Podcasts about palpate

Dr. Darrell Martin is an OB/GYN with four decades of expertise in women's health and the author of the bestselling memoir “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” In this episode, Dr. Martin and Meagan walk down memory lane talking about differences in birth from when he started practicing to when he retired. He even testified before Congress to fight for the rights of Certified Nurse Midwives and for patients' freedom to select their healthcare providers! Dr. Martin also touches on the important role of doulas and why midwifery observation is a huge asset during a VBAC.Dr. Martin's TikTokIn Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth RightsDr. Martin's WebsiteCoterie DiapersUse code VBAC20 at checkout for 20% off your first order of $40 or more.How to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. We have Dr. Darrell Martin joining us today. Dr. Martin hasn't really been in the OB world as of recently, but has years and years and over 5000 babies of experience. He wrote a book called, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” We wanted to have him on and talk just a little bit more about this book and his history. That is exactly what he did. He walked us down memory lane, told us lots of crazy stories, and good stories, and things they did along the way to really advocate for birth rights and midwives in their area. Dr. Darrell Martin is a gynecologist, a dedicated healthcare advocate with four decades of expertise in women's health, and the author of the bestselling memoir, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” His dedication to patient care and choice propelled him to testify before Congress, championing the rights of Certified Nurse Midwives (CNMs) and advocating for patients' freedom to select their healthcare providers. A standout moment in his career was his fervent support for nurse-midwifery in Nashville, Tennessee, showcasing his commitment to advancing the profession. Additionally, Dr. Martin takes great pride in having played a pivotal role, in like I said, more than 5,000 births, marking a legacy of life and joy he has helped bring into the world.Our interview was wonderful. We really walked down what he had seen and what he had gone through to testify before Congress. We also talked about being safe with your provider, and the time that he put into his patients. We know that today we don't have the time with our providers and a lot of time with OBs because of hospital time and restricting how many patients they see per day and all of those things. But really, he encourages you to find a provider who you feel safe with and trust. I am excited for you guys to hear today's episode. I would love to hear what your thoughts were, but definitely check out the book, “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.”Meagan: Okay, you guys. I really am so excited to be recording with Dr. Martin today. We actually met a month ago from the time of this recording just to chitchat and get a better feel for one another. I hung up and was like, “Yes. Yes. I am so excited to be talking with Dr. Martin. You guys, he has been through quite the journey which you can learn a lot more about in more depth through his book. We are going to talk right there really quick. Dr. Martin, welcome to the show. Can we dive into your book very first? Dr. Darrell Martin: Surely. Thank you. Meagan: Yeah. I think your book goes with who you are and your history, so we will cover both. Dr. Darrell Martin: Okay, okay. Meagan: Tell us more. Darrell Martin's book is “In Good Hands”. First of all, I have to say that I love the picture. It's baby's little head. It's just so awesome. Okay, we've got “In Good Hands: A Doctor's Story of Breaking Barriers for Midwifery and Birth Rights.” Just right there, that title is so powerful. I feel like with VBAC specifically, if we are going to dive into VBAC specifically, there are a lot of barriers that need to be broken within the world of birth. We need to keep understanding our birth rights. We also have had many people who have had their rights taken away as midwives. They can't even help someone who wants to VBAC in a lot of areas. A lot of power is in this book. Tell us a little bit more about this book and how it came about. Dr. Darrell Martin: Well, the book came because of patients. As I was heading into my final run prior to retirement, that last 6-8 months, and I use that term, but it shouldn't be patient. It should be client because patient would imply that they have an illness. Occasionally, they do have some problems, but in reality, they are first the client wanting a service. I thought my role as to provide this service and listen to them about what that was and what they wanted to have occur. In response to the question of what was I going to do when I retired, I just almost casually said, “I'm going to write a book.” The book evolved into the story of my life because so much of the patients and clients when they would come to me were sharing their life, and they were sharing what was going on in their life. Amazingly, it was always amazing to me that in 3 or 4 minutes of an initial meeting, they would sometimes open up about their deepest, darkest secrets and it was a safe place for them to share. I always was blown away with that. I respected that. Many times there were friends of my wife who would come in. I would not dare share a single thing notwithstanding the fact that there were HIPAA regulations, but the right thing was they were sharing with me their life. I thought, “I'm going to turn that around as much as I can by sharing my life with them.” It was an homage to that group of individuals so I would like them to see where I was coming from as I was helping them. That was the goal. That was the intent. Secondarily, for my grandchildren and hopefully the great-grandchildren that come whether I'm here or not because including them with that was the history of my entire American heritage and my grandfather coming over or as we would call him Nono, coming over to the United States and to a better place to better a life for his family. Our name was changed from Marta to Martin at Ellis Island. I wanted that story of his sacrifice for his family and subsequently my uncles' sacrifice and my parents' sacrifice for the priority they placed on families. That was for my children as well and grandchildren. There were a lot of old pictures that we had that we pulled out and that didn't occur in the book because there wasn't enough money to produce a lot of those pictures into the book, but they will be there in a separate place for my kids and grandkids. It was a two-fold reason to do the book. It started just as a narrative. I started typing away. The one funny ironic, and I don't know if ironic is the right word, story as I was growing up, is that people as my why I become an OB/GYN. I'm sure this was not the reason, but it's interesting as I reflected that growing up, it was apparently difficult for my mother to have me. I was her only child. She always would say I was spoiled nice, but I was definitely spoiled. When she was mad at me, the one thing she would say, and I didn't understand it until much later when I was actually probably in medical school, was that I was a dry birth and I was breech, and I just ruined her bottom. When she really got aggravated occasionally, she would say those little words to me as I was probably a teenager. Then on reflection, I became an OB/GYN so I really understood what she was saying then. Meagan: It was interesting that you said the words “dry birth” because my mom, when my water broke with my second, she was telling me that I was going to have this dry birth. She was like, “If you don't go in, you're going to have this dry birth.” So many people I have said that to are like, “What? I have never heard of that in my entire life,” and you just said that, so it really was a thing. It really was something that was said. Dr. Darrell Martin: Yes. It was a term back then in the late 40s to late 50s I guess. Meagan: Crazy. So you were inspired. You decided to do the OB route. Tell us a little bit of how that started and then how you changed over the years. Dr. Darrell Martin: Well, when I was in med school, and I went to West Virginia University Medical School, principally, it was fortunate because I would say in retrospect, they were probably lower middle class. I had the opportunity to go to West Virginia. Literally, my tuition per semester was $500. Meagan: Oh my gosh. Dr. Darrell Martin: My parents didn't have to dig into money they didn't have. They never had to borrow any money, so I was fortunate. I did have a scholarship to college. They didn't have to put out the money with the little they had saved. The affordability was there and never an issue. I went to West Virginia, and in my second year, I guess I connected a little bit with some of the docs and some of the chair of the department in West Virginia, Dr. Walter Bonnie, who I didn't realize at the time had left. He was the chairman of Vanderbilt before he was the chairman of West Virginia so now I understand why he was pointing me to either go to Vanderbilt or to Duke. I think I'm fortunate that I went to Vanderbilt. In spite of everything that happened, it was the path I was supposed to take. I did a little rotation as a 2nd-year medical student with some private OBs. I was just amazed. I was enthralled by the intervention of the episiotomies I observed. I said, “Well, you're going to learn how to sew.” What really struck me was that I went into this. I still can picture it. It was a large room where there were probably four or six women laboring. They had almost one of the baby beds. They had the thing where you can pull up the sides so someone couldn't get out of the bed. I couldn't figure out why someone in labor was like this. There was a lady there. I'll never forget. She had been given scopolamine which is the amnesiac which was often used where women sometimes don't even know where they are. They don't even have memory of where they are. She was underneath the bed on all fours barking like a dog. I asked him, “Why are you not going to let her husband in here?” They were saying things they probably shouldn't say under the influence of these crazy drugs. It made me start thinking even from that point on, “Why are they doing this? Why are they zapping them so much in the way of drugs?” Then I didn't see or understand fetal monitoring. We didn't have it at West Virginia. It came in my residency. It had just come in the first year prior to that, and the new maternal-fetal head at Vanderbilt brought in fetal monitoring. He had done some of the original research with Dr. Han at Yale. What I was doing a medical student during my rotations was sitting at the bedside. That's what we as medical students were responsible to do. Sit at the bedside. Palpate the abdomen. Sit with the fetoscope, the little one you stick around your head and put down, and count the heartbeats. We would be there six or eight hours. We were responsible for drawing all of the blood, but more importantly, we were there observing labor. Albeit, they weren't allowed to get up, but it was just the connection and I loved that connection. I loved that sense of connecting with people, and then that evolved into you connecting with them when they come back for their visits. I've had quite a few people who I've seen for 20, 30, 35 years annually. That became a much more than just doing a pelvic exam, blah, blah, blah. It became a connection. It was a communication of, “What's going on in your life? What's happening?” Meagan: A true friendship. Dr. Darrell Martin: Yes. Meagan: It became true friendships