Podcasts about nsaids

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

Inulin, fatty fish, and foot and ankle comfort Listen to the latest episode of Live Foreverish as Drs. Mike and Crystal discuss how a prebiotic fiber can help with functional constipation; food as medicine with product prescriptions; how B vitamins help NSAIDs work better; and the best diet for fatty liver disease. #LELearn #EDULiveforeverish

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.

Based on a popular well known Christmas carol this episode reminds us about prescribing thoughtfully, recognising key red flags, and keeping often-missed diagnoses like bile acid diarrhoea, coeliac disease and liver disease on the radar. The episode also reinforces the importance of early-life microbiome influences and structured differential diagnosis for abdominal symptoms in primary care. Prescribing and de-prescribing • Taper PPIs rather than stopping abruptly to avoid rebound acid hypersecretion, driven by upregulated gastrin during PPI therapy. • Always link NSAID use and H. pylori status to ulcer risk, and remember: gastric ulcers typically cause pain with meals, duodenal ulcers 2–3 hours after eating. Diagnosis, tests and red flags • Use three coeliac test “groups”: serology (tTG/EMA, with total IgA checked), genetics (HLA‑DQ2/DQ8) and duodenal biopsies; ensure patients eat gluten for at least six weeks pre‑testing and to endoscopy. • Actively screen for GI red flags: dysphagia and weight loss (upper GI), PR bleeding and unexplained iron‑deficiency anaemia (lower GI), and escalate for urgent investigation. Practical tools and endoscopy indications • Use the Bristol Stool Chart (types 1–7) routinely in consultations to standardise conversations about stool form and avoid ambiguous “food analogies.” • Remember the three main indications for endoscopy: diagnostic (e.g. dyspepsia, chronic diarrhoea), surveillance (Barrett's, polyp follow‑up) and therapeutic (RFA/EMR in Barrett's, polyp removal). Conditions to consider and not miss • Keep bile acid diarrhoea prominent in the differential for IBS‑D: up to ~40% of IBS‑D patients may have it, particularly with ileal disease/resection, Crohn's, or post‑cholecystectomy. • Maintain a broad GI bleeding differential beyond cancer (e.g. gastritis, peptic ulcer, Mallory–Weiss tear, haemorrhoids/fissures, liver disease/coagulopathy, IBD, angiodysplasia, diverticular disease). Liver disease, microbiome and early life • Remember major causes of liver failure in primary care: excess alcohol, paracetamol overdose, DILI, autoimmune hepatitis, Wilson's disease, haemochromatosis, viral hepatitis B/C and progressive MASLD. • Support breastfeeding where possible to promote a healthy infant microbiome (HMOs favouring bifidobacteria) and recognise how birth mode and early microbes shape immune development and later allergy/immune risk. Structuring abdominal symptom assessment • For undifferentiated abdominal symptoms, consciously work through a core list: IBS, lactose intolerance, coeliac disease, gastroenteritis, SIBO, IBD, diverticular disease, colorectal cancer, peptic ulcer disease, gallstones/biliary colic, pancreatic insufficiency and medication‑related causes (e.g. metformin, NSAIDs, antibiotics). • Use these categories to guide targeted history, examination, basic tests and thresholds for referral back to gastroenterology or specialist services. Chapters (00:00:04) - The 12 Days of Gutmas(00:01:04) - PPIs(00:02:19) - How to manage gastric and duodenal ulcers on(00:03:40) - Celiac disease tests 6, Interventions(00:05:33) - GI red flags on Christmas Day(00:07:48) - The main indications for endoscopy(00:09:07) - 7 causes of liver failure on Christmas Day(00:10:17) - Healthy gut microbiome 8 days after Christmas(00:12:03) - Bile acid diarrhea(00:13:52) - 10 causes of abnormal gastrointestinal bleeding(00:15:34) - The microbiome of the body(00:17:55) - 12 causes of abdominal dysrhythmia(00:19:59) - 12 Days of Gutmas

A Game Plan for Sports HealthSports have always played an important role in Hayden Lee's life. Now a Doctor of Pharmacy/MBA student at Cedarville University, Hayden's journey from high school athlete to aspiring sports pharmacist shows how passion and purpose can collide in powerful ways.Growing up, Hayden was all in — on the field, in the weight room, and in the classroom. His love for biology and fascination with how the body works fueled his curiosity. He noticed how athletes managed pain, sometimes relying heavily on medications like ibuprofen before games. But as he dove deeper into his studies, he discovered how pre-treating pain with NSAIDs could actually hinder recovery, muscle growth, and bone health. This insight lit a fire: What if athletes had pharmacists guiding their training and recovery?That question led Hayden to the emerging field of sports pharmacy, a dynamic intersection of athletic performance and pharmaceutical care. “We're stewards of our bodies,” he shared on the Cedarville Stories podcast, “and sports pharmacy helps us perform and heal in a way that honors that responsibility.”Hayden now serves as a student board member for the U.S. Sports Pharmacy Group, where he advocates for his peers, builds mentorship bridges, and helps shape the future of the profession. The field is growing fast — so fast that it may not be long before sports pharmacists are regulars on the sidelines with college and professional teams.With his faith as a guide and a playbook full of purpose, Hayden Lee is training for more than a career — he's on a mission to help athletes steward their health and shine both on and off the field.https://share.transistor.fm/s/00891df0https://youtu.be/m_tqgjpmFxA

Send us a textA packed hallway at the ACNM Annual Meeting turned into the perfect backdrop for a clear, compassionate deep dive on adolescent gynecology. We talk candidly about what really helps teens feel safe in care: transparent consent, real confidentiality, and avoiding unnecessary pelvic exams. From there, we walk through the high-yield topics every clinician faces with young patients—irregular cycles after menarche, painful periods that derail school days, and the difference between normal discharge and vaginitis that needs treatment.We spotlight the red flags that can't be missed, especially ovarian torsion posing as vague lower abdominal pain, and why transabdominal ultrasound often beats transvaginal imaging for adolescents. You'll hear how we build a thorough menstrual history that captures timing, flow, and impact on daily life; how we normalize the maturing hypothalamic-pituitary-ovarian axis; and where first-line therapies like NSAIDs, combined pills, progestin-only methods, and levonorgestrel IUDs fit. We also lay out a patient-led approach to contraception counseling—centered on goals like bleeding control, privacy, and ease of use—while weaving in emergency contraception, STI screening strategies, and the crucial role of the HPV vaccine in preventing cervical and other cancers.Throughout, we keep the focus on trauma-informed practice. That means offering safe words like stop and out during exams, letting teens handle instruments to reduce fear, and moving complex conversations to when patients are fully dressed. We include considerations for transgender and gender-diverse adolescents, from menstrual suppression to reputable clinical resources. By combining practical tools with a respectful tone, this episode gives you a roadmap to adolescent gyn that improves comfort, detects danger early, and builds trust that lasts into adulthood.If this conversation helps you care for teens with more confidence, subscribe, share with a colleague, and leave a quick review to help others find the show.

In this episode of Your Natural Dog, Angela Ardolino is joined by holistic pet health coach Naja Muller of Tonka's Journey and Green Paws Holistic Pet Care. Naja shares how she's helped her handicapped and chronically challenged dogs stay comfortable, mobile, and joyful using a holistic pain management toolkit, without relying on long-term pharmaceuticals. Angela and Naja dive into the five pain pathways, why conventional pain meds often lead to stacking multiple drugs with serious side effects, and how whole-plant cannabis, psilocybin, nutrition, and at-home therapies can work together to support dogs living with pain.Episode Recap:Angela introduces Naja Muller, Tonka's Journey and sets the stage for a deep dive into chronic pain, handicapped dogs, and holistic pain support. (00:00)They break down the five pain-signaling pathways and explain how conventional drugs usually target just one, while cannabis and other botanicals can influence multiple pathways at once. (03:13)Naja shares her dog Tripp's osteosarcoma story, how conventional pain meds quickly caused severe constipation, and how switching to high-THC and CBD plus a wheelchair transformed his final six months. (05:17)Naja shares about her dog Tonka's congenital deformities, and how she committed early to a holistic pain plan instead of cycling through combinations of dog pain meds and their side effects. (07:19)They discuss their shared experiences using full extract cannabis (THC-rich oil) and CBD for pain support in dogs, including why whole-plant cannabis works differently than pharmaceuticals and practical tips for balancing THC and CBD for comfort without heavy sedation. (09:45)Angela and Naja unpack the problem with NSAIDs, opioids, steroids, Librela and other popular pain drugs for dogs, highlighting issues like gut damage, liver and kidney strain, and long-term fallout. (13:50)Why the conversation should actually be about being proactive with food and lifestyle, rather than adding more synthetic supplements and pharmaceuticals. Naja shares her go-to foods for joint support and inflammation. (18:24)Angela discusses the need to reframe hemp, functional mushrooms and adaptogens as functional food, rather than “supplements”, stressing clean sourcing, COAs, and why real liquid mushroom extracts beat cheap powders with fillers. (21:02)Naja shares the at-home modalities she uses with her dogs, including light therapy, infrared and PEMF mats, cold laser, tuning forks, Reiki, ozone and bodywork, to support comfort and recovery. (26:49)Naja describes her own experience microdosing psilocybin, then using it with Tonka, and the subtle but noticeable shifts she saw in his mobility, reactivity and emotional balance over time. (32:42)They close by urging pet parents not to blindly trust every prescription, to learn the real risks of dog pain meds and steroids, and to build proactive, “do no harm” holistic pain plans that protect quality of life. (40:02)Episode Resources:Download Angela's Resources including Natural Alternatives for Arthritis Pain in Dogs and Cats & her Cosequin Ingredient Breakdown at AngelaArdolino.com/podcast-downloads Follow Tonka's Journey on Facebook, Instagram and TikTokLooking for a Holistic Pet Health Coach - Green Paws Holistic Pet CareHave a question about your pet that you want answered on the podcast? Email us at Carter@yournaturaldog.com Sign up for episode reminders and updates from Your Natural Dog with Angela ArdolinoVisit Angela Ardolino's website for more holistic pet health education: www.AngelaArdolino.comFollow Your Natural Dog on Facebook and Instagram and if you want to see what Angela is up to, follow her on Facebook or join our CBD & Holistic Pet Advice Facebook Group.

