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

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

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

This episode is a soul-deep, no-BS conversation about healing, authenticity, and reclaiming your voice in a world that profits off your disconnection. My guest, Erin Telford, shares her powerful story trauma-healing, and societal pressure to rediscover a life of radical joy, service, and self-expression through authenticity + stepping into your power.Erin is a Breathwork facilitator and teacher trainer, a conscious business mentor for healers and coaches, and an intuitive guide. Her career began 14 years ago as an acupuncturist, Chinese herbalist and Reiki Master. She supports her clients in connecting to their intuition and innate wisdom so that they can find the answers that already exist within themselves and in expanding their consciousness through deprogramming patterns, societal conditioning, limiting beliefs, and healing core wounds. Her business mentorship supports healing professionals in liberating their true voices, expanding their impact, vision, abundance, and personal evolution.She has created Breathwork experiences for Free People, the Soul Cycle/Soul Legends retreat, In Goop Health NYC, Wanderlust Festival, and YPO. Her work has been featured in Vogue, InStyle, Shape Magazine, Nylon, and NY Magazine. She currently lives in Joshua Tree and is deeply enjoying her life.Follow Erin on Instagram www.erintelford.comIn this episode explore the messy middle—the liminal space between who you've been and who you're becoming—and how to navigate it with grace, truth, + nervous system safety. If you've ever felt the tug toward something more but don't know where to start, this conversation is the invitation you've been waiting for.We discuss…The healing power of breathworkHow authenticity feels in your body—and how to follow itLetting go of the “good girl” archetype + choosing freedom over performative healingThe role of grief and stillness in becoming your truest selfWhy your nervous system needs safety before it can allow expansionUnderstanding trauma patterns that keep you stuck (even when you're “doing the work”)Rebuilding identity after burnout, heartbreak, or lossHow acts of kindness, joy, + play can become your compass back to wholeness

A Legacy of Unaffected Living, DOMUS NYC, became an iconic landmark in Hell's Kitchen from 2002 to 2024. This beloved store Domus, translating to "home" in Latin, was located in Hell's Kitchen NYC, was founded by Luisa Cerutti and Nicki Lindheimer, who drew inspiration from their extensive travels around the globe. The shop was renowned for its quirky, artsy feel, characterized by eclectic window displays, a distinctive red doorway, and a warm, welcoming sign that invited passersby to explore its unique offerings. Before launching DOMUS, Luisa Cerutti cultivated a rich background in retail. She spent five years as a footwear buyer at the prestigious Fifth Avenue JOAN & DAVID store, and prior to that, she owned Luisa Boutique in St. Thomas, U.S. Virgin Islands, where she showcased clothing, shoes, and accessories. Luisa's also served as an area manager for the BENETTON GROUP from 1980 to 1984, further deepening her expertise in fashion retail. Fluent in English, French, Italian, and Spanish, Luisa's linguistic skills were instrumental in her global sourcing efforts. Prior to founding DOMUS with her partner Luisa Cerutti, Nicki Lindheimer built a career in retail that combined her love for art and design with an entrepreneurial spirit. She embraced an open-minded approach to merchandising, allowing her to expand the store's offerings to include arts, crafts, and whimsical gift items. Together with Luisa, she embarked on annual trips to countries such as Vietnam, Morocco, Cambodia, Myanmar, Philippines, India, South Africa, Mexico, Peru, Cuba, Colombia, Laos and Guatemala, forging relationships with artisans and championing fair trade practices, allowing them to expand their inventory beyond home goods to include arts and crafts, toys, and other playful items, making their store part art gallery, part showroom, and part gift shop. Their collection told stories of artisans from around the world, with a commitment to fair wages and sustainable practices, pathways for social change. The store's centerpiece—a massive tree adorned with unique ornaments and wind chimes—served as a metaphor for the interconnectedness of various cultures and crafts represented within their walls. DOMUS NYC earned significant accolades, winning the prestigious W42ST Award for Best Retail Store three times (2020, 2022, and 2023) and being named a runner-up in 2021. The store was also frequently featured in the popular "West Side Stories" segment and received coverage from NY Magazine, acknowledging its special place in the New York retail landscape. Matty Selman wrote a book titled "The Ornaments" a children's story inspired by Luisa and Nicki's unique and wonderful gift store tucked away on a side street in New York City, which celebrates their journey and the artisan stories behind their products and the beautiful ornaments that hung on the massive tree. Beyond their commercial endeavors, Luisa and Nicki are passionate about supporting various causes, including animal welfare, arts and culture, children's rights, civil rights, education, environmental conservation, and human rights. Their philanthropic efforts have always been integral to the DOMUS mission, reflecting their desire to contribute positively to society and empower the vulnerable. They both have been a part of Ozzie's history for 22 grateful years, leaving, through DOMUS NYC without a doubt, an indelible mark on the neighborhood, synonymous with creativity, culture, and a special kind of love for the immediate and larger community. https://www.domusnewyork.com/ order@domusnewyork.com

The latest film releases include Karate Kid: Legends, The Phoenician Scheme, Bring Her Back, and Mountainhead. Weighing in are Alison Willmore, film critic for NY Magazine and Vulture, and Tim Grierson, senior U.S. critic for Screen International and author of This Is How You Make a Movie.

This Week: Everywhere you turn nowadays we are bombarded within AI.  From commercials to websites, to our smartphones, you can't escape it. And neither can the nation's college students. A bombshell piece in NY Magazine's Intelligencer this week profiles the extent to which AI use to cheat is endemic in colleges, and the growing concerns around the ethics and potential harm to humans of AI use (also try here).  From students doing virtually no writing and relying entirely on AI, to those who use AI to outline their work and tell them how to construct their thinking, to those who actively use it to undermine efforts to prevent cheating, this is deeply concerning. Questions and concerns are being confirmed by early studies showing negative impacts on students' ability to do critical thinking, solve problems, and perform tasks more complex than simply using tools like ChatGPT to complete tasks. Manuel and Jeff discuss!WAYS TO HELP WITH THE EATON FIRE IN ALTADENA/PASADENA -- Please consider giving what you can! Here are links to GoFundMe pages set up by Altadena families, links to GoFundMe pages supporting Black families devastated by the Eaton fire, and the Pasadena Educational Foundation's page set up to benefit Manuel's school community, which has been devastated by the fire. Thanks for your support!MAXIMUM WOKENESS ALERT -- get your All of the Above swag, including your own “Teach the Truth” shirt! In this moment of relentless attacks on teaching truth in the classroom, we got you covered. https://all-of-the-above-store.creator-spring.com Passing Period is an AOTA podcast extra that gives us a chance to check-in, reflect, and discuss powerful stories in between our full episodes. Watch, listen and subscribe to make sure you don't miss our latest content!Website: https://AOTAshow.comStream all of our content at: linktr.ee/AOTA  Watch at: YouTube.com/AlloftheAboveListen at: apple.co/38QV7Bd and anchor.fm/AOTAFollow us at: Facebook.com/AOTAshow and Twitter.com/AOTAshow

