Podcasts about PAP

Entra a www.invierteconplata.com, abre tu cuenta en menos de 5 minutos Y EMPIEZA A CONSTRUIR TU FUTURO hoy mismo Sigueme en Twitch donde hago streams todos los días a las 8pm Hora centro de México:   / lawlergg   ✅ Suscríbete Al Canal Para Ver Mas Videos:    / @lawlerev   ✅ Conectate Conmigo:

Harminc évvel az olajszőkítés fénykora után még mindig nem tudjuk pontosan, kik voltak a rendszerváltás utáni Magyarország egyik legnagyobb korrupciós és szervezett bűnözési botrányának valódi haszonélvezői. A Papíron Szép legújabb adásában Papp László Tamás oknyomozó újságíróval beszélgetünk az olajügyekről, az eltűnt aktákról, a megsemmisített dokumentumokról és azokról az új információkról, amik most látnak napvilágot. A tartalomból 00:00:51 – Miért beszélünk még mindig az olajszőkítésről? A rendszerváltás egyik legnagyobb botránya harminc évvel később is felvet kérdéseket. 00:01:17 – Hogyan teremtenek az állami döntések váratlan lehetőségeket a szervezett bűnözés számára? A szesztilalomtól a drogháborúig. 00:06:35 – Az olajbiznisz következményeként több százmilliárd forint tűnhetett el a költségvetésből. Hogyan vált iparággá a kis ügyeskedés? 00:08:27 – Az Energol felemelkedése: Portik Tamás, volt rendőri vezetők és az állami korrupció szerepe. 00:11:38 – A hatóságok éveken, évtizedeken át jelezték a problémát. Miért maradt mégis érintetlen a rendszer? 00:12:35 – „Ezt a pontot külön kérésre töröltük.” Friss dokumentumok helyezhetik új megvilágításba a döntéshozatalt. 00:14:20 – Miért lett újra aktuális az olajügy 2026-ban? Leszámolások, robbantások és a Boros-ügy: mi történt, amikor véget ért az olajbiznisz? 00:19:06 – Polt Péter, Pintér Sándor és a felelősség kérdése az olajügyek kivizsgálásában. 00:20:03 – Több mint négyezer olajügy, több száz elítélt – mindössze egy rendőr és egy minisztériumi tisztviselő volt a vádlottak között. Mi hiányzott: az eszköz vagy a politikai akarat? 00:24:03 – „A rendőrség kereste Portikot, de mindig olyankor, amikor nem volt ott.” 00:27:34 – A kormányváltás után derült ki, hogy több kulcsfontosságú olajügyi dokumentumnak is nyoma veszett. Az Átlátszó olajügyekkel foglalkozó cikksorozata itt olvasható: https://atlatszo.hu/szerzo/papplaszlotamas/

En 1998, un tsunami masivo golpeó la costa de Papúa Nueva Guinea, arrasando aldeas enteras en un instante. Pero el verdadero terror llegó después de que las olas retrocedieron, porque algo no cuadraba. Los científicos esperaban un terremoto de mayor magnitud para desencadenar un tsunami tan devastador, sin embargo, el sismo registrado fue demasiado pequeño. Fue entonces cuando descubrieron la aterradora verdad: un deslizamiento submarino había amplificado secretamente el desastre, creando olas mucho más mortales de lo esperado. Este evento cambió cómo los expertos estudian los tsunamis, demostrando que a veces, el mayor peligro es el que nunca ves venir. ¡Mira ahora para descubrir la historia completa de esta pesadilla oculta bajo el mar!

En la espuma de los días quisimos hablar de fe sin filtros de perfección. Porque La Casa de Papá no nació en un estudio de grabación, sino en un hospital, cuidando a una esposa que apenas podía caminar. ¿Qué pasa cuando la vida se derrumba y aun así decides agradecer? Para descubrirlo, nos acompaña el cantautor Daniel Calveti.La espuma de los días, con Neyra Moncayo, un producto de adn Noticias Radio.

► Agenda FGC et réseaux sociaux : linktr.ee/kahikusu► Bluesky : https://bsky.app/profile/kahikusu.bsky.social► https://twitter.com/kahikusu► https://twitter.com/M4rtelus► https://twitter.com/Naudno77► https://twitter.com/iamarktall► https://twitter.com/Linkexelo► https://twitter.com/Pap_fgc---------------------------------------------------------------Chapitrage0:00 Intro 6:54 Agenda FGC10:55 l'arrivée de l'équipe21:31 Point Matos 36:54 Débrief de l'UFA1:35:28 Le patch 2.60 de Granblue Fantasy Versus Rising 1:44:50 Arjun va-t-il casser la meta de Street Fighter 62:05:21 L'EVO Singapour est un EVO au rabais ? 2:22:45 Un trailer et une date pour Kim Kaphwan dans Fatal Fury2:23:42 Zohar enfin disponible dans Under Night In-Birth 22:25:26 Marvel Tokon veut déjà changer sa formule2:56:15 Les rendez-vous du week-end2:59:29 Fin de l'émission

Relebogile Mabotja speaks to Dr. Tumi Sebopa the Head of Brands at Spur Corporation and Mduduzi Mthombeni the operations manager at RocoMamas about 13 years of RocoMamas which has been serving up smashburgers, ribs and wings and now the King’s Feast menu taking inspiration from the sounds and energy of Amapiano led to proudly local flavours like chakalaka, atchar and pap, reimagined through a distinctly RocoMamas lens. 702 Afternoons with Relebogile Mabotja is broadcast live on Johannesburg based talk radio station 702 every weekday afternoon. Relebogile brings a lighter touch to some of the issues of the day as well as a mix of lifestyle topics and a peak into the worlds of entertainment and leisure. Thank you for listening to a 702 Afternoons with Relebogile Mabotja podcast. Listen live on Primedia+ weekdays from 13:00 to 15:00 (SA Time) to Afternoons with Relebogile Mabotja broadcast on 702 https://buff.ly/gk3y0Kj For more from the show go to https://buff.ly/2qKsEfu or find all the catch-up podcasts here https://buff.ly/DTykncj Subscribe to the 702 Daily and Weekly Newsletters https://buff.ly/v5mfetc Follow us on social media: 702 on Facebook https://www.facebook.com/TalkRadio702 702 on TikTok: https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/Radio702 702 on YouTube: https://www.youtube.com/@radio702 See omnystudio.com/listener for privacy information.

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Magazín: Konference o duševním zdraví v církvi; Papírový palouk. Host: Ráchel Černá, Jana Šarounová.Tento podcast můžete podpořit na https://radio7.cz

Palmen aus Plastik feiert 10-jähriges Jubiläum

Sigueme en Twitch donde hago streams todos los días a las 8pm Hora centro de México:   / lawlergg   ✅ Suscríbete Al Canal Para Ver Mas Videos:    / @lawlerev   ✅ Conectate Conmigo:

Grandes de la rumba y el guaguancó registrados por la discografia independiente cubana de los años 50. Celeste Mendoza apoyada por la etiqueta Gema de los hermanos Alvarez Guedes; el grupo "Guaguancó Matancero" con Saldiguera y Virula en la delantera vocal y Papín y sus rumberos con Fuico, su cantante estrella, desde el catálogo Puchito de Jesús Gorís. Sonidos que nos recuerdan que, afortunadamente, no existieron barreras sociales entre músicos populares y productores discográficos. Carlos Embale todo lo cantó bien. Sonero inmenso brilló además en la rumba y el guaguancó. Presencia de la obra del maestro Ernesto Lecuona en las voces más destacadas del canto lirico cubano del siglo XX. Sarita Escarpenter, María de los Ángeles Santana unen sus voces para cantar "Tus ojos azules" y por separado: "Al fin" y "Mariposa". Esther Borja con el pianista Nelson Camacho nos recuerda la faceta del genio de Guanabacoa como musicalizador. "La rosa del jardinero" es un texto de los poetas españoles Serafín y Joaquín Álvarez Quintero. Los tesoros de la música popular cubana, todos los domingos, los reservamos aquí para ti. Tres piezas del pianista, arreglista y compositor Moisés Simons en voz de la Rita Montaner correspondientes al despegue discografico de la intérprete como artista exclusiva de la etiqueta norteamericana Columbia. En agosto de 1928, durante uno de sus viajes a Nueva York, grabó con el apoyo de los pianistas Rafaelito Betancourt y Nilo Menéndez: "Rumba guajira" y "Palmira". Un año más tarde, en julio de 1929, la feliz coincidencia de Rita y Bola de nieve al piano iluminó el mundo del disco con esta versión del pregón: "Con picante y sin picante". El ayer y hoy de una isla y su música. Harold López Nussa y CimaFunk en este formidable tributo al timonel del tren vanvanero Juan Formell. Del "Buey cansao" a una mirada más contemporánea del clásico de Samuell: "Los ojos de Pepa" nos sigue acompañando este notable pianista. Continuamos con unos tracks del álbum "Black and white" del año 1989. El trabajo discografico del trompetista Jorge Varona que, lamentablemente, resultó ser póstumo nos devuelve el sonido de este formidable instrumentista. Desde formaciones como el Conjunto Casino, la banda de Beny Moré, la Orquesta de Música Moderna e Irakere, Varona completó su paso memorable por los escenarios. En la despedida un recuerdo para el gran Emiliano Salvador a la manera del saxofonista, arreglista y compositor Carlos Averhoff (junior). Cubakústica, todas las semanas compartimos contigo más de cien años de música popular cubana

In this episode of the Hope Natural Health Podcast, Dr. Erin Ellis talks about why so many women dread Pap smears and how a difficult or painful past experience can lead to years of avoidance. She breaks down the importance of cervical cancer screening, current screening guidelines, HPV, vaccination, and the newer at-home HPV self-collection options that may make screening more accessible and comfortable for some women.   In This Episode, You Will Learn: Why a difficult or painful past experience can make women avoid Pap smears and pelvic exams for years Why cervical cancer screening is important, even when you feel completely healthy and have no symptoms How often women actually need cervical cancer screening and the differences between HPV testing, Pap testing, and co-testing How at-home HPV self-collection works and how it may make screening more comfortable and accessible What a positive HPV result means, including why it does not automatically mean you have cervical cancer and why follow-up care is still important How HPV vaccination, regular screening, and a supportive Well Woman Exam can all play a role in protecting your cervical health For more on Dr. Erin: Schedule a Well Woman Exam with Dr. Erin: https://hopenaturalhealth.practicebetter.io/#/619ef36b398033103c7b6bf9/bookings?s=61bbf0633980331230a27d04&step=date Work with Dr. Erin here: https://p.bttr.to/3E88ps4 Buy Dr. Erin's Supplements here: https://drerinellis.com/shop Get the Period Productivity Planner here: https://www.amazon.com/dp/B0BBYBRT5Q?ref_=pe_3052080_397514860 Download the FREE Menstrual Cycle Nutrition Guide here: https://detox.drerinellis.com/ Watch The Free Video "7 Hormones Affecting Your Weight Loss Goals" here: https://weightloss.drerinellis.com/   Let's Be Friends: Follow Dr. Erin on Instagram: https://www.instagram.com/dr.erinellis/ Follow Dr. Erin on Facebook: https://www.facebook.com/drerinellisnmd Follow Dr. Erin on TikTok: https://www.tiktok.com/@dr.erinellis?lang=en Join the Free Hope Circle Community: https://hormonehealingproject.drerinellis.com/communities/groups/the-hope-circle/home?invite=69120d498b7e3f60397656b8 Bookmark Dr. Erin's Website: www.drerinellis.com Subscribe to Hope Natural Health on YouTube: https://www.youtube.com/channel/UChHYVmNEu5tKu91EATHhEiA Follow Hope Natural Health on FB: https://www.facebook.com/hopenaturalhealth Sign up for Newsletters here: https://booking.hopenaturalhealth.com/widget/form/VUubL7MNYELduwQL8ssI  

Reproductive health is a part of women's health throughout every stage of life, yet so many of us still have questions about what preventative care we actually need, when we should be getting screened, and what our options are when it comes to our bodies and our healthcare. In this episode, we're having an open, honest, and judgment-free conversation with Jennifer Love, a certified nurse midwife and Lead Clinician at Planned Parenthood of Southern New England. With more than 20 years of experience in reproductive healthcare and over a decade at Planned Parenthood, Jen brings a science-based, evidence-based, and patient-centered perspective to some of the most important topics women need to understand. We're breaking down cervical cancer screenings, including what Pap tests and HPV testing actually look for, why routine screening matters, and what women should know if they've been putting off an appointment. We're also talking about STI testing and treatment — why someone can have an STI without symptoms, how testing works, and why getting tested should be viewed as a normal part of taking care of your health rather than something associated with shame or judgment. And we're having an honest conversation about abortion care, including the differences between medication abortion and procedural abortion, what each experience can look like, and how healthcare providers help patients understand their options and make informed decisions about their care. Most importantly, this conversation is about access, education, prevention, and empowering women to feel comfortable asking questions about their own bodies. Whether you're overdue for a screening, wondering when you should get tested, trying to understand your reproductive healthcare options, or simply want reliable information from a medical professional, this episode is designed to give you straightforward answers without the stigma. No shame. No judgment. Just facts — and a reminder that taking care of your reproductive health is taking care of yourself.

durée : 00:59:51 - Le 13/14 - Dès 13h30, nous aborderons la question du marché immobilier en France. Pourquoi est-il si difficile de louer dans les grandes villes ? Quelles sont les tendances observées localement ? Corinne Jolly, présidente du site PAP, sera notre invitée. Vous aimez ce podcast ? Pour écouter tous les épisodes sans limite, rendez-vous sur Radio France