Ageless Athletic Knee Reset The Ageless Athlete Knee Reset (6 Weeks): Start 2026 Without Knee Pain “Do your knees hurt when you walk, go down stairs, stand up, play pickleball, golf, or even just get out of bed? If so, I want you to know something important: It's NOT aging. It's NOT inevitable. And it's absolutely NOT too late to fix.” “I'm Dr. Brian McKay from Core Health Darien. For over 35 years, I've helped hundreds of people in Fairfield County get out of knee pain without drugs, injections, or surgery. But the truth is—most knee treatments out there fail because they only mask symptoms.” “Maybe you've tried cortisone shots… gel shots… braces… rest… NSAIDs… even physical therapy. But you're still in pain. You're still avoiding stairs. You're still modifying your golf swing. You're still sitting on the sidelines.” “But what if you could feel 10–20 years younger in your knees… in just 6 weeks? What if you could start the New Year MOVING the way you want to — not the way your pain forces you to?” “I want to introduce you to the Ageless Athlete Knee Reset, a 6-week knee restoration program designed for active adults who refuse to slow down. This is NOT more injections. NOT more painkillers. And NOT another ‘wait and see' program.” 1. Knee on Trac Joint Decompression Opens compressed joints and reduces pressure. 2. Trigenics Neuromuscular Activation Reboots weak or inhibited muscles so the knee tracks properly. 3. ESWT Shockwave Therapy Breaks up scar tissue and stimulates natural healing. 4. Low-Level Laser Therapy Reduces inflammation and speeds cellular repair. 5. BFR (Blood Flow Restriction) Strength Training Builds stabilizing muscles safely, even when painful exercise isn't an option. “These therapies work together to restore youthful knee mechanics — the same mechanics you had long before arthritis, injuries, or years of wear and tear took over.” “If you want 2026 to be the year you move better, feel younger, and finally conquer your fitness goals — this is your moment. Schedule your $99 session. Start your comeback.” Darien — Ageless Athlete Ageless Athlete Knee Reset Program special offer $99 click the link in the description below (203) 656-3636Dr.Brian McKay Core Health Darien551 Post RoadDarien CT 06820 203-656-3636This podcast welcomes your feedback here are several ways to reach out to me. If you have a topic you would like to hear about send me a message. I appreciate your listening. Dr. Brian Mc Kayhttps://twitter.com/DarienChiro/https://www.facebook.com/ChiropractorBrianMckayhttps://chiropractor-darien-dr-brian-mckay.business.sitehttps://podcasts.apple.com/us/podcast/not-just-chiropractor-for-stamford-darien-norwalk-new/id1503674397?uo=4Core Health Darien-Dr.Brian Mc Kay 551 Post RoadDarien CT 06820203-656-363641.0833695 -73.46652073GMP+87 Darien, Connecticuthttps://youtu.be/WpA__dDF0O041.0834196 -73.46423349999999https://darienchiropractor.comhttps://darienchiropractor.com/darien/darien-ct-understanding-pain/Find us on Social Mediahttps://chiropractor-darien-dr-brian-mckay.business.site https://www.youtube.com/channel/UCNHc0Hn85Iiet56oGUpX8rwhttps://docs.google.com/spreadsheets/d/1nJ9wlvg2Tne8257paDkkIBEyIz-oZZYy/edit#gid=517721981https://goo.gl/maps/js6hGWvcwHKBGCZ88https://www.youtube.com/my_videos?o=Uhttps://www.linkedin.com/in/darienchiropractorhttps://www.facebook.com/ChiropractorBrianMckayhttps://sites.google.com/view/corehealthdarien/https://sites.google.com/view/corehealthdarien/home

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 

Most people are stuck in a healthcare system designed to manage symptoms, not create real healing. Today, Dr. InJun Chong joins Josh Kosnick to expose why so many patients end up on painkillers, unnecessary surgeries, and endless treatment plans that never address the root cause.Dr. Chong is the founder of Reveal Wellness and a leading practitioner in regenerative medicine, specializing in human cellular tissue products, shockwave therapy, and non-invasive recovery methods. His approach challenges the traditional medical model by prioritizing the body's natural ability to heal.In this episode, Josh and Dr. Chong break down:• Why the medical system prioritizes pharmaceuticals over long-term healing• The truth about regenerative therapies and who they actually help• The misconceptions around chiropractic care• What people can do at home to reduce pain and improve mobility• The leadership crisis inside the healthcare industry• Why most people wait too long to address pain• How Dr. Chong is integrating high-performance leadership through the Bridge Builder MastermindIf you've been frustrated with the medical system, are looking for alternatives to surgery or NSAIDs, or want to understand how to take ownership of your long-term health, this conversation will give you the clarity and direction you need.Learn more about Dr. InJun Chong and Reveal Wellness:https://www.revealwellness.life/For coaching, events, and leadership development:https://www.joshkosnick.com/00:00 – Introduction and Personal Responsibility02:00 – Dr. Chong's Backstory and Path to Regenerative Medicine07:00 – Chiropractic vs. Medical Industry11:00 – Stem Cell Therapy: Misconceptions and Real Results15:00 – How the Body Heals: Cells, Pain, and Dysfunction19:00 – Insurance, Incentives, and Healthcare System Failures23:00 – Lifestyle, Habits, and Personal Accountability30:00 – Media Influence and Health Confusion32:00 – Regenerative Medicine, Shockwave, and Peptides40:00 – Personalized Treatment and Ozone UV46:00 – Mindfulness, Thought Work, and Emotional Health53:00 – Risks of Surgery, NSAIDs, and Inflammation58:00 – Gut-Brain Connection01:06:00 – Building a Sustainable Healthy LifestyleSpartan Valor Foundation is dedicated to empowering veterans, military families, and survivors of child trafficking. Through strategic partnerships, we provide critical resources, advocacy, and hope for those who have sacrificed so much. Join us in making a difference—because no hero should stand alone.