On this episode of Heard Tell host Andrew shares some thoughts on the NY Magazine article "Everyone Is Cheating Their Way Through College” and uses it to talk about higher education, why we should have a healthy skepticism of AI, why the learning part of education has been lost in the credentialism, what education ought to mean, and why he signed up for community college this past week.All that and more on this episode of Heard Tell.--------------------Heard Tell SubStack Free to subscribe, comes right to your inboxhttps://heardtell.substack.com/Questions, comments, concerns, ideas, or epistles? Email us HeardTellShow@gmail.comPlease follow @HeardTellShow like the program, comment with your thoughts, and share with others.Support Heard Tell here: https://app.redcircle.com/shows/4b87f374-cace-44ea-960c-30f9bf37bcff/donationsSupport this podcast at — https://redcircle.com/heard-tell/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

After Googling “how to run for office” in the wake of the 2016 election, Mallory McMorrow took on an incumbent Republican State Senator and won, moving the seat 20 percentage points. When a right-wing state senator baselessly called her a “groomer”, she took to the floor in a now viral speech and declared "we will not let hate win.” NY Magazine called the speech “remarkable.” James Carville said it was “enormously effective.” The Atlantic wrote that it was “stunning.” After her viral speech, Mallory helped flip control of the Michigan Senate for the first time in 40 years, becoming the first woman Senate Majority Whip in state history. She has worked to strengthen unions and raise wages, eliminate the retirement tax on seniors, expand civil rights, repeal the state's 1931 abortion ban, tackle gun violence, expand affordable housing, and feed kids in schools. She recently released her first book, HATE WON'T WIN Mallory is a major Democratic rising star, and she's in THE BACK ROOM sharing insights into her new book, her campaign for Michigan's open U.S. Senate seat, and how Americans can take action to fight tyranny, hatred, bigotry and achieve real change in Washington. Don't miss this truly inspiring chat. Got somethin' to say?! Email us at BackroomAndy@gmail.com Leave us a message: 845-307-7446 Twitter: @AndyOstroy Produced by Andy Ostroy, Matty Rosenberg, and Jennifer Hammoud @ Radio Free Rhiniecliff Design by Cricket Lengyel

Fanny Allié was born in Montpellier, South of France. She received her Master's Degree from the Ecole Nationale Supérieure de la Photographie (The National School of Photography) in Arles, France in 2005 and moved to New York City. Princeton University, Equity Gallery, Hyatt Centric (Philadelphia), DOT Art, A.I.R Gallery, New York City Department of Parks & Recreation, Fresh Window, Chashama and St Eustache Church (Paris, France), Hudson Yards Alliance have organized solo exhibitions and public installations of her work. Tappan Gallery, Owen James Gallery, NYU/Gallatin Gallery, Dorsky Gallery, Freight + Volume, BRIC Rotunda Gallery, Dekalb Gallery/Pratt Institute, UConn University, Mana Contemporary, Hamburg Museum of Arts and Crafts, The Bronx Museum, Teachers College Columbia University among others have featured her work in group exhibitions. Fanny is the recipient of various fellowships and residencies including AIM (Bronx Museum), BRIC Lab Fellowship, Emergency Grant (Foundation for Contemporary Arts), A.I.R. Fellowship Program, Robert Blackburn Printmaking SIP Fellowship, Elizabeth Foundation for the Arts Studio Program, Yaddo Residency, Dieu Donné Workspace Residency, NYSCA/NYFA Artist Fellowship (Craft/Sculpture), MacDowell Fellowship, Puffin Foundation Grant, Wildacres Residency and National Arts Club Artist Fellowship. Her work has appeared in the New York Times, The Guardian, Time Out, ARTnews, NY Magazine, Brooklyn Magazine, Hyperallergic, Le Monde Diplomatique, Blouin Art Info, DNA Info, Marie Claire Italy, AM New York among others. Her neon light sculpture “The Glowing Homeless” and sound installation will be exhibited at the Church of St. Eustache in Paris from December 18th 2024 until May 31st 2025. In 2025, Kaliner Gallery in New York City and Giovanni Bonelli Gallery (Milan, Italy) will present her work in solo exhibitions. Fanny lives in Brooklyn and works from her studio at the Elizabeth Foundation for the Arts in Manhattan, NY. Exhibits discussed are KALINER and Giovanni Bonelli. A Longing, March 6 - April 12, 2025, Installation view at Kaliner Gallery, 42 Allen St, NYC Ladder Leg, 2024, found fabric, collagraph print and acrylic paint, 32.5in x 50in The Night the Wind Learned to Dance, April 24 - May 25, 2025, Installation view at Giovanni Bonelli Gallery, Milan, Italy Shelved, 2025, found fabric and collagraph prints, 59in x 38.5in Circles, 2024, found fabric and collagraph prints, 55.5in x 55.5in

The latest film releases include The Accountant 2, Until Dawn, Havoc, and On Swift Horses. Weighing in are Tim Grierson, senior U.S. Critic for Screen International and author of This Is How You Make a Movie, and Alison Willmore, film critic for NY Magazine and Vulture.

It's no secret that silence, stigma, and shame surround many of the major moments of grief and loss in women's lives, especially during pregnancy loss. Today's guest shares her personal story, along with her professional perspective as a psychologist, author, and respected voice in social media. Join us to hear the conversation. Dr. Jessica Zucker is a Los Angeles-based psychologist specializing in reproductive health, and she holds advanced degrees from NYU and Harvard. She's the author of the award-winning book, I Had A Miscarriage: A Memoir, A Movement and is the creator of the viral hashtag, I Had A Miscarriage Campaign. She has been featured on NPR, CNN, the Today Show, and Good Morning America, and her writing has appeared in the NY Times, Washington Post, NY Magazine, Vogue, Harvard Business Review, and others. Today's conversation focuses on Jessica's second book, Normalize It: Upending the Silence, Stigma, and Shame That Shape Women's Lives, newly released on April 22, 2025. Jessica shares her personal experience through miscarriage and a breast cancer diagnosis, and how her motherhood journey has been profoundly impacted by silence, stigma, and shame.  Show Highlights: Jessica's inspiration to write her most recent book, Normalize It Jessica's traumatic miscarriage experience that changed the course of her life The purpose behind Normalize It, which offers a compassionate invitation to women Our culture teaches women to have silence, stigma, and shame. If we ALL spoke our truth . . .(just imagine the possibilities!) Common platitudes minimize our pain and can alienate and isolate those who are hurting. Jessica's breast cancer experience compared to her miscarriage experience Why Jessica doesn't like the term “warrior” when referring to her resilience Living with tamoxifen, which blocks estrogen and brings early menopause symptoms What the research reveals around silence, stigma, and shame Resources: Connect with Dr. Jessica Zucker: Website, Instagram, Normalize It: Upending the Silence, Stigma, and Shame That Shape Women's Lives, and I Had A Miscarriage Call the National Maternal Mental Health Hotline at 1-833-TLC-MAMA or visit cdph.ca.gov Please find resources in English and Spanish at Postpartum Support International, or by phone/text at 1-800-944-4773. There are many free resources, like online support groups, peer mentors, a specialist provider directory, and perinatal mental health training for therapists, physicians, nurses, doulas, and anyone who wants to be more supportive in offering services.  You can also follow PSI on social media: Instagram, Facebook, and most other platforms Visit www.postpartum.net/professionals/certificate-trainings/ for information on the grief course.   Visit my website, www.wellmindperinatal.com, for more information, resources, and courses you can take today! If you are a California resident looking for a therapist in perinatal mental health, email me about openings for private pay clients! Learn more about your ad choices. Visit podcastchoices.com/adchoices

The latest film releases include The Alto Knights, Snow White, Misericordia and Ash. Weighing in are Alison Willmore, film critic for NY Magazine and Vulture, and Tim Grierson, senior U.S. critic for Screen International and author of This Is How You Make a Movie.