with these parents and these mothers. I think that says a lot about you as a provider. Yeah. That makes us feel more connected and safe. Dr. Darrell Martin: Yeah. I desperately miss that. I still miss that as a vocation and that connection. I would look forward to it. I would look on the schedule, “Who's coming in?” I could remember things about them that we would deal with for 15 years or more. One client of mine who, we would begin by, “How are you doing?” We would still go back to when her son was at a college in Florida and was on a bicycle and got hit and killed. We were relating and discussing that 15 years later. It was a place where she knew that we would go back to that point and talk a little bit about her feelings and it's much more important to me. If everything's fine doing a breast exam and doing a pelvic exam, listening to the heart and lungs, that's all normal and perfunctory. It's important, but what's really important is that connection. My goal also was, if I could, to leave the person as they went out the door laughing and to try to say something to cheer them up, to be entertaining, not to make light of their situation if obviously they had a bad problem, but still to say as they would leave with a smile on their face or a little laugh, but the funny one, I still remember this. We had instituted all of these forms. It would drive me crazy if I went to the doctor. We had all of these forms with all of these questions. They were repetitive every year. You just couldn't say that it was the same. She came in. She was laughing. She said, “These forms are crazy. It's asking me do I have a gun at home?” I said, thinking about it, in my ignorance, I hadn't reviewed every single question of these 15 pages that they were going to get. I'm sure it was about depression and to pick up on depression if they have a gun at home. She laughed. She said, “The young lady who was asking me the questions said, ‘Do you have a gun at home?' I said, ‘No, I have it right here in my purse. Would you like to see it?'” Meagan: Oh my gosh. Dr. Darrell Martin: So it was just joking about how she really got the person flustered who was asking the question. Sometimes we ask questions in those forms that are a little over the top. Meagan: Yeah. What I'm noticing is that you spent time with your patients not even just to get to know them, but you really wanted to get to know them. You didn't just do the checked boxes and the forms. It was to really get to know them. We talked about finding a good practice last time. What does that look like? What can we do? What are things to do? What is the routine that is normal for every provider's office or is there a normal routine for every provider's office? From someone coming in and wanting an experience like what you provide, how can we look for that? How can we seek that?Dr. Darrell Martin: Well, what you're saying and particularly when it evolves into having a chat, is first trust. you want to trust your provider. If you don't trust, you're anxious. We know that anxiety can produce a lot of issues. I would often tell a client who was already pregnant let's say as opposed to what should be done before they get pregnant. I would say they are getting ready to take a big test, and that test is having a baby. I said, “It's like a pass/fail. You're all going to pass. What do you want to have happen? You need to be comfortable and learn as much as you can and have people alongside you that you trust so that it is a great experience.” The second one, I'm sure you've seen this is that sometimes you just worry that people get so rigid in what they want, and then they feel like a failure if it doesn't happen. We want to avoid that because that can lead to a lot of postpartum depression and things that last. They feel like a failure. That should never happen. That should never happen. They should understand that they have a pathway and a plan. If they trust who's there with them, what ends up happening is okay. It's not that they've been misled which is then where the plan is altered by not a good reason maybe, but it's been altered and it really throws them for a loop. Meagan: Yeah. Dr. Darrell Martin: I think in preparation, first they've got to know what their surroundings are. They start off. Ideally, someone's thinking about getting pregnant before they get pregnant. I've had enough clients who, when we start talking about birth control, and I'll say, “Are you sexually active?” “Yes.” “Are you using anything for birth control?” “No, I don't want to use anything for birth control.” I said, “Do you want to get pregnant?” “No.” I said, “Well, that's not equal. A, you're not having intercourse and B, you're not using anything, so eventually, you're going to get pregnant. You need to start planning for that outcome, but the prep work ahead of time is to know your surrounding. You've got to know what you know and you've got to know what you want. You really should be seeking some advice of close friends who you trust who have been through and experienced it in a positive way. You've got to know what your town where you live is like. Is there one hospital or two hospitals? What are the hospitals like?” Someone told me one time that I should just write a book about what to do before you get pregnant. Meagan: Yeah, well it's a big deal. Before you get pregnant is what really can set us up for the end too because if we don't prep and we're not educating ourselves before, and we don't know what we're getting into, we don't know our options. That can set us up for a less-ideal position. Dr. Darrell Martin: Yeah. I think that's where the role of a doula can come into play. I hate to say it this way, but if they're going to go to the provider's office, they're not going to get that kind of exchange in that length of time to really settle in to what it is what that plan is going to be like. To be honest, most of the providers are not going to spend the time to do that. Meagan: Mhmm, yeah. The experience that you gave in getting to know people on that level is not as likely these days. OBs are limited to 7-10 minutes per visit?Dr. Darrell Martin: That's on a good day probably. Meagan: See? Yeah. Dr. Darrell Martin: You're being really kind right there. You're being really kind. It's just amazing. Sometimes you're a victim of your own success. If you're spending more time, and you're involved with that, then you've got to make a decision in your practice of how many people you're going to see. If you're seeing a certain amount, then the more you see, what's going to happen to them? You have control of your own situation, but then often you feel the need to have other partners and other associates, and then it gets too business-like. Smaller, to me, is better. The only problem with small with obstetrics is we know that if it's a solo practice, for example, someone will say, “I'm going to this doctor here because I want to see he or she the whole time.” I say, “You've got to think about that. Is that person going to be on-call 365 days a year?” Then what happens later on in the pregnancy when that becomes more of a concern to the client, they'll ask. They'll say, “Well, I'm on-call every Thursday and one weekend out of four.” They freak out. They get really anxious. “What's going to happen? I just know you.” They'll say, “I'm on-call on Thursday. I do inductions on Thursday.” So it leads into that path of wanting that provider. So then to get that provider, they're going to be induced. And we know that that at least doubles the rate of C-sections, at least, depending on how patient or not patient they are.Meagan: I was going to say they've got this little ARRIVE trial saying, "Oh, it doesn't. It lowers it. But what people don't really know is how much time these ARRIVE trial patients were really given. And so when you say that time is what is not given, but it's needed for a vaginal birth a lot of the times with these inductions.Dr. Darrell Martin: Yes, yes, if the induction is even indicated to begin with because the quality assurance, a lot of hospitals, you have to justify the induction. But it doesn't really happen that way. I mean, if there's a group of physicians that are all doing the same thing, they're not going to call each other out.Meagan: Yeah.Dr. Darrell Martin: It's just going to continue to happen is there're 39 weeks. I love how exactly they know how big the baby's going to be. But even more importantly, how big can this person have? I mean, there are no correlations. There are no real correlations. I can remember before ultrasound, we were taught pelvimetry. the old X-ray and you see what the inner spinous distance is, but you still don't know for sure what size has going to come through there.Meagan: Oh right. Well, and we know that through movement, which what you were seeing in the beginning of your OB days in your schooling, they didn't move. They put them in the bed. They put them in a bed and sat them in the bed. So now we're seeing movement, but there's still a lack of education in position of baby. And so we're getting the CPD diagnosis left and right and being told that we'll never get a baby out of our pelvis or our baby's too large to fit through it, when in a lot of situations it's just movement and changing it up and recognizing a baby in a poor position. An asynclitic baby is not going to have as easy as a time as a baby coming down in an OA, nice, tucked position. Right?Dr. Darrell Martin: Exactly. Exactly. There was the old Friedman Curve and if you went off the Friedman Curve, I was always remarked it's 1.2 centimeters, I think prime at 1.5 per hour. But I can never figure out what 0.2 two was when you do a pelvic exam. What is that really? Is the head applied against the cervix? So it's all relative. It's not that exact. But no, I think that if a person could find a person they trust who knows the environment, I think that's where the value of a really good doula can help because they're emotionally connected to the couple, but they're not as connected as husband and wife are or someone else.Meagan: Or a sister or a friend.Dr. Darrell Martin: Yes. And that may be their first shot at that sister of being in a room like that other maybe her own child. It's nice to have someone with a lot more experience that can stand in the gap when they're emotionally distraught, maybe the husband is. He's sweating it out. He's afraid of what he's going to say sometimes. And then she's hurting and she needs that person who can be just subjective to  stand in the gap for her when they're trying to push the buttons in the wrong direction or play on their emotions a little too much.Meagan: Yeah. I love that you pointed that out. We actually talked about that in our course because a lot of people are like, "Oh, no, it's okay. I can just hire my friend or my sister." And although those people are so wonderful, there is something very different about having a doula who is trained and educated and can connect with you, but also disconnect and see other options over here.So we just kind of were going a little bit into induction and things like that. And when we talked a couple weeks ago, we talked about why less is better when it comes to giving medicine or induction to VBAC or not. We talked about it impeding the natural process. Can you elaborate more on that? On both. Why less is more, but then also VBAC and induction. What's ideal for that? What did you use back then?Dr. Darrell Martin: Well, we're going back a long time.Meagan: No, I know, I know.Dr. Darrell Martin: We're going back a long time. See, that would be like what you just did was give me about three questions in one that would be like being on a defensive stand on trial. And then you're trying to