Podcasts about obstructive

In this special episode on Obstructive Sleep Apnea our host, Dr. Neil Skolnik will discuss an overview of OSA. In Part 2 we will take a deep dive into diagnosis, Part 3 will discuss treatment options, and Part 4 will look at cases. This special episode is supported by an independent educational grant from Lilly. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Paul Doghramji, MD – Medical Director of Health Services at Ursinus College, Attending Family Physician at Collegeville Family Practice Selected references: Diagnosis and Management of Obstructive Sleep Apnea - A Review. JAMA. 2020;323(14):1389-1400 Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments.  Sleep Medicine Reviews 2024;78:1-12

In this Healthed lecture, Prof Brendon Yee explains how GPs and specialists can work together to ensure effective management, balancing road safety with appropriate return-to-driving protocols after successful treatment.See omnystudio.com/listener for privacy information.

Story at-a-glance Obstructive sleep apnea (OSA) affects nearly a billion people worldwide. It causes breathing interruptions during sleep that prevent you from reaching restorative sleep stages Common symptoms include loud snoring, gasping/choking during sleep, morning headaches, daytime fatigue, difficulty concentrating and mood changes that are often mistaken for normal tiredness Risk factors for OSA include age, excess throat tissue, weak throat muscles, structural airway abnormalities and vitamin D deficiency, which affects sleep regulation and quality Untreated sleep apnea leads to serious health complications including cardiovascular disease, Type 2 diabetes, cognitive decline, weakened immune function and increased accident risk Treatment options include CPAP therapy, oral appliances, orofacial myofunctional therapy and lifestyle changes like optimizing breathing habits, maintaining healthy weight and adjusting sleep position

In today's VETgirl online veterinary continuing education podcast, Dr. Amy Kaplan, cVMA, DACVECC, MRCVS discusses a potential way to help smooth out surgical recovery in those tricky brachycephalic patients. Listen along to hear the benefits one study found in having owners present to help recover their canine companion following airway surgery, as supported in the veterinary journal article, "Owner-assisted Recovery and Early Discharge After Surgical Treatment in Dogs with Brachycephalic Obstructive Airway Syndrome."

Speaker:  Mr Julian Gaskin -Paediatric ENT consultant at Bristol Royal Hospital for Children   Blurb: When are sleep studies warranted for children with suspected obstructive sleep apnoea? How do we avoid missing cholesteatomas? When should we refer infants with laryngomalacia? Is there a link between gastro-oesophageal reflux and laryngomalacia?  Paediatric ENT consultant Julian Gaskin answers these questions and more as GP Ruth Bowen interviews him  the common Primary Care ENT scenarios of obstructive sleep apnoea, laryngomalacia and acute, recurrent and chronic supporative otitis media.   Resources: -ENT UK -Bristol Royal Hospital for Children guideline: Obstructive sleep apnoea -NICE guideline: Acute otitis media -NICE guideline: Otitis media with effusion -NICE guideline: Chronic supporative otitis media  

Une première étape dans la lutte contre lʹostéoporose Les brèves du jour Des ateliers pour mieux vivre avec une bronchopneumopathie chronique obstructive Incroyable histoire de la géographie 2/2

Au lendemain d'une émission consacrée aux conseils et prises en charge pour cesser de fumer, nous parlons aujourd'hui d'une maladie chronique directement liée — dans une majorité de cas — à cette exposition au tabac. À l'occasion de la journée mondiale contre la BPCO (le 21 novembre), nous faisons un point sur cette maladie chronique inflammatoire des bronches. Quelles expositions ou habitudes du quotidien favorisent le risque de BPCO, cette maladie respiratoire chronique ?  Pr Bruno CRESTANI, chef de service de pneumologie à l'hôpital Bichat Claude-Bernard à Paris. Président de la Fondation du Souffle   (Rediffusion)Retrouvez l'émission dans son intégralité ici : La BPCO, bronchopneumopathie chronique obstructive 

This episode covers hypertrophic obstructive cardiomyopathy.Written notes can be found at https://zerotofinals.com/paediatrics/cardiology/hypertrophicobstructivecardiomyopathy/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. Obstructive sleep apnea (OSA) is the most common type of sleep apnea, characterized by repeated episodes of partial or complete blockage of the airway during sleep. These blockages occur when the muscles at the back of the throat relax excessively, causing the airway to narrow or close, and momentarily stopping breathing. This condition contrasts with central sleep apnea, where the brain fails to send proper signals to the muscles that control breathing. When the brain is deprived of oxygen during sleep, OSA can lead to a number of serious conditions affecting not only quality of life, but brain health and function. It is important to seek medical attention.Omid B. Mehdizadeh, MD, is an otolaryngology-head & neck (ENT) surgeon with particular expertise in voice, swallowing and airway conditions at Pacific Neuroscience Institute (PNI). A Los Angeles native, his career has spanned treating world-class opera and Broadway singers to surgical mission trips serving underprivileged and indigenous populations of Central America. Outside PNI, he has focused his time on educating medical and undergraduate students and providing medical care to disenfranchised populations through community clinics.

$5 Q-BANK: https://patreon.com/highyieldfamilymedicine Intro 0:30, Hypertension classifications 1:45, Lifestyle modifications 3:00, Thiazide diuretics 4:16, ACE Inhibitors and ARBs 5:59 Calcium channel blockers 8:15, Beta blockers 9:36, Mineralocorticoid receptor antagonists 10:49, Goal-directed medical therapy 12:49, Resistent hypertension 15:37, Other antihypertensives 16:38, Hypertensive emergency 20:33, Hypertension in pregnancy 23:00, Primary hyperaldosteronism 24:38, Renal artery stenosis 26:24, Cushing syndrome 27:22 Pheochromocytoma 28:53, Obstructive sleep apnea 30:26, Coarctation of the aorta 31:30, Practice questions 32:30

Au lendemain d'une émission consacrée aux conseils et prises en charge pour cesser de fumer, nous parlons aujourd'hui d'une maladie chronique directement liée — dans une majorité de cas — à cette exposition au tabac. À l'occasion de la journée mondiale contre la BPCO (le 21 novembre), nous faisons un point sur cette maladie chronique inflammatoire des bronches. Quelles expositions ou habitudes du quotidien favorisent le risque de BPCO, cette maladie respiratoire chronique ?  Pr Bruno CRESTANI, chef de service de pneumologie à l'hôpital Bichat Claude-Bernard à Paris. Président de la Fondation du Souffle    Retrouvez l'émission dans son intégralité iciLa BPCO, bronchopneumopathie chronique obstructive 

Au lendemain d'une émission consacrée aux conseils et prises en charge pour cesser de fumer, nous parlons aujourd'hui d'une maladie chronique directement liée — dans une majorité de cas — à cette exposition au tabac. À l'occasion de la journée mondiale contre la BPCO (le 21 novembre), nous faisons un point sur cette maladie chronique inflammatoire des bronches. La bronchopneumopathie chronique obstructive (BPCO) est causée, dans environ 80% des cas, par la consommation de tabac, mais aussi par l'exposition à la biomasse, c'est-à-dire l'inhalation de fumées de combustion intérieure principalement, dans les Pays en Voie de Développement. Quels sont les symptômes de la BPCO ? Quelles prises en charge existent, pour les patients ?    Pr Bruno CRESTANI, chef de service de pneumologie à l'hôpital Bichat Claude-Bernard à Paris. Président de la Fondation du Souffle   Pr Alexandre Boko KOUASSI, pneumologue et responsable de l'unité d'aide au sevrage tabagique au CHU de Cocody en Côte d'Ivoire   Christiane Poculu, patiente atteinte de BPCO, sous oxygénothérapie. Patiente experte diplômée de la faculté de médecine de l'université de Marseille. Vice-présidente de l'association « Santé respiratoire France ». Vice-présidente de l'Alliance contre le tabac      Programmation musicale :► Seckou Keita – Bodula► Liniker – Negona dos olhos terriveis

Au lendemain d'une émission consacrée aux conseils et prises en charge pour cesser de fumer, nous parlons aujourd'hui d'une maladie chronique directement liée — dans une majorité de cas — à cette exposition au tabac. À l'occasion de la journée mondiale contre la BPCO (le 21 novembre), nous faisons un point sur cette maladie chronique inflammatoire des bronches. La bronchopneumopathie chronique obstructive (BPCO) est causée, dans environ 80% des cas, par la consommation de tabac, mais aussi par l'exposition à la biomasse, c'est-à-dire l'inhalation de fumées de combustion intérieure principalement, dans les Pays en Voie de Développement. Quels sont les symptômes de la BPCO ? Quelles prises en charge existent, pour les patients ?    Pr Bruno CRESTANI, chef de service de pneumologie à l'hôpital Bichat Claude-Bernard à Paris. Président de la Fondation du Souffle   Pr Alexandre Boko KOUASSI, pneumologue et responsable de l'unité d'aide au sevrage tabagique au CHU de Cocody en Côte d'Ivoire   Christiane Poculu, patiente atteinte de BPCO, sous oxygénothérapie. Patiente experte diplômée de la faculté de médecine de l'université de Marseille. Vice-présidente de l'association « Santé respiratoire France ». Vice-présidente de l'Alliance contre le tabac      Programmation musicale :► Seckou Keita – Bodula► Liniker – Negona dos olhos terriveis