Episode Summary: In this episode of NRAP's PainExam Podcast, host David Rosenblum, MD, interviews Dr. Thomas Strouse about his extensive experience with Scrambler Therapy and the evidence supporting its use in treating chronic pain.   They delve into the intricacies of this innovative therapy, discussing treatment protocols, patient responses, and the overall effectiveness of Scrambler Therapy for various pain conditions.    Key Topics Discussed: - Overview of Scrambler Therapy and its analgesic response. - The importance of adjusting treatment intensity based on patient feedback. - Sensations experienced by patients during therapy (from burning to tapping). - Safety considerations for patients with pacemakers during treatment. - Insights into the effectiveness of Scrambler Therapy for conditions such as discogenic back pain and peripheral neuropathy. - Discussion on treatment costs for patients and providers. - Experiences with patients who have experienced pain recurrence after treatment. - The role of booster sessions in maintaining pain relief. -   Challenges faced by failed back surgery patients and the potential benefits of Scrambler Therapy. Resources Mentioned: -   Contact information for Stefan Erickson at  stefan@mail.scramblertherapy.com to integrate Scrambler therapy into your practice.   Links to additional resources and research on Scrambler Therapy. Info] Additional Information: - For more information about upcoming webinars, including the next session on cervical ultrasound, visit  www.NRAPpain.org   Thank you for tuning in to NRAP's PainExam Podcast! We hope you find the insights shared in this episode valuable in your journey toward understanding and managing chronic pain.   NY based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246   Creators Biography: David Rosenblum, MD, currently treats patients in Garden City and Brooklyn. He serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn , NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.    Dr. Rosenblum has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is working closely with the American Society of Interventional Pain Physicians (ASIPP), Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, and various state societies, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum is a co-founder of the International Pain Academy and created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Office based Pain Physicians, Physiatrists, Emergency Room Physicians, Anesthesiologists, Neurologists and Orthopedics who treat pain, utilize Neuromodulation and use PRP, Bone Marrow Aspirate or any other Biologics will benefit from this course. #longislandpaindoctor #interventionalpain #paindoctor #scrambler #scramblertherapy

Episode Summary: In this episode of NRAP's PainExam Podcast, host David Rosenblum, MD, interviews Dr. Thomas Strouse about his extensive experience with Scrambler Therapy and the evidence supporting its use in treating chronic pain.   They delve into the intricacies of this innovative therapy, discussing treatment protocols, patient responses, and the overall effectiveness of Scrambler Therapy for various pain conditions.    Key Topics Discussed: - Overview of Scrambler Therapy and its analgesic response. - The importance of adjusting treatment intensity based on patient feedback. - Sensations experienced by patients during therapy (from burning to tapping). - Safety considerations for patients with pacemakers during treatment. - Insights into the effectiveness of Scrambler Therapy for conditions such as discogenic back pain and peripheral neuropathy. - Discussion on treatment costs for patients and providers. - Experiences with patients who have experienced pain recurrence after treatment. - The role of booster sessions in maintaining pain relief. -   Challenges faced by failed back surgery patients and the potential benefits of Scrambler Therapy. Resources Mentioned: -   Contact information for Stefan Erickson at  stefan@mail.scramblertherapy.com to integrate Scrambler therapy into your practice.   Links to additional resources and research on Scrambler Therapy. Info] Additional Information: - For more information about upcoming webinars, including the next session on cervical ultrasound, visit  www.NRAPpain.org   Thank you for tuning in to NRAP's PainExam Podcast! We hope you find the insights shared in this episode valuable in your journey toward understanding and managing chronic pain.   NY based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246   Creators Biography: David Rosenblum, MD, currently treats patients in Garden City and Brooklyn. He serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn , NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.    Dr. Rosenblum has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is working closely with the American Society of Interventional Pain Physicians (ASIPP), Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, and various state societies, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum is a co-founder of the International Pain Academy and created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Office based Pain Physicians, Physiatrists, Emergency Room Physicians, Anesthesiologists, Neurologists and Orthopedics who treat pain, utilize Neuromodulation and use PRP, Bone Marrow Aspirate or any other Biologics will benefit from this course. #longislandpaindoctor #interventionalpain #paindoctor #scrambler #scramblertherapy

Episode Summary: In this episode of NRAP's PainExam Podcast, host David Rosenblum, MD, interviews Dr. Thomas Strouse about his extensive experience with Scrambler Therapy and the evidence supporting its use in treating chronic pain.   They delve into the intricacies of this innovative therapy, discussing treatment protocols, patient responses, and the overall effectiveness of Scrambler Therapy for various pain conditions.    Key Topics Discussed: - Overview of Scrambler Therapy and its analgesic response. - The importance of adjusting treatment intensity based on patient feedback. - Sensations experienced by patients during therapy (from burning to tapping). - Safety considerations for patients with pacemakers during treatment. - Insights into the effectiveness of Scrambler Therapy for conditions such as discogenic back pain and peripheral neuropathy. - Discussion on treatment costs for patients and providers. - Experiences with patients who have experienced pain recurrence after treatment. - The role of booster sessions in maintaining pain relief. -   Challenges faced by failed back surgery patients and the potential benefits of Scrambler Therapy. Resources Mentioned: -   Contact information for Stefan Erickson at  stefan@mail.scramblertherapy.com to integrate Scrambler therapy into your practice.   Links to additional resources and research on Scrambler Therapy. Info] Additional Information: - For more information about upcoming webinars, including the next session on cervical ultrasound, visit  www.NRAPpain.org   Thank you for tuning in to NRAP's PainExam Podcast! We hope you find the insights shared in this episode valuable in your journey toward understanding and managing chronic pain.   NY based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education. Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246   Creators Biography: David Rosenblum, MD, currently treats patients in Garden City and Brooklyn. He serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn , NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.    Dr. Rosenblum has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is working closely with the American Society of Interventional Pain Physicians (ASIPP), Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, and various state societies, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum is a co-founder of the International Pain Academy and created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Office based Pain Physicians, Physiatrists, Emergency Room Physicians, Anesthesiologists, Neurologists and Orthopedics who treat pain, utilize Neuromodulation and use PRP, Bone Marrow Aspirate or any other Biologics will benefit from this course. #longislandpaindoctor #interventionalpain #paindoctor #scrambler #scramblertherapy

The media outlets like CNN, MSNBC, NBC can't keep up with how fast President Trump moves. Donald Trump will be going to the Super Bowl this upcoming Sunday. USA Today slams Trump for being a divisive man. NY Magazine is getting sued by the organizer of a conservative event, for lying about a cover story they wrote about a celebration, that they claimed was racist. 60 Minutes is getting sued by Trump.

