-up plans by defining treatment endpoints, minimizing medication overuse, and identifying patients who require referral or inpatient management. References 1. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice Guideline Update Summary: Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095. 2. Patterson-Gentile C, Szperka CL. The Changing Landscape of Pediatric Migraine Therapy: A Review. JAMA Neurology. 2018;75(7):881-887. doi:10.1001/jamaneurol.2018.0046. 3. Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics. 2015;135(2):232-238. doi:10.1542/peds.2014-2432. 4. Ashina M. Migraine. The New England Journal of Medicine. 2020;383(19):1866-1876. doi:10.1056/NEJMra1915327. 5. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the Acute Treatment of Migraine in Children and Adolescents. The Cochrane Database of Systematic Reviews. 2016;4:CD005220. doi:10.1002/14651858.CD005220.pub2. Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. And today we're gonna talk about the acute treatment of migraine headache in children and adolescents. This is bread and butter for the PED, requires precise diagnosis and evidence-based treatment. We're gonna talk about making that diagnosis, red flags, outpatient and ED treatment, as well as some second-line agents, admission decisions, and a whole lot more. So migraine in children is defined by three criteria, and at least five attacks lasting two to 72 hours. So you gotta have at least two of the following: pulsating or throbbing quality, moderate to severe intensity, aggravation by routine activity, and a unilateral location. Although in children, it's often bilateral, plus at least one of nausea or vomiting and photophobia and/or phonophobia. In children headaches are frequently bilateral, bifrontal, bitemporal. The duration might be shorter than adults, especially in kids under second or third grade. And you may have to infer whether or not they have photophobia from their behavior. Like does the child close their eyes or wanna go into a dark room? In the emergency department, we're often diagnosing based on pattern recognition plus exclusion of dangerous secondary causes. Or even more often than that, the patient comes in and says, I've got a migraine. Before I move on to treatments, let's talk about some red flags where you might wanna pause and not just jump to migraine therapy. And the mnemonic SNOOP can be helpful here. And it stands for S for systemic symptoms such as fevers, myalgia, weight loss, or another S, secondary risk factors such as an immune deficiency, cancer, pregnancy, N for neurologic signs, papilledema, focal deficit, confusion, seizures. O onset sudden, or thunderclap. Migraines are often a little more gradual than that. The other O is older age, or technically younger age too, younger than five years or older than 50. Hopefully those patients are not coming into the pediatric emergency department. And then pattern changes, these new symptoms in a previously stable pattern. Don't ignore that. And precipitants, you know, is it worse with Valsalva, position change, or under significant exertion? If these signs are present, you'll probably wanna take a pause and just not throw migraine treatment at the patient. If they're stable, MRI is the preferred imaging modality, but a very sick patient, it'd be okay to get a head CT. If you've got a normal neurologic exam, there's no red flags. Again, you don't need routine imaging for migraine headaches. So let's talk about treatment. So hopefully patients have actually started to treat their headache before they arrive in the emergency department. If they haven't, it's a good idea to have some triage protocols in place. So ibuprofen, 7.5 to 10 milligrams per kilogram, 10 milligrams per kilogram is superior to placebo and it's superior to acetaminophen at two hours. So that's what we would use. Early treatment's critical. So ideally within the first hour of onset. So that's why triage protocols help. We'll give kids 10 mg per kg of ibuprofen and like 30 ounces of Gatorade. Blue is often the first Gatorade choice, though that's not an evidence-based statement. You can also use naproxen, but most of the studies are on ibuprofen. If NSAIDs fail, many adolescents and some older children will be prescribed triptans. The best evidence currently supports sumatriptan plus naproxen or zolmitriptan nasal spray. Rizatriptan is FDA approved down to age six. Adolescents respond to these agents better than younger children, and the route matters. The nasal formulations help when nausea is prominent. Families should be counseled to treat early, use weight-appropriate dosing, and avoid using acute medications more than 10 days per month. Often patients will have already taken an NSAID and a triptan before they get to the ED, and that's where we get into the treatment of refractory migraine. Now this is most of the patients that I will see, and before we push medications, let's briefly review ED treatment goals. You either want the patient headache free. Back to their baseline or mild descending pain. So a pain score of one to three. If you don't reach one of those endpoints and it's not agreed upon with the patient and their family, you've not completed treatments. You should do a reassessment within one hour after each intervention. And let's face it, if you're not reassessing within an hour and defining treatment goals, you're not practicing protocolized migraine care. So in the emergency department, many of you may be familiar with the migraine cocktail. So what is that? In general, it's a dopaminergic agent such as prochlorperazine or metoclopramide plus ketorolac, plus IV fluids. Let's take a look at all three of those components and see if you can guess which one is actually the one that can abort the migraine. So fluids are commonly given in pediatric migraine, but they alone do not treat it. They're helpful. Many patients have been throwing up or a bit dehydrated, but there are small randomized trials that show essentially no meaningful pain reduction in patients that get IV fluids alone. Well, what about ketorolac? Toradol, like that's the first thing you give to a kid with a kidney stone, right? It does help, but it's really adjunctive. So the main first-line agents for refractory or status migrainosus in the emergency department are the dopamine antagonists, and the first-line treatment for most patients is prochlorperazine or Compazine. The dose is 0.15 milligram per kilogram IV. The max is 10 milligrams. This is the backbone of ED migraine care. And why do they work? Well, migraines aren't just some random vascular headache. This is an inherited disorder with central pain pathways gone awry. Dopamine plays a large role in that pain, nausea, hypersensitivity, amplification of symptoms and more that, frankly, I won't get into this podcast because molecules hurt my head. The dopamine antagonists treat the headache, they reduce the nausea, and they just tamp down this process. Overall, the response rates approach 85%. Some studies have suggested that the response rate is about 77% at an hour and 90% at three hours. If you add the ketorolac and IV fluids, you get your response rate up to about 93 to 94%. These agents really do work well together. There have been randomized trials comparing IV prochlorperazine versus ketorolac. 85% of prochlorperazine patients achieved headache relief versus only 55% of ketorolac patients. So ketorolac helps, but really it's the prochlorperazine. Metoclopramide, or Reglan, is used in a lot of centers as well. There are some smaller studies in children and adolescents that show that prochlorperazine is more effective, but if kids have an adverse reaction, more on that in a moment, or they prefer metoclopramide because they've responded to it in the past, it's okay to go with it as well. Right. So what does it actually look like when you give the migraine cocktail to a patient? I think it's important to explain to patients and families what to expect, and if this is a teenager, I'm talking to them directly. I mean, they're getting the medication first and foremost. I tell them that the most effective way to treat their headache is with an IV. This often causes lots of angst, even in older teenagers. The medication just does not get to the brain as effectively and fast enough if you take it by mouth. Many patients who get the dopaminergic agents, so prochlorperazine, will invariably feel jittery or anxious or like they gotta move or like they got ants in their pants. I tell them to expect this so they're not surprised and worried when it happens. I tell them that once they start feeling that way, it means the medicine is probably working. They need to hit the nurse button and we're gonna get them up and have them take a walk. This fixes it for the majority of patients just getting up and moving. In adult centers, even with the initial administration of the prochlorperazine or as sort of a reflexive response to any of those symptoms, they just give a slug of IV Benadryl. There's some studies in adolescents especially that this may decrease the effectiveness of the IV agents you're giving in the first place, and it may also increase return rates to the ED. So I will use IV diphenhydramine if getting up and moving around isn't working, or if the distress is significant, or if the patient clearly indicates they've needed it in the past. So if after the migraine cocktail, the patient has met their pain goals and the reassessment is favorable, they can go home to outpatient follow-up. How about if the headache got better, but not all the way? It's usually when the initial migraine cocktail didn't achieve the pain endpoints fully, like it helped partially. If the dopamine blockade didn't do anything, valproate is unlikely to rescue the case. And so valproate works on GABA and it stabilizes some of these pain processes, but the dopaminergic agent needs to have done something first for valproate to work. Per the most common protocol, you give an initial dose of IV valproate, then you discharge the patient home on Depakote ER. So oral valproic acid under 10 years old or under 50 kilograms, 250 milligrams PO twice a day for two weeks, or older than 10 or greater than 50 kilos, 500 milligrams twice a day for two weeks. This is the extended release and it's most helpful if you give the first oral dose in the emergency department. So that's why it's very important to build this protocol in advance. If you don't have IV valproate, then don't just give the patient oral valproate, and definitely don't prescribe an oral course for discharge. All right, well, what about DHE? Dihydroergotamine for refractory or status migrainosus? Generally, this is only given at pediatric centers where you have neurology coverage. It's contraindicated if you've had another dose of DHE within 14 days, or you've had any triptan of any sort within 24 hours, and you must obtain a pregnancy test in adolescent females before giving it. The dosing for less than 30 kilograms is 0.5 milligram. At least 30 kilograms is one milligram. You give 50% of the dose over three minutes, then the remaining 50% over 30 minutes. If this is gonna work, the patients are gonna start feeling wretched at first. They're gonna get very nauseous and they're gonna vomit. They're gonna have flushing, and you'll see transient hypertension. Most of that resolves within the hour in most centers. If you're committing to DHE, you're kind of bringing the patient into the hospital anyway, though some facilities will have DHE done in the emergency department with close outpatient follow-up. Either way, it's really best practice to involve child neurology if you're giving DHE. Alright, well what about steroids? They give those in grownups too, right? Steroids really only have a role for recurrence prevention in children. So for kids that have a history of returning within 72 hours for rebound headache, you can give dexamethasone 0.6 milligram per kilogram IV dose, the max of 10 milligrams. You do not discharge them home on a steroid prescription or a Medrol dose pack or something else, and this can cut the recurrence risk down a bit. There's other therapies out there like magnesium and ketamine. There's just not enough evidence there. And the purpose of this episode is to discuss the therapies that have good evidence behind them and should be part of protocols across the country. Some patients are unfortunately not responsive to emergency department therapy and need admission. The main inpatient therapy is the DHE protocol. If they're not DHE eligible, they haven't tolerated it well or it's unavailable, admission's unlikely to help them unless they just need some IV fluids to help them get back up on their feet. You should consult neurology if the headache goals are not met after maximizing ED therapy for advice. And we should definitely avoid opioids. They don't treat patients with migraines. They increase recurrence risk. They increase revisit rates. Again, the dopamine antagonist prochlorperazine, it's superior for sustained relief when families ask about them, and fortunately they're asking about opioids far less. We use medications that treat the migraine pain pathways and signaling. We don't just wanna mask the pain. All right, so that's all I've got on the acute management of migraine headaches, especially in the emergency department. Remember that migraine care in the ED should be protocolized and evidence-based. IV fluids are supportive. Prochlorperazine is the first line, or you can use metoclopramide as well. Ketorolac is an adjunctive therapy. Valproate is next line. If you've gotta escalate, and DHE is specialized therapy, you can start in the ED, but most of these patients are getting admitted. Dexamethasone or steroids in children can reduce recurrence risk, but they're not really part of the acute management. You should definitely define the endpoints and structurally and systematically reassess patients at an hour. The goal is to get them feeling better to a defined endpoint and to restore function. There is evidence-based pediatric emergency migraine care. You should understand that, plus how to explain why these agents are being given and some of the side effects to patients and families. I find that that approach increases your likelihood of buy-in and success. Alright, so that's it for this episode on the Acute Management of Migraine Headaches in Children and Adolescents. I hope you found it helpful and I can pretty much guarantee that you're gonna see a patient with a migraine on your next shift. If you've got any feedback or comments, send them my way. If you like this episode, leave a review on your favorite podcast site. It helps more people find the show. Or recommend it to a colleague. If there's other topics that you'd like to hear, send them my way for the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.    