Episode 207: Understanding Hypertension and Diabetes (Pidjin English)Written by Michael Ozoemena, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.HypertensionSegment 1: What Is Hypertension?HOST:Let's start with the basics. Blood pressure is the force of blood pushing against the walls of your arteries. Think of it like water running through a garden hose—if the pressure stays too high for too long, that hose starts to wear out.Hypertension, or high blood pressure, means this pressure is consistently elevated. It is measured using two numbers:Systolic: the pressure when the heart beatsDiastolic: the pressure when the heart relaxesNormally reading is around 120/80 mmHg. Hypertension is defined by the American College of Cardiology/American Heart Association (ACC/AHA) as 130/80 mmHg or higher.The American Academy of Family Physicians (AAFP) defines hypertension as persistent elevation of systolic and/or diastolic blood pressure, with the diagnostic threshold for office-based measurement set at 140/90 mm Hg or higher.Segment 2: Why Should We Care?HOST:Hypertension is known as “the silent killer” because most people have no symptoms. Even without symptoms, it steadily increases the risk of:Heart attackStrokeKidney diseaseThink of high blood pressure as a constant stress test on your blood vessels. The longer it goes uncontrolled, the higher the chance of complications.Segment 3: What Causes High Blood Pressure?HOST:Hypertension usually doesn't have a single cause. It often results from a combination of genetic factors, lifestyle, and underlying medical conditions.Modifiable FactorsHigh-salt diet and low potassium intakePhysical inactivityTobacco useExcessive alcohol intakeOverweight or obesityChronic stressPoor sleep or sleep apneaNon-Modifiable FactorsFamily history of hypertensionBlack race (higher prevalence and severity)Age over 65Hypertension may also be secondary to other conditions, such as kidney disease, thyroid disorders, adrenal conditions, or medications like NSAIDs or steroids.Segment 4: How Is It Diagnosed?HOST:Diagnosis requires multiple elevated blood pressure readings taken on different occasions. This includes office readings, home blood pressure monitoring, or ambulatory blood pressure monitoring.If you haven't had your blood pressure checked recently, this is your reminder. It's simple—and it could save your life.Segment 5: Treatment and ManagementHOST:Lifestyle changes are often the first line of treatment:Reduce salt intakeEat more fruits, vegetables, and whole grainsAim for 150 minutes of moderate exercise per weekManage stressMaintain a healthy weightGet enough sleepLimit alcoholQuit smokingIf these steps aren't enough, medications may be necessary. These include:Diuretics, ACE inhibitors, ARBs, Calcium channel blockers, Beta-blockersYour healthcare provider will choose the best medication based on your health profile.Segment 6: What You Can Do TodayHOST:Here are three simple, actionable steps you can take right now:Check your blood pressure—at a clinic, pharmacy, or at home.Pay attention to your salt intake—much of it is hidden in processed foods.Move more—even a 20-minute daily walk can help reduce blood pressure over time.Small steps can lead to big, lasting improvements.SummaryHypertension may be silent but understanding it gives you power. Early action can add healthy years to your life. Take charge of your blood pressure today.Diabetes1. Wetin Diabetes Be and Wetin E Go Do to Person Body?Q: Wetin diabetes mean?A: Diabetes na sickness wey make sugar (glucose) for person blood too high. E happen because the body no fit produce insulin well, or the insulin wey e get no dey work as e suppose.Q: Wetin go happen if diabetes no dey treated well?A: If diabetes no dey treated well, e fit damage the blood vessels, nerves, kidneys, eyes, and even the heart.2. Wetin Cause Diabetes and Why Black People Suffer Pass?Q: Wetin cause diabetes?A: E no be one thing wey cause diabetes. E dey happen because of mix of gene, lifestyle, environment, and society factors.Q: Why Black/African Americans get diabetes more?A: Black people for America get diabetes more because of long-standing inequality, stress, low access to healthcare, and the kind environment wey many of them dey live in. These things dey make Black people more at risk.3. Diabetes Rates for America and Black People?Q: How many people get diabetes for America?A: For America today, over 38 million people get diabetes, and the number dey rise every year.Q: Why Black people dey suffer diabetes more than White people?A: About 12% of Black adults get diabetes, compared to just 7% for White adults. Black people also dey get the sickness earlier and e dey more severe.4. Signs and Symptoms of Diabetes?Q: Wetin be the early signs of diabetes?A: The early signs no too strong, but when e show, e fit include:Too much urine (polyuria)Thirst (polydipsia)Hunger, tiredness, and blurred visionWounds no dey heal fastTingling for hand or legSometimes weight loss5. How Doctor Go Diagnose Diabetes?Q: How doctor fit confirm say person get diabetes?A: Doctor go do some lab tests to confirm:Fasting Plasma Glucose (FPG): 126 mg/dL (7.0 mmol/L) or higherHbA1c: 6.5% or higher2-hour Oral Glucose Tolerance Test (OGTT): 200 mg/dL (11.1 mmol/L) or higher after person drink glucose.Random Blood Glucose: 200 mg/dL (11.1 mmol/L) or higher plus classic symptoms like too much urination, thirst, or weight loss.Q: Wetin happen if HbA1c test no match the person?A: If HbA1c result no match person symptoms, doctor fit repeat test or try other tests like FPG or OGTT.6. Wetin Screening and Early Diagnosis Fit Do?Q: Why screening for diabetes dey important?A: Screening dey important because early detection fit prevent serious complications from diabetes.Q: How often person go do diabetes test?A: Adults wey get overweight or obesity, between 35–70 years, suppose do diabetes screening every three years. But because Black adults get higher risk, doctors dey start screening earlier and more often.7. How Person Fit Manage Diabetes?Q: Wetin be the best way to manage diabetes?A: The two main ways to manage diabetes be:Lifestyle changes: Eat better food (vegetables, fruits, whole grain, beans, fish, chicken) and exercise regularly.Medicine: If person sugar still high, doctor fit give drugs like metformin, SGLT-2 inhibitors, or GLP-1 receptor agonists.Q: Wetin be SGLT-2 inhibitors and GLP-1 drugs?A: SGLT-2 inhibitors dey help with kidney and heart problems, while GLP-1 drugs dey help with weight loss and prevent stroke.Q: Wetin be first-line treatment for diabetes?A: First-line treatment for diabetes be metformin, unless person no fit tolerate am.Q: How much exercise a person suppose do?A: Person suppose do at least 150 minutes of moderate exercise per week. This fit include things like brisk walking, swimming, or cycling. E also good to add muscle-strength training two or three times weekly to help control sugar.Q: When insulin therapy go be needed?A: Insulin therapy go be needed if person A1c is higher than 10%, or if person dey hospitalized and their glucose dey above the 140-180 range. This go help bring the blood sugar down quickly.8. Wetin Be the Complications of Diabetes?Q: Wetin fit happen if diabetes no dey well-managed?A: Complications fit include kidney disease, blindness, nerve damage, leg ulcers, heart attack, stroke, and emotional issues like depression.Q: Why Black adults get more complications?A: Black people get higher risk of these complications because of inequality, stress, and poor access to healthcare.9. Wetin Dey Affect Access to Diabetes Treatment?Q: Wetin make Black people struggle to get treatment for diabetes?A: Many Black people no dey get new effective treatments like GLP-1 and SGLT-2 inhibitors because of price, insurance issues, and lack of access. COVID-19 also worsen things.Q: Wetin government and doctors fit do?A: Policymakers dey work on improving access to drugs, better community programs, and screening for social issues wey fit affect diabetes care.10. ConclusionQ: Wetin be the solution to reduce diabetes impact?A: The solution go need medical treatment, early screening, lifestyle support, and policy changes. With proper treatment and community support, e possible to reduce the impact of diabetes, especially for Black communities.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References: Whelton PK, Carey RM. Overview of hypertension in adults. UpToDate. 2024.Carey RM, Moran AE. Evaluation of hypertension. UpToDate. 2024.Mann SJ, Forman JP. Lifestyle modification in the management of hypertension. UpToDate. 2024.Giles TD, Weber MA. Initial pharmacologic therapy of hypertension. UpToDate. 2024.American Heart Association. Understanding Blood Pressure Readings. Accessed 2025.American Heart Association. AHA Dietary and Lifestyle Recommendations. Accessed 2025.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode, Therese Markow and Dr. Tami Rowen discuss the controversy surrounding the use of Tylenol during pregnancy and its potential link to autism. She emphasizes that the evidence is largely anecdotal and not supported by robust scientific studies. Dr. Rowen highlights a study published in Environmental Health in 2025 that found a weak association between Tylenol use and autism, but adds that a subsequent study revealed flaws in the earlier study and showed no association.  Fever in pregnant women can have dangerous effects and should be relieved. She stresses that Tylenol is the safest pain reliever and fever reducer for pregnant women, who experience fevers in 20% of pregnancies. Dr. Rowen criticizes the media and some health officials for misrepresenting the risks, potentially leading to harmful decisions by pregnant women.    Key Takeaways: Tylenol is the safest option that we have in terms of a fever reducer and pain reliever. Fevers actually have more association with autism than Tylenol does in the research. On the other hand, Ibuprofen and NSAIDs are unsafe in pregnancy, especially in the third trimester.    "Pregnancy is quite an uncomfortable state of being. We tell pregnant women, and we tell women in general, to tough out a lot of things, but pain is not something that I think is reasonable. I think that it goes against the principle of doing no harm, to tell people they should just suffer with pain when there is actually effective and safe medication for them." —  Dr. Tami Rowen   Episode References:  The Conversation Article: https://theconversation.com/as-an-ob-gyn-i-see-firsthand-how-misleading-statements-on-acetaminophen-leave-expectant-parents-confused-fearful-and-lacking-in-options-265947    Connect with Dr. Tami Rowen: Professional Bio: https://profiles.ucsf.edu/tami.rowen    Connect with Therese: Website: www.criticallyspeaking.net Bluesky:@CriticallySpeaking.bsky.social Email: theresemarkow@criticallyspeaking.net   Audio production by Turnkey Podcast Productions. You're the expert. Your podcast will prove it.  

Still in pain after “rest and NSAIDs”? There's a smarter path. Discover how comprehensive orthobiologics, osteopathic care, and IV wellness can get you back to lifting, running, and living without surgery.Dr. Sean Goddard, DO founder of The Osteopathic Center (Miami, Jupiter, Jacksonville, and Tennessee) is an osteopathic physician known for integrative, non-pharmaceutical care. With a biochemistry background and advanced training in OMT, PRP, exosomes, acupuncture, and regenerative injections, he helps pro athletes and weekend warriors regain function fast.In this episode, Dr. Shivani and Dr. Goddard break down orthobiologics done right: why treating only the painful spot misses the root cause, how to stabilize joints for long-term results, what PRP vs. “medicinal signaling cells” actually do, and how IV therapies (ozone, NAD, chelation) accelerate recovery and metabolic health. You'll hear real patient wins from plantar fasciitis and knee pain to severe spine cases and leave with clear next steps and smart questions to ask any clinic.Key Highlights• The three injection styles (joint, spot, comprehensive) and why a stability-focused, whole-joint protocol outperforms “one-shot” fixes• PRP vs. stem cells vs. exosomes mechanisms, when to use each, and why naming matters (“medicinal signaling cells”)• Dr. Goddard's “MAP to healing” framework: Mobility, Activity, Pain relief and realistic recovery timelines• Case studies: pro-athlete knee recovery, stubborn plantar fasciitis, spinal stenosis nerve pain, lingual nerve injury, and more• The post-procedure stack: OMT, targeted rehab, IV ozone/NAD/chelation, peptides, anti-inflammatory nutrition, and turmeric support• How to vet clinics and avoid pop-up pitfalls: imaging, technique, and team-based care that prevents unnecessary surgeryWhy You Should WatchLearn exactly how to get out of pain without surgery: what PRP, stem cells, and exosomes really do, when they work, and how to combine injections, OMT, and IV wellness for faster recovery. Walk away with steps, smarter questions for clinics, and a plan to stay active for life today.