Donald Trump will be going to the Super Bowl this upcoming Sunday. USA Today slams Trump for being a divisive man. NY Magazine is getting sued by the organizer of a conservative event, for lying about a cover story they wrote about a celebration, that they claimed was racist. 60 Minutes is getting sued by Trump. Mark Interviews Commentator Liz Peek. Mark and Liz talk about how getting rid of federal aid for certain programs will be beneficial for Americans wallet. Elon Musk is making moves to pay down the government's debt. Liz thinks Trump's plan to help Gaza will work.

President Trump unveils the idea of The United States going into Gaza and rebuilding it. Border czar Tom Homan said that he would prosecute New Jersey Governor Phil Murphy, if he keeps the illegal migrant he allegedly has living at his home. Mark Interviews Roger Friedman from Showbiz 411. Grammy's ratings we're down 9 percent this year. The event lasted 4 hours. The music industry was different 35 years ago on the volume of albums made. The media outlets like CNN, MSNBC, NBC can't keep up with how fast President Trump moves. Donald Trump will be going to the Super Bowl this upcoming Sunday. USA Today slams Trump for being a divisive man. NY Magazine is getting sued by the organizer of a conservative event, for lying about a cover story they wrote about a celebration, that they claimed was racist. 60 Minutes is getting sued by Trump.  Mark Interviews Commentator Liz Peek. Mark and Liz talk about how getting rid of federal aid for certain programs will be beneficial for Americans wallet. Elon Musk is making moves to pay down the government's debt. Liz thinks Trump's plan to help Gaza will work. 

Tonight's rundown:  Hey BillOReilly.com Premium and Concierge Members, welcome to the No Spin News for Wednesday, January 29, 2025. Stand Up for Your Country.  Talking Points Memo: As Robert F. Kennedy Jr.'s confirmation process begins, Bill takes a look at the main controversies surrounding him. An update on the Trump administration's latest executive orders, including plans to freeze federal aid and a transgender military ban. Author Tyler O'Neil joins the No Spin News to discuss Joe Biden, dark money and how it has played a role promoting progressive policies like gender ideology. Why New York Magazine is being exposed for its latest cover photo. This Day in History: Edgar Allan Poe's poem The Raven is first published. Final Thought: Seeking political revenge. In Case You Missed It: Read Bill's latest column, Follow the Money For a limited time, get Bill O'Reilly's bestselling The United States of Trump and a No Spin Mug for only $39.95. Get Bill's latest book, CONFRONTING THE PRESIDENTS, out NOW! Now's the time to get a Premium or Concierge Membership to BillOReilly.com, the only place for honest news analysis. Learn more about your ad choices. Visit megaphone.fm/adchoices

Newsom crashes Trumps Cali arrival and gets greeted like family...even gets a Melania kiss. Trump finds his testicles just in time for presser with Mayor Bass. Conspiracy theorists anxiously await the JFK, RFK and MLK files. Change is in the air at CNN. NY Magazine goes for cheap fake with cruel kids. Confessions from a former Politico reporter. The drones were ours and we knew it all along. JD schools Margaret Brennan at CBS. Zig gets back in the ring with the Superintendent and Diana Ziegler own the libs.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-death-of-journalism--5691723/support.

It's only the 10th day of the glorious Trump presidency and already the nation and the world have irrevocably changed. In this episode, I talk about the dramatic impact of President Trump's executive orders on illegal immigration and how Trump's policies are shaking up the political landscape, with even prominent Democrats like James Carville acknowledging that illegal immigration should be punished, not celebrated. Find out how Trump's actions are effectively dismantling the Democrat power and even has the clueless legacy media unknowingly and inadvertently working to destroy the left as well. -- Go to http://patriotmobile.com/turleytalks or call 972-PATRIOT for your FREE MONTH of service today *The content presented by sponsors may contain affiliate links. When you click and shop the links, Turley Talks may receive a small commission.*   Join my new Courageous Conservative Club and get equipped to fight back and restore foundational values. Learn more at http://fight.turleytalks.com/join  Highlights: “Carville is the heart and soul of the Democrat Party. He's the godfather of the Clinton era and even hE is saying that the Democrats completely blew it on illegal immigration.” “The legacy media, in going full woke over these raids and mass deportations, is only guaranteeing Trump's rise in popularity.” Timestamps: [00:21] The latest on Trump's illegal immigration policy [05:34] Legacy media's lies about the border crisis and NY Magazine's latest deceptive article [09:43] Mass deportations surging while the Democrats are imploding -- Thank you for taking the time to listen to this episode.  If you enjoyed this episode, please subscribe and/or leave a review. FOLLOW me on X (Twitter): https://twitter.com/DrTurleyTalks Sign up for the 'New Conservative Age Rising' Email Alerts to get lots of articles on conservative trends: https://turleytalks.com/subscribe-to-our-newsletter **The use of any copyrighted material in this video is done so for educational and informational purposes only including parody, commentary, and criticism. See Hosseinzadeh v. Klein, 276 F.Supp.3d 34 (S.D.N.Y. 2017); Equals Three, LLC v. Jukin Media, Inc., 139 F. Supp. 3d 1094 (C.D. Cal. 2015). It is believed that this constitutes a "fair use" of any such copyrighted material as provided for in section 107 of the US Copyright Law.

TRENDING - New York Magazine cropped black people out of their cover photo and claimed lack of diversity at Trump inauguration party, CNN's Jim Acosta quits with a message to Trump, Vegas ice cream truck mistaken for ICE truck, TGH patient ate so much fat cholesterol oozed from his hands.

Tara and Tony get you some. Indiana ‘Whippets’ ban. NY Magazine calls young Trumpers “casually cruel”. Selena Gomez is triggered by deportation of criminal illegal aliens. White Castle Crocks for sale.KY Gov Andy Beshear believes that health care is a “human right”See omnystudio.com/listener for privacy information.