figure out where the attorney going, and he sets you up with three questions in one, and then you know you're in trouble when he does that.Meagan: I'm finding that I'm really good at doing that. Asking one question with three questions or five questions?Dr. Darrell Martin: Yes.Meagan: So, okay, let's talk about less is more. Why is less more?Dr. Darrell Martin: Well, first of all, you can observe the natural process of labor. Anytime you intervene with whatever medication-wise or epidural-wise, you're altering the natural course. I mean, that to me it just makes sense. I mean, those things never occurred years ago. So you are intervening in a natural course. And you then have got to factor that in to see how much is that hindering the labor process? Would it have been hindered if you hadn't done that? If you'd allow them to walk, if you allowed them to move? The natural observation of labor makes a lot more sense than the intervention where you've then got to figure out, is the cause of the arrest of labor, so to speak, is it because of the intervention or was it really going to occur?Meagan: Light bulb.Dr. Darrell Martin: Yes.Meagan: That's an interesting concept to think about.Dr. Darrell Martin: Yeah. And you want to be careful because it's another little joke. I say you just don't want to give the client/patient a silver bullet. Often I've had husbands say, "Well, they don't need any medicines." You have to be careful what you're saying because you're not the one in labor. But I wouldn't say that quite to them. But they got the picture really quickly when their wife, their spouse, lashed back out at them.Meagan: Yeah.Dr. Darrell Martin: So you can come over here and sit and see how you like it. I can still remember doing a Lamaze class with Sandy, and we also did Bradley class because I wanted to experience it all. She was the first person to deliver at Vanderbilt without any medication using those techniques. And when we would do that little bit of teaching, I can remember doing that when they would try to show a guy by pinching him for like 30 seconds and increasing the intensities to do their breathing, maybe they should have had something else pinched to make them realize-- Meagan: How intense.Dr. Darrell Martin: Yeah. How intense it isMeagan: Yeah.Dr. Darrell Martin: We can't totally experience it. So we have to be empathetic and balance that. And that's where, to me, having that other person can be helpful because I'm sure that that person who is the doula would be meeting and with them multiple times in the antepartum course as opposed to they go into labor and if there's a physician delivery, chances are their support person is going to be a nurse they've never met before or maybe multiple ones who come in and out and in and out and in and out, and they're not there like someone else would be. To me that's suboptimal, but that's the way it works. And I observed the first birth. I didn't tell the people at the hospital for my daughter-in-law that I was an obstetrician.Meagan: And yeah you guys, a little backstory. He was a doula at his daughter-in-law's birth.Dr. Darrell Martin: Yes. But her first birth did not turn out that well at an unnamed hospital. She didn't want to come to my practice because they weren't married that long and that's getting into their business a little bit. Plus, she lived on the north side of town and I was on the south side. So she chose, a midwifery group, but the midwife was not in there very much. I mean, she was responsible. They were doing probably 15 to 20 births per midwife.Meagan: Wow.Dr. Darrell Martin: They were becoming like a resident, really. They were not doing anything a whole lot differently. And then she had a fourth degree, and she then, in my opinion, got chased out of the hospital the next day and ended up turning around a day later and coming back with preeclampsia. I heard she had some family history of hypertension. I had to be careful because I'm the father-in-law. I'm saying, "Well, maybe you shouldn't go home." And then she ends up going back. And she didn't have HELLP syndrome, but she was pretty sick there for a day or two. That was unfortunate because she went home, and then she had to go right back and there's the baby at home because the baby can't go back into the hospital. And so her second birth, because it was such a traumatic experience with the fourth degree, she elected to use our group and wanted one of my partners to electively section her. She did the trauma of that fourth degree. That was so great. So she did. But obviously, she had a proven pelvis because she had a first vaginal delivery. And then she came to me and she said, "I want to do a VBAC." And so I said, "Oh, that's great." And so one of my partners was there with her, but my son got a little bit antsy and a little bit sick, so he kind of left the room. I was the support person through the delivery. That was my opportunity to be a doula. And of course, she delivered without any medication and without an episiotomy and did fine. Meagan: Awesome.Dr. Darrell Martin: And a bigger baby than the one that was first time.Meagan: Hey, see? That's awesome. I love that.Dr. Darrell Martin: Yes.Meagan: So it happens.So we talked a little bit about midwives, and we talked about right here "A Doctor's Story of Breaking Barriers for Midwifery". Talk to us about breaking barriers for midwifery. And what are your thoughts one on midwives, but two, midwives being restricted to support VBAC?Dr. Darrell Martin: Okay, that's two questions again.Meagan: Yep. Count on me to do that to you.Dr. Darrell Martin: I'll flip to the second one there. I think it's illogical to not allow a midwife to be involved with a VBAC. That makes no sense to me at all because if anybody needs more observation in the birth process, it would potentially or theoretically actually be someone who's had a prior C-section. Right? There's a little bit more risk for a rupture that needs more observation, doesn't need someone in and out, in and out of the room. The physician is going to be required to be in-house or at least when we were doing them, they were required to be in house and there was the ability to do a section pretty quickly. But observation can really mitigate that rush, rush, rush, rush, rush. I've had midwives do breeches with me and I've had them do vaginal twins. If I'm there, they can do it just as well as I can. I'm observing everything that's happening and they should know how to do shoulder dystocia. One thing that you cannot be totally predictive of and doctors don't have to be in the hospital for the most part in hospitals. Hopefully, there probably are some where they're required, but it makes no sense and they're able to do those. So if I'm there observing because the hospital is going to require that, and I think that's not a bad thing. I never would be opposed or would never advocate that I shouldn't be there for a VBAC. But I think to have the support person and that be the midwife is going to continue and do the delivery, I think that's great. There's no logic of what they're going to do unless that doctor is just going to decide that they're going to play a midwife role and that they're going to be there in that room. They're advocating that role to a nurse or multiple nurses who the person doesn't know, never met them before, and so that trust is not there. They're already stressed. The family's stressed. There are probably some in-laws or relatives out there and they say, "Well, you're crazy. Why are you doing this for? Why don't you just have a section?" Everybody has an opinion, right? So there's a lot of family. I would observe that they're sitting out there and we've got into that even back then that's a society that some of them don't want to be there, but they feel obliged to be out there waiting for a birth to occur. Right. When four hours goes by, "Oh, oh, there must be a problem. Why aren't they doing something?" You hear that all the time. I try to say, "Well, first labor can be 16 to 20 hours." "16 to 20 hours?" and then they think, "I'm going to be here for that long."Meagan: Yeah.Dr. Darrell Martin: So there's always that push at times from family about things aren't moving quickly.Meagan: Right.Dr. Darrell Martin: They're moving naturally, but their frame of reference is not appropriate for what's occurring. They don't really understand. And so that's the answer. Yes. I think that it makes no sense that midwives are not involved. That does not make any sense at all.So the first part of the question was what happened with me and midwives?Meagan: Well, breaking barriers for midwifery. There are so many people out there who are still restricted to not be able to support VBAC. I mean, we have hospital midwives here in Utah that can't even support VBAC. The OBs are just completely restricting them. What do you mean when you say breaking barriers for midwifery and birth rights?Dr. Darrell Martin: Okay, what I meant was this is now in late 1970, 79, 80. And I'd observe midwifery care because as residents, we were taking care of individuals at three different hospitals, one of which was Nashville General, which was a hospital where predominantly that was indigent care, women with no insurance. And we had a program there with midwives.Dr. Darrell Martin: And so we were their backup. I was their backup for my senior residency, chief residency, and subsequently, as an attending because I was an attending teaching medical students and residents and really not teaching midwives, just observing them if they needed anything, within the house most of the time, principally for the medical students and the junior residents. But I saw their outcomes, how great they were. I saw the connection that occurred. We didn't have a residency program where you saw the same people every time then. It was just purely a rotation. You would catch people and it just became seeing 50 or 75 people and just try to get them in and out. But then you observe over here and watch what happens with the midwifery group and the lack of intervention and the great outcomes because they had to keep statistics to prove what they were doing. Right? Meagan: Yeah, yeah. I'm sure. Dr. Darrell Martin: They were required to do that, and you would see that the outcomes were so much better. Then it evolved because a lot of those women over the course of the years prior to me being there and has evolved while I was there, I was befriended by one midwife. She was a nurse in labor and delivery who then went on to midwifery school. We became really close friends. Her family and my family became very close. They had people, first of all, physicians' wives who wanted to use them and friends in the neighborhood who wanted to use them, but they had insurance and people that had delivered there who then were able to get a job and had insurance and wanted to use them again, but they couldn't at the indigent hospital. You had to not have insurance. So there was no vehicle for them in Nashville to do birth. We advocated for a new program at Vanderbilt where they could do that and at the same time do something that's finally occurring now and that's how midwives teach medical students and teach residents normal birth because that's the way you develop the connection that moves on into private practice is they see their validity at that level and that becomes a really essentially part of what they want to do when they leave. They don't see them as competition as much. Still, sometimes it's competition. So anyhow, at that point, our third hospital was relatively new. The Baptist private hospital run by the private doctors where the deliveries at that point were the typical ones with amnesiac, no father in the room, an