Podcasts about pathological

Send us Fan MailIn this Journal Club episode, Daphna reviews a retrospective cohort study from Istanbul examining clinical, laboratory, and ultrasound factors associated with UTI in neonates hospitalized for unexplained hyperbilirubinemia. Among 96 term and near-term infants, 31% had culture-proven UTIs, a striking prevalence. Pathological renal ultrasound findings were independently associated with UTI, with affected neonates 4.6 times more likely to have a concurrent infection. Notably, standard laboratory markers including CRP and white blood cell count failed to distinguish UTI-positive from UTI-negative infants. The findings prompt a practical question: should urine culture be part of the routine workup for neonatal hyperbilirubinemia?----Renal ultrasonography findings are associated with urinary tract infection in neonates with asymptomatic hyperbilirubinemia. Sarı EE, Salihoğlu Ö.J Perinatol. 2026 Apr 13. doi: 10.1038/s41372-026-02686-x. Online ahead of print.PMID: 41975209Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

In today's episode, Tanner and Anne provide ideas on how to get to the root cause of your chronic pain or symptoms.Neuroplastic pain/symptoms occur when there's a sense of danger and dysregulation in the brain and nervous system - not due to physical disease or damage. So it makes sense to ask - what's creating this sense of danger?You'll learn about pain/symptoms can be fueled by:• Prolonged high stress, including perfectionism and people pleasing• Childhood adversity and trauma as sensitizing factros• Pathological views of the body fueled by medical ideas, Googling, ChatGPT, fear, and avoidance • Emotional resistance• Dysregulated responses to feeling pain/symptoms throughout the day.Tanner Murtagh and Anne Hampson are therapists who treat neuroplastic pain and mind-body symptoms. They are also married!In his 20s, Tanner overcame chronic pain and a fibromyalgia diagnosis by learning his symptoms were neuroplastic, not structural. Post-healing, Tanner and Anne have dedicated their lives to developing effective treatment and education for neuroplastic pain and symptoms.Listen and learn how to assess your own chronic pain and symptoms, gain tools to retrain the brain and nervous system, and make changes in your life and health!The Mind-Body Couple podcast is owned by Pain Psychotherapy Canada Inc. This podcast is produced by Alex Klassen, one of the wonderful therapists at our agency in Calgary, Alberta. https://www.painpsychotherapy.ca/Tanner, Anne, and Alex also run the MBody Community, an in-depth online course that provides a step-by-step process for assessing, treating, and resolving mind-body pain and symptoms. https://www.mbodycommunity.comCheck out Tanner's YouTube channel for more free education and practices: https://www.youtube.com/channel/UC-Fl6WaFHnh4ponuexaMbFQAnd follow us for daily education posts on Instagram: @painpsychotherapyDisclaimer: The information provided on this podcast is for general in...

In 1991, the quiet Cotswold town of Tetbury became the centre of a devastating double murder involving family, violence, mental illness, and a confession that stunned police…*** LISTENER CAUTION IS ADVISED *** This episode was researched and written by Eileen Macfarlane.Script editing, additional writing, illustrations and production direction by Rosanna Fitton.Audio editing by Joel Porter at Dot Dot Dot Productions.Narration, additional audio editing and mixing, and script editing by Benjamin Fitton.To get early ad-free access, including Season 1, sign up for They Walk Among PLUS, available from Patreon or Apple Podcasts.More information and episode references can be found on our website https://theywalkamonguspodcast.comSOCIAL MEDIA: https://linktr.ee/TheyWalkAmongUsSupport this show http://supporter.acast.com/theywalkamongus. Hosted on Acast. See acast.com/privacy for more information.

This episode continues the Heal NPD Seminar Series with Dr. Mark Ettensohn, joined by his associates Deanna Young, Psy.D., and Danté Spencer, Ph.D. In this session, the group discusses the paper “Living with Pathological Narcissism: A Qualitative Study” (Day et al., 2020), which examines narcissistic personality pathology from the perspective of partners and family members. Unlike most research on narcissism, this study does not rely on self-report or clinician ratings. Instead, it draws on qualitative descriptions from over 400 individuals in close relationships with someone exhibiting high levels of pathological narcissistic traits. These accounts provide a window into how narcissism is experienced interpersonally, particularly in intimate and long-term relationships. The discussion focuses on the study's central finding: that pathological narcissism is best understood as a system characterized by the co-occurrence of grandiosity and vulnerability. Loved ones described patterns of entitlement, arrogance, and need for admiration alongside insecurity, hypersensitivity, emotional instability, and chronic feelings of emptiness. In the majority of cases, these features were not separate “types,” but fluctuating states within the same individual. The group explores how these findings challenge common assumptions about narcissism, including the tendency to equate it with overt grandiosity or interpersonal abusiveness. Particular attention is given to the limitations of DSM-based models, which emphasize observable traits while underrepresenting the internal dysregulation and vulnerability that define the disorder. The conversation also examines broader relational and developmental themes, including: The oscillation between grandiose and vulnerable self-states The role of dissociation and splitting in personality organization The impact of early attachment trauma and “empathic failures” How narcissistic dynamics are expressed and amplified within close relationships The tendency for polarized, dehumanizing narratives to emerge in response to relational injury Finally, the group discusses the concept of “narcissistic abuse,” noting that while experiences of harm in these relationships are real and often significant, the term itself is not a well-defined clinical construct. The discussion emphasizes the importance of distinguishing between lived experience and explanatory frameworks, and of maintaining a nuanced, non-reductive understanding of personality pathology. Key themes include: Pathological narcissism as a dysregulated self-state system The interdependence of grandiosity and vulnerability Limitations of categorical and trait-based models of narcissism The relational expression of personality pathology The role of trauma, attachment, and development in narcissistic adaptation Clinical implications for assessment, formulation, and treatment This series is intended for clinicians, trainees, and viewers seeking a nuanced, clinically grounded understanding of narcissism beyond popular discourse. To learn more about our work, visit: www.HealNPD.org Additional Resources: Newsletter: https://healnpd.substack.com Assessment and therapy inquiries: https://healnpd.org/contact Purchase Unmasking Narcissism: A Guide to Understanding the Narcissist in Your Life: https://amzn.to/3nG9FgH LISTEN ON APPLE PODCASTS: https://rb.gy/cklpum LISTEN ON GOOGLE PODCASTS: https://rb.gy/fotpca LISTEN ON AMAZON MUSIC: https://rb.gy/g4yzh8 Citation: Day, N. J. S., Townsend, M. L., & Grenyer, B. F. S. (2020). Living with pathological narcissism: A qualitative study. Borderline Personality Disorder and Emotion Dysregulation, 7(19).  Full Text Link: https://pmc.ncbi.nlm.nih.gov/articles... About Heal NPD Heal NPD is a clinical practice specializing in the assessment and treatment of pathological narcissism, narcissistic personality disorder, and related personality difficulties. We offer comprehensive diagnostic assessments, individual psychotherapy, and consultations for partners and family members. Learn more or inquire about services: https://healnpd.org

Open Discussion!

Prevention matters because once these patterns are learned, they are extremely difficult to undo. I am not convinced we can confidently call them curable. This is a practical look at what could make a difference, first at the individual-level, and then at a societal level. Listen to ad-free epsiodes of Psychobabble by subscribing on Substack! Chapters:  00:00 The Missing Piece: Prevention 00:28 The Temperament Foundation 02:10 How it Develops 05:35 Where Parents Lose Ground 06:53 Containing Neuroticism 11:30 Training Agreeableness 13:14 Culture vs Parenting 16:06 The Danger Effects of Peer Saturation 17:19 The Role of Social Norms and External Constraints 18:11 Cultural Shift: From Restraint to Expression 21:13 Feminism's Role in Shaping Behavior Norms 23:14 A Practical Example 26:06 Preserving Innocence and Delaying Instrumentalization 27:29 What Needs to Change (Family, Culture, Mental Health Framing) 30:25 Indulgence vs Adversity (Why Traits Are Increasing Today) 31:37 Final Framework: Containment vs Expression

In this episode of Giant Ideas, Jimmy Wales, founder of Wikipedia, discusses how trust, purpose, and community design shaped one of the world's most used websites. He reflects on three photographs that define his life, Wikipedia's core purpose and why transparency, clear purpose, and walking the walk are central to trust.He also shares the trust framework of building trust, and why execution matters more than idea secrecy, and the real‑world costs of living in mistrust.----------------------------------------------------------------------------------------------------------------Building a purpose driven company? Read more about Giant Ventures at www.Giant.vcMusic credits: Bubble King written and produced by Cameron McLain and Stevan Cablayan aka Vector_XING.Please note: The content of this podcast is for informational and entertainment purposes only. It should not be considered financial, legal, or investment advice. Always consult a licensed professional before making any investment decisions.Building a purpose driven company? Read more about Giant Ventures at www.Giant.vc.Music credits: Bubble King written and produced by Cameron McLain and Stevan Cablayan aka Vector_XING.Please note: The content of this podcast is for informational and entertainment purposes only. It should not be considered financial, legal, or investment advice. Always consult a licensed professional before making any investment decisions.