Ladies, if you have ever been told your labs look normal while your body says otherwise, this one is for you. Dr. Amy Loden is a physician who nearly died from preeclampsia and now builds her practice around what medicine misses in women. She breaks down why pregnancy complications are a warning sign, what perimenopause is really doing to you, and why heart disease deserves your attention more than you think. You will walk away knowing what to ask for and why it matters.If you have any questions about this episode or want to get some of the resources we mentioned, head over to LesleyLogan.co/podcast https://lesleylogan.co/podcast/. If you have any comments or questions about the Be It pod shoot us a message at beit@lesleylogan.co mailto:beit@lesleylogan.co. And as always, if you're enjoying the show please share it with someone who you think would enjoy it as well. It is your continued support that will help us continue to help others. Thank you so much! Never miss another show by subscribing at LesleyLogan.co/subscribe https://lesleylogan.co/podcast/#follow-subscribe-free.In this episode you will learn about:How pregnancy complications reveal health risks that were already there.Why perimenopause symptoms get dismissed as normal aging.The heart disease signs that look nothing like the classic ones.Why good quality sleep matters more than hours in bed.How to eat and move to protect your metabolic health.Episode References/Links:Vitality Medical and Wellness - https://www.vitalitymwc.orgDr. Amy's TEDx talk on pregnancy - https://beitpod.com/amytedxDr. Amy Tiffany on Instagram - https://www.instagram.com/dramytiffanyDr. Amy Loden on LinkedIn - https://www.linkedin.com/in/amy-lodenThe Postpartum Pivot by Dr. Amy Loden - https://vitalitymwc.org/read-the-bookSubmit your wins or questions - https://beitpod.com/questionsGuest Bio:Dr. Amy Loden Tiffany is a St. Louis-based physician entrepreneur, author, and TEDx speaker dedicated to women's metabolic, hormonal, and cardiovascular health. After surviving severe preeclampsia and experiencing burnout in traditional, high-volume medicine, she pivoted her career toward a personalized, root-cause approach to patient care. As the founder of Vitality, she guides women through major life transitions—from postpartum to perimenopause—to help them recognize subtle warning signs and prevent long-term illness. Through her clinical work and her book, The Postpartum Pivot, Dr. Loden empowers high-achieving women to listen to their bodies, optimize performance, and take control of their long-term health.  If you enjoyed this episode, make sure and give us a five star rating and leave us a review on iTunes, Podcast Addict, Podchaser or Castbox. https://lovethepodcast.com/BITYSIDEALS! DEALS! DEALS! DEALS! https://onlinepilatesclasses.com/memberships/perks/#equipmentCheck out all our Preferred Vendors & Special Deals from Clair Sparrow, Sensate, Lyfefuel BeeKeeper's Naturals, Sauna Space, HigherDose, AG1 and ToeSox https://onlinepilatesclasses.com/memberships/perks/#equipmentBe in the know with all the workshops at OPC https://workshops.onlinepilatesclasses.com/lp-workshop-waitlistBe It Till You See It Podcast Survey https://pod.lesleylogan.co/be-it-podcasts-surveyBe a part of Lesley's Pilates Mentorship https://lesleylogan.co/elevate/FREE Ditching Busy Webinar https://ditchingbusy.com/Resources:Watch the Be It Till You See It podcast on YouTube! https://www.youtube.com/channel/UCq08HES7xLMvVa3Fy5DR8-gLesley Logan website https://lesleylogan.co/Be It Till You See It Podcast https://lesleylogan.co/podcast/Online Pilates Classes by Lesley Logan https://onlinepilatesclasses.com/Online Pilates Classes by Lesley Logan on YouTube https://www.youtube.com/channel/UCjogqXLnfyhS5VlU4rdzlnQProfitable Pilates https://profitablepilates.com/about/Follow Us on Social Media:Instagram https://www.instagram.com/lesley.logan/The Be It Till You See It Podcast YouTube channel https://www.youtube.com/channel/UCq08HES7xLMvVa3Fy5DR8-gFacebook https://www.facebook.com/llogan.pilatesLinkedIn https://www.linkedin.com/in/lesley-logan/The OPC YouTube Channel https://www.youtube.com/@OnlinePilatesClasses Episode Transcript:Amy Loden Tiffany, MD, MBA 0:00  If we're going to call pregnancy a stress test, which is becoming an increasingly common term, is pregnancy a stress test of a woman's metabolism and her cardiovascular system? Then we have to ask, what are we stressing it for? And the way I'm looking at this is a little bit different than how I was trained, which again was if you got the problem, the solution is in the pregnancy. So what if we started looking at pregnancy from the perspective of this is an unveiling, an unveiling of what was already there, and that nothing's actually gone wrong. Lesley Logan 0:29  Welcome to the Be It Till You See It podcast where we talk about taking messy action, knowing that perfect is boring. I'm Lesley Logan, Pilates instructor and fitness business coach. I've trained thousands of people around the world and the number one thing I see stopping people from achieving anything is self-doubt. My friends, action brings clarity and it's the antidote to fear. Each week, my guest will bring bold, executable, intrinsic and targeted steps that you can use to put yourself first and Be It Till You See It. It's a practice, not a perfect. Let's get started. Lesley Logan 1:11  Oh my God, Be It babe. Get ready. Get your notepad out. Get ready. If you're driving, listen. You're gonna re-listen. You're gonna share this episode with everybody. I am so freaking stoked about the guest that we have. I fell in love with her with every single answer, and we need women like this in the medical world. So Dr. Amy Loden is our guest today. We're going to talk everything from postpartum to perimenopause and heart health, because ladies, you can't be it till you see it if you get sick, cannot. And I know it's confusing. There's so much information out there in the world, and it's like, who do we trust? What do we do? And I'm just so grateful I found her, and you're gonna love it. So make sure you get ready to hit share on this episode for women in your life and the men who need to know about what women are going through. My mind is blown on the episode. Here's Dr. Amy Loden.Lesley Logan 1:54  All right, Be It babe, I'm excited. I'm super stoked. We're gonna talk about all things women, health-related, with an amazing professional person who actually studies this stuff, not what I've read, and then I'm asserting to you because I don't want to be that influencer. I think those people need to take a little step back and let the professionals do it. We have Dr. Amy Loden here on the show, who's going to tell us everything we need to know. But Dr. Amy, we tell everyone who you are and what you rock at, kind of how you got here.Amy Loden Tiffany, MD, MBA 2:20  Sure, thanks for inviting me. I'm happy to be here, Dr. Amy Loden. I am in St. Louis, Missouri. I help primarily women over 40, but certainly anyone who's like, "How are my hormones working for my life or not? How is my weight in the mirror matching the weight in my head or not?" And all the things that come with life transitions from postpartum to perimenopause, beyond, my goal is that women who've interacted with our team will have a better care experience because it's the care experience we want each of us to have had ourselves, and because each of us are not only professionals within the medical nursing communities, we're patients too, or daughters and sisters and mothers and neighbors and all the things. We know how much it sucks to be patient, right? And so we've tried to redesign what is the best thing for our ladies. Now, in full transparency, we do have a few dudes, but most of them have had their arms twisted by our rock-star ladies, and they are the ones that are coming because they're forced to. And eventually, they decide they like us, but we're pretty cool too. So that's who we serve, and that's what we do. And happy to go into any detail or rabbit hole you want to chase?Lesley Logan 3:21  Oh my God, Amy! I love that. When people ask about the people who listen to this podcast, we have mostly women and a few good men because there are some men out there, including my husband. They want to be interested. They want to. They want their partners, the women, their lives. They want to get what's going on. They don't want them to feel like an alien or like they're alone in this journey. So I think that's really, really cool. I also just want to highlight. I love that you brought up your patients too, because as someone who I feel very lucky to go through my perimenopause journey in today's time when people actually are talking about it, versus even 10 years ago, generations were not talking about this stuff, and I just feel it's really nice because then there's information I would never have known about HRT unless my girlfriend had told me about it. Oh, that could be going on, and then I could talk to someone. Can we go back though? Yeah, I feel like to be a doctor like yourself, who has empathy and understands, like you must have gone through a journey as well. You don't just want to do this Amy Loden Tiffany, MD, MBA 4:13  Because you wanted to do this. That's true. Lesley Logan 4:16  Maybe there are a few. There might be a few, but typically, like there there has there's a story there that got you to be like I want to care about this. So can you tell us a little bit more about that?Amy Loden Tiffany, MD, MBA 4:24  Absolutely, yeah. So definitely with the traditional college to medical school road, really didn't understand that there's a and I say this with all the love in my heart, but there is a bit of brainwashing to be a good doctor, right? And what is a good doctor was who you've been told it is. It's not necessarily an external criteria. It's who does academic medical center say, and that was very different. I learned through transferring all of my non-medical student fears into the actual application of those fears, and then being a patient and living those fears. That I realized there's a whole lot we're not talking about. There's a whole lot that we're not being told, both as doctors and as women, as patients, and it's hard to realize you don't know what you don't know if you've been told you're the expert and you know everything, right? And most doctors don't go around saying they know everything, but there's enough patients who feel like that's what's communicated, that that's the language I'm using.Lesley Logan 5:18  Yeah.Amy Loden Tiffany, MD, MBA 5:19  And that's really frustrating as a patient, so I didn't realize how frustrating though it was until I was a patient, and I'm a mom of five kids, my third and fourth are twins, and really I am so grateful to live in the United States in a time in history where complicated pregnancies does not mean that mom dies, because I developed severe preeclampsia with heart failure, and my twins came 31 weeks instead of at least 37, and I nearly died the night they were born. They nearly died the night they were born, and I just am grateful that God let me be in this situation that I had the help I needed. Historically, these are not good situations. We see this on TV and in movies frequently. And something like 70,000 women a year across the globe die of the same disease I had, preeclampsia. So it's not nothing, even in our day and age, in certain countries, and even in countries where you have advanced medical care and they do everything right. It can still happen. So, that for me was the pinnacle of this isn't working. What we're telling people to do isn't working because I had done all the things.Lesley Logan 6:30  Right, you were a doctor. You did all the things. I did all the things. You enjoyed all the appointments. You were probably doing, and this is your third and fourth. So you knew what it should feel like. You knew what you should be eating. You knew all the vitamins to take.Amy Loden Tiffany, MD, MBA 6:41  Correct, and it didn't work, right? It didn't work, and so I think that is the fundamental kind of if you place a pivot on why did I change how I think about healthcare as a doctor, it was because of my experience as a patient for myself. My husband had cancer twice, so being the advocate for him in those types of things, guiding my children and now my parents through healthcare, you start to carry a lot of stories, and you start to see, wow, they're not doing what I think is just the bare minimum. And if they're not doing that for me or for my family, I know they're not doing it for everybody else.Lesley Logan 7:11  Yeah.Amy Loden Tiffany, MD, MBA 7:12  And then at the same time, holding a ton of grace in my heart because that's—they're doing what they were taught.Lesley Logan 7:17  Right?Amy Loden Tiffany, MD, MBA 7:17  Right. And they can't do differently if they don't know differently. You can't be better if you don't know to be better.Lesley Logan 7:23  Yeah.Amy Loden Tiffany, MD, MBA 7:23  So that is a really tight tension. But I thought I would just keep plodding through and just be a better doctor in that context of me being a patient until a little—I guess it was two years later. My daughter at that time, my oldest, was seven, and I had about 3000 patients. I was working somewhere between 65 and 80 hours a week, and had four kids at that time. And my daughter came up to me one night, and I'm opening the computer. I'm doing work like I do every night, and she says, "You're gonna make my birthday gifts. Like, can I help?" Right, totally innocent seven-year-old looking forward to her birthday knows that her mom shops online, right? And so she's like, "I want to pick my birthday presents," and I kind of stared at her. I was like, "No, no, I'm going to work. We'll do that later," and go watch whatever show. It's probably Paw Patrol for all I know, right? That's in the background. Go watch it. It's gonna be bedtime soon. And she just stands there, and I haven't even looked at her at this point. My eyes are on my computer. I'm just telling her this as I'm going. I'm totally not in the moment, right?Lesley Logan 8:19  Of course, because like you have so many, you have 3000 patients and four kids.Amy Loden Tiffany, MD, MBA 8:23   I can't keep up. I can't keep up. Right? I'm barely getting enough sleep. I'm not exercising, and I'm just trying to survive. And she doesn't move. And so I remember not totally slow motion, but I remember turning to her and feeling like I was going to be like, "What?" Right? What do you need? And she's just got out of the shower, so her hair's wet. She's got her pink pajamas on, bright big blue eyes, and they're full of tears. And there are just silent tears tracking down her face, and I'm horrified. Oh my gosh, what's wrong? Right now, I'm in fix-it mode.Lesley Logan 8:55  Yeah.Amy Loden Tiffany, MD, MBA 8:55  And she still doesn't really budge, and she just says in a very sad voice, "Mommy. Why do you love your job more than me?"Lesley Logan 9:05  Oh.Amy Loden Tiffany, MD, MBA 9:07  Yes. So the twins tried to kill me. She did kill me, right? Like, that was a knife in my heart because nothing ever had I wanted to be better than a so-called good doctor than to be a good mom.Lesley Logan 9:17  Yeah.Amy Loden Tiffany, MD, MBA 9:18  And that was for me the moment that I realized I'm not doing either of these well, and I'm not showing up how I want to be personally or professionally. I'm certainly not taking care of my health. I'm not doing the things I'm telling my patients to do. Like, it was a moment where I really felt the failures. I felt all the feelings, and I told my husband that night, "This is not working anymore." And he actually thought I thought was talking about our marriage, and so he was like, "Oh my gosh, what's wrong with our marriage?" Right? No, but I need to, like, redo. We have to redo this. I either have to retire, or I have to do something different.Lesley Logan 9:51  Yeah.Amy Loden Tiffany, MD, MBA 9:51  And he was like, "You're not retiring. You will drive me crazy. Go find something different to do, and I will make sure our family is okay." And so I did. And this June will be five years of having Vitality here in St. Louis and serving women and trying to lean into all the pain and the things and the feelings they're dealing with from all the things and the feelings I dealt with having walked that path.Lesley Logan 10:13  Yeah. Oh, Dr. Amy, I love that you shared that whole story because I think there's so many women who are listening here and, like, they don't have, they may have one kid or they have no kids, but, like, I think we can all relate to, like, having just too much on the plate because.Amy Loden Tiffany, MD, MBA 10:27  Right.Lesley Logan 10:28  Hello, my high-achieving woman. I see you, everyone here listening. We call recovering perfectionists and overachievers. There's nothing wrong with being a high achiever, but what happens is we tend to just keep saying yes to things, and we're like, yeah, we can fit that one more thing in, that one more thing. All of a sudden, it just comes to, like, a volcano breaking point. Yes, and because we don't, we don't see the signs early that we are at the breaking point. We don't, you know, we, it's almost, it's actually proven to be not true. But everyone uses the frog in the boiling water, right? Like, we just kind of, like, you don't realize how hot it's getting until it's until your daughter is crying in front of you. Oh, exactly.Amy Loden Tiffany, MD, MBA 11:05  Yes, it was awful. I never want to relive that moment.Lesley Logan 11:08  Yeah, but also, like, thank goodness for her because that she felt brave enough to say that. Like, what a badass she is. I mean, she's just going to be, like, she's just going to be a girl who speaks her mind. She does.Amy Loden Tiffany, MD, MBA 11:18  She's 13 now, and she heard me tell that story once, and now she's like, "Well, you have to credit me for opening your business because I hadn't said what I did." I was like, "Won't you just tone it down a notch, please?"Lesley Logan 11:27  It's called balance, babe. It's called balance. Yes. Okay. So, can we, like, let's get to some of the health stuff that I think our listeners want to—I want to definitely get into perimenopause, but I do want to, because we started with a pregnancy, and I have had family members who, you know, have had preeclampsia in their, and it's scary. So, how are pregnancy complications connected to long-term heart risk? I don't think anyone's thought about that. I just thought, like, if it's because I don't have kids, like it's going to screw up your pelvic floor, and you might have to rebuild your abs and these other things. But I didn't know it can affect your heart long term.Amy Loden Tiffany, MD, MBA 12:01  I had no idea. I'm so glad you brought that up. So I actually did a TEDx talk on this very topic, where the idea is pregnancy is so much more than just the birth of a kid. That's how we think about pregnancy in our culture. That's even how we think of it medically, right? Like if you have preeclampsia, you have gestational diabetes, you have high blood pressure, whatever in pregnancy, the answer is end the pregnancy, deliver the kid if they're old