episiotomy, and forceps. So when we tried to do the program, the chairman-- and we subsequently found some of this information out. It wasn't totally aware at the time. They were given a choice by the private hospital. Either you continue to have residents at the private hospital or you have the midwifery private program at Vanderbilt. But you can't have both. If you're going to do that, you can't have residence over here. So they were using the political pressure to stop it from happening. Then I said, they approached myself and the two doctors, partners, I was working with in Hendersonville which is a little suburb north of town. We had just had a new hospital start there and we were the only group so that gave us a lot of liberties. I mean, we started a program for children of birth with birthing rooms, no routine episiotomies, all walking in labor, and all the things you couldn't do downtown. Well, the problem was we wanted midwives in into practice but we didn't have the money to pay them. We were brand new. So we had a discussion and they said, "Well, we want to start our own business." And I said, "Oh." And I kind of joked, I said, "Well that's fine, I can be your employee then." And that was fine for us. I mean, we had no problem being their consultant because someone asked, "Well, how can you let that happen?" I said, "We still have control of the medical issues. We can still have a discussion and they can't run crazy. They're not going to do things that we don't agree with just because they're paying for the receptionists and they're taking ownership of their practice." So they opened their doors on Music Row in Nashville.Meagan: Awesome.Dr. Darrell Martin: But as soon as that started happening and they announced it, at that time, the only insurance carrier for malpractice in the state of Georgia was State Volunteer Mutual which was physician-owned because of the crisis so they couldn't get any insurance the other way a physician couldn't unless it was through the physician-owned carrier. Well, one of the persons who was just appointed to the board was a, well I would call an establishment old-guard, obstetrician/gynecologist from Nashville. And he said in front of multiple people that he was going to set midwifery back 100 years, and he was going to get my malpractice insurance. He was going to take my malpractice insurance away.Meagan: Wow.Dr. Darrell Martin: For practicing with midwife. And that was in the spring of the year. Well, by October of that year, he did take my malpractice insurance. They did.Meagan: Wow. For working with midwives? Dr. Darrell Martin: For risks of undue proportion. Yes. The Congressman for one of the midwives was Al Gore, and in December of that year we had a congressional hearing in D.C. where we testified. The Federal Trade Commission got involved. The Federal Trade Commission had them required the malpractice carrier to open their books for five years. And what that did was it stopped attacks across the United States. There were multiple attacks going on all across the country trying to block midwives from practicing independently or otherwise. And so from 1980-83, when subsequently a litigation was settled, the malpractice carrier, including the physicians who were involved, all admitted guilt before it went to the Supreme Court. I went through a few years there and that's where you see some of those stories where I was blackballed and had to figure out a place where I was going to work. I almost went back to school. This is a little funny story. I was pointed in the direction of Dr. Miller who was the head of Maternal Child Health at Chapel Hill University of North Carolina. I didn't realize that then two months later, he testified before Congress as well because he wanted me to come there. I interviewed and then I would get my PhD and do the studies that would disprove all the routine things that physicians were doing to couples. I would run those studies. It was a safe space. It was a safe place, a beautiful place in Chapel Hill. So he told me, he said, "You need to meet with my manager assistant and she'll talk to you about your stipend, etc." Now I had three children under four years of age.Meagan: Wow, you were busy.Dr. Darrell Martin: Well, the first one was adopted through one of the friends I was in school with, so we had two children seven months apart because Sandy was pregnant and had like four or five miscarriages before.Meagan: Wow.Dr. Darrell Martin: So I had three under four. So she proceeded to say, "Well Dr. Martin, this is great. Here's your stipend and I have some good news for you." I said, "Well, what's that?" He said, "Well, you're going to get qualified for food stamps." That's good news? Okay. So I'm trying to support my three children and my wife. I said, "I can't do that. As much as I would love to go to this safe place," and Chapel Hill would have been a safe place because it would have been an academia, but then I had to find a place to work. So it was just how through my faith, it got to the point where know ending up in Atlanta, I was able to not only do everything I wanted to do, but one of the midwives that I worked with, Vicki Henderson Bursman won the award from the midwifery college. And the year after, I received the Lewis Hellman Award for supporting midwives from ACOG and AC&M. But we prayed. We said, "One day we're going to work together." And this was 1980. In 93, when we settled the lawsuit, we reconnected. I was chairman of a private school, and we hired her husband to come to Atlanta to work at the school. Two weeks, three weeks later, I get a call from the administrator of the hospital in Emory who was running the indigent project at the hospital we were working at teaching residents. They said that they wanted to double the money. Their contract was up and they wanted double what they had been given. So the hospital refused and they asked me to do the program. We didn't have any other place to go. And then what was happening? Well, Rick was coming to Atlanta, but so was Vicki. So Vicki, who I hadn't worked with for 13 years, never was able to work, came and for the next 20 years, worked in Atlanta with me. And we did. She ran basically the women's community care project, and then also worked in the private practice. And then the last person, Susie Soshmore, who was the other midwife, really couldn't leave Nashville. She was much, much more, and rightly so, she was bitter about what happened and never practiced midwifery. Her husband was retiring. She decided since they were going to Florida to Panama City, that she wanted to get back and actually start doing midwifery, but she needed to be re-credentialed. So she came and spent six months with us in Atlanta as we re-credentialed her and she worked with us. So ultimately we all three did get to work together.Meagan: That's awesome. Wow. What a journey. What a journey you have been on.Dr. Darrell Martin: Yeah, it was quite a journey.Meagan: Yeah. It's so crazy to me to hear that someone would actively try to make sure that midwifery care wasn't a thing. It's just so crazy to me, and I think it's probably still happening. It's probably still happening here in 2024. I don't know why midwives get such a bad rap, but like you said, you saw with the studies, their outcomes were typically better. Dr. Darrell Martin: Yeah.Meagan: Why are we ignoring that?Dr. Darrell Martin: Doctors were pretty cocky back then. They may be more subtle about what they do now because to overtly say they're going to get your malpractice insurance, that's restricted trade.Meagan: Yeah. That's intense.Dr. Darrell Martin: Intense. Well, it's illegal to start with.Meagan: Yeah, yeah, yeah, right?Dr. Darrell Martin: If you attack the doctor, you get the midwife. They tried to attack the policies and procedures. That was the other thing they were threatening to do was, "Well, if you still come here, we're going to close the birthing room. We're going to require women to stay flat in bed. We require episiotomies. We require preps and enemas." Well, they wouldn't require episiotomies, but certainly preps and enemas and continuous monitoring just to make it uncomfortable and another way to have midwives not want to work there.Meagan:  Yes. I just want to Do a big eye-roll with all of that. Oh my goodness. Well, thank you so much for taking the time and sharing your history and these stories and giving some tips on trusting our providers and hiring a doula. I mean, we love OBs too, but definitely check out midwives and midwives, if you're out there and you're listening and you want to learn how to get involved in your community, get involved with supportive OBs like Dr. Martin and you never know, there could be another change. You could open a whole other practice, but still advocate for yourself.I'm trying to think. Are there any final tips that you have for our listeners for them on their journey to VBAC?Dr. Darrell Martin: Well, pre-pregnancy that next time around, we know very quickly that the weight of the baby is controlled by heredity which you really essentially have no control over that including who your husband is. If he's 6'5", 245, their odds are going to be that the baby might be a little bigger. However, you do have control what your pre-pregnancy weight is, and if you get your BMI into a lower range, we know statistically that the baby's probably going to be a little bit smaller, and that gives you a better shot. You don't have control of when you deliver, but you do have control of your weight gain during the pregnancy and you do have control of what your pre-pregnancy weight, which are also factors in the size of the baby. So control what you can control, and trust the rest that it's going to work out the way it should.Meagan:  Yeah, I think just being healthy, being active, getting educated like you said, pre-pregnancy. It is empowering to be educated and prepared both physically, emotionally, and logistically like where you're going, and who you're seeing. All of that before you become pregnant. It really is such a huge benefit. So thank you again for being here with us today. Can you tell us where we can find your book?Dr. Darrell Martin: Yeah, it's available on Amazon. It's available at Books A Million. It's available at Barnes and Noble. So all three of the major sources.Meagan:  Some of the major sources. Yeah. We'll make sure to link those in the show notes. If you guys want to hear more about Dr. Martin's journey and everything that he's got going on in that book, we will have those links right there so you can click and purchase. Thank you so much for your time today.Dr. Darrell Martin: Thank you. I enjoyed it and it went very quickly. It was enjoyable talking to you.Meagan:  It did, didn't it? Just chatting. It's so fun to hear that history of what birth used to be like, and actually how there are still some similarities even here in 2024. We have a lot to improve on. Dr. Darrell Martin: Absolutely, yes. Meagan:  But it's so good to hear and thank you so much for being there for your clients and your customers and patients, whatever anyone wants to call them, along the way, because it sounds like you were really such a great advocate for them.Dr. Darrell Martin: Well, we tried. We tried. It was important that they received the proper care, and that we served them appropriately, and to then they fulfill whatever dream they had for that birth experience or be something they would really enjoy.Meagan:  Yes. Well, thank you again so much.Dr. Darrell Martin: Okay, thank you. I enjoyed talking to you. Good luck, and have fun.Meagan: Thank you.Dr. Darrell Martin: Bye-bye.Meagan: Thank you. You too. Bye.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