Description: Chronic pain can be difficult to live with. If you have psoriatic arthritis you know all too well what that means. Listen as physiatrist Dr. Erin Maslowski and LB Herbert offer ways to manage pain before it manages your life.  Join host Susan McClelland-Tobert, a retired pediatric cardiologist who also lives with psoriatic disease as she uncovers the topic of what is chronic pain and how to manage it with Dr. Erin Maslowski, a physiatrist at Emplify Health System who specializes in physical medicine, rehabilitation and pain management, along with LB Herbert who also lives with psoriasis and psoriatic arthritis, and knows all too well what it means to live with pain, developing her own pain tool kit. Hear different strategies for managing initial flares to when pain escalates. Pain doesn't have to dictate how you live your life.  This episode addresses why pain occurs, it's impact, and what can be done to manage pain both physically and emotionally. Timestamps: (0:23)  Intro to Psoriasis Uncovered & guests physiatrist Dr. Erin Maslowski and LB Herbert (1:48)  The unpredictability of pain and what pain means to LB. (2:31)  The science behind what happens in the body when acute and chronic pain occurs. (5:08)  General principles and first steps to managing pain associated with inflammatory arthritis. (11:00) Recognition of flares and taking action to reduce the impact before pain escalates.        . (14:02) Steps to address the chronic pain cycle as it escalates such as steroid injections and                     medications that change how the brain perceives pain signals. (20:54) Side effects and cautions for use of pain management medications. (24:17) What and who LB turns to for managing her pain. (25:50) Support resources and who to consider as part of a pain management team.   (33:16) Overcoming the stigma of mental health and "it's all in your head". (34:45) Addressing the challenge of fatigue that often comes with pain. It's more than feeling                 tired.  (39:32) Activities to keep the body moving to help avoid stiff joints.          . (42:11) What's on the horizon for managing pain. (44:55) Start small, experiment with change, but above all give yourself grace if you're not able to           do something. Gain what control you can to live your life your way. Key Takeaways: ·       Chronic pain (existing for more than 3 months) occurs when ongoing inflammation keeps signaling pain via the nervous system becoming hypersensitized and greater than the original pain signal. This can occur even when inflammation is managed and in control.   ·       Treating chronic pain is complicated however there are many different avenues to help minimize pain associated with inflammatory diseases such as psoriatic arthritis.   ·       Management of chronic pain involves a variety of specialists and support to help address the         physical and emotional impact of living with chronic pain. Guest Bios: Dr. Erin Maslowski is a board-certified physician, physiatrist, at Emplify Health System where she specializes in Physical Medicine, Rehabilitation, and Orthopedic Sports Medicine providing care for musculoskeletal and spine injuries and pain management including image-guided injection procedures. She has expertise in treating arthritis, spinal stenosis and spondylosis, rotator cuff injury, and other conditions with the ultimate goal of restoring function after injury to the muscle, bone, soft tissue, or nervous system.  Dr. Maslowski is a Clinical Assistant Professor at the University of Wisconsin School of Medicine and Public Health where she teaches both medical students and residents. She has over 15 years of clinical experience in physical medicine and rehabilitation.   LB Herbert, has been living with the challenge of managing pain associated with psoriatic arthritis for 16 years, even developing her own tool kit through the years. She has shared what's she's learned on other episodes of this podcast, through articles, and as a One-to-One Program mentor for the National Psoriasis Foundation. LB began her journey in 2009 with back pain. Following many years of being misdiagnosed she finally found a rheumatologist who put all her symptoms together to diagnose her with psoriatic arthritis and place her on an appropriate treatment path. She states "my biggest challenge is not knowing what each day will bring, what the symptoms will be, and if I wake up and flare. It's a continuous unknown." Resources: Chronic Pain kit  NSAIDS for Psoriatic Disease  Podcast episode: "Living with Chronic with Chronic Pain and Fatigue in PsA and SpA" with rheumatologist Dr. Philip Mease, Dr. Ernest Choy, from Cardiff University School of Medicine, with patients Melissa Leeolou and Minionette "Mini" Wilson who discuss causes, symptoms, risks, and tips for managing chronic pain and fatigue successfully.   

In this episode, we tackle one of the most common questions in pregnancy of late: Is Tylenol safe? It's the medication nearly every pregnant person reaches for at some point, yet the internet is full of conflicting headlines and confusing studies. We break down what the data actually shows, when Tylenol is appropriate, and how to use it safely. What We Cover • Why Tylenol (acetaminophen) is considered one of the first-lines in pregnancy We explain decades of clinical use, major guideline recommendations, and why it remains the preferred option for fever and pain relief. • What the research actually says about safety We unpack the difference between correlation and causation, discuss recent observational studies, and highlight what ACOG and SMFM currently recommend. • When Tylenol is truly needed Fever above 100.4, migraines, musculoskeletal pain, postpartum use, and how untreated fever or pain can create more risk than the medication itself. • How to use it safely Typical dosing, maximum limits in 24 hours, how to avoid hidden acetaminophen in combination products, and who should be more cautious. • What to avoid We clarify why NSAIDs (like ibuprofen) are not recommended in most stages of pregnancy and why people often confuse these medications. Resources Mentioned • ACOG guidance on pain and fever management during pregnancy • SMFM clinical recommendations • FDA medication safety overview (pregnancy and lactation) Call to Action If you have questions about medication safety in pregnancy or aren't sure what's right for your symptoms, talk with a clinician who understands the nuances of both maternal health and functional medicine. The right guidance can give you confidence and peace of mind.   Got something you want to share or ask? Keep it coming.  We love hearing from you. Email us or send a voice memo, and you might just hear it on the next episode. Don't forget to like, comment, and subscribe—your questions could be featured in our next episode! For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: YouTube: Dive deeper into pregnancy tips and stories atyoutube.com/maternalresources . Instagram: Follow us for daily inspiration and updates at @maternalresources . Facebook: Join our community at facebook.com/IntegrativeOB Tiktok: NatureBack Doc on TikTok Grab Our Book! Check out The NatureBack Method for Birth—your guide to a empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com .  

NSAIDs have long been the cornerstone of pharmaceutical pain relief for dogs with OA. But with the arrival of an OA monoclonal antibody therapy, is it time to rethink our approach? In this episode of Clinician's Brief Partner Podcast, Dr. Beth invites renowned orthopedic expert Dr. John Innes to discuss how he approaches OA management, drawing from >4 years of experience with bedinvetmab in the United Kingdom. They also dive into a head-to-head study comparing bedinvetmab with an NSAID and explore what the findings mean for today's treatment strategies.  Sponsored by Zoetis Contact us:Podcast@instinct.vetWhere to find us:Cliniciansbrief.com/podcastsFacebook.com/clinciansbriefTwitter: @cliniciansbriefInstagram: @clinicians.briefThe Team:Beth Molleson, DVM - HostSarah Pate - Producer & Project Manager, Brief StudioTaylor Argo - Podcast Production & Sound EditingLIBRELA IMPORTANT SAFETY INFORMATION: For use in dogs only. Women who are pregnant, trying to conceive or breastfeeding should take extreme care to avoid selfinjection. Hypersensitivity reactions, including anaphylaxis, could potentially occur with self-injection. Librela should not be used in breeding, pregnant or lactating dogs. Librela should not be administered to dogs with known hypersensitivity to bedinvetmab. The most common adverse events reported in a clinical study were urinary tract infections, bacterial skin infections and dermatitis. See full Prescribing Information at LibrelaPI.com

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 hope-filled episode of the UnabridgedMD Podcast, Dr. Isabelle Amigues sits down with Cliff—a former patient—to trace his journey from sudden, debilitating pain and months of uncertainty to full remission and a return to the life he loves. After being dismissed and delayed elsewhere, Cliff found UnabridgedMD, received an accurate diagnosis of polymyalgia rheumatica (PMR), and followed a clear, compassionate plan: calm the “fire” of inflammation, treat decisively, and taper safely. Within a few months he was off steroids, symptom-free, and cleared to travel to Africa—proof that partnership, precise listening, and a treat-to-target mindset can change everything.

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

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 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.Just Ingredients Lemon Swish Protein Powder Vitality Radio POW! Product of the Week $29.99 per bag (regular price $59.99) with PROMO CODE: POW15Additional 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.