Leftists crying over the deportation of illegal immigrants. Trump has 2 years to get things done. Iron Dome for the US? CDC not working with WHO. Lawmakers float meal delivery fee as part of road funding package. Left is triggered by the deportations. Tara and Tony get you some. Indiana ‘Whippets’ ban. NY Magazine calls young Trumpers “casually cruel”. Selena Gomez is triggered by deportation of criminal illegal aliens. White Castle Crocks for sale. KY Gov Andy Beshear believes that health care is a “human right”. Hamilton County introduces new Immigration Commission to ‘advance public safety’. New York Magazine crop the following photo to sew racial division. Deepseek should not be allowed to operate in the United States. Gavin Newsom career is not sunk because of the fires, it’s sunk because he’s white. RFK Jr should not get confirmedSee omnystudio.com/listener for privacy information.

Pod Crashing episode 356 with Steve Fishman from the podcasts The Burden. Detective Louis N. Scarcella was a legendary figure in New York City during the '90s. In a city overrun with violent crime, he cracked the toughest cases and put away the worst criminals. But the story changed when a group of convicted murderers-turned-jailhouse lawyers made a startling discovery that linked all their cases: Scarcella was the cop who helped put many of them away. They made a vow: Take down Scarcella. And with the help of a relentless New York Times reporter, they did just that. Thirty years later, 20 people who Scarcella helped put behind bars have since walked free. In the media, he's known as the disgraced, rogue cop who hoodwinked an entire system. But was this really the workings of one person?   "We spent hundreds of hours talking with witnesses who were coerced, jailhouse lawyers, outraged attorneys, and righteous cops. Scarcella insists he didn't do anything wrong. And after finally tracking him down, he agreed to take us into the belly of the beast... where justice is done (and undone)."   Episodes here:   https://www.iheart.com/podcast/1119-the-burden-157314804/   

Pod Crashing episode 356 with Steve Fishman from the podcasts The Burden. Detective Louis N. Scarcella was a legendary figure in New York City during the '90s. In a city overrun with violent crime, he cracked the toughest cases and put away the worst criminals. But the story changed when a group of convicted murderers-turned-jailhouse lawyers made a startling discovery that linked all their cases: Scarcella was the cop who helped put many of them away. They made a vow: Take down Scarcella. And with the help of a relentless New York Times reporter, they did just that. Thirty years later, 20 people who Scarcella helped put behind bars have since walked free. In the media, he's known as the disgraced, rogue cop who hoodwinked an entire system. But was this really the workings of one person?   "We spent hundreds of hours talking with witnesses who were coerced, jailhouse lawyers, outraged attorneys, and righteous cops. Scarcella insists he didn't do anything wrong. And after finally tracking him down, he agreed to take us into the belly of the beast... where justice is done (and undone)."   Episodes here:   https://www.iheart.com/podcast/1119-the-burden-157314804/   Become a supporter of this podcast: https://www.spreaker.com/podcast/arroe-collins-unplugged-totally-uncut--994165/support.

Susan Shapiro is the author of The Forgiveness Tour: How To Find the Perfect Apology. She's an award-winning writer and professor, freelances for the NY Times, Washington Post, WSJ, LA Times, NY Magazine, Salon, Elle, Oprah, Wired & New Yorker online. She's the bestselling author/coauthor of 18 books her family hates like Five Men Who Broke My Heart, Lighting Up, Unhooked, The Bosnia List and her recent memoir The Forgiveness Tour. She lives with her scriptwriter husband in Manhattan and uses her writing/publishing guides The Book Bible and Byline Bible to teach her wildly popular "instant gratification takes too long" courses at The New School, NYU, Columbia University and in private classes & seminars - now online. Help Zak continue making this show by becoming a Best Advice Show Patron @ https://www.patreon.com/bestadviceshow---Call Zak on the advice show hotline @ 844-935-BEST---Share this episode on IG @BestAdviceShow

Federal Prosecutors, lead by special counsel Jack Smith, put forth their most extensive case to date against former President Trump and his effort to overturn the 2020 election. It was unsealed in court yesterday. Michael welcomes CNN Senior Legal Analyst Elie Honig for a conversation on his unbelievable take on this bombshell report - Michael is hearing from Ellie, a perspective that not being offered anywhere else, which he has published today in New York Magazine. Listen to this conversation now. Honig is a former state and federal prosecutor. Original air date 3 October 2024.

In this edition of Trendsformers Uno, Jack and Miles discuss their respective weekends, RFK Jr. bragging about getting nudes from a NY Magazine reporter, Trump unveiling a $100 silver coin with his face on it, Georgia's election board requiring ballots to be hand counted, Beetlejuice Beetlejuice being boffo at the box office and much more!See omnystudio.com/listener for privacy information.

Kamala Harris gives the same answers for every interview she does, including Oprah's interview she did yesterday. New York's Magazine's reporter Olivia Nuzzi's is on leave for an alleged relationship with RFK Jr. NY Magazine is biased against the right's redirect.

Kamala Harris gives the same answers for every interview she does, including Oprah's interview she did yesterday. New York's Magazine's reporter Olivia Nuzzi's is on leave for an alleged relationship with RFK Jr. NY Magazine is biased against the right's redirect. Mark Takes Your Calls! Mark Interviews Radio Host Howie Carr. Mark and Howie spoke about RFK Jr's possible thinking behind his alleged affair with a NY media reporter. Howie and Mark both broke down how every interview Kamala does, doesn't help boost her election chances.

The Burden: Empire on Blood - the Director's cut of the true crime classic Empire on Blood which reached #1 on the overall charts when it was released half a dozen years ago - has now launched on The Burden feed. This 7 episode limited series (plus 3 brand new bonus episodes!) features never-before-heard tape and new interviews with characters who've gone on to riches, to freedom and to infamy. The Burden: Empire on Blood is set In the Bronx in the early 90s when two young drug dealers ruled an intersection known as “The Corner on Blood.” The boss, Calvin Buari, lived large, wearing mink, drinking champagne, stacking bills. He and a protege swore they would build an empire on blood. Then the relationship frayed, dead bodies piled up, and the protege accused Calvin, the boss, of a double homicide, which he claimed he didn't do. But did he? Witnesses came forward. A prosecutor, who went by Turtle Man, swore Calvin was the culprit. Father Frank, the detective who got the impossible-to-get confessions, gathered evidence. Meanwhile, Calvin put his faith in a legendary 85-year-old attorney on his death bed, and a born-again preacher who carried a gun and a Bible and who promised to find the mysterious Evilina – she supposedly saw it all go down twenty years ago. Host and journalist Steve Fishman (recently of #1 ranked My Friend The Serial Killer) spent seven years untangling this dark intrigue and is available to talk about the show, new information they uncovered about those involved and NYC (especially the Bronx) in the 90s.Listeners can follow The Burden: Empire on Blood on The Burden feed, as well as all major podcast platforms, including Apple Podcasts and Spotify. Become a supporter of this podcast: https://www.spreaker.com/podcast/arroe-collins-like-it-s-live--4113802/support.