Millions of people struggle with sleep, but letting a real condition go undiagnosed could be fatal. Obstructive sleep apnea occurs when the airway is blocked during sleep and can cause major issues, including your alertness during the day and mental health. Our experts discuss which treatment options may be right for you. Learn More: https://radiohealthjournal.org/i-accidentally-fell-asleep-at-the-wheel-the-dangers-of-sleep-apnea Learn more about your ad choices. Visit megaphone.fm/adchoices

MINOCA: Myocardial Infarction with Non-Obstructive Coronary Arteries   Guest: Claire E. Raphael, M.B.B.S., Ph.D. Host: Sharonne Hayes, M.D.   MINOCA is a myocardial infarction with no obstructive coronary artery disease.  This podcast will discuss the underlying causes of MINOCA, how to and who to investigate and discuss contemporary management strategies.   Topics Discussed: What is MINOCA? What testing should I consider in patients with MINOCA How are these patients treated?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Charlie Andrews talks to Dr Anthony (Tony) Wisken, Consultant Paediatric Gastroenterologist in Bristol.The Ingest podcast is hosted by Dr Charlie Andrews a GPwER in gastroenterology based near Bath. Charlie works as a GP partner at Somer Valley Medical Group, trained as an endoscopist and leads the national GPwER in gastroenterology training programme, launched in 2023 in the southwest of England. Charlie is a committee member of the PCSG (Primary Care Society of Gastroenterology). For more information visit pcsg.org.uk Chapters (00:00:05) - INGEST(00:01:02) - Chronic abdominal pain in children(00:07:47) - Pediatric gastroenterology, pain in the tummy(00:13:13) - Reflux in children, 6 years and older(00:15:26) - Headache and abdominal pain in children, age 6(00:21:34) - Idiopathic bowel syndrome in children(00:24:51) - Tummy pain 11, constipation(00:31:08) - Mesenteric adenitis 20, Cancer(00:35:06) - Functional GI disorders, the role of ultrasound(00:38:57) - Obstructive bowel disease in teenagers(00:45:41) - Gallstones in children, anaesthesia and surgery(00:47:01) - Celiac disease, tests and how to manage it(00:49:40) - Top 3 Take Homes for kids(00:51:51) - H. Pylori in children's tummy pain(00:55:37) - 3 take home points from the abdominal pain episode

Obstructive sleep apnea, commonly referred to as OSA, affects 25% of adults yet 80% of cases go undiagnosed. And we know that sleep-related breathing disorders can cause havoc on a patient's oral and systemic health. And with so many patients having OSA, dentists have an amazing opportunity to treat these patients that are already patients of record. In this episode, we'll hear from two experts on the best way to start the journey of dental sleep medicine, helping patients on their path to good oral and systemic health while boosting revenue for the practice.

In this episode, Dr. Valentin Fuster highlights the Forest HCM study, which focuses on the withdrawal of standard care medications in patients with obstructive hypertrophic cardiomyopathy receiving afficantin. The study shows promising results: nearly half of the patients who attempted to reduce or stop their medications did so successfully, with significant improvements in functional class and symptoms. While the findings suggest that afficantin may allow for the reduction of traditional therapies, caution is advised, as not all patients may benefit equally.

In this episode, Dr. Valentin Fuster introduces a dedicated focus on hypertrophic cardiomyopathy, featuring a pivotal study by Dr. Martin Maron and Dr. lacopo Olivotto on the impact of aficamptin. This pre-specified sub-analysis from the SEQUOIA HCM trial aims to comprehensively evaluate the drug's effects on various aspects of disease burden, enhancing our understanding of its clinical efficacy.

In this episode, Dr. Valentin Fuster delves into a groundbreaking study on the effects of the cardiac myosin inhibitor, Aficamten, on patients with obstructive hypertrophic cardiomyopathy. The findings reveal significant improvements in echocardiographic measures of cardiac function, despite a mild and reversible decrease in left ventricular ejection fraction, highlighting the need for long-term safety evaluations of this promising treatment.

In this episode, Dr. Valentin Fuster explores groundbreaking research on hypertrophic cardiomyopathy, focusing on the effects of the drug aficamten on cardiac structure and function. Highlighting significant findings from the Sequoia HCM trial, the discussion underscores the potential of aficamten to induce favorable cardiac remodeling and improve patient outcomes, signaling a transformative era in the management of this condition.

In this episode, Dr. Valentin Fuster delves into the latest research on hypertrophic cardiomyopathy, highlighting the significant health status improvements achieved with the new cardiac myosin inhibitor, Aficamten, compared to placebo. The findings from the Sequoia HCM study reveal that Aficamten markedly enhances patients' quality of life and alleviates symptoms like chest pain and shortness of breath, paving the way for more effective treatments in this challenging condition.

In this episode, Dr. Martin Stentebjerg Skøtt (DK) presents findings from a recently published systematic review on the topic of "Endoscopic balloon dilatation and incision for treating primary obstructive megaureter in children".Historically, ureteral re-implantation has been the gold standard for addressing primary obstructive megaureter (POM) in children, but its challenges, particularly in infants, have spurred interest in less invasive methods. Dr. Skott discusses the effectiveness, safety, and benefits of endoscopic management as an alternative to the traditional surgical approach.Dr. Skøtt also discussses potential complications, the need for long-term follow-up, and the importance of future research to refine treatment protocols for better patient outcomes.Join us for this insightful conversation as Dr. Martin Skott sheds light on cutting-edge approaches to managing primary obstructive megaureter in children.  Tune in and stay informed!

Join me for a summary looking into the increasingly popular topic of paediatric obstructive sleep apnoea, a review of orthodontic treatments available, and how effective they are in this growing field of both medicine and dentistry. This episode is a summary of Alberto Capriglio's lecture from the AAO and Carlos Flores Mir's lecture at the IOF earlier this year.     OSA - Defined upper airway dysfunction causing complete or partial airway obstruction during sleep   Sleep = Slow wave sleep – constructive phase of sleep (recuperation of the mind) ·      Growth hormones secreted ·      Glial cells within brain restored ·      Cortical synapses increase in number – Moberget 2019   Outcomes to paediatric patients of SDB: (AASM) ·      delays in development,  Poor academic performance, Aggressive behaviour, attention- deficit/hyperactivity disorder, , emotional problems in adolescence   First line medical treatment – adenotonsillectomy  ·      40% residual  OSA       Effect palatal expansion 1.        Roof the mouth = base of the nose - Increase in nasal airway volume - Reduction in OSA, if obstruction in naso-pharynx, 2.        Short term reduction in OSA (not cure AASM) a.        20% improvement in AHI, 85% of cases Villa 2015 b.        15% got worse by 20% c.        57.5% residual AHI greater than 1 - not resolution 3.        Caprioglio 2019 long term AHI return to initial scores, from 7 to 5 long term 4.        Change in metabolism when combined with Vit D3 a.        Vit D3 with RME increases reduction in AHI, sustained long term, Caprioglio 2019 AHI 61.9% Vs 35.5% long term     Expansion other outcomes -  school performance  Bariani 2024 ·      AJODO – RME improves academic performance – o   BEHAVOUR 1 of 8 parameters improved only for academic performance  - change small 0.68 o   COGNITIVE 1 in 8 improve       Mandibular advancement Move mandible forwards and open space behind the tongue – oropharynx ·      Anatomical – increase size of oropharangeal airway ·      YAnyAn 2019 mandibular advancement for pOSA systematic review:  1.75 AHI reduction (CI) −2.07, −1.44) – modest change ·      However long term use required of the paediatric patient     Orofacial features in children with obstructive sleep apnea.  Fagundes Flores-Mir 2022 o   No craniofacial features specific to pOSA – ANB, o   However medical diagnosis through polysomnography may under-estimate incidence, o   Broader diagnosis such as snoring, may over-estimate OSA   AADSM 2024 – consensus statement ·      Expansion o   Prevention: No consensus o   Management: No consensus o   Cure: Insufficient ·      Mandibular advancement o   Prevention, management, cure – unclear   More about OSA? To hear more about OSA, please check out the last interview on orthodontics in interview with Sanjivan Kandasamy, where we had a deep dive into OSA and where we are in our understanding today from the research Interview with Sanjivan Kandasamy on OSA                          

This week I'm talking to Dr Jane Ladlow. Jane is a veterinary surgeon who is widely known as an expert on BOAS, or brachycephalic obstructive airway syndrome. BOAS is the umbrella disorder that covers a variety of different airflow obstructions in different flat-faced breeds such as the pug, French bulldog, and English bulldog. Jane developed the Respiratory Function Grading Scheme, a straightforward clinical exam which allows grading of a BOAS-effected dog. Jane works with the Kennel Club in the UK to promote this scheme, which is also being rolled out in other countries including the US. I was really pleased to get to talk to Jane about BOAS, her grading scheme, and what this means for breeding healthy brachycephalic dogs.