Who Knew It with Matt Stewart is a comedy game show podcast hosted by Australian comedian Matt Stewart. Episode 191 features comedians JNaomi Higgins, Jett Archer and Josephine Bowser!Buy tickets for the 200th episode: https://tickets.oztix.com.au/outlet/event/7bb3026b-b8a8-40b8-8693-2cadee9f423cCheck out Pathological episode 1 feat. Big Wet: https://youtu.be/sdV-rKRBkTk?si=IDU8MEllQ69kBXSdSupport the show via http://patreon.com/dogoonpod and you can submit questions for the show!Check out Matt's stand up special 'Best Man': https://youtu.be/ZgukEPerWZc?si=SW8PttGAB-ly_GF8And his stand up special 'Live at Stupid Old Studios': https://youtu.be/cWStRpI-BhESee the podcast/Matt live: https://www.mattstewartcomedy.com/Check out Matt's podcast network: https://dogoonpod.com/Theme song by Evan Munro-Smith, Logo by Murray Summerville and edited by Connor Schmidt! Hosted on Acast. See acast.com/privacy for more information.

BPD Joint Therapy Fantasy BPD Right-Fighting & Pathological Lying vs Your Eggshell-WalkingBPD joint therapy doesn't work and is a fantasy bonded nightmare of Borderline victim/martyr cs your Codependent walking on eggshells and trauma bond addiction to intermittent reinforcement.Borderlines - unless clinically proven to actually be recovered need their own therapy and you need yours. BPD relationships without full BPD recovery are toxic and you're not being “loved” while being abused.BPD right-fighting and pathological lying block anything meaningful in joint therapy as they control the process initiating BPD Induced Conversation and projecting on to the therapist as they do you in life. Stop trying to recycle toxic relationships after the first breakup!https://ajmahari.ca/sessions - Sessions with A.J.https://ajmahari.ca/podcastshttps://ajmahari.com - Online Store100 Best Relationship Podcasts You Must Follow in 2025Million Podcasts has ranked this podcast in the top 60 Codependency Podcasts,the topThis podcast is ranked in the Top 100 Relationships Podcasts on feedspot.com at: 100 Narcissistic Abuse Podcasts and the top 100 in their Toxic RelationshipMillion Podcasats:https://www.millionpodcasts.com/codependency-podcasts/https://www.millionpodcasts.com/narcissistic-abuse-podcasts/https://www.millionpodcasts.com/toxic-relationship-podcasts/

What does it mean to say the world is fundamentally open for play - and why does it take something to even have to say it at all? In this episode - the third and final in a live-recorded three-part series with Ethan Hsieh, Taylor Barratt, and John Vervaeke - the conversation centers on Ethan as he unpacks the distinction between teaching and facilitation, the purpose of TIAMAT, and the deep personal why that drives his work. John maps the teacher/facilitator divide onto Aristotle's sophia and phronesis, while the group works through how theory and practice function as mutual correctives - each able to expose the other's blind spots. They examine phenomenological adequacy (how a theory can be causally sound yet fail to account for what's actually showing up in lived practice), the necessity of an ecology of practices over any single panacea, and why no closed overarching theory can substitute for genuine interdisciplinary dialogue. Ethan unpacks TIAMAT's purpose as psycho-education toward a good life - affording self-knowledge and heightened religiosity (bindedness to self, other, and world) without becoming a religion - and walks through the SPIRE framework (Service, Pilgrimage, Inquiry, Ritual, Enlightenment). The conversation deepens into the primordial nature of relationality, the actor training roots of TIAMAT, and Ethan's core conviction: that serious play - wrestling fully with what matters, using every faculty of one's being - is the most human way to stay genuinely coupled to a reality that always exceeds our grasp. The episode closes on joy: not pleasure, not comfort, but contact. Ethan Hsieh is the Director of Community Development and Partnerships at the Vervaeke Foundation. He comes from an acting background focused on character development. LinkedIn Taylor Barratt is the Director of Practice and Education at the Vervaeke Foundation. He has over a decade of experience in relational leadership through Authentic Relating Toronto. LinkedIn X 00:00 Welcome to the Lectern 01:30 Introducing Ethan - the third and final session 03:00 Teaching vs. facilitation - the core distinction 04:20 The knowing-doing and being-becoming questions 06:30 What truly distinguishes a teacher from a facilitator? 08:00 Responsibility, longitudinal tracking, and development 09:00 Training containers vs. drop-in practice 11:10 Sophia and phronesis - Aristotle on wisdom 12:30 Self-correction and attachment to theory or practice 14:10 Adaptive fit vs. adaptive transfer 17:30 When to bring theory in as a leader 20:00 Theory as legitimation of practice 22:00 Does practice challenge theory? Practice as research 24:00 Phenomenological adequacy - what theory can miss 26:00 Being too precious about theory or practice 27:00 Voice work and the emotional dimension as data 28:30 Deficit, excess, and the normativity of practice 30:30 Ecology of practices as pedagogical design 32:20 Why there's no closed theoretical system 33:00 Why there's no panacea discipline 35:00 TIAMAT as a living, evolving system 35:50 Predictive processing, CBT, and Jungian thought 36:30 Propositional knowledge must afford participation 38:10 What's ours to do? Defining scope of practice 41:20 What is TIAMAT actually for? 43:00 Pathological vs. positive psychology 46:10 TIAMAT: psycho-education for a good life 47:00 Religiosity without religion 48:30 SPIRE - Service, Pilgrimage, Inquiry, Ritual, Enlightenment 49:30 Enriching religio and relationship 50:20 Relationality is primordial - all of it is real 52:00 Depersonalization and the world-as-instrument trap 54:00 Why Taylor does this work 56:40 "The world is open for play" 58:00 Joy as good 59:00 Serious play as anamnesis - recovering what was forgotten 01:00:00 Joy vs. pleasure - genuine coupling to reality 01:01:00 Daoism, Zen, and the blurry line with philosophy 01:02:00 Actor training as the origin of TIAMAT 01:03:30 Anger and sadness at unnecessary suffering 01:08:30 "Why do I have to tell you that you matter?" 01:10:00 Holding the suchness of where someone is 01:11:10 Joy as developing relationship - closing thoughts The Vervaeke Foundation is committed to advancing the scientific pursuit of wisdom and creating a significant impact on the world. Become a part of our mission. Join Awaken to Meaning to explore practices that enhance your virtues and foster deeper connections with reality and relationships. Follow John Vervaeke: Website | Twitter | YouTube | Patreon Thank you for listening!

Read the full article at: https://oncdata.com/ai-driven-pathological-subtyping-pancreatic-cancer-ashish-manne Artificial intelligence (AI) continues to generate excitement across oncology, but its real-world clinical impact remains uneven. In this episode of Exploring AI in Oncology, Dr. Ashish Manne, a Gastrointestinal Medical Oncologist at The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, shares his American Association for Cancer Research (AACR) presentation on AI-driven pathological subtyping in pancreatic cancer and highlights a critical shift: moving AI from theoretical promise to practical application.

Zammit is missing, presumed dead. We can only assume that all his bad decisions have finally caught up with him. But never fear as the beautiful and normal hosts are joined by the beautiful and normal Naomi Higgins. Reality TV is pop culture, we dare you to say otherwise and today the gang try and figure out the best way to win Big Brother. They also get into the nitty gritty of Big Brother Up Late, decide what counts as an act of terrorism, and explore how Duscher requires ego death if he's to even have a chance of meeting Gretel Killeen. So listen on, enjoy and do your best to avoid intruders Frank and Oz who wish to do you some serious harm.Go listen to Naomi's podcast 3 Lemons Carcass Out wherever you listen to podcasts. It really is the perfect pop culture podcast. And check out her new show Pathological over at Humdinger Studios on YouTube starting May 7th.Links to everything at https://linktr.ee/plumbingthedeathstar including our terrible merch, social media garbage and where to become a subscriber to Bad Brain Boys+ Hosted on Acast. See acast.com/privacy for more information.

Dan speaks to Aydin Paladin about why Mass democracy is dangerous and stupid, much like the voters. 

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Welcome to Light ‘Em Up!At the conclusion of the editing and postproduction process for this episode in preparation for its upload and debut - DHS Secretary Kristi Noem was fired from her role as the Secretary of the Department of Homeland Security.Tonight, on this brand-new, intense episode we'll investigate and examine the more than 32 deaths that have happened at the hands of Immigration & Customs Enforcement (ICE).It may come as a surprise, but the killing of Renee Good (a mother of three) and Alex Pretti (an ICU nurse at the Minneapolis Veterans Affairs Health Care System Hospital in Minnesota) were not the first and they won't be the last.We'll drill down on the Department of Homeland Security — an organization led by individuals who lack both qualifications and integrity.This witch's brew often forces an organization — whether desired or not -- to eventually face severe consequences, ranging from operational inefficiencies to catastrophic, fatal incidents.Research indicates that when leadership prioritizes self-interest over competence and honesty, it creates a toxic culture that undermines safety and performance. ICE has made our streets unsafe with its tyrannical tactics, terrorizing our own people in the name of Trump.Since returning to office in 2025, President Trump has implemented a "hardline" and "maximalist" immigration policy focused on executing the largest domestic deportation operation in U.S. history.The administration doesn't care how the policy is carried out — ONLY that it is — so that Stephen Miller can satisfy his own sick, sadistic wishes.Miller is credited with shaping the racist and draconian immigration policies of President Trump, and Noem oversaw carrying those decisions out, which include:—   zero-tolerance policy, also known as family separation,—   the Muslim ban and—   ending the Deferred Action for Childhood Arrivals (DACA) program.As we go to air with this episode, a federal judge accuses the White House of ‘terror' against immigrants in the U.S.The administration has pursued a whole-of-government approach to identify, detain, and remove undocumented immigrants, aiming for a "1 million per year" deportation goal.But, in the process, there've been:—  tremendous oversights,—  poor procedural safeguards and protocols put in place,—  very little to no training for new hires,—  negligence and outright lies which have led to more than 32 people's death across the nation.We'll introduce you to those who have lost their lives at the hands of the governmental “political theater” that is unfolding right in front of our own eyes, daily.We will report that the (former) DHS Secretary, Kristi Noem is an outright liar — as is her boss.  That isn't opinion — that is fact and we have the receipts to prove it.Be sure to tune in for our reporting regarding a completely fabricated story — that Noem stated in one of her press briefings to the nation — about a man in deportation proceedings “cannibalizing” others, then, himself, like the fictitious character Hannibal Lecter, who Trump thinks is a real person.As we speak truth to power, we never cower — as we expose the fact that Secretary Noem has deported U.S. military veterans AND U.S. citizens and lied and covered up about that as well.As a painter paints and a singer sings, a liar lies.The streets of the U.S. are safer with Noem ousted at the top of DHS, but the man tapped to be her replacement isn't much of an improvement.Tune in for this episode and our sponsors Newsly & Feedspot!We want to hear from you!Support the show