enough, right? Like, get, move it along and it's gone. But that I strongly believe is not true. We can't test this in a lab, so you have to do a little bit of extrapolation here. But if we're going to call pregnancy a stress test, which is becoming an increasingly common term, is pregnancy a stress test of a woman's metabolism and her cardiovascular system? Then we have to ask, what are we stressing it for? And the way I'm looking at this is a little bit different than how I was trained, which again was, if you got the problem, the solution is in the pregnancy. So, what if we started looking at pregnancy from the perspective of this is an unveiling, an unveiling of what was already there, and that nothing's actually gone wrong. It's scary. It's horrifying. And yes, absolutely, people die. So how can I say nothing's gone wrong? What I mean is nothing has gone wrong in the context of the situation we put your body in. It's exactly responding the way it should for the context it's in. So if I have underlying insulin resistance, and then I put a pregnancy on top of that or perimenopause, and I'm starting to have more insulin resistance. Well, of course I'm going to develop gestational diabetes. If I'm having a lot more fluid retention and I'm putting up a low weight, of course my blood pressure is going to go up, right? If I've got underlying inflammation, of course preeclampsia is going to develop. So I think we need to stop and think about it as it's not done; it is unmasked.Lesley Logan 13:42  Got it. Amy Loden Tiffany, MD, MBA 13:42  And then once you know it's unmasked, you treat it.Lesley Logan 13:45  I see. I see. Because again, we think of pregnancy as just the baby, so you have the baby, but it's well, but there's a problem, an underlying problem that the pregnancy revealed is what you're saying. And so great if having the baby is the safest thing for both people, we do that. But also, you still have this underlying issue.Amy Loden Tiffany, MD, MBA 14:01  Yes, it's still there. Correct.Lesley Logan 14:03  Yes, and I don't think anyone does that. I think they're just, "Okay. Now you don't have gestational diabetes anymore." But I have had clients who had it, and then afterwards, so what do we got? Oh, I'm fine. Are you correct? I don't think so. I'm not a doctor, but they're not fine. Don't just be diabetes. Yeah, for a moment. Yes.Amy Loden Tiffany, MD, MBA 14:19  So I actually experienced this as a patient too. I went in after my first pregnancy with gestational diabetes. At the time, I was living in New York City. I walked everywhere. I was a normal weight. I ate pretty clean, and despite being in residency, I'd got decent sleep. I didn't have any other kids. It's my first kid, so I got decent sleep. Right, but I had the baby after having had gestational diabetes. I go see my OB, and she's, "Oh, just follow up with your primary doctor." I go see my primary doctor, and he's, "Your weight's normal, your labs are normal. We're done," and that is how I was trained too. So again, lots of love in my heart. They're not; they're just not told. But for more than 10 years, we've known that women who have these high-risk pregnancies are at high risk not just for diabetes, but heart disease, stroke, kidney failure, dementia. Listen, I can't treat dementia well in the clinic, right? So why wouldn't I want all hands on deck trying to prevent it?Lesley Logan 15:07  Yeah.Amy Loden Tiffany, MD, MBA 15:07  But that's not how our medical professionals are trained—nurses, advanced practice providers, any of them. And so we're asking people and expecting people to fill in a gap they don't know exists, and so all these reproductive-age women are falling into it. And then where it gets really interesting is some of the same things you have immediately postpartum in all your different types of hormone fluctuations are matched intermittently for 10 to 15 years before menopause when you're in the perimenopausal years.Lesley Logan 15:32  What?Amy Loden Tiffany, MD, MBA 15:33  Correct, but that's why these women are feeling, "I'm going to my doctor, I'm putting on weight, I'm doing all the things, it's not working," and they're being gaslit, partly because their doctors don't know what they don't know, and partly because we're not acknowledging this is the same physiologic status of hormones that are different than baseline. So we're not in a country, and we don't have the testing that would promote or facilitate checking what is your normal hormone level at 18, so that we know what 18 should look like, and then by 45, you know, we're not. So we're trying to patchwork together a whole bunch of tests, and different labs have different testing, and different people say different things about testing. It's very confusing.Lesley Logan 16:10  Yeah.Amy Loden Tiffany, MD, MBA 16:11  And you end up with women suffering. And at the end of the day, that's the problem I'm trying to solve: is how do we stop these women from suffering? Because they are called to live big lives, to be ambitious for a purpose, for a calling. They have a lot to do, and their health is one of their biggest assets. It should not be a liability.Lesley Logan 16:27  Yeah.Amy Loden Tiffany, MD, MBA 16:27  And that's what's happening, especially for women who are trying to not work just in the home but outside the home. Right? There's a lot they're carrying. Yeah. So that's, I don't remember. Sorry, I'm having a total perimenopause moment. I don't remember where we started with that question here. I'll stop there. Lesley Logan 16:42  Don't worry, babe. I got my focus meds on the ADHD today, so I'm tracking. So we're good. But we were talking about the postpartum, and then we got into those hormones that switch as, and they can repeat into perimenopause. And I think this is fascinating. I love that you brought up. It doesn't matter if you're in the home or out of the home. We have big lives. Correct. We can't have our health be a liability, and I think for a lot of us, it feels like, like my girlfriend's a weight-loss coach for women over 40 who feel like their body gave a middle finger. That's what her coaching is, and it's all about not going to yo-yo diet. That's not going to work. We have to figure out what is the underlying issues, and it can only go so far because you said we don't test our hormones at 18. We don't do that, so we don't know what is normal for us, and I remember I was having a lot of health issues, digestive issues in my 30s, and no doctor could help me. In fact, one doctor sending me to, I was in this weird part where they study HIV and Ebola in the hospital, and she's like, "Do you know why you're here?" I don't know why I'm here. I don't. This scares the hell out of me. This feels like a department I should not be in. I'm not in any pain. I feel like I'm taking someone's spot, and so because he could, he just couldn't figure out what's going on my stomach. So I found someone who did an actual test of everything. He's so range normal. We don't know what normal is for you. We just know what the average person of this population of people that who knows who they were that were tested. So what is normal for you might not be the average. And I was, "Oh well, that's the first time anyone said anything that makes sense. That's the first time." So you can be in range, but for your hormones, but it wasn't in range for you because maybe you were used to higher testosterone, you're used to higher things. And so I love that people like you exist. I'm sorry for the frustration of your own journey, but also without people like you, women like me wouldn't have someone going, "Hey, actually, maybe you should be on testosterone right now," even though the, this is what it is. Mine was actually zero, but people, you know, we can actually get you help because I feel so much better because someone finally was listening to me and thought, "Yes, we're not going to compare you to a random person. We got to compare you to how you're used to feeling."Amy Loden Tiffany, MD, MBA 18:42  Correct. And for most people, that can't happen in the traditional system.Lesley Logan 18:47  Yeah.Amy Loden Tiffany, MD, MBA 18:47  You can't do that in a 10-minute visit.Lesley Logan 18:49  Right.Amy Loden Tiffany, MD, MBA 18:50  You can't do it when your doctor has 3000 patients, 10-minute visits, and they really don't actually know who you are.Lesley Logan 18:55  Yeah.Amy Loden Tiffany, MD, MBA 18:56  You just can't. So we've got a little bit of unrealistic expectations as a society, and then you know any women's magazine or journal article you read says, "Talk to your doctor about this." So then you go in, I'm all prepared. I have my list. I've done it too, folks. Right? This is not a criticism, but they, they can't. They don't have the ability to process it, and the way they're paid is based on the questions they ask you for insurance. So every incentive is misaligned, and at the end of the day, women, people are being screwed.Lesley Logan 19:22  Yeah, yeah. No, it's so true. So I'm glad we talked about the postpartum. I want to get into now. We're in the perimenopause, and yep, this is hard because you mentioned the hormone shift of people after postpartum is its own crazy world. I keep checking on my sister-in-law every day. How are you feeling? Are you feeling okay? Right. You feel okay? She's, "I'm fine." Are you fine? Let me just, I just want you to know. It's okay if you feel different, right? I think I'm crazy, but I know that that people don't realize how they're feeling, and it's hard to get to the doctor until it's too late. So I'm just, I'm on her. But for people like me, we didn't have children, so we have never experienced a crazy shift. We just start to experience, "I don't feel like my, anymore," and all the symptoms are so different for every single person. I'm not having hot flashes, but I'm, I got to keep my hair still here. But my inflammation was insane. I was putting on weight and working out and eating the same. And I don't understand what's going on. You know, so can we talk a little bit about what, I don't know where you want to start with that. So you tell me where you want to start with my post, my perimenopausal people who are not necessarily attributing these changes to that.Amy Loden Tiffany, MD, MBA 20:27  So I think the biggest confusion I see in the exam room conversations is that there's just question of, am I in perimenopause or not? And it's more of a less of a yes-no and more of, are you on the spectrum, and where on the spectrum are you? And so if you think of it as a sliding scale, because some months those ovaries are working really great, and you feel all the feels, and you're 18 again, but a lot of months maybe you're more like 20 or 25, right? And then maybe out of the blue, I feel like I got run over by shock. Nothing's working for two or three months, and then we're back to 25, right? And so it's ups and downs. You're like, what is happening? It is a roller coaster, and it runs anywhere from 10 to 15 years before you actually go through menopause. So I think of it as reverse adolescence, and I think it's completely ironic that God lets us have teenage girls when moms are going through perimenopause because that is just double-adolescence whammy, right?Lesley Logan 21:19  And no wonder, no wonder marriages don't survive certain things. Right, you have a daughter going through puberty and a wife with a pair of menopause. Good luck to the husband. Correct, becauseAmy Loden Tiffany, MD, MBA 21:28  I want to have sex. I don't want to have sex. I have pimples all over my face. I don't want to go to the house. I do. My belly's bloated. It's not like my mood's up. All the things, and it's all in reverse. So it's a it's a period of a woman's life that I think needs to be acknowledged, and then within the healthcare system, there's more noise about it over the last five years. You're seeing more and more people talk about this, but there's not a lot of standardization, and so you're getting chiropractic, functional medicine, traditional medicine. You're getting all sorts of different recommendations. So my hope is that over the next decade, we start to see some standardization, and we start to say this is what is normal for this population. You still have to apply it to the person. You cannot take population data and apply it to individuals and say that you're going to have good luck, bye. We'll see you in a year. That doesn't work. What I do think is that women need to know what's normal for that time, and then they need to decide, do they want to do something about it beyond what their body is experiencing? And here's some really interesting data that I hope your listeners suddenly stop and listen. If they don't hear anything I've said yet, this will be really important for women who have hot flashes and night sweats. Either one, they're actually the same thing. We call them vasomotor symptoms. When you have those at a certain degree, so that they're happening most days of the week, more than 10 times a day would be an easy target to kind of pay attention to. You have that, and you choose not to take hormones. You actually have an increased risk for cardiovascular disease and stroke. That does not mean every woman in that category can or should take it. There may be reasons they can't, but the hormones we use today are different than what in the Women's Health Initiative that came out in the early 2000s. So you're getting a lot of confusion because women are reading about data from that, not realizing that it has changed, and that study is not going to be redone. It was a huge study. We're not going to see data like that, so we have to make really informed decisions. But cardiovascular disease, hear me, ladies. Cardiovascular disease, which includes stroke and heart failure, kills more women every year than all your cancers combined. Yeah, I get the women and they come in religiously for their mammograms or their Pap tests, right? But they don't know that the bigger risk is that they're going to die of heart disease, cardiovascular stroke, and we know that one in eight women, roughly, have breast cancer risk, and those women get it. One in two women are getting heart disease. So there's one inLesley Logan 23:50  Two.Amy Loden Tiffany, MD, MBA 23:51  One in two. So that means there's two of us on this call, right? We already know I'm going to get it because I had preeclampsia. So I'm the one. Lesley Logan 23:56  I was going to say. I hope it's not maybe. I hope it's not you. But, like, thank God you know that because I think it's one and two, especially if you don't know. Because if you know that you're at risk, you do. Then you can you do something. I am. I'm double the risk for breast cancer, so I have to do an MRI and a mammogram every six months, and I have some decisions I might have to make in my life. But because I know.Amy Loden Tiffany, MD, MBA 24:18  Right, I can take.Lesley Logan 24:20  I can take action. Yeah, correct.Amy Loden Tiffany, MD, MBA 24:22  And you know, using that same kind of history, if someone comes in my office and says that I don't want to take hormones because I was a breast cancer, I'm like, that's fine. But let's look at all the facts. Let's lay it out like your financial advisor does, and then you can make an informed decision. Because just acting out of fear or reacting is not wise either.Lesley Logan 24:38  I actually really appreciate you mentioning that because it's true. If I'm, I'm very lucky in that I still get to do the HRT that I'm on, even with my risk. But also they're checking me every six months, and I'm checking me. So if anything's going to happen, we're going to catch it so much more quicker. Whereas the hard stuff, there's only so much you can do with that. And so if you're, especially if you're not aware. Say there's all conversations, but I liked the way you laid it out with the wealth manager. I just met with mine. He laid out here's where we're being aggressive. Here's where we're doing this. Here's what's going on here. We're going to move this over here because we're going to risk-manage these risks. And I think that's that's a better way to look at it because we're not going to, every single one of us is unfortunately going to experience something because it's a body. We're not a machine. Amy Loden Tiffany, MD, MBA 25:21  It wears out.Lesley Logan 25:22  I did not know it was one in two, girl.Amy Loden Tiffany, MD, MBA 25:26  Yeah, and what's even more disturbing, you may have heard a lot of women have by now that women's heart disease presents differently than men.Lesley Logan 25:32  Yeah, can you tell us just in case my people haven't heard because I didn't know it was one in two? So let's go over the signs.Amy Loden Tiffany, MD, MBA 25:38  A lot of times people think of what's the so-called traditional? It's the jaw pain, the radiation of pain from your chest up to your jaw, to your back, down your left arm. Very classic symptoms. Classic because it was studied in men, and then we have these so-called atypical for women because they're not typical compared to men, but they're classic for women. And so, got a little bit of lingo here that it doesn't make total sense. But for women, sometimes it's they just feel a lot more anxious than they've been for unclear reasons. They have this sense that something bad is on the horizon. They can't really place why their sleep is different. Maybe they're having some shortness of breath they didn't used to have. Maybe they go up the stairs in their house, with a laundry basket, and they're huffing and puffing when six months ago they weren't. So it can be very subtle differences. It could be a new fatigue. Check labs are normal, but the fatigue's still there. That worries me when I hear women say this. Unfortunately, the number one sign that you have heart disease is sudden death.Lesley Logan 26:33  Oh.Amy Loden Tiffany, MD, MBA 26:34  So let that sink in for a second. So we can't always wait on what the signs are.Lesley Logan 26:39  Yeah, we can't fix that. Right. Correct. Okay, so that's hard because our signs are also. I feel like high-achieving women would so easily brush away that anxiety.Amy Loden Tiffany, MD, MBA 26:51  All the stuff. Correct. Because I have a lot of tabs open.Lesley Logan 26:54  Yeah, I got this going on, or I haven't been working out, so of course I'm out of breath going up the stairs. They would just so easily.Amy Loden Tiffany, MD, MBA 26:58  It's May, it's graduation season. It's wedding season, right? This is just aging, and that's not the story at all. The problem is 10-minute visit with your doctor who has 3000 patients. They don't know who you are. They're not going to notice that this is different for you.Lesley Logan 27:13  Yeah.Amy Loden Tiffany, MD, MBA 27:13  Decreased exercise tolerance is a big one. And so, if you could walk three miles every day in your neighborhood, now you're like, "Wow, I'm really struggling to get through one." I'm worried about that. I want to know what's going on and why.Lesley Logan 27:25  Yeah. So I guess since one getting a 10-minute visit is hard. I, where I live in, I live in Las Vegas. Last I heard, we are short general practitioners by 1400. I don't have one. I