If waiting for your results from the WatchPAT One at-home sleep apnea testing device is stressing you out and keeping you up at night, At Home Sleep Apnea Testing offers top tips for improving rest quality. Visit https://athomesleepapneatesting.com/tips-for-improving-sleep-quality-while-awaiting-test-results for details. At Home Sleep Apnea Testing City: Thousand Oaks Address: 317 S. Moorpark Rd, Thousand Oaks, CA 91361 Website: https://athomesleepapneatesting.com/ Phone: +1 805 557 9930 Email: support@athomesleepapneatesting.com

Obstructive sleep apnea in adults (1:40), e-cigarettes (5:30), breastfeeding support for healthy mothers and infants (7:40), hematologic emergencies (10:20), midodrine for recurrent vasovagal syncope (15:30), and cranberry products for preventing urinary tract infections (17:20).

Justin Coleman talks to Darren Mansfield, Director of the Epworth Sleep Centre, about his article on the diagnosis and management of obstructive sleep apnoea (OSA) in adults. Darren outlines high-risk populations for OSA and the importance of screening. He also covers treatments, including CPAP therapy, positional and oral appliances, and surgical options. Read the full article by Darren and his co-author, Daniel Hynes, in Australian Prescriber.

PetAbility Podcast hosts, Cathy and Chris, once again lend their experiences and expertise to the show - this time discussing Brachycephalic Obstructive Airway Syndrome.Who gets it?What is it?Why should we care?With the popularity of Frenchies and other smoosh-faced dogs exponentially increasing  world-wide, caretakers of these endearing breeds need to be equipped to address some commonly concurrent medical issues. For example, their unique anatomical features negatively impact their ability to not only breathe, but also regulate their body temperature. This can lead to chronic respiratory distress, heat intolerance, and even death. However, there are surgical options as well as environmental changes, both at home and in physical rehab, that can improve these little  nuggets' quality of life. Educate yourself to potentially save a life!Support the Show.DisclaimerFollow us on Facebook, Instagram, TikTok, and YouTube.Check out VitalVet.org for all PetAbility Podcast episodes related to rehabilitation as well as a plethora of other resources and product information.MedcoVet (show sponsor) - the next generation in laser therapy by putting healing in the hands of the pet owner! By using the Promo Code PETPOD22, when placing your first order with any of our affiliate partners, you will receive 10% off and PetAbility receives 10% . Dr. Buzby's Toe Grips – dog nail grips to keep your dog from slipping! Extra love – use this link and the entire 20% goes to support our show! HedzUpPets Watercollars – save your dog from drowning with this unique lightweight collar when around any body of water!...

Brachycephalic obstructive airway syndrome (BOAS) is a chronic, lifelong and debilitating disease that adversely affects the quality of life of many popular dog breeds, such as French and English bulldogs, pugs and Boston terriers. Tune in to this VetFolio Voice podcast episode to learn about the anatomy of brachycephalic dogs and how it contributes to airway obstruction. Dr. Cassi and Dr. Fox-Alvarez delve into the indications for surgery and what types of surgical procedures are performed to help correct airway obstruction. They discuss comorbidities associated with BOAS as well as expectations for recovery from surgery and the long-term prognosis for these patients.

Christopher J. Allen, MD (SleepDrChris) is a board certified Sleep Medicine Doctor for kids and adults. He received his sleep medicine training at the University of Michigan (Go BLUE

This week Dr Darren Reed, a respiratory consultant from Northampton General Hospital discussed both OSA and OHS with us. We cover the mechanisms for both conditions, looking at the overlap and teasing apart the differences, before covering how to diagnose and treat these patients. This is definitely an episode you don't want to sleep on!

CardioNerds Dr. Josh Saef and Dr. Tommy Das join Dr. Omkar Betageri, Dr. Andrew Geissler, Dr. Philip Lacombe, and Dr. Cashel O'Brien from the Maine Medical Center in Portland, Maine to enjoy an afternoon by the famous Portland headlight. They discuss a case of a patient who presents with obstructive cardiogenic shock. Dr. Bram Geller and Dr. Jon Donnelly provide the Expert CardioNerd Perspectives & Review segment for this episode. Dr. Maxwell Afari, the Maine Medical Center cardiology fellowship program director highlights the fellowship program. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. This is the case of a 42 year-old woman born with complicated Tetralogy of Fallot repair culminating in a 29mm Edwards Sapiens (ES) S3 valve placement within a pulmonary homograft for graft failure who was admitted to the cardiac ICU for progressive cardiogenic shock requiring vasopressors and inotropic support. Initial workup showed lactic acidosis, acute kidney injury, elevated NT-proBNP, and negative blood cultures. TTE showed at least moderate biventricular systolic dysfunction. She was placed on furosemide infusion, blood cultures were drawn and empiric antibiotics initiated. Right heart catheterization demonstrated elevated right sided filling pressures, blunted PA pressures with low PCWP, low cardiac index, and low pulmonary artery pulsatility index. Intracardiac echocardiography (ICE) showed a large mass within the ES valve apparatus causing restrictive valve motion with a low gradient across the pulmonic valve in the setting of poor RV function. Angiography revealed a large filling defect and balloon valvuloplasty was performed with immediate hemodynamic improvement. Blood cultures remained negative, she was gradually weaned off of inotropic and vasopressor support, and discharged. Despite empiric treatment for culture negative endocarditis and ongoing anticoagulation, she was readmitted for recurrent shock one month later at which time the pulmonic mass was revisualized on ICE. A valve-in-valve transcatheter pulmonary valve (29mm ES S3) was placed to compress what was likely pannus, with an excellent hemodynamic result and no visible mass on ICE. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls - Obstructive Cardiogenic ShocK Tetralogy of Fallot is the most common cyanotic defect and can lead to long term complications after surgical repair including chronic pulmonary insufficiency, RV dysfunction, residual RVOT obstruction and branch pulmonary artery stenoses. Chronic RV failure may be more indicative of a structural defect and therefore require interventional or surgical management. Valve thrombosis, infective endocarditis and obstructive pannus formation should be considered in the differential of a patient with obstructive shock with a prosthetic valve. Bioprosthetic pulmonic valve obstruction may be effectively managed with balloon valvuloplasty in patients who present in acute extremis but TCPV will likely provide a more lasting result. While valvular gradients are typically assessed via echocardiography, invasive hemodynamics can serve as a critical adjunctive tool in its characterization. Show Notes - Obstructive Cardiogenic ShocK Notes were drafted by Drs. Omkar Betageri, Philip Lacombe, Cashel O'Brien, and Andrew Geissler. What are the common therapies and management for Tetralogy of Fallot? Tetralogy of Fallot is the most common cyanotic defect in children beyond the age of one year Anatomic Abnormalities: Anterior and Superior deviation of the conal septum creating a SubAo VSD and encroachment on the RVOT.

Obstructive shock may be the least common type of shock, but it's no less critical. As part of Nurse PodCrawl 2024, Bryan Boling and Brandon Oto from the Critical Care Scenarios podcast join host Sarah Lorenzini in this episode to talk about the critical care management of obstructive shock. Together, they walk nurses through a patient scenario, detailing the diagnostic process of obstructive shock due to pulmonary embolism.Sarah, Bryan and Brandon review the three main causes of obstructive shock: pulmonary embolism, tension pneumothorax, and cardiac tamponade. They also discuss the importance of clinical assessments and diagnostic tools like ultrasound to distinguish between each cause, as well as considerations for treatment.This episode is the perfect resource for nurses who want to deepen their understanding of obstructive shock. Tune in now to hear insights from three experienced pros!Topics discussed in this episode:Patient assessment and key diagnostic toolsDiagnosing obstructive shock due to pulmonary embolismTreating obstructive shock due to pulmonary embolismTreatment implications for major causes of obstructive shockDiagnosis and treatment of tension pneumothoraxTreatment strategies for cardiac tamponadeKey takeaways on obstructive shock managementCheck out the rest of Nurse PodCrawl 2024 episodes around cardiogenic, hypovolemic, and distributive shock!Critical Care Scenarios: https://podcasts.apple.com/us/podcast/critical-care-scenarios/id1491559787How Not to Kill Your Patient: https://podcasts.apple.com/us/podcast/how-not-to-kill-your-patient/id1612099061Nurse Dose Podcast: https://podcasts.apple.com/us/podcast/nurse-dose-podcast/id1486427611The Q Word Podcast: https://podcasts.apple.com/us/podcast/the-q-word-podcast/id1407523803Straight A Nursing: https://podcasts.apple.com/us/podcast/straight-a-nursing-study-for-nursing-school-exams-nclex/id1210975738Up My Nursing Game: https://podcasts.apple.com/us/podcast/up-my-nursing-game/id1527032817Mentioned in this episode:Nurse's Week 2024 SpecialHAPPY NURSE'S WEEK! You can use code: NURSESWEEK2024 When you check out to get 50% off your first month of Rapid Response AcademyRapid Response and Rescue Intro CourseCONNECT

Our collaboration with Sarah Lorenzini of the Rapid Response RN podcast, discussing a case and general principles for diagnosing and managing obstructive shock. Check out the other episodes on shock in the Nurses' Podcrawl 2024! Find us on Patreon here! Buy your merch here!