Send a textIn this episode, we sit down with Marley to hear her two very different birth stories and how they shaped her journey in the motherhood space. Marley is a doula, birth educator, nanny, and babysitter who continues to support families through pregnancy, birth, and early parenting.Her first pregnancy followed the cascade of interventions, ultimately leading to an instrumental birth. During her second pregnancy, Marley planned a home birth. However, after discovering her baby was breech and having open discussions with her midwife and hospital team, weighing up the information available to her at the time, she chose to have a caesarean birth. She proactively wrote to the hospital outlining her wishes and the context surrounding her decision, advocating for a respectful and supported experience.Her second baby was admitted to NICU with pathological jaundice, and Marley also navigated recovery from a caesarean infection.Support the show@homebirthstoriesaustralia Support the show by buying us a coffee! Please be advised that this podcast may contain explicit language. Listener discretion is advised.The information, statistics, and research presented in this podcast are for informational purposes only and are not intended to constitute or replace medical or midwifery advice. All information discussed can be found online and is provided in the links in the show notes. It is always recommended to conduct your own research and make informed decisions. We advise you to discuss any topics or concerns with your healthcare provider. While we strive to incorporate the most up-to-date research in our episodes, we do not warrant or guarantee the accuracy of the information discussed on the show.

Will Tom Brady be the modern-day Bugsy Siegel in Las Vegas? Being a great player is no guarantee of future success as a coach or executive. Michael Jordan, a majority owner of the Charlotte Bobcats/Hornets, and Wayne Gretzky, behind the bench for the Phoenix Coyotes, were classic examples. Jason questions whether Brady, a minority owner of the Las Vegas Raiders, will follow suit as the sometimes not-so-stealthy leader of the team. The Raiders imploded last season with a new head coach and quarterback and now are on the verge of losing the face of the franchise, Maxx Crosby, while beginning anew with a different head coach and quarterback. Steve Kim and Jay Skapinac join the conversation, responding to Stephen A. Smith explaining how he moved on up from the mean streets; Kendrick Perkins claiming that a title will elevate Jalen Brunson to the greatest player in New York Knicks history; and Fight Night at a women's college basketball game. Shaun King shares his takes on Logan Paul offering $1 million to any NFL player who can beat him in combat; the A's telling Kyler Murray he can come home; and the Los Angeles Rams sending a bevy of draft picks to Kansas City for premium cornerback Trent McDuffie. ​​Today's Sponsors: PreBorn PreBorn has helped rescue more than 400,000 babies, and every single day, they continue that work by offering mothers something powerful and life-changing: an ultrasound. Will you help us? Just dial #250 and say the keyword “BABY” or donate securely at https://Preborn.com/FEARLESS  ➢ Subscribe Jason's other channel https://www.youtube.com/@JasonWhitlockHarmony  https://www.youtube.com/@JasonWhitlockBYOG  ➢ Connect with Jason on Social Media:  https://x.com/WhitlockJason https://www.instagram.com/realjasonwhitlock/ https://www.facebook.com/jasonwhitlock ➢ Send Jason an Email FearlessBlazeShow@gmail.com ➢ Support The Blaze Visit https://TheBlaze.com. Explore the all-new ad-free experience and see for yourself how we're standing up against suppression and prioritizing independent journalism. Support Conservative Voices! Subscribe to BlazeTV at https://www.fearlessmission.com and get $20 off your yearly subscription. Learn more about your ad choices. Visit megaphone.fm/adchoices