go to a women's clinic, and I'm really grateful. It's a, it's also a student-teacher thing. So I actually, they've caught things because the students are asking the questions because they'reAmy Loden Tiffany, MD, MBA 27:44  Yes, yes.Lesley Logan 27:46  I love them. I'm so grateful for them, but are there things that women can do to check their heart, or is it just being, is it just noticing the one mile versus a three mile? What can we, what are the signs we need to be checking on?Amy Loden Tiffany, MD, MBA 27:57  Certainly be aware of what your body is telling you. Again, if you have to remember nothing else, this is another one: is that your body is smart; it will talk to you, but you have to listen.Lesley Logan 28:05  Yeah.Amy Loden Tiffany, MD, MBA 28:06  So that's really essential. If something's different, say something. You're right. There's a big collapse, if you will, of how much support we have in healthcare, whether it's nurse practitioners or chiropractor or whatever. And the issue is not all of them are trained the same way. So when I worked in the OB/GYN clinic, it became apparent to both of us, on both sides of it, that OBs know stuff about women's health. I don't know, but I know stuff about metabolic and heart health that the OBs aren't taught, and most women use their OBs as their primary care, at least to a certain age.Lesley Logan 28:32  Right.Amy Loden Tiffany, MD, MBA 28:33  And again, you don't know what you don't know, so you don't realize what you're not looking for that you should be. And our system's not set up for good collaboration. So if I could tell women, here's a checklist of things I want to make sure you get, your doctor is going to give you some resistance, most likely because they don't realize that lipoprotein with a little a, it's like in parentheses at the end of it, not the big A. Lipoprotein little a. If you have that mutation, and 10 to 20% of our population does, you have a different rate of plaque development, at least risk for that than the average risk will miss. If you have high insulin levels, you have a higher risk that you're going to be on a pathway toward diabetes. Those are not things that are standard checks. So knowing that there's other tests you can ask for, and even if your insurance doesn't cover it, they're not expensive tests. Just get it once, right? Have an idea of what's going on in your body once gives you a ton of information. I offer a lot of our patients to wear different glucose monitors, even if they're not on diabetes. And all my physicians who are listening to this are probably like, "You do what?" But the reason is, if you can figure out that your glucose and insulin are high before you develop diabetes or pre-diabetes, if you figured out that insulin-resistant stage, that's a lot easier to fix, and our doctors aren't even taught about what is insulin resistance, what is the criteria for it, and how do we reverse it?Lesley Logan 29:47  Right, because there's some prevention we can do if we have information.Amy Loden Tiffany, MD, MBA 29:50  There's a ton, and it's things women can do in their homes or their businesses. It's not stuff I'm doing in the exam room.Lesley Logan 29:56  Yeah, and that's also, you know, you're listening to this podcast, you're kind of a go. Anyway, so you're gonna, you'll take the action. Our health insurance is very bizarre. I thought it was crap because, but it has a lot of preventative stuff that goes on with it. Hey, we want to put this thing in your house and check your heart and some other levels every, I don't know, two or three times a week. They keep calling them. I have two adults. We have two ADHD adults in this household. The box is here. One of us will open it when it becomes the pressure. I just have to hang tight. We'll get there. But I'm really impressed by that because we don't have access to a regular doctor. So what information can we gather so we could be watching it and monitoring it? So we can advocate for ourselves if something comes up. So having that prevention is really amazing. Okay, so we talked a little bit about the perimenopause and the different things. What are some simple shifts that women can make now to protect their future? I mean, obviously we have a wide range of women, so the now is different. But what are some things that they could be doing? Because I do think that they are getting information from the magazines and the Instagrams, and we should get it from the person who's experienced it and has seen it. You know, so you.Amy Loden Tiffany, MD, MBA 31:00  Some easy things, and I say easy relative because they're easy to do, which means they're easy not to do. So acknowledging that, right? It's real. Number one, understanding that just because you get eight hours of sleep, if they're not high-quality hours, you've got a metabolic risk from your sleep not being normal. That's important to understand because you spend a third of your life asleep, right?Lesley Logan 31:19  What's a metabolic risk? Just in case my people. So.Amy Loden Tiffany, MD, MBA 31:22  If you don't get good-quality sleep, your cortisol goes up. It's one of your stress hormones, and when cortisol goes up, glucose goes up. When glucose goes up, insulin goes up. Insulin's your fat-storing hormone. So even without your sex hormones being involved, or the ghrelin and leptin you're hearing about with weight and GLPs and all that, just those, you're not getting good sleep. It's going to be a problem. Insulin resistance is going to go up. Insulin resistance means your cells are not listening to the insulin your body is giving it, so your body works harder to get more insulin, and the cells work harder to ignore it, and it just keeps going in a vicious cycle. So if we consider that that's the root cause of a lot of these problems we've been talking about, we fix that. Number one is get good sleep, get good-quality sleep, and it's not, not just enough time in bed.Lesley Logan 32:02  Yeah, so.Amy Loden Tiffany, MD, MBA 32:03  That's important. Number two is most people don't realize that they're doing it backwards. They're, if they're, if they're even able to get exercise in their life right now, right? So we're going to make the assumption that you figured out some exercise regimen you like. We're, we're at that level, but they're doing it at the wrong time, and they're doing it in a way that they're sabotaging their end result. So rather than going to the gym and then going and eating dinner, or going to the gym first thing in the morning and skipping breakfast and all these things, you need to eat protein and fat, and then you need to move your thighs. I don't care if that's jumping jacks, going for a walk, running up the stairs, something where your thighs are moving regularly for 10 minutes. So make it whatever you like doing. This can be the mom at home who's doing all sorts of fun class activity with her kid, right? Like moving the baby around or the teenager can be equally fun to move around for what it's worth. And then it could be the CEO who's getting ready for a meeting and has 10 minutes after eating whatever lunch she had in the five-minute break she did, right? So looking at what makes sense in your life, but 10 minutes of physical activity, ideally after every meal, that's not realistic, but that's ideal. And then you start with the one meal a day you can do, and you do it most days of the week to start with, because most of us have to figure out how to make it a habit.Lesley Logan 33:15  Yeah.Amy Loden Tiffany, MD, MBA 33:15  But movement for 10 minutes after eating, it's, it's crucial. I cannot stress that enough.Lesley Logan 33:20  I didn't realize it was. It makes total sense moving your body after eating because I like to go for a walk after I have lunch. Otherwise, I'm tired. Correct. I can't go back to work now. Amy Loden Tiffany, MD, MBA 33:30  The reason you're tired though is because your glucose goes up and your insulin went up to match it. When you walk right after you eat, glucose still goes up, but it's less, and so you have less insulin spike. Insulin is the bright driver here, and so you've got to do the movement after. And if it helps to understand why, think back to what our ancestors did 1000 years ago. Right? We weren't checking hormones. We weren't checking insulin. We weren't talking about hacks. We were trying to survive most of the time. Yeah. But the things they did is they, if they, what, after they ate, they moved around. Right? Like they were building their shelters. They were taking care of the kids. They were moving in the community, helping build, create, relocate, whatever. They were always moving, and they did not get the whole three square meals a day. That's bogus. You don't need three meals a day, okay? And most of my ladies don't realize that they're eating their nutrients potentially in the wrong order for their body. That they're eating them in the wrong time for the cycle of the month they're in, they're not getting enough protein, not getting enough fat for their hormones and their brain, and it doesn't happen quickly, right? It's months, years, maybe even a couple decades before they're, I don't know what happened, but my body in the mirror is not the body in my head. This is not who I am. There's a disconnect, and they finally are at that place where they have to do something, where the body is forcing them to stop because they've pushed it as hot as you know.Lesley Logan 34:44  Oh my God, that's a whole episode. We're having you back. I'm just telling you right now because I want to have a whole episode on the whole. Because what I do know is if you eat certain things, if you work out too late, if you get your cortisol up, sleep that. I have been trying to figure out sleep for over a decade, and I, I get good-quality sleep most of the time. But I'm obsessed with it because I'm like, I don't want Alzheimer's. I do not want heart problems. It doesn't really matter what I'm doing at the gym if I'm not sleeping. None of that matters. Doesn't matter what you're, If you don't get good sleep, all the rest is gonna just fall apart anyways. So it's interesting. It makes sense about the food because I remember when I was having problems with my cycle and I had my one of my doctor friends, she said you should try seed cycling because I just, the worst cramps and, like, the worst everything was just the worst in the world, and so I tried seed cycling and my goodness, you know, I'm not a woo-woo girl, but the seed cycling makes, I got, I had no more zits, my boobs didn't hurt as bad, everything leveled out, and I didn't need any extra hormones for it. I was, whoa, so now there must be more. We need to know about it. So we'll have to have you back for that. I can talk to you forever. So we'll just, this is part one of many. I'm just going to take a brief break and then find out if people can find you, follow you, and work with you. All right, Dr. Amy Loden, where do you hang out? You mentioned St. Louis. Can people work with you if they're not in St. Louis? How does this work?Amy Loden Tiffany, MD, MBA 36:03  Yes, absolutely. Best way to get into contact with our office is just going to our website, www.vitalitymwc.org. They can sign up for a consultation, and we can go through what their options are. There is also lots of opportunity if you don't want to work with us directly, but you want to continue the conversation and hear what we're seeing. I do all the social media I can so that people can hear what's being said in their exam rooms and have it in their real lives too. So you can do that on follow me at Dr. Amy Tiffany, whether it's on Instagram or TikTok or Facebook. You find it where they're also on LinkedIn at Dr. Amy Loden. So lots of places depends on what their needs are. One special offer I do have for your audience: we talked about pregnancy and perimenopausal bit through this conversation, they can contact my office for a free physical copy of my book, The Postpartum Pivot. And before you stop listening, ladies, and you think, "Well, I'm not postpartum." If you've had a baby, you're postpartum even it's 20 years ago. Your body's different than it was before that baby, and so you can understand what does this look like for perimenopause and other types of areas that we go through as we grow less young, but grow more wise.Lesley Logan 37:03  Oh my God! Every one of my female females, that's where your Christmas present is. Sorry, just gonna get a doctor because they don't. It's, if their doctor doesn't tell them, they don't know, right? And then they are just going through it. And I feel so bad because every woman in my life is such a badass, and then they get their body doesn't keep up with what they're wanting to do in life, and then it just becomes not just like a liability, but like this hangup. So you are amazing. Okay, you've given us some great stuff already. I mean, we're gonna have to rewind, and I'll listen to this. I've got, you know, getting my notepad out, but our bold, executable, intrinsic, or targeted steps people can take to be it till they see it. What do you have for us?Amy Loden Tiffany, MD, MBA 37:37  I want each one. When you be it as you see it, I want you to be true to what your body's telling you, and recognize nothing's gone wrong. Listen when things are happening and they seem like it's a crisis. Nothing's gone wrong. Your body's talking to you. Listen, and when you listen, you become more wise. You become a better version of yourself.Lesley Logan 37:55  Okay, I really love that. We talked about that earlier, but it's true. Some of us think our body is against us, and it's doing something to us. But really, it's like, hello. The alarm bells. Amy Loden Tiffany, MD, MBA 38:05  It's doing exactly what it should do for the situation we've put it in. That doesn't mean we like it. You get diabetes. No one's like, oh yeah, my body did exactly what it's supposed to do. But if we understand that, then it becomes a neutral thought. It's not bad or wrong. It's I didn't listen, so now I'm going to stop, and the best place to reverse is as soon as you realize you're going in the direction. Right? It's not to keep going in the wrong direction. So nothing has gone wrong. We just need to listen. We need to turn around, create a better story.Lesley Logan 38:33  Love it. Love it. This is and then so enlightening. This is so fun. Thank you so much for being you and your and and the journey that you've been on is something we can all benefit from. So thank you for that, you guys. We all need to share this episode with all the women in our lives, and I would love for you to make sure that Dr. Amy knows your favorite takeaways. Send them to the Be It Pod as well. And since I'm going to have her back, not that I even like asked her beforehand, but I'm just going to tell her she's doing that. You can send your questions, and we'll make sure we get that. So, beitpod.com/questions. Until next time, my loves, Be It Till You See It. Lesley Logan 39:03  That's all I got for this episode of the Be It Till You See It Podcast. One thing that would help both myself and future listeners is for you to rate the show and leave a review and follow or subscribe for free wherever you listen to your podcast. Also, make sure to introduce yourself over at the Be It Pod on Instagram. I would love to know more about you. Share this episode with whoever you think needs to hear it. Help us and others Be It Till You See It. Have an awesome day. Be It Till You See It is a production of The Bloom Podcast Network. If you want to leave us a message or a question that we might read on another episode, you can text us at +1-310-905-5534 or send a DM on Instagram @BeItPod.Brad Crowell 39:45  It's written, filmed, and recorded by your host, Lesley Logan, and me, Brad Crowell.Lesley Logan 39:50  It is transcribed, produced and edited by the epic team at Disenyo.co.Brad Crowell 39:54  Our theme music is by Ali at Apex Production Music and our branding by designer and artist, Gianfranco Cioffi.Lesley Logan 40:02  Special thanks to Melissa Solomon for creating our visuals.Brad Crowell 40:05  Also to Angelina Herico for adding all of our content to our website. And finally to Meridith Root for keeping us all on point and on time.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Send us Fan MailRoutine cancer screenings have been proven to lead to better health outcomes and an increase in survival rates in the U.S. Finding cancer before it spreads can significantly improve outcomes. Bayless Drum, M.D., generalist in obstetrics and gynecology with Texas Tech Physicians and an assistant professor with the Texas Tech University Health Sciences Center School of Medicine, explains that Pap smears detect cervical cancer and precancerous changes and how new screening recommendations have changed leading to a decrease in frequency. She emphasizes the importance of screenings and the HPV vaccine, which can reduce the risk of cervical cancer. Dr. Drum also assures us that while these exams might be uncomfortable, they're important for early detection and prevention.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Sahil Chopra to discuss research challenging a fundamental assumption: that residual AHI measurements from PAP device downloads accurately reflect whether patients' sleep apnea is adequately treated. Sleep medicine clinicians routinely rely on residual AHI from PAP downloads to determine treatment success, typically targeting an AHI under 5. But what if this metric significantly underestimates untreated sleep apnea? Dr. Chopra's study comparing PAP-determined residual AHIs to cardiopulmonary coupling (CPC)-derived AHIs reveals striking discrepancies: mean residual AHI was 2.4 via PAP download versus 12.1 via objective testing. Even more concerning, 85% of nights showing residual AHI under 5 on PAP downloads had elevated AHI based on objective CPC measurement. Dr. Chopra explains why he chose cardiopulmonary coupling as the comparator metric, using a PPG-based wearable ring worn for 7-10 nights. He clarifies why PAP devices may systematically underestimate residual disease through mask leak, unstable breathing, and periodic breathing patterns. A particularly concerning finding involves residual hypoxia. Dr. Chopra discovered significant hypoxic burden in many patients considered "well-treated" by PAP standards—important since hypoxic burden, not just AHI, drives cardiovascular risk. Dr. Chopra's conclusion isn't that PAP-derived AHI is "bad"—rather, that it shouldn't be the sole metric for assessing treatment efficacy. Even patients with good symptoms may have significant residual respiratory events and hypoxia that PAP downloads fail to detect. Clinical applications are discussed, including when to pursue objective testing and what interventions to consider when objective testing reveals inadequate control despite acceptable AHI. Whether you rely on PAP downloads to assess treatment efficacy, manage patients with residual symptoms, or seek emerging objective metrics, this episode provides essential perspectives on optimizing PAP therapy. Join us for this important discussion that challenges current assumptions about measuring treatment success in sleep apnea.