In today's episode we take you through our approach to a disease with a wide array of clinical presentations and evolving treatment landscape - hypertrophic obstructive cardiomyopathy. Written by: Dr. Kate Haichin (Internal Medicine Resident) Reviewed by: Dr. Michael Chetrit (Cardiologist) & Dr. John Angelopoulos (General Internist) Support the show

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Novel AI Technology to Improve Risk Stratification of Patients Without Obstructive Coronary Artery Disease Undergoing CCTA: The Oxford Risk Factors and Non-Invasive Imaging (ORFAN) Study (AHA 2023)

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Obstructive sleep apnea and other sleep-related disorders are some of the most common conditions requiring Special Issuance Authorization clearance from the FAA.  On this episode, we hear from a sleep disorders expert followed by discussion on aeromedical implications.

Obstructive sleep apnea affects millions of people in the United States each year, and left untreated it can lead to several complications. Vaibhav Ramprasad, MD, the newest member of our Section of Surgical Sleep and Snoring, joins to discuss surgical options for patients suffering from sleep apnea who cannot tolerate a CPAP machine.

What does caregiving look like when you're living nearly 9,000 miles apart? In this episode of The Mighty Podcast, a mother — who lives with symptomatic obstructive hypertrophic cardiomyopathy (HCM) — and her daughter discuss her mom's life from symptom onset to finding a treatment that is working for her. They also talk about the duality in the daughter's role as both daughter and caregiver as she supports her mom through her best and worst days with the disease (and everything in between!). Come for their relatable story, and stay for the genuine mother-daughter bond you can feel through the microphones. Listen in: https://bit.ly/49dqxRg #Sponsored by Bristol Myers Squibb The patient and caregiver are paid spokespeople on behalf of BMS. Click here for U.S. Prescribing Information, including Boxed WARNING: https://bit.ly/3OlFtVQ Click here for Medication Guide: https://bit.ly/3UixuN1

CardioNerds Dr. Rick Ferraro (cardiology fellow at Johns Hopkins Hospital) and Dr. Eunice Dugan (cardiology fellow at the Cleveland Clinic) join episode lead Dr. Tiffany Brazile (cardiology fellow at the University of Texas Southwestern Medical Center and postdoctoral fellow at the Institute for Exercise and Environmental Medicine) to discuss the impact of obesity on cardiovascular disease risk, differential risk in specific populations, and effective strategies for counseling patients. They are joined by expert Dr. Jaime Almandoz, Medical Director of the Weight Wellness Program and an Associate Professor of Medicine at the University of Texas Southwestern Medical Center. Audio editing was performed by CardioNerds Academy Intern, student Dr. Tina Reddy. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Obesity & Cardiovascular Disease Risk The durability of metabolically healthy obesity (i.e., normal A1c, lipids, LFTs, BMP, normotensive) is limited. Within 5 years, a third of adults with “metabolically healthy” obesity will develop a cardiometabolic complication. The biomechanical and psychosocial complications of obesity are just as important as the cardiometabolic complications. Biomechanical and psychosocial complications, including obstructive sleep apnea, joint pain, and mood disorders also influence cardiovascular disease risk. Weight loss is not always the patient's goal. Meet patients where they are and understand their challenges, concerns, and long-term goals with respect to their cardiovascular health and obesity. This information provides an opportunity to frame the conversation in a supportive and engaging way that allows for patient education. Body mass index (BMI) is a screening tool for obesity, but is not sufficient for providing individualized care. Obesity management methods that result in rapid weight loss may not be appropriate for all patients. These methods, such as bariatric surgery and GLP1-receptor agonists, require regular monitoring, follow-up, and multidisciplinary care (e.g., nutritionist, exercise physiologist, endocrinologist, cardiologist, psychologist, etc.). Show notes - Obesity & Cardiovascular Disease Risk Is it possible to be healthy at any size? Whether an individual can be healthy at any size depends on the definition of health and its durability.Approximately 10-15% of adults with obesity are metabolically healthy.The risk for developing cardiometabolic disease is higher in obese versus non-obese adults. One in three adults with metabolically healthy obesity will develop cardiometabolic complications (i.e., insulin resistance/diabetes, hyperlipidemia, hypertension) within five years. Thus, metabolically healthy obesity may represent a transient phenotype with adverse long-term consequences. Consider non-metabolic health consequences of obesity that also influence cardiovascular disease risk. Obstructive sleep apnea, joint pain leading to decreased physical activity, and mood disorders are key considerations here and encompass the biomechanical and psychosocial consequences of obesity. Does large, rapid weight loss result in poorer long-term weight loss than slower, gradual weight loss? When approaches to weight loss are not sustainable, such as extremely low-calorie diets or extreme fitness regimens, the results and associated health benefits are less likely to be durable. Rapid, large-magnitude weight loss is appropriate for some adults with obesity and can be achieved throug...

Visit www.drstevenlin.com for this episode and moreSleep apnea is snoring and associated pausing of breathing during sleep. Obstructive sleep apnea (OSA) is diagnosed when breathing stops for a certain amount of time and oxygen levels drop.Symptoms include daytime tiredness, dry mouth, low energy, and insomnia.  Today nearly 1 billion people suffer from sleep apnea.Long term complications of sleep apnea include heart disease, metabolic dysfunction, and Alzheimer's disease.Solutions for snoring are difficult as breathing is a learned behavior, however structural jaw problems like a narrow dental arch can increase risk.A narrow palate or upper jaw is a risk factor for snoring and sleep apnea.My guest this week is Professpr Dave Singh, founder of Vivos. Prof Singh has been researched adult palate expansion to shift craniofacial epigenetics for positive impact on the airway and sleep apnea. Vivos has a range of devices FDA cleared to help treat sleep apnea and OSA.For more information on Dr. Singh and VIVOS, visit https://vivos.com/

 In this episode of The Ten Minute Medic, we dive into the essential aspects of asthma for paramedic students.  Like the song Hotel California, air checks into the alveoli, but doesn't (tend) to leave without help. Join us as we explore the pathophysiology behind this common respiratory condition, understanding the inflammation and bronchoconstriction that can lead to life-threatening situations. Learn how to assess a patient experiencing an asthma attack, including key signs and symptoms to watch for. We'll also discuss emergency treatment options, from administering bronchodilators like albuterol to the importance of oxygen therapy. Whether you're a seasoned paramedic or a newcomer to the field, this episode equips you with the knowledge and skills to manage asthma emergencies effectively in just ten minutes. After you listen, jump over to The Ten Minute Medic Facebook page at https://www.facebook.com/TenMinuteMedic/.  While there leave us a topic or two that you would like to see covered in a future episode.  Thanks!

Commentary by Dr. Valentin Fuster

This week we delve into cardiovascular surgery when we review a recent report from the Congenital Surgeons' Society on the outcomes of the hybrid approach of pulmonary artery bands for treatment of infants with critical left heart obstructive disease. What risk factors are associated with worse outcomes? Does this approach confer an advantage in comparison to the traditional 'stage I/Norwood' approach to this problem? Does the presence of multiple risk factors worsen outcomes and if so, to what degree? How does the heterogeneity of indications for this approach to obstructive left heart lesions stymie efforts to study this intervention? DOI: 10.1016/j.jacc.2023.07.020Editorial Comment :DOI: 10.1016/j.jacc.2023.08.023

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Obstructive sleep apnea (OSA) is a common condition where the muscles in the throat relax during sleep, causing partial or complete airway blockage. Risk factors include obesity, age, family history, and being male. Symptoms include loud snoring, gasping, and excessive daytime sleepiness. Left untreated, OSA can increase risks of high blood pressure, heart disease, diabetes, and vehicle accidents. Diagnosis involves an overnight sleep test to measure breathing disruptions. Weight loss and lifestyle changes can help mild cases. Treatment often involves using a CPAP machine, which blows air to keep the airway open during sleep and reduces daytime sleepiness by 70%. This episode highlights how undiagnosed OSA in truck drivers increases safety risks on the road.

We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessons

Do you ever feel like your immune system is working against you? You don't know what's wrong, no one else knows what's wrong, you keep doing medical tests and it's coming back normal or the pieces don't add up. Autistic people often experience a myriad of chronic health conditions and nervous system dysregulation that leaves us feeling terrible, overwhelmed, and with tons more questions than answers about what's going on with our bodies. In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, talk with Dr. Mel Houser (she/they), an autistic family physician, about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), mast cell activation syndrome (MCAS), the connection between Autism and nervous system dysregulation, the struggles with the healthcare system and getting treatment for these symptoms, and the importance of becoming a “detective in your own life.” Top 3 reasons to listen to the entire episode: Understand the role that daily experiences play in potentially triggering health conditions or pain through nervous system dysregulation. Uncover the complexities of living with neuroimmune conditions like ME CFS and mast cell dysfunction. Learn how to get support to address the unique challenges that neurodivergent individuals face in accessing mental health and medical care. More about Dr. Mel Houser: Dr. Mel Houser (she/they) is an Autistic family physician with a clinical focus on providing primary care for neurodivergent patients across the lifespan. She is the Founder and Executive Director of All Brains Belong VT, a nonprofit 501(c)(3) organization in Montpelier, Vermont that uses universal design principles to provide neurodiversity-affirming medical care, social connection opportunities for all ages, and neurodiversity-related educational training. At age 37, Dr. Houser was diagnosed as autistic, ADHD, dyspraxic, dyslexic, and dyscalculic. She is also the parent of an autistic 6-year-old, who is her guru of so many keys to the universe. Website: https://allbrainsbelong.org  Instagram: @allbrainsbelongvt Check out All Brains Belong's new project: Everything is Connected to Everything: Improving the Healthcare of Autistic & ADHD Adults provides health education resources to support people with this constellation of intertwined conditions, as well as strategies for discussing the project with medical providers. There is also a Clinician Guide with a combination of evidence-based practice and the lived experiences of more than 100 Autistic and ADHD community members. Here's the link to the project: https://allbrainsbelong.org/all-the-things    Transcript PATRICK CASALE: Hey, everyone, you are listening to the Divergent Conversations Podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale. MEGAN NEFF: And I'm Dr. Neff. PATRICK CASALE: And during these episodes, we do talk about sensitive subjects, mental health, and there are some conversations that can certainly feel a bit overwhelming. So, we do just want to use that disclosure and disclaimer before jumping in. And thanks for listening. MEGAN NEFF: Well, Mel, I was so excited when you reached out to me over email. Patrick and I have been talking about how we just keep getting sick. I've been dealing with long COVID. And we've been saying probably for the last four weeks we've got to do an episode on health.  So, you're an autistic physician, this is your, like, specialty. I'm so excited you're here. Before we started recording, I was talking about like, "Oh, we don't do bios." Which I actually love. It feels more organic. But it does put a little bit more pressure on you to explain to the audience who you are and give us context.  So, can I hand it over to you to give us some context of who you are, why this conversation is important to you around autism and health? MELISSA HOUSER: Definitely, and thank you so much for having me. So, yes, I am an autistic physician. I am the founder and executive director of a nonprofit in Vermont called All Brains Belong. We provide neurodiversity-affirming medical care, in addition to social connection opportunities for kids and adults, plus, community education.  And in my medical practice, I am providing medical care, both primary care and additional support for the conditions that we'll talk about today for kids and adults. And so, not all of my patients are neurodivergent but most are. And the majority of my autistic and ADHD adult patients suffer from a constellation of related medical conditions. And the problem is that not only do many medical providers not know that these conditions are related, the standard management of some parts of this constellation, and in my practice, we would really call it all the things because mostly all the people here have all the things, so… MEGAN NEFF: I love that, all the things. That's a good hashtag. MELISSA HOUSER: Yeah, so the standard management of some parts of all the things make the other parts of all the things worse. It's like internal conflicting access needs. MEGAN NEFF: Absolute, I love how you unpack that. A lot of the folks I work with and myself included will talk about that of like, well, I could do this medication for this diagnosis, but then, this other diagnosis I have is going to be negatively impacted by that treatment. So, it's like this wacky mole of health conditions.  Yes, so having a provider who can do the zoom out which Western medicine is not historically great at, the, like zoom out, let's look at this whole body, and how its integrated. I get the sense you're absolutely doing that. I love the language of constellation. I feel like that is a really integrative way of thinking about it. I'm curious what you would say are some of the like, big planets in the constellation. Also, I love how we're like co-creating a metaphor here as we [CROSSTALK 00:03:51]- MELISSA HOUSER: I love this. Yes, like, yes. So, I've been thinking about these "planets" as like buckets. So, this constellation includes something in the allergy immunology bucket, something in the connective tissue bucket, something in the gastrointestinal bucket, something in the sleep bucket. MEGAN NEFF: That's that. MELISSA HOUSER: Yeah, great, right, right, yeah. Something in the nervous system or neuropsychiatric bucket, something in the metabolic or vitamin absorption bucket, and something in the dental face and jaw bucket. And- MEGAN NEFF: Oh, that's a new one. I didn't know about that. MELISSA HOUSER: Yeah, yeah. And so, one of the things about this is that many people go often decades with like, maybe some like prodromal mild symptoms, and then because these are all neuro immune conditions, meaning they impact the nervous system and the immune system, and like the system's crosstalk, the mast cells, which we can talk more about, anytime the neuro immune systems get triggered by something, whether that be infection like COVID, for example, or surgery, or a concussion, or like, you know, trauma, you know, physical/emotional trauma, any kind of trauma, like these, or pregnancy, or menopause, or like just any trigger to the neuro immune systems, these conditions can get worse and for many people, they can get a lot worse. MEGAN NEFF: So, not that I'm going to treat this like a consult, but this feels like a consult question. So, for me, I had two very complicated pregnancies as well as two pregnancy losses. So, pregnancy, that whole season of life was difficult for me. But both of my two labors, complicated and did C-sections, my recovery to C-sections was brutal. And I always attributed that to the fact that I'd had a 36-hour labor and uterine infections. But based on what you're saying about surgery, is it possible that my difficulty coping post-C-section was actually related to organic things going on related to being autistic? MELISSA HOUSER: That is certainly possible. And in my practice, we see surgery, both from… there's all these different aspects of surgery, that's like a whole other podcast episode maybe. But like, when we think about, you know, aspects of connective tissue, for example, many autistic ADHD people have a condition called Hypermobile Ehlers-Danlos syndrome. So, like. wound healing from a connective tissue standpoint. Like, we just maybe don't heal well. And then, like, again, the autonomic nervous system aspects of, you know, maybe there's an impact in like blood flow, and maybe there's an impact in like, blood pressure, and heart rate, and like, all these things. Yeah, all of it, it's all related.  But I think the take-home point is that everything's connected to everything. And I think patients know that. It's the medical system that's so like, fragmented and siloed with like the body parts are treated as separate entities, but like, we know everything's connected to everything.  And you know, I love, Megan, you're talking about zooming out. You know, it's kind of like, you know, like on Google Maps, and you're so zoomed in, you don't even know what [INDISCERNIBLE 00:06:52] that you're on. Like, that's what goes on in healthcare. PATRICK CASALE: Yeah, I think this is such an important topic because so many medical professionals don't look at it in that perspective, or are not neurodivergent affirming, in general. And that [INDISCERNIBLE 00:07:08] to impact everything in terms of even like seeking out treatment, seeking out support, being comfortable disclosing your own autistic diagnoses sometimes can feel really challenging and triggering as well.  I was telling Megan, like, I'm 36 years old, I can remember being sick all my life, like getting mono at super early ages, in like second and third grade, being out of school a lot. And now my career has taken me to a place where I travel pretty often, and I'm sick constantly, whether it's upon arrival, or when it's upon landing, and coming home. And the immune system just feels like it can never catch up. And I just started to think about how much association there was between the way an autistic nervous system and body heals and recovers, and also, responds to stimuli, and just responds to immunity, in general. And it's just fascinating to start thinking about it from this lens. MELISSA HOUSER: Yes, and a good search term is myalgic encephalitis chronic fatigue syndrome, MECFS. So, MECFS is this really complicated neuro immune condition that impacts multiple organ systems. It's part of the cluster, it's not its own thing, it's part of it. You know, and many people, for example, think about long COVID as being MECFS triggered by COVID. And the thing about MECFS that's really important, and, you know, patients with MECFS, which is, like, for any people's triggered by illness, you know, doesn't have to be COVID, it could have been like, you know, Epstein Barr virus, which is the virus causes mono, like you're saying, you know, Lyme. There's like all these things that kick off MECFS.  And what we know is that one of the common hallmarks of MECFS is something called post-exertional malaise, PEM. And PEM is the consequence of, like you just said, the body doing too much. So, you tell me the story of every time you go do something too much your neuro immune system responds. And what happens is if you push through post-exertional malaise, it actually prolongs recovery. And so, and this can be, you know, physically pushing through, this can be emotionally pushing through, a cog really pushing through, and like you think about it, like, that is daily life for many neurodivergent people to survive in this world that is not built for us. PATRICK CASALE: Yeah, Megan and I talk about that constantly about the fact that we're both very privileged to work from home, to work for ourselves, to have a lot of privilege in terms of employment. And I think about it, like, I'm intentionally placing myself in situations that are going to make me feel this way, but a lot of people don't have the choice, and have to go to work from a 9:00 to 5:00, or have to show up in large communities of people, and just thinking about how much impact that has on both the body, the immune system, and the nervous system, and not just feel pretty constant, and feeling like there's not a lot of escape from that in a lot of ways, either, in terms of recovery. MEGAN NEFF: Mm-hmm (affirmative.) MELISSA HOUSER: Yes, yes. And like when you think about, like, zooming way out, when viewed through an equity lens of like who gets to show up in society. And so, you have these layers that we might talk about like a lack of neuro inclusion. But like, if you don't have, like, the privilege of autonomy over like the safety of the air you breathe, or like whether you, in fact, are forced because as a survival requirement to put yourself in situations that harm your health, and there's so many layers of that.  MEGAN NEFF: I think what really complicates it, you know, when I hear you talking about MECFS or some of these other conditions, these are not conditions that are well recognized by most doctors, and so, the experience, and then, especially, if you're a high masking autistic or ADHD person, the experience of chronic invalidation from the medical community that a lot of us experience of like, "There's something wrong with me, I'm tired." Like, I remember what I was at the height of my fatigue, I had gone to a naturopath who was like, "Your adrenals are…" Like, "You're producing cortisol of an 80-year-old woman." And I was 31. And I went to my Western doctor, and I showed her these, like hormone tests, totally dismissed. And then, she's like, "Well, you seem kind of emotional." Because I was really anxious talking to a medical provider, "How about we start you on an antidepressant?" MELISSA HOUSER: Hashtag health care, right? Like, this is what goes on.  MEGAN NEFF: Yeah. So, that, like, chronic diffuse, just feeling of unwell paired with chronic invalidation is just, I'm trying not to swear, but like, I will swear here, it is a mind fuck. MELISSA HOUSER: Yap, yap. Amen to that. So, you know, it's really hard. And I can send you a recording from a free educational that my organization put on last month about the health care system, and like, everything you just said. And so, we had a panel of clinicians, medical clinicians talking about, like, the system.  So, a lot of times it's not the individual healthcare provider who's like setting out to, like, thwart and invalidate the patient. It's the system is thwarting and invalidating the clinicians, which, like, interferes with full access to one's cortex to like perspective taking, you know? What's the consequence of saying that thing right now to that person? Like, it's everything. MEGAN NEFF: I love that Mel. So, I think an unfair burden gets placed on the providers, and the clinicians, and people don't often realize. So, I used to work in hospice, people don't often realize like, these medical providers are so booked in their days and like, it is like the system, like there's a reason so many medical providers are experiencing burnout, moral injury is so elevated in the medical community. So, this is not like medical providers being terrible humans, this is a much, like, the context around this is so much bigger, and I appreciate that you could bring that in. MELISSA HOUSER: Yeah, like, it's, you know, healthcare system is the villain, not the individual people within. MEGAN NEFF: Right, right. They've got 20 minutes with you, like 20 patients that day, and yeah. PATRICK CASALE: And if we're being honest, most of the medical model is set up to just treat symptoms, right? Like, we're treating symptomology. We're saying, okay, if this is what you're explaining, and experiencing, this is how we fix it and alleviate it. And for autistic, or ADHD, or any neurodivergent human, it's so much more complicated than just saying, "Oh, Megan's emotional right now, let's start an antidepressant." Like, that's just a quick band-aid fix that does not actually zoom out, as we're saying, and take into consideration everything that's going on behind the scenes. But if you don't have time to take in to consideration everything that's going on behind the scenes, it's a double-edged sword. It's like where do you fix the problem? And how do you alleviate that?  I was telling Megan, yesterday, I have a healthcare collective that I'm a part of here in Asheville. And my PCP I think is quite open-minded, and really wants to be holistic, and integrative, and perspective. I sent her Megan and I episode on neurodivergence and sleep because we were talking about feeling dismissed when you go in and talk about sleep. And the issue is like, "Have you tried mindfulness? Have you tried relaxation techniques? Have you tried this? Have you tried this?" And we're like, yes, we're fucking autistic. Like, I've researched everything under the sun that could help me sleep more than two hours a night. I promise you, anyway. She messaged me yesterday and was like, "I listened to your episode. I can't believe how dismissive I came across. I'm so sorry for that. And can you help me navigate how we can better understand how to help you sleep and rest?" And I thought that was so unbelievably validating. And I was like, "Okay, I can see this person and feel really comfortable here." MELISSA HOUSER: I mean, this person cued safety right there? Like, "Oh, I just got chills." Like that, yeah, right. There are people who get it and can come to get it. So, and I don't know if this will air, or when this will air, or whatever but All Brains Belong has for the past year, we've been creating a free resource both for patients and for medical providers to different versions about this picture of all the things to just like be available of like, here's, you know, what's going on, here are some things that might help.  And it has been about really bridging the double empathy problem, where, you know, when we think about, you know, the questions, or even the style, the way of clinical interviewing that medical providers are trained in, like, does not work for all brains, right?  So, like, the medical writers are often not getting the information because they're not able to elicit the information. Like, the patients will tell you what's wrong, if you can, like, cue safety, and allow people to have access to their own cortex, to communicate in their own way. And we did focus groups of autistic adults, about like the words they use to describe their experiences. And so, that's all like built in to the tool. And so, like, when it's out, it'll be out like, maybe in like, three weeks. You know, I can send it along. MEGAN NEFF: That's amazing. That is like one of the top requests I get is, can I have like a one-page handout to help me advocate with my medical providers? I'm so glad you've created that or are creating that. We'll absolutely link that because I think that'd be a really helpful resource.  I like how you keep going back to cueing safety. I had a medical appointment last week and it's interesting. I'm not emotional. I've talked about that on this podcast. The one place I cry is in medical offices. Like, it's not intense, but it's like I'll say something vulnerable. And I think it's because I'm so prepared and scared about being misunderstood that it is really like the one place I cry. MELISSA HOUSER: Yeah, I know, that resonates with me a lot. I, in general, don't seek a lot of health care for all the things. I have all the things also- MEGAN NEFF: [CROSSTALK 00:17:54]. MELISSA HOUSER: Yeah, except very health care avoidant, right, exactly. But, yeah. Yes, like your nervous system is like, it's a trauma response, right? It's just, you know, you're waiting for the next hit. MEGAN NEFF: Yeah. PATRICK CASALE: Well, Megan and I have also talked about, you know, as mental health professionals how often autistic adults or adolescents, young adults won't come into a therapy room and say, "Hey, I'm autistic." And therapists will then say, "I don't work with autistic people, this is not my area of expertise." And refer the person out the door. And how invalidating and dismissive that is.  So, if we take that in the mental health realm, and then, go into the medical world, there's almost this additional layer of fearfulness and vigilance around disclosure, and feeling safe, and feeling like you have to prepare to be dismissed or misunderstood, or you already feel dismissed and misunderstood in most areas of your life. So, it really does complicate seeking out treatment and support.  And I think myself, like, talking about just chronic health conditions, people in my life, you know, especially, like family members, or friend groups, or probably like, this is all hypochondria, like this is like you're sick all the time, there's always an issue here, like there's always something going on. And that can feel really invalidating and shame-inducing as well to constantly feel like, I always feel this way and I wonder what it would feel like to have a week or two where you're like in optimal health as a 35, 36-year-old human being. MEGAN NEFF: You know, one thing I've said my whole life pre-autism discovery was I just wish I could have a day in someone else's body. I just want to experience it. And I think it's because it's like, I don't feel like what I'm feeling is what other people are describing, but I don't know that because I only have my subjectivity. So, that's been my fantasy since I was a child, can I just experience someone else's body for 24 hours? MELISSA HOUSER: Yeah, so what our model at All Brains Belong is that connection is the path to health. So, we do a lot of group medical appointments, for example.  MEGAN NEFF: I love that.  MELISSA HOUSER: So, not only do we have this piece of like, I learned for the first time that I'm autistic and/or ADHD, but I'm also like, I have this thing, and it's called all the things. And the thing you've been saying was happening, it has been happening. And guess what, there's like a ton of other people who are experiencing this also, and you have fun together, and you learn together, and you learn how to adapt the environment, and the routines, you know, to meet your access needs and, you know, be promoting neuro immune health. MEGAN NEFF: I love that, I love that, this community of all the things. Okay, I'm going to ask a question, and if you're like, no, I just don't want to go there, like just- MELISSA HOUSER: Okay.  MEGAN NEFF: …tell me. I noticed the first few years or the first year of entering autism advocacy space, I was really cautious of talking about anything related to gut health, nutrition, because for so long the message was, if you cure your gut, you will cure autism. And so, I wanted to steer so clear from any of those reductionistic stories of autism of this health thing or like if you cure your nervous system, you cure autism. I've heard that too. So, that nuance of autistic people are more vulnerable to a ton of health conditions and supporting it supports our well-being, and no, we're not trying to cure autism, that sort of middle line of here are some things you can do to support yourself. Like, do you ever experience tension around that or? MELISSA HOUSER: Yeah, no, it's interesting. I, like, sick mono-tropism. I, like, forgot to experience tension around that because I like experience tension by so many other things. So, I would say that it's not that these neuro immune conditions, like I read this book about like, some component of all the things that was talking about, you know, it had like a curative narrative, and it was gross. Anyway, whatever, I won't even like name the book.  But it is worth like throwing that narrative out, like I am autistic, I have always been autistic, I always will be autistic. And in fact, it is the fact that I am autistic that allows me to zoom out and see the whole pattern because that's, like, what my brain does, right?  So, it's that. These patterns are more common because of the way that we're wired. And most of the environment is unsafe, it's the environment that's unsafe. And so, that is why we're going to have a dysregulated autonomic nervous system, we're going to have a dysregulated immune system, we're going to have mast cells, which are a type of immune cell that like crosstalks between the nervous system, and the immune system, and the soft tissue, there's mast cell receptors on every organ system, like, so it's a good search term because that like managing your mast cells is like part of how you support this cluster.  And it's not because we're trying to like, not be autistic anymore, we're trying to like, not be in pain, and we're trying to not have a blood pressure plummeting, we're trying to not have you know, trouble breathing, we're trying to not have a GI tract that's completely flipping its lid all the time when we eat. Like, that. So, I would just name… MEGAN NEFF: Yes, I love that. And then, this is where also like mental health, right, so many of the things you just named are going to cause mental health issues, right? MELISSA HOUSER: Of course. MEGAN NEFF: A dysregulated nervous system, fight/flight anxiety. So, for therapists like Patrick and I, you know, we aren't typically trained to look for, like nervous system dysregulation as the cause. So, we'll go straight to like, here's some emotion regulation strategies. Not that those don't have an impact on nervous system, a lot of emotion regulation strategies are downregulation strategies, but I find adding an element of nervous system work in therapy for autistic people is so important.  MELISSA HOUSER: I would add to that because like, what you're both bringing to the community is so critical because, you know, not only do we have patients who are seeking mental health support from like, neuro normative therapists that are like, you know, pointing out their irrational thoughts or something, but also, we bring this layer now, in the context of all the things that not only is emotional dysregulation, you know, equal, nervous system dysregulation, actually, making the mast cells more pissed off, actually, impacting the immune system.  But the other way goes too, so if you have, you know, for example, where I am in Montpelier, Vermont, there was just really devastating floods. So, like, everything is wet and there's all kinds of crap in the flood water, and so, you know, a lot of people's mast cells are flaring. And so, what they may feel in their bodies may not be, "You know, I feel my mast cells." Like, they just feel terrible. They don't know what kind of terrible they feel because it's not like one or the other, it's everything because everything's connected. MEGAN NEFF: Okay, so my internal clock just went off around how long we've been talking. And one thing I'm trying to be mindful of is as much as we talk about some of the hardships and the challenges we experience around navigating healthcare, I also want to have some words of encouragement, or empowerment, or just really practical advice that people can take away. So, I'm curious, kind of, what do you recommend to people, if they're listening to this, and they're like, "Oh, my goodness, I think maybe I've got all of the things but I didn't realize it." Like, what's next steps for them? Especially, if they're struggling to navigate with their medical team, things like that. Like, where do you start with people? What are some of your recommendations? MELISSA HOUSER: I think, like, first step is to figure out that this cluster or this constellation of related medical conditions may apply to you. And, you know, first off, I need to say the disclaimer that of course, this is like general education, this is not medical advice. But like in general, what people find helpful is first step to recognize that this pattern applies to them, and then to learn about the pattern because a lot of what we talked about earlier were some parts of the management of all the things, maybe other parts worse. A lot of times people know that, they know it about themselves, and there's also a ton of information out there amongst the neurodivergent community. They may not know it, they may not like, you know, know that all these conditions are connected or, but a lot of people do because they feel it in their own bodies, and there's a ton of information.  And I think what we've tried to do at All Brains Belong is like, synthesize all that information and put it in one place. But I think figuring out the things that make you feel better, that don't make you feel worse, like stopping the things and working with, you know, your personal medical provider to, like, figure out what are the things that I'm doing that might be making this thing worse, eliminating those things that are maybe making you worse, you know, is the first step I think.  And a lot of times, especially, you know, I would say like, if you're going to pick like one search term, I would read about mast cell activation syndrome, MCAS because if you can understand mast cells, this is a cornerstone of this constellation. MEGAN NEFF: So, I actually went on a rabbit trail a little earlier this year, and I was like, "Oh, maybe this is the missing thing." I've then, like, took a one-hour course on it. And like, in the course, the provider recommended a ton of vitamins. But I walked away from the course and I was like, "I don't actually know how to implement this or start."  MELISSA HOUSER: Yeah, yeah, yeah. And I think, like, figuring out what your triggers are is the most important thing. And so, like, I'll give a personal example, sometimes when I do podcast interviews I shut off my air purifier because it makes a noise, and then, I feel terrible afterwards, and then, I'm like, "Huh, I think it took like the, like, sixth or seventh time over the past year." And I'm like, "Really, it's every podcast interview, what is that? I'm not stressed out." Like, I shut the freaking air purifier. There's something in the air that my mast cells are responding to. So, like, you have to be like zooming out, you feel like zoom out on your day, on your week, on your month, and like, identify these things, there's no test. Like, there's going to be no test that says, "You know, my mast cells are pissed off by something in my office." Like, we're not going to have that. It's like being a detective in your own life.  Or I've never had a problem with dairy, but after I had COVID I can't eat dairy anymore. It took me like a few weeks even to be like, "Wow, I feel so terrible." And I realized that's what it was. And so, yes, you know, there are a variety of medications and supplements that can be helpful, and like, you know, life-altering for many people in the context of all the things. But trigger elimination is really important. MEGAN NEFF: I love that idea of become a detective in your life. PATRICK CASALE: My mind immediately goes like to the cynical place, though, like when it's all the things, and then, you're like, I have to identify all of the triggers and all of the things. It feels very overwhelming. So, I think for our audience, like, one thing at a time, you know? Try really hard to start small. So, that's a good example of having like, major throat surgery this year, and still being impacted by it. MELISSA HOUSER: Sorry to hear that. And possibly related to all the things, right? So, yeah. The other thing is, Patrick, you brought up sleep a little while ago, that is a critical starting piece as well. When I listed the different buckets or like Megan's use of planets, you know, one of the things I listed was face, teeth, jaw. So, many of us we have long faces. You know, we have more of an oval-shaped face as opposed to a round face, right? Like, the three of us, like, look at our long faces. And so, we have, therefore, a narrower airway.  And if we also have Hypermobile Ehlers-Danlos, for example, we may have a high-arched palate, her palate though that like also is making the airway more narrow. And so, there's like extent, I should have said this earlier, each piece of all the things is known to be more common in autistic people and some of which are known to be more common ADHD which, of course, are like, you know, almost superimposed Venn diagram circles, right? But the idea being that, you know, these pieces are known by healthcare, but they're known as pieces, not as a whole entity. So, like, yeah, you might say, yes, you know, I know that obstructive sleep apnea, for example, is more common in autistic people because that is known, and having, you know, obstructive sleep apnea is more common in people with long faces and higher arched palates, that's known. Obstructive sleep apnea is more common in people with Ehlers-Danlos Syndrome, that's known. Put it together, zoom way out, this is one thing and a lot of us have sleep apnea.  And so, you know, in my medical practice that is a starting place in many people, is identifying what's going on with sleep because it is so much bigger than like, like the examples you gave Patrick of like, you know, do you have a bedtime routine? Like, this is neuro immune, right? So, that is what I have to say about that. Fixing your sleep is essential and like if you don't fix your sleep, it's very hard to get the rest of all the things better.  MEGAN NEFF: Yes, I talk about that a lot, too. Same thing for mental health, it's like well, if sleep's off the rails, let's start there. Okay, so now I'm super curious, one thing that I hear and know is also common among autistic people is our voices tend to be raspier or just have a different tone. Like, both my kids have done speech pathology. I know and I talk more from my throat, so I've kind of a raspy voice, is that connected to the like high arch, and what you were just describing about throat jaw stuff? Or is that a different mechanism? MELISSA HOUSER: That's really interesting. I've never been asked that question before. That's a pattern I certainly see a lot and that I personally experience. And I wonder… I would imagine, I'm just like speaking off the cuff, I have no, like, literature to support what I'm about to say. But it's probably multiple things, right? So, raspiness might be because there's like mucus on the vocal cords because there's mast cell dysfunction. And so, you know, like, the allergic responses to things in the environment, so that might be playing a role of it.  There's also like the dyspraxia component of like, ineffective or inefficient motor plans of like, when I speak, you know, I'm using, like, all of my upper body at the same time. I'm turning all of it on because like, that's how I learned to do it. So, I keep doing it this way, at almost 40 years old. Or, you know, if I have, you know, Hypermobile Ehlers-Danlos syndrome, and I'm working harder to hold myself upright, my diaphragm might get stuck, and I'm using my neck muscles to breathe, and so, these muscles get really tight, and so, that tension may be impacting, you know, vocal cord usage. Anyway, I would imagine it's like many, many things that are connected to all the things because everything's connected to everything.  