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Episode 211: Understanding HFpEF.  Hyo Mun and Jordan Redden (medical students) explain the pathophysiology of heart failure with preserved ejection fraction (HFpEF) and how it differentiates from HFrEF. Dr. Arreaza asks insightful questions and summarizes some key elements of HFpEF. Written by Hyo Mun, MS4, American University of the Caribbean; and Jordan Redden, MS4, Ross University School of Medicine. Comments and edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is EF? Just imagine, the heart is a pump, blood gets into the heart through the veins, the ventricles fill up and then squeeze the blood out. So, the percent of blood that is pumped out is the EF. Let's start at the beginning. What is HFpEF?Mike: HFpEF stands for heart failure with preserved ejection fraction. Basically, these patients squeeze normally—their ejection fraction is 50% or higher—but here's the thing: the heart can't relax and fill the way it should. The muscle gets stiff, almost like a thick leather boot that just won't stretch. And because the ventricle can't fill properly, pressure starts backing up into the lungs and the rest of the body. That's when patients start experiencing shortness of breath, leg swelling, fatigue—all those classic symptoms.Dr. Arreaza: And this is where people get fooled by the ejection fraction.Mike: Exactly. The ejectionfraction tells you total left ventricular emptying, not just forward flow.Jordan: The classic example is severe mitral regurgitation. You can eject 60% of your blood volume and still be in cardiogenic shock because most of that blood is leaking backward into the left atrium instead of going into the aorta. So, you get pulmonary edema, hypotension, fatigue, all with a “normal” EF. Which is honestly terrifying if you're over-relying on echo reports without thinking clinically.Dr. Arreaza: And in HFpEF, functional mitral regurgitation often shows up later in the disease. It's not usually the primary cause; it's more of a marker of advanced disease. Moderate to severe MR in HFpEF independently predicts worse outcomes, including a higher risk of mortality or heart failure hospitalization. So, let's contrast this with HFrEF. How are these two different?Mike: HFrEF—heart failure with reduced ejection fraction—is a pumping problem. The heart muscle is weak and can't contracteffectively. Ejection fraction drops below 40%, and this is your classic systolic dysfunction.Jordan: HFpEF, on the other hand, is diastolic dysfunction. The heart muscle is thick, fibrotic, and noncompliant. It squeezes fine, but it just doesn't relax, even though the EF looks reassuring on paper.Mike: I like to explain it this way: HFrEF is a weak heart that can't squeeze. HFpEF is a stiff heart that can't relax. Totally different problems.Dr. Arreaza: And then there's the gray zone: heart failure with mildly reduced EF, or HFmrEF. That's an EF between 41 and 49% with evidence of elevated filling pressures. It really shares the features of both worlds. So, what actually causes HFpEF versus HFrEF?Jordan: HFpEF is basically what happens when all the problems of modern living catch up with you. You've got chronic hypertension, obesity, diabetes, metabolic syndrome, aging, systemic inflammation—all of these things slowly remodel the heart over years. The muscle gets thick and stiff, and eventually the ventricle just loses its ability to relax. So, HFpEF is really a disease of metabolic dysfunction and chronic stress in the heart. Mike: HFrEF is more about direct injury. Think about myocardial infarctions, ischemic cardiomyopathy, viral myocarditis, alcohol toxicity, chemotherapy like doxorubicin, genetic cardiomyopathies, or chronic uncontrolled tachycardia. These insults actually damage or kill heart muscle cells, leading to a dilated, weak ventricle that can't pump effectively.Dr. Arreaza: So the short version: HFpEF is caused by chronic metabolic and hypertensive stress, while HFrEF is caused mainly by myocardial damage. A question we get a lot: does HFpEF eventually turn into HFrEF? What do you guys think?Mike: In most cases, no. HFpEF patients usually stay HFpEF throughout their disease course. They don't just “burn out” and turn into HFrEF.Jordan: They're generally separate disease entities with different pathophysiology. A patient with HFpEF can develop HFrEF if they have a big myocardial infarction or ongoing ischemia that damages the muscle, but that's not the natural progression.Mike: Interestingly though, the opposite can happen. Some HFrEF patients actually improve their ejection fraction with good medical therapy—that's called HF with improved EF—and it's a great sign that treatment is working.Dr. Arreaza: Another question. How do HFpEF and HFrEF compare to restrictive cardiomyopathy and constrictive pericarditis?Jordan: Clinically, they can all look very similar: dyspnea, edema, fatigue, but the underlying mechanisms are completely different.Mike: In HFpEF, the myocardium itself is stiff from hypertrophy and fibrosis. The problem is intrinsic to the heart muscle, and EF stays preserved. Echoshows diastolic dysfunction with elevated filling pressures.Jordan: In HFrEF, the myocardium is weak. The ventricle is often dilated and contracts poorly, with a reduced EF.Mike: Restrictive cardiomyopathy is different. Here, the myocardium gets infiltrated by abnormal stuff—amyloid, iron, sarcoid—and that makes it extremely stiff. It can look like HFpEF on the surface, but it's usually more severe. On Echo You'll see biatrial enlargement, small ventricles, and preserved EF. And importantly, it's a pathologic diagnosis, so you need advanced imaging or biopsy to confirm it.Jordan: Constrictive pericarditis is another mimic, but here the myocardium is usually normal. The problem is that the pericardium is thickened, calcified, and rigid. This will physically prevent the heart from being filled. Imaging shows pericardial thickening, septal bounce, and respiratory variation in flow, and cath shows equalization of diastolic pressures, which is the hallmark of constrictive pericarditis.Dr. Arreaza: So the takeaway is: HFpEF is a clinical syndrome driven by common metabolic and hypertensive causes, while restrictive and constrictive diseases are specific pathologic entities. If “HFpEF” is unusually severe or not responding to treatment, you need to think beyond HFpEF. Which type of heart failure is more common right now?Mike: Good question, the answer is: HFpEF. It now accounts for up to 60% of all heart failure cases, and it's still rising.Dr. Arreaza: Why is that?Jordan: Because people are living longer, gaining weight, and developing more metabolic syndrome. HFpEF thrives in older, or people with obesity, hypertension, or diabetes: basically, the modern American population. At the same time, better treatment of acute MIs means fewer people are developing HFrEF from massive heart attacks.Mike: HFpEF is the heart failure epidemic of the 21st century. It's honestly the cardiology equivalent of type 2 diabetes.Dr. Arreaza: Let's talk aboutCOVID-19. (2025 and still talking about it) Does it actually increase heart failure risk?Mike: Yes, absolutely. COVID increases both acute and long-term heart failure risk.Jordan: During acute infection, COVID can cause myocarditis, trigger massive inflammation, and precipitate acute decompensated heart failure, especially in patients with pre-existing disease. It also causes microthrombi, which can injure the myocardium.Mike: And after infection, even mild cases are linked to a significantly higher risk of developing new heart failure within the following year. Both HFpEF and HFrEF rates go up.Dr. Arreaza: I remember seeing this in 2021, we had a patient with acute COVID and HFrEF, her EF was about 10%, I lost contact with the patient and at the end I don't know what happened to her. What's the pathophysiology of COVID and heart failure?Mike: COVID causes direct viral injury through ACE2 receptors, triggers massive inflammation that damages the endothelium and heart muscle, leads to microvascular clotting and fibrosis—all mechanisms that promote HFpEF.Jordan: Add autonomic dysfunction, persistent low-grade inflammation, and worsening metabolic syndrome, and you've got a perfect storm for heart failure.Dr. Arreaza: Bottom line: COVID is a cardiovascular disease as much as a respiratory one. If someone had COVID and now has unexplained dyspnea or fatigue, think about heart failure. Get an echo, get a BNP, start treatment. Last big question: why did we have so many therapies for HFrEF but essentially none for HFpEF for years?Mike: HFrEF is mechanistically straightforward. You've got a weak heart with excessive neurohormonal activation going on — so you block RAAS, block the sympathetic system, drop the afterload. The drugs make sense.Jordan: HFpEF is messy. It's not one disease. It's stiffness, fibrosis, inflammation, microvascular dysfunction, metabolic disease, atrial fibrillation, all overlapping. One drug can't fix all of that.Mike: And some drugs that worked beautifully in HFrEF actually made HFpEF worse. Take Beta blockers, for example.  They slow heart rate, which is a problem because HFpEF patients rely on heart rate to maintain their cardiac output.Jordan: The breakthrough came with SGLT-2 inhibitors: diabetes drugs that unexpectedly addressed multiple HFpEF mechanisms at once: volume, metabolism, inflammation, and myocardial energetics.Dr. Arreaza: The miracle drug for HFpEF! Alright, let's wrap up.Mike: Bottom line: HFpEF is common, complex, and dangerous: even if the EF looks “normal.”Jordan: And if you're relying on ejection fraction alone, HFpEF will humble you every time.Dr. Arreaza: If you liked this episode, share it with a friend or a colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Barzin A, Barnhouse KK, Kane SF. Heart Failure With Preserved Ejection Fraction. Am Fam Physician. 2025;112(4):435-440.Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. Circulation. 2022;145(18):e895-e1032.Kittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC expert consensus decision pathway on management of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2023;81(18):1835-1878.Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461.Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098.Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370(15):1383-1392.Yusuf S, Pfeffer MA, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction. Lancet. 2003;362(9386):777-781.Solomon SD, McMurray JJV, Anand IS, et al. Angiotensin-neprilysin inhibition in heart failure with preserved ejection fraction. N Engl J Med. 2019;381(17):1609-1620.Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084.Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590.Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19. JAMA Cardiol. 2020;5(11):1265-1273.Basso C, Leone O, Rizzo S, et al. Pathological features of COVID-19-associated myocardial injury. Eur Heart J. 2020;41(39):3827-3835.Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-615.Badve SV, Roberts MA, Hawley CM, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in adults with estimated GFR less than 60 mL/min per 1.73 m². Ann Intern Med. 2024;177(8):953-963.Navis G, Faber HJ, de Zeeuw D, de Jong PE. ACE inhibitors and the kidney: a risk-benefit assessment. Drug Saf. 1996;15(3):200-211.Textor SC, Novick AC, Tarazi RC, et al. Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med. 1985;102(3):308-314.Hackam DG, Spence JD, Garg AX, Textor SC. Role of renin-angiotensin system blockade in atherosclerotic renal artery stenosis and renovascular hypertension. Hypertension. 2007;50(6):998-1003.Ronco C, Haapio M, House AA, et al. Cardiorenal syndrome. J Am Coll Cardiol. 2008;52(19):1527-1539.Prins KW, Neill JM, Tyler JO, et al. Effects of beta-blocker withdrawal in acute decompensated heart failure. JACC Heart Fail. 2015;3(8):647-653.Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30(18):2186-2192.Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

On this episode of the CPC Podcast, Kevin, Brandon, and Rachel delve into the themes of complacency and self-deception within the context of faith and personal growth. Through humorous anecdotes and deep reflections, the hosts of CPC Together discuss practical ways to cultivate awareness, remembrance, and repentance.

Welcome to The Mental Breakdown and Psychreg Podcast! Today, Dr. Berney and Dr. Marshall discuss the signs of typical cognitive decline that happens as we age, and symptoms that suggest the need for an evaluation to rule out a potential dementia. Read the articles from The National Library of Medicine here, from Presbyterian Living here, and from the Alzheimer's Association here. You can now follow Dr. Marshall on twitter, as well! Dr. Berney and Dr. Marshall are happy to announce the release of their new parenting e-book, Handbook for Raising an Emotionally Healthy Child Part 2: Attention. You can get your copy from Amazon here. We hope that you will join us each morning so that we can help you make your day the best it can be! See you tomorrow. Become a patron and support our work at http://www.Patreon.com/thementalbreakdown. Visit Psychreg for blog posts covering a variety of topics within the fields of mental health and psychology. The Parenting Your ADHD Child course is now on YouTube! Check it out at the Paedeia YouTube Channel. The Handbook for Raising an Emotionally Health Child Part 1: Behavior Management is now available on kindle! Get your copy today! The Elimination Diet Manual is now available on kindle and nook! Get your copy today! Follow us on Twitter and Facebook and subscribe to our YouTube Channels, Paedeia and The Mental Breakdown. Please leave us a review on iTunes so that others might find our podcast and join in on the conversation!

Josh Slocum is back after almost 4 years of pushing back against this culture war. We talk about the madness becoming mainstream, cluster B psychology, the external locus of control, happiness in Canada, Alberta separation, media influence, reversal of reality, the climate thing, Trump and Carney and civil war.   In the second half we chat about American exceptionalism, the AWFUL's, these bitches, solutions, sex typical hard wire, sports, Tate on PBD, man hating, what they will say in the future, election fraud, hard realities, EU collapse, and cultural fatigue on this rise.   Mommy has been running the show, Dad hasn't come home for 60 years. Illuminating the abnormal psychology that's become the new normal.   We are in an abusive relationship with our government, our media, and increasingly, ourselves. Today's activists use the same tools as abusive families. They keep us in fear while we wonder if we've lost our minds. It's not a passing fashion and its not well-meaning misguided activism. It's abuse dynamics. Pathological narcissism, indiscriminate rage, and tactical emotional break-downs by bullies who claim that they are the victims. Domestic abuse has gone public, and feral. Join us to talk about it. https://www.youtube.com/@DisaffectedPodcast https://substack.com/@disaffectedpod?utm_source=account-card https://disaffected.com/   To gain access to the second half of show and our Plus feed for audio and podcast please clink the link http://www.grimericaoutlawed.ca/support.   For second half of video (when applicable and audio) go to our Substack and Subscribe. https://grimericaoutlawed.substack.com/ or to our Locals  https://grimericaoutlawed.locals.com/ or Rokfin www.Rokfin.com/Grimerica Patreon https://www.patreon.com/grimericaoutlawed   Support the show directly: https://grimericacbd.com/ CBD / THC Tinctures and Gummies https://grimerica.ca/support-2/ Our Adultbrain Audiobook Podcast and Website: www.adultbrain.ca Our Audiobook Youtube Channel:  https://www.youtube.com/@adultbrainaudiobookpublishing/videos Check out our next trip/conference/meetup - Contact at the Cabin www.contactatthecabin.com Other affiliated shows: www.grimerica.ca The OG Grimerica Show Join the chat / hangout with a bunch of fellow Grimericans  Https://t.me.grimerica grimerica.ca/chats   Discord Chats Darren's book www.acanadianshame.ca Eh-List Podcast and site: https://eh-list.ca/ Eh-List YouTube: https://www.youtube.com/@TheEh-List www.Rokfin.com/Grimerica Our channel on free speech Rokfin Leave a review on iTunes and/or Stitcher: https://itunes.apple.com/ca/podcast/grimerica-outlawed http://www.stitcher.com/podcast/grimerica-outlawed Sign up for our newsletter http://www.grimerica.ca/news SPAM Graham = and send him your synchronicities, feedback, strange experiences and psychedelic trip reports!! graham@grimerica.com InstaGRAM https://www.instagram.com/the_grimerica_show_podcast/  Purchase swag, with partial proceeds donated to the show www.grimerica.ca/swag Send us a postcard or letter http://www.grimerica.ca/contact/ ART - Napolean Duheme's site http://www.lostbreadcomic.com/  MUSIC Tru Northperception, Felix's Site sirfelix.bandcamp.com 