Who really controls our plate? Tune in as we explore the intersection of food science, politics, and economics with Brett Casper, author of The Political Gut: Reset Your Reality: Quantum Nutrients, Two Brains, Upside-Down Diets. Moments with Marianne airs in the Southern California area on KMET1490AM & 98.1 FM, an ABC Talk News Radio affiliate! Brett Casper is a food expert and recognized internationally as a ‘pioneer' in the kombucha industry. He founded award winning wellness brand Pure Luck® and opened NYC's first kombucha café, all before gut health became a buzzword. He has been profiled on 3 continents and received accolades from Food & Wine, NY Magazine, Vogue and ELLE. While notably collaborating with Michelin Starred chefs, FENDI, Fresh®, Brooklyn Brewery, Porsche and Six Senses Resorts. https://thepoliticalgut.com  For more show information visit: www.MariannePestana.com#book #speaker #radioshow #MomentsWithMarianne #guthealth #BrettCasper #ThePoliticalGut #healing #food #foodscience #wellness #wellbeing #diet #diets #nutrients #guthealth  

Title: Part 2 - Israel & Palestine Description:  While the military battles rage overseas, the verbal battles have been raging all over social media, across college campuses, and maybe even in your own home. NY Magazine called the war in Gaza “THE defining moral issue of our time”. Join us as Pastor Steve Garcia continues with part 2 of a four part series where we address the most controversial topics of the day through a biblical lens. In this  message we are discussing an extremely tense issue that has been on the forefront especially with Gen Z, which is the war in Israel on the Gaza strip. - NEXT STEPS  Looking to take your next step?  We want to help! Text the word NEXT to 909-281-7797 or visit sunrisechurch.org/nextsteps. - GIVE TO SUNRISE CHURCH Imagine what God can do through our giving. You can give today at sunrisechurch.org/give  - FOLLOW US ON SOCIAL MEDIA Facebook: https://www.facebook.com/SunriseChurchCA  Instagram: https://www.instagram.com/sunrisechurchca  Youtube: https://www.youtube.com/SunriseChurch 

In today's episode:In 2020, claims of election interference made by DNI Ratcliffe were said by Democrats to be election interferenceRegime media seeds the notion that if comms, power, and banking go down in the US or Europe, it's because mean ol' Russia cut some undersea cablesThe government's involvement in censorship is undeniable, even in the courts nowDonald Trump's sentencing is delayed in Law & Order: New York - The Loudest Hush MoneyCourts decide on RFK Jr's behalf that his name must be removed from ballots in Michigan and North CarolinaNY Magazine suggests that Texas abortion 'extremism' will flip Ted Cruz's senate seat blue and definitely not election fraudCNN muses that Nebraska's 'blue dot' will defeat TrumpTrump being declared the winner by the TV and a 'split ticket' down-ballot has entered the conversation.Connect with Be Reasonable: https://linktr.ee/imyourmoderatorHear the show when it's released. Become a paid subscriber at imyourmoderator.substack.comVisit the show's sponsors:Diversify your assets into Bitcoin: https://partner.river.com/reasonableDiversify your assets into precious metals: reasonablegold.comOther ways to support the work:ko-fi.com/imyourmoderatorDonate btc via coinbase: 3MEh9J5sRvMfkWd4EWczrFr1iP3DBMcKk5Make life more comfortable: mypillow.com/reasonableMerch site: https://cancelcouture.com or https://riseattireusa.com/intl/cancelcouture/Follow the podcast info stream: t.me/veryreasonableOther social platforms: Truth Social, Gab, Rumble, or Gettr - @imyourmoderator Become a member at https://plus.acast.com/s/be-reasonable-with-your-moderator-chris-paul. Hosted on Acast. See acast.com/privacy for more information.

In today's episode:In 2020, claims of election interference made by DNI Ratcliffe were said by Democrats to be election interferenceRegime media seeds the notion that if comms, power, and banking go down in the US or Europe, it's because mean ol' Russia cut some undersea cablesThe government's involvement in censorship is undeniable, even in the courts nowDonald Trump's sentencing is delayed in Law & Order: New York - The Loudest Hush MoneyCourts decide on RFK Jr's behalf that his name must be removed from ballots in Michigan and North CarolinaNY Magazine suggests that Texas abortion 'extremism' will flip Ted Cruz's senate seat blue and definitely not election fraudCNN muses that Nebraska's 'blue dot' will defeat TrumpTrump being declared the winner by the TV and a 'split ticket' down-ballot has entered the conversation.Connect with Be Reasonable: https://linktr.ee/imyourmoderatorHear the show when it's released. Become a paid subscriber at imyourmoderator.substack.comVisit the show's sponsors:Diversify your assets into Bitcoin: https://partner.river.com/reasonableDiversify your assets into precious metals: reasonablegold.comOther ways to support the work:ko-fi.com/imyourmoderatorDonate btc via coinbase: 3MEh9J5sRvMfkWd4EWczrFr1iP3DBMcKk5Make life more comfortable: mypillow.com/reasonableMerch site: https://cancelcouture.com or https://riseattireusa.com/intl/cancelcouture/Follow the podcast info stream: t.me/veryreasonableOther social platforms: Truth Social, Gab, Rumble, or Gettr - @imyourmoderator Become a member at https://plus.acast.com/s/be-reasonable-with-your-moderator-chris-paul. Hosted on Acast. See acast.com/privacy for more information.

Today the Chicks chat about the weird "white women for Kamala" efforts, Biden's big plans to destroy the Supreme Court before he leaves office, and the absurd cover of New York Magazine that has Kamala sitting on a giant coconut. Visit http://fogchicks.com and use promo code CHICKS to save 15% off your order plus Free Rush Shipping.Find out how fast they can help you get out of debt with ZERO DEBT USA. Visit https://zapmydebt.com

Today the Chicks chat about the weird “white women for Kamala” efforts, Biden’s big plans to destroy the Supreme Court before he leaves office, and the absurd cover of New York Magazine that has Kamala sitting on a giant coconut.