This episode is all about the visceral connections in your body, how chronic pain can be linked to your gut, and how to understand certain feelings / irritations within the visceral area of the body.In this #ClinicalBite Dr. David Miller ND tells you his experience and advice when feeling the abdomen of a patient. Along with the various other organs that mysteriously seem to keep showing a connection is his patients and practice!

Take Home Points Approach leg pain with the seconds, minutes, hours mindset – think about acute limb ischemia, compartment syndrome, and necrotizing fasciitis Do a thorough physical exam – get their shoes and socks off – you will find crazy stuff when you actually look Palpate and image the joint above and below any injury ... Read more The post REBEL Core Cast – Basics of EM – Leg Pain appeared first on REBEL EM - Emergency Medicine Blog.

Mellow out with the body language of massage in this first of a two-part story.

This time we have a special and yet familiar guest which I'm happy to have back after our great comeback. @nic-palpate, who was hosting the Gießkannensoundsystem events together with Chriso, is now also one of the heads of Odyssey which is the most aspiring event series in the area around Gießen. They started their new event series this year and this set of him is live from one of their first parties. @nic-palpate and his friends are mostly responsible for the party life in Gießen and without them, the nightlife wouldn't be the same during these times. Nic is working hard which is why I love him so much. Listening to his music is always a pleasure and everything he's involved in is growing fast, so make sure to leave a like and enjoy this one and a half-hour set of him.

 Listen to it on SoundCloud: https://bit.ly/3pqOfWz
 Get it on iTunes as well: https://apple.co/3kEjVVi 
And YouTube: https://youtu.be/bAu5P4dpgWI
 Deezer: https://bit.ly/2XB0mF8 

Nic Palpate on social media:
 Instagram: www.instagram.com/nicpalpate
 SoundCloud: www.soundcloud.com/nic-palpate
 Head of: www.instagram.com/odyssey_gi

 MarmorMetall on social media: SoundCloud: http://soundcloud.com/marmormetall Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx MarmorMetall's music on all platforms: Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Deezer: http://bit.ly/2hsS0nR Contact me if you have any questions about my music or just want to be a part of Loops of Life: marmormetall@gmail.com

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Urgent Care RAP show. Earn CME on your commute while getting the latest practice-changing urgent care information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/UCRAPPOD When someone comes in with prostate related symptoms and infection, it’s hard to know if we’re working with prostatitis vs prostate abscess. How can we improve our prostate game? Tarlan Hedayati, MD schools Matthieu DeClerck, MD, and Neda Frayha, MD with her prostate pro-tips.   Pearls: Think about acute bacterial prostatitis when someone presents with symptoms of acute prostatitis AND has the following characteristics: immunocompromised, symptoms > 36 hours, progressive urinary retention, recent antibiotics for prostatitis. Avoid prostate exams in people with neutropenia given theoretical risk of seeding bacteria.   Distinguishing between acute bacterial prostatitis and prostate abscess can be difficult because patients will look sick (fever, tachycardia, abdominal pain) in both cases Suprapubic pain Abdominal pain Urinary retention History of having had prostatitis in the past Pain with defecation or with prolonged sitting Immunocompromised patient Protracted symptoms > 36 hours Progressive urinary retention Patients who have received antibiotics for prostatitis but are getting worse Overlap symptom: Physical exam and CT scan ultimately will help rule out deadly abscess or other Things to make you think more about abscess: Pearl: do not send a PSA during acute prostatitis. Leads to unnecessary worry and future monitoring of PSA levels. Prostate exam tips: Start with palpation of the anal-rectal junction to get a sense if discomfort is coming from the exam itself versus the prostate and examine if there a rectal abscess Palpate the prostate last to feel for bogginess, tenderness Prostate massage is supposed to increase the sensitivity of urine culture by squeezing bacteria out of the prostate into the urethra. However given the discomfort, probably not needed in the emergency or even primary care setting → it should be a quick exam Pearl: avoid prostate exam in people with neutropenia given theoretical risk of seeding bacteria Categories of prostatitis: A urinalysis, gram stain and culture should not have any bacteria Patients have been dealing with for a longer time and are non-toxic appearing Chronically have WBC’s in the urine with no symptoms Diagnosed by biopsy Acute bacterial prostatitis  Chronic bacterial prostatitis Chronic prostatitis or chronic pelvic pain (90% of prostatitis) Asymptomatic inflammatory prostatitis Treatment: E-coli is the bacteria you’re treating against → check your local antibiogram for resistance patterns Prostate abscess  5th or 6th decade of life Immunosuppression End stage renal disease Indwelling catheter Any recent instrumentation of the prostate Potential complication of inflammatory prostatitis At most 2.5% of patients Risk factors:   REFERENCE: Carroll DE, Marr I, Huang GKL, Holt DC, Tong SYC, Boutlis CS. Staphylococcus aureus Prostatic abscess: a clinical case report and a review of the literature. BMC Infect Dis. 2017 Jul 21;17(1):509. Datillo WR, Shiber J. Prostatitis or prostatic abscess. J of Emerg Med. 2013; 44(1):e121-e122 Hsieh MJ, Yen ZS. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: Is there a role for serum prostate-specific antigen level in the diagnosis of acute prostatitis? Emerg Med J. 2008 Aug;25(8):522-3. Khan FU, Ihsan AU, Khan HU, Jana R, Wazir J, Khongorzul P, Waqar M, Zhou X. Comprehensive overview of prostatitis. Biomed Pharmacother. 2017 Oct;94:1064-1076.