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Dr. Margarita Fedorova outlines how genetic, environmental, and pathological factors interact in Parkinson's disease and what this means for patient counseling.  Show citation:  Blauwendraat C, Morris HR, Van Keuren-Jensen K, Noyce AJ, Singleton AB. The temporal order of genetic, environmental, and pathological risk factors in Parkinson's disease: paving the way to prevention. Lancet Neurol. 2025;24(11):969-975. doi:10.1016/S1474-4422(25)00271-6  Show transcript:  Dr. Margarita Federova: Welcome to Neurology Minute. My name is Margarita Fedorova, and I'm a neurology resident at the Cleveland Clinic. Today we're exploring a framework for understanding how genetic, environmental, and pathological factors interact in Parkinson's disease and what this means for how we counsel our patients. A personal view paper by Blauwendraat and colleagues, published in The Lancet Neurology in September 2025, addresses a critical question. We've identified over 100 genetic loci for Parkinson's, but how do they act? The common saying is genetics loads the gun and environment pulls the trigger, but this paper suggests the relationship may be more complex. The key tool here is alpha-synuclein seeding amplification assays or SAAs. These detect misfolded alpha-synuclein protein in cerebrospinal fluid. Over 90% of Parkinson's patients test positive for misfolded alpha-synuclein using this assay. But here's what's notable. 2% to 16% of neurologically healthy older adults also test positive with prevalence increasing with age. This means there are more asymptomatic people with detectable alpha-synuclein pathology than people with actual Parkinson's disease. Most of these asymptomatic individuals will never develop symptoms. This raises an important question. What determines who converts to a disease and who doesn't? By integrating SAA results with genetic data, researchers can examine whether genetic factors drive initial protein misfolding or whether they modulate the response to pathology triggered by environmental or random events. Preliminary data suggests polygenic risk scores don't strongly associate with SAA positivity in healthy older adults. In other words, people with high genetic risk for Parkinson's aren't necessarily more likely to have misfolded alpha-synuclein if they're healthy. This suggests most Parkinson's genetic risk factors may not be causing initial misfolding. Instead, they may be determining what happens afterward, such as whether the pathology progresses to clinical disease. LRRK2 mutations support this model. About 33% of LRRK2 related Parkinson's patients are SAA-negative compared to only 7% in sporadic disease. This means many people with LRRK2 mutations develop Parkinson's without the typical alpha-synuclein pathology. LRRK2 mutations also show varied pathology. Sometimes alpha-synuclein, sometimes tau, sometimes neither. This suggests LRRK2 may modulate responses to different initiating events rather than directly causing protein misfolding. What does this mean for us as clinicians? Asymptomatic SAA-positive individuals could represent a window for intervention. If we can understand what protects them from converting to disease or what triggers that conversion, we could enable earlier identification of at risk individuals and potentially intervene before symptoms develop. The authors call for large scale studies using SAAs in older populations, combined with genetic analysis and longitudinal follow-up. By integrating pathological biomarkers with genetic and environmental data, we can better understand the temporal sequence of events in development of Parkinson's. This approach could fundamentally change how we think about disease prevention and early intervention, potentially allowing us to identify at risk individuals before symptoms appear and develop targeted prevention strategies. That's your neurology minute for today. Keep exploring, and we'll see you next time. If you want to read more, please find the paper by Cornelis Blauwendraat et al titled The Temporal Order of Genetic, Environmental and Pathological Risk Factors in Parkinson's Disease: Paving the Way to Prevention, published online in September 2025 in Lancet Neurology.

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Chelsey Cole is a psychotherapist focusing on narcissistic abuse and complex trauma. She is the best-selling author of If Only I'd Known, and has joined Dr. Rob to explore what narcissism really is and what it isn't. She offers clear signs and strategies of a grandiose narcissist, and offers hope for any partner who has been frustrated by assuming their narcissistic partner views relationships through the same lens they do. Unless you understand the views of a narcissist, you will never succeed in true communication and connection with them.    TAKEAWAYS: [2:10] Is he just selfish or is he a true narcissist?  [5:26] Characteristics of the grandiose narcissist.  [9:38] The danger of transactional views of relationships.  [10:31] Stages of the narcissist spectrum.  [14:45] Remorse motivation in a narcissist's mind.  [17:07] Steps in the cycle of narcissistic abuse.  [20:03] Characteristics of the moderate to severe narcissists.  [23:01] You're not crazy! Narcissists actually want the conflict you are avoiding.  [25:49] Pathological insecurity versus healthy insecurity.    RESOURCES: Sex and Relationship Healing @RobWeissMSW Sex Addiction 101  Seeking Integrity Free Sexual Addiction Screening Assessment Partner Sexuality Survey Chelsey Cole   Seeking Integrity Podcasts are produced in partnership with Podfly Productions.    QUOTES: “True narcissists don't have the stuff that it takes to create deep, committed relationships.”  “Narcissists believe they are always the exception to every rule.”  “For a true narcissist, their default is to not care about you, and to put their needs first.”  “Narcissists actually seek the conflict you are avoiding.” 

Welcome to episode 78 of Rapaport's Reality! Starring Kebe & Michael Rapaport. This is the reality television podcast that the whole reality world has been waiting for. The Rapaport's are here to discuss: The Golden Age of Reality TV Gia Guiadice Huge Shoutout New Years Resolution Jen Shaw coming out of jail Real Housewives Redemption Pathological In Potomac? Wendy & Eddie's jail situation 9th Year of Marriage Being in Israel Leak Gate & Grading Heather Gay Taking That Reality Ride This episode is not to be missed! An iHeartPodcasts Show Stand Up Comedy Tickets on sale at: MichaelRapaportComedy.com Produced by DBPodcasts.comFollow @dbpodcasts, @rapaportsreality, @michaelrapaport on Instagram & X Subscribe to Rapaport's Reality Feeds: iHeartRadio: https://www.iheart.com/podcast/867-rapaports-reality-with-keb-171162927/ Apple Podcasts: https://podcasts.apple.com/us/podcast/rapaports-reality-with-kebe-michael-rapaport/id1744160673 Spotify: https://open.spotify.com/show/3a9ArixCtWRhfpfo1Tz7MR Pandora: https://www.pandora.com/podcast/rapaports-reality-with-kebe-michael-rapaport/PC:1001087456 Amazon Music: https://music.amazon.com/podcasts/a776919e-ad8c-4b4b-90c6-f28e41fe1d40/rapaports-reality-with-kebe-michael-rapaportSee omnystudio.com/listener for privacy information.

BUFFALO, NY — November 18, 2025 — A new #research paper was #published in Volume 17, Issue 10 of Aging-US on October 3, 2025, titled “Growth hormone excess drives liver aging via increased glycation stress.” In this study, led by first author Parminder Singh alongside with corresponding authors Pankaj Kapahi from the Buck Institute for Research on Aging and Andrzej Bartke from Southern Illinois University School of Medicine, researchers investigated how elevated growth hormone (GH) levels contribute to liver aging and dysfunction. They found that excess GH disrupts liver metabolism in ways that resemble aging-related liver damage. The study suggests that managing glycation stress may help prevent or treat liver diseases linked to abnormal hormone levels. Excess GH is known to cause different disorders, but its long-term impact on internal organs like the liver has remained unclear. To address this, researchers used a mouse model engineered to overproduce bovine GH and examined how chronic hormone exposure affects liver function over time. “Pathological conditions such as acromegaly or pituitary tumors result in elevated circulating GH levels, which have been implicated in a spectrum of metabolic disorders, potentially by regulating liver metabolism.” The team found that young mice with GH overexpression showed molecular and cellular patterns similar to those in naturally aged livers. In both groups, genes involved in metabolism were suppressed, while those linked to immune and inflammatory responses were activated. On one hand, the metabolic changes were associated with the buildup of advanced glycation end products, harmful compounds formed when sugars attach to proteins or fats without proper regulation. On the other hand, the immune and inflammatory changes reflected a process known as “inflammaging,” a form of chronic, low-grade inflammation commonly associated with aging. By revealing the overlap between hormone-driven and age-related liver dysfunction, the study provides new insight into how GH may accelerate aging processes. Importantly, the team showed that reducing glycation stress can reverse many of these negative effects. Mice treated with a compound that lowers glycation levels demonstrated improved liver health, reduced insulin resistance, and enhanced physical function. This intervention also corrected several abnormal genetic patterns caused by excess GH. The findings point to a potential therapeutic strategy for liver diseases associated with aging and hormonal imbalances. Overall, this research identifies glycation and its byproducts as key contributors to liver damage caused by excess GH. It suggests that targeting glycation could offer broad therapeutic benefits, not only for hormone-related conditions but also for supporting liver health during aging. DOI - https://doi.org/10.18632/aging.206327 Corresponding authors - Andrzej Bartke - abartke@siumed.edu and Pankaj Kapahi - pkapahi@buckinstitute.org Abstract video - https://www.youtube.com/watch?v=6v8xi5muLwA Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206327 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, growth hormone, glycation stress, Gly-Low To learn more about the journal, visit https://www.Aging-US.com​​ and connect with us on social media at: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@Aging-US LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