NSAIDs are everywhere, prescription, OTC, topical, oral, injectable, you name it! In an era of Opioidphobia, are they really a panacea? Heck no, all medications come with baggage. We could spend hours talking about NSAIDs, and not even get to the elephant in the room: Which NSAID for Which Patient? So we'll go there in this succinct, yet comprehensive rapid review of all things NSAIDs on the Pain Pod! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us

NSAIDs are everywhere, prescription, OTC, topical, oral, injectable, you name it! In an era of Opioidphobia, are they really a panacea? Heck no, all medications come with baggage. We could spend hours talking about NSAIDs, and not even get to the elephant in the room: Which NSAID for Which Patient? So we'll go there in this succinct, yet comprehensive rapid review of all things NSAIDs on the Pain Pod! Come one, come all, to the Pain Pod!!! Pain Guy • www.painguy.us

Safety of NSAIDs in Inflammatory Bowel Disease  Screen RA ILD Properly  Biologics Improve Sexual Function in axSpA  Catching PsA before it Starts  Multidimensional Pain inventory in Axial SpA  RA: Does upfront TNFi save heartache?  Novel Insights into Sjogren's Disease  New Paradigms in RA Treatment  Biomarkers in Still's and Macrophage Activation Syndrome  "The Power of Gamma Delta T Cell for Autoimmunity"  The Heartbreak of Sarcoidosis 

Many patients have questions on the use of peptides. What are peptides and what are the most common peptides used as well as the safety and other concerns. BPC157 is one of the most common peptides that patients ask about. There are more but today, Ray Solano of PD Labs and I discussed peptide use and safety. Chapters: 0:00

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.

Send us a message with this link, we would love to hear from you. Standard message rates may apply.We continue our hypertension journey with two pillars—lifestyle and medication—and show how small, honest changes shift blood pressure in meaningful ways. From sodium awareness and exercise to sleep apnea, tobacco, alcohol, and med side effects, we focus on what actually works.• two pillars of treatment: lifestyle and medication• non‑modifiable risks: age, sex, race, family history• sodium literacy and the DASH eating pattern• track intake and aim for 1,500–2,300 mg sodium• clinically meaningful weight loss of 5–10%• exercise dose: 150 minutes weekly that extends life• insurance incentives for gyms and movement access• tobacco cessation strategies and realistic goals• alcohol guidelines and honest self‑audit• common meds that raise blood pressure (NSAIDs, estrogen, decongestants)• social determinants and chronic stress impact• sleep apnea screening and CPAP benefits• medication adherence, side effects, and combo pills• reducing or stopping meds with sustained lifestyle changeMake sure you subscribe, rate, and review wherever you listen to your podcastsFollow our Instagram, your checkup podcastSupport the showSubscribe to Our Newsletter! Production and Content: Edward Delesky, MD & Nicole Aruffo, RNArtwork: Olivia Pawlowski

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!  