My homie Nic Palpate from the Gießkannesoundsystem is back with a big b2b special together with Domenico Francesco. They both recorded this two hour session live at the Scarabée club in gießen where I’ve performed a few times as well together with Chriso and Nic himself. This is definitely one of the biggest Deep House sets for your afterhour sessions which I enjoy having on this podcast for a while now. Please make sure to stay tuned with Nic Palpates’ and Chriso’s event series called Gießkannesoundsystem and also their parties taking place in and around Gießen. I’m performing together with Kikz, Maed Maexx and Alivemaex on Ennea’s next event called “Der Advokat des Teufels” at the Roof 175 club in Main on the 21 st of March. This one will be the darkest and heaviest party of the Ennea series so far so make sure that you don’t miss this one. This set is also on Spotify: https://spoti.fi/37H78bn Get it on iTunes as well: https://apple.co/2BOtBIL All eyes on Nic Palpate: https://soundcloud.com/nic-palpate https://www.instagram.com/giesskannensoundsystem/ MarmorMetall on social media: SoundCloud: http://soundcloud.com/marmormetall Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx MarmorMetall’s music on all platforms: Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR Contact me if you have any questions about my music or just want to be a part of Loops of Life: marmormetall@gmail.com

Craig is on with Jack Heath this Monday morning. Jack was extremely interested in some military tech he saw in the news and the future of tech as it related to AI and medical robotics, so that is what we talked about today.  These and more tech tips, news, and updates visit - CraigPeterson.com --- Related Articles  Apple has a problem with Zoom and so should you  New MacBooks Coming Did You Turn of Tracking? Guess What?  Apps are Still Tracking You. Chinese Ministry of State Security Attacks Major Companies Internal Networks Hollywood on the Skids with Virtual Stars Worried About Privacy? Steve Wozniak says Delete Facebook Got Chinese Security Cameras? Just Try to Remove them. --- Below is a rush transcript of this segment, it might contain errors. Airing date: 07/15/2019 Flying Soldiers, AI, Robots Craig Peterson Hey, good morning, everybody. Craig Peterson, here. I was on with Jack Heath this morning talking about something that this was not in my weekly newsletter, right? If you get that my show notes for my weekly newsletter, in fact, I haven't even got it sent out today. It's been so busy, so busy. My brother came down with his wife and kids, late last week, and we helped them out with a few different things. It was, quite lovely to visit with them, but it threw my whole schedule off. So, you're going to be getting my weekly newsletter a little bit late this week. It was a crazy week. Earlier last week, I was down in DC, and with all of the stuff I've been doing it has been a busy time. So this morning, I got to talk with Jack about some of the futurist stuff. I don't know if you saw on the coverage of the Bastille Day celebrations over in Paris, and the guy on a kind of a board, kind of like you would see going down on Hill, a ski hill, but he was flying over Paris. Very, very cool technology. We talked about the future, and where's it going? We discussed how artificial intelligence would impact us as we move forward as well as one or two other things right along those lines, including a small local entrepreneur who owns a limo service and the way he's fighting back against Uber and Lyft. So, it was a fun conversation this morning. I am getting ready, of course, for my security summer summit and they sponsoring today's podcast. Security summer is all about you learning the things you need to know about security. It is good for your business, for your home, and if you are a CEO, we have an exclusive track for you as a business owner as well. So keep an eye on your email box will be sending out notifications about that soon. And you can sign up just by going to Craig Peterson dot com. All right, guys. Here we go. Jack Heath So this is pretty cool. The Flying soldier its called and it is pretty cool and maybe the stuff of the future but Craig Peterson his show airs Saturday mornings Tech Talk, and he joins us live now, Good morning, Craig. Craig Peterson Hey, good morning. Yeah, Bastille Day is quite a celebration there in Paris. Is he soaring over the streets? It's kind of cool to think about, you know, we've been promised for how many years from James Bond that we would all have these jetpacks, right or at least flying cars. And somehow it just hasn't happened for any of us. There's also another interesting article, I don't know if you saw this in the union leader, but a local Manchester couple owns a limo service. And he was lobbying the state to try and get some restrictions on ride-sharing services. So he decided, hey, if you can beat them, join them. And he has started a new app called ride links RYDELIMX. And then hoping that that's going to compete with ride-sharing services like Uber and Lyft. But one of the main differences is it allows the driver to set the price. And you know, that's kind of a bit of an innovative thing for them to do. With Uber, the many people I know that that drive for Uber are not happy with the company and some of them have shifted over to Lyft. With this, there is now gives them another opportunity. Jack Heath Interesting, but I want to go back to the flying jet pack. You can imagine down the road like Hey, what are you doing this weekend, I'm going to just literally going to fly up and go skiing this afternoon is going to fly up and go through the notch and my jetpack just going to you know, go. Justin's going to be I mean, it's pretty cool video, have you seen it? Justin McIsaac I have. But you know, this isn't going to go very far. So I can let you go up to the mountains. Craig Peterson But they're a little bit ridiculous. But you know, this one, but there are about a half a dozen companies right now, Jack, who are making various types of personal transportation planes if you will. Most of them use electric power to charge them up. They're suitable for give-or-take an hour of flight. And they are being automated. The FAA is responsible for setting up flight rules for some of these things. They are trying to figure out how do we handle this. NASA is involved with some of the technology too. Currently, anyone could apply for a license like you would your driver's license, and with just a few hours worth of training, would be able to fly some of these. They're expecting them they hit the skies, certainly by 2025. And maybe a little bit earlier. So you could hop in your plane no matter where you are in the states fly up north in the wintertime, be up there in a matter of about 45 minutes or so and have the plane fly itself the whole way. It's that it's finally going to happen. Jack Heath I imagined it would and in one of our movers and shakers episodes, had a guest who's a futuristic type thinker, and he was talking about them and come back to it. But just on the personal jetpack things with a battery that you want to make. It's big. What do you want to make sure it's charged? Because if you're out there, and it doesn't work, I don't know how well the parachute works. Do you follow me? Is it hard to pull over? And like 2500 feet, right? Yeah. But um, you know, yeah, there's a gentleman that was in Florida. And he was on our movers and shakers show and one of these upcoming episodes. And his big thing was how AI really over the next 15 trying to think of the years less than 20 years. So the AI of what it's going to do to our workforce. And you know, well beyond just like automatic checkouts at the supermarket. We're talking transforming industries, not all good because you know, the reduction of jobs, but impact things in our lives that you don't think about whatever happened in our lives are going to happen. So you're very much right about that. Craig Peterson Well, and it's going to be huge, because there are alternate opinions on that Jack where they're saying, if you look at machine learning, Ai, right now, it has created three times as many jobs as it has eliminated. And so there's either futurists are looking at this saying we look back years ago, right when we had steam coming in, and we had cars, motorized cars, and all of these ended up creating more jobs, and they eliminated. But ultimately, I think what we need is, and I think Justin would agree with us like a Star Trek universe if we can turn energy into matter. And then we have the ability, and we have unlimited power, we can have a society where anyone can do almost anything they want to because everything is effectively free. And hopefully, we'll get to that point. But AI itself, yeah, it's going to eliminate a lot of the first jobs. But it is ultimately going to create a lot of jobs to disruption, I think, is probably the name of the game for the next 50 years, frankly, but Jack has not always been the case. Craig Peterson 7:16 Yeah, it takes a while. But you know what, what, what I've found interesting is you could take the number of aging Americans who live alone. And as they age and get older, you know, nursing homes have been had been such an expensive thing for families. I'm reading and seeing some stories, where a small robot in a home can be beneficial. Now you see Alexa or something on the table, you can talk to it and play this or do something, but a small robot that has other capabilities like to speak to you with maybe daily instructions in an entertaining way. Or even do some functions around the house, will change the entire nursing home industry. You're going to go into some fast-food restaurants, and then maybe one human being working and five robots, not just at the checkout area, but preparing your food and hence to medical. Jack Heath The medical industry, you know, more procedures are going to be done by robots, you know, then surgical assistance. Yeah, well, Craig Peterson That's going to happen to and but it's also going to allow us to have an expert in a foreign city, do surgery, etc. But Amazon has a prototype of something called the vest, its a robot. And this thing's waist-high, it can be summoned by voice. Amazon's have already invested very heavily into robots. And Bloomberg is reporting right now that this investor robot is going to do what you were talking about Jack, it's going to be in the system for people who are at home who are aging and who may have various types of capabilities that are limited. Amazon revealed that this whole interest is frankly not only in prototype right now, but they're hoping to have it out within the next year. It should be in our homes. So yeah, you're again, you're spot on Jack, this is going to be huge. The robots as far as surgery goes, that is still a ways away but using robotic assistance, so that you can have a world-class surgeon perform surgery is going to be a big deal. As you may know, I was in emergency medicine for ten years as a volunteer, and the ability then to have a surgeon as we have right here in New Hampshire at any of our Southern central hospitals or out on the Seacoast. The ability to have those types of surgeons available and doctors available, who can then examine a patient in some small rural community in northern New Hampshire and even treat them, that's coming very, very quickly. We already have some of that technology and with the physical feedback, where the robot is remotely-controlled, but the doctor can feel exactly what that robot is feeling, right Palpate and do various things. Man, I'm so looking forward to some of this feature. Jack Heath I can tell. All right, thanks, Craig. Appreciate it, right. Don't fight it. Embrace it. All right. That was some tech talk. And we come back to the tropical storm. Craig Peterson By the way, just pointed out that if you want to sign up, right now for my regular email list. So if you're not already on my list, you can subscribe by going to Craig Peterson dot com at the top of the page. There is a little subscribe link that you can just put in your name and email. And I'll let you know when it happens. I'll also be sending you my weekly security notes, show notes, whatever you might want to call it. People call it different things right as I try and keep you up to date on the most important happenings in the world of technology and security, although I do produce exclusive newsletters for security, those are a paid subscription. Anyhow, we'll I'll talk to you tomorrow. Bye-bye. --- More stories and tech updates at: www.craigpeterson.com Don't miss an episode from Craig. Subscribe and give us a rating: www.craigpeterson.com/itunes Message Input: Message #techtalk Follow me on Twitter for the latest in tech at: www.twitter.com/craigpeterson For questions, call or text: 855-385-5553