This episode marks the beginning of a new educational series from Heal NPD, featuring Dr. Mark Ettensohn and his associates: Deanna Young, Psy.D. and Danté Spencer, MA. This series offers a rare window into clinical reasoning and supervision, bringing viewers inside real discussions about theory, diagnosis, and treatment of personality pathology. In this first seminar, the group examines an influential paper by Pincus & Lukowitsky (2010) and explores one of the central challenges in the field: how to define pathological narcissism. The conversation addresses the criterion problem surrounding narcissism. That is, the lack of a unified construct definition. It traces how this has led to conflicting models and measures of narcissism. Topics include the distinction between pathological narcissism and NPD, the interplay of grandiosity and vulnerability, the overlap with depression and trauma, and emerging dimensional approaches to understanding personality. This series is designed for clinicians, students, and anyone interested in a deeper and more integrative understanding of narcissism, personality, and self-regulation. To learn more about our work, visit www.HealNPD.org Citation for the article discussed: Pincus, A. L., & Lukowitsky, M. R. (2010). Pathological narcissism and narcissistic personality disorder. Annual Review of Clinical Psychology, 6, 421–446. https://doi.org/10.1146/annurev.clinpsy.121208.131215

In this episode, Jason Ferguson - former D1 football player, top sales leader, and now renowned author and speaker - shares GOLD about overcoming adversity, tapping into realistic but tenacious optimism, and building daily wins through high-performance routines.Check out Jason's book, "Nobody's Legend: Let Go of Who You Were, Rewrite Your Story, and Take Back Your Life": https://jfinspires.com/book/

During this session from the 2025 Neurodiverse Love Conference, Daniel Dashnaw discusses the concept of demand avoidance, challenging the conventional view that it is inherently pathological. Demand avoidance can sometimes serve as a healthy response to overwhelm, misaligned expectations, or autonomy needs.  He will also briefly touch on research from neurodiversity, social dynamics, and stress regulation. His goal is to expand demand avoidance as a spectrum behavior that can signal unmet needs or adaptive coping rather than wholesale dysfunction. He will also offer a few clinical insights into recognizing, understanding, and addressing demand avoidance in a compassionate and constructive way.Daniel Dashnaw MFT, is the co-founder of Couples Therapy Inc., the largest evidence-based couples therapy practice in the USA. Daniel specializes in working with the neurodiverse, in both his part time work in a public health agency, and his private practice. Known for his compassionate yet no-nonsense approach, he draws upon cutting-edge research and therapeutic techniques, including the Gottman Method and Emotionally Focused Therapy, to help couples rebuild trust, improve communication, and deepen their connection. You can reach Daniel at the link below:https://danieldashnawcouplestherapy.com/

Distinguishing Humane Nationalism from Pathological Ideologies Guest Name: Daniel Mahoney Summary:Nationalism must be distinguished from pathological forms like "blood and soil" ideology, which champions ethnic rooting and the subordination of others. Moderate, humane national loyalty is tied to self-government and common humanity, rejecting the path that leads to "zoological wars." Critics often unfairly conflate nationalism with isolationism or imperialism. 1916 SWITZERLAND

Distinguishing Humane Nationalism from Pathological Ideologies Guest Name: Daniel Mahoney Summary:Nationalism must be distinguished from pathological forms like "blood and soil" ideology, which champions ethnic rooting and the subordination of others. Moderate, humane national loyalty is tied to self-government and common humanity, rejecting the path that leads to "zoological wars." Critics often unfairly conflate nationalism with isolationism or imperialism. 1865 MONTENEGRO

We asked Dr. Im about the role of sleep in injury recovery, what is considered optimal sleep, and when someone should be referred for pathological sleep.Timestamps(8:50) What signs & symptoms may indicate less than optimal sleep(11:09) Sleep and recovery(17:16) Stages of sleep(18:23) Adapting stages of sleep(21:32) Recommendations to improve sleep quality(25:40) Special considerations for maintaining optimal sleep(27:21) Role of naps in improving sleep quality(30:39) Optimal timing of naps(31:49) Relationship of mental health and sleep(34:40) Pathological sleep(41:05) Changing the circadian rhythm (43:59) When to refer an athlete with pathological sleep(46:30) Monitoring sleepAction Item: What are some talking points you use with athletes to educate about their sleep and importance of sleep?--AT CORNER FACEBOOK GROUP: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/groups/atcornerpodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram, Website, YouTube, and other links: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠atcornerds.wixsite.com/home/links⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠EMAIL US: atcornerds@gmail.comSAVE on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbridge⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠: Use code ATCORNER to get $101 off your subscriptionWant to host a podcast like ours? Use our link to sign up for Zencastr, the service we use to record our interviews: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://zencastr.com/?via=atcorner⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Music: Jahzzar (betterwithmusic.com) CC BY-SA---Sandy & Randy

Dr. Nadine Macaluso is a licensed marriage and family therapist, trauma expert, and author. Once married to Jordan Belfort, the "Wolf of Wall Street," she now uses her personal experiences and professional expertise to help others heal from trauma, build healthier relationships, and thrive. She is also the founder of the Surthriver™ community, where she empowers women to transform their pain into purpose.Connect with Dr. Nadine!https://www.instagram.com/therealdrnadinehttps://www.tiktok.com/@drnaelmftVisit Her Website To Learn More!drnae.comCHAPTERS:0:00 – Introduction1:45 – Meet Nadine Macaluso2:50 – Nadine talks about the relationship between her children and Jordan Belfort3:24 – Has Jordan changed over the years from being a pathological husband?4:02 – How Nadine raised her kids despite Jordan's traits5:02 – Nadine talks about her relationship with her father5:57 – Andy reflects on being raised by a single mom7:26 – Nadine's thoughts on Andrew Tate's view of “potent time with kids”8:36 – Should Andy avoid people with childhood trauma?9:49 – How Nadine was “used” in her past relationship with a pathological husband11:04 – Nadine shares when she decided to become a therapist12:02 – Nadine shares how therapy helped her survive chaos13:22 – Nadine talks about applying psychology to raising her children14:25 – Should parents cuddle babies every 3 hours or let them cry it out?15:28 – Nadine talks about the effects of using iPads with kids17:09 – Why families struggle to communicate feelings19:08 – Andy reflects on his experience with his dad only calling when he needed money21:01 – Are men becoming too emotional today?21:56 – Should men share financial struggles with their partners?23:10 – Did Andy's single mom influence his siblings' love lives?24:59 – Nadine shares how she met her husband after Jordan25:49 – Nadine talks about life inside a marriage26:59 – Nadine shares advice for finding a best-friend partner in life27:34 – Nadine shares the things she is giving the most of and needs the most in her life28:55 – How Nadine balances inbound requests vs. reaching out29:38 – Is Nadine introverted or extroverted?30:40 – Nadine talks about independence and individuality in relationships31:27 – Nadine talks about how she built her personal brand32:36 – Did Nadine finish her studies before or after the movie?33:26 – Meeting Margot Robbie before filming The Wolf of Wall Street33:43 – How actors play pathological characters in The Wolf of Wall Street34:09 – Nadine talks about the difference between narcissistic and pathological people35:43 – Nadine shares how to spot a pathological person39:11 – How Nadine's kids handled the Belfort name and the movie40:13 – How Nadine built a safe space for her kids40:55 – Nadine shares how to have proper communication about drugs with children42:19 – Did Nadine's kids openly share about their relationships?42:52 – Nadine shares how her kids always get along with each other44:01 – Nadine talks about how she built her $30/month Surthriver community for women46:16 – Does Nadine ever ask Jordan for business advice?46:41 – Who the Surthriver Community is for and how to join47:33 – Nadine talks about the meaning of a trauma bond48:06 – What are codependent relationships?48:59 – Nadine's recent life discoveries50:59 – Nadine's goals and focus for the next 6 months51:30 – Connect with Nadine52:11 – Outro

Your favorite psychologists, John Gartner and Harry Segal, review Trump's disastrous Alaska summit and marvel at how he has reverted to Putin's absurd Ukraine talking points. They also speak with Richard Wood, eminent clinical psychologist and expert on malignant narcissism, who shares his insights on Trump's pathology. Be sure to subscribe wherever you get your podcasts: Our site Subscribe on iTunes Subscribe on Spotify Subscribe on Amazon Music Subscribe on iHeartRadio We open with a “therapy session” framework—our way of inviting you into a collective examination of how Trump's behavior has infiltrated our daily lives. Too often, political coverage tip-toes around psychological insights. Not here. We argue that to understand Trump's volatility, his tantrums, and his rule-by-instinct style, you have to start with his inner life. Dr. Woods steps in to define malignant narcissism: a toxic cocktail of grandiosity, ruthlessness, and paranoia. He walks us through examples—obsessive self-aggrandizement, zero empathy for victims, and a ferocious need to dominate. When you hear Trump lob insults or bully subordinates, that's not business as usual. It's the playbook of someone for whom status and control override every other impulse. Too many pundits tiptoe around Trump's slurred speeches, jumbled tweets, and off-script rants. We don't. We break down the warning signs of cognitive fragility—memory lapses, word-salad tangents, even motor-skill stumbles. These aren't just gaffes; they're red flags that a leader who can't stay on message is a risk to national security. Why do millions still cheer him on? In a frank discussion, we and Dr. Woods explore how Trump transforms fear into solidarity. His promises of vengeance and identity-based appeals speak to grievances deeper than policy. When democracy feels abstract, demagoguery feels personal—and that's how authoritarian figures like Trump cement loyalty. We draw parallels to his moves in Washington itself: weaponizing local police, twisting museum exhibits to sanitize his image, and rewriting history to suit his narrative. It's not accidental. It's an orchestrated strategy to freeze dissent and manufacture consent. This episode doesn't leave you helpless. We outline concrete steps—peer education, fact-based conversations, and refusing to normalize destructive behavior cloaked in charismatic populism. Psychological insight isn't therapy; it's ammunition. It helps us name the tactics, defang the threats, and reclaim our public life. If you want to see past the tweets and the rallies and understand the man behind the façade, tune in to Shrinking Trump wherever you get your podcasts. Let's sharpen our collective lens—because democracy demands more than headline-chasing. It demands that we understand, confront, and ultimately shrink the power of rulers unfit to lead. Learn more about your ad choices. Visit megaphone.fm/adchoices