Facioscapulohumeral muscular dystrophy (FSHD) is one of the most common forms of muscular dystrophy, affecting individuals across the lifespan with variable severity. Advances in genetic understanding and therapeutic development have led to an era of promising disease-modifying strategies. In this episode, Katie Grouse, MD FAAN, speaks with Renatta N. Knox, MD, PhD, author of the article “Facioscapulohumeral Muscular Dystrophy” in the Continuum® October 2025 Muscle and Neuromuscular Junction Disorders issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Knox is an assistant professor of neurology in the Division of Pediatric Neurology and Neuromuscular Section at Washington University School of Medicine in St. Louis, Missouri. Additional Resources Read the article: Facioscapulohumeral Muscular Dystrophy Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN  Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Renatta Knox about her article on fascioscapulohumeral muscular dystrophy, which appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Welcome to the podcast, and please introduce yourself to our audience. Dr Knox: Hi Katie, thank you so much for the invitation for the audio interview. I'm looking forward to our conversation. As she mentioned, my name is Renata Knox. It's a pleasure to be here today. Dr Grouse: I'd like to start by asking, what is the key message that you hope your readers will take from your article? Dr Knox: I would say two things. The first is an appreciation and understanding of the unique genetic mechanism that leads to FSHD. And the second is the really exciting therapy landscape that we find ourselves in. So, we're hopeful that there will actually be disease-modifying therapies for FSHD soon. Dr Grouse: We're really looking forward to learning more about that. Now, before we get to that piece, could you just remind us of the clinical manifestations and features that are specific to FSHD? Dr Knox: So, one of the most unique things about FSHD that we see clinically is the pattern of weakness. So, one of the first features is that it's asymmetric. And then there are certain muscle groups that typically are affected, and that's partly where the name comes from. So, we see effects in the face, the limbs, the trunk; and so, those are some of the unique features that we see clinically. Dr Grouse: I'd love it if you could walk us through how you approach diagnosing a patient who presents with proximal weakness where FSHD is in your differential. Dr Knox: Yeah, it's a really great question. So, I would say it depends. So, I actually focus on FSHD in my clinical practice. So, many times patients are referred to me because there's a very high suspicion or there's a known family history of FSHD. So, that's one category of cases. I would say the other category of case is where it's, as you said, maybe more proximal weakness more broadly. Someone that's before me who has a known family history, they really have some of the characteristic physical features---which I'm pretty attuned to, as this is, you know, part of my subspecialty---I'll actually go directly to FSHD genetic testing. And that is one of the unique features of this disease, that the next-generation sequencing panels that are typically used for some of our other muscle diseases, FSHD is not captured on those. So, we actually have to send targeted testing for FSHD to diagnose it. So, that is one category where, again, I have a very high suspicion either based on their clinical presentation and/or a known family history, then I will actually go directly to FSHD-targeted genetic testing. In the second case, where it is one of the conditions that I'm considering among others, I will do more broad testing. So, I will get a CK level to see if there's evidence of muscle breakdown. I'll likely also do one of the next-generation sequencing panels that we have access to, which will allow us to identify, potentially, one to two hundred potential muscle diseases. And then again, if FSHD is higher on my differential in that second group of patients, then I will also send targeted FSHD-specific testing. Dr Grouse: That's really helpful. And I'm wondering if you have any thoughts about common pitfalls that you've seen when providers are trying to work this up? Dr Knox: I don't know if I would say pitfalls. I think I would acknowledge that it's challenging. My subspecialty training in neuromuscular medicine and also gene therapy. And so FSHD is pretty high on my radar. But I would say in neurology in general---and then, you know, the general medical population---,it really isn't something that many people are seeing. So, I would say what patients will communicate to us sometimes is some frustration that maybe it took time to make the diagnosis, but I just have a deep understanding that it's not something that is on many people's radars. And I think, again, it's tricky because it's not picked up on these next-generation sequencing panels, which many of us can send pretty easily. It will be missed. And I will say the biggest pitfall is, again, if you're not thinking about it and you don't send that testing, you actually- it's very difficult to diagnose it. Dr Grouse: Thank you so much for highlighting that. I think there are many people who are not aware that those different panels really aren't picking that up and that they have to test specifically. So, I think that's a great thing for all of us to keep in mind. Are there any tips or tricks to the diagnosis, other than the genetic issues that you mentioned, that sometimes can really bring this diagnosis to the forefront? Dr Knox: I think things that really tip me off to having a higher suspicion for FSHD is facial weakness that we can detect on our exam. Scapular winging---again, there's a small subset of disorders which can impact that. Someone who's presenting with foot drop, you know, with facial weakness, I think definitely about FSHD more. Also, clinically, kind of the presentation or things that they're beginning to have difficulty with is a tip-off. So, if someone is an athlete, like, they're a volleyball player or basketball player and they say, oh, I'm having difficulties, you know, with movements that require them to elevate their arm, which can be a sign of the shoulder weakness that we classically see. Or someone who says, oh, I'm having a harder time shampooing my hair or combing my hair. So those can be tip-offs again, which are basically referencing the type of weakness that they have. Another feature of FSHD which isn't necessarily as broadly appreciated is that pain and fatigue are very common. So, if someone is coming in and saying, actually, I also have a significant amount of fatigue as well or a lot of pain, that's something that can tip me off to it. Hearing loss is something that we can also see in up to 20% of patients with FSHD. So, if they are having those symptoms or saying they're ringing in their ears, these are some things that will make me begin to think about it more. Dr Grouse: Oh, really helpful. I also found it really fascinating reading some of the very FSHD-specific clinical signs, some interesting- some diagrams and pictures as well, that are very specific to the pattern of weakness that develops in FSHD. So, I encourage our listeners to check that out. But are there any highlights from those little clinical pearls that you'd like to point out? Dr Knox: I think the poly-hill sign---so, these are these literal hills that we can see in the shoulders of patients with FSHD---is pretty classic. Popeye arms, which is this older term that we still use that has to do with which muscle groups are preserved versus those that have atrophy. So that's a common feature. And then I would say, really, the asymmetry is something that is a unique feature in FSHD. And again, we did our best to provide good representative images. So again, as you mentioned, Katie, I would really encourage people to look at those images and then think about cases that they may have seen and how similar they are so they can begin to recognize those signs as well. Dr Grouse: Now going back to the genetic topic, the complex genetic underpinnings of FSHD are really well-explained in your article; and again, worth taking a look at to remind ourselves of everything that's of that pathology. Now, I was wondering though, if you could give us a brief overview of how we should approach genetic testing in a suspected case of FSHD? You mentioned some specific panels, but it does sound like there's some more complexity to it as well. Dr Knox: Yes, and I'll just kind of briefly explain that complexity. Part of the thing that we're detecting in the genetic testing is the repeat number. And so, we're actually looking for a contraction in a repeat number. So, not an expansion, which were typical for some of the diseases that we think about, the trinucleotide repeat disorders. And this is why it's not captured in the next-generation sequencing panels, because they do not currently have the ability to do that. And so, again, what the type of testing that I do really depends on my suspicion. So again, if my suspicion is very high for FSHD---they have a family history, they have the classic features---then I will actually go directly to an FSHD-specific testing, which is available from various sources. If, again, it's among different things that I'm thinking about, I will get a CK lab. I typically will also send a next-generation sequencing panel specific for muscle diseases, perhaps muscular dystrophy; again, depending on what I'm thinking about. And then I will also send in a specific FSHD genetic test as well. People are beginning to use whole-genome sequencing, which is capturing some of our true nucleotide repeat disorders and becoming more comprehensive. So, my hope is that as that becomes more standard of care---like, whole-exome sequencing can be gotten pretty routinely now---that it may be easier for us to make some of these diagnoses. Dr Grouse: Well, that's really helpful, and thanks for that overview. Now another thing that you mentioned that I thought was really interesting in your article was that patients with, you know, history of FSHD, perhaps in the family, who are pregnant and want to screen for this disease would not be able to use sort of the more common screening tests like cell-free DNA testing and may have to go to other means to do that. What is generally their route to this type of testing? Dr Knox: Yeah, great question, and really important question for family planning purposes, and it definitely comes up in clinical practice. And so again, because of the unique genetics of FSHD, you actually have to do invasive genetic testing currently to be able to test it. And so that's, you know, amnio or chorio, and then send it to a lab that can perform, again, FSHD-specific testing on the samples that are presented. And there are obviously labs that are capable of doing that and centers that are capable of doing that, but it is not picked up on the cell-free DNA panels that are being very routinely used. You or your provider has to be thinking about it to send that specific testing, similar to our patients that come into clinic and have not yet been diagnosed. Dr Grouse: Once you have the diagnosis, what are our options for therapy? I think it sounds like at this current time, it looks to be mostly supportive. What are some of the supportive care options we should keep in mind? Dr Knox: Yes, so that is definitely accurate. Care today is supportive, but again, we're very excited about the clinical trial and therapy landscape for FSHD. So, I work very closely with my physical therapy colleagues that are in clinic with me. So, we work very closely with physical and occupational therapists to help with supportive measures, adaptive measures, doing assessments, helping our patients to be able to move and exercise safely and effectively. As I mentioned, pain is very common in FSHD and so we can treat that with medications. The most common medication that we use to treat for pain in FSHD are NSAIDs. And then other than that it's really, you know, supportive measures. Do they need to see other subspecialists? There are some surgical options. Those are used very rarely to help with some of the scapular weakness, but typically it's physical therapy, occupational therapy, supportive devices. We treat the pain as we're able to, and then we work with other subspecialists to screen, monitor and support our patients to the best of our ability. Dr Grouse: Well, without further ado, I'd love to hear more about what's coming down the pipeline in clinical trials. What can we look forward to seeing, hopefully, in future years to treat these patients? Dr Knox: Yes. And so, this is actually what got me interested in the neuromuscle space in general is that, because we now for many years have known the genetic cause of many of these disorders as well as some of the underlying mechanisms, we can actually use advances in therapeutics to do what we call targeted therapies. So, rather than treating symptoms or indirect methods or doing kind of broad drug screens---which, again, still do take place and still do have their place---we actually can target mechanisms directly. And so, we know that the underlying biology of FSHD is due to this protein called DUX4 being expressed when it should not be. So, it's what we call a toxic gain of function. And so, the targeted way to address this is to suppress DUX4 expression. And so, kind of broadly speaking, what we're really excited about are a couple of products that are currently in clinical trials right now that actually caused DUX4 suppression to be suppressed. And again, these are targeted pathways. And so, again, the hope is that by doing that, we can hopefully slow the progression of the disease, potentially stop progression of the disease, and potentially reverse. Again, we don't know if that might be possible, but that is one of the hopes. Dr Grouse: Well, that's really exciting, and I know we're all looking forward to more coming down the pipeline soon, and hopefully more things that can really offer some exciting treatments for our patients with this condition. Now, a little more deep-dive into our patients who are diagnosed. You've reviewed some of the treatments currently available and hopefully may someday soon be available. Are there other things that we should be keeping in mind in this population? For instance, screenings that we should be doing for other extramuscular manifestations that we need to be thinking about? Dr Knox: I will answer that question two ways. I think something that's very important to acknowledge is the impact that these diagnoses and these conditions have on our patient practically, psychologically. One of the other unique features of FSHD is, it's autosomal-dominant. So, if it is in a family, you can have many family members who are affected, but the variability is very high. And so, you can have in the same family someone who is wheelchair-dependent, and someone else in the family with the same underlying genetics who has no signs or symptoms or is very mildly affected. And that is something that is definitely challenging for our families and patients to navigate if they're very different than their family members with the same condition. And just navigating the world with a condition that, you know, can be physically debilitating and cause changes to what they're able to do or not able to do, progression is something that's very difficult to handle. So, I think that's one set of things. And we try our best, you know, with my team and my other colleagues in the space, to support our families and patients in the best way that we can. Secondly, there is very important screening that needs to be done for this condition. So, one of the things- and the current guidelines which are actually being updated, the last update was in 2015 is all patients that undergo pulmonary function testing or PFTs. And so that's something we do at baseline and we do at least annually in my practice. Young kids who are presenting very early or patients with certain genetics that we know are more predisposed to extra muscular manifestations, we recommend screening for hearing, which is one of the manifestations, and ophthalmologic exam to look for retinovascular changes, which is one of the manifestations as well. Those are the more common ones that are typically done. There's also some evidence in pediatric patients with very severe manifestations that there may be some cognitive impacts, learning impacts. And so, that is something we're also thinking about screening and supporting our patients in that way. And again, we typically work with these patients in a multidisciplinary team depending on what manifestations and the degrees to which they're impacted by the disorder. Dr Grouse: Thank you so much for that answer. I think a lot of us forget sometimes when we get really focused on what can we do now, that we forget to kind of stop and reflect on sort of the more holistic approach. How is this affecting the patient? How is this affecting the patient's family dynamic, and what other ways are they going through life with this condition that we need to be thinking about? So, I appreciate you bringing that up. I wanted to ask, sort of based on what you're talking about and what you mentioned already, you happened to mention that what initially drew you that to this work was your interest in some of the really exciting breakthroughs in the field. Well, was there anything else that drew you to, specifically, congenital neuromuscular diseases, and FSHD in particular? Dr Knox: I'm a physician scientist by training, and so I would describe myself also as a molecular biologist. So, I love getting into the nitty gritties of disease mechanisms, what genes are doing in bodies, how they function. And so, as I mentioned earlier, in the neuromuscle space, we've known for many years the genetic cause of many of these disorders and have done great, you know, mechanistic work to kind of define why we see the disease. And then now we're at this intersection of that knowledge marrying with these really novel therapeutic approaches, gene therapy approaches, being able to intersect and then in very creative ways actually target diseases very directly. And so, I would say it really is the combination of those two things. FSHD has a really fascinating unique biology, which again, we encourage everyone to read about more in the article. That really drew me to it. I'm very interested in gene regulation, transcription. This is one of the underlying mechanisms that is gone awry in the disorder, and then that being married to advances in therapeutics. So, you could wed those two pieces of information and actually meaningfully impact patient 's lives. And again, that's the real privilege and honor to witness is how these therapies can transform lives. And I saw it happened with this one case for this one disorder when I was a resident where there was no treatment. Young children, unfortunately, would not survive the disease. And then I saw the therapy come be in development and literally change the trajectory. And this is what we're very hopeful for in the FSHD space, that wedding, this wonderful basic science research, translational research, companies working together to develop these therapies that can transform lives. It is just so beautiful to witness and see, and it's something that I get to do. You know, it's a part of my job, so it's a real privilege. Dr Grouse: Well, I have to say, it's really inspiring hearing you talk about it. And I imagine that many neurologists-in-training who are listening to this may be inspired as well and may be convinced to go into this field for that very reason. So, thank you so much for sharing all of this information with us today. I learned a lot, and I think all of our listeners have too. Dr Knox: Thank you. It's really been a pleasure. Dr Grouse: Again, today I've been interviewing Dr Renatta Knox about her article on fascioscapulohumeral muscular dystrophy, which appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Episode 204: Adult Pneumococcal Vaccines in 2025.  Luz Perez (MSIV) presents all the available pneumococcal vaccines for adults. Dr. Arreaza guides the discussion about what to do with adults who have previously received pneumococcal vaccines. Written by Luz Perez, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Today we're answering a clinic classic: Which pneumococcal vaccine should my adult patient get—and when? This is an update of episode 90.Why pneumococcal vaccines matter?Pneumococcal vaccines prevent infections caused by the bacteria Streptococcus pneumonia. These bacteria can cause serious infections like pneumonia, meningitis, and bacteremia. In 2017, the CDC reports that there were more than 31,000 cases of pneumococcal infections and 3,500 deaths from invasive pneumococcal disease. Children are vaccinated in early childhood, before age 5, with PCV15 or PCV 20, at the age of 2, 4, 6 months and a last dose around 12-15 months. Why do we vaccinate adults?Adults are vaccinated because they're at higher risk of getting pneumococcal disease or of having worse outcomes if they do. Vaccines are important because they protect these at-risk patients and reduce the spread of infections among communities. What are the available vaccines? PCV vs PPSV.There are two pneumococcal vaccines used in practice: a polysaccharide vaccine (PPSV) and a conjugate vaccine (PCV). Both protect by targeting capsular polysaccharides from pneumococcal serotypes most often responsible for invasive disease. In simple terms, these vaccines target a part of the bacteria “coating” and create antibodies or proteins that protect the body when the strep enters the body. PPSV (polysaccharide): PPSV is made from purified pieces of the pneumococcal capsule or coating. The current vaccine PPSV23 (Pneumovax®) covers 23 serotypes (or strains) that were the leading cause of pneumococcal infections in the 1980s. PCV (conjugate): Pneumococcal conjugate vaccines (PCVs) take capsular polysaccharides from the bacterium and chemically link them to a carrier protein, which changes and strengthens the immune response. Current PCVs come in four versions: PCV13 (Prevnar 13)PCV15 (Vaxneuvance)PCV20 (Prevnar 20)PCV21 (Capvaxive) The number indicates the amount of pneumococcal capsule types covered by each vaccine. PCV21 was designed around adult disease patterns and covers many serotypes currently driving invasive disease in adults. However, it does not include serotype 4, but this serotype is covered by the PCV20 and PCV15.Who should be vaccinated? In 2024, the United States Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) updated their recommendations on Pneumococcal vaccinations for adults. Their recommendations are: Everyone 50 years or olderAdults age 19–49 with risks: chronic lung/liver disease, heart failure, diabetes; CSF leak or cochlear implant; immunocompromised states (e.g., HIV, hematologic malignancy, CKD/nephrotic syndrome); functional/anatomic asplenia.Patients with history of prior invasive pneumococcal disease: still vaccinate. What vaccine should be given for adults that have never received the Pneumococcal vaccine?For eligible adults with no prior pneumococcal vaccines, there are three choices:PCV21 oncePCV20 oncePCV15 now, followed by PPSV23 later, usually 1 year; 8 weeks if immunocompromised, CSF leak, or cochlear implant.PCV 20 or PCV21 seem more convenient. Once and done. If available, PCV21 is a great one-and-done pick for most adults because it's tailored to current adult serotypes.Serotype 4 caveat: If your patient is at higher risk for serotype 4 disease—think Navajo Nation, or folks in the Western US/Canada with substance use disorders or experiencing homelessness—choose PCV20 (or PCV15 followed by PPSV23 if PCV20 isn't available).What if the patient already received a Pneumococcal vaccine in the past?Plan depends on which vaccine they received and when.PPSV23 only: give PCV21 ≥1 year later (or PCV20 if serotype-4 risk or PCV21 unavailable).PCV10 or PCV13 only: give PCV21 (or PCV20 if PCV21 unavailable) ≥1 year later. If a PCV is not available, discuss PPSV23 now vs waiting until PCV is available.If patient receives PPSV23 now will need to return ≥1 year later to receive a PCV vaccine, and no more vaccines are needed after that.Is it safe to administer the Pneumococcal vaccine with other vaccines?Coadministration is fine with other non-pneumococcal vaccines, as long as we use different syringes and sites. Data support same-day administration of PPSV23 + influenza, and PCV20 with influenza or mRNA COVID-19 vaccines.Some patients are hesitant to receive vaccines, Are there side effects and contraindications to the vaccine?Local reactions are most common: pain/tenderness; swelling/induration (~20%); redness (~15%). Some people “baby” the arm for a couple of days. These typically resolve in 3–4 days; NSAIDs and warm compresses help.Systemic symptoms: fatigue, headache, myalgias/arthralgias, chills; fever ≥38°C is uncommon (