In this episode of Run the Riot, David sits down with Ryane Broussard, a driven runner, mom of four, and woman of faith who chased one goal for nearly two decades: qualifying for the Boston Marathon. But Ryane's path wasn't a straight line. After a sudden back injury left her unable to feel or control her left leg, doctors told her she'd need to find a new hobby and stop running. Ryane refused to accept that as the final word. What followed was years of rehab, identity rebuilding, and learning what perseverance really looks like—until she finally put it all together on race day and earned her Boston qualifier. This conversation is packed with practical lessons for any ultrarunner (or anyone training for marathons, ultrarunning, or ultra racing) who's faced setbacks, self-doubt, or the weight of a long-term goal. What You'll Hear in This Episode: Ryane's start in sports (including lacrosse) and how competition shaped her mindset Moving from Texas to South Louisiana and finding a running community The back injury that changed everything (and the hard season that followed) Doctors said “no more running”—how Ryane approached recovery anyway Identity shifts: when running becomes who you are (and how to reset it) The Boston qualifier chase: flu, self-sabotage, vomiting at mile 19, and trying again The power of words, self-talk, and what you “partner with” mentally Why community matters: pacers, training partners, and people who believe with you How she fits training into real life: faith, marriage, kids, work, then running Key Moments Starting point: sports background + love of achievement Back injury + surgery: the moment everything changed Rehab reality: relearning basic movement and rebuilding confidence The Boston goal: 30 marathons, setbacks, and alignment on race day The win: qualifying—and keeping it in the right place Practical Takeaways for Runners Race-day alignment matters: sleep, health, weather, and fueling can make or break the day Mindset is trainable: negative self-talk can sabotage fitness you've already earned Fueling is personal: don't introduce “new” habits (like NSAIDs) without understanding the cost Build a support system: a coach, a pacer, and training partners can carry you when your brain gets loud Keep running in its place: what you do isn't who you are—especially when setbacks hit Races Mentioned in the Episode Louisiana Summer Nights 50K/ultra effort Zydeco Marathon Stennis Marathon Boston Marathon qualifying standards shift