Gobernadores tendrán que tener sólo una nacionalidad  ¡Nacen 88 tortugas caguama en Los Tuxtlas!  Papa León XIV lamenta tragedia por riada en Nepal  Más información en nuestro podcast#grc

Un ministerio en El Salvador apoya a mujeres víctimas de violencia. Un pastor usa el surf para evangelizar. Pilotos llevan la Palabra de Dios a las regiones más remotas de Papúa Nueva Guinea.

Un ministerio en El Salvador apoya a mujeres víctimas de violencia. Un pastor usa el surf para evangelizar. Pilotos llevan la Palabra de Dios a las regiones más remotas de Papúa Nueva Guinea.

Un ministerio en El Salvador apoya a mujeres víctimas de violencia. Un pastor usa el surf para evangelizar. Pilotos llevan la Palabra de Dios a las regiones más remotas de Papúa Nueva Guinea.

Central sleep apnea is a complex and often underrecognized sleep-related breathing disorder that differs from obstructive sleep apnea by involving reduced respiratory drive rather than upper airway obstruction. In this episode, Dr. Ran Liu reviews the underlying mechanisms of central sleep apnea, including the role of ventilatory control instability, discusses its association with neurologic conditions such as stroke, multiple sclerosis, ALS, and myasthenic disorders, and highlights key considerations for diagnosis and management. Learn how emerging technologies, personalized treatment strategies, and advances in sleep medicine are improving outcomes for patients with this heterogeneous group of disorders. In this episode, Teshamae Monteith, MD, FAAN, speaks with Ran R. Liu, MD, FRCPC, MSc, author of the article "Central Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Liu is an Adjunct Clinical Assistant Professor at McMaster University in Hamilton, Canada, and an Adjunct Lecturer at the University of Toronto in Toronto, Canada. Additional Resources Read the article: Central Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @SleepyNeuroDoc  Full episode transcript available here Dr Monteith: You may be familiar with obstructive sleep apnea, but central sleep apnea is often less understood and frequently underdiagnosed. In this podcast, we break down the key clinical pearls to sharpen your diagnostic reasoning, discuss why central sleep apnea matters, and to explore some of the fascinating advances transforming the field. Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Monteith: This is Dr. Teshamae Monteith. Today, I'm interviewing Dr. Richard Liu about his article on central sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Welcome to our podcast. How are you?  Dr Liu: Good. Thank you, Dr. Monteith, for having me today.  Dr Monteith: Please introduce yourself to our audience.  Dr Liu: Hello, everybody. My name is Richard Liu. I am a sleep neurologist. I am working out of Toronto at both Sunnybrook Health Science Center and MedSleep. I did my residency at Queen's for neurology and my sleep medicine fellowship at Harvard University.  Dr Monteith: Great. And what got you interested in sleep?  Dr Liu: Thank you very much for asking. For me, sleep medicine is a field where essentially everything is connected. Certainly, impaired sleep can affect many other conditions, including many neurological conditions. And even within sleep medicine, when somebody has a sleep disorder, often the entire system is connected. So as an example, if you have insomnia and fragmented sleep and periodic limb movements of sleep, certainly these conditions can impact sleep apnea. And certainly, for today's topic of central sleep apnea, this is an extremely complicated disorder where it's a very in-depth integration between neurological and respiratory physiology, among other systems as well.  Dr Monteith: So, I guess you're kind of like the cornerstone, sleep being the cornerstone of neurology. Everyone has to sleep. That's for sure. Great. So why don't we talk about what central sleep apnea is, and how prevalent is it as a collective group of disorders compared to obstructive sleep apnea?  Dr Liu: So, one way to think about central sleep apnea is that this is a heterogeneous group of etiology. But the primary concept here for central sleep apnea is that there's a reduction in respiratory drive. This is in contrast to obstructive sleep apnea, where essentially this is some form of airway obstruction in the presence of relatively intact respiratory drive. And of course, there's mixed apneas where they may contain features of both. But of course, now we know that even obstructive sleep apnea, there's a certain degree of drive dependence somewhat blurring these distinctions. The overall prevalence of central sleep apnea is about five to ten percent of all patients with sleep- disorder breathing. And certainly, it could be higher in some neurological conditions, such as things like stroke, multiple sclerosis, and multisystem atrophy.  Dr Monteith: Great. So certainly, it's out there. Why don't you tell us about the objectives of your article?  Dr Liu: Absolutely. Thank you for asking. I think the main objective of this article is really to highlight that central sleep apnea is a complex syndrome resulting from a large group of heterogeneous etiologies. And of course, again, it could be associated with many neurological conditions. And really here, I want to highlight advancements, both medicine and technology, on both the side of diagnosis of central sleep apnea, as well as the multimodal targeted treatment.  Dr Monteith: And what do you want our listeners to take away from this talk and certainly your article? What are the key essential points?  Dr Liu: Thank you very much for asking. I think that one way of looking at central sleep apnea to etiologically divide this into both hypocapnic and hypercapnic central sleep apnea. And of course, loop gain being a major driver for a hypocapnic central sleep apnea, and that one can actually think about hypocapnic central sleep apnea beyond a phenotypic spectrum with obstructive sleep apnea, with many patients having overlapping features of both obstruction and central component. On the other hand, hypercapnic central sleep apnea, often also known as hyperventilation syndrome, can span etiology from chemoreflex dysfunction to a broad range of neuroanatomical localization, such as central nervous system, peripheral nervous system, neuromuscular junction, and muscle disorders.  Dr Monteith: And what are some of the symptoms of central sleep apnea? Do any of them differ from obstructive sleep apnea?  Dr Liu: Thank you for asking, that's an excellent question. So certainly, central sleep apnea symptoms can overlap with obstructive sleep apnea symptoms. And of course, given the large range of underlying etiology, often the CSA symptoms depend on the underlying etiology. There may be less snoring compared to obstructive sleep apnea patients, especially the hypocapnic CSA patients. Of course, these patients, like OSA, may have frequent awakenings, gasping and choking their sleep, and nocturia, and so on.These patients may have daytime sleepiness, insomnia-like symptoms, or they could be asymptomatic. Interestingly, the hypocarbnic central sleep apnea patients, they're a bit more prone to have the insomnia-like symptoms, whereas the hypercarbnic central sleep apnea patients, they tend to have a bit more of the daytime sleepiness and morning headaches.  Dr Monteith: You spoke about some of the neurological disorders that might be associated with central sleep apnea, like stroke and multiple sclerosis. What about some of the more traditional risk factors associated with obstructive sleep apnea or conditions associated with it, like obesity and hypertension? Or does that just mix the picture?  Dr Liu: There is many overlap between risk factors between obstructive sleep apnea and central sleep apnea, and certainly one of the things that I highlight in this article is really that often it's not just black and white, that this could be a spectrum with overlapping disease between both conditions. So certainly, in our neurological world, stroke is the most common thing that may be associated with central sleep apnea. But overall, cardiovascular issues such as heart failure, atrial fibrillation, these things can also be associated with central sleep apnea. And again, from the neurological perspective, if we were to divide from hypocarbnic versus hypercarbnic central sleep apnea, by thinking about the hypercarbic central sleep apnea, again, this is where we're thinking about hypoventilation syndromes. You know, anything that can cause neuromuscular weakness, this is something that we should have a high alarm for, that potentially there may be a hypoventilation component. So, things like any myasthenic syndromes and ALS.  Dr Monteith: Great. Why don't we also talk about the classification? When was the last time central sleep apnea's classification was updated, and what should we know about the classification?  Dr Liu: The most recent classification for central sleep apnea is written in the International Classification of Sleep Disorders, third edition. In this edition, it's classified with six central sleep apnea syndromes. So, these are the CSA with Cheyne-Stoke breathing, CSA due to high altitude periodic breathing, primary CSA, CSA due to medication or substance, CSA due to medical disorder without Cheyne-Stoke breathing, and treatment-emergent central sleep apnea. These classifications more so describe the circumstance of when CSA occurs. A more etiological classification that we can consider would be classifying them by the underlying pathophysiology, which is dividing this from hypercarbnic central sleep apnea versus a hypocarbnic central sleep apnea. Certainly, both set of classification are discussed in this article.  Dr Monteith: Yeah. You discussed at length, the major physiological factors that our audience is just going to have to read. I don't want them to hear this too much while they're driving or on the treadmill, cause its super high level. But why don't we just start with some very basic factors that we need to know about this circuitry?  Dr Liu: Perhaps I can start with this concept of loop gain, which is the most important concept under hypocarbnic central sleep apnea. For any one of my colleagues who's listening to this, they're probably laughing right now cause they think that loop gain is my favorite word. So, loop gain is an engineering term referring to the sensitivity of a feedback loop. So, in the context of sleep medicine, this is an overly sensitive respiratory control to carbon dioxide and oxygen fluctuation. There are three components. The main one is controller gain. This is a chemosensitivity predominant to CO2. The second is plant gain, which is the lung's effectiveness for carbon dioxide excretion. And the last is what's called the mixing gain. This is circuitry delay from the time the signal travels from the pulmonary artery to the peripheral and central chemoreceptors. So conceptually, one may think, let's say something decreases your ventilation, so for example, apnea or hypopnea. With this, as you can imagine, when you stop breathing, your CO2 builds up, and this builds up according to the curve of the plant gain. And of course, this build of CO2 signal takes time to go from your lung to your chemoreceptor. That's your mixing gain. And of course, here it meets the overly sensitive chemoreceptors. This is your controller gain. As a result, this results in amplification of your ventilation to the initial respiratory disturbance. So, you have a overshoot of ventilation. All of a sudden, you're blowing out too much carbon dioxide, then you become hypocarbnic. At one point, if you blow out way too much carbon dioxide, your CO2 goes below what's called a PCO2 apneic threshold. After this, if your CO2's below, you essentially stop breathing. And of course, after that, you can imagine your CO2s are building up again. So, when this loop goes over and over, you generate what's called a chemoreflex-driven respiratory oscillation, where you create a crescendo, decrescendo-like flow pattern, which is underneath what we see in periodic breathing in central sleep apnea.  Dr Monteith: So, without going into too much detail, what is the key way to target restoration of equilibrium? Are there anatomical targets, physiologic targets that we're trying to manipulate here? Dr Liu: Again, thank you very much for that wonderful question. There's certainly many approaches that we could do to improve the stability of the system. Certainly, there are treatments for ventilation, either CPAP or in the case of hypocarbon central sleep apnea, things like adaptive servo ventilation. There is also medications that we can certainly discuss later that can double down the entire system for loop gain. Positional therapy can help for many of these patients. For the appropriate patient, improving their arousal threshold can actually reduce arousal-induced amplification of loop gain. Many of these patients, again, if appropriate, certainly weight loss may be helpful, and these are among many things that we can potentially do to improve the ventilatory stability of these patients.  Dr Monteith: Okay, great. But let's also talk about the general overall approach to diagnosing, and much of it is by history, as you mentioned. There's also sometimes a need, as you say, to differentiate out how much is obstructive. So, what is the thinking process there when you're approaching a patient?  Dr Liu: So perhaps I can start with in terms of the diagnostic modalities that we could use for this. So, the gold standard for diagnosis of central sleep apnea is still our polysonogram. The home sleep apnea test sometimes may be harder to distinguish between obstructive and central events. In addition, on a PSG, you have EEG. This allows you to assess for sleep quality and arousals, as well as the EMGs, which can help you pick up periodic limb movements of sleep. And of course, all of these things themselves can affect the central sleep apnea and can be a potential treatment factor.  Dr Monteith: Before we get into treatment, can you just give us, like, the top five or six drugs or drug classes we need to look for so that, you know, we can discontinue or try something else for our patients that might be complicating their presentation?  Dr Liu: Certainly medications, in some cases, can help central sleep apnea, but other cases can certainly be a precipitant of central sleep apnea. So, one thing to consider would be opioid medication. They can certainly cause very complicated central sleep apnea, something called ataxic breathing, where you have irregularity to the tidal volume and the rate of breathing. Other medications such as Oxybate, baclofen, valproic acid, gabapentin, all of which can certainly contribute to central sleep apnea. And of course, in the stroke world, something that we should always think about is that Tetagelor can also contribute to central sleep apnea. And outside of this, things like muscle relaxants, anesthetic agents can also be a contributor.  Dr Monteith: Great. Now let's get into some of the treatment.  Dr Liu: I like to divide treatment into targeting a hypercarbnic central sleep apnea and a hypocarbonic central sleep apnea. For hypocarbonic central sleep apnea, the first line is CPAP treatment. But for many patients, CPAP therapy is insufficient. There's also adaptive servo ventilation, which is an advanced device designed for hypocarbonic central sleep apnea. For hypercarbic central sleep apnea, again, first line is CPAP treatment, with more advanced devices being a bilevel therapy as well as volume-assured pressure support ventilation. There are also medications that can reduce loop gain, with the most researched one being acetazolamide. We can also reduce arousal thresholds, which could be appropriate for certain patients. And for certain patients, improving arousal threshold can be helpful as, especially in hypocarbic central sleep apnea, that arousals can amplify loop gain. Weight loss can be helpful for both hyper- and hypocarbonic central sleep apnea, and we have great new medication on the market for this. Other therapy can include supplemental oxygen that can be added to PAP devices, as well as phrenic nerve stimulation, positional therapy, as well as carbon dioxide modulation.  Dr Monteith: Excellent. So, it sounds like there's a lot of opportunity to help patients. Now, what are you most excited about in terms of latest development for detection as well as for intervention?  Dr Liu: Thank you very much. I'm actually excited about many things in sleep medicine. Perhaps the thing that I'm most excited about in detection in sleep medicine would be the wearable technologies. So, these technologies may use photoplethysmography to detect peripheral artertonometry. This is where we're measuring the pulsatile arterial volume signals as a surrogate of cardiac and respiratory function. And when paired, that was often desaturation. With these technologies, we can actually detect the staging, autonomic arousals, and HI. So of course, these technologies do not have flow, and they do not have EEG. But they're very powerful technology that allows us to do multi-night testing from home. And of course, understanding both the potential limitation of these technology in the context of patients can be very useful. In terms of treatment-wise, we're learning so much about the underlying contributing drivers of different forms of central sleep apnea. So again, this is highlighted in my article that many of these patients needs multimodal targeted treatment, both between either a PAP device in addition to other things such as medication, oxygen, positional therapy, and so on.  Dr Monteith: Great. So, I mean, I think there's so much to this field. Your article is very extensive. Thank you very much for writing this. I know it may have taken a bit of time, and I appreciate you being on our podcast.  Dr Liu: Thank you very much.  Dr Monteith: Again today, I've been interviewing Dr. Richard Liu about his article on central sleep apnea. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio. 

Can preterm birth be prevented? Historically the answer has been no, and the numbers back that up. In 2006 the U.S. preterm birth rate was about 12 percent. In 2024 it was 10.4 percent. Medicine has gotten dramatically better at keeping premature babies alive, but almost no better at keeping pregnancies from ending early. In this episode, Kristin and Dr. Abdelhak make the case that the answer is yes, preterm birth can be prevented far more often than it is now, and that the field has been looking in the wrong place. Preterm birth is not one condition. It is a grab bag: placental abruption, systemic infection like appendicitis or pyelonephritis, uterine overdistension from twins, triplets, or polyhydramnios, trauma, severe hypertension, stimulant and cocaine use. Every one of those causes announces itself. The woman with triplets is obviously carrying triplets. The woman with an abruption is bleeding and in pain. So what about the woman with none of that, doing everything right, who shows up at 30 weeks contracting and three centimeters dilated? For forty years the answer was "subclinical infection," a diagnosis Dr. Abdelhak takes apart in this episode. If it is subclinical, why is preterm labor the only clinical thing it ever does? Why does an appendicitis start with pain and fever and end in labor, while this mystery infection skips straight to the last step? And after four decades of amniocentesis studies cataloguing cytokines, interleukins, and prostaglandins, where is the treatment? There isn't one, because researchers found exactly what they went looking for. His answer is mechanical, not microbial. The cervix is a timekeeper on the pregnancy. Conventional teaching says contractions open the cervix. He argues it runs the other way: the cervix quietly gives way over weeks, and when it opens far enough, labor starts. That is why he says he is almost never surprised by a preterm labor. He was already watching the cervix shorten. Also covered: why previous preterm birth is the single strongest risk factor (it is the same cervix), why cone biopsy raises risk more than LEEP does, what funneling on ultrasound actually tells you, the difference between classic cervical insufficiency and the milder version that still lets you reach the third trimester, and why a three-hour precipitous labor at 38 weeks may be the same finding wearing a friendlier face. The practical takeaway: serial cervical length measurement for anyone with a red flag, first-time moms included, and cerclage when the cervix starts to open. Screening plus treatment, not a pill for an infection nobody can find. Plus: why the president and Taylor Swift would get their cervix measured every single week, and what that tells you about the standard of care the rest of us are offered. Topics covered, in order Why this topic is worth repeating, and why the framing here is not the conventional one The better question: preventing preterm birth, not preterm labor Fifty years, the March of Dimes, and a rate that has barely moved What we did get better at: neonatal survival and outcomes, not prevention Preterm birth as a grab bag, not a single disease Placental abruption Systemic infection: appendicitis, pyelonephritis, sepsis, severe pneumonia, COVID The subclinical infection theory, and the case against it Why the amniocentesis and cytokine studies found what they set out to find Uterine overdistension: twins, triplets, polyhydramnios Trauma, decidual hemorrhage Severe hypertension, pulsatile flow, and abruption risk before 20 weeks Cocaine, methamphetamine, smoking The patient nobody can explain, and what is actually going on The core claim: dilation causes the contractions, not the other way around Why Dr. Abdelhak is rarely surprised by a preterm labor Mild cervical insufficiency, and "dreamlike" cervical insufficiency at 38 weeks Why previous preterm birth is the number one risk factor LEEP versus cone biopsy, and why cone matters more Normal variation in cervical length, and the big nose analogy Length is not everything: bulk, thickness, and how the cervix feels Funneling on ultrasound as a warning sign The proposal: serial cervical length screening plus cerclage Why the numbers are U.S. numbers, and why international rates are not trustworthy The VIP standard of care, and who actually gets weekly scans Key takeaways Preterm birth is not one condition. Abruption, systemic infection, overdistension, trauma, and severe hypertension each have their own mechanism, and each is usually obvious on arrival. "Subclinical infection" is not a diagnosis, it is a placeholder. Forty years in, it has produced no treatment and no measurable drop in the preterm birth rate. The cervix is the timekeeper. When it is weak, it opens slowly over weeks, and labor follows the opening rather than causing it. Previous preterm birth predicts the next one because it is the same cervix. You cannot order a new one. Cone biopsy raises preterm birth risk more than LEEP, because more cervix is removed. Length is a clue, not a verdict. Plenty of women have naturally short cervixes and carry to term. Funneling, bulk, and change over time matter as much as a single number. The intervention that would move the needle already exists. Serial cervical length measurement in anyone with a risk factor, and cerclage when it starts to open. Screening and treatment, not a mystery pill. Terms mentioned Placental abruption — the placenta separating from the uterine wall before delivery. Pyelonephritis — kidney infection. Polyhydramnios — too much amniotic fluid. Uterine overdistension — the uterus stretched beyond its comfortable capacity, as with twins or triplets. Cervical insufficiency — a cervix that opens without labor. Funneling — the cervix opening from the inside out, visible on ultrasound before any external change. Cerclage — a stitch placed to reinforce the cervix. LEEP and cone biopsy — procedures removing cervical tissue after abnormal Pap or HPV findings. Precipitous labor — a very fast labor, often under three hours. Memorable quotes: "I am telling you what happened was the three centimeters dilated caused the contractions." "If it's subclinical, why doesn't it stay that way?" "The cervix is a mechanical timekeeper on the pregnancy." Got something you want to share or ask? Keep it coming. We love hearing from you. Email us or send a voice memo, and you might just hear it on the next episode. Don't forget to like, comment, and subscribe your questions could be featured in our next episode. For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/ You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: YouTube: youtube.com/maternalresources Instagram: @maternalresources Facebook: facebook.com/IntegrativeOB TikTok: NatureBack Doc on TikTok Grab Our Book: The NatureBack Method for Birth—your guide to an empowered pregnancy and delivery. Shop now at naturebackbook.myshopify.com

Alison welcomes Katie Kirklin, a registered nurse and certified functional nutrition counselor who is also training in nervous system regulation. The discussion focuses on digestive health and gut health, with an emphasis on both the science behind the topic and practical steps listeners can apply.Katie shares her personal health history and describes developing health problems in her teens and 20s, trying different diets and medications, and feeling that standard approaches did not address underlying causes.She then explains a major turning point in 2020 when an abnormal Pap smear and biopsy showed moderate cervical lesions. After choosing to make diet and lifestyle changes and working with a naturopath, she later received clear results, which led her to learn about functional nutrition and the idea of addressing root causes rather than isolated symptoms.The discussion moves to gut health and Katie explains that gut health affects nutrient absorption, the microbiome, and the gut lining. She describes leaky gut as increased permeability in the gut lining, which can allow proteins and pathogens into the bloodstream and contribute to inflammation.Katie identifies common inflammatory factors, including highly processed seed oils, ultra-processed foods, processed sugar, gluten for some people, and dairy for some people. She recommends reading ingredient lists rather than front labels and gradually increasing whole foods to crowd out processed foods.Alison and Katie also discuss the importance of individualized nutrition and reintroduction after elimination, since the gut microbiome benefits from diversity. Katie emphasizes that different people can respond differently to the same foods.They also cover the gut-brain connection. Katie describes the vagus nerve as a two-way communication pathway between the brain and gut and notes that most of the body's serotonin is produced in the gut. She says these connections help explain why digestion, mood, sleep, and overall health are linked.In her client work, Katie starts with blood sugar balance, sleep, digestion, hydration, movement, and fiber intake. She recommends tracking food, symptoms, and bowel movements, and suggests beginning with a nourishing whole-food breakfast to support stable energy and better choices throughout the day.HIGHLIGHTS:4:03 Functional Nutrition Journey7:29 What Gut Health Means10:47 Gut Inflammation Triggers14:58 Understanding Leaky Gut18:59 Body Systems Connected27:43 Start With Breakfastconnect with Katiewebsite: https://www.katiekirklin.comSPONSOR:Cellev8Discount code: THEALISONK ALISON'S LINKS:Website | Facebook | Twitter | InstagramGET MY FREE 4 part Pop-up Podcast SeriesJOIN Borderless Hybrid Innovators FB GroupINNOVATION AVENUE: Fitness and Self-Care Revolution