In this week's episode, I discuss ulcers ooooo. The bane of horse owner's across the world! Anywho, I'll be talking about what I've learned about ulcers, how to figure out if your horse has them, & what changes you can make to treat & prevent them. I am not vet or nutritionist, so I highly recommend talking to your vet & doing your own research outside this episode! Have a listen and enjoy! Let me know your thoughts & be sure to leave a positive review for me(: Links on Ulcers: How to Palpate - https://www.youtube.com/watch?v=Fr05hMmLCY4 Depaolo Health Library - http://hl.depaoloequineconcepts.com/?q=taxonomy/term/3 My feed video - https://youtu.be/T-xfwNqwxrI Where to find me: ◇ Instagram − @JETequitheory @JETrealpodcast @Jill.Treece ◇ YouTube − youtube.com/c/jeteventing ◇ Facebook − facebook.com/JETrealpodcast ◇ Website − www.jetequitheory.com ◇ Business Email − jetrealpodcast@gmail.com Music: "Endless Motion" from Bensound.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/jetrealpodcast/message

In this podcast, Dr. Wade Swenson, an otolaryngologist with Ridgeview Specialty Clinics, provides an overview of the work-up and management of common pediatric neck masses. Objectives:    Upon completion of this podcast, participants should be able to: Identify the most appropriate algorithm to work-up and manage pediatric neck masses. Choose a focused differential diagnosis of a pediatric neck mass. Recognize when a referral to an otolaryngologist for a pediatric neck mass is recommended. 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: "Pediatric Neck Masses" (**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: CHAPTER 1: Pediatric neck masses fall into 3-categories:  Inflammatory, Congenital, and Neoplastic.  Seventy-five percent (75%) of neck masses are inflammatory, 20% congenital, and 5% or fewer are consistent with malignancy. The American Academy of Family Practice has a great algorithm on Pediatric Head and Neck masses. The majority of children with enlarged lymph nodes are largely reactive in nature. Most neck masses that are rubbery, mobile and B/L, are indicative of inflammatory in nature. Five (5) or more CTs of head and neck region can increase pediatric malignancy 3-fold. Palpate the parotids, submental, anterior SCM, posterior triangle, supraclavicular lymph nodes. Specific characteristics of a neck mass its midline or lateral.  The size, fixed or mobile, painful or non-tender, firm or soft, solitary or multiple nodes, skin changes. Do an oral and dental exam. Staph and strep are the bacterial causes of most inflammatory neck masses. Antibiotics typically used include: Keflex, Augmentin, and Clindamycin for 10-days; recheck in 3-days to document improvement or continued concern. Atypical mycobacterium infection is generally the cause of chronic inflammatory granulomatous processes.  Often found in the submandibular and periparietal lymph nodes. Generally unilateral and non-tender lymph nodes. Workup includes: PPD skin tests, Bartonella Henslae (or Cat Scratch Fever) and Toxoplasmosis. CHAPTER 2: Physical location and history will guide you to the diagnosis of thyroglossal and brachiocleft cyst. Up to 50% of cysts present infected. Thyroglossal cyst present in the midline from hyoid bone to thyroid isthmus. They tend to be smooth and will often be raised when a child sticks out their tongue. The average of diagnosis is around 6-yrs. of age. About 40% present before the age of 10. Typical treat similar to infected lymph node. With a course of abx and observation to "cool down" the neck mass for 5-6 weeks and then usually surgery. I&D are not recommended as it can cause a fistula track. Imaging choice for a thyroglossal cyst is ultrasound. Furthermore, confirming normal thyroid function in imperative, as you do not want to be fooled by an ectopic thyroid. It is acceptable for the primary care to initiate abx therapy with referral to ENT 1-2 weeks after abx management for recheck and further evaluation. ENT typically recommends surgery for congenital neck masses b/c they do not resolve on their own. Brachiocleft cyst represents 1/3 of congenital neck masses. Most common is a 2nd brachiocleft cyst. Present high in the neck anterior and deep to the SCM border below the angle of the mandible. Ultrasound you guessed it is the imaging modality of choice. One limitation of US is not great at differentiating a lymph node vs. cancer. That's where history and physical exam findings come into play. As an example - Is it a supraclavicular mass, firm, fixed, hard with dimensions greater than 3cm, which is going to be more concern for cancer. Most common cause of pediatric head and neck CA is Hodgkin's lymphoma. Look for fever, chills, malaise, night sweat, weight loss, pallor, fatigue, and failure to thrive. Vascular anomalies are relatively uncommon and are typically referred to as lymphatic malformation. Typically referred to pediatric ENT at Children's or the U. Another name for these lymphatic malformation are also called Cystic Hygromas. Hygromas are typically soft, doughy, trans-illuminate - found commonly in posterior triangle. US are initial imaging choice, however CT or MR can help with delineating the extent of the hygroma. There is about a 5% or fewer risk of malignancy in children with persistent head or neck masses. FNA's are NOT recommended in children. Forty to 50% of cancers in children with head and neck masses are lymphomas. Incisional or excisional biopsy for larger neck masses is generally the next step in evaluation and treatment. SUMMARY OF EVALUATING PEDIATRIC NECK MASSES: Evaluation of pediatric neck masses include: observation, antibiotics, imaging with US to differentiate if lymph node remains - consider obtaining PPD, bartonella and toxoplasmosis titer - looking for granulomatous disease. Next step is surgical removal of the lymph node. As far as labs go - often times the ENT will have the specific titers they want for ruling out certain disease processes. Leave the detailed lab ordering to ENT. When the lymph node is finally excised, generally sent for pathology and culture. RECAP: Neck masses are common. Majority are benign in etiology. They fall into 3-categories: inflammatory, congenital, or neoplastic. Characterize the neck mass with a detailed physical exam. Location, size, mobility, consistency, single or multiple, unilateral or bilateral. Is there fever or chills, accompanied with sxs? Managed with observation and a course of abx. No improvement, consider an US to further differentiate the mass. No improvement 4-6 weeks, send off to ENT for further evaluation.