Join us (Dr. Henry Emmons and Dr. Aimee Prasek) as we dig into this phenomenon of 'pathological productivity.' We'll talk about how over-focusing on productivity can lead to mental and physical health issues, why us humans have a deep aversion to idleness, why rest can feel "bad," and most importantly, how we can get out of this kind of pathological productivity and embrace rest and play in ways that nourish us.   If you enjoyed this episode, please rate and review us wherever you listen to your favorite podcasts! Sources and Notes: Joy Lab Program: Take the next leap in your wellbeing journey with step-by-step practices to help you build and maintain the elements of joy in your life. Joy Lab episodes referenced: Where's Your Third Place? [ep. 171] Sometimes I Just Sits... (the power of solitude) [ep. 74] Four Thousand Weeks by Oliver Burkeman Series on authenticity from our Joy Lab podcast: Unmasking Your True Self: Exploring Authenticity and Awe [ep. 216] Embrace Your True Self: Accepted, Connected, & In The Game [ep. 217] The Road Most Travelled: Awakening Through Suffering [ep. 218]  Follow Your Bliss: Awakening to Joy [ep. 219] The Still Small Voice: Awakening with soulfulness [ep. 220] Chandola, T., Ling, W., & Rouxel, P. (2025). Are anxious Mondays associated with HPA-axis dysregulation? A longitudinal study of older adults in England. Journal of Affective Disorders, 389. Access here.   Full transcript here.   Please remember that this content is for informational and educational purposes only. It is not intended to provide medical advice and is not a replacement for advice and treatment from a medical professional. Please consult your doctor or other qualified health professional before beginning any diet change, supplement, or lifestyle program. Please see our terms for more information. If you or someone you know is struggling or in crisis, help is available. Call the NAMI HelpLine: 1-800-950-6264 available Monday through Friday, 10 a.m. – 10 p.m., ET. OR text "HelpLine" to 62640 or email NAMI at helpline@nami.org. Visit NAMI for more. You can also call or text SAMHSA at 988 or chat 988lifeline.org.  

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Will Karen Read's lying be centerstage in her civil trial? Here's one tale that Karen Read told that she has never had any questions about. Let's talk about it!Get access to exclusive content & support the podcast by becoming a Patron today! https://patreon.com/robertaglasstruecrimereportThrow a tip in the tip jar! https://buymeacoffee.com/robertaglassSupport Roberta by sending a donation via Venmo. https://venmo.com/robertaglassBecome a channnel member for custom Emojis, first looks and exclusive streams here: https://youtube.com/@robertaglass/joinShow Notes: Masshole Mafia "The Feds Are Coming! For Turtleboy & Karen Read?" - https://youtu.be/gWruNzMK1aE?si=P5K0oI366tUmsD-ZInnocence Fraud Watch "Cop Killer Karen Read, Her Alleged 5pm Appointment With Mansfield Plumber Called Richie & 6pm Call With Her Depraved Father William Read. Incl. Questions On Wrongful Death Civil Lawsuit" -https://theerrorsthatplaguethemiscarriageofjusticemovement.home.blog/2025/07/18/cop-killer-karen-read-her-5pm-appointment-with-alleged-mansfield-plumber-called-richie-6pm-call-with-her-depraved-father-william-read-incl-civil-suit/Choosing Therapy "17 Manipulation Tactics of Abusers" - https://www.choosingtherapy.com/manipulation-tactics/Thank you Patrons!Therese Tunks, JC, Lizzy D, Elizabeth Drake, Texas Mimi, Barb, Deborah Shults, Debra Ratliff, Stephanie Lamberson, Maryellen Sudol, Mona, Karen Pacini, Jen Buell, Marie Horton, ER, Rosie Grace, B. Rabbit, Sally Merrick, Amanda D, Mary B, Mrs Jones, Amy Gill, Eileen, Wesley Loves Octoberfest, Erin (Kitties1993), Anna Quint, Cici Guteriez, Sandra Loves GatsbyHannna, Christy, Jen Buell, Elle Solari, Carol Cardella, Jennifer Harmon, DoxieMama65, Carol Holderman, Joan Mahon, Marcie Denton, Rosanne Aponte, Johnny Jay, Jude Barnes, JenTheRN, Victoria Devenish, Jeri Falk, Kimberly Lovelace, Penni Miller, Jil, Janet Gardner, Jayne Wallace (JaynesWhirled), Pat Brooks, Jennifer Klearman, Judy Brown, Linda Lazzaro, Suzanne Kniffin, Susan Hicks, Jeff Meadors, D Samlam, Pat Brooks, Cythnia, Bonnie Schoeneman-Dilley, Diane Larsen, Mary, Kimberly Philipson, Cat Stewart, Cindy Pochesci, Kevin Crecy, Renee Chavez, Melba Pourteau, Julie K Thomas, Mia Wallace, Stark Stuff, Kayce Taylor, Alice, Dean, GiGi5, Jennifer Crum, Dana Natale, Bewildered Beauty, Pepper, Joan Chakonas, Blythe, Pat Dell, Lorraine Reid, T.B., Melissa, Victoria Gray Bross, Toni Woodland, Danbrit, Kenny Haines and Toni Natalie.

Episode 198: Fatigue.  Future doctors Redden and Ibrahim discuss with Dr. Arreaza the different causes of fatigue, including physical and mental illnesses. Dr. Arreaza describes the steps to evaluate fatigue. Some common misconceptions are explained, such as vitamin D deficiency and “chronic Lyme disease”. Written by Michael Ibrahim, MSIV, and Jordan Redden, MSIV, Ross University School of Medicine. Edits and comments by Hector Arreaza, MDYou are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza: Today is a great day to talk about fatigue. It is one of the most common and most complex complaints we see in primary care. It involves physical, mental, and emotional health. So today, we're walking through a case, breaking down causes, red flags, and how to work it up without ordering the entire lab catalog.Michael:Case: This is a 34-year-old female who comes in saying, "I've been feeling drained for the past 3 months." She says she's been sleeping 8 hours a night but still wakes up tired. No recent illnesses, no weight loss, fever, or night sweats. She denies depression or anxiety but does report a lot of work stress and taking care of her two little ones at home. She drinks 2 cups of coffee a day, doesn't drink alcohol, and doesn't use drugs. No medications, just a multivitamin. Regular menstrual cycles—but she's noticed they've been heavier recently.Jordan:Fatigue is a persistent sense of exhaustion that isn't relieved by rest. It's different from sleepiness or muscle weakness.Classification based on timeline:    •   Acute fatigue: less than 1 month    •   Subacute: 1 to 6 months    •   Chronic: more than 6 monthsThis patient's case is subacute—going on 3 months now.Dr. Arreaza:And we can think about fatigue in types:    •   Physical fatigue: like muscle tiredness after activity    •   Mental fatigue: trouble concentrating or thinking clearly (physical + mental when you are a medical student or resident)    •    Pathological fatigue: which isn't proportional to effort and doesn't get better with restAnd of course, there's chronic fatigue syndrome, also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is a diagnosis of exclusion after 6 months of disabling fatigue with other symptoms.Michael:The differential is massive. So, we can also group it by systems.Jordan:Let's run through the big ones.Endocrine / Metabolic Causes    • Hypothyroidism: A classic cause of fatigue. Often associated with cold intolerance, weight gain, dry skin, and constipation. May be subtle and underdiagnosed, especially in women.    • Diabetes Mellitus: Both hyperglycemia and hypoglycemia can cause fatigue. Look for polyuria, polydipsia, weight loss, or blurry vision in undiagnosed diabetes.    • Adrenal Insufficiency: Think of this when fatigue is paired with hypotension, weight loss, salt craving, or hyperpigmentation. Can be primary (Addison's) or secondary (e.g., due to long-term steroid use).Michael: Hematologic Causes    • Anemia (especially iron deficiency): Very common, especially in menstruating women. Look for fatigue with pallor, shortness of breath on exertion, and sometimes pica (craving non-food items).     • Vitamin B12 or Folate Deficiency: B12 deficiency may present with fatigue plus neurologic symptoms like numbness, tingling, or gait issues. Folate deficiency tends to present with megaloblastic anemia and fatigue.    • Anemia of Chronic Disease: Seen in patients with chronic inflammatory conditions like RA, infections, or CKD. Typically mild, normocytic, and improves when the underlying disease is treated.Michael: Psychiatric Causes    • Depression: A major driver of fatigue, often underreported. May include anhedonia, sleep disturbance, appetite changes, or guilt. Sometimes presents with only somatic complaints.    • Anxiety Disorders: Mental fatigue, poor sleep quality, and hypervigilance can leave patients feeling constantly drained.    • Burnout Syndrome: Especially common in caregivers, healthcare workers, and educators. Emotional exhaustion, depersonalization, and reduced personal accomplishment are key features.Jordan: Infectious Causes    • Epstein-Barr Virus (EBV):Mononucleosis is a well-known cause of fatigue, sometimes lasting weeks. May also have sore throat, lymphadenopathy, and splenomegaly.    • HIV:Consider it in high-risk individuals. Fatigue can be an early sign, along with weight loss, recurrent infections, or night sweats.    • Hepatitis (B or C):Can present with chronic fatigue, especially if liver enzymes are elevated. Screen at-risk individuals.    • Post-viral Syndromes / Long COVID:Fatigue that lingers for weeks or months after viral infection. Often, it includes brain fog, muscle aches, and post-exertional malaise.Important: Chronic Lyme disease is a controversial term without a consistent clinical definition and is often used to describe patients with persistent, nonspecific symptoms not supported by objective evidence of Lyme infection. Leading medical organizations reject the term and instead recognize "post-treatment Lyme disease syndrome" (PTLDS) for persistent symptoms following confirmed, treated Lyme disease, emphasizing that prolonged antibiotic therapy is not effective. Research shows no benefit—and potential harm—from extended antibiotic use, and patients with unexplained chronic symptoms should be thoroughly evaluated for other possible diagnoses.Michael: Cardiopulmonary Causes    •   Congestive Heart Failure (CHF): Fatigue from poor perfusion and low cardiac output. Often comes with dyspnea on exertion, edema, and orthopnea.    •   Chronic Obstructive Pulmonary Disease (COPD): Look for a smoking history, chronic cough, and fatigue from hypoxia or the work of breathing.    •   Obstructive Sleep Apnea (OSA): Daytime fatigue despite adequate hours of sleep. Patients may snore, gasp, or report morning headaches. High suspicion in obese or hypertensive patients.Jordan:Autoimmune / Inflammatory Causes    •   Systemic Lupus Erythematosus (SLE): Fatigue is often an early symptom. May also see rash, arthritis, photosensitivity, or renal involvement.    •   Rheumatoid Arthritis (RA): Fatigue from systemic inflammation. Morning stiffness, joint pain, and elevated inflammatory markers point to RA.    •   Fibromyalgia: A chronic pain syndrome with widespread tenderness, fatigue, nonrestorative sleep, and sometimes cognitive complaints ("fibro fog").Cancer / Malignancy    •   Leukemia, lymphoma, or solid tumors: Fatigue can be the first symptom, often accompanied by weight loss, night sweats, or unexplained fevers. Consider when no other cause is evident.Michael:Medications:Common culprits include:    ◦   Beta-blockers: Can slow heart rate too much.    ◦   Antihistamines: Sedating H1 blockers like diphenhydramine.    ◦   Sedatives or sleep aids: Can cause grogginess and daytime sedation.    •   Substance Withdrawal: Fatigue can be seen in withdrawal from alcohol, opioids, or stimulants. Caffeine withdrawal, though mild, can also contribute.Dr. Arreaza:Whenever we evaluate fatigue, we need to keep an eye out for red flags. These should raise suspicion for something more serious:    •   Unintentional weight loss    •   Night sweats    •   Persistent fever    •   Neurologic symptoms    •   Lymphadenopathy    •   Jaundice    •   Palpitations or chest painThis patient doesn't have these—but that doesn't mean we stop here.Dr. Arreaza:Those are a lot of causes, we can evaluate fatigue following 7 steps:Characterize the fatigue.Look for organic illness.Evaluate medications and substances.Perform psychiatric screening.Ask questions about quantity and quality of sleep.Physical examination.Undertake investigations.So, students, do we send the whole lab panel?Michael:Not necessarily. Labs should be guided by history and physical. But here's a good initial panel:    •   CBC: To check for anemia or infection    • TSH: Screen for hypothyroidism    • CMP: Look at electrolytes, kidney, and liver function    • Ferritin and iron studies    • B12, folate    • ESR/CRP for inflammation (not specific)    • HbA1c if diabetes is on the radarJordan:And if needed, consider:    • HIV, EBV, hepatitis panel    • ANA, RF    • Cortisol or ACTH stimulation testImaging? Now that's rare—unless there are specific signs. Like chest X-ray for possible cancer or TB, or sleep study if you suspect OSA.Dr. Arreaza:Unaddressed fatigue isn't just inconvenient. It can impact on quality of life, affect job performance, lead to mood disorders, delay diagnosis of serious illness, increase risk of accidents—especially driving. So, don't ignore your patients with fatigue!Jordan:And some people—like women, caregivers, or shift workers—are especially at risk.Michael:The cornerstone of treatment is addressing the underlying cause.Jordan:If it's iron-deficiency anemia—treat it. If it's depression—get mental health involved. But there's also: Lifestyle Support: Better sleep hygiene, light physical activity, mindfulness or CBT for stress, balanced nutrition—especially iron and protein, limit caffeine and alcoholDr. Arreaza:Sometimes medications help—but rarely. And for chronic fatigue syndrome, the current best strategies are graded exercise therapy and CBT, along with managing specific symptoms. Beta-alanine has potential to modestly improve muscular endurance and reduce fatigue in older adults, but more high-quality research is needed.SSRI: fluoxetine and sertraline. Iron supplements: Even without anemia, but low ferritin [Anecdote about low ferritin patient]Jordan:This case reminds us to take fatigue seriously. In her case, it may be multifactorial—work stress, caregiving burden, and possibly iron-deficiency anemia. So, how would we wrap up this conversation, Michael?Michael:We don't need to order everything under the sun. A focused history and exam, targeted labs, and being alert to red flags can guide us.Jordan:And don't forget the basics—sleep, stress, and nutrition. These are just as powerful as any prescription.Dr. Arreaza:We hope today's episode on fatigue has given you a clear framework and some practical tips. If you enjoyed this episode, share it and subscribe for more evidence-based medicine!Jordan:Take care—and get some rest~___________________________Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:DynaMed. (2023). Fatigue in adults. EBSCO Information Services. https://www.dynamed.com (Access requires subscription)Jason, L. A., Sunnquist, M., Brown, A., Newton, J. L., Strand, E. B., & Vernon, S. D. (2015). Chronic fatigue syndrome versus systemic exertion intolerance disease. Fatigue: Biomedicine, Health & Behavior, 3(3), 127–141. https://doi.org/10.1080/21641846.2015.1051291Kroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome. The American Journal of Medicine, 86(3), 262–266. https://doi.org/10.1016/0002-9343(89)90293-3National Institute for Health and Care Excellence. (2021). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: Diagnosis and management (NICE Guideline No. NG206). https://www.nice.org.uk/guidance/ng206UpToDate. (n.d.). Approach to the adult patient with fatigue. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

In this episode, we review the high-yield topic ⁠Pathological RBC Forms⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Hematology section at ⁠⁠⁠⁠Medbullets.com⁠⁠⁠⁠⁠⁠Follow⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets

Across centuries and continents, documented cases reveal supernatural forces that escalated beyond typical paranormal activity — resulting in physical harm, unexplained deaths, and encounters that defy conventional explanations.Join the DARKNESS SYNDICATE: https://weirddarkness.com/syndicateIN THIS EPISODE: Many ghost stories are frightening but leave the person encountering them shaken, but no more worse for wear. Perhaps a light touch on the shoulder, the moving of an object, a whisper in the ear, or a cold chill for the more intense cases. But then there are those hauntings that leave the person hysterical… or physically hurt… or even dead. We'll look at some of the most violent ghosts and hauntings of all time. (History's Most Violent Ghosts) *** Dixon, Illinois needed a bridge – Mr. L.E. Truesdell was an expert bridge builder. But people had doubts as to whether what he was being asked to do could be accomplished. The naysayers were ignored – and tragedy arrived, (The Truesdell Bridge Disaster) *** The witch trials in Salem, Massachusetts were horrid… the trials in Europe even more so. Now, imagine being a soldier tried as a witch because you returned with supernatural knowledge imparted to you after you were abducted by extraterrestrials. It sounds like the makings of a terrible novel and an even worse movie… but it's the true story of Major Thomas Weir. (The True Story of the Alien Abduction Witch Trial) *** He's believed to have killed over 50 women inside his soundproof torture trailer – which he called his “toy box.” We'll look at the case of serial killer David Parker Ray. (Evils of the Toybox Killer) *** Our criminal justice system tries to be the most fair in the world – considering the accused “innocent until proven guilty.” And while our system is not perfect, for the most part it does its job well. But because it is not perfect, once in a while a murderer walks… or even worse, an innocent defendant goes to prison. And in some cases, that innocent person is convicted and imprisoned based on one thing – they confessed to the crime that they didn't commit. Why would someone do that? (Why Do Innocent People Confess?) *** Port St. Lucie, Florida is full of disturbing urban legends – some true, many false – as urban legends go. But somehow, most all of these terrifying stories tie back to a single oak tree in a neighborhood park, and Florida's first serial killer. (The Devil Tree Hauntings)ABOUT WEIRD DARKNESS: Weird Darkness is a true crime and paranormal podcast narrated by professional award-winning voice actor, Darren Marlar. Seven days per week, Weird Darkness focuses on all thing strange and macabre such as haunted locations, unsolved mysteries, true ghost stories, supernatural manifestations, urban legends, unsolved or cold case murders, conspiracy theories, and more. On Thursdays, this scary stories podcast features horror fiction along with the occasional creepypasta. Weird Darkness has been named one of the “Best 