Papá, su futuro no es tuyo by Andres Gutierrez

When it comes to really getting to the bottom of anything new, exciting or interesting in the shooting or ballistics space, as it relates to hunting, it's a pretty short list of people you can trust to give you the straight goods...especially when it comes to actual hunting experience. "Pap" is one of those sources.  Some time is spent discussing yet another trip to Africa, and why his passion for African hunting is even more intense than it was after his last trip and then the conversation transitions to one of the truly hot topics in hunting ballistics at present: the proven performance of very fast, small diameter bullets on an increasingly wide range of game animals.   @papwinkle  ---------------------------  TRUSTED PARTNERS:  For over 100 years Leica has set the standard for premium optics. From spotting scopes to binoculars, rifle scopes and the new CRF MAX rangefinders, Leica is the choice for those who accept no compromises.  onX Hunt is the most powerful 3D mapping solution for hunters. Get your FREE trial today. If you're already a member, check out the exclusive offers and perks available when you upgrade to an Elite Member.   Spartan Precision Equipment is built for the mountains. Ultra-lightweight, packable, and versatile across shooting platforms. Be sure to check out their new Springbok line of products and the Ascent and Javelin series.  If you're interested in becoming a truly competent, confident and capable rifleman the Modern Say Sniper platform and Modern Day Rifleman community need to be on your radar. Digital courses, podcasts, videos, and in-person instruction taught by one of the best in the industry.  Tired of gut rotting instant coffee? Check out This Is Coffee and get yourself some great instant coffee for when you're in the backcountry or on the road.  ---------------------------  CONSERVATION ORGS TO SUPPORT:  Go to Wild Sheep Foundation to find a membership option that suits your budget and commitment to wild sheep.  Go to Wild Sheep Society of BC to become a member, enter raffles, buy merch and support BC's wild sheep populations.  Go to Rocky Mountain Goat Alliance to find a membership option that suits your budget and commitment to conserving mountain goats and their habitat. 

In this episode, Kristen explores three steps to help listeners work through anxiety, guilt, and shame while creating meaningful change through deeper self-awareness and healing. You'll Learn: How to process and connect with your core emotions. Why acknowledging your feelings is essential for healing. How the PAP method works. Why jumping into problem-solving can disrupt someone's emotional process. How self-compassion, vulnerability, and awareness can help you create lasting change.   Subscribe HERE and get a free 5-day journal to begin closing the chapter on what doesn't serve you and open the door to the real you. Connect with Kristen: Get Kristen's newsletter, packed with tangible tools, resources, and inspiration Watch the episodes on YouTube Follow Kristen on Instagram   Kristen's TikTok   Have Kristen Speak at Your Event  Disclaimer This information is being provided to you for educational and informational purposes only. It is being provided to you to educate you about ideas on stress management and as a self-help tool for your own use. It is not psychotherapy/counseling in any form. This information is to be used at your own risk based on your own judgment. For counseling services near Indianapolis, IN, visit www.pathwaystohealingcounseling.com. Pathways to Healing Counseling's vision is to provide warm, caring, compassionate and life-changing counseling services and educational programs to individuals, couples and families in order to create learning, healing and growth.

What does a Professional Parliamentarian do, and why is this role important at the LCMS Convention? Al Gage (current Parliamentarian for the National Association of Parliamentarians, CPP-T, PRP, PAP; past president of the American Institute of Parliamentarians) joins Andy Bates (co-host of The Coffee Hour) and the Rev. Roy Askins (executive editor of the Lutheran Witness, LCMS Communications) to share his story and why he became a parliamentarian, what exactly a professional parliamentarian is, the purpose and intention behind Robert's Rules of Order, what these rules accomplish and how they do it, how congregational voter's assembly can get the benefits of Robert's Rules without having to have a full time parliamentarian, one of the most creative ways Al has seen Robert's Rules used, and how congregations can implement Robert's Rules of Order in their congregations. For more information on The Lutheran Witness or to subscribe to the magazine, please visit witness.lcms.org.

What does a Professional Parliamentarian do, and why is this role important at the LCMS Convention? Al Gage (current Parliamentarian for the National Association of Parliamentarians, CPP-T, PRP, PAP; past president of the American Institute of Parliamentarians) joins Andy and guest co-host the Rev. Roy Askins (executive editor of the Lutheran Witness, LCMS Communications) to share his story and why he became a parliamentarian, what exactly a professional parliamentarian is, the purpose and intention behind Robert's Rules of Order, what these rules accomplish and how they do it, how congregational voter's assembly can get the benefits of Robert's Rules without having to have a full time parliamentarian, one of the most creative ways Al has seen Robert's Rules used, and how congregations can implement Robert's Rules of Order in their congregations. As you grab your morning coffee (and pastry, let's be honest), join hosts Andy Bates and Sarah Gulseth as they bring you stories of the intersection of Lutheran life and a secular world. Catch real-life stories of mercy work of the LCMS and partners, updates from missionaries across the ocean, and practical talk about how to live boldly Lutheran. Have a topic you'd like to hear about on The Coffee Hour? Contact us at: listener@kfuo.org.

Entrevista con Sebastian Jaramillo Valencia, psicólogo con experiencia en primeros auxilios psicológicos (PAP) by LA PATRIA

Obstructive sleep apnea affects approximately one in four adults and is especially common among patients with neurologic disorders, including stroke, Parkinson disease, dementia, epilepsy, and neuromuscular conditions. In this episode, Dr. Stephanie Stahl discusses why neurologists should routinely screen for OSA, highlights key symptoms and risk factors, reviews important considerations when interpreting sleep studies, and outlines current treatment options beyond CPAP. Learn how recognizing and treating sleep apnea can improve quality of life, optimize management of neurologic disease, and reduce long-term health risks. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Stephanie M. Stahl, MD, FAASM, author of the article "Obstructive Sleep Apnea" in the Continuum® August 2026 Sleep Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Stahl is an Associate Professor of Clinical Medicine and Sleep Medicine Fellowship Program Director at Indiana University School of Medicine in Indianapolis, Indiana, where she also serves as Sleep Laboratory Medical Director in the Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine. Additional Resources Read the article: Obstructive Sleep Apnea Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz  Full episode transcript available here Dr Berkowitz: Obstructive sleep apnea is very common. It can cause or contribute to common neurologic symptoms, such as headache and impaired cognition, and it's a risk factor for stroke. And yet, if you're like me, you may not know too much more about sleep apnea than that. Today, I have the pleasure of talking to sleep expert Dr. Stephanie Stahl to learn what every neurologist should know about OSA.  Dr Jones:  This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Berkowitz: This is Dr. Aaron Berkowitz. Today I'm interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the 2026 Continuum issue on Neurology of Sleep. Welcome to the podcast, Dr. Stahl, and could you please introduce yourself to our audience?  Dr Stahl: Yeah. Thank you for having me. I'm a sleep medicine physician and neurologist and medical director of the Indianapolis Sleep Lab at Indiana University Health. I serve as the director of the Sleep Medicine Fellowship program. I'm faculty advisor for our very first student interest group in sleep medicine at Indiana University School of Medicine. I'm also actively involved in some national leadership roles, including the incoming chair of the American Academy of Sleep Medicine's Education Committee and co-chair of the Academy's Inter-Scorer Reliability Gold Standard Panel. So, I really appreciate this opportunity. I look forward to our discussion.  Dr Berkowitz: Me too, and we appreciate the opportunity too to get to talk to you. You have so much expertise in this area, and I certainly encourage our listeners to look at your article, which is very comprehensive and up to date, and I learned a ton from it. I didn't get much exposure to sleep neurology as a trainee, and I've always worked in academic centers where we have a sleep group and we can refer patients there. So, I have to admit, sleep may probably be the area of neurology I know the least about, and felt like I was learning something new from pretty much every line of your article, and I know our readers will too. So, your article has a lot of excellent detail for our readers on the diagnosis and treatment of this very common condition. But I'd like to keep our interview relatively high level today and focus on the essentials for the practicing general neurologist. So, to start, can you just give us a sense of what obstructive sleep apnea is, and what every neurologist should know about it?  Dr Stahl: Yeah. So obstructive sleep apnea is characterized by either partial or full obstructions in the upper airway. That may sound pretty simple, but this leads to a whole bunch of issues. It leads to oxygen desaturations, arousals from sleep, leading to sleep fragmentation. This can then lead to sympathetic nervous system activation, cerebral hypoperfusion, leading to a whole bunch of symptoms or neurologic conditions.  Dr Berkowitz: Great. And you mentioned this in your article, but just to emphasize, how common is obstructive sleep apnea in the general population?  Dr Stahl: Yeah. So, about a quarter of the general population have obstructive sleep apnea. Much more common in many neurologic conditions.  Dr Berkowitz: Yeah, so very common disorder. We are seeing patients with it quite frequently, whether that's the reason they are seeing us in neurology or not. And this leads to my next question, which is what neurologic symptoms or presenting concerns of a patient should make us think about OSA and the differential diagnosis, and what factors based on the history or the exam or the context would make you suspicious for OSA as the cause of a neurologic symptom? In other words, the patient's presenting with classic symptoms of OSA, and that's why they're seeing a neurologist or seeing a primary care doctor, but is coming for evaluation of, say, headache or other symptoms. And what symptoms would make you think of wanting to consider OSA, and then what aspects of the history or otherwise would make you want to evaluate the patient for OSA?  Dr Stahl: I think a really important takeaway is for neurologists to know that obstructive sleep apnea is very common in neurologic conditions and has that potential to worsen a lot of these conditions or their associated symptoms. And so, it should be on our radar. There are certainly some basic questions and signs and symptoms that we can ask patients about or, or take a look at on exam. And so particular symptoms include snoring. Anybody that snores loudly or frequently, that's a strong risk factor for obstructive sleep apnea. If someone's seeing them stop breathing in their sleep, if they are waking up a lot throughout the night. There are some other symptoms that we may not necessarily attribute upfront to obstructive sleep apnea, such as nocturia, nocturnal reflux, night sweats. There are some daytime symptoms, of course, too, like unrefreshing sleep, daytime sleepiness, morning headaches, an important one in neurology. And then we take a look at the patient's exam. And so, some things that neurologists might want to be thinking about are people with obesity are certainly at a risk for obstructive sleep apnea. But it's also very important to know that someone does not need to have obesity in order to have obstructive sleep apnea. We look at neck size, other morphologic characteristics, such as how much that we can see in the back of their mouth. Can we see their uvula? Does their tongue size appear large in their mouth? And then some other risk factors too, such as male gender, older age, family history, post-menopausal state in women. All that being said, though, sometimes in neurologic conditions, we don't have all of those symptoms or risk factors to be thinking about. And so, in certain neurologic conditions such as stroke where obstructive sleep apnea is very common and has the potential to increase the risk of another stroke, we may need to be thinking about testing these patients even with minimal symptoms or other risk factors.  Dr Berkowitz: That's very helpful. So, you mentioned their headache might be the presenting symptom, right, to a neurologist, and we should certainly be thinking about obstructive sleep apnea as a potential diagnosis, even the cause of the patient's headache, particularly you said patients with morning headache. I often try to think about in patients presenting with, for memory loss, or other cognitive concerns, and that may be due more to inattention from poor sleep, so asking about sleep and symptoms of sleep apnea in those contexts. Are there any other presenting neurologic symptoms not particularly related to sleep? I'm thinking of headache, memory loss, other symptoms that would make you think, "Oh, I should actually screen this patient for sleep apnea also."  Dr Stahl: Yeah, other symptoms to think about in pediatrics, hyperactivity, people that have impaired vigilance, as you alluded to, that poor attention. Sometimes people get misdiagnosed with ADHD, and it's actually just a manifestation of obstructive sleep apnea.  Dr Berkowitz: You alluded to this, Dr. Stahl, that stroke, for example, patients are at higher risk of developing sleep apnea as a result of stroke, and it's also a risk factor for stroke. What other neurologic conditions, primary neurologic diseases, put patients at a higher risk of OSA? And again, similar to the last question I asked you, what are some clues that we should evaluate for? We might be following a patient for their post-stroke care over time and not necessarily thinking about diagnosing a separate condition in them since we're following them for their stroke or their degenerative disease. What are the conditions that put patients at a higher risk of OSA as a result of the condition, and then when would you think about screening them for it?  Dr Stahl: Some particular neurologic conditions where obstructive sleep apnea are very common, in addition to stroke and, and TIA, include Parkinson disease. It can worsen a lot of the motor, cognitive symptoms, sleep disruption that we can see in Parkinson disease. Very common in all causes of dementia, but in particular Alzheimer disease and Lewy body dementia. Very common in neuromuscular conditions. We should definitely have obstructive sleep apnea and all forms of sleep-disordered breathing high on our radar. In conditions like myotonic dystrophy. Charcot-Marie-Tooth is another one where obstructive sleep apnea is very common. Myasthenia gravis, it can worsen the symptoms of that. In particular, a pearl is if somebody has morning weakness in myasthenia gravis, obstructive sleep apnea should be high on your radar. And also, as you mentioned, any forms of headaches. There are some other things too. If somebody has poor seizure control, especially nocturnal seizures, you might have obstructive sleep apnea on your radar as well.  Dr Berkowitz: So, I think you've covered essentially every category of neurologic disease, right? We have cerebrovascular, movement, neurodegenerative, neuromuscular, epilepsy, all conditions where either the disorder itself, such as stroke or the, correct me if I'm wrong, the neurodegenerative disease puts the patient at risk. Or the patient may be at risk for exacerbations of their disease, as you mentioned in myasthenia. I love that pearl. Not fatiguable at the end of the day, but if the patient with myasthenia is telling you they're feeling weaker at the beginning of the day, then think about obstructive sleep apnea and that obstructive sleep apnea worsening control of epilepsy due to poor sleep. So really a lot of bidirectional interactions with this common condition. Okay, so if we're concerned about obstructive sleep apnea, again, myself, a general neurologist speaking perhaps on behalf of other general neurologists, we see a patient with headache or reporting memory loss that we find to be impaired attention, or we see exacerbation of their underlying primary neurologic disease. As you mentioned, we think, "Oh, I've listened to this podcast. I've read Dr. Stahl's article. I should probably be thinking about OSA in this patient, and I should order a sleep study." Now, I admit when I get the sleep study back, I scroll to the bottom, I see they do have obstructive sleep apnea, I'm going to send them over to a sleep specialist. But for the general neurologist, what are some high-yield pearls and some pitfalls to be aware of when we get sleep studies for obstructive sleep apnea, and we are looking at the results? Dr Stahl: The first thing is to understand that there are two main types of sleep studies: in-lab polysomnography and home sleep apnea test. In-lab studies are typically what we consider the more accurate type of study. Main reason for that is that we have EEG, so we can see if someone is awake versus asleep. Most home sleep apnea tests do not utilize EEG, and so when we're looking at respiratory events, apneas or hypopneas, we're looking at over the total recording time rather than the total sleep time. So, we know we're going to capture some time where a person is awake, where we don't have sleep apnea events, and that can be a big amount of time in people with insomnia, poor sleep efficiency. And as a result of that, it can lead to an underestimation of the apnea-hypopnea index. That's really important for people to understand that that means we can end up with a false negative home sleep apnea test, or it can put them in a category of lower severity than what they actually have. And so, if you get a home sleep study report back that's negative for sleep apnea and you remain concerned, you need to go on to do an in-lab study, where about twenty to fifty percent of people will go on to have a positive in-lab study. You can also get false positives with home sleep apnea tests too, and so ideally, we should only be doing home sleep apnea tests in people that are at high risk of having obstructive sleep apnea to decrease our chance of false positive study. When we get that sleep study report, what's important to take a look at? So the main number that we look at currently is the apnea-hypopnea index. The number of apneas, which are full obstructions in that upper airway, or hypopneas, partial obstructions in the upper airway where either there's an oxygen desaturation or an arousal associated with that. Less than five is considered to be normal. Anything five or more gives them a diagnosis of obstructive sleep apnea, and then we stratify them based on the AHI. But it's important to take a look at more than just the apnea-hypopnea index. And while my eyes too on various reports like echocardiograms want to jump to the impression, it is important to take a look at that full report, see what their oxygen levels averaged and what they dipped down to. The arousal index, which is how many times a patient may have woken up briefly throughout the night. Take a look at the histogram, usually an image at the bottom of their report that shows what sleep fragmentation may have been like so that you can take that all in and make that decision. How important are these study findings, and is this a person that would benefit from treatment?  Dr Berkowitz: That's a fantastic overview of sleep studies and some of the highlights to look out for, even if we won't be understanding every detail as you would to know most importantly the caveats about home sleep testing having a fairly high percentage of false negative and false positive results. So being wary if our suspicion is high, and that test is normal or inconclusive to get an in-lab sleep study. And if our suspicion is low or maybe we haven't ordered the test and the patient has had it done elsewhere, and the history doesn't really match up to know that there are false positives on the home studies as well, and again, an in-lab study to settle the diagnosis. Is that right?  Dr Stahl: Yes.  Dr Berkowitz: Okay. Now, for most neurologists, probably if we diagnose OSA, we will be referring the patient to a sleep specialist like yourself for treatment. I think we're all familiar with CPAP and patients being on CPAP. Your article mentions a number of treatment modalities I admit I have not heard of before or maybe heard of in passing, acknowledging most general neurologists are not going to be prescribing or knowing with the nuance that you do as an expert how to decide which treatment a patient would most benefit from or most qualify for. So, can you just give us a broad overview, again, for the general neurologist acknowledging we might see a patient whose past medical history says OSA being treated with fill in the blank. What are the different treatment modalities, and how do you think, just so we can learn from you in broad brush strokes, about particular treatments for particular patients?  Dr Stahl: As you mentioned, most people are familiar with positive airway pressure or PAP therapy, and that does remain our most efficacious treatment. The way I explain it to patients is why PAP therapy is the most effective treatment is it's the only treatment that can take all of the tissues of that upper airway and open them up. Whereas all of our other treatments, we're going to target smaller spaces of that upper airway. So, our first option is if we can get somebody on PAP therapy, we know that that's going to be the best option for the majority. PAP therapy works by basically acting as an air splint to open up the air tissues. Know that masks are not interchangeable. There are masks that cover the nose and go over the nose and mouth and under the nose. Full face masks that cover the nose and mouth, they do typically require higher pressures, also tend to be less comfortable for a lot of patients as well. In addition to different PAP masks, there's different modalities of positive airway pressure therapy too. There are machines that auto-adjust, some that provide fixed pressure, bi-level PAP that provides a higher inspiratory pressure, lower expiratory pressure. Then outside of PAP therapy, there are, as you alluded to, a lot of options and more, continuing to come down the pipeline as well. Mandibular advancement devices or a form of oral appliances has been around for a while. This is device that somebody wears in their mouth. It's preferably customized for their teeth and titratable, meaning that they can make adjustments that pulls their mandible forward in relation to the maxilla in order to pull those tongue tissues further away from the back of the upper airway. That's ideally managed by a qualified sleep dentist or someone that specializes in oral appliance management. Other treatments include surgical options, including hypoglossal nerve stimulation, which is an implanted device that causes the tongue to protrude repetitively throughout their sleep period to hopefully open up the airspace. There's some other surgical options too that open up various places of the upper airway. There's a daytime treatment of obstructive sleep apnea, transoral neuromuscular electrical stimulation that changes the muscle fiber type of the tongue. And then there's some adjunctive treatments that can be helpful too, such as positional therapy, oral facial myofunctional therapy that helps a person breathe better through their nose and may help train the upper airway muscles.  Dr Berkowitz: Great. Well, that's a very helpful overview, and again, I refer our listeners to your article, which talks about all of those modalities in very comprehensive detail. So, Dr. Stahl, as we wrap up our conversation, you have a captive audience of neurologists and neurology trainees here. What would you like to leave us with that every neurologist should know about obstructive sleep apnea?  Dr Stahl: The most important, again, is for neurologists to know that obstructive sleep apnea is so common in your patient population, and it can have a significant negative impact on quality of life and health, including many neurologic conditions. And at the same time, obstructive sleep apnea is very treatable. We have so many options nowadays that we can usually get someone onto adequate treatment. And treatment has that potential to improve several neurologic symptoms and disorders, even at times when you don't think that there's an opportunity to improve symptoms such as say in, headache. So, neurologists really should be screening for signs and symptoms of obstructive sleep apnea, as well as considering testing in high-risk, potentially asymptomatic or minimally symptomatic patients.  Dr Berkowitz: That's a fantastic overview of some of the many pearls that you shared with us today, as well as in your article. So, thank you so much again. Today, I've been interviewing Dr. Stephanie Stahl about her article on obstructive sleep apnea. This article appears in the August 2026 Continuum issue on neurology of sleep. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining today, and thank you again, Dr. Stahl.  Dr Stahl: Thank you again for having me.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.  