Should you forgive? How and under what circumstances? A deeply moving memoir by Susan Shapiro, a gifted, award-winning writer and professor, explores the nuanced topic of forgiveness in her book, The Forgiveness Tour: How to Find the Perfect Apology, which comes out in paperback on July 23. "[W]hat if the person who hurt you most refuses to apologize or express any regret? That's the question haunting Manhattan journalist Susan Shapiro when her trusted advisor of fifteen years repeatedly lies to her. Stunned by the betrayal, she can barely eat or sleep. She's always seen herself as big-hearted and benevolent, someone who will forgive anyone anything --as long as they're remorseful.... In her entrancing, heartfelt new memoir The Forgiveness Tour: How to Find the Perfect Apology, Shapiro wrestles with how to exonerate someone who can't cough up a measly "my bad" or mumble "mea culpa." Seeking wisdom, she explores the billion-dollar forgiveness industry touting the personal benefits of absolution, where the only choice on every channel is: radical forgiveness. She fears it's all bullshit. Desperate for enlightenment, she surveys her old rabbis, as well as religious leaders from every denomination. Unable to reconcile all the confusing abstractions, she embarks on a cross-country journey where she interviews people who suffered unforgivable wrongs that were never atoned: victims of genocides, sexual assault, infidelity, cruelty and racism. A Holocaust survivor in D.C. admits he's thrived from spite. A Michigan man meets with the drunk driver who killed his wife and children. A daughter in Seattle grapples with her mother--who stayed married to the father who raped her. Knowing their estrangement isn't her fault, a Florida mom spends eight years apologizing to her son anyway--with surprising results. Does love mean forever having to say you're sorry? Critics praised Shapiro's previous memoir Lighting Up: How I Stopped Smoking, Drinking and Everything Else I Loved in Life Except Sex as fiercely honest, fascinating, funny and "a mind-bendingly good read." Now the bestselling author and popular writing professor returns with a darker, wiser follow-up, addressing the universal enigma of blind forgiving. Shapiro's brilliant new gurus sooth her broken psyche and answer her burning mystery: How can you forgive someone without an apology? Does she? Should you?" In this episode, Susan talks about what she learned about forgiveness, some of her previous provocative books, tips for people who want to get published, and a few life lessons that have helped her along the way. A few reviews of her latest book: "Enlightening and universally relevant, the book shows us how to forgive even when it might be impossible to forget."-Kirkus "Susan Shapiro mixes memoir, religion, psychology and journalism to tell amazing stories of forgiveness. The tales, ranging from uplifting to unsettling, are always riveting."-A.J. Jacobs, bestselling author of The Year of Living Biblically and It's All Relative Susan freelances for The New York Times, The Washington Post, WSJ, LA Times, NY Magazine, Salon, Elle, Oprah, Wired & New Yorker online. She's the bestselling author/coauthor of 18 books her family hates, like Five Men Who Broke My Heart, Lighting Up, Unhooked, The Bosnia List and her recent memoir The Forgiveness Tour. She lives with her scriptwriter husband in Manhattan and uses her writing/publishing guides The Book Bible and Byline Bible to teach her wildly popular "instant gratification takes too long" courses. She taught for 25 years at The New School, NYU, and Columbia University and now teaches primarily online in private classes & seminars, as well as in the MFA programs in the schools mentioned. For more information and to follow Susan: https://susanshapiro.net/index.html  https://www.facebook.com/susanshapironet https://www.instagram.com/profsue123/ https://twitter.com/Susanshapironet https://www.linkedin.com/in/susan-shapiro-9171755/   --- Support this podcast: https://podcasters.spotify.com/pod/show/maria-leonard-olsen/support

Jeffrey Epstein and Harvey Weinstein were part of a group that attempted to by New York Magazine in the early 2000s. Why was Jeffrey Epstein so interested in buying a tabloid magazine? What purpose would owning such an outlet serve? Let's dive in and take a look. (commercial at 10:21)to contact me:bobbycapucci@protonmail.comsource:https://www.businessinsider.com/jeffrey-epstein-media-connections-weinstein-career-2019-7Become a supporter of this podcast: https://www.spreaker.com/podcast/the-epstein-chronicles--5003294/support.

This week is the second half of my conversation with secondhand-fashion-obsessed writer Erika Veurink. She's written everywhere from NY Magazine to Vogue to WSJ, and currently writes the newsletter Long Live. She grew up in Iowa, has lived in NYC for nearly a decade, and recently visited LA so we spoke about how places become part of our identities.In Part 2, she shares how she met her husband and offers advice on romantic relationships. And of course, personal style, including her go-to outfit. We talk more about her Substack publication, where she covers everything from her advice on scoring vintage gems on Ebay to to body image. I even get an exclusive when I ask if she'd write a Substack on her favorite athletic shorts recs and she shares a few. If you missed Part 1 last week, we covered spirituality and rest and spoke about writing at length, including her love for the personal essay and how she structures her daily writing practice. Let us know if you listen! Show Notes:- Find Erika on Instagram | Web | Substack (Long Live)- Find me on IG: @letitouttt + @katiedalebout | Substack- A couple spots left in the Creative Clinic: book a call with me here- Check out the Let It Out Kits | Write Kit | Talk Kit Waitlist- More on Creative Underdogs/In Process here | waitlist If you liked this episode, try out from the archive:Episode 380: Spoonful of Sugar: Roam Vintage Founder Natasha Zoë Garrett on Finding Purpose and Flow, Role Models, Sobriety and More (Part 2 of 2)

This week is the first half of my conversation with secondhand-fashion-obsessed writer Erika Veurink. She's written everywhere from NY Magazine to Vogue to WSJ, and currently writes the newsletter Long Live. She grew up in Iowa, has lived in NYC for nearly a decade, and recently visited LA so we spoke about how places become part of our identities.In Part 1, she shares how her religious upbringing led to her work ethic and ability to maintain multiple projects and jobs, but also impacted her thoughts on spirituality and rest. We cover writing at length including: her love of the personal essay and why publications are no longer running them, and where she sees the future of that style and media in general. She shares the best writing advice she's been given and breaks down exactly how she structures her daily writing practice. We cover her Substack publication, where she covers everything from her advice on scoring vintage gems on Ebay to to body image.Next week in Part 2, we cover how she met her husband and advice on romantic relationships. And of course, personal style, including her go-to outfit. I even get an exclusive when I ask if she'd write a Substack on her favorite athletic shorts recs and she shares a few.  Show Notes:- Find Erika on Instagram | Web | Substack (Long Live)- Find me on IG: @letitouttt + @katiedalebout | Substack- A couple spots left in the Creative Clinic: book a call with me here- Check out the Let It Out Kits | Write Kit | Talk Kit Waitlist- More on Creative Underdogs/In Process here | waitlist If you liked this episode, try out from the archive:Episode 379: Spoonful of Sugar: Roam Vintage Founder Natasha Zoë Garrett on Finding the Good Within the Challenging, Non-Attachment, Modeling, Mental Health and More (Part 1 of 2)

In the 5 AM Hour: Larry O'Connor and Julie Gunlock discussed:  NY MAG: How Did Republican Women End Up Like This? The baffling, contradictory demands of being female in the party of Donald Trump. ‘Squad' Rep. Cori Bush claimed she miraculously healed woman with tumors in bizarre resurfaced TV interview ‘Cheapfakes': White House blasts clips purporting to show Biden's decline Where to find more about WMAL's morning show:  Follow the Show Podcasts on Apple podcasts, Audible and Spotify. Follow WMAL's "O'Connor and Company" on X: @WMALDC, @LarryOConnor,  @Jgunlock,  @patricepinkfile and @heatherhunterdc.  Facebook: WMALDC and Larry O'Connor Instagram: WMALDC Show Website: https://www.wmal.com/oconnor-company/ How to listen live weekdays from 5 to 9 AM: https://www.wmal.com/listenlive/ Episode: Tuesday, June 18, 2024 / 5 AM Hour  O'Connor and Company is proudly presented by Veritas AcademySee omnystudio.com/listener for privacy information.