https://teachhoops.com/ Injury prevention is the "invisible" component of a championship season. While most coaches focus on tactical execution, the most successful programs are those that can keep their best players on the floor. Prevention starts with the RAMP Protocol (Raise, Activate, Mobilize, Potentiate) during every warm-up. Instead of static stretching—which can actually decrease power output—you should utilize dynamic movements that mimic the lateral slides, jumping, and sprinting required in a game. By preparing the nervous system and the joints for the specific stresses of basketball, you significantly reduce the risk of non-contact injuries like ankle sprains and ACL tears. Effective management also requires a sophisticated approach to Load Management. Modern sports science emphasizes the Acute:Chronic Workload Ratio (ACWR) to identify when a player is in the "danger zone" for overuse injuries. If you suddenly spike a player's minutes or intensity after a layoff, their risk of injury increases exponentially. Ideally, your acute workload (this week) should remain within a specific range of your chronic workload (the average of the last four weeks): Staying within this "sweet spot" ensures that athletes are building resilience without reaching a point of structural failure. Monitoring "Internal Load" through subjective measures like RPE (Rate of Perceived Exertion) can provide a low-tech way to track this in any gym setting. When an injury does occur, the focus must shift to immediate and evidence-based management. While the "RICE" method was the standard for decades, modern practitioners often favor the PEACE & LOVE protocol, which emphasizes long-term tissue healing over short-term inflammation suppression. Finally, a coach's role in injury management is largely about Return-to-Play Communication. There is often a disconnect between a player's desire to "play through the pain" and their actual physical readiness. Establishing a clear, objective criteria for return—such as "100% pain-free during lateral cutting"—removes the emotion from the decision. By working closely with athletic trainers and parents, you protect the athlete's long-term health and your program's integrity, ensuring that when they return to the court, they are fully prepared to compete at their highest level. Basketball injury prevention, RAMP warm-up, load management basketball, ACWR, sports medicine for coaches, basketball recovery, PEACE and LOVE protocol, ankle sprain management, ACL prevention, youth sports safety, coach development, athletic training, basketball conditioning, player wellness, sports psychology recovery, return to play, high school basketball, team culture, coach unplugged, teach hoops, basketball success, athletic leadership. $$0.8 le frac{text{Acute Workload}}{text{Chronic Workload}} le 1.3$$StageActionDescriptionPProtectAvoid activities that increase pain in the first 1-3 days.EElevateKeep the limb higher than the heart to promote fluid drainage.AAvoidAvoid anti-inflammatory meds (NSAIDs) which can slow long-term healing.CCompressUse tape or bandages to limit swelling.EEducateTeach the athlete about the recovery timeline and expectations.&------LLoadLet pain guide a gradual return to activity.OOptimismFoster a positive mindset to improve recovery outcomes.VVascularizationChoose pain-free aerobic activity to increase blood flow.EExerciseUse strength and balance drills to restore full function.SEO Keywords Learn more about your ad choices. Visit podcastchoices.com/adchoices

Teachhoops.com⁠ https://teachhoops.com/ Injury prevention is the "invisible" component of a championship season. While most coaches focus on tactical execution, the most successful programs are those that can keep their best players on the floor. Prevention starts with the RAMP Protocol (Raise, Activate, Mobilize, Potentiate) during every warm-up. Instead of static stretching—which can actually decrease power output—you should utilize dynamic movements that mimic the lateral slides, jumping, and sprinting required in a game. By preparing the nervous system and the joints for the specific stresses of basketball, you significantly reduce the risk of non-contact injuries like ankle sprains and ACL tears. Effective management also requires a sophisticated approach to Load Management. Modern sports science emphasizes the Acute:Chronic Workload Ratio (ACWR) to identify when a player is in the "danger zone" for overuse injuries. If you suddenly spike a player's minutes or intensity after a layoff, their risk of injury increases exponentially. Ideally, your acute workload (this week) should remain within a specific range of your chronic workload (the average of the last four weeks): Staying within this "sweet spot" ensures that athletes are building resilience without reaching a point of structural failure. Monitoring "Internal Load" through subjective measures like RPE (Rate of Perceived Exertion) can provide a low-tech way to track this in any gym setting. When an injury does occur, the focus must shift to immediate and evidence-based management. While the "RICE" method was the standard for decades, modern practitioners often favor the PEACE & LOVE protocol, which emphasizes long-term tissue healing over short-term inflammation suppression. Finally, a coach's role in injury management is largely about Return-to-Play Communication. There is often a disconnect between a player's desire to "play through the pain" and their actual physical readiness. Establishing a clear, objective criteria for return—such as "100% pain-free during lateral cutting"—removes the emotion from the decision. By working closely with athletic trainers and parents, you protect the athlete's long-term health and your program's integrity, ensuring that when they return to the court, they are fully prepared to compete at their highest level. Basketball injury prevention, RAMP warm-up, load management basketball, ACWR, sports medicine for coaches, basketball recovery, PEACE and LOVE protocol, ankle sprain management, ACL prevention, youth sports safety, coach development, athletic training, basketball conditioning, player wellness, sports psychology recovery, return to play, high school basketball, team culture, coach unplugged, teach hoops, basketball success, athletic $$0.8 le frac{text{Acute Workload}}{text{Chronic Workload}} le 1.3$$StageActionDescriptionPProtectAvoid activities that increase pain in the first 1-3 days.EElevateKeep the limb higher than the heart to promote fluid drainage.AAvoidAvoid anti-inflammatory meds (NSAIDs) which can slow long-term healing.CCompressUse tape or bandages to limit swelling.EEducateTeach the athlete about the recovery timeline and expectations.&------LLoadLet pain guide a gradual return to activity.OOptimismFoster a positive mindset to improve recovery outcomes.VVascularizationChoose pain-free aerobic activity to increase blood flow.EExerciseUse strength and balance drills to restore full function.SEO Keywords ⁠Win the Season Masterclass⁠ Learn more about your ad choices. Visit podcastchoices.com/adchoices

Do you know the real difference between a sprain and a strain?

Strength training is more and more looking like the closest thing we have to an elixir of youth. But how do you get started building muscle when you're over 60? And if you're already bitten by the iron bug, are there any changes you should make or be aware of past that age? In this episode, we try to answer all of your questions on the topic (see the timestamps below) to leave no stone unturned. Timestamps: 05:00 - The benefits of strength training for people over 60. 09:15 - Intro to building muscle after 60: sarcopenia, lower hormone levels, and blunted signals for muscle growth. 15:00 - Common questions and objections: it's too late to start, it's dangerous, and joints hurt. 22:30 - The effects of menopause: is it game over? 28:40 - What actually changes in your body after 60? 30:20 - How do you keep your connective tissue strong and healthy so it doesn't become a bottleneck? 31:30 - Do you need longer recovery time after heavy workouts when you're over 60? Would it be better to split your training into shorter, more frequent workouts? 33:40 - How to strength train when over 60. 38:30 - Are higher rep-ranges safer? 41:00 - Should we reduce or increase training volume and/or frequency as we age? 42:00 - Choosing the right training program. 44:20 - Eating for muscle, strength, and health: metabolism, macronutrients, and supplements. 52:00 - Will nonsteroidal anti-inflammatory drugs (NSAIDs) impair muscle growth? 55:45 - Managing joint pain. 01:00:00 - Specific advice for women getting back into lifting after 60. 01:00:45 - For how long can people with impressive physiques maintain their muscle and strength as they age? 01:05:00 - What are the most impactful recovery methods? Most of these questions came in through our Subreddit. You should join the conversation over there, if you haven't already! *** Do you like what you hear so far? Please leave a five-star review in your podcast player. And hit that follow button! You can also follow us on Instagram. You'll find Daniel at @strengthdan, and Philip at @philipwildenstam. Become a part of our Reddit community here. *** This podcast is brought to you by Styrkelabbet AB, Sweden. To support us, download the world's best gym workout tracker app StrengthLog here. It's completely ad-free and the most generous fitness app on the market, giving you access to unlimited workout logging, lots of workouts and training programs, and much, much more even if you stay a free user for life. If you want a t-shirt with "Train hard, eat well, die anyway", check out our shop here.

#207 - One phone call redirected a life. When Matt Harmody's father entered emergent dialysis, Matt saw both the power and the limits of modern medicine—and it set him on a path from corporate engineer to emergency physician, living kidney donor, and advocate who ties purpose to action in unforgettable ways. We trace that journey from the earliest signs of kidney disease to a courageous decision to donate to a stranger, and then to the mountains where advocacy turns into motion: Kilimanjaro with a team of donors and a Guinness World Record campaign to reach the highest point in all 50 states in 41 days.We dig into the realities few people see: why hypertension and diabetes quietly erode kidney function, how dialysis extends life but extracts a heavy toll, and why living donor kidneys typically last longer and require fewer medications. Matt explains today's safeguards for donors—rigorous screening, prioritization if a donor ever needs a kidney, wage and travel protections, and even voucher programs to help family members in the future—so the decision rests on facts, not fear. He also shares the practical side of life post-donation: smarter hydration, avoiding NSAIDs, and the surprising truth that donors routinely return to high performance across endurance and strength sports.Then comes the adventure. Starting with Denali's brutal cold and thin air, the team navigated storms, snow-choked trailheads, RV logistics, and a thousand tiny delays that can sabotage a long project. Strategy shifts, reroutes, and relentless teamwork kept the mission alive, each summit doubling as a platform to raise awareness for living kidney donation. Along the way, trailhead reunions with donors and recipients, hot meals from strangers, and stories from dialysis patients stitched community into every mile.If you've wondered what it really takes to donate, or how purpose can reshape a career and redefine adventure, this story will stay with you. Hear the science, the safeguards, and the soul of a movement that saves lives—then consider sharing this episode with someone who needs it. Subscribe, leave a review, and tell us: what moment moved you most?To learn more about Matt Harmody and to get a copy of his book, Ascending America, check out his website www.mattharmodymd.com and you can also see some posts regarding the record breaking feat of peaking in every state by following checking out Instagram @50k50ss.To learn more about the Human Adventure and see some clips and stories from me check out my Instagram page @humanadventurepod.

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

Why This Natural Compound Can Reduce Pain Like Ibuprofen (Without the Gut Damage) | Podcast #470

Send us a textIn this episode, Dr. Amy Gelfand, a child neurologist specializing in pediatric headaches, discusses the complexities and treatment of migraines in children. Gelfand explains the genetic nature of migraines and their commonality among kids, noting triggers like menstrual cycles and changes in sleep patterns. She elaborates on distinguishing features of migraines and provides insight into preventive and acute treatments, including NSAIDs, triptans, neuromodulation devices, and supplements. The discussion also covers the importance of a regular schedule, the benefits of cognitive behavioral therapy (CBT), and recent advancements in migraine-specific medications. Dr. Gelfand emphasizes the significant progress in migraine treatment and encourages families to consult specialists for personalized care.About Dr Gelfand:Dr. Amy Gelfand is a pediatric neurologist who specializes in diagnosing and treating children with a variety of headache disorders, as well as those with childhood periodic syndromes (such as abdominal migraine), which may be precursors to migraine headache later in life. Her research focuses on the epidemiology of pediatric migraine and childhood periodic syndromes.Gelfand received her medical degree from Harvard Medical School. She completed residencies in pediatrics and child neurology at UCSF.Gelfand has received a teaching award from the UCSF pediatric residency program and writing awards from the medical journal Neurology. She is a member of the American Academy of Neurology, Child Neurology Society and American Headache Society.Your Child is Normal is the trusted podcast for parents, pediatricians, and child health experts who want smart, nuanced conversations about raising healthy, resilient kids. Hosted by Dr. Jessica Hochman — a board-certified practicing pediatrician — the show combines evidence-based medicine, expert interviews, and real-world parenting advice to help listeners navigate everything from sleep struggles to mental health, nutrition, screen time, and more. Follow Dr Jessica Hochman:Instagram: @AskDrJessica and Tiktok @askdrjessicaYouTube channel: Ask Dr Jessica If you are interested in placing an ad on Your Child Is Normal click here or fill out our interest form.-For a plant-based, USDA Organic certified vitamin supplement, check out : Llama Naturals Vitamin and use discount code: DRJESSICA20-To test your child's microbiome and get recommendations, check out: Tiny Health using code: DRJESSICA The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditi...

Dr. Tesha Monteith and Dr. Michael Eller discuss the implications of CGRP therapies in migraine treatment, particularly for patients with vascular risk factors or a history of stroke.  Show citation: Eller MT, Schwarzová K, Gufler L, et al. CGRP-Targeted Migraine Therapies in Patients With Vascular Risk Factors or Stroke: A Review. Neurology. 2025;105(2):e213852. doi:10.1212/WNL.0000000000213852  Show transcript:  Dr. Tesha Monteith: Hi, this is Tesha Monteith with the Neurology Minute. I've just been speaking with Michael Eller from the Department of Neurology Medical University of Innsbruck, Austria on the neurology podcast on his paper, CGRP Targeted Migraine Therapies in Patients with Vascular Risk Factors or Stroke: A Review. Hi, Michael. Dr. Michael Eller: Hello. Dr. Tesha Monteith: Why don't you summarize your general approach to use of CGRP targeted therapies in patients that might be at risk for vascular events when considering safety? Dr. Michael Eller: Yeah. About acute vascular events, we should stop CGLP targeted drugs immediately. When we come to post-stroke, we should reassess the necessity of these targeted treatments after recovery. We suggest a minimum of three months pause after ischemic stroke to allow early recovery and remodeling, and then restart only after individualized benefit risk review. In high-risk primary prevention, so no stroke yet, but elevated risk, if the patients are 65 years or older with established cardiovascular disease, we should prefer traditional preventives. And if CGLP targeted therapy is essential, we should consider Gepants cautiously due to their shorter half lives. We should avoid CGLP targeted treatments in small vessel disease, distal stenosis, Raynaud's phenomenon, and uncontrolled hypertension. For acute migraine treatment, we can consider gepants or ditans as alternatives to triptans and NSAIDs in relevant stroke risk or post-stroke patients, individualized to comorbidities. Dr. Tesha Monteith: Great. And we should say that the label updates include hypertension and Raynaud's phenomenon as potential vascular complications. Otherwise, these are more theoretical risks based on what we know about CGRP. Dr. Michael Eller: Yes, I totally agree because large studies did not show any elevated cardiovascular risk signals. And for post-marketing databases, we did not see any elevated cardiovascular risk so far. However, in pre-clinical settings, studies showed large infarct size in pretreated mice. Dr. Tesha Monteith: Great. Well, thank you again for doing this work. It was a phenomenal read and congratulations. Dr. Michael Eller: Thank you. Dr. Tesha Monteith: This is Tesha Monteith. Thank you for listening to the Neurology Minute.