Exercise—for those who hate exerciseDealing with post-exercise pain and fatigueIs there any treatment for Primary Progressive Aphasia?

A closer look at plasmalogensDetermining your healthy weightI'm having tight, painful cramps in my thighs while sleeping as well as standing after driving my car. Is this from dehydration?

Pregnancy pain is common, often dismissed, and rarely easy to manage. At the same time, recent headlines have stirred anxiety by suggesting that acetaminophen (Tylenol) use in pregnancy may be linked to autism. These claims spread quickly online, leaving many parents-to-be with more questions than answers. In this episode of Plugged into Public Health, host Lauren Lavin talks with Dr. Julie Vignato, assistant professor at the University of Iowa College of Nursing and a leading researcher on pain in pregnancy. Dr. Vignato brings both professional expertise and personal insight as a mother, helping us unpack what the science actually says, where misinformation creeps in, and how healthcare providers and public health communicators can share clearer messages. Topics discussed include: -Why pregnancy pain is too often under-treated and misunderstood -What the evidence shows about acetaminophen and NSAIDs during pregnancy -How a large Swedish “sibling study” helps rule out Tylenol as a cause of autism -The role of maternal guilt, stigma, and communication in shaping these conversations -Practical advice for both pregnant people and healthcare providers navigating pain management -How to identify trustworthy evidence and avoid misinformation online Resources mentioned in this episode: -Swedish sibling study on acetaminophen and autism: https://jamanetwork.com/journals/jama/fullarticle/2817406 -Cochrane Library – Plain language reviews: https://www.cochrane.org/evidence -Dr. Vignato's study on OTC pain relievers during pregnancy: https://jamanetwork.com/journals/jama/fullarticle/2817406 A transcript of this episode will be available here soon. Have a question for our podcast crew or an idea for an episode? You can email them at CPH-GradAmbassador@uiowa.edu You can also support Plugged in to Public Health by sharing this episode and others with your friends, colleagues, and social networks. #publichealth #pregnancy #autism #pain #painmanagement #healthcare #acetaminophen #NSAIDs #maternalhealth #evidence #misinformation

Protein Myths Debunked: What Really Damages Your Kidneys | Podcast #463

EP. 232:  Grab my FREE 4 Part Video Series: GLP1s Uncovered: https://bit.ly/GLP1uncovered In this episode I'm clearing up the confusion and political noise around Tylenol and NSAIDs. These over the counter medications are handed out like candy, yet decades in practice treating pain have shown me how often they backfire: from gut damage and hormone disruption to stalled healing and liver stress. Add in the recent headlines about Tylenol's potential link to autism, and suddenly what was once considered safe has become a lightning rod of controversy. I'll break it down simply: what these meds really do in the body, why long-term reliance can set you up for bigger problems, and how to think critically instead of getting caught in the political crossfire. This is not about fear. It is about facts, context, and giving you tools to make better choices for your health. Plus I let you know what to you can do instead. Topics Discussed:→ Is Tylenol safe for long-term use?→ What are the risks of ibuprofen and other NSAIDs?→ How does Tylenol affect liver and gut health?→ What are safer alternatives for pain relief?→ Why was the Vioxx scandal important for pain management? Sponsored By: → Qualia | Go to qualialife.com/drtyna for up to 50% off at and use code DRTYNA for an extra 15% off.  → Sundays | Go to sundaysfordogs.com/DRTYNA and use code DRTYNA at checkout. → Graza | So head to Graza.co/DRTYNA and use DRTYNA to get 10% off and get to cookin' your next chef quality meal! → Manukora | Head to manukora.com/DRTYNA to save up to 31% & $25 worth of free gifts in the Starter Kit, which comes with an MGO 850+ Manuka Honey jar. On This Episode We Cover:  → 00:00:00 - Introduction → 00:04:44 - Medscape findings and Tylenol → 00:08:16 - Tylenol and neurodevelopment concerns → 00:13:51 - Common sources of acetaminophen → 00:16:31 - Risks of NSAIDs → 00:19:15 - A brief history of pain relief → 00:23:05 - The Vioxx scandal explained → 00:29:12 - Safe NSAID dosing → 00:33:15 - Tylenol PM and its issues → 00:34:12 - Black box warnings → 00:36:54 - Bone health risks and more → 00:39:16 - Gut and pregnancy safety → 00:42:46 - COX pathways and cartilage effects → 00:45:25 - Approaches to pain management → 00:50:02 - Hormones, HRT, and pain relief → 00:53:41 - Liver health considerations → 00:57:04 - Peptides and microdosing → 01:03:26 - Reliable herbal options Show Links:  → Acetaminophen Use During Pregnancy, Behavioral Problems, And Hyperkinetic Disorders → Evaluation Of The Evidence On Acetaminophen Use And Neurodevelopmental Disorders Using The Navigation Guide Methodology Further Listening:  → EP: 227 | How I Broke Free From The Pain Trap | Solo → EP. 221 | The GLP-1 Microdosing Lie: It's NOT a Weight Loss Strategy | Solo → EP. 196 | The Answer Is The Gym | Quick + Dirty → EP. 82: Movement Overrides Pain - Solo Episode → EP. 22: Solo Episode: The Not So Easy Answer to Pain Management → Playlists (Orthopedics, Hormones, Strength Training + More) Disclaimer: Information provided in this podcast is for informational purposes only. This information is NOT intended as a substitute for the advice provided by your physician or other healthcare professional, or any information contained on or in any product. Do not use the information provided in this podcast for diagnosing or treating a health problem or disease, or prescribing medication or other treatment. Always speak with your physician or other healthcare professional before taking any medication or nutritional, herbal or other supplement, or using any treatment for a health problem. Information provided in this blog/podcast and the use of any products or services related to this podcast by you does not create a doctor-patient relationship between you and Dr. Tyna Moore. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent ANY disease.