A Szuverenitásvédelmi Hivatal alig két évig működött, mégis az Orbán-rendszer egyik legvitatottabb egykori intézménye volt. A Papíron szép új adásában felidézzük, hogyan jött létre a hivatal, milyen politikai célt szolgált, miként próbálta megfélemlíteni a független sajtót és a civil szervezeteket, illetve hogyan zajlott az Átlátszó és a hivatal közötti per. Arról is szó esik, mit jelent a hivatal megszüntetése, és vajon eltűnt-e vele együtt az a politikai gondolkodásmód is, ami létrehozta. A tartalomból 00:00:00 – Bár a Szuverenitásvédelmi Hivatal már a múlté, ez nem jelenti azt, hogy felesleges beszélni róla. Így jött létre, és így vált hamar az egyik legvitatottabb állami intézménnyé. 00:01:14 – Az öröksége még sokáig itt marad velünk – és nem csak a célba vett civilekkel, újságírókkal, ellenzékiekkel. 00:04:23 – Felidézzük azt a politikai környezetet, amiben a hivatal megszületett, és azt, hogy miért pont a független sajtó és a civil társadalom lett a rendszer egyik fő célpontja. 00:08:19 – Milyen szerepet vállalt (önkéntelenül is) a független média a politikai változások előkészítésében, a Tisza felemelkedésében? 00:12:10 – Így működött és nem működött a SzuHi. Miért kapta ezt a nehezen értelmezhető nevet? Hogyan szolgálta ez a politikai kommunikáció céljait? 00:19:22 – Körbejárjuk, hogyan illeszkedett az intézmény az Orbán-rendszer hatalmi struktúrájába, és miben hasonlított a titkosszolgálatokhoz. 00:28:47 – Átlátszó vs Szuverenitásvédelmi Hivatal. Mindent a perről és arról, melyik ügyekkel hívhattuk fel magunkra Láncziék figyelmét. 00:33:00 – A gödi Samsung-akkugyár, a GödÉrt Egyesület, az Átlátszó és a külföldi támogatásokról szóló narratíva esete. 00:39:00 – A hivatal jogkörei korlátozottak voltak, de így is nagy károkat tudott okozni. 00:41:45 – Miyen érzés volt úgy dolgozni, hogy egy állami intézmény jelentéseket készített a szerkesztőségről? Milyen hatással volt ez ránk, újságírókra? 00:49:00 – A SzuHi kudarca: hiába a milliárdos költségvetés és a széles jogkör, bizonyítékot nem tudtak felmutatni. 00:54:10 – Szuverenitásvédelmi? Átláthatósági? Ellehetetlenítési? 00:57:40 – A hivatal megszűnésével eltűnt-e az a politikai gondolkodásmód is, ami létrehozta? Milyen tanulságokat érdemes levonnunk a történtekből?

Se reforzará seguridad en carreteras: Sheinbaum Industria automotriz mantiene buen ritmoEl Vaticano revela gira del Papa por FranciaMás información en nuestro podcast#grc

Namibië vier Nasionale Kankerbewustheidsweek van vandag tot Vrydag, en die Kankervereniging van Namibië nooi vroue tussen 20 en 65 jaar oud uit na bekostigbare Pap-smeer-ondersoeke en borsondersoeke in Windhoek. Siftings sal plaasvind op Dinsdag, Woensdag en Donderdag, 4 tot 6 Augustus, vanaf 8-uur die oggend by die vereniging se mediese sentrum by sy hoofkantoor in Windhoek-Wes. Die vereniging se uitvoerende hoof, Rolf Hansen, sê vroue moet 100 Namibiese dollar, hulle ID's en 'n japon of handdoek saambring. Hy het meer.

Siyabonga Motha is joined by Dr Nhlamulo Hlungwane, a Family Doctor and Clinical Director of the Myclinic and Dr Mandy Mpatlanyane is a medical doctor to unpack the essential yearly screenings every woman needs, why they are so important, and how to make the most of your annual health check. Tags: 702, Aubrey Masango show, Aubrey Masngo, Bra Aubrey, Siyabonga Motha, Medical Matters, Dr Nhlamulo Hlungwane, Dr Mandy Mpatlanyane, Health screenings, Annual health check, Menopause, Pap smear, Mammogram The Aubrey Masango Show is presented by late night radio broadcaster Aubrey Masango. Aubrey hosts in-depth interviews on controversial political issues and chats to experts offering life advice and guidance in areas of psychology, personal finance and more. All Aubrey’s interviews are podcasted for you to catch-up and listen. Thank you for listening to this podcast from The Aubrey Masango Show. Listen live on weekdays between 20:00 and 24:00 (SA Time) to The Aubrey Masango Show broadcast on 702 https://buff.ly/gk3y0Kj and on CapeTalk between 20:00 and 21:00 (SA Time) https://buff.ly/NnFM3Nk Find out more about the show here https://buff.ly/lzyKCv0 and get all the catch-up podcasts https://buff.ly/rT6znsn Subscribe to the 702 and CapeTalk Daily and Weekly Newsletters https://buff.ly/v5mfet Follow us on social media: 702 on Facebook: https://www.facebook.com/TalkRadio702 702 on TikTok: https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/Radio702 702 on YouTube: https://www.youtube.com/@radio702 CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567See omnystudio.com/listener for privacy information.

For seventy years, cervical cancer screening has meant a table, stirrups, and a speculum. Now it can mean a padded envelope on your kitchen counter. MamaDoc goes solo to unpack what's actually in those at-home cervical cancer screening kits, how self-collection works, why the FDA cleared it, and what the American Cancer Society said when it folded self-collected samples into its screening guidelines. After thirty years of doing this exam the old-fashioned way, I'll tell you honestly what I think we gain and what I worry we lose. We'll cover: why an HPV test isn't a Pap test (and why that distinction matters more than the marketing suggests); who's a good candidate and who isn't; what happens if your result comes back positive; and the piece nobody's putting on the box — a mail-in swab doesn't check your ovaries, your blood pressure, or the thing you were finally going to bring up at that appointment. For the sixty percent of cervical cancers that show up in people who were never screened or under-screened, this is genuinely good news. Let's talk about how to use it well.

In this episode of Talking Sleep, host Dr. Seema Khosla welcomes Dr. Laura Donahue, an assistant professor of sleep medicine at Vanderbilt University with a background in internal medicine and a researcher in sustainable healthcare, to discuss the environmental impact of sleep medicine practice and practical strategies for reducing carbon footprint and medical waste. Recent environmental challenges—heat waves exacerbating insomnia, wildfires affecting respiratory and sleep health—highlight how climate directly impacts patient wellbeing. But do sleep medicine clinicians have an obligation to reduce their own environmental footprint? Dr. Donahue explores this question, examining the waste generated by sleep testing, PAP therapy, and ongoing supplies. The conversation begins with foundational concepts: How does climate change impact sleep health? What exactly constitutes medical waste, and how does it differ from carbon footprint? Dr. Donahue explains methods for calculating carbon footprint and how the US healthcare system compares globally. She introduces life cycle analysis—a comprehensive tool for understanding environmental impact across product lifecycles. Sleep lab waste assessments receive detailed attention. Dr. Donahue walks through how to conduct a waste audit of sleep facilities and why examining both carbon footprint and waste matters, acknowledging that these metrics don't always move directionally. Her research on PAP device waste, conducted with Dr. Morgenthaler, revealed substantial environmental costs associated with standard OSA therapy—findings that prompted examination of alternatives. Telemedicine emerges as a potential sustainability strategy. Dr. Donahue compares carbon footprints of virtual versus in-person sleep consultations, exploring how practice model choices affect environmental impact. However, the analysis doesn't focus solely on PAP therapy—hypoglossal nerve stimulators and other non-PAP treatment options receive consideration as alternatives with potentially different environmental profiles. SHAPE, an organization dedicated to helping healthcare providers examine their carbon footprint and waste generation, receives discussion. Dr. Donahue explains SHAPE's mission and practical resources available to sleep medicine programs. She provides concrete guidance on reducing environmental impact: waste audits, supply chain evaluation, and transitioning to circular economy models where possible. A particularly relevant discussion addresses plastic waste from CPAP devices and consumable supplies. Dr. Donahue explains how waste audits serve as the first step toward identifying reduction opportunities and discusses strategies for minimizing single-use plastics in sleep medicine practice. The episode acknowledges that sustainability requires institutional commitment and individual awareness. Dr. Donahue emphasizes that small changes—from supply selection to practice model design—accumulate to meaningful environmental impact. Whether you're interested in sustainable healthcare, concerned about medical waste, seeking to reduce your sleep practice's carbon footprint, or wanting to better understand climate impacts on sleep health, this episode provides practical guidance and evidence-based approaches. Join us for this important conversation about environmental responsibility in sleep medicine practice.

Esto es lo que tienes que saber para empezar el día.IKEAAprovecha las Rebajas de IKEA para renovar tu sala, terraza o cualquier espacio de tu hogar con descuentos en muebles y decoración. Visita sus tiendas o entra a IKEA.com.do y llévate tus muebles a casa el mismo día.PRODUCTOS LINDAProductos Linda acompaña tus comidas, parrilladas y momentos en familia. Porque este mes, con Papá, todo sabe mejor. Conoce más en @productoslinda.