This is an unlocked bonus episode! Find it and more on our patreon! -------- This week, Hussein and Phoebe are joined by tech writer John Herrman to discuss his recent article in NY Magazine's Intelligencer about the 'Pussy in bio' bots. We all know them, we've all seen them. John takes us through the history of spam bots, and helps us place this most modern expression of them into context of online scams. Read John's article here!  -------- PALESTINE AID LINKS As the humanitarian crisis continues to unfold in Gaza, we encourage anyone who can to donate to Medical Aid for Palestinians. You can donate using the links below. Please also donate to the gofundmes of people trying to escape Rafah, or purchase ESIMs. These links are for if you need a well-respected name attached to a fund to feel comfortable sending money. https://www.map.org.uk/donate/donate https://www.savethechildren.org.uk/how-you-can-help/emergencies/gaza-israel-conflict -------- PHOEBE ALERT Can't get enough Phoebe? Check out her Substack Here! -------- This show is supported by Patreon. Sign up for as little as $5 a month to gain access to a new bonus episode every week, and our entire backlog of bonus episodes! Thats https://www.patreon.com/10kpostspodcast -------- Ten Thousand Posts is a show about how everything is posting. It's hosted by Hussein (@HKesvani), Phoebe (@PRHRoy) and produced by Devon (@Devon_onEarth).

Jeffrey Epstein and Harvey Weinstein were part of a group that attempted to by New York Magazine in the early 2000s. Why was Jeffrey Epstein so interested in buying a tabloid magazine? What purpose would owning such an outlet serve? Let's dive in and take a look. (commercial at 9:13)to contact me:bobbycapucci@protonmail.comsource:https://www.businessinsider.com/jeffrey-epstein-media-connections-weinstein-career-2019-7

In today's episode, Kate and Emma chat about the Andrew Huberman article in NY Magazine — touching on what his mistreatment of women and character revealed in the piece mean about the integrity of his podcast Huberman Lab and the health + wellness advice he preaches on the show. Other topics include the credibility and purpose of Reiki healing and why all the TikTok girlies are taking colostrum. Kate Glavan — instagram.com/kateglavan/ Emma Roepke — instagram.com/emma.roepke/ Sea Moss Girlies — instagram.com/seamossgirlies/ Sea Moss Girlies TikTok — tiktok.com/@seamossgirlies Sea Moss Girlies App on Geneva —https://bit.ly/3N2rPUu Head to athleticgreens.com/SEAMOSS to get a FREE 1 year supply of immune-supporting Vitamin D AND 5 FREE travel packs with your first purchase. Head to unifydhealing.com/seamoss to check out UNIFYD Healing. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Today on Sense of Sound Podcast we have Joan Carra. She is a fully vetted psychic and medium who offers a variety of divinations. She is one of the few readers who uses a regular deck of playing cards, actually only half a deck. Her interpretations are less abstract and symbolic than a Tarot reader and are highly intuitive. She glances at your palm- the map of your brain and does numerology to help you know timing for events and themes in your life. As a sought after medium, she will can offer messages from loved ones who have passed. Joan grew up in a metaphysical family; psychic phenomena was natural and not supernatural and she has been practicing for 30 years. Joan's spiritual counseling is recognized in seven books including the first edition of The 100 Top Psychics in America, Interdimensional Universe and The Rational Psychic.  She is a contributing writer for the new book series Harmony in Chakras and will have articles in Volume I-III. She has been interviewed in WAG Magazine, The Wall St. Journal. NY Magazine and The Daily News, in which she predicted the flooding of NYC – Hurricane Sandy and in 2000 predicted on channel 11 television news that Hillary Clinton would not be America's first woman president.  She taught at Lily Dale Assembly, A.R.E. –Edgar  Cayce Center NYC, and many other venues. Contact Joan at www.psychicjoancarra.net

Dr. Rani is one of two ophthalmologists in the country who is also certified in functional medicine. How does this change how she approaches eye health? Dr. Rani is able to diagnose up to 200 conditions from your eyes – things like MS and diabetes, but also Lupus, and Lyme Disease. We discuss glaucoma, cataracts, macular degeneration, and more. This is a fascinating conversation. If you want to learn how to care for your eyes as you age and what supplements and foods to prioritize, this is the episode for you. For example, did you know you should get an eye exam every year after the age of 40? Learn more now! Visit https://thegoodlifecoach.com/298 for show notes and links mentioned. Join The Newsletter + Receive Your Free List of 52 Selfcare Tips Connect with Michele on Instagram RESOURCES MENTIONED Dr. Rani Banik's website: www.drranibanik.com Instagram: https://www.instagram.com/dr.ranibanik/ YouTube: https://www.youtube.com/channel/UC8mIi8P9tXSRXXwEdNX6aRw Book: Beyond Carrots: Best Foods For Eye Health A to Z Dr. Rani's Visionary Kitchen (Beyond Carrots) If you enjoyed this interview, please take a moment to rate and review it on Apple podcasts. Your reviews are so appreciated! Not sure how to do it? Instructions are below. XO, Michele Rate + Review: 1. Click on this link 2. Click “View in Apple Podcasts” button 3. Make sure to “Follow” 4. Scroll down until you see “Ratings and Reviews” as shown below. ABOUT OUR GUEST Dr. Rudrani (Rani) Banik is a board-certified neuro-ophthalmologist. She completed her MD at Brown University, residency at UC Irvine, and fellowship at Wilmer Eye Institute. Dr. Banik runs a private practice based in NYC and is Associate Professor of Ophthalmology at Mount Sinai.Dr. Banik is also certified in Integrative and Functional Medicine. She focuses on the root cause of eye diseases, and uses strategies based on nutrition, botanicals, lifestyle modification, and supplements.Dr. Banik is often featured as an expert in the media. She has been voted Castle Connolly Top Doctor and NY Magazine's Best Doctor in Ophthalmology annually since 2017.Dr. Banik is the author of two best-selling books,“Beyond Carrots – Best Foods For Eye Health A to Z' and “Dr. Rani's Visionary Kitchen.”

The economy is soaring. Stocks are at all time highs. Inflation has been tamed. Yet young people are angry and anxious. This episode isn't about “OK Boomer” inter-generational warfare — it's about trying to understand the angst driven by economic inequality, the blowback from the “attention economy” and social media-induced loneliness. [Episode 36]  Kyla Scanlon is a financial commentator and author. Her work has been featured in the NY Times, NY Magazine and Bloomberg Opinion. Her book, In this Economy? How Money and Markets Really Work comes out in April 2024. Learn more about Kyla: • Subscribe to Kyla's Newsletter • Kyla's Website • Read Kyla's book: In This Economy?: How Money & Markets Really Work • Connect with Kyla on X/Twitter, TikTok & Instagram • Kyla's YouTube channel —- JOIN OUR GROUP COACHING COHORTS: Are you looking to ask deep, introspective and provocative questions about your own life (with Khe and likeminded peers) ⁠⁠⁠⁠⁠Apply today⁠⁠⁠⁠⁠ —- BECOME A RADREADER: