Podcasts about ocps

Birth control is used by many individuals for prevention of pregnancy, but also to help control their bleeding month-to-month. One of the most commonly used types of birth controls are pills, also referred to as oral contraceptives (OCPs).Our episode today focuses on a specific side effect often reported for individuals on OCPs: low libido or low sex drive.  We unpack the science behind why certain individuals may experience low libido on OCPs and while others may not. We also break down studies that reflect the percentage of patients that experience these symptoms as well as which OCPs are more generally linked to low libido.  Additionally, we comment on a published article that discusses other birth control options that may have a positive effect on libido.We value the ability to prescribe our patients birth control, and we use this as a tool in our toolbox when we're seeing patients in our office. It is SO important, though, to discuss the possible side effects of each medication we offer patients, such as birth control. Individuals should know what side effects they may experience and then decide if that option is still best for them.

Ep. 103- Join me and Orange County Public School board candidate for District 6 Jeni Grieger as we discuss the abysmal literacy rates through OCPS schools, and what she plans to do once elected to turn things around for good. With a focus on what best sets students and teachers up for success and a determination to disrupt the status quo, Jeni shares her vision for her district. As the only former teacher running in her race, Jeni is passionate about solving the many problems facing our school district with a non-partisan approach and a loud voice that puts kids first. Visit ⁠voteforjeni.com⁠ to learn more about her grassroots campaign, or to support her efforts. And don't forget to vote on August 20th! Follow the All My Favorite People podcast on Instagram ⁠instagram.com/allmyfavoritepeoplepodcast⁠

Oral Hormonal contraception gets the blame for a lot of things, including the development of hypothyroidism. Hypothyroidism is one of the most common endocrine disorders affecting 5 to 10 times more women than men, and its prevalence increases with age. This association of OCPs with hypothyroidism comes from a controversial article in BMJ published in 2021, but is still very active in current social media posts. Does combination oral birth control cause hypothyroidism with prolonged use? Are birth control pills responsible for “micronutrient depletion” which negatively affects the thyroid? In this episode, we will explore and dissect this study and look at a January 2024 case-control study that provides an alternative conclusion. Listen in for details.

This edWeb podcast is sponsored by Sora.The edLeader Panel recording can be accessed here.If the eighth-largest school district in the U.S. can do it, so can you! Listen to this edWeb podcast with educators from Orange County Public Schools (FL) to learn how their diverse district—which includes 200+ schools and 170+ languages spoken—rolled out ebooks and audiobooks to the entire school community. You hear from Director of Instructional Technology and Library Media Allison Kibbey about how this 1:1 district, which supplies over 188,667 devices to students, got started with a digital reading platform in February 2021.From there, Digital Learning and Library Media Program Specialist Margie Wells takes you through her keys to effective rollout and implementation of digital books, from using curation tools creatively to spark reading engagement, to cost-effectively managing your collection, to promoting your ebooks and audiobooks so that they're always on your students' minds. Plus, you discover how digital books make reading more accessible to students, with unique features and formats to draw in even struggling and reluctant readers. The end result? Over 120% checkout growth over the last two years!This edWeb podcast is of interest to K-12 teachers, librarians, as well as school, district, and education technology leaders.Sora from OverDrive EducationThe leading digital reading platform for libraries and schools worldwideDisclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Learn more about viewing live edWeb presentations and on-demand recordings, earning CE certificates, and using accessibility features.

Hispanic Day at the State Capitol is shifting gears.A new leader is taking over Oklahoma City Public Schools.The Thunder hopes to bounce back in game four of the N-B-A semifinals.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, Twitter and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday.

Orange County Public Schools says it's vital for residents to vote for the continuation of the half-penny sales tax this November. It's episode #561 of The ANEZ SEZ podcast...

S3E061 - Doddering old man leaves the White House to come to Florida to mumble about Donald Trump; OCPS board to vote on sales tax extension; 'White devil' Alec Baldwin ambushed at NYC coffee house by anti-Israeli activist.

WWF Presents Food Waste Warriors: OCPS and South FL  Description  Join WWF's Food Waste Warriors team as they dive into their collaboration with K-12 school food waste leaders in 5 Orange County Public Schools and expand efforts to South Florida.  Speakers  Mary Chandler, World Wildlife Fund, Food Waste Warriors  Dan St Onge, OCPS  Elaine Fiore, Broward Schools   

In this episode of That Music Podcast, join us for an in-depth discussion on the foundational concepts of Orff Schulwerk methodology, focusing specifically on rhythmic building blocks. Our guest, David, a seasoned music educator deeply rooted in the Orff approach, shares insights into how rhythmic building blocks can transform music education experiences for students of all ages. From engaging activities to literacy connections, David delves into practical strategies for integrating rhythmic building blocks into the music classroom. Discover how these fundamental elements not only enhance rhythm comprehension but also foster creativity and improvisation skills. David also highlights the versatility of rhythmic building blocks, demonstrating how they can be adapted for different age groups and subject matter. Be sure to check out David's Masterclass inside That Music Teacher Community, where he provides hands-on demonstrations and practical advice for implementing rhythmic building blocks in the classroom. Don't miss out on this opportunity to deepen your understanding of Orff methodology and take your music teaching to the next level! With unlimited access within the membership, you can catch the Masterclass and earn PD credit at any time. Episode Chapters: 0:00 Introduction 1:19 David's Background 5:50 The Orff Approach 12:38 Rhythmic Building Blocks 17:49 How To Start 25:56 Common Struggles 33:19 Additional Resources 37:18 Takeaways Links and Resources: Elementary Newbie Guide Disabilities Guide Steady Beat Survival Guide Join That Music Teacher Community More About David Row David Row loves teaching music to kids! A Nebraska native and Midwesterner at heart, David now lives and teaches in the Kansas City metroarea for the DeSoto Unified School District. He holds a Master's Degree in Music Education from the University of Missouri – Kansas City Conservatory, completed three levels and a master course in Orff Schulwerk training, and has extensive experience with critical thinking in the arts. David is an active clinician and has presented workshops at national, state, and local conventions across the United States and Canada. He is an AOSA-approved Orff Schulwerk teacher educator and teaches Level 1 Pedagogy at the OCPS & Central Florida Orff Chapter Summer Course in Orlando. On his blog, MakeMomentsMatter.org, David shares ideas about classroom content, management, lesson plans, critical thinking, and more. Search for “Make Moments Matter: A Music Education Podcast!” wherever you download podcasts or catch up with David every week on his “Musical Mondays” LIVE videos on Facebook.

The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review this new prospective population-based study to see if it makes the case for universal screening for thrombophilia variants before starting OCPs. In this episode, we'll also discuss high-risk versus low-risk thrombophilia, discuss relative risk versus absolute risk of VTE on the combination pill, and give clear clinical implications for patient management.

Dr. Klimczak and Dr. Reed give their advice to Madison LeCroy as she gets her IUD taken out. How long should you wait before trying to get pregnant after having had an IUD? And why do Elon Mush & Tik Tok hate birth control pills? Do you need a birth control pill detox? And should we all be taking Wild Yams?

Barbara Shipley, senior VP of brand integration at AARP, discusses on The Current Podcast the risk of perpetuating myths associated with older generations.   Episode TranscriptPlease note, this transcript  may contain minor inconsistencies compared to the episode audio. DAMIAN (00:01):I'm Damian Fowler.ILYSE (00:02):And I'm Ilyse Liffreing.DAMIAN (00:04):And welcome to this edition of the current podcast.ILYSE (00:10):This week we sit down with Barbara Shipley, the senior Vice President of Brand integration at A A RP. TheDAMIAN (00:17):A A RP is the nation's largest non-profit nonpartisan organization, which is in its own words, dedicated to empowering Americans 50 and older to live their best lives. It's taken great pains to assure people that it's not about silver haired grannies and granddadsILYSE (00:33):To be sure it's building on a tremendous legacy that started back in 1958. But as the perception of aging has changed in that time, so has the organization and its messaging. The A A RP is on a mission to debunk the myths about growing old. One of the ways it's doing this is by investing heavily in digital marketing in a world focused on youth. Barbara talks to us about what's unique about the A A RP demographic,BARBARA SHIPLEY (01:04):So we totally understand why people have a focus on Gen Z millennials. Um, let's be honest, there's definitely an obsession with youth, not just in this country, but all around the world. I think what's important for people to remember is not to put generations against each other, but to recognize where the customer base could be and potentially take age out of the equation for just a second, think about what your brand is, what your marketing, what your bottom line is, and then who makes the most sense? And in most cases, your marketing team, your brand team, your strategy team is going to zero in on people, 50 plus, they don't know it now, but if they open their mind to see where their customer is, I can almost guarantee it will include a huge proportion of the 50 plus because that's where the money is being spent. That's where the population growth is. Aging, is fueling growth in almost every market and segment.ILYSE (02:22):Just how big is that spending power, I guess, of that demographic? And then basically, how should brands think about this audience?BARBARA SHIPLEY (02:30):In the US alone, you've got 110 million people over 50, and the fastest growing audience is people over 85. So that is something to celebrate. Now, in a youth, and you could say youth obsessed, but in a youth focused environment, it's hard to pull people's attention over to the power of the 50 plus audience. But when we talk to brands and marketers in the industry and say, $8.6 trillion, they stop and listen, that's a lot, that contribution that the 50 plus in the US alone makes to the US economy each year.ILYSE (03:15):Now, the A A RP was founded 65 years ago in 1958. How has your organization changed to reflect the values and the needs of the demographic that you now serve?BARBARA SHIPLEY (03:27):The biggest way a A RP has changed is we are still extremely proud and focused of the, on the work that we do to help retired senior citizens, but that is not all we do. So if you think about an organization that is focused primarily on the 50 plus their families and their communities, how many 50-year-old people do you know that are retired right now or even thinking about retirement, they may be planning for it. I have to say I hope they are, because if you're not planning for it by the time you're 50, that's gonna be a challenge. But retirement could be 20 years away. And so A A RP has adapted it's content, it's programs, it's services, it's products, it's community outreach, it's volunteers to really address the way people are aging today, not just the way they aged when their parents or grandparents were going through their lives.DAMIAN (04:26):In addition to changing the programming that you have, um, how has the narrative changed in terms of your marketing, in terms of your campaigns? Now, I know you work with BBDO to create this new narrative. Could you address that a little bit? SoBARBARA SHIPLEY (04:39):This longevity message that I was just talking about is really important and it, and it really became one of the big insights to this new narrative, as you say. So if you could spend or live half your life after 50, you want to make sure that your money, your health, and your happiness live as long as you do. It starts to capture in a really concrete way. Our role, the AARP's role, is as a wise friend and a fierce defender, we are uniquely equipped to help you make sure your money, health and happiness live as long as you do. And the reason why it works so well as a marketing campaign is because of what I call the rug pull at the end, which is in fact, the younger you are, the more you need A A RP. And that has stopping power and gets people's attention because it is not easy to make sure your money, health and happiness live as long as you do. But we are here to help you do that.DAMIAN (05:44):It's interesting here, you talk about this because that line in the sand of retirement, sort of mid sixties, uh, has always been there and as sort of as a sort of psychological threshold. And, and that's clearly changing, you know, not just in the United States, but everywhere around the world. And I know that one of the important focuses for you has been around the importance of work and not just work for people, you know, under 65. It's not about retirement anymore, is it?BARBARA SHIPLEY (06:09):So you're right, it's not about the traditional old book of retirement. So work has become one of the biggest areas for A A RP. And it, it, it's interesting when you see it at first, people can be a little bit surprised. Wait a minute, I thought you were about retirement. And very quickly they get to that moment where of course you're not just going to help me in my retirement years, you are going to help me in my working years as well. And we do have to be honest here, there's a lot of ageism in the workplace. There's age discrimination, which is even a more deeper legal issue. If you're over 50 and you need to work and you're outta work, it's a daunting task just to get an interview. So what we do is work with the environment that you're trying to succeed in, not just help you with your resume, which we do provide you a network, which we do connect you to a job board, which we do. But we are also communicating to the HR industry, hiring managers sectors, the creative industry to push and help people understand the power of the multi-generational workforce. There is so much power in the multi-generational workforce. The work is better, the experience is better, the culture is stronger, the learnings never end and it goes every which way. And that's why I'm so passionate about the multi-generational workforce, specifically in the creative industry and how powerful that can be for business outcomes for your clients and for the culture of your agency.ILYSE (07:50):Yeah, and definitely there is an ageism issue in America and not even to mention the marketing industry. Could you describe some of those like stereotypes and misperceptions that do show up in media and we, we still see,BARBARA SHIPLEY (08:05):On the one hand, if you're thinking about hiring an older person, a little bit different than you just asked, but if you're thinking about hiring an older person, the myth associated with that is they can't use technology. They're slow, they're always gonna call in sick. They're not really looking to work here for a long time. They're just marking time until they retire. False, false, false and false. This is a group of people who largely have accumulated so much experience and so much wisdom that they are going to right the ship when there is some kind of a crisis in the workplace, they are going to be the steady hand. They can be, um, a receptacle for learning, for teaching, for sharing. There are lots of things that people learn how to do. So there are some opportunities for learning, but let's create those opportunities so that we can get the benefits of people in the workplace.BARBARA SHIPLEY (09:05):In marketing. We still see brands, brands are really starting to get it right. I think there's a lot of reasons for that. We're gonna take some credit for that, but we won't take all that credit. I think part of it is because a lot of creative directors at your agencies, they're turning 50 and they want to be relevant. They know their life experience and their talent is relevant. And I think that's part of where the new narrative in a lot of these ads is coming from. They're also, I think, looking at the realities of aging. They're looking at the research, the data, and they're seeing that people are developing their own stories, their own timelines. pe half of people in America that are 65 to today are still working. So to tell a story in an ad of people in their sixties with sort of blank stares, fumbling around technology, doddering fools only vulnerable, wearing beige does not tell the story of how people are actually living their lives today.BARBARA SHIPLEY (10:09):Now watch an ad for a restaurant, the older people, I bet you are background, that's not how it actually is, but that's how the ad portrays it because the younger hipper people are in the front, they are your OCPs. So let's get it actually the way it is because the danger of perpetuating these myths is twofold. One, your prime audience that has all the spending power is feeling ignored or insulted by your brand. And two younger people who come in contact with your work fear aging, that's a societal problem. And I would ask you and all of your listeners to answer the question, what's the alternative to aging? Everybody wants to age their way, which is why our mission is to empower people to choose how they live as they age.ILYSE (11:10):Now, are there any specific tools that A A RP turns to, um, to kind of bust some of those myths around those stereotypes?BARBARA SHIPLEY (11:19):So that's a great question because the tools and the concrete, um, opportunities are the best way to educate and change the environment. And I am so proud of the work that we launched about five years ago in a very special partnership with Getty Images. We have introduced a signature collection on Getty images that has grown to tens of thousands of images called Disrupt Aging. And the goal of disrupt aging is to, through imagery tell the more current contemporary real and varied stories associated with how people age. You see multi-generational images, you see images of people at work, you see images of people at play. They are not overly photoshopped, they are not overly beautiful. They are very real and it makes a huge difference. And to me, one of the most exciting things that I didn't even anticipate when we built this is the search techniques that we have introduced.BARBARA SHIPLEY (12:22):Instead of agencies searching for old people on the beach, we now are shifting the, the search, which means the input is changing. And the models are also really shifting how we think about the imagery that captures today's realities of aging. So the Getty images work is pretty radical. And then we also have all of the data from the usage that shows us what people are gravitating to and what they need. So it can be a very responsive tool, but it isn't enough. We need more tools in our industry and I recognize that I grew up in this industry, I grew up in the agency world. I know what it's like. The big problem I have with where our industry is right now is stop making assumptions about me because you know one thing about me, which is my age, nobody wants that. So this is what we need to break ourselves out of and stop putting everything through an age lens, which may it sound funny coming from an organization that is about aging, but it's about the freedom to choose how you live as you age and not be put into a box or a category or segment because of one data point.ILYSE (13:41):Now there's no doubt a lot of brands are getting it wrong still, but are there any brands that are doing it right?BARBARA SHIPLEY (13:48):Yeah, absolutely. So I'll give you one example, which is Hyundai. And the story is taking the daughter to college and they're driving. So the Hyundai is the vehicle, and by the end of the ad you realize the daughter is dropping the father off at college, and you just have you, you're seized in this moment. I would say there's another narrative coming out of an interesting brand, which is indeed and uh, you see a story of, you know, the the sort of quintessential man carrying the box with stuff in it, which your mo your brain says to you, he's leaving the job, he's been fired, he's retiring. But what you realize by the end of the ad is he's a new hire and he's in his fifties and people couldn't be happier that he's there and he's happy that he's there and it's the new beginning instead of an ending. And that just captures everything about what this audience is actually going through. They aren't just nice stories, they're realDAMIAN (14:49):Speaking of perception. And I know that you have the A A RP magazine, which I understand is the world's largest circulation magazine, which has more than 47 million readers and across a broad age range, it goes back to that multi-generational approach that you've been talking about. You know, how does the magazine as it were, fit into the whole, you know, tapestry of everything that you're doing in terms of your marketing efforts and the perceptionBARBARA SHIPLEY (15:13):A A RP the magazine is one of the most exciting things we have. It's a lifestyle magazine uniquely focused on interests, needs, topics that the 50 plus, now that's a huge group of people, right? There is almost no such thing as a 50 plus segment. So we have a lot of elasticity in the A A RP magazine, you'll see a lot of health topics, you'll see a lot of sex topics, you'll see a lot of travel topics, friends, um, empty nest. There's so much that we are able to cover, but we do it with a really deaf hand. There's so much soul in the way we cover these topics and the way we do interviews with the a a-listers that really wanna be on the cover of the magazine. Um, over the years, uh, we've had actors, actresses, uh, musicians, uh, Michael J. Fox, lady Gaga, Henry Winkler was on the last issue. People don't throw it away, it's a keeper.DAMIAN (16:16):That is an interesting way of kind of gauging one's own aging in a way, in relation to these pop culture people that you've grown up withBARBARA SHIPLEY (16:25):Because these people are still relevant. That makes me still relevant. That makes you still relevant, not some memory of who we once were. This isn't just a group that likes nostalgia either. This is a group of taste makers. You are probably a taste maker. I'm gonna bet. And so you like new music, you like exploring new artists and a A RP sponsors a lot of music. We do a lot of virtual concerts. We do a lot of in-person concerts. We were a huge part of celebrating the 50th anniversary of hip hop. And I think that's why people recognize what we are bringing to the table. We don't just want to sit around and remember, but it's about where are we goingILYSE (17:06):Now, speaking about being like taste makers, A lot of people might be surprised to hear that you guys are so into social media. So curious about your approach there and and why it's an important platform to be on. Yeah,BARBARA SHIPLEY (17:22):We're very big on Facebook. Facebook is important to us, but so is TikTok. So is Instagram. I don't know anybody that really only lives on one social media platform. They go to different social media platforms for different things. And so we show up differently depending on where their mindset may be, their needs are. Our presence on TikTok is a little bit of an alter ego for a a RP. It's an opportunity for us to bring a, a different part of our personality to bear because that's what the users of TikTok are doing. Same thing with Instagram. We have really dedicated our presence on Instagram to capturing and telling and celebrating the story of Gen X in all its glory. It's all its craziness, all its forgottenness. You know, we used to call this the sandwich generation, right? You used to hear that phrase about people who are caring for aging parents and raising their young children, and they're sort of sandwiched in between.BARBARA SHIPLEY (18:15):We are concert goers and we are restaurant goers and we are travelers and we are caregivers. The average age of a caregiver is not a boomer or a Gen X, it's a millennial. And this is, this is a very big deal that people really need to recognize. And we are doing things that we never thought we would need to know how to do. And in many cases we need help. So there's, that's what I mean when I say that these are soulful stories. There is this isn't one dimensional or two dimensional. It's so multi-dimensional. And if people, marketers would just recognize that this 50 plus audience is basically giving everybody else a roadmap. Because what we are blazing, this is a trail, people will be going down basically if there's one message to leave here in terms of how our creative industry writ large reflects older segments, don't do it because it's charitable. Do it because it's good business. And oh, by the way, it's also a better way to engage with your audience and tell the truth versus be stuck in an old stereotype. This is a bottom line opportunity for agencies, brand managers to recognize who their audience is and engage them with their brand.DAMIAN (19:44):And that's it for the current podcast. We'll be back next week. So stay tuned and if you like what you hear, subscribe and leave us a review. Also tune into our other podcast, the current report as we round up the week's biggest marketing headlines from across the open internet.ILYSE (19:59):The current podcast is produced by Wonder Media Network. Our theme is by love and caliber. The current team includes Chris Brooklier and Kat Vesce.DAMIAN (20:07):And remember,BARBARA SHIPLEY (20:08):They don't know it now, but if they open their mind to see where their customer is, I can almost guarantee it will include a huge proportion of the 50 plus because that's where the money is being spent. That's where the population growth is. Aging is fueling growth in almost every market and segment.DAMIAN (20:32):I'm Damian.ILYSE (20:32):And I'm Ilyse,DAMIAN (20:33):And we'll see you next time.

Blue Is The New White: Episode #152   Alright so today we bring in someone from the education sector to give us his perspective of the industries that we all know and love. Parker Antoine is the CTE Director of Marketing, Recruitment, and Enrollment Management for the Orange County Public School District in Florida. Which happens to be something like the 8th largest school district in the US. Parker's passion for the industry and the success of tomorrows workforce bleeds through every word he speaks on today's show. And we talk about everything from the importance of education, the value of college, and the marketing of the skilled trades. Listen in to this incredible conversation filled with hope for success, motivation, and fulfillment for the skilled trades people of tomorrow! Don't forget to subscribe to this channel, and on our website blueisthenewwhite.com to receive all the latest updates. You can now find this podcast on Iheart Radio, Sirius XM, and Pandora. As always, we rely on the word of mouth from our listeners to further the mission. So if you enjoyed this episode, please take a moment to rate, review, and share. The future generations of tradespeople depend on it. On you! So thank you again and enjoy this episode of Blue is the New White with Parker Antoine

We are continuing with our "How to..." series by delving into the world of Oral Contraceptive Pills (OCPs). OCPs, commonly known as birth control pills or simply "the pill," are a form of hormonal contraception designed to prevent pregnancy. But that's not the only thing OCPs are prescribed for.There are two primary types of OCPs: Combination Pills: These OCPs contain two key hormones—estrogen and progestin. Combination pills work by suppressing ovulation (the release of an egg from the ovaries), thickening cervical mucus to impede sperm movement, and altering the uterine lining to make it less receptive to a fertilized egg. Combination pills are available in various formulations, including monophasic (the same hormone dosage in each pill) and multiphasic (changing hormone dosages throughout the cycle). Progestin-Only Pills (Mini-Pills): As the name suggests, progestin-only pills contain only a synthetic form of the hormone progestin. These pills primarily work by thickening cervical mucus and altering the uterine lining, making it less suitable for implantation. Progestin-only pills are often recommended for women who cannot tolerate estrogen or have specific medical conditions that contraindicate estrogen use.In the episode, Dr. Rachel Pope is joined by Dr. Maria Shaker, an OB/GYN expert in Contraception Management, Family Planning, Minimally Invasive Gynecologic Surgery, Minority and Medically Vulnerable Populations, and Obesity in Obstetrics and Gynecology. She is board-certified in Complex Family Planning. Together they discuss how to take OCPs not just for birth control but to also control bleeding or just not have a period. They are taken orally, typically on a daily basis, and contain synthetic hormones that mimic the effects of naturally occurring hormones in a woman's body.Featured in this episode: Combined OCPs Breakthrough bleeding Birth control isn't just for birth control Escape Ovulation History of Birth Control Pills by Dr. Rachel PopeSubscribe to our newsletter here to stay updated and not miss out on new episodes.Submit your questions on anything and everything women's health-related and we will answer them in one of our episodes.

NSAIDs have been shown to be associated with development of VTEs. This data is not new, but is more than 10 years old. Of course, hormonal contraception is also known to potentially increase the risk of VTE depending on the amount of estrogen in the combination product as well as the type of progestin used. So, a reasonable question to ask is whether the use of these two medications TOGETHER synergistically increase the risk of VTE. A recent publication in BMJ (06 Sept 2023) provided some controversial results in this very topic. Could those study results be the result of "indication bias" or protopathic bias? In this episode we will look at the data, summarize the key results, review the study limitations, and provide some real world clinical insights as to what to do with this new info.

Have you wondered if it's ok from a halachic perspective to skip your period using hormonal IUDs or OCPs? What about a hashkafic perspective? What if you experience light staining every month, but don't get a full period—does that put you into niddah? Join Yoetzet Halacha Lisa Septimus as she and guest Rabbi Assaf Bednarsh, Rosh Yeshiva at RIETS and teacher of Yoatzot Halacha in Israel, discuss these questions and more.

OK, OK…we all get that past history of DVT related to hormonal exposure is a true and persistent contraindication for estrogen birth control. We get that. But what about the incidental presence of lower extremity varicose veins? Are varicose veins a contraindication to estrogen containing birth control? After all, some data has linked superficial varicose veins to the development of DVT. That must mean that estrogen containing BC is contraindicated due to the additional risk of clot formation, right? Is that true? There is some STRANGE information on the internet regarding the association of oral birth control pills and varicose veins. Do combo OCPs cause varicose veins? Do they increase the risk of DVT in those with varicose veins? In this episode we will explore the science, data, and published guidelines related to the prescribing of estrogen containing birth control in patients with varicose veins. PLUS, we will cover which patients- who do by chance develop a superficial venous thrombus in a varicose vein- need anticoagulation.

What are the new rules and how do we see this going moving forward?

Attorneys for Race Massacre survivors are taking their case to the state's highest court.Classes begin soon at Oklahoma City Public Schools.Federal environmental officials are rethinking herbicides.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, Twitter and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday. Mentioned in this episode:Stitcher Notice (kill 8/29)

Oral contraceptive pills (OCPs), or “the pill,” revolutionized women's healthcare in 1950. Now, almost 75 years later, women and their practitioners are asking questions. In this thought-provoking episode of the DUTCH Podcast, Dr. Jaclyn Smeaton and Dr. Rebecca Clemson compare and contrast the usefulness of the pill with some of its side effects.  You can join the conversation on the good and bad of birth control. Listen now! Sections and Timestamps 00:00Intro 04:10The pill to “fix” female problems 08:02Uses for the pill 12:10The pill is not benign 18:20Cardiovascular risks and the pill 19:56When should a patient take an OCP? 24:50Endometriosis and OCPs 27:41How to do birth control right 34:15Conclusion

Bloomberg Intelligence Technology Analyst Woo Jin Ho hosts Open Compute Project (OCP) CEO George Tchaparian to discuss the current and future innovations introduced by the consortium. Since its inception in 2009, the consortium has grown to over 300 members and boasts $18 billion in OCP-recognized vendor revenues. We discuss OCPs latest projects, such as disaggregating motherboards and chips, bringing cloud technologies to telecom and enterprise users, and tackling climate change.

I'd like to welcome you to something a little bit different on the Battlefield Next network of podcasts. You all have I'm sure heard of the world-famous, hard-hitting, cutting edge discussions on society and technology, known as Ted Talks. Well . . . . we don't own any fancy skinny microphones, we can't trade in our OCPs for black turtlenecks, BUT we can and will bring to you a segment fondly known as Fred Talks. Join us weekly as the Army JAG Corps' Regimental Historian provides short glimpses of our institutional past. You can only succeed on the battlefields of tomorrow, IF you learn about the battlefields of yesterday, SO TODAY, it's time to settle in for our very first “Fred Talk” on the evolution of the JAG Corps. ***The views expressed on the podcast are the views of the participants and do not necessarily represent those of The Judge Advocate General's Legal Center and School, the Army, the Department of Defense, or any other agency of the US Government.

Omni Consumer Products former Senior Vice President, Dick Jones personally picked hosts Charlie and Nate to discuss one of OCPs black eyes in the corporate world...RoboCop. We here at OCP care about you and your listening habits while also looking toward the future of podcasting. Now please take some time and enjoy the latest episode of Give Me Back My Action Movies, the one podcast for all your action needs. Be sure to listen closely for all the fine OCP products and services you need in this special episode. The Future of Tomorrow...Is Today

In this Healthed lecture, Prof Deborah Bateson, Sexual Health Physician and Professor of Practice at The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, explains the differences between the various oral contraceptive preparations available in Australia. Participants will be able to take an evidence-based approach to both the pros and cons of oral contraceptive pill use, be able to discuss ways that they might tailor an oral contraceptive preparation to the user's particular needs, understand the differences between combined and progestogen-only OCPs and examine the rationale behind the development of the newer oral contraceptive preparations available in Australia and internationally. See omnystudio.com/listener for privacy information.

Jennifer Fix is the founder of Ahne Studio, an urban design and community engagement firm that works with cities across Canada to build OCPs, heritage districts, downtown plans and neighbourhood plans. Jennifer is also a Regina resident. So, as Regina city council looks set to crack open their OCP to give themselves the ability to lower density targets on the fly, I thought Jennifer would be a great person to talk to about the value of urban density and why council's density target discretion might not be such a great idea. Music for QCIB is by Ryan Hill aka Guidewire.

Actualízate con nuestro podcast por Spotify MásReport por Más100.7FM --- Support this podcast: https://anchor.fm/du00e1maso-jimenez/support

Episode 90: Vaccines and Acne. Updates on pneumococcal and COVID-19 vaccines. Sarah explains the treatment of acne.New Pneumococcal Vaccine Recommendations. Written by Harkiran Bhattal, MS4, Ross University School of Medicine; Timiiye Yomi, MD; and Hector Arreaza, MD.During the recording, we used brand names because they are easier to use. We are not sponsored by the manufacturers of these vaccines. Terminology of pneumococcal vaccines: PCV13: Prevnar13®PPSV23: Pneumovax23®PCV15: Vaxneuvance® PCV20: Prevnar20®Tips about pneumococcal vaccines:-Prevnar13 is no longer used in adults. -Pneumovax23 is still being used in adults.-The two newer members of the pneumococcal vaccines are: Prevnar20® (PCV20) and Vaxneuvance® (PCV15). The following groups of patients are all adults 19-64 with underlying conditions OR >65 years old. Group A: Unknown or no prior doses of Prevnar13 or Pneumovax 23Option 1: Prevnar20 given as a single doseOption 2: Vaxneuvance followed by a dose of Pneumovax23 at least a year later (Consider >8 weeks in patients >19 at the highest risk)Group B: Previously received Pneumovax 23Give Prevnar20 or Vaxneuvance (at least 1 year since the last Pneumovax 23)Group C: Previously Received Prevnar13Give Pneumovax23 or Prevnar20 (if Pneumovax 23 is not available) >1 year since last dose of Prevnar13Group D: Previously completed series of Prevnar13 and Pneumovax23 in any orderNo additional doses are needed. Scenario 1: 68 yo M who has not previously received PCV or whose previous vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by a dose of Pneumovax23. Scenario 2: 25 yo F with HIV not previously received PCV or whose vaccination history is unknown (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed bya dose of Pneumovax 23 given 8 weeks later. This patient is in the highest risk group. Scenario 3: 50 yo M with chronic alcoholism who has not received any vaccine or unknown status (Group A). This patient should receive: 1 dose of Prevnar20 and be done, or Vaxneuvance followed by Pneumovax 23 one year later. Scenario 4: 43 yo M with previous Pneumovax 23 only (Group B). This patient should receive either: a single dose of Prevnar20 or Vaxneuvance and be done with either vaccine. Give either vaccine at least 1 year after Pneumovax 23. Scenario 5: 25 yo F with CSF leak and previously received Prevnar13 (Group C). This patient should receive Pneumovax23 or Prevnar 20 (if Pneumovax 23 is unavailable) at least one year after her las Pneumovax dose. Scenario 6: 35 yo M who previously completed Prevnar13 and Pneumovax in any order because he has a cochlear implant (Group D). This patient should NOT receive any additional dose. Research and MonitoringCDC and ACIP will continue to assess the safety of Vaxneuvance and Prevnar20 vaccines (the new kids on the block), monitor the impact of the implementation of new recommendations, and assess post-implementation effectiveness and recommendations as appropriate. Examples of risk factors to consider administration of pneumococcal vaccines: Chronic renal failure, HIV infection, alcoholism, cigarette smoking, chronic heart, liver, and lung disease. For a complete list of conditions, visit CDC.gov.___________________ A second booster shot of COVID-19 vaccines. By Hector Arreaza, MD.On March 29 and 30, 2022, CDC announced that a second booster dose of any mRNA COVID-19 vaccine may be given to certain individuals who are at risk of severe outcomes from COVID-19(1). Individuals who may choose to receive a second booster are: 1. People older than 12 years of age who have a moderate to severe immunocompromising condition. Remember, use Pfizer for older than 12 yo, and Moderna for older than 18 yo.2. People older than 50 years of age who are NOT moderately or severely immunocompromised.3. People 18-49 years of age who are NOT immunocompromised but received the J&J COVID-19 vaccine as both the primary and booster dose. When can you receive the second booster shot? At least 4 months after the first booster dose.Who is considered up to date? A person is considered up to date when he/she has received all recommended doses in their primary vaccine series, and a booster dose when eligible. A second booster dose is not required to be considered up to date at this time.Underlying medical conditions associated with higher risk for severe COVID-19 include: Cancer, obesity, cerebrovascular disease, diabetes mellitus, HIV, obesity, COPD, smokers, and chronic liver disease.Comment: Remember to give the second booster to your patients. ____________________Acne Treatment.  By Sarah Park, MS3, University of California Los Angeles. Discussed with Hector Arreaza, MD.  Definition: Acne vulgaris is a common inflammatory disorder of the pilosebaceous unit, which includes the hair follicle and sebaceous gland. It is characterized by chronic or recurrent development of papules, pustules, or nodules commonly on the face, chest, or upper back.(1,2) Acne affects nearly 50 million people in the U.S. per year and can cause significant psychological distress in those who are affected. It primarily begins at puberty when the production of androgens and/or sensitivity of androgen receptors increase, thereby commonly affecting adolescents and young adults.(2) Pathophysiology: The pathophysiology of acne involves four main processes: 1) sebum overproduction, 2) hyperkeratinization of the follicle, 3) bacterial colonization by Cutibacterium acnes, and 4) inflammation.(2,3) It can be classified as mild, moderate, or severe based on the extent and types of lesions.3Treatment: Treatment is selected based on the severity of the condition, patient preference, and tolerability. Acne treatment often requires long-term, consistent use of one or more medications.(3) The main objective of treatment is to decrease sebum production, get rid of extra keratin, treat infection and decrease inflammation. You can warn your patients that their skin may feel dryer and more scaly than usual, but that's part of the treatment. For mild and exclusively comedonal acne, topical retinoids like tretinoin are the treatment of choice(4), but topical retinoids can be used in any level of severity for maintenance. Examples: Adapelene, tazarotene, and tretinoin, For mild inflammatory papulopustular acne or mild mixed comedonal and papulopustular acne, topical retinoids may be used in combination with antimicrobial therapy (either combined with benzoyl peroxide or combined with benzoyl peroxide plus clindamycin or erythromycin). If patients cannot tolerate a topical retinoid, alternatives include salicylic acid and azelaic acid. Of note, oral or topical antibiotics should only be used in combination with benzoyl peroxide and retinoids for a maximum of 12 weeks. If unresponsive to these topical therapies, namely retinoids, benzoyl peroxide, and/or clindamycin, alternative therapies may be initiated. These include topical dapsone, minocycline, and clascosterone.Topical dapsone is an effective treatment for both inflammatory papulopustular and comedonal acne lesions. Topical minocycline is an alternative topical antibiotic used for specifically moderate to severe acne. And last but not least is topical clascosterone, a relatively new topical (specifically an androgen receptor inhibitor) approved by the FDA in 2020.(4)Treatment for moderate to severe acne: For moderate to severe acne vulgaris, management is systemic therapy. This includes oral antibiotics or hormonal therapies, often used in conjunction with topical therapy, or monotherapy with oral isotretinoin. 1. Oral antibiotics for acne vulgaris include doxycycline, minocycline, and sarecycline. Treatment should be limited to three to four months.(5)2. For female patients, hormonal therapy with oral contraceptives and/or spironolactone is also an option. A meta-analysis comparing oral contraceptive therapy and oral antibiotic therapy suggests similar efficacy for the treatment of acne. OCP treatment is often the first-line choice for hormonal therapy, especially for patients who desire the added benefit of contraception. Spironolactone is often used for patients who have contraindications to OCP therapy or prefer to avoid OCPs. Both methods work to inhibit acne by reducing the effects of androgen on the pilosebaceous unit.53. For severe, extensive, nodular acne vulgaris, oral isotretinoin is the drug of choice. It is given as a monotherapy and is often used when all other treatment modalities fail.  Oral isotretinoin is the only medication that can permanently affect the natural course of acne by affecting all four factors in acne pathogenesis. Isotretinoin is most notably known for its teratogenic adverse effects and so is contraindicated in pregnant women and pregnancy must be avoided during therapy by using two forms of birth control.(5)Comment about isotretinoin use: Although prescribing isotretinoin (brand name Accutane®) is within the scope of family medicine, many providers choose not to prescribe it because of lack of training, monitoring hassles, fear of side effects, especially due to concerns with teratogenicity. Isotretinoin is an effective treatment for a condition that can not only disfigure and scar the face but can also cause significant psychosocial dysfunction. Dr. Van Durme recommended when you prescribe isotretinoin, you should have a regular schedule of monthly laboratory tests (including pregnancy test), then office visit, and then prescription, in that order. This schedule will improve the likelihood that side effects are managed promptly and medication is taken appropriately(7). If you would like more information about prescribing isotretinoin, visit https://ipledgeprogram.com.Conclusion: Use topical retinoids alone for mild cases of acne; topical retinoids combined with benzoyl peroxide or topical clindamycin or erythromycin for moderate cases; and topical retinoids combined with benzoyl peroxide and oral antibiotics in severe cases. Remember that isotretinoin is an oral treatment reserved for severe inflammatory papules and pustules with nodules. Treating acne effectively can certainly improve the quality of life of your patients. Now we conclude Episode 90 “Vaccines and Acne”. We gave you an update on pneumococcal and COVID-19 vaccines. Prevnar 20 seems to be the new star in the show. PCV15 is also useful but it needs to be followed by a shot of Pneumovax 23. Regarding COVID-19 vaccines, a second shot may be given to patients older than 12 who are immunocompromised or patients older than 50 who are NOT immunocompromised. Then we finished with a discussion about acne and we learned that topical is usually enough for mild cases, but oral therapy may be needed in moderate to severe cases of acne. Even without trying, every night you go to bed being a little wiser. Thanks for listening to Rio Bravo qWeek. Send us your feedback by email to RioBravoqWeek@clinicasierravista.org, or in our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Timiiye Yomi, Amardeep Chetha and Sarah Park. Audio edition: Suraj Amrutia. See you next week!  References:Kobayashi M, Farrar JL, Gierke R, et al. Use of 15-Valent Pneumococcal Conjugate Vaccine and 20-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:109–117. DOI: http://dx.doi.org/10.15585/mmwr.mm7104a1 2. Pneumococcal Vaccination Timing for Adults, CDC. https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf, accessed on March 30, 2022. Interim Clinical Considerations for Use of COVID-19 Vaccines, Centers for Disease Control and Prevention, CDC.gov, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster, accessed April 5, 2022.  Thiboutot, Diane, MD; and Andrea L Zaenglein, MD. Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021 Oct 11;10:2021-8-6. doi: 10.7573/dic.2021-8-6. PMID: 34691199; PMCID: PMC8510514. Oge' LK, Broussard A, Marshall MD. Acne Vulgaris: Diagnosis and Treatment. Am Fam Physician. 2019 Oct 15;100(8):475-484. PMID: 31613567. Graber, Emmy, MD, MBA. Acne vulgaris: Overview of management, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-overview-of-management Harris C. Clascoterone (Winlevi) for the Treatment of Acne. Am Fam Physician. 2021 Jul 1;104(1):93-94. PMID: 34264597. Acne vulgaris: Management of moderate to severe acne, UpToDate. Accessed on April 1, 2022. https://www.uptodate.com/contents/acne-vulgaris-management-of-moderate-to-severe-acne Van Durme DJ. Family physicians and accutane. Am Fam Physician. 2000 Oct 15;62(8):1772, 1774, 1777. PMID: 11057835. https://www.aafp.org/afp/2000/1015/p1772.html

Oral Contraceptives should be avoided by certain Women. --- Send in a voice message: https://anchor.fm/dr-mcdaniel/message

The old adage, “Too much of anything is a bad thing”, is traditionally credited to Mark Twain. Was he right? Does the same apply to medical information?What about finding incidental genetic carrier states from online companies like “23AndMe”? In a patient with no personal or family history of any medical complication or malignancy, is this information helpful or more psychologically harmful? In this episode we will review a recent real-world case of how gynecological care was impacted by a patient's curiosity regarding her genetic makeup.

Orlando Sentinel Now afternoon update for Tuesday, Feb. 1, 2022. OCPS students must attend class or become homeschoolers; adult mask mandate on-campus extended (:41) Florida wants execution drugs hidden from you - and the companies that make them | Commentary (3:42)

The Week's Hyperlocal News: * This week's paper is full of West Orange Forecast for 2022 * An editorial statement from Austin: New Year.. No Change. * OCPS Wants to Place Its Buses in an East Winter Garden Neighborhood Austin's Final Message @08:38 #NewYearNoChange #OCPSBusCompound #EastWinterGarden Brought to you by: Foundation Academy | https://www.foundationacademy.net Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #FoundationAcademy #OCPS #BusCompound #EastWinterGarden #NewYear

The Week's Hyperlocal News: * This week's paper is full of West Orange Forecast for 2022 * An editorial statement from Austin: New Year.. No Change. * OCPS Wants to Place Its Buses in an East Winter Garden Neighborhood Austin's Final Message @08:38 #NewYearNoChange #OCPSBusCompound #EastWinterGarden Brought to you by: Foundation Academy | https://www.foundationacademy.net Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #FoundationAcademy #OCPS #BusCompound #EastWinterGarden #NewYear

Orlando Sentinel Now afternoon update for Wednesday, Jan. 5, 2022. Florida Surgeon General proposes children skip COVID tests (:32) OCPS logs record COVID-19 cases, Osceola high absentee rates (5:49)

Dr. Shannon M. Clark discusses the following with REI specialist, Dr. Lucky Sekhon @lucky.sekhon: •diagnosis of PCOS •irregular cycles and ovulatory dysfunction •biochemical and clinical hyperandrogenism •role of pelvic ultrasound in PCOS •workup for infertility in someone with PCOS •role of letrozole, clomid, metformin, gonadotropins and IVF in a fertility treatment plan for someone with PCOS •adverse pregnancy outcomes in those with PCOS •does getting pregnant fix PCOS •PCOS in those over age 35 •role of OCPs in PCOS •dietary recommendations •supplements and PCOS •beware of the influencers who are selling fertility and supplement products for PCOS! --- Support this podcast: https://anchor.fm/adoctordeliverspodcast/support

The Week's Hyperlocal News: * City News Bonanza in Winter Garden * Orange County Teachers Union is Fighting for Higher Pay * West Orange has Sports Talent * The Winter Garden Christmas Golf Parade Gets Postponed by a Near Tragedy and the lesson we should learn from it. Brought to you by: Foundation Academy | https://www.foundationacademy.net STORIES: @00:56 City of Winter Garden News from Latest Commissioner Mtg. @02:32 Local Nonprofit Brings Christmas Gifts to Foster Children @03:34 Young Olympia Highschool Student Starts Flying at 15 years old @05:14 #OCPS and Teachers Union Battle Over Wages @06:45 Hyperlocal SPORTS! @08:27 | Foundation Academy – Best Private Education in West Orange | SPONSOR @09:13 Hit and Run at Winter Garden Christmas Golf Cart Parade Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #FoundationAcademy #MerryChristmas #Christmas #GolfCartParade #WinterGardenGolfCartParade #GolfCartDistrict

The Week's Hyperlocal News: * City News Bonanza in Winter Garden * Orange County Teachers Union is Fighting for Higher Pay * West Orange has Sports Talent * The Winter Garden Christmas Golf Parade Gets Postponed by a Near Tragedy and the lesson we should learn from it. Brought to you by: Foundation Academy | https://www.foundationacademy.net STORIES: @00:56 City of Winter Garden News from Latest Commissioner Mtg. @02:32 Local Nonprofit Brings Christmas Gifts to Foster Children @03:34 Young Olympia Highschool Student Starts Flying at 15 years old @05:14 #OCPS and Teachers Union Battle Over Wages @06:45 Hyperlocal SPORTS! @08:27 | Foundation Academy – Best Private Education in West Orange | SPONSOR @09:13 Hit and Run at Winter Garden Christmas Golf Cart Parade Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #FoundationAcademy #MerryChristmas #Christmas #GolfCartParade #WinterGardenGolfCartParade #GolfCartDistrict

This week in Oklahoma Politics, KOSU's Michael Cross talks with Republican Political Consultant Neva Hill and Civil Rights Attorney Ryan Kiesel about the State Supreme Court overturning a $465M award against opioid manufacturers and the State of Oklahoma challenging the Biden Administrations order mandating vaccines or testing for private businesses with more than 100 employees, federal agencies and organizations with federal contracts including several Oklahoma universities. The trio also discusses a chastisement by Governor Stitt against Oklahoma City Public Schools after its board voted unanimously to fire six teachers for not following the school's masking policy and Oklahoma County Commissioner and former lawmaker Kevin Calvey announcing he is running for district attorney. Support this podcast

The Week's Hyperlocal News: *Ocoee Massacre is Remembered. *Your Newspaper Just got Bigger. *Turnpike Forces Defeated BY THE PEOPLE OF WINTER GARDEN. *A Tremendous event, that you will NOT want to miss out on! EVENT: https://bit.ly/3E5GOIJ Brought to you by: City of Winter Garden | https://bit.ly/3E5GOIJ , Foundation Academy | https://www.foundationacademy.net Stories: @00:53 #CityOfOcoee Remembers 101th Anniversary of #OcoeeMassacre @01:36 #WinterGarden Gets Huge Rescue Improvements @02:30 Winter Garden Residents BEAT #FDOT @03:16 #WestOrangeTimes & Observer EXPANDS! @05:19 #ReadingReindeer Program! Giving Books to Kids. @06:38 #WestOrange Student Receives Presidential Award @07:57 #OCPS allows children's parents to opt out of #Masks @08:25 Hyperlocal #SPORTS High Five! @07:50 #LionWitchAndTheWardrobe at #FoundationAcademy | SPONSOR @11:21 #HUGE Winter Garden Festival MUST GO THIS SATURDAY! CLICK: https://bit.ly/3E5GOIJ Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #GymnasticsUSA #FoundationAcademy #MayorDemings #OrangeCountyFireFighters #OCPS #Mask #Vaccine #OrangeCountyPublicSchools #TheresaJacobs Winter Garden Fall Heritage and Music Festival: The City of Winter Garden is hosting a daylong celebration of the community's historic roots. The Winter Garden Fall Heritage and Music Festival will take place on Saturday, November 6, from 8:00 am to 10:00 pm. The event will include 19 bands across five stages, street performers, sport games, a hay maze and fall activities, heritage exhibits, and much more for all ages to enjoy. Music and festivities will be throughout Downtown Winter Garden, as well as at the Sam Williams Little League Complex, and at Veterans Memorial Park! https://bit.ly/3E5GOIJ

The Week's Hyperlocal News: *Ocoee Massacre is Remembered. *Your Newspaper Just got Bigger. *Turnpike Forces Defeated BY THE PEOPLE OF WINTER GARDEN. *A Tremendous event, that you will NOT want to miss out on! EVENT: https://bit.ly/3E5GOIJ Brought to you by: City of Winter Garden | https://bit.ly/3E5GOIJ , Foundation Academy | https://www.foundationacademy.net Stories: @00:53 #CityOfOcoee Remembers 101th Anniversary of #OcoeeMassacre @01:36 #WinterGarden Gets Huge Rescue Improvements @02:30 Winter Garden Residents BEAT #FDOT @03:16 #WestOrangeTimes & Observer EXPANDS! @05:19 #ReadingReindeer Program! Giving Books to Kids. @06:38 #WestOrange Student Receives Presidential Award @07:57 #OCPS allows children's parents to opt out of #Masks @08:25 Hyperlocal #SPORTS High Five! @07:50 #LionWitchAndTheWardrobe at #FoundationAcademy | SPONSOR @11:21 #HUGE Winter Garden Festival MUST GO THIS SATURDAY! CLICK: https://bit.ly/3E5GOIJ Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter Garden App LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #GymnasticsUSA #FoundationAcademy #MayorDemings #OrangeCountyFireFighters #OCPS #Mask #Vaccine #OrangeCountyPublicSchools #TheresaJacobs Winter Garden Fall Heritage and Music Festival: The City of Winter Garden is hosting a daylong celebration of the community's historic roots. The Winter Garden Fall Heritage and Music Festival will take place on Saturday, November 6, from 8:00 am to 10:00 pm. The event will include 19 bands across five stages, street performers, sport games, a hay maze and fall activities, heritage exhibits, and much more for all ages to enjoy. Music and festivities will be throughout Downtown Winter Garden, as well as at the Sam Williams Little League Complex, and at Veterans Memorial Park! https://bit.ly/3E5GOIJ

"Inclusive educators believe in valuing student differences and supporting their learning needs to the greatest extent possible." Today, Drs. Lisa Dieker and Rebecca Hines sit down and talk to Anna O'Connor-Morin. Anna O'Connor-Morin is the Director of Education and Instruction at United Cerebral Palsy (UCP) of Central Florida's Bailes Campus. UCP Bailes is an OCPS public charter school for students with and without disabilities in a full-inclusion model. Please tune in to hear more about UCP and how they re-invent the classroom by bringing support, education, and therapy to children of all abilities.Don't forget we love to hear from our listeners! If you have any questions, feel free to reach out. We look forward to receiving your questions on our Google Phone (407) 900- 9305, Facebook (Practical Access), Twitter (@AccessPractical), or Instagram (@Practical_Access).To learn more about United Cerebral Palsy (UCP), click the link to view videos from their YouTube channel.Link: https://www.youtube.com/channel/UCvzlswbpXl3UKZ72zbvDcZg

Would you lose your job for standing on your convictions? Willing to fight for medical freedom and bodily autonomy not only for herself, but all students, teachers, and staff, former OCPS employee Naomi Gallawa did just that when she refused to wear a mask to her job as a school administrator and was subsequently publicly fired for it. Listen in as she shares her story of standing up to the corrupt Orange County School Board, why she did it, and her encouragement for those who might be ready to do the same. Support Naomi here: https://givesendgo.com/ngallawafreedom --- Support this podcast: https://anchor.fm/all-my-favorite-people/support

I'd like to welcome you to something a little bit different on the Battlefield Next network of podcasts. You all have I'm sure heard of the world-famous, hard-hitting, cutting edge discussions on society and technology, known as Ted Talks. Well . . . . we don't own any fancy skinny microphones, we can't trade in our OCPs for black turtlenecks, BUT we can and will bring to you a segment fondly known as Fred Talks. Join us weekly as the Army JAG Corps' Regimental Historian provides short glimpses of our institutional past. You can only succeed on the battlefields of tomorrow, IF you learn about the battlefields of yesterday, SO TODAY, it's time to settle in for our very first “Fred Talk” on the evolution of the JAG Corps. ***The views expressed on the podcast are the views of the participants and do not necessarily represent those of The Judge Advocate General's Legal Center and School, the Army, the Department of Defense, or any other agency of the US Government.

This Week's Hyperlocal News: *Speed Limit Change on Winter Garden Vineland Rd *Gotha Community Advocates Rally Against Turnpike Forces *OCPS Disables Your Comments *A BIG LOSS to the preservation of our local environment. Celebrating the life of Madison "Maddy" Trover GoFundMe: https://bit.ly/3AW6JRY Brought to you by: Gymnastics USA | https://www.gymnasticsusa.us Foundation Academy | https://www.foundationacademy.net Stories: @00:55 Speed Limit Change on Winter Garden Vineland Rd @01:34 United Cerebral Palsy of Central Florida @02:05 #WinterGarden Proclaims "Outdoor Dining Month!" @02:30 Gymnastics USA | SPONSOR @02:54 Windermere High School Mourns Death of Student @04:35 Gotha Community Takes on Florida's Turnpike @06:15 How to Get Your Hyperlocal News @07:21 Orange County Public Schools Bans Comments on Facebook @08:44 Hyperlocal SPORTS News! @10:14 Foundation Academy | SPONSOR @11:00 Jim Thomas Passes Away | Environmental Leader in West Orange Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter GardenApp LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur of Winter Garden and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com Follow Austin at: Austin Arthur of Winter Garden #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #GymnasticsUSA #FoundationAcademy #LakeApopka #FriendsOfLakeApopka #OCPS

This Week's Hyperlocal News: *Speed Limit Change on Winter Garden Vineland Rd *Gotha Community Advocates Rally Against Turnpike Forces *OCPS Disables Your Comments *A BIG LOSS to the preservation of our local environment. Celebrating the life of Madison "Maddy" Trover GoFundMe: https://bit.ly/3AW6JRY Brought to you by: Gymnastics USA | https://www.gymnasticsusa.us Foundation Academy | https://www.foundationacademy.net Stories: @00:55 Speed Limit Change on Winter Garden Vineland Rd @01:34 United Cerebral Palsy of Central Florida @02:05 #WinterGarden Proclaims "Outdoor Dining Month!" @02:30 Gymnastics USA | SPONSOR @02:54 Windermere High School Mourns Death of Student @04:35 Gotha Community Takes on Florida's Turnpike @06:15 How to Get Your Hyperlocal News @07:21 Orange County Public Schools Bans Comments on Facebook @08:44 Hyperlocal SPORTS News! @10:14 Foundation Academy | SPONSOR @11:00 Jim Thomas Passes Away | Environmental Leader in West Orange Show launches weekly on Thursdays 5AM: Podcast Channels and YouTube 8AM: Facebook Live ** Also available for listening on the We Are Winter GardenApp LISTEN via that app HERE: https://qrco.de/bbLWIe ** West Orange on the Go is hosted by Austin Arthur of Winter Garden and brought to you by the West Orange Times & Observer. #WestOrange! This is your news! “West Orange on the Go” hyperlocal news and comment. Please send Austin Arthur your feedback, questions, and ideas by visiting https://www.westorangeonthego.com Follow Austin at: Austin Arthur of Winter Garden #WestOrange #WinterGarden #Windermere #HorizonWest #WestOrangeTimes #ObserverMedia #Observer #AustinArthur #WestOrangeOnTheGo #GymnasticsUSA #FoundationAcademy #LakeApopka #FriendsOfLakeApopka #OCPS

Discussing the history of Oral Contraceptive Pills. --- Send in a voice message: https://anchor.fm/dr-mcdaniel/message

An estimated 8 million migratory shorebirds frequent the East Asian-Australasian Flyway (EAAF) annually. In recent years, global change has resulted in population declines of up to 80% in some species of this flyway. To greater understand the threat that pollution poses to migratory shorebirds of the EAAF, Toby Ross, through Deakin University, is studying three relatively common migrants that frequent Australian coasts every Austral summer. Ruddy turnstones, Curlew sandpipers and Red-necked stints act as good indicator species for the health of the flyway due to their diverse migration routes and strategies, foraging behaviours, and conservation status. The annual presence of these birds along the Australian coast allows us to ascertain population dynamics such as breeding success and rate of decline of these species through counts and continual banding studies, particularly by the Victorian Wader Study Group (VWSG). These field studies, predominantly along the Victorian coast and on King Island (TAS), have accrued a decade's worth of blood cell and serum samples, allowing us to gain an in-depth understanding of the pollutant loads these birds accumulate. Blood cell and serum samples continue to be analysed for pollutant data by his co-supervisor Prof. Veerle Jaspers and her team at the Norwegian University of Science and Technology. Toby has access to an extensive, unique set of data that allows him to examine accumulation dynamics of pollution in populations of shorebirds, looking into a range of heavy metal pollutants (for example, lead and mercury), as well as persistent, organic pollutants (POPs) which may include (but are not limited to) polybrominated diphenyl ethers (PBDEs) and organochlorine pesticides (OCPs) and per/polyfluoroalkyl substances (PFASs). Thus far, the primary contaminants Toby is looking at in these blood samples are PFASs. Toby is looking into pollutant load comparisons between his three chosen species to garner a broad understanding of pollutant loads in shorebirds, allowing comparisons to be drawn between their varying foraging and migratory strategies as well as population trends. Following these PFAS analyses, Toby hopes to further broaden my scope of pollutant analyses to include heavy metal pollutants such as lead and mercury, and other POPs as well – watch this space! Photo - Ken Gosbell Photo - Ken Gosbell   Photo - Ken Gosbell Currently trying to get some eyes and subscribers on The Bird Emergency on YouTube, so I can put a bit more effort into the video side of things, so if you would like more visual content, please subscribe, and I will watch with interest if that's what you want!

We sit down with Dr. Nathalie Duroseau to discuss ALL things OCPs, from hormone content to side-effect profiles. Find Nat on Instagram @Dr_Nat_HD for adolescent medicine and advocacy tips & tricks! 

Colorectal cancer screening update, COVID-19 vaccine update, and abnormal uterine bleeding basics.Today is May 24, 2021.Colorectal cancer screening update Written by Hector Arreaza, MD. Participation: Ikenna Nwosu, MD, and Daniela Viamontes, MD.Today is May 24, 2021.On august 29, 2020, we were in the midst of a pandemic and we woke up with the sad news about the death of Chadwick Aaron Boseman (also known as Black Panther). An interesting fact: The tweet in which his family announced his death on Twitter became the most-liked tweet in history. But why are we talking about Chadwick’s death? Because he died of colon cancer. I do not know if this recommendation came because of Chadwick, but it’s a good way to open this episode: remembering Black Panther.We heard the rumors, but now it’s official. On May 18, 2021, the USPSTF released their final recommendation statement about colorectal cancer screening. The age to start screening has been changed from 50 to 45 years old. This is a grade B recommendation. Grade B means that this recommendation has moderate to substantial net benefit, so offer this service to your patients. Screening adults between 76 and 85 years old who have been previously screened has a small net benefit (grade C recommendation). So, select patients may be screened for colorectal cancer in this age group (76-85), especially those who have never been screened.Do you remember this recommendation from medical school for high risk patients? Start screening at age 40 or 10 years before a patient’s direct-relative was diagnosed with colon cancer. This was a recommendation given by the US Multi-Society Task Force (which includes the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy). This same organization already recommended in 2017 to start screening at age 45 in African American patients, and the American Cancer Society recommended screening all patients at age 45 in 2018. The ACS does not have a guideline to screen high risk patients for colon cancer. Most organizations agreed on not screening after age 85.Strategies for screening:High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yearDani: Stool DNA-FIT every 1 to 3 years (Cologuard®)  CT colonography every 5 years Flexible sigmoidoscopy every 5 years OR Flexible sigmoidoscopy every 10 years + annual FIT Colonoscopy screening every 10 yearsDiscuss different options with your patients, choose your favorite and do it!  Introduction: Update on COVID 19 vaccines  By Hector Arreaza, MD, and Lillian Petersen, RN. COVID-19 vaccines now can be co-administered with other vaccines according to the ACIP. COVID-19 vaccines and other vaccines may now be administered without regard to timing. They can be given on the same day or within the 14 days previously recommended between vaccines.  It is not known if reactogenicity of COVID-19 vaccine is increased with co-administration with other reactogenic vaccines (such as vaccines with live attenuated viruses).  How do you decide if you want to co-administer a vaccine? 1. Consider whether the patient is behind or at risk of becoming behind on recommended vaccines.2. Consider their risk of vaccine-preventable disease.3. Consider the reactogenicity profile of the vaccines. If multiple vaccines are administered at a single visit, administer each injection in a different injection site, at least one inch apart or in different limbs. Current or previous SARS-CoV-2 infection: Everyone should be offered COVID-19 vaccination regardless of their history of COVID-19 infection. Viral testing or serologic test is not recommended for the purposes of vaccine decision-making. People with current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. This applies to patients who got the disease before receiving any vaccine or after receiving the first dose.  A minimum interval between infection and vaccination has not been established, but evidence suggests that the risk of reinfection is low in the months after initial infection but may increase with time due to waning immunity. People with a history of multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A):It is unclear if people with a history of MIS-C or MIS-A are at risk of recurrence of the same dysregulated immune response following reinfection with SARS-CoV-2 or in response to vaccination. People with a history of MIS-C or MIS-A may choose to be vaccinated but they should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis. Find more information at the CDC.gov website. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Abnormal Uterine Bleeding. By Sherika Adams, MS3, P. Eresha Perera, MS3, and Hector Arreaza, MD.  Definition. AUB is a symptom, not a diagnosis. It is equivalent to say: “This patient’s periods are abnormal.” Anything that falls out of what is considered “normal periods” is classified as abnormal uterine bleeding.These 4 elements are assessed when determining if a patient has AUB: Regularity, frequency, duration, and volume.  What is considered normal? Frequency = Every 24-38 days, regularity +/- 2-20 days over 12 months, duration = 4.5 to 8 days, volume = 5-80 mL. 10-30% of women of reproductive age may have AUB. According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is characterized by bleeding or spotting following sexual intercourse or menopause, between menstrual cycles, menstrual cycles lasting more than 38 days or shorter than 24 days, heavy bleeding during menstruation, and “irregular” menstrual cycles that have 7-9 days of variation.Terms no longer used: menorrhagia, metrorrhagia, and dysfunctional uterine bleeding (DUB). Not all symptoms reported as “vaginal bleeding” are coming from the vagina. For example, bleeding from anus, urethra, bladder, and perineum should be ruled out before establishing the diagnosis of AUB. Classification of Abnormal Uterine Bleeding (AUB). Abnormal uterine bleeding (AUB) in nonpregnant premenopausal women can be classified by the acronym PALM-COEIN, which was established by the International Federation of Gynecology and Obstetrics (FIGO) in 2011.  PALM-COEIN: Palm: Structural etiologies, Coein: Non-structural etiologies P is for polyps: Polyps are epithelial tumors in the endometrium or cervix and can be identified by hysterosonography or hysteroscopic imaging. A is for adenomyosis: Adenomyosis is endometrial stroma and glands in the myometrium and can be identified by histopathology, and now MRI and transvaginal ultrasound. L is for leiomyomas: Leiomyomas also known as uterine fibroids are benign smooth muscle tumors that are diagnosed by pelvic examination and pelvic imaging such as ultrasound with contrast or MRI. M is for malignancy and hyperplasia: Malignancy and hyperplasia are often abnormal epithelial tissue that is benign or cancerous that can be seen with transcervical endometrial sampling. C is for coagulopathy: Coagulopathy is bleeding disorders such as Von Willebrand disease is identified by laboratory testing. O is ovulatory dysfunctions: Ovulatory dysfunction occurs when there is a variation of more than seven days of the menstrual cycle in the past 12 months and ovulation is dysfunctional. In a woman without ovulation, there is no corpus luteum, and there is no progesterone, so estrogen goes unopposed, causing a buildup of endometrium and irregular bleeding.   E is endometrial causes: Endometrial causes can occur when there is normal ovulation, no other identifiable cause of AUB, and there is heavy menstrual bleeding, which includes intermenstrual bleeding. Primary disorders of endometrial hemostasis are likely due to vasoconstriction disorders, inflammation, or infection. Endometrial dysfunction is poorly understood; there are no reliable diagnostic methods, and it should be considered only after other causes are excluded. I is for iatrogenic cause: Iatrogenic causes include gonadal steroids (estrogen, androgens), anticoagulants, intrauterine devices, antipsychotics, antidepressants, and anti-hypertensives. N is for not otherwise classified: Example of an etiology under not otherwise classified might be AV malformations. This classification does not include pregnancy. Postmenopausal bleeding: Abnormal uterine bleeding can also occur in post-menopausal women and is an indication of potentially lethal endometrial cancer. Post-menopausal women should be worked up for cancer when they present with bleeding. However, most common cause of bleeding in this population is atrophy of the vaginal mucosa or endometrium. If younger than 45 patients but history of unopposed estrogen exposure (PCOS, obesity, estrogen therapy) should also undergo endometrial biopsy to rule out possibility of endometrial cancer.  Management of AUB. Management of the AUB can be initiated only after the etiology of the bleeding has been established. Firs of all, rule out pregnancy related bleeding by performing a pregnancy test. Also, rule out other sources of bleeding. The first question to answer would be: Does this patient need an emergent treatment for her AUB or can she be treated as outpatient? Determine that by checking the history, vitals, orthostatic vitals, physical exam, and labs.  If patient requires admission, the options for treatment include: uterine tamponade, intravenous estrogen, dilation and curettage, and uterine artery embolization. In case of severe bleeding without hemodynamic instability, patients can be treated initially with oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, or intravenous tranexamic acid.For chronic AUB, once etiology has been established, the goal is to treat the underlying condition. The goal of treatment is to control the bleeding since AUB can persists until menopause.  Initial outpatient treatment is usually pharmacological. For those not wanting to conceive soon, consider IUD placement. “Among medical therapies, the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is most effective for decreasing heavy menstrual bleeding (71% to 95% reduction in blood loss) and performs similarly to hysterectomy when quality-adjusted life years are considered.”[8] Other long-term medical treatment options include estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, NSAIDs (nonsteroidal anti-inflammatory drugs), and depot medroxyprogesterone. Surgical treatment is often considered for patients on long term medical therapy with no response, or for severe cases of bleeding with recurrent need for emergent treatment. Some surgical options are endometrial ablation, which performs as well as the levonorgestrel-releasing intrauterine system. Some structural lesions can be resected via hysteroscopy (polyps). Myomectomy and uterine artery embolization are options for patients with severe AUB who want to preserve fertility. Uterine leiomyomas or adenomyosis can be medically managed with OCPs but can also be treated with surgery as well, depending on the physician-patient discussion of options. Hysterectomy is the definitive treatment of severe AUB. Remember, PALM COEIN stands for: Polyps, Adenomyosis, Leiomyomas, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic cause, Not otherwise classified. ____________________________Conclusion. Written by Hector Arreaza, MDNow we conclude our episode number 53 “Abnormal Uterine Bleeding”. Eresha and Sherika did a great job explaining the Palm-Coein classification, and gave us a good overview of the management of AUB. Remember to start screening for colorectal cancer at age 45 now, what strategy for screening will you use? And for those patients who were hesitant about getting the COVID-19 vaccine with other vaccines, well, the ACIP said we can co-administer it with other vaccines. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Daniela Viamontes, Ikenna Nwosu, Lillian Petersen, Sherika Adams, and P. Eresha Perera. Audio edition: Suraj Amrutia. See you next week! _____________________References:U.S. National Library of Medicine, Clinical Trials.Gov, https://clinicaltrials.gov/ct2/show/study/NCT02026869. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Coadministration, accessed on May 20, 2021.  Colorectal Cancer: Screening, Final Recommendation Statement, U.S. Preventive Services Task Force, May 18, 2021, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Abnormal Uterine Bleeding FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding, accessed on May 17, 2021.  Fraser, Ian, et al. Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification, Up to Date, last updated: Dec 16, 2019. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-reproductive-age-women-terminology-and-palm-coein-etiology-classification?search=palm%20coein&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Goodman Annekathryn, et al, Postmenopausal uterine bleeding, Up to Date, last updated: Feb 02, 2021. https://www.uptodate.com/contents/postmenopausal-uterine-bleeding?search=abnormal%20uterine%20bleeding%20postmenopausal&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Kaunitz, Andre M, Abnormal uterine bleeding: Management in premenopausal patients, Up to Date, last updated: Aug 25, 2020. https://www.uptodate.com/contents/abnormal-uterine-bleeding-management-in-premenopausal-patients?search=abnormal%20uterine%20bleeding%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019 Apr 1;99(7):435-443. PMID: 30932448. https://pubmed.ncbi.nlm.nih.gov/30932448/ 

Orlando Sentinel Now afternoon update for Wednesday, May 5, 2021. OCPS students must get heart test to play sports, school board decides (:25) OCPS videos aim to reconnect students with the arts (5:18)

Heavy menstrual bleeding affects up to 30% of women. Combined hormonal contraceptives are a traditional treatment option to decrease menstrual flow. Oral TXA is also indicated for reduction of heavy menses. Is it safe to use both of them together? Is there an increased risk of VTE formation? In this podcast we will review a published commentary out of the journal Contraception which addresses this off-label use of TXA. (This article summary is also part of the ABOG MOC 2021 reading list).

Host:Shannon McClintock Miller, Future Ready Librarian Spokesperson and National Faculty Member, Future Ready Schools. District Teacher Librarian and Innovation Director, Van Meter Community School (Van Meter, IA). @shannonmmillerFuture Ready Schools Website: FutureReady.orgFree Future Ready Institutes: FutureReady.org/Institutes Twitter: @FutureReady Instagram: @FutureReadySchoolsFacebook: Facebook.com/FutureReadySchoolsFuture Ready Schools is a registered trademark of the Alliance for Excellent Education, located in Washington, D.C.#FutureReady

Lora Gilbert, senior director of Food and Nutrition Services, and Jamila Adams, menu and nutrition senior administrator, of OCPS explain how they've managed to feed kids during the pandemic while keeping options exciting.

Also ask yourself, did this study compare their treatment to the 'gold standard' and if the answer is no they compared it to a straw man, then think big Pharma, or authors that needed publication for their job. We can't treat what we don't know exist and 30-50% of the time COVID19 is asymptomatic. Combined Oral Contraception DO NOT have an increase risk of DVT and long term the risk are very minimal if a DVT does develop while on COC. Speaking of studies that should have never been done- Multicentre, prospective, randomised study comparing the diagnostic yield of colon capsule endoscopy versus CT colonography in a screening population (the TOPAZ study) | Gut (bmj.com) Diagnostic Yield of Colon Capsule Endoscopy vs CT Colonography in a Screening Population | PracticeUpdate The authors of this multicenter, prospective, randomized study compared the diagnostic yield of colon capsule endoscopy (CCE) with that of CT colonography (CTC) for colon cancer screening in an average-risk adult population. First you had either a CCE or a CTC and then the findings were confirmed with colonoscopy. The sensitivity and specificity of CCE for polyps ≥6 mm were 79.2% and 96.3%, respectively, compared with 26.8% and 98.9%, respectively, with CTC. The sensitivity and specificity of CCE for polyps ≥10 mm were 85.7% and 98.2%, respectively, compared with 50% and 99.1%, respectively, with CTC. They authors say this may work for people who refuse colonoscopy. Which is true it might but we have a fit test—it cost pennies—why in the world do we need this test?!? Its more money its more invasive its not better than FIT….. This is a study we didn’t need till I read the 30 line conflict of interest and I knew exactly why we needed this trial—to keep big pharm in business Colon cancer is scary cause most of the time we don’t know we have it and speaking of thigs we don’t know we have Asymptomatic SARS-CoV-2 Infections Among Persons Entering China From April 16 to October 12, 2020 | Global Health | JAMA | JAMA Network China controlled their cases because Beginning April 1, 2020, persons entering China via air, sea, or land have been mandatorily tested for SARS-CoV-2 infection by PCR test at border checkpoints. retrospective cohort study looked at All international entrants found to have SARS-CoV-2 infection via a positive PCR test result at China’s border checkpoints from April 16 to October 12 were included in this study. 3103 had confirmed COVID-19 cases, AMONG THOSE 1612 (51.9%) never developed symptoms through day 13 and were considered to have asymptomatic SARS-CoV-2 infection. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review: Annals of Internal Medicine: Vol 0, No 0 (acpjournals.org) Purpose: To estimate the proportion of persons infected with SARS-CoV-2 who never develop symptoms. And results found- about 1/3 of people had no symptoms and if you test positive and have no symptoms then about 75% of the time you will never have symptoms. WE will never be able to stop what we don’t even know about. WE can never and I repeat NEVER flatten a curve on something that you may not even know you have 33% of the time. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis | The BMJ Prescribe antidepressants for depression not for pain Design Systematic review and meta-analysis. Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Results 33 trials (5318 participants) were included. Back pain- serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). SNRIs reduced disability from back pain at 1-13 weeks around 1-3 points—TO WHAT SIGNIFCANT CLINCALY ON 100 point scale. osteoarthritis- SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks TCAs and other antidepressants did not reduce pain or disability from back pain. ReplyForward 8000 women from 2004-2006- to be included you could not be pregnant or postpartum and aged ≤ 50 years, without active cancer There were 220 women had either a first distal dvt, first prox dvt, or a first PE Of these women, 47.3% (n/N = 104/220) were on COC pills at the time of their VTE event. Overall, 27.6% of patients developed venous thromboembolism (VTE)

Orlando Sentinel Now afternoon update for Thursday, Jan. 28, 2021. OCPS, Orlando unveil high school program to improve police relations with Black community (:39) Darden donation to help bring mobile food pantries to places hardest hit by pandemic, including Central Florida (5:17) Florida Fresh Air: Cross Florida Greenway provides hiking, biking and equestrian trails (8:47) Weather presented by Premier Sotheby’s International Realty (13:50)

Episode 36: Birth Control and HTN.  Gonorrhea treatment update. Use of birth control in hypertension. Explanation of allodynia and hyperalgesia. Tips on contraceptives. Jokes.HAPPY NEW YEARS EVERYONE! Welcome to our first episode of 2021. We are full of hope and optimism for this new year, even though this year is looking just the same so far.Outdated treatment for gonorrhea: Ceftriaxone 250 mg IM and azithromycin 1 gram PO.Updated treatment of gonorrhea: On December 18, 2020, the CDC recommended a new treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhea with a single IM dose of 500 mg of ceftriaxone (instead of 250 mg). For patients who weigh more than 150 kg (300 lbs), the single intramuscular dose is 1 gram. If chlamydial infection has not been excluded, doxycycline 100 mg orally twice a day for 7 days is recommended (instead of azithromycin). However, azithromycin, 1 g PO single dose, is still recommended in pregnancy.Allergy to cephalosporins: In patients with cephalosporin allergy, a single 240 mg IM dose of gentamicin PLUS a single 2 GRAMS oral dose of azithromycin is an option.Expedited Partner Therapy – EPT: When permitted by state law, the partner may be treated with a single 800 mg oral dose of cefixime, and ADD oral doxycycline 100 mg twice daily for 7 days if chlamydia infection has not been excluded.Test of cure: A TOC is not needed for patients with uncomplicated urogenital or rectal gonorrhea who are treated with any of the recommended or alternative regimens. However, a test-of-cure is recommended for pharyngeal gonorrhea, 7–14 days after initial treatment. Retest: ALL persons treated for gonorrhea should be retested 3 months after treatment. If retesting at 3 months is not possible, we should retest within 12 months after initial treatment.Summary: treat urogenital, rectal, and pharyngeal gonorrhea with single IM dose of 500 mg of Ceftriaxone PLUS doxycycline 100 mg BID for 7 days.  This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ____________________________Interview to Dr Tammela by Dr Arreaza (unscripted)Highlights of the interview:What measurement is essential before starting combined oral contraceptives? The answer is blood pressure measurement.Dr Tammela is the chief of women’s health in Clinica Sierra Vista. She is a practicing OB/Gyn specialist. Some topics discussed during the interview includes: Why is blood pressure measurement essential before starting combined hormonal contraception?Contraindications to combined hormonal contraceptionThree scenarios and recommend what type of contraception should be used: Patient younger than 35, healthy, well-controlled hypertensionPatient older than 35, well-controlled HTN, or patient of any age with BP 140-160/90-100 mm HgPatient of any age with blood pressure >160/100Continued blood pressure monitoring after initiation of combined hormonal contraceptionWhen to stop CHCTIPS by Valerie Civelli, MD and Patrick De Luna, MS3Which OCP to choose?Tip #1:In general, higher estrogen in birth control pills (35mcg) means better cycle control but worse estrogen-related side effects: such as nausea or breast tenderness. Lower dose estrogen birth control, (typically 20 µg) are better for those experiencing estrogen related side effects and must be taken at the same time every day. Remember: the lower the dose of Estrogen means the higher risk of breakthrough ovulation and breakthrough bleeding. LoLo® is a great option!Dr. Karen Tammela, OBGYN, when asked about her OCP preference for patients, she states, “I pretty much always use monophasic pills. They seem in general to provide improved cycle control. I think most OB/GYN‘s agree...”Tip #2:For patients who c/o bloating, weight gain, hirsutism and acne, think about Yaz®, and its higher dose sister Yasmin®: Drosperinone + Ethinyl Estradiol. Yaz or Yasmin have a special type of progesterone, Drospirinone, which makes it unique. Tip #3:Yaz and Yasmin: Let’s talk about insurance coverage (Family Pact and Kern Health) 12-month Supply may be provided twice in one year. For a 3rd dispense of 12-month supply, TAR is required for prior authorization. If you see this med was not covered, it’s likely the patient has been prescribed two-12/month supplies OCPs already. Submit a TAR in this case for coverage.Tip #4:Yaz or Yasmin are special because it is not just a low androgen option (which is what you look for in a pill for patients in need of acne control), but it is actually an ANTI-androgen, so it is THE BEST OPTION for acne. It also is the best option to reduce pill related weight gain, as the progesterone element (drospironone) acts as a diuretic.  Did you know Drosperinone has antiandrogenic properties equivalent to 25mg of spironolactone? Tip #5:Menstrual headaches? Think Mircette®. Mircette® is good for patients with menstrual headaches, because it reduces the stark drop in estrogen that happens from the active pills to the placebo (and it is the drop that is believed to be the trigger for menstrual headaches) by having a smoother estrogen step-down effect and a shorter placebo pill length. In patients with migraines with aura, it is best to avoid Combined Hormonal Contraceptives, especially if older than 35. Speaking Medical: Allodyniaby Xeng Xiong, MS4Ouch my hair hurts! Are you serious? Yes. There is a condition where a person can experience pain from stimuli that isn't normally painful; the term is called allodynia. But wait, can that pain also be considered hyperalgesia? This is so confusing. Allodynia and hyperalgesia are both related to hypersensitivity to pain, so let’s break them down.  Allodynia is the feeling of pain caused by usually nonpainful stimuli, such as brushing your hair. Allodynia results from increased pain receptors. Some people with migraine may have allodynia and will often describe this experience by saying, “My hair hurts.” Hyperalgesia, on the other hand, is an increased numbers of action potentials and spontaneous discharges in response to painful stimuli leading to a lower threshold. This means a patient will experience more pain with a stimulus that was previously less painful. In practice, patients on high dose opioid may experience hyperalgesia and stroking on their skin can cause pain. The treatment for this condition is to lower the opioids dose.   In the mist of all this medical jargons, allodynia and hyperalgesia are referred to as hypersensitivity to pain. However, their pathophysiology is different. Allodynia is related to stimuli that are generally non-painful which becomes painful upon stimulation, while hyperalgesia is related to stimuli that are generally painful but becomes significantly more painful when stimulated. By this time if you’re still confuse, Allodynia = non-painful stimuli; Hyperalgesia = painful stimuli. I hope listening to this was not so painful for you[3].  For your Sanity: Jokesby Lisa Manzanares, MDFinland has closed its borders, no one can cross the Finnish line.Did you hear the rumor about butter? Well, I’m not going to spread it.A cheese factory exploded in France. Da Brie is everywhere.I have two dogs named Rolex and Timex. They are my watch dogs.The difference between a numerator and a denominator is a short line. Only a fraction of people would understand this.I know a lot of jokes about retired people, none of them work.Now we conclude our episode number 36 “Birth Control and Hypertension”. Dr Tammela explained that whenever you have a patient with uncontrolled hypertension, be alert of the contraindications to hormonal birth control. Dr Civelli and Patrick gave us some interesting tips on birth control pills, and Xeng explained the difference between allodynia and hyperalgesia.  Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Lisa Manzanares, Steven Saito, Valerie Civelli, Patrick De Luna, Xeng Xiong, and Mohammad Suleman. Audio edition: Suraj Amrutia. See you next week! _____________________References:St. Cyr S, Barbee L, Workowski KA, et al. Update to CDC’s Treatment Guidelines for Gonococcal Infection, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1911–1916. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm?s_cid=mm6950a6_w#B1_down Onusko, Edward, M.D., Diagnosing Secondary Hypertension, Am Fam Physician. 2003 Jan 1;67(1):67-74. https://www.aafp.org/afp/2003/0101/p67.html#afp20030101p67-t1. Zeng, Thomas, MD, Comprehensive Handbook, Obstetrics & Gynecology, Second Edition, 2012 by Phoenix Medical Press LLC, pages 176-178.

On this second episode of this series dedicated exclusively to the female cyclist and endurance female athletes, we are talking again with Kirsty Elliott-Sale and Eimear Dolan about the role of oral contraceptive pills (OCPs) and exercise performance. This episode was based on a recent Meta-Analysis published by the guests themselves on Sports Medicine and they'll tell us what they found. Do OCP users have a lower performance when compared with naturally menstruating women? Is performance superior in OCP taking days vs. OCP withdrawal days? Tune in to find out.

Orlando Sentinel Now afternoon update for Friday, Oct. 2, 2020. President Trump, 74, has mild COVID-19 symptoms (:55) OCPS looks to boost base teacher pay to $47,000, meeting state goal (4:57) COVID-19 hospitalizations in Central Florida hit plateau; experts worry people will let down their guard (7:35) Scream n' Stream and Tunnel of the Damned: First look at 2 new Orlando Halloween attractions (11:07) Weekend weather forecast (14:52)

Dr Kristi Milley spoke to Dr Rebecca Bergin research fellow at the Cancer Council Victoria and member of PC4’s Early Researcher Career Network. Rebecca recently published a paper in the journal of Cancer Policy entitled “Optimal care pathways: A national policy to improve quality of cancer care and address inequalities in cancer outcomes?" Rebecca highlights that the OCPs specify the key features of cancer care across the whole pathway - from prevention to end of life.  Rebecca emphasises that primary care is an integral part of the OCPs and explains how they have had a unifying effect in Australia in establishing the best cancer care that all people should receive.

Orlando Sentinel Now afternoon update for Thursday, Sept. 24, 2020. More than 15,700 OCPS students want to return to campuses next month (1:14) Florida protest laws could be harshest in nation under DeSantis proposal (4:00) Orlando fall festivals and corn mazes: How to celebrate the season safely (8:30)

Orlando Sentinel Now afternoon update for Monday, Sept. 21, 2020. COVID-19′s latest toll in Central Florida: Rising drug overdoses, mental health issues (1:02) OCPS faces laptop shortage, asks parents to return school devices if they have others (5:54) Orlando City thrashes Chicago Fire; Orlando Pride fend off North Carolina Courage in scoreless draw (8:57)

Back to school moral booster. How to respond to the anxiety that New Normal triggered? In this episode, I interviewed a teacher who explained to us OCPS choices. And how the faculty's member are taking action to receive our kids for face-to-face learning. Share & Subscribe and support this podcast. --- Support this podcast: https://podcasters.spotify.com/pod/show/maria0564/support

Your patient is a 22 yo female who has tested positive for SARS-CoV2. Will you keep her on her estrogen containing birth control? In this podcast, we will cover the ACOG response to this clinical dilemma as well as provide updated information from a soon to be released commentary in ENDOCRINOLOGY.

The following episode is a didactic activity. Our goal is teaching family medicine residents about these diseases and prepare them to treat their patients. We hope those who are suffering from these diseases do not find this activity offensive. May you find an appropriate treatment and get better. Consult your own family medicine doctor to learn more. Similar but different, sound-alike but opposite, analogous but heterologous. Welcome to the Sick Duel, an epic comparison between two merciless opponents. Our rivals today are: Ulcerative Colitis, “I will show you how to ulcer”; and Crohn’s Disease, “I will drill your guts”. Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the GI tract. Ulcerative colitis and Crohn's disease are the main representatives of these disease. Today we will hear why they don’t get along and hopefully we’ll come to a good end. Here we have our first guest Arreaza: Who are you?UC: Ulcerative Colitis is the name, and inflammation is the game. They say to save the best for last, so I tend to stick to the rectum and distal colon.  I like to come and go (no pun intended), creating episodic, mucinous diarrhea for my victims that is usually bloody.  I can be mild or severe, depending on the extent of mucosal involvement and level of inflammation.  Arreaza: How do you manifest?UC: I like to make my victims as uncomfortable as possible, creating urgency, pain, and constipation, while leaving them with a feeling like they aren’t “done” yet (aka tenesmus).  Arreaza: I thought you said diarrhea, and now you mention constipation?UC: Yes, I may cause periods of constipation when I am merciful, but diarrhea when I am cruel. Regardless of the thickness of the stools, I give them a mucinous and usually bloody discharge, sometimes leading to anemia. I like to attack extra intestinal organs such as the skin (causing pyoderma gangrenosum and erythema nodosum), the eyes (causing uveitis), and the joints (causing arthritis). Yes, my aunt Cronh’s can do some things right!6. Arreaza: I’ve heard Ms Cronh’s is really mean. Where else do you go?UC: Occasionally, I’ll make my way to the liver and cause primary sclerosing cholangitis.  My primary goal though is creating crypt abscesses and ulcerations.  If I’m lucky enough, I can progress to a fulminant, toxic level creating systemic symptoms and abdominal distention.  I hope to eventually make my way out of the GI tract through perforation (who doesn’t like a pinata?). Arreaza: I can see why your last name, colitis, can be deceiving, you can actually get out of the colon… Who are more likely to be your victims?UC: I like to run in families. I prefer people who eat lots of fatty foods (Standard American Diet anyone?), high omega-6:omega-3 ratio, with history of previous bouts of gastroenteritis.  HLA autoimmune association, especially HLA-DR2. Even though smoking is a risk in many diseases, in my case, cigarette smoking may protect my victims from my attack, but if they smoked before and quit, I have a better chance to show up.Arreaza: How do you get caught?UC:  My victims tend to have chronic diarrhea for at least four weeks.  Because I am an inflammatory villain, many inflammatory tests can be non-specific such as ESR, fecal calprotectin/lactoferrin, etc.  Therefore, if you want me, you’re gonna have to come and get me.  Beware of your hospitalized patients, as a colonoscopy will greatly increase my ability to form a toxic megacolon and perforation!  Flexible sigmoidoscopy is recommended and will show you crypt abscesses, friable mucosa, decreased vascular markings and my continuous pattern of inflammation, yes, continuous, you gotta be consistent, unlike Ms. Crohn’s who likes skipping like a loser! How do you get eliminated? (What humans call treatment)UC:  When my victims aren’t suffering as much as I’d like, those doctors first like to throw anti-inflammatories at me (such as mesalamine).  If that doesn’t work, they’ll throw in some steroids. However, if I’ve really done my job, then treatment usually starts with some immunomodulators (Azathioprine, Infliximab, etc.) followed by steroids with the goal of inducing remission.  If all else fails, they’re just gonna have to remove me along with my victims’ colon, so surgeons are their last resource to get rid of me!Arreaza: What determines how bad you will be? (Prognosis)UC:  Several factors influence my prognosis such as age of onset. Victims older than 50 have more chances to have a steroid-free remission. I hate smoking! Smoke does not let me grow, so when a patient quit smoking I can be more aggressive. When the intestinal mucosa heals early in the disease, my victims have a better prognosis. My chance of extension is higher in more distal areas, for example, patients with proctitis have 50% chance of extension. If my victims had an appendectomy before age 20, they have less chances of hospitalization and colectomy. With treatment, my victims may experience long periods of symptomatic remission along with intermittent exacerbations, although a small percentage may continue to have chronic symptoms and are less likely to achieve remission. The latter may require lifelong therapy or possible colectomy (Physicians 1, Me 0).  Ulcerative colitis, you really know how to ulcer. Now we invite our next guest.Arreaza: Who are you?Crohn’s: Hi everyone, I’m Crohn's disease and unlike UC I don’t only affect the colon but I can affect any area of the GI tract from the mouth to the anus. Not only can I affect the whole GI tract but also, I can affect all the layers of the GI wall. Doctors like to call that “transmural inflammation”. Also, I can be sneaky, showing symptoms for a long time before diagnosis or I can happen all of a sudden and be diagnosed acutely.How do you manifest?Crohn’s: There are a few ways I can show up, but mainly I cause crampy abdominal pain, diarrhea either bloody or non-bloody, fatigue and weight loss. If I’m only located in the distal ileum, then I will give you right lower quadrant pain. Since I have transmural inflammatory forces, I can cause formation of sinus tracts that can result in abscesses or phlegmons. Phlegmon is a word that a lot of radiologist like to use and it pretty much means the formation of an abscess but not yet an abscess, so it can’t be drained but can treated with antibiotics. Sinus tracts can end up in microperforations or even fistulas. A fistula is when a connection forms between two tissues that are not supposed to be connected and, yes, it kinda sucks for my victims, especially when this connection happens between the bladder and the colon and you end up with urine mixed with feces coming out of either end. Ohh and if it connects from the GI tract to the skin then you may have continuous leakage of feces. WOW! I’m terrible, I know…Arreaza: You are really mean!On a lighter note, sometimes I cause no symptoms… at least not for a while until I make your GI tract so narrow that you defecate less frequently and end up having pain, and eventually your tract becomes obstructed. Man, yeah this pretty much sucks too. My bad!Arreaza: I know you have more, tell us more about you.I almost want to stop telling you anything else but there are a few more things. For example, I could give you aphthous ulcers in the mouth, pain in the esophagus or difficulty swallowing, abdominal pain, watery diarrhea, steatorrhea or oily diarrhea. OMG there's a bit more; last but not least some people may also have: arthritis of large joints, skin disorders like erythema nodosum or pyoderma gangrenosum and very few will experience hepatobiliary involvement such as primary sclerosing cholangitis or even eye issues like uveitis, iritis and episcleritis… among others.Arreaza: You and your nephew UC really like going out of the GI tract, but I think you are more adventurous. Who are more likely to be your victims?Crohn’s: Unlike UC, I actually like smokers, smoke helps me thrive! Those who have antibiotic exposure are at risk, also those with increased fats in diet, and maybe a little increased risk with NSAIDs and OCPs. Appendectomy may be a result of hidden CD vs a risk factor. If you want to avoid CD, high fiber and a Vit D supplementation are associated with decrease risk of CD. If you were breastfed, you have lower risk to get CD.How are you caught? (diagnosis)Crohn’s: You can usually suspect CD when there is a combination of suggestive features, such as RLQ pain, chronic intermittent diarrhea, fatigue and weight loss. Laboratory tests can show anemia, vitamin B12 and Vitamin D deficiency (malabsorption). Diagnosis is made certain via imaging, endoscopy and histological findings that show the aforementioned “transmural inflammation”. I think everyone will remember this “transmural inflammation” sign.How can your victims fight you? (treatment)Crohn’s: The treatment will be different depending on where I’am at, how bad I am and whether you want to stop me or keep me quiet. If I’m mild, then you can use oral 5-aminosalicylates like sulfasalazine or mesalamine, glucocorticoids, immunomodulators such as methotrexate or azathioprine; and biologic therapies such as infliximab, adalilumab, etc. Yep, these are some pretty tough names to combat a tough disease like me!If I am moderate to severe then you’ll need a combo of meds: anti-TNF like infliximab plus an immunomodulator. The GI doctors are my archenemies! What determines how bad you will be? (prognosis)Crohn’s: It can vary, most of the patients will experience a continuous progression while about 20% of patients can experience remission after initial presentation. Risk factors for progressive disease are smoking, age

Are you thinking about starting a family and having a baby? What should you eat? How do you know when you are fertile? Are there specific foods that are optimal for genetic health for both you and the baby? Join Anisa Woodall real-food certified nutritionist and natural mama as she discusses conscious conception and how to prepare for the healthiest pregnancy, birth, baby and life with a little one on Episode #008 of The Genetic Genius Podcast. Some of the fertility and conscious conception topics we discuss on this week's show. 1. What's conscious conception? 2. Does being on the pill for for 10+ years and not having a normal cycle effect fertility? 3. Are their possible side effects to being on OCPs long term? Nutrient deficiencies? 4. Are there specific micronutrients to be tested prior to conception? 5. What about hormone testing? 6. What's a normal cycle look like and how can you chart it? 7. How do you know when you are ovulating? 8. What's a menstrual calendar journal? 9. What are specific supplements that can assist with estrogen metabolism. 10. How do genetic variations effect fertility? Watch it on youtube here: https://youtu.be/ydCDQ1_kWAY

This episode celebrates OCPS' historic decision to proclaim October a month-long annual observance of the history and related civil rights movement of gay rights.

Polycystic ovary syndrome (PCOS) is more common than we think!  Listen as our esteemed guest Dr Katherine Sherif (@katherinesherif) reviews common patient complaints that should trigger PCOS in the differential, its pathophysiology, key physical exam findings, an algorithm for lab evaluation for PCOS diagnosis, and common treatments (OCPs, metformin, spironolactone and more!). Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Molly Heublein, MD Cover Art and Infographic: Kate Grant MBChB DipGUMed  Hosts: Matthew Watto MD, FACP; Molly Heublein, MD Editor: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Katherine Sherif, MD Sponsors AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.   Primary Care Physician Opportunity in beautiful Ithaca, NY! Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.  Time Stamps 00:00 Sponsors - AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/ 00:35 Intro, disclaimer, guest bio 03:00 Guest one-liner, book recommendation; Picks of the Week*: The Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, by Dr BJ Miller and Shoshana Berger; Overdrive App to download audio books and other media from libraries 07:58 AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/ 09:30 Case of PCOS; Definition; Common presenting complaints 14:40 Hirsutism and terminal hair growth 17:05 Alopecia 20:25 Acne; Hidradenitis suppurativa 23:05 Irregular menses; Lab workup; Non-classic congenital adrenal hyperplasia 28:38 Hyperandrogenism lab workup (Testosterone, DHEA-S, Anti-Mullerian Hormone, utility of LH and FSH); Quick word on US 37:15 Recap of how to diagnose PCOS 38:15 Insulin resistance, body habitus in PCOS 40:04 Pathophysiology in PCOS (two schools of thought: Hypothalamus vs Insulin) 43:27 Dr. Sherif’s spiel to patients newly diagnosed with PCOS 46:40 Long term risks in PCOS 50:35 Approach to treatment of PCOS (OCPs, metformin, spironolactone, hair removal) 60:35 Treatment of alopecia; Lifestyle factors 63:55 Take home points and Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will explain the basic pathophysiology, diagnosis, and management of PCOS. Learning objectives After listening to this episode listeners will…   List the criteria for diagnosis of PCOS. Explain the relationship between PCOS and metabolic risks. Determine first line treatments for PCOS symptoms including oligomenorrhea, hirsutism, acne and alopecia.  Counsel patients on long term risks associated with PCOS and how to mitigate these. Disclosures Dr Sherif reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Sherif K, Heublein M, Grant K, Okamoto E, Watto MF.  “#198 PCOS: Polycystic Ovary Syndrome with Katherine Sherif MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 9, 2020.

As the district commemorates its 150 anniversary, Chartine and Tammi celebrate their combined 70 years of experience within OCPS.

We're heading back into the world of adolescent medicine to talk about contraception. We'll cover OCPs, IUDs, LARCs and more to have you ready for your next exam and to keep your patients from having babies of their own until they're good and ready

Learn why Melissa Pappas, the current Orange County Public Schools’ Teacher of the Year, chose to teach students who cannot advocate for themselves.

Because of the increased risk for breast cancer, BRCA mutation carriers may have concerns about taking oral contraceptives or using hormone replacement therapy after a premenopausal prophylactic bilateral salpingo-oophorectomy (removal of the ovaries and fallopian tubes). Here, we review the current literature about hormone use by BRCA mutation carriers.

In this podcast, Dr. Mark Damario, a Reproductive Endocrinologist and Infertility Specialist with the Center for Reproductive Medicine, presented at Ridgeview Medical Center's Live Friday CME Series on May 24, 2019. At this event, Dr. Damario provided insights to the emerging roles of assisted reproductive technologies. Enjoy the podcast! Objectives:    Upon completion of this podcast, participants should be able to: Describe the role of assisted reproductive technologies for infertile and non-infertile conditions. Differentiate the various forms of assisted reproductive technologies. Identify changes and new developments in assisted reproductive technologies. CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. Click on the following link for your CME credit: CME Evaluation: "Update in Assisted Reproductive Technologies" (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.”   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES:  INTRODUCTION: Dr. Damario is the medical director of the Center for Reproductive Medicine in St. Paul, MN; and is a practicing reproductive medicine specialist who earned his medical degree at the Medical College of Virginia, and completed his OB/GYN residency there as well. He then went on to complete fellowships in reproductive surgery at Emory University and reproductive endocrinology at Cornell. We were delighted to have him join us on May 24, 2019, to provide his insights and updates on assisted reproductive technology. CHAPTER 1: ART (assisted reproductive technology) was initially done in rabbit models, and then the first successful IVF birth in humans in 1978. Use of oocyte donation in 1983, a surrogate mother in 1986. Pre-implantation genetic dx in an embryo in 1989, and a single sperm injected in an egg in 1992. These were major breakthroughs. Where is ART these days? There are over 500 clinics in the U.S. that contribute for the most part to the national database on stats for ART. Ultimately, there are over 65,000 live births, and the percentage is now about 1.9% of total babies born now in the U.S.   Forbes.com in 2012, estimated 900,000 approximately conceived persons in the U.S. derived from IVF. That's about 305 people at Times Square bumping into each other on any given day. In 2017, the trend of multiple pregnancies in IVF and ART has come down. This issue has been contentious in the field of ART. Triplets in particular happen less often. Less than 1% from 7% in the mid-1990s. Twins have decreased in rate as well. Oocyte cryopreservation has continued to increase, as it is much more efficient now for donor and fertility preservation. More elective single embryo transfers as well. Indications for IVF include: Tubal factors such as occluded or absent tubes are indications, Male factors, such as severe oligospermia is also an indication for IVF. Advanced endometriosis and failed induction of ovulation, diminished ovarian reserve, unexplained infertility and a variety of specific conditions, such as the need for pre-implantation genetic diagnosis are also indications. Dr. Damario's program treats women age less than 45 with their own eggs and less than 50 with donor eggs. Smoking is a contraindication. BMI is also an issue for patients. Assessment of the woman will include antimullerian hormone (which has key roles in folliculogenesis), basal antra follicle count by U/S (an ovarian follicle in the latter stage of formation) and less often day 3 FSH and estradiol. Sonohysterography or saline hysterography, semenalysis, and sperm penetration testing, cervical canal evaluation, testing for Hep B and C, HIV and Syphilis are also performed ahead of time. How does the treatment phase of IVF work? Pituitary inhibition needs to happen in order to suppress the LH surge before oocyte retrieval. OCPs are given ahead of time to suppress other ovarian cysts, and to help start some of the later fertility medications. Pituitary suppression with Lupron or antagonists, such as Ganorelix. The gonadotropins are given after withdrawal bleeding from discontinuation of the pill and for about 8 to 12 days. Ultrasounds for follicles and estradiol accounts are performed. HCG is then given if all looks well with the above steps. It is similar to LH and then oocyte retrieval is scheduled 36 hours later. This is a precise action so as to not have egg immaturity or have ovulation occur. Embryo transfer then happens on the 5th day, most commonly. Usually then a pregnancy test happens on the 9th day. egg retrieval occurs transvaginally with ultrasound guidance. This is a day surgery procedure, and is generally tolerated well. Dr. Damario shows a short video of the procedure at this time. The embryologist takes the follicular fluid to ID eggs. They are graded for maturity, and they simultaneously prepare sperm. Eggs are incubated, then are exposed to sperm. They are observed the following day, embryos cleave and then on days 3 to 5, the embryo is transferred. A mature egg is actually the largest cell in the human body, and is surrounded by a clump of cells called a corona. Micro-droplet of sperm onto the egg and intracytoplasmic injection of a single sperm injected into the egg can also be done, especially if sperm quality is lower. The embryo is then cultured and grown, with cell division occurring daily and exponentially. A morula, which is many cells, is followed by a blastocyst forming, which is an expansion with an inner cell mass and fluid space. At this stage, the embryo is felt to be doing well. If they're not doing well, the embryo won't be chosen for transfer. Egg fertilization occurs at a rate of about 75%. The embryo is transferred into the uterus with transabdominal U/S guidance as it is placed into the uterus. Little to no anesthesia is required for this. CHAPTER 2: Outcomes are impacted by age to a fair degree, obviously higher (success) in younger women. The older the patient the less likely it will take effect. Cryogenically preserved embryos are doing well in transfer, in fact slightly better in some cases than traditional transfer. Risks of IVF include: multiple pregnancies, ovarian hyperstimulation syndrome, bleeding and infection, which are rare. Adverse pregnancies such as ectopic and miscarriage can occur. There is a possibility of subtle increase in congenital anomalies. Third party reproduction options include: oocyte donation from someone, sperm donation, embryos donated and gestational surrogate. This involves gestational carrier of the couple's own embryo. Oocyte donation is performed win carious ovarian failure conditions in general. Anonymous donors are screened very well, and hopefully in a hormonally synchronized recipient. They will be maintained on hormones through the first trimester in most cases. Oocyte donation has a very good success; especially with the improvement of cryopreservation. In older women, for instance up to age 45, there is good success with this procedure. Beyond 45 yo, there is lack of sufficient data to support doing this. Gestational carrier is indicated when there is no uterus, uterine complications, substantial risk to patient due to other conditions, same sex male couples for instance. Fertility preservation is performed in instances of cancer treatment. These include oocyte, sperm and embryo cryopreservation. These are experimental, but are coming down the pipeline in the future. Fertility preservation is not a guarantee that it will work but the odds do go up proportionate to the number of eggs frozen; although this does decline the older you are. Preimplantation genetic screening: random chromosome abnormalities, or embryonic aneuploidy is screened for more often now. Age of the woman is an impact, although problems can be derived from sperm too, but there is no age impact in men. Embryos can be screened for such things as SC disease and CF. Now embryos are biopsied at day 5, and the trophectoderm (outer layer) is sampled for this. The embryo is the frozen after biopsy. These samples are sent to national labs for this. Usually, affected embryos will not be transferred. Next generation sequencing testing modalities are used commonly now. A significant proportion of anuploid embryos are found now, actually. It appears, for instance, that women who are of older gestational age, are to benefits most from genetic testing. Gestational carrier cases are also good reason for genetic testing, since the surrogate will be taking on a significant risk in carrying the child. CHAPTER 3: Evolving ART.  Major advances have been made in many areas. Cryopreservation, genetic testing and counseling, etc. We're not quite there yet with oocyte in-vitro maturation. Essentially embryonic stem cell therapy is still being done, but more adult stem cells are being used. Mitochondrial transfer therapy for mitochondrial diseases are being done in the U.K.  Germ line gene editing, for instance, to have HIV protection, has come up at a recent conference. This is in the very early stages of development though. Question from the audience: Pre-implantation genetic diagnosis - how many things can be screened for? PGS is still for a limited list of conditions, mostly the disease conditions are monogenic. Sex chromosome reports are also obtained. But, this is not done only for sex selection, especially in fertile couples. When appropriate, this can be chosen, however.  There is a slight chance of error, but certainty is very high. Other questions included freezing of eggs. Not only in dire circumstances such as cancer, but also for women who may want to wait to have children for any variety of reasons. Vitrification is the method used for this now which is essentially "flash freezing" and has been perfected over the past 7-8 years. Also, Dr. Damario mentions that studies show that visualized hydrosalpinx on U/S is associated with poorer IVF outcomes. Salpingectomy can improve chances with this. Cost is also addressed, and of course when insurance doesn't cover the cost of ART, there is a significant expense to the patient. Screening tests are commonly covered by insurance. Finally, Dr. Damario comments on a question regarding egg transfer. Transferring eggs to someone else is not a simple task and is governed by the FDA, much like transplant surgery.  

Weight gain is commonly cited as a side effect of combination oral contraception, and is amount the top reasons for pill discontinuation. Do birth control pills make women gain weight? Where did this perception come from? What does the data show? In this session we will review systematic reviews and the Cochran database regarding this subject.

Listen to the podcast for why each multiple choice answer is right or wrong!1. A 21 YO F who is taking OCPs presents to the ED with increasing SOB starting 4 hours ago. On PE she’s tachycardic and has tachypnea at 23 breaths a minute. Her BP is 120/80. She has wheezing to all lung fields and appears to be in moderate distress. Both calves are mildly edematous and somewhat tender. What will you do next?A. CT chest B. Chest x-ray C. Ventilation to perfusion scan D. Pulmonary arteriography E. MRI chest2. A 33 YO M presents for an evaluation of a chronic cough for the past 6 months. He does not smoke and does not report any seasonal allergies. He denies any systemic complaints such as fever or weight loss, and does not have any symptoms of heartburn or regurgitation or runny nose. He does not take any medications. Lungs are clear to auscultation and a chest x-ray shows no acute disease. He reports having tried bronchodilators and Claritin recently with no symptomatic improvement. What is the next step?A. A trial of a proton pump inhibitor B. Pulmonary function tests to r/o COPDC. 24-hour pH monitoringD. Start z-pack for subclinical URIE. Methacholine inhalation test3. An 18-year-old F presents complaining of a very sore throat, swollen lymph nodes in her neck, fever, and general malaise for the past 2 days. She’s febrile at 102.2°F, has enlarged exudative tonsils, tender cervical lymphadenopathy, rapid strep screen is negative. What additional PE findings will you most likely find? A. Increased monocytes on white cell differential B. Enlarged spleenC. IgA antibodies for Epstein-Barr virusD. Decreased atypical lymphocytes on white blood cell differentialAnswers1. D. Pulmonary arteriography2. A. A trial of a proton pump inhibitor3. B. Enlarged spleenWells' Criteria for Pulmonary Embolism: www.mdcalc.com/wells-criteria-pulmonary-embolismPERC Rule for Pulmonary Embolism: www.mdcalc.com/perc-rule-pulmonary-embolismLung sounds: www.youtube.com/watch?v=TlgP8MzlMawFeel free to reach out with questions and suggestions at leonardsee94@gmail.com. IG: @lenny_see

Introduction: Many patients who were diagnosed as polycystic ovary syndrome- (PCOS-) related acne were not capable of sustaining or beginning oral contraceptive pills (OCPs) due to pill scaring, contraindications of OCP use, migraine, or smoking. In this situation, oral isotretinoin treatment may become an important option for PCOS-related acne. The aim of the study was to determine the effects of isotretinoin treatment on PCOS patients who were complicated with severe cystic acne. Materials and Methods: This study consisted of 40 female patients diagnosed as PCOS complicated with severe cystic acne. These patients were not eligible candidates for OCP use due to migraine, thrombophilia, heavy smoking, or pill scare. To establish baseline values of hormone levels, on days 2–5 of the menstrual cycle, venous blood samples were obtained. Moreover Modified Ferriman-Gallwey (mFG) score, acne score (AS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment. Results: Isotretinoin treatment significantly decreased Ferriman-Gallwey score, free testosterone, insulin level, hemoglobin level, acne score, and ovarian volume. Increased triglyceride and cholesterol levels were detected after treatment. Conclusion: Isotretinoin treatment may have beneficial effects on free testosterone, insulin, acne score, and Ferriman-Gallwey score. Solely isotretinoin administration may supply adequate healing in PCOS patients' symptoms complicated with severe cystic acne who is not eligible candidates for OCP use. This trial is registered with Clinicaltrials.gov NCT02855138. Acmaz G, Cınar L, Acmaz B, et al. The Effects of Oral Isotretinoin in Women with Acne and Polycystic Ovary Syndrome. Biomed Res Int. 2019;2019:2513067. Published 2019 Apr 7. doi:10.1155/2019/2513067 This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Sections of the Abstract, Introduction, Methods, and Discussion are presented in the Podcast. Access the full-text article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475563/

Historically, oral contraceptive pills were prescribed in attempt to help quicken resolution of ovarian cysts. Is this practice evidence-based? In this session we will review the Cochrane Database regarding this topic as well as the mechanism of action of how certain contraceptives (etonogestrel/levonorgestrel) pre-dispose to the “unruptured ovarian follicle“.

On this edition of Good Morning Orlando Bud, Alan, Yaffee, and Melissa discuss the College Admissions Scandal and Culture of Cheating! AND, Latest on Boeing 737 Mac 8 and Trump weighs in on the controversy. ALSO, Orange County School Board votes against arming teachers. PLUS, World Wide Web turns 30! The Founder is dismayed. How about you? BONUS! Move over Siri and Alexa! Hear the next voice of AI...and it's gender neutral!

On this episode we talk about Polycystic Ovarian Syndrome (PCOS) with board-certified Ob/Gyn Dr. Michael McCullough. We scratch the surface on PCOS symptoms and treatment with oral contraceptives (OCPs). Most importantly, we demystify some common misconceptions of OCP use that all women can benefit from. Want us to talk about other women health topic? let us know: https://linktr.ee/drirenelazarus Dr. McCullough details: Office 643 S. Great Southwest Parkway Suite 101 Grand Prairie, Tx 972.988.1588 mrmgyn.com --- Support this podcast: https://anchor.fm/santopia/support

In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Cynthia L. Chen about the prescribing practices of US dermatologists regarding oral contraceptives (OCPs) for acne treatment. Dr. Chen describes the results of a recent survey that was used to collect data about the demographics and practice settings of dermatologists who prescribe OCPs in the United States as well as how their knowledge and beliefs about OCPs inform their prescribing practices. She also discusses the use of 4th-generation drospirenone-containing OCPs, which have been shown to be slightly more effective for acne than other combined OCPs but also are associated with an increased risk of venous and thromboembolic events. Dr. Chen also explains her process for prescribing OCPs for acne treatment, including how to discuss the effects of hormonal treatments with patients.

Show Notes for Podcast Seven of seX & whY, Part 1 Thank you for Alyson McGregor for correctly pointing out that although the NIH, as of January 2016, does require its basic scientists to include both males and female animals in their grant proposals it is not called the “Research for All Act”. The Research for All Act of 2014 is actually a bill sponsored by Congressman Jim Cooper of Tennessee that would require, among other things, that the FDA have access to subgroup analysis of data by sex prior to granting expedited approval of a new product. As of now, this bill has not passed. Host: Jeannette Wolfe Guests: Dr. Neha Raukar, Emergency and Sports Medicine Physician Katherine Snedaker, Executive Director of Pink Concussions Topic: Sex and Gender Differences in Concussions Take home points The research behind traumatic brain injury is rapidly evolving as technology advances are allowing us to better understand how the human brain works and the nuances between male and female brains We still have a long way to go because most of the basic science surrounding traumatic brain injury has been conducted on male animals In 2015 the NIH passed The Research for All Act that requires NIH funded basic science to include both male and female animals or be able to justify their exclusion Men, compared to women, have an overall greater incidence of traumatic brain injury and this is likely associated with differences in risk tolerance and exposure to activities associated with potential injury In situations in which risk exposure is the same- like playing basketball or soccer- after sustaining the same impact, women appear to have a lower neurobiological threshold to obtain a traumatic brain injury than men Definitive/proportionate reasons for these differences are not fully understood, however possible factors include: Weaker neck muscles Decreased neurobiological threshold for injury Hormonal differences Reporting bias- this theory is quite controversial and it was emphasized throughout the podcast that many athletes, especially at elite levels- will underreport symptoms regardless of their biological sex Hormonal influences- it appears that a woman's vulnerability to traumatic brain injury may vary depending upon where she is within her menstrual cycle (with injury during the luteal phase leading to increased concussive symptoms) or whether or not she is on oral contraceptives (with some evidence that women on OCPs having decreased symptoms). Symptoms of concussion can be broken down into different categories: Cognitive- issues with memory/concentration/fogginess Emotional- anxiety, irritability/sadness Somatic- headaches/ light noise sensitivity/nausea and vomiting Vesitibular/Ocular- balance, eye tracking Sleep References: http://www.pinkconcussions.com/science/concussion-info/ Collins, C.L., Fletcher, E.N., Fields, S.K. et al. Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports J Primary Prevent (2014) 35: 309. https://doi-org.ezproxy.library.tufts.edu/10.1007/s10935-014-0355-2 Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004-2005 through 2008-2009. J Athl Train. 2016;51:189-194. Wilcox, B. J., Beckwith, J. G., Greenwald, R. M., Raukar, N. P., Chu, J. J., McAllister, T. W., … Crisco, J. J. (2015). Biomechanics of head impacts associated with diagnosed concussion in female collegiate ice hockey players. Journal of Biomechanics, 48(10), 2201–2204. Wunderle K, Hoeger KM, Wasserman E, Bazarian JJ. Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil. 2014;29:

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz! Written by: Molly Heublein, MD, Beth Garbitelli and Sarah Roberts, MPH. Edited by Matt Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Disclaimer 00:35 Intro 01:32 Guest bios 03:45 One liners, app recommendations, picks of the week 09:32 Picks of the week 12:45 Intro to contraception and a clinical case 13:33 Starting a conversation about contraception 16:55 Is having a period needed? And, which agents cause amenorrhea? 19:28 The menstrual cycle reviewed 23:29 Pros and Cons of long acting progesterone only agents 26:55 Choosing between IUDs 30:00 Who should get a copper IUD 30:53 Mechanism of hormonal IUDs 31:37 Risk with IUDs 34:05 Why are there so many OCPs? 36:05 Counseling patients on risks of OCPs 38:00 Risk of breast cancer with hormonal contraception 42:10 Benefits of hormonal contraception 43:38 Migraines and hormonal contraception 44:53 Mono- vs bi- vs triphasic pills. Does it matter? 46:15 Starting dose for OCPs 48:31 Is the mini pill effective? 49:37 Patches and rings 51:15 Take home points 52:40 Whoops, almost forgot emergency contraception! 56:32 How do copper IUDs work? 58:10 The Curbsiders recap the episode, plus some clinical pearls from Molly about birth 65:00 Outro Tags: contraception, birth control, IUDs, LARCs, mirena, skyla, lilletta, Paragard, OCPs, minipill, birth, control, pills, menstruation, follicular, phase, luteal, side, effects, emergency, contraceptives, ulipristal, ella, plan B, levonorgestrel, women’s, health, internal, medicine, internist, primary, care, family, practice, nexplanon, depo-provera, breast, cancer, family, planning, CDC, MEC, eligibility, criteria, bedsiders, pregnancy, ovulation, meded, foamed, nurse, student, physician, assistant, doctor

This week we talk about the subacute headache and the dangerous, can't miss diagnoses of cerebral venous thrombosis and IIH https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_127_0_Final_Cut.m4a Download Leave a Comment Tags: Cerebral Venous Sinus Thrombosis, Headache, Neurology Show Notes Take Home Points Keep IIH and CVST on the differential for patient's coming in with a subacute headache, particularly if they have visual or neuro symptoms. Consider an ocular ultrasound! It's quick, shockingly easy to do, and can help point you toward a diagnosis you may have otherwise overlooked.  I have made it my practice now to include a quick look in the physical exam of my patients with a concerning sounding headache or a headache with neurologic symptoms.  Consider IIH particularly in an overweight female of child bearing age with a subacute headache, but remember patients outside that demographic can have IIH as well. Consider CVST in a patient with a thrombophilic process like cancer, pregnancy or the use of OCPs or androgens or in a patient with a recent facial infection like sinusitis or cellulitis. Read More WikEM: Idiopathic Intracra...

This week we talk about the subacute headache and the dangerous, can't miss diagnoses of cerebral venous thrombosis and IIH https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_127_0_Final_Cut.m4a Download Leave a Comment Tags: Cerebral Venous Sinus Thrombosis, Headache, Neurology Show Notes Take Home Points Keep IIH and CVST on the differential for patient’s coming in with a subacute headache, particularly if they have visual or neuro symptoms. Consider an ocular ultrasound! It’s quick, shockingly easy to do, and can help point you toward a diagnosis you may have otherwise overlooked.  I have made it my practice now to include a quick look in the physical exam of my patients with a concerning sounding headache or a headache with neurologic symptoms.  Consider IIH particularly in an overweight female of child bearing age with a subacute headache, but remember patients outside that demographic can have IIH as well. Consider CVST in a patient with a thrombophilic process like cancer, pregnancy or the use of OCPs or androgens or in a patient with a recent facial infection like sinusitis or cellulitis. Read More WikEM: Idiopathic Intracranial Hypertensi...

I had a great interview recently with Lara Briden. She spoke with me from Australia, where she is a naturopathic doctor with twenty years’ experience in women’s health. She is also the author of a truly interesting book, Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. We had a wide-ranging and candid talk about many important women’s health topics, including the use of hormones during perimenopause. We also discussed how it is so true that women experiencing perimenopause often are doing so at the same time that their daughters are experiencing the challenge of starting their cycles! (yes, it’s true!) Lara had a good deal of insights relating to the use of birth control pills in teens as well as in perimenopause; and the consequences as well as precautions and alternatives. Other topics included: Estrogen fluctuations during perimenopause. Why hormonal birth control is not a good option. What is natural progesterone and why does it help? The crucial difference between the real hormone progesterone and the progestins in birth control. Is natural progesterone safe? What other natural treatments are found to be helpful for perimenopause? What are the effects of OCPs on the gut microbiome? Lara Briden runs a hormone clinic in Sydney, Australia…and you can check out the first 2 chapters of her book for free, her gift to my community…just click here

I had a great interview recently with Lara Briden. She spoke with me from Australia, where she is a naturopathic doctor with twenty years' experience in women's health. She is also the author of a truly interesting book, Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. We had a wide-ranging and candid talk about many important women's health topics, including the use of hormones during perimenopause. We also discussed how it is so true that women experiencing perimenopause often are doing so at the same time that their daughters are experiencing the challenge of starting their cycles! (yes, it's true!) Lara had a good deal of insights relating to the use of birth control pills in teens as well as in perimenopause; and the consequences as well as precautions and alternatives. Other topics included: Estrogen fluctuations during perimenopause. Why hormonal birth control is not a good option. What is natural progesterone and why does it help? The crucial difference between the real hormone progesterone and the progestins in birth control. Is natural progesterone safe? What other natural treatments are found to be helpful for perimenopause? What are the effects of OCPs on the gut microbiome? Lara Briden runs a hormone clinic in Sydney, Australia…and you can check out the first 2 chapters of her book for free, her gift to my community…just click here

Nestaly “Dolly” Morales Office of Business Opportunity, Orange County Public Schools (OCPS) Dolly works for the Orange County Public Schools as the Supplier Diversity Specialist for Goods and Non-Professional Services at the Office of Business Opportunity.  Dolly has been employed with Orange County Public Schools for the last nine years.  Her contractual, administrative, financial, analytical and networking experience has contributed to the district’s continuous growth proven by the years of successful employment. Dolly received her degree in Business Administration from the University of Puerto Rico. Dolly’s experience includes business administration, service coordination, customer service and auditing.  As a facilitator she is committed to superior service.  She was nominated and selected the Employee of the Month in 2008 for her department at OCPS, Advocate of the Year in 2013 for Central North Florida Minority Supplier Diversity Council (cnFMSDC) and elected official for cnFMSDC Central Florida Chapter as Vice-President.  Dolly’s passion is to serve with Integrity.  Dolly believes in investing time to cultivate relationships, share knowledge and provide support with enthusiasm and passion.  Her goal is to partner with community agencies to assist our communities in achieving their individual and common goals.  Dolly’s ultimate goal is the betterment and success of Orange County Public Schools students.

Oral case presentations (OCPs) are an integral part of the medical student learning experience and more importantly the team aspect of patient care.  In this podcast I sit down with Dr. Natasha Bray DO, Director of Medical Education at Broward Health Medical Center, to discuss some tips for presenting a patient, the common mistakes made […]

Drs Paul Browne and Nicholas Fogelson discuss articles from January 2011.  Topics include 21 vs 24 day OCPs, Antiphospholipid Syndrome a la ACOG, Wound Complications with Lovenox, Yolk Sacs on Ultrasound, and the relation between PCOS and Dyslipidemia. Academic OB/GYN Episode 30 – Articles for January 2011