Welcome back to another episode of BUTT HONESTLY! We've got a Booty Gangster who's wondering whether years of living in the closet have been wreaking havoc on his gut, another listener who got his very first anal Pap and is now facing HPV, biopsies, and surgery, and one listener whose weekend adventures somehow escalated from the dance floor to double F's before breakfast.Plus, we'll talk about why France just shut down one of the world's most famous gangbang venues and what the ruling actually means…So lube up your curiosity... because we're going in.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Today I'm chatting with Nurse Amber, a board-certified women's health nurse practitioner, to discuss sexual health and STIs. We cover the prevalence and stigma of herpes, common STIs like chlamydia and gonorrhea, testing frequency, and prevention methods including PrEP and DoxyPEP. Our conversation also addresses female health concerns such as UTIs, bacterial vaginosis, and pelvic floor health, as well as men's sexual health topics. Nurse Amber emphasizes open communication, regular testing, and finding a sex-positive healthcare provider.Understanding Herpes Transmission (00:02:11)Discussion on HSV-1 and HSV-2, how both can be transmitted genitally or orally, and why blood testing has limited utility.Most Common STIs (00:08:18)Chlamydia, gonorrhea, and trichomonas are identified as the most common STIs seen in clinical practice, with chlamydia being most frequent.Symptoms of Common STIs (00:08:50)A description of potential STI symptoms in people with vaginas and penises, noting that 50% of cases are asymptomatic.What is Trichomonas? (00:10:02)An explanation of trichomonas, a common parasitic STI that often causes no symptoms but can cause severe inflammation.Long-Term Risks of Untreated STIs (00:11:50)Untreated bacterial STIs can lead to serious complications like Pelvic Inflammatory Disease (PID), chronic pain, and impaired fertility.STI Incubation Periods (00:14:39)Genital STIs are detectable 1-2 weeks post-exposure, while blood-borne infections like HIV and syphilis can take 1-3 months.How to Disclose an STI to a Partner (00:15:53)Advice on having a direct conversation with partners about a positive STI test and the need for mutual treatment.STI Testing Frequency (00:17:19)Recommendations for testing frequency based on sexual activity, ranging from every 6-12 months to every 2-3 months for active individuals. PrEP and DoxyPEP Explained (00:21:49)An overview of PrEP for HIV prevention and DoxyPEP, a post-exposure prophylaxis to reduce the risk of bacterial STIs.Syphilis is Not Gone (00:26:47)Syphilis, known as "the great pretender," is still prevalent and can have sneaky symptoms, making regular screening important.The Current State of HIV (00:29:00)HIV is now a highly treatable chronic condition, and transmission rates are much lower than for other STIs like Hepatitis C.What to Ask For at the Gynecologist (00:31:59)Clarifying that a pelvic exam is not always a Pap smear and what specific STI tests patients should request.The Importance of Triple Testing (00:37:23)Why testing genital, oral, and rectal sites is crucial for a comprehensive screening, as infections can exist in one area.Myth-Busting: Partner Testing (00:42:04)Debunking the myth that if one partner tests negative, the other is also clear. Each person needs individual testing.Vaginal Health and Hygiene (00:44:01)Advice on maintaining vaginal health, emphasizing that vaginas are self-cleaning and harsh soaps or douching should be avoided.Squirting and Prolapse (00:50:31)Explaining that squirting is largely urine and discussing bladder prolapse, a common condition that can cause stress incontinence.Pelvic Floor Health (00:54:39)How to maintain pelvic floor health through exercises like Pilates and yoga, which can improve sex and prevent incontinence.Hormone Replacement Therapy (HRT) (00:58:16)A discussion on the benefits and considerations of HRT for perimenopausal symptoms, cautioning against unproven testing methods.When Men Should See a Doctor (01:02:54)An overview of symptoms like itching, discharge, pain, or sores that should prompt a person with a penis to seek medical care.Finding a Sex-Positive Provider (01:17:29)The importance of finding a healthcare provider you can be open with about your sexual health for accurate testing and treatment.Follow The Open Bedroom:https://www.instagram.com/theopenbedroompodcast/

Welcome to How Humans Heal. In this episode I'm going to be covering the most important first step you can take to improve your ability to clear high-risk HPV and for your general health: Avoid Sugar. Many women who are dealing with an abnormal Pap and HPV ask me: what can I do to start turning this around and prevent HPV from causing abnormal cells? I'm so glad you're asking, because in a standard doctor's office, you are likely to be told to wait six or twelve months to see if things get worse or turn into cancer. That's unsettling, to say the least! It is much better to take action and ask what you can do between now and your next appointment to help prevent progression. That's exactly what I help women and men do: prevent progression and help your body clear high-risk HPV to negative. Where do I begin? Helping to balance your blood sugar levels by decreasing sugar consumption. I'm here to help you! LINKS FROM THE EPISODE:   Join Dr. Doni's Kickstart Program: https://hpv.doctordoni.com/hpv/hpv-kickstart-program   Schedule A Chat With Dr. Doni: https://intakeq.com/new/hhsnib/vuaovx    Read the full episode notes and find more information: https://doctordoni.com/blog/podcasts/ MORE RESOURCES FROM DR. DONI:   Quick links to social media, free guides and programs, and more: https://doctordoni.com/links     Disclosure: Some of the links in this post are product links and affiliate links and if you go through them to make a purchase I will earn a commission at no cost to you. Keep in mind that I link these companies and their products because of their quality and not because of the commission I receive from your purchases. The decision is yours, and whether or not you decide to buy something is completely up to you.

Esto es lo que tienes que saber para empezar el día.PRODUCTOS LINDAProductos Linda acompaña tus comidas, parrilladas y momentos en familia. Porque este mes, con Papá, todo sabe mejor. Conoce más en @productoslinda.———BMWLa nueva BMW X5 anticipa una etapa de diseño más limpio, tecnología más integrada y una experiencia más conectada. Conoce más en @bmwrd.———SLEEP IN MATTRESSSleep In Mattress ofrece colchones y soluciones pensadas para mejorar tu descanso y ayudarte a dormir más cómodo. Conoce sus opciones y visita sus tiendas en Santo Domingo, Santiago y Puerto Plata.———MISS RDVive la final de Miss República Dominicana 2026 este jueves 30 de julio, a las 8:00 p. m., en el  Watch Party de La Magacín en Dave & Buster's, BlueMall. Los cupos son limitados, así que reserva tu espacio.

Howard Herrell and Stuart Winkler question long-standing OB-GYN habits that feel “routine” but do not add value, then replace them with evidence and practical decision-making. We move from hysterectomy follow-up and cuff dehiscence management to the data behind cesarean sutures, endometrial cancer evaluation in postmenopausal bleeding, and the ongoing shift to HPV-based cervical cancer screening. • why routine 6 to 8 week vaginal cuff exams after hysterectomy may not prevent or predict dehiscence • how telehealth post-op care can improve access while keeping symptom-driven safety nets • four tips for evaluating and managing vaginal cuff dehiscence, including when laparoscopy matters • what Ethicon discontinuing chromic and plain gut could mean for cesarean technique choices • how the CORONIS trial informs chromic vs Vicryl decisions and why transfusion risk is part of the conversation • where the 4 mm endometrial stripe rule came from and why it can fail in real-world care • why persistent postmenopausal bleeding still warrants endometrial biopsy despite reassuring ultrasound • how race, tumor subtype, and fibroids affect endometrial cancer detection and counseling • the arc from Pap smear cytology to HPV DNA testing, vaccines, and primary HPV screening • why self-collected HPV testing may raise screening uptake for patients avoiding speculum exams Be sure to check out thinking about obgyn.com for more information, and be sure to follow us on Instagram.0:00 Welcome And Today's Game Plan0:35 Rethinking The Six-Week Pelvic Exam13:25 Four Practical Tips For Cuff Dehiscence24:42 Chromic Gut Is Disappearing35:40 CORONIS Trial And Cesarean Sutures42:22 Postmenopausal Bleeding And The 4 mm Rule53:12 HPV Testing Takes Over ScreeningFollow us on Instagram @thinkingaboutobgyn.

Why is there a Christian book about women's health and fertility? What does faith have to do with PAP smears and endometriosis?? Too often, the only time we see religion take part in conversations around reproductive health is when there's controversy or debate. That is not what we're about, or what our book is about. If you're interested in hearing just a hint of why we talk about faith alongside women's health, this episode is for you.NOTE: This episode is appropriate for most audiences but does mention sex ed.SHOW NOTES:Learn more about the Woven Well BookWoven Well on bookshop.orgWoven Well on AmazonWoven Well on ChristianbookCaitlin's article in Christianity TodayFertile Faith: Caitlin's SubstackSend Us a Text!Support the showOther great ways to connect with Woven Natural Fertility Care: Learn the Creighton Model System with us! Register here!Get our monthly newsletter: Get the updates!Chat about issues of fertility + faith: Substack Follow us on Instagram: @wovenfertilityWatch our episodes on YouTube: @wovenfertilityLove the content? The biggest gift you could give is to click a 5 star review and write why it was so meaningful! This podcast is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician. Always seek the advice of your doctor or other qualified health provider regarding a medical condition. If you think you may have a medical emergency, call 911 or go to the nearest emergency room immediately. Neither Woven nor its staff, nor any contributor to this podcast, makes any representations, exp...

What if everything you thought you knew about menopause was either wrong, incomplete, or decades behind the science?Tammy Hadfield has been a women's health nurse practitioner for over 35 years — 25 of those as a hormone specialist. She was in the field in 2001 when the Women's Health Initiative scared an entire generation of women away from hormone therapy. Instead of backing down, she leaned in. She spent years being called one of the "crazy gals" giving hormones to women when most of the medical community said not to. The science eventually caught up. Her patients were better long before it did.This conversation covers everything you've been wondering about perimenopause and menopause — bioidentical versus synthetic hormones, why your cholesterol and your weight might have more to do with estrogen than your diet, what the hormone cascade actually looks like, and why the annual Pap smear is not the appointment to bring up your hot flashes, your mood changes, or your missing libido.But this episode also becomes something deeply personal. Tammy attended the BEST LIFE Retreat in Sun Valley in October 2025 — and what happened in the months after, including a planning meeting where she took a black Sharpie to her patient load and crossed out the number she'd been chasing, is one of the most honest things Laurie has heard in a recording studio.What we coverTammy's origin story: from postpartum nursing to military service in Alaska to hormone trailblazerWhat happened on the Today Show in 2001 — and how a single news segment derailed decades of women's healthWhy Tammy was considered "crazy" for giving hormones to women — and what the data eventually showedBioidentical versus synthetic hormones: what the difference actually means and why it matters for dosing and side effectsPremarin — the story behind the name, and why Tammy tells patients "I'm not a veterinarian and you're not a horse"Why all your hormones come from cholesterol — and what that means for women who are told their cholesterol is too highWhy your body holds onto fat when estrogen is low — and why estrogen is not making you fat; excessive estrogen isThe full hormone picture: estrogen, progesterone, testosterone, and DHEA — what each does and why all four matterWhy women who've had a hysterectomy are often wrongly told they don't need progesteroneThe difference between progestin (synthetic) and progesterone (bioidentical) — and why they are not the same thingADHD in menopause: why symptoms spike when estrogen and testosterone declineAlzheimer's, brain protection, and why 70% of new Alzheimer's cases are womenWhen hormone deficiencies actually start — and why Tammy says mid-30s, not menopauseWhy your annual Pap smear is the wrong appointment for this conversationTammy's biggest pet peeve: the male testosterone formulation being prescribed to women with instructions to use "a tenth of the packet"The four cornerstones that support hormones: nutrition, sleep, movement, and connectednessWhy Tammy closed her brick-and-mortar practice, stopped taking insurance, and launched Only HormonesHow to work with Tammy — including insurance, labs, FSA/HSA, and what the process looks likeThe BEST LIFE Retreat: what shifted for Tammy, the planning meeting with the blank calendar, and why she took a Sharpie to the patient number she thought she wantedRedefining success: from 30 patients a week to 12 — and why that's the better versionPermission to dream again — and why wanting what you want is not selfishWhat Tammy loves most about being a midlife womanWhat she'd tell her 20-year-old self: glimmers, breathing, and relaxingQuotable moments"I'm not a veterinarian, and you are not a horse — so we're not going to use this for your hormone replacement therapy.""All of your hormones come from cholesterol. Every single hormone.""Estrogen is not going to make you fat. Excessive estrogen will. But we need some estrogen so that our body can actually get rid of fat.""I just do hormones. I love hormones. That's all I wanna do.""Your appointment with me should be the easiest appointment you ever have.""I'm just your girlfriend on FaceTime.""We are taught as little girls not to be selfish — over and over again. And it's not selfish. It is figuring out what kind of life I want.""I took a freaking black Sharpie to that number of patients and said, 'Screw it. I'm gonna see 12.'""It's a redefinition of what I think success is. That's probably the bottom line.""I don't have to accept a smaller version of what I want my life to look like.""I would just tell myself: take a moment for yourself and breathe, girl. Just breathe."Resources + links mentionedThe Menopausal Brain by Lisa MosconiOnly Hormones — Tammy Hadfield's practiceApply for the BEST LIFE MastermindBook a 15-minute call with LaurieConnect with Tammy HadfieldWebsiteEmailInstagram

Cientos de personas abandonaron el lugar esa noche. Brian no estaba entre ellas. Su auto seguía estacionado. Sus tarjetas, intactas. El vuelo a Miami que tenía reservado con su novia, perdido. Dos años después, alguien dejó un mensaje en el libro de condolencias de su padre fallecido: "Papá, te amo. Con amor, Brian. Islas Vírgenes."  El mensaje fue rastreado hasta una computadora pública en Ohio. Alguien había decidido jugar. Brian Shaffer nunca apareció.

Al, Zach, Christian, and John Luke wrap up Ancient Christianity with stories about sermon critiques, mispronounced words, and the kind of mentorship that only works when trust has been earned. Al shares how a gift from his granddaughter brought Phil's larger-than-life legacy to mind, while John Luke explains how he turned the Roman Empire into a summer camp lesson about Jesus, persecution, and the kingdom of God. The guys dig into Augustine's impact on the Trinity, the incarnation of Christ, and why God must reveal himself before we can truly know him.  In this episode: John 1:1; Genesis 1:28; John 17:3; John 14:6; Ephesians 3:10; Luke 15; Psalm 48:1-8; 1 John 4:8-10; Romans 1-2; Romans 7:24-25 Today's conversation is a recap of Ancient Christianity taught by visiting Hillsdale Professor of History Kenneth Calvert. Take the course with us at no cost to you! Sign up at http://unashamedforhillsdale.com/. More about Ancient Christianity: Christ entered the world during the reign of Caesar Augustus. The tensions between Christianity and the Roman Empire shaped the daily practice of the Christian faith and led many Romans to distrust and persecute the early Christians. But Christianity also benefitted from the Roman world. And when Rome collapsed in the West, Christianity provided the hope for preserving civilization. In this free, eleven-lecture course, Professor Kenneth Calvert will explore: How the Jewish, Greek, and Roman cultures all contributed to preparing the world to hear the Gospel. Why many Romans distrusted and persecuted the early Christians. The inspiring stories of Christ, His apostles, and faithful ones throughout the first four centuries of Christianity. The arguments of key early Christian apologists—Ignatius, Irenaeus, Justin, Athanasius, and more—who defended and defined the Christian faith amidst the animosity of the Roman world. The conversion of Constantine and how he brought stability to Rome, and how the rivalry between his sons almost returned Rome to paganism. How Augustine's writings helped preserve the message of Christianity during the collapse of the Roman Empire in the West. You will discover the uncertainties, trials, and triumphs of the earliest Christians as they confronted controversies within the faith and persecutions from outside it. Join us today to discover the improbable and miraculous story of Christianity. Sign up at ⁠http://unashamedforhillsdale.com/ Listen to Not Yet Now with Zach Dasher on Apple, Spotify, iHeart, or anywhere you get podcasts. Check out At Home with Phil Robertson, nearly 800 episodes of Phil's unfiltered wisdom, humor, and biblical truth, available for free for the first time! Get it on Apple, Spotify, Amazon, and anywhere you listen to podcasts! https://podcasts.apple.com/us/podcast/at-home-with-phil-robertson/id1835224621 Chapters 00:00 Pap's Shuttle Service 04:38 Getting Called Out for Mispronunciation 10:11 Learning to Land the Plane 16:28 John Luke Brings the Roman Empire to Camp 20:48 Knowing the God We Can't Fully Grasp 26:53 Why the Incarnation Reveals Who God Is 30:20 Who Was Jesus in the Old Testament? 36:35 The City of God Still Reigns 43:02 Augustine's Wounds & the Power of Surrender — Learn more about your ad choices. Visit megaphone.fm/adchoices

In this special live episode recorded from the SLEEP 2026 annual meeting in Baltimore, host Dr. Seema Khosla welcomes Dr. Sanjay Patel, director of the clinical sleep program at University of Pittsburgh Medical Center, to discuss groundbreaking medications for sleep disorders poised for FDA approval in 2026 and 2027. The pharmaceutical landscape for sleep medicine is undergoing unprecedented transformation. Dr. Patel surveys the emerging drug pipeline that will fundamentally change how clinicians treat obstructive sleep apnea, narcolepsy, and idiopathic hypersomnia. For obstructive sleep apnea, Dr. Patel discusses AD-109 (atomoxetine and R-oxybutynin), explaining the mechanistic rationale and practical considerations including use with tirzepatide. The Incannex drug combining dronabinol and acetazolamide receives analysis for different patient populations, and sultiame is discussed as a carbonic anhydrase inhibitor option. A critical framework emerges: Should treatment be symptom-based or airway-focused when PAP-intolerant patients present? Tirzepatide, the GLP-1 agonist FDA-approved for moderate-to-severe OSA, receives comprehensive coverage including muscle loss concerns, long-term use, and emerging oral GLP-1 options. Retatrutide, the triple-hormone agent combining GLP-1, GIP, and glucagon, is also discussed. The episode's most exciting segment focuses on orexin agonists for narcolepsy. Three pharmaceutical companies—Alkemeres, Centessa (purchased by Lilly), and Takeda—are developing these mechanistically novel agents. Dr. Patel clarifies how these medications differ, discusses why one medication disrupted nocturnal sleep (suggesting continued roles for oxybates), and addresses how clinicians will choose between similar medications. Dr. Patel emphasizes a fundamental question: Should the field prioritize symptom management versus airway patency for OSA, and mechanistic approaches versus symptom management for narcolepsy? Whether you're interested in emerging OSA treatments, narcolepsy innovations, or the future of pharmacological sleep medicine, this live episode provides essential updates on medications that will soon reshape clinical practice. Join us for this exciting conversation about how sleep medicine will transform in the coming years.