MEGAN NEFF: Yeah, yeah. PATRICK CASALE: So, it's blowing my mind. I'm like, I wonder if my [INDISCERNIBLE 00:37:34] is diverticula? [CROSSTALK 00:37:36] 65, that's a whole conversation that we can go into, but it's the third issue that I have at 36 years old that I've had two surgeries for that impacts my vocal cords, that impacts everything, and it's just interesting to start conceptualizing it from this lens, and the recognition of everything being so connected, and yeah, potentially impactive. MELISSA HOUSER: All that's related because it's definitely related, it's like on the list, is that connective tissue goes to the whole body, and so, if you look at the connective tissue of your esophagus is extra stretchy than like, the outpouching within the connective tissue. Like, you push it through same way that like, a lot of autistic people who struggle with, like chronic constipation, it's because the colon gets extra stretched out, and then, loses it squeeze. You know, I mean, there's a lot of ableism in healthcare, right? But, you know, of course, that autistic person is constipated because, like, look at their terrible diet or look at their inactivity. It's like, no look at their connective tissue. MEGAN NEFF: So, I'm having like both aha moment, and kind of like an oh, shit, moment. Like, I think I sometimes feed into reductionism, partly, because my head just would like, it would be too much to contain. But like, I think I probably over-attribute a lot of autistic struggles to interoception issues and autistic burnout. I actually had this thought a few weeks ago when I was reading more on the research on autism and chronic fatigue of like, yes, burnout, but like, also, all of these, like, all of the things that you're describing, or even hearing that thing about the colon and constipation, I didn't know about this stretchy tissue aspect of it. So, there's more than interoception struggles going into that. It's kind of overwhelming. MELISSA HOUSER: It is overwhelming. So, like, I wouldn't say that, like, oh no, I like erred on the side of saying things were attributable to interoception. Like, there are also interoception differences, but also, when you're Hypermobile because for anyone, you don't get feedback, you don't get like proprioceptive feedback until you're at the end range of motion. And if you're like extra stretchy, you go past, you know, what someone else's end range of motion is. So, you don't feel your body, you don't get that proprioception until you've gotten big movements.  So, you know, when, like, I don't ever thought about this until, you know, I learned about all the things. But you know, I don't think I really feel my face unless I'm like smiling really, really big or like I think I'm smiling, but I'm really not. And the people are like, "Why are you so upset? "I'm like, "I'm not." Anyway, all that it's like that. So, it's [CROSSTALK 00:40:20]- MEGAN NEFF: So, do people feel their face?  MELISSA HOUSER: I think people feel their face. I think they, like, know like what facial expression they're making [CROSSTALK 00:40:29]- PATRICK CASALE: We can have so many conversations on this [CROSSTALK 00:40:33]. MEGAN NEFF: …and you're listening to this, like, I want people to comment if they feel their face. PATRICK CASALE: Yeah, when you see the reel for this video, or for this episode, please comment if you can feel your face. We would like to know, this is part of our research. MEGAN NEFF: Well, it's the same thing with interoception, when I read about how interoception is measured, it's you connect a person to a machine and ask them to detect how many heartbeats they've had, and then, how accurate they are. And I was like, "Wait, what? People feel their heartbeat." Like, unless you're, like, sprinting- MELISSA HOUSER: Well, there's like a- MEGAN NEFF: …but otherwise no. MELISSA HOUSER: So, the thing is, what's really interesting is, you know, you could feel like, I don't feel hungry until I'm like ferociously hungry, and then, can like, no longer access food. But I feel my heartbeat all the time. And I feel all kinds of things all the time. Like, that was surprising to me to see how common that is, that like people might have, you know, an increased sensitivity to some types of interoception signals, but not to the others. MEGAN NEFF: Yeah, yeah. No, and that difference of, and I think that's really important too of like, some interoception might be exaggerated, some might be under, and then, it's really more about the differentiation that causes a struggle. Can you differentiate? Is it accurate reflection of what's objectively going on? Yeah. MELISSA HOUSER: And like what you explain to yourself, so for example, like in my medical practice, when people learn about all the things, and then, something happens, they have a narrative to understand it. So, to the extent that your mast cells are triggered by your autonomic nervous system being triggered. Like, so that's where this integration of, you know, nervous system regulation strategies actually directly impacts the immune system. And part of that is like, knowing what this is, and not like… I mean, it's not that you don't worry that because like, it's still like, uncomfortable, and we need to have it not happen because it's impacting your quality of life. But we don't, like, you know, that like special narrative of like, I don't know what's wrong, and no one knows what's wrong, and they keep doing tests, and they come back normal, and there must be something really very dangerously wrong with me, that triggers mast cells, triggers autonomic nervous system, therefore, makes your symptoms worse. MEGAN NEFF: I love that kind of tie-in. And I did this a lot when I worked with chronic pain, not that it's all in your head, that's a terrible message. But the story we end up telling ourselves about the pain signals will influence whether or not we get more pain signals or not. And I'm hearing that same as you talk about the narrative around your health conditions and what you're experiencing is going to actually influence your mast cells and influence your body's response because if your body thinks it's in danger, it's going to say, "Hey, we need to go on high alert." And that fight/flight activation. So, absolutely, not that it's all in our head, but that the story we tell ourselves about our experience will influence what's happening in our body, MELISSA HOUSER: Just from a nervous system regulation standpoint, how could it not? You know, it's part of like, one of the strategies that one… But the other thing that I would say is that, like in my medical practice, you know, many people know that they're autistic and/or ADHD, many people come because they're wondering if they're autistic or ADHD, but many people come not having anything to do with that. They come because their needs were not met by the traditional healthcare system. And amongst that group, that group is much more likely to have all the things and that group is much more likely to be autistic and/or ADHD.  So, like, it goes both ways. And either way, when people just, you know, I would say very similarly for many people, when they discover their neuro divergence, that organizing narrative, like you said Megan, that organizing narrative is so… it can be like life alteringly helpful for many people so it is with all the things. Like, having a narrative to understand often like decades of your whole life of living in your body all through a single lens, that's the point. PATRICK CASALE: So, I think that we can have a whole series with you now because this is so unbelievably informative and honestly enjoyable. But I am always timekeeping for Megan's purposes, and we are getting close. So, I think that is a perfect way to wrap up with what you just said. And also, I think we're going to have like, once we release this episode, so many people Googling, "Can I see this practice in Montpelier, Vermont for health care?" And it's unfortunate, I wish that we knew about more practices within our country who are doing things the way you are doing them. It's really amazing. And I appreciate you showing up for the community the way that you are. MELISSA HOUSER: Thank you and I think, like, this is probably my, like, most enjoyable podcast experience. Like, this has been wonderful. PATRICK CASALE: I like hearing that. We are just going with the flow and seeing where it goes. And that's kind of been our routine since day one. And I think that's what works for us. And it's felt really, really enjoyable so far. MELISSA HOUSER: That's awesome. And I'll send you… when our All the Things resource is out, it's almost out, the flood was a setback. But we're still on track, we just have to do some… Because we also want to be using universal design principles in presenting this information. So, we have text, and we have graphics, and we just have to record some videos, and then, we'll be ready to go. MEGAN NEFF: So, yeah, I did want to ask Mel kind of so obviously, if people are in Vermont, they can come to your practice. But when I was on your website, it felt like you were also providing, at least education, but maybe not medical services to people outside of Vermont. But for people who might be interested in your work, like, are there ways that they can connect with you or connect with your center?  MELISSA HOUSER: Yeah, definitely. So, first off, we do educational trainings that, yes, most of the trainings that we do are for organizations of a wide variety of types. But we do have people who they are coming to learn about specific health topics. So, it's an educational consult. So, I do those. And so, it's not medical advice, it's not prescribing medicines or making diagnoses. But like, you know, we definitely have people who come and want to learn about all the things, so we definitely offer that.  And then, we have free community programs. So, for adults, we have Brain Club, it's virtual, it's open to anyone, everywhere, and it's free. It's [CROSSTALK 00:47:15]- MEGAN NEFF: …it's open to anyone  MELISSA HOUSER: [CROSSTALK 00:47:17] we have people… Like, last week we had somebody from the UK and somebody from Australia. Anyway, so it's open to everybody and like, it's a community education on everyday brain life. And we have, like, panelists, and presenters, and stuff, and it's really fun. And for kids, also, open to anyone, anywhere, we have Kid Connections. It's a friend-matching program. So, like, we connect kids based on their shared interests, like their shared [INDISCERNIBLE 00:47:42] and [CROSSTALK 00:47:44]. Yeah, that was a kid's idea. So, we have a junior advisory board, so this kid is nine-year-old. We were like, "How do you make kids feel like they belong?" "You let us do what we love." Holy crap, yes. So, anyway, that's what Kid Connections is. PATRICK CASALE: And where can people find this information for those that are like, "Oh my God, this sounds amazing." Where do they find that? MELISSA HOUSER: allbrainsbelong.org. PATRICK CASALE: And all of this information will be in the show notes so that everyone has easy access, and all of the links, and all of the information that Mel provided today. And we really appreciate you coming on and making the time. This has been really enjoyable and wonderful, wonderful resource for the community.  MELISSA HOUSER: Awesome, thank you so much. PATRICK CASALE: And to everyone listening to the Divergent Conversations Podcast, new episodes are out every single Friday on all major platforms and YouTube. Like, download, subscribe, and share.