Veterinarians, veterinary technicians/nurses and pet owners all have a crucial role to play when it comes to pets and pain management, including pain assessment, diagnosis, patient monitoring and care. Tune in to the episode of this VetFolio Voice podcast as Dr. Cassi chats with Mary Ellen Goldberg about the importance of taking a collaborative approach, communication and the role of tools—such as videos—in accurately assessing a patient. Learn about objective measures, such as clinical metrology instruments, and the importance of tailoring treatment plans to patients. They also briefly cover medications and modalities, such as NSAIDs, Adequan, acupuncture, TENs units, Assisi loops, cold laser, physical therapy, and more.

Welcome to Resiliency Radio with Dr. Jill Carnahan, where today's episode explores how to heal from within by optimizing gut hormones, peptides, and recovery biology. Dr. Jill is joined by Dr. Daniel Chille, integrative and functional medicine expert and founder of TBD Fit, to break down the science of recovery, performance, and long-term health—from elite athletes to everyday high performers.

Your dog's health advice no longer comes from your veterinarian alone—it comes from your social media feed.Longevity chews. “Stem cell” drops. CBD everything. Miracle arthritis injections. PEMF mats. Laser wands. Every ad promising “10 more years” with your dog.But how much of it is real… and how much is just marketing wrapped in hope?In this episode, we do something rare in modern pet health conversations: we slow down, remove the hype, and look at the evidence.To help cut through the noise, we're joined by Dr. Sonja Friedbauer, a highly respected veterinarian known for blending natural medicine, clinical experience, and evidence-based decision making. Dr. Friedbauer returns to help pet owners understand what actually works, what's overpromised, and where caution is warranted.We dig into some of the most controversial and misunderstood topics in canine health today, including:How to spot red flags when a product claims to be “clinically proven” to reverse arthritis or extend lifespanWhat real evidence looks like in veterinary medicine—and what doesn't qualifyThe truth about Librela: when it can be a powerful option, what's still unknown, and how owners should monitor dogs month to monthHow Librela compares to NSAIDs, weight loss, rehab, and supplementsIf you want a natural-first approach, which supplement ingredients actually have meaningful evidence in dogs—and which ones don'tOmega-3 dosing that matters, how long it takes to see change, and why most owners underdoseUC-II vs glucosamine and chondroitin—explained simply and practicallyHow to avoid junk supplements by understanding sourcing, testing, and quality controlWe also explore the growing obsession with dog longevity, including the buzz around rapamycin and other anti-aging candidates—what we truly know today, and what pet owners should not assume yet.Gut health is another major focus. With probiotics, postbiotics, and microbiome testing flooding the market, we discuss what's promising, what's premature, and how gut and immune inflammation often show up as joint pain, skin issues, and accelerated aging.As veterinary costs rise faster than inflation, we also tackle a difficult but necessary conversation: how pet parents and clinicians can work together to create care plans that are financially realistic and medically responsible—without sacrificing long-term health.And for new and future dog owners, we shift gears to puppies:What the latest research says about puppy nutrition from 8 weeks through adolescenceThe science behind puppy food vs adult food and feeding frequencyWhy early gut health can shape lifelong wellnessThe behavioral and developmental milestones that matter more than most people realizeHow early socialization and structured learning influence confidence, resilience, and long-term behaviorThis episode is for dog owners who love deeply, think critically, and want to make decisions based on clarity—not fear or marketing.If you've ever felt overwhelmed by pet health trends, confused by conflicting advice, or unsure where to spend your money wisely, this conversation will change how you look at your dog's care.We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies. Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Dr. Vaughn discusses:Immune health & prevention: vitamin D, C, zinc, elderberry, herbal immune formulasDetox & cleansing: liver support, lymph drainage, ion detox foot baths, infrared saunasPain, inflammation & arthritis: natural options beyond NSAIDs and opioidsStress, anxiety & sleep: magnesium, Holy Basil, homeopathic ME Support, nervous system supportGut & digestion: enzymes, GI repair herbs, probiotics, food triggers, reflux & IBSHeart & metabolic health: hydration, minerals/electrolytes, sugar and alcohol impactsWomen's health: hormones, gut–hormone connection, vaginal microbiome & probioticsPractical protocols: what to take, when to take it, and how to combine herbs & supplements safelyTo find out how we can help you on your health journey, book a free 15-minute Discovery Call with one of our New Client Coordinators! Click the link: https://www.spiritofhealthkc.com/discoverycall For more health tips and information visit: https://www.spiritofhealthkc.com/To buy natural health supplements visit: http://store.spiritofhealthkc.com Facebook: https://www.facebook.com/SpiritofHealth/ Instagram: https://www.instagram.com/spiritofhealthkc/ Pinterest: https://www.pinterest.com/spiritofhealthkc/YouTube: https://www.youtube.com/channel/UCwRcNSxR3kMYi9wP8OmxlQQ Spotify: https://open.spotify.com/show/7yfBBUjWKk3yJ3auK71O7H?si=295c77ed21f14568&nd=1&dlsi=af01c00121ed4aed

Nutritionist Leyla Muedin details key aspects of supplement use and addresses frequently asked questions. Topics include the importance of targeted supplementation, the rationale behind personalized dosages, best practices for starting new supplements, and managing common issues like nausea and bright yellow urine. Leyla also explains why some supplements may cause gastrointestinal discomfort and provides guidance on how to adjust dosages for optimal results. Emphasis is placed on the benefits of pharmaceutical-grade supplements available on Fullscript and the necessity of regular blood tests to fine-tune supplementation.

NSAIDs are everywhere, and for good reason. They're incredibly effective at reducing inflammation and pain, managing fever, and even reducing cardiovascular risk. But while NSAIDs definitely have some great uses, they're also not without risks.  In this episode, you'll learn: How NSAIDs work in the body Common examples you'll see at the bedside and what they are used to treat What conditions NSAIDs are used to treat Four major health risks tied to NSAID use Practical tips for safer NSAID use and patient education If you're reviewing pharmacology for school or clinicals, or just want a deeper understanding of a drug class you'll see every single day as a nurse, this episode is for you! ___________________ Full Transcript - Read the article and view references GI Bleeds - Did this episode pique your interest in GI bleeds? Check out episode 107! FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Pharmacology Success Pack - Want to get a head start on pharmacology? Download the FREE Pharmacology Success Pack.  Fast Pharmacology - Learn pharmacology concepts in 5 minutes or less in this audio based program. Perfect for on-the-go review!

In this episode, Ben Azadi reveals the earliest warning signs of kidney decline—signals that appear years before traditional labs detect a problem. He explains why kidneys can lose up to 80% of their function with no pain, what subtle symptoms to watch for, and how insulin resistance, inflammation, uric acid, dehydration, and NSAIDs silently damage the kidneys. Ben shares the 7 major early symptoms most people miss: foamy urine, fatigue, puffy eyes, lower back discomfort, metallic taste, itchy skin, and frequent nighttime urination. He then guides listeners through the Metabolic Freedom Kidney Reset Protocol, a research-backed plan to regenerate kidney health naturally. This includes the renal reset morning drink, removing fructose and seed oils, kidney-support supplements, fasting strategies, mineral support, and the daily “Vitamin G” gratitude practice. Ben also answers audience questions on hydration, protein intake, keto, and kidney stress. This episode is a must-listen for anyone wanting to protect their kidneys, reduce inflammation, support metabolic health, and catch problems early—before they become irreversible. FREE GUIDE: 5 Vegetables You Must Avoid To Lose Weight & Belly Fat - https://bit.ly/49PBbRX 

If you suffer from severe menstrual cramps, this is for you. Find out how to stop menstrual cramps naturally by addressing the root cause with these 13 natural remedies for period pain. Never experience menstrual cramps again! 0:00 Introduction: How to reduce period pain0:23 What is a menstrual cramp? 1:30 What causes severe period cramps? 6:42 Vitamin D3 and painful menstrual cramps 12:38 13 natural remedies for period painToday, I'm going to show you how to relieve period cramps fast, and for good. There are two types of period cramps: the primary type is labeled idiopathic, and secondary cramps that are caused by fibroids, ovarian cysts, or endometriosis.Many women take NSAIDs, birth control pills, and Depo shots for period pain relief. The medical community generally discourages the use of natural remedies for menstrual cramps, but does not discourage the use of medication. Research has shown the effectiveness of vitamin B1 and vitamin E.Upon searching for the root cause, I stumbled upon the following clues:• Painful cramps are caused by pain chemicals called prostaglandins. • Vasopressin, which causes contractions and decreased blood flow, is elevated when you have menstrual cramps.• Painful period cramps are associated with high parathyroid hormone levels. • Women with painful menstrual cramps also have much higher inflammation in the uterus, often related to NF-KB. • Black women have a 33% higher likelihood of getting severe period cramps than white women. • Menstrual cramps are sometimes treated with calcium channel blockers. This led to the conclusion that the root cause of menstrual cramps is a severe vitamin D3 deficiency! Try the following natural remedies for period pain and say goodbye to menstrual cramps for good:1. Take 20,000 IU of vitamin D3 daily2. Take 400-600 mg of magnesium glycinate 3. Follow a low-carb diet4. Intermittent fasting5. Cod liver oil for pain relief6. Vitamin E7. Vitamin B18. Increase iron with red meat9. Zinc for vitamin D3 absorption10. Exercise11. Fenugreek12. Heating pad13. Ginger Dr. Eric Berg DC Bio:Dr. Berg, age 60, is a chiropractor who specializes in Healthy Ketosis & Intermittent Fasting. He is the Director of Dr. Berg Nutritionals and author of the best-selling book The Healthy Keto Plan. He no longer practices, but focuses on health education through social media.Disclaimer: Dr. Eric Berg received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1988. His use of “doctor” or “Dr.” in relation to himself solely refers to that degree. Dr. Berg is a licensed chiropractor in Virginia, California, and Louisiana, but he no longer practices chiropractic in any state and does not see patients, so he can focus on educating people as a full-time activity, yet he maintains an active license. This video is for general informational purposes only. It should not be used to self-diagnose, and it is not a substitute for a medical exam, cure, treatment, diagnosis, prescription, or recommendation. It does not create a doctor-patient relationship between Dr. Berg and you. You should not make any change in your health regimen or diet before first consulting a physician and obtaining a medical exam, diagnosis, and recommendation. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition.

In this episode of Iron Culture, Eric Trexler and Eric Helms discuss significant updates in fitness research, particularly focusing on the constrained energy expenditure model and the effects of NSAIDs on muscle hypertrophy. They also revisit a prior episode about PhDs (how they're obtained and what they mean) by discussing the international differences in PhD programs. If you're in the market for some gym gear or apparel, be sure to support our friends at elitefts.com and use code "MRR10" for a 10% discount. Chapters 00:00 Intro 5:11 Constrained Energy Expenditure Model (background) 18:54 Did new research "debunk" the constrained model? 35:05 New Insights on NSAIDs and Muscle Hypertrophy 46:03 Caution with NSAIDs: Risks and Benefits 50:10 Understanding International PhD Structures

Modern joint pain isn't just wear and tear—it's a systemic, metabolic disease that starts years before symptoms show. In this episode, you'll learn how inflammation, mitochondria dysfunction, and immune imbalance trigger cartilage loss… and how to reverse it using targeted cytokine modulation, cellular regeneration, and smarter supplements for longevity and human performance. Watch this episode on YouTube for the full video experience: https://www.youtube.com/@DaveAspreyBPR Host Dave Asprey sits down with Kiran Krishnan, a research microbiologist and Chief Scientific Officer at Calroy Health Sciences. He's the founder of Microbiome Labs—one of the most trusted microbiome-focused brands in functional medicine—and a formulator behind cutting-edge supplements like Arterosil and Vascanox. With over two decades of experience, Kiran has launched multiple health ventures, authored scientific textbook chapters, published clinical trials, and holds global patents in human health. He's a leading authority on systemic inflammation, mitochondrial dysfunction, and gut-driven disease—and one of the few voices making complex biology accessible for real-world results. He breaks down their new supplement Cartigenix HP, and how cytokines like IL-6 and TNF-alpha flip your cartilage cells from anabolic repair to catabolic destruction, how mitochondrial decline speeds up joint damage, and why most modern painkillers make your joints worse. You'll learn how a specialized blend of boswellia and celery seed reprograms inflammation, why walking beats medication in clinical trials, and how fasting, nitric oxide, and gut health work together to optimize joint regeneration. You'll learn: • How cartilage cells (chondrocytes) rely on mitochondria for tissue repair • Why global cytokines like IL-6 and TNF-alpha drive joint degradation and brain fog • How cartilage begins to break down in your teens—and what to do about it now • The surprising clinical data on walking distance, inflammation markers, and recovery • Why most supplements and NSAIDs fail—and what actually rebuilds joints • How diet and leaky gut create 5-day inflammation spikes from a single fast-food meal • The mitochondrial link between joint pain, cardiovascular risk, and depression • Why perimenopausal women are at 10x higher risk for arthritis—and how to prevent it • How to track your biological joint age using imaging and systemic inflammation labs This is essential listening for anyone serious about biohacking, functional medicine, pain-free aging, and human performance. Whether you're lifting heavy, walking daily, or just trying to stay mobile into old age, this episode gives you the science and tools to reverse joint degeneration and extend your healthspan. Dave Asprey is a four-time New York Times bestselling author, founder of Bulletproof Coffee, and the father of biohacking. With over 1,000 interviews and 1 million monthly listeners, The Human Upgrade brings you the knowledge to take control of your biology, extend your longevity, and optimize every system in your body and mind. Each episode delivers cutting-edge insights in health, performance, neuroscience, supplements, nutrition, biohacking, emotional intelligence, and conscious living. New episodes are released every Tuesday, Thursday, Friday, and Sunday (BONUS). Dave asks the questions no one else will and gives you real tools to become stronger, smarter, and more resilient. Keywords: Joint cartilage regeneration, IL-6 inflammation suppression, TNF-alpha cytokine modulation, Chondrocyte mitochondrial repair, Catabolic to anabolic tissue shift, Osteoarthritis reversal, Rheumatoid arthritis inflammation, Mitochondria and collagen synthesis, Boswellia seratol extract, Celery seed COX inhibition, Matrix metalloproteinase (MMP) inhibition, Synovial fluid inflammation, Leaky gut and joint pain, Six-minute walk test improvement, Global cytokine markers, High sensitivity CRP reduction, ESR sedimentation rate, Uric acid crystal formation, Post-prandial glucose walking, Cartilage MRI biomarkers, Functional medicine joint support, Fasted repair stacking, Vasodilation and nitric oxide, Anti-inflammatory supplement stacking, NF-kB pathway reduction, Joint space biological age, Microvascular circulation and cartilage, Caloric load and cytokine spike, Perimenopause and arthritis risk, Joint tissue anabolic activation **Get an exclusive discount for podcast listeners at calroy.com/dave : https://calroy.com/product/cartigenix-hp/?lp=dave ** Thank you to our sponsors! -BodyGuardz | Visit https://www.bodyguardz.com/ and use code DAVE for 25% off. -BiOptimizers | Go to http://bioptimizers.com/dave and use code DAVE15 to get 15% off your order. -Quantum Upgrade | Go to https://quantumupgrade.io/Dave for a free trial. -Caldera + Lab | Go to https://calderalab.com/DAVE and use code DAVE at checkout for 20% off your first order. Resources: • Danger Coffee: https://dangercoffee.com/discount/dave15 • Dave Asprey's BEYOND Conference: https://beyondconference.com • Dave Asprey's New Book – Heavily Meditated: https://daveasprey.com/heavily-meditated • Upgrade Collective: https://www.ourupgradecollective.com • Upgrade Labs: https://upgradelabs.com • 40 Years of Zen: https://40yearsofzen.com Timestamps: 0:00 — Trailer 1:25 — Introduction 2:01 — Why Modern Medicine Fails at Joint Pain 3:07 — Painkillers That Accelerate Joint Damage 7:35 — Rheumatoid vs. Osteoarthritis Explained 8:54 — Cytokines That Destroy Cartilage 12:10 — Arthritis Begins in Your Teens 15:35 — 75% Pain Reduction in 7 Days 18:35 — The Science Behind Boswellia & Celery Seed 24:10 — Six-Minute Walk Test Results 25:45 — The $200/Month Painkiller Trap 28:53 — Proof Cartilage Can Regrow 31:01 — Mitochondria and Joint Repair 32:29 — Inflammation Links to Heart Disease 35:52 — Why Glucosamine Doesn't Work 37:07 — Silent Arthritis in 90% of Adults 40:44 — Why Women Face Higher Joint Risk After 40 45:52 — Food as the #1 Inflammation Trigger 47:23 — Fasting & Cartogenics Stack for Repair 50:27 — Movement Snacks and Efficient Training 55:54 — Why Joints Heal Slower Than Muscles 57:48 — Dave's Stack and Final Takeaways See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Welcome back to today's Friday Review where I'll be breaking down the best of the week!     I'll be sharing specifics on these topics:     The Biblio Diet (book review) Kiwis & Cholesterol (research) Dementia & NSAIDs(research)     For all the details tune in to today's Cabral Concept 3542 – Enjoy the show and let me know what you thought!   - - - For Everything Mentioned In Today's Show: StephenCabral.com/3542 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!