Leah explains how veterans may qualify for VA disability compensation if they experience side effects from medications prescribed for service-connected conditions. She outlines what the VA recognizes under 38 CFR 3.310, provides real-world examples such as ulcers from NSAIDs, metabolic syndrome from antipsychotics, sexual dysfunction from SSRIs, and liver damage from anticonvulsants, and stresses the importance of proving secondary service connection with medical diagnoses, documentation, and nexus statements. Leah also highlights relevant medical literature, explains the potential for special monthly compensation or TDIU in severe cases, and warns about common pitfalls like failing to directly link symptoms to medications. 

In today's VETgirl online veterinary CE podcast, we talk to Dr. David Dycus, MS, CCRP, DACVS, paid consultant for Elanco Animal Health, about a real-life approach to osteoarthritis management in dogs. NSAIDs are the cornerstone for reducing pain and inflammation associated with osteoarthritis. Tune in to learn about effective options for the management of canine osteoarthritis!Sponsored By: Elanco

EPISODE 152 – Why RFK Jr. is wrong to claim that Tylenol causes autism. According to the Wall Street Journal, RFK Jr. and the HHS are planning to release a report claiming acetaminophen (Tylenol/paracetamol) is inked to autism spectrum disorder. The evidence says he's wrong. Not just because the better quality studies show no link, not just because autism is probably mostly genetic with some minor environmental factors impacting its prevalence, but also because the alternatives to Tylenol for pain/fever control are much worse.   Become a supporter of our show today either on Patreon or through PayPal! Thank you! http://www.patreon.com/thebodyofevidence/ https://www.paypal.com/donate?hosted_button_id=9QZET78JZWCZE Email us your questions at thebodyofevidence@gmail.com. Editor:    Robyn Flynn Theme music: “Fall of the Ocean Queen“ by Joseph Hackl Rod of Asclepius designed by Kamil J. Przybos Chris' book, Does Coffee Cause Cancer?: https://ecwpress.com/products/does-coffee-cause-cancer Obviously, Chris is not your doctor (probably). This podcast is not medical advice for you; it is what we call information. References: 1)    The Wall Street Journal article:  https://www.wsj.com/health/healthcare/rfk-jr-hhs-to-link-autism-to-tylenol-use-in-pregnancy-and-folate-deficiencies-e3acbb4c 2)    Chris article in the Montreal Gazette: https://www.montrealgazette.com/opinion/columnists/article1154467.html 3)    The safety warning about NSAIDs in pregnancy: https://www.fda.gov/safety/medical-product-safety-information/nonsteroidal-anti-inflammatory-drugs-nsaids-drug-safety-communication-avoid-use-nsaids-pregnancy-20 4)    The 2024 Swedish study that used sibling controls: https://jamanetwork.com/journals/jama/fullarticle/2817406 5)    Data showing the roughly 3:1 preponderance of males vs. females with autism https://pubmed.ncbi.nlm.nih.gov/34855727/ 6)    Some of the environmental factors that may affect autism spectrum disorder https://pubmed.ncbi.nlm.nih.gov/21746727/

The “China Study” is cited as evidence vegetarian diet is best—but big new study shows vegetarians age less well than omnivores; Can a popular men's health supplement ward off prostate cancer? MAHA officials hit pause on looming natural thyroid ban; Can diet alleviate symptoms of lipedema? Precision-engineering your gait can alleviate knee pain better than NSAIDs; After a lifetime of profound depression, novel brain implant enables man to experience joy for the first time.

Vilazodone (brand name Viibryd) is an antidepressant with a unique pharmacologic profile compared to most other agents in the SSRI class. While not a first-line choice for every patient, understanding its mechanism, adverse effects, and interaction profile is essential for optimizing therapy and preventing downstream prescribing problems. Mechanism of ActionVilazodone is classified as a selective serotonin reuptake inhibitor (SSRI) and a partial agonist at the 5-HT1A receptor. The SSRI activity increases synaptic serotonin by blocking the serotonin transporter, while partial agonism at 5-HT1A receptors may contribute to antidepressant effects and potentially reduce certain SSRI-associated adverse effects (though clinical evidence for this benefit is mixed). Adverse Effects GI effects – diarrhea, nausea, and vomiting are frequent early in therapy. Taking the medication with food can help minimize these. Insomnia – often dose-related; morning dosing may help. Sexual dysfunction – may be slightly lower than with some SSRIs but still present. Serotonin syndrome – rare but serious, particularly if combined with other serotonergic drugs. Discontinuation syndrome – abrupt cessation can lead to dizziness, irritability, and flu-like symptoms. Drug InteractionsVilazodone is primarily metabolized by CYP3A4. This means: CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir) can increase vilazodone concentrations, potentially worsening side effects—dose reductions may be required. CYP3A4 inducers (e.g., carbamazepine, rifampin, St. John's Wort) can lower drug levels, reducing effectiveness. Other serotonergic agents (e.g., triptans, SNRIs, MAOIs, tramadol, linezolid) increase the risk of serotonin syndrome. Antiplatelets and anticoagulants – SSRIs can impair platelet aggregation, increasing bleeding risk when combined with aspirin, NSAIDs, or warfarin. Prescribing Cascade ExamplesVilazodone's adverse effects can easily lead to unnecessary prescriptions if side effects aren't recognized: GI upset → Acid suppression therapy – Diarrhea or nausea prompts the addition of proton pump inhibitors or antiemetics, instead of adjusting vilazodone dose or timing. Insomnia → Hypnotic initiation – Trouble sleeping results in adding zolpidem or trazodone, without reassessing morning dosing or vilazodone's role. Sexual dysfunction → PDE5 inhibitor prescription – Erectile dysfunction leads to sildenafil use, when the root cause is vilazodone's serotonergic activity. Vilazodone's combination of SSRI and 5-HT1A partial agonist activity makes it somewhat distinct, but its side effect profile and interactions require the same careful monitoring as other antidepressants. Healthcare professionals can play a key role in catching early signs of adverse effects, preventing prescribing cascades, and ensuring drug–drug interactions are managed appropriately.

297: In today's Bite Of Knowledge, I'm talking all about NSAIDs, what they are, the side effects of long term use, as well as how to heal your gut after taking them….We've all taken them at some point in our life and perhaps you even took some today! As always, if you have any questions for the show please email us at digestthispod@gmail.com. And if you like this show, please share it, rate it, review it and subscribe to it on your favorite podcast app.  Sponsored By:  → Bethany's Pantry | Go to bethanyspantry.com and use code PODCAST10 for $10 anything! → Pique Life | Check out piquelife.com/digest for up to 20% OFF and a free starter kit Check Out Bethany: → Bethany's Instagram: @lilsipper → YouTube → Bethany's Website → Discounts & My Favorite Products → My Digestive Support Protein Powder → Gut Reset Book  → Get my Newsletters (Friday Finds) Learn more about your ad choices. Visit megaphone.fm/adchoices

On a prior podcast we talked with Todd Semla and Mike Steinman about the update to the AGS Beers Criteria of potentially inappropriate medications in older adults (Todd and Mike co-chair the AGS Beers Criteria Panel).  One of the questions that came up was - well if we should probably think twice or avoid that medication, what should we do instead? Today we talk with Todd and Mike about their new recommendations of alternative treatments to the AGS Beers Criteria, published recently in JAGS, and also presented at the 2025 AGS conference in Chicago (and available on demand online). We had a lot of fun at the start of the podcast talking about the appropriate analogy for how clinicians should use the AGS Beers Criteria.  In our last podcast, the analogy was a stop sign. You should come to a stop before you prescribe or refill a medication on the Beers list, look around at alternatives, and consider how to proceed.  You might in the end decide to proceed, as there are certainly situations in which it does make sense to start or continue a medication on the Beers list. Today's analogy had somewhat higher stakes, involving a driver, a pothole in the road, and a cyclist on the side who you'd hit if you swerved.  Really upping the anti!!! The podcast is framed around a case Eric crafted of a patient with most of the medications and conditions on the Beers list. We used this as a springboard to discuss the following issues (with links to prior GeriPal podcasts): Insomnia (Doxepin is an alternative, trazodone and melatonin are not?!?) Diabetes management  PPI for GERD Treatments for pain, including NSAIDS, COX2, and gabapentinoids Cannabis Deprescribing,org - terrific Canadian website (no tariff to use) And I hope that the prescribing landscape is indeed getting better (thanks to Kai on guitar)! -Alex Smith  

Story at-a-glance Common medications like NSAIDs, antibiotics, acid blockers, and laxatives quietly damage your kidneys, even when used as directed Kidney symptoms often show up late, so damage is underway before you feel anything, especially if you're older or taking multiple prescriptions NSAIDs reduce blood flow, antibiotics clog, or inflame kidney filters and proton pump inhibitors trigger immune reactions that harm kidney tissue Imaging contrast dyes used in CT or MRI scans sharply reduce kidney function in vulnerable people, particularly those with diabetes or dehydration Reviewing your medications regularly, leading a healthy lifestyle and using natural alternatives help reduce your kidney burden and prevent long-term harm