The journey is coming to an end. Chriso & Nic Palpate are finishing their 4 hour set packed with Deep House and Techno from their own Deep Inn Techno series with this last enjoyable part. I'm proud that the Loops of Life Podcast is a part of this. So let the music speak for itself and I hope you enjoyed this special from my good friends Chris and Nic especially for our Loops of Life Podcast. And be aware of our next special guest I'm super excited about who will present her second Set on our Podcast. *for tracklist ask Chris & Nic All eyes on Chriso and Nic:
 https://soundcloud.com/chriso_dj
 https://www.facebook.com/dj.chrisjost
 https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR Background photo by Leonardo Yip on Unsplash

Hey, guys, I think I have to say no more. The fact that Chriso and Nic Palpate are a fundamental part of the Loops of Life family is not a big secret anymore. So as I promised you guys the journey is not over yet. I don't want to talk too much so just enjoy and be prepared for this penultimate insane part of Chriso & Nic Palpate's Deep Inn Techno session here on the Loops of Life Podcast. *for tracklist ask Chris & Nic All eyes on Chriso and Nic:
https://soundcloud.com/chriso_dj
https://www.facebook.com/dj.chrisjost
https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR Background photo by Kevin Cochran on Unsplash

Hello everybody. I've nothing special to say today because like I teased last time we will get to enjoy another three parts of Chriso & Nic Palpate's Deep Inn Techno Session. So I'm super excited to have this little piece of a different kind of music here as a part of the Loops of Life Podcast. So if you are a fan of a good selection of any kind of electronic music during a long nice mixed set you are gonna be definitely a fan of Chriso & Nic Paplapte too. Stay tuned. Part 3 and 4 will come soon! *for tracklist ask Chris & Nic All eyes on Chriso and Nic:
 https://soundcloud.com/chriso_dj
 https://www.facebook.com/dj.chrisjost
 https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR

Today I’ve got something special for you guys. This is the first hour of a four-hour special live set by Chriso & Nic Palpate. Chriso & Nic's well established Elektronische Klangprodukte sessions are known for good and passionate Techno parties every Thursday at the Scarabée Club. After that, they also took over the weekends at the Gießen club scene with their new party series: Deep Inn Techno. So I’m really proud to present you one of many great live-sets of their new series which you definitely should check out if you don’t have any special plans for the weekend. Prepare yourself: three more sets are coming soon on our Loops of Life Podcast. 

*for tracklist ask Chris & Nic All eyes on Chriso and Nic:
 https://soundcloud.com/chriso_dj
 https://www.facebook.com/dj.chrisjost
 https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR

So for the first time, I can proudly present you Nic Palpate’s first Solo-Session here on the Loops of Life Podcast. After some B2B Sessions with him and Chriso who has also released some Podcasts on the Loops of Life station, he is going to give you a look into his own style of mixing. Nic is an awesome dude who is easy to be around with and he’s also a great DJ who plays every Set with passion and a lot of fun. Nic Palpate is a guy you should see when he is playing I can tell you it is definitely worth it.

 All eyes on Nic Palpate:
 Soundcloud: https://soundcloud.com/nic-palpate 1. Matt Sassari - Roi Perc | Stereo Production 2. Waveshape - The Concept | Cocoon Recordings 3. Matt Sassari - Cops Mood | Tronic 4. OC & Verde - Hex | Filth on Acid 5. Spektre - Nightshade | Phobiq 6. Fjaak - Gewerbe 15 | 50 Weapons 7. Aitor Ronda - Tweezer | ELEVATE 8. Carlo Reutz - Obscure | Rukus 9. Dimitri Nakov, Flow & Zeo - Outsider (feat. Mari-Anna) [Boy Next Door Remix] | Plano B Records 10. Gregor Trasher - Goliath | Bedrock Records SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR Contact me if you have any questions about my music or just want to be a part of Loops of Life: sppitps@web.de

During the Easter weekend I played together with two great DJ’s and friends of mine at the Scarabée Club in Gießen. After my 2 hour Set, I’ve played until 3 am Chriso & Nic played a huge closing Set as always. Their set had the perfect mix of some deep and melodic techno tracks and some of their typically deep house sound. I had a lot of fun not standing behind the desk and dance until the end of their playtime instead. If you hadn’t the opportunity to listen to Chriso & Nic live at Scarabée or you just want to listen to their closing set again. Here it is. Enjoy! *no tracklist available All eyes on Chriso and Nic:
 https://soundcloud.com/chriso_dj 
https://www.facebook.com/dj.chrisjost 
https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR Contact me if you have any questions about my music or just want to be a part of Loops of Life: sppitps@web.de

No matter what kind of music you prefer we all like a good selection of nice deep house music. This time I’m proud to present you the first b2b Set in the Loops of Life Podcast history. Chriso who is known for an excellent deep house track selection in his sets recorded this awesome groovy one hour b2b set together with his good friend Nic Palpate. Keep your ears open and don’t miss any upcoming collaborations between Chriso and Nic. If you like deep house music I’m pretty sure you gonna love this one. 
Btw: Chriso and me are gonna play at the Scarabeé in Gießen on the 29th of March. All eyes on Chriso and Nic: 
https://soundcloud.com/chriso_dj
 https://www.facebook.com/dj.chrisjost
 https://soundcloud.com/nic-palpate SoundCloud: http://soundcloud.com/marmormetall http://soundcloud.com/marmormetall-official Instagram: http://instagram.com/marmormetall Facebook: http://facebook.com/marmormetall Youtube: http://bit.ly/2lfHtyx Spotify: http://spoti.fi/2xfZPJ0 Beatport: http://bit.ly/2CMwnyi iTunes: http://apple.co/2hQPHMu Amazon Music: http://amzn.to/2hQW2HR Deezer: http://bit.ly/2hsS0nR 1. Giorgia Angiuli –Axial Tilt | Stil vor Talent 2. Miyagi – A better Ghost | Einmusika Recordings 3. Miyagi & Giorgia Angiuli – Infinity Bells | Einmusika Recordings 4. Ray Okpara – Satin Curtain (Kevin Yost Remix) | Mobilee Records 5. Beatamines – Echoes (Einmusika Recordings 6. Florian Kruse & Henrik Burkhard pres. The Ground – Reflections | Stil vor Talent 7. Einmusik & Philipp Kempnich – Haunting | Einmusika Recordings 8. Marco Resmann – Babylon (feat. Deep Aztec & Black Soda) | Watergate Records 9. Giorgia Angiuli – Around Your Space (Marc Romboy Lost in Space Remix) | Systematic Recordings 10. Nicone – Imiah | Ritter Butzke Studios 11. Betoko & Beatamines – Ciento | Einmusika Recordings 12. Internacional Electrical Rhythms – Momental | Lossless Contact me if you have any questions about my music or just want to be a part of Loops of Life: sppitps@web.de

Nic Palpate & Chriso: Aufgewachsen in der selben Hood am Dorf sind sich die beiden DJs 2017 in der Gießener Technoszene wieder über den Weg gelaufen und planen nun, diese mit neuen Projekten aufzumischen. Hier eines ihrer ersten gemeinsamen Sets. Facebook: www.facebook.com/dj.chrisjost/ Soundcloud https://soundcloud.com/nic-palpate https://soundcloud.com/chriso_dj Mixcloud www.mixcloud.com/nicpalpate/ www.mixcloud.com/chriso_dj/ Instagram https://www.instagram.com/nicodownmiddlehessen/ www.instagram.com/chriso_dj/

Nic Palpate & Chriso: Aufgewachsen in der selben Hood am Dorf sind sich die beiden DJs 2017 in der Gießener Technoszene wieder über den Weg gelaufen und planen nun, diese mit neuen Projekten aufzumischen. Hier eines ihrer ersten gemeinsamen Sets. Facebook: www.facebook.com/dj.chrisjost/ Soundcloud https://soundcloud.com/nic-palpate https://soundcloud.com/chriso_dj Mixcloud www.mixcloud.com/nicpalpate/ www.mixcloud.com/chriso_dj/ Instagram https://www.instagram.com/nicodownmiddlehessen/ www.instagram.com/chriso_dj/

Nic Palpate & Chriso: Aufgewachsen in der selben Hood am Dorf sind sich die beiden DJs 2017 in der Gießener Technoszene wieder über den Weg gelaufen und planen nun, diese mit neuen Projekten aufzumischen. Hier eines ihrer ersten gemeinsamen Sets. Facebook: www.facebook.com/dj.chrisjost/ Soundcloud https://soundcloud.com/nic-palpate https://soundcloud.com/chriso_dj Mixcloud www.mixcloud.com/nicpalpate/ www.mixcloud.com/chriso_dj/ Instagram https://www.instagram.com/nicodownmiddlehessen/ www.instagram.com/chriso_dj/

In this video Dr. Aleem Lalani, an Orthopedic surgeon at the University of Alberta, demonstrates how to give a complete physical examination of the spine. After watching this video you should be able to: Look for any abnormalities in the spine Palpate the spine for any causes of pain for discomfort Understand the range of motion tests on the spine Perform a neurologic exam of the spine Complete special tests for further investigation

Tom F struggles to make peace with peace lizards in Endless Legend; Tom S struggles to make peace with the problems of The Swindle; Marsh struggles to make war using the physics combat of Feist; and Graham relishes the lack of struggle in Rocket League. Also discussed: why Tomb Raider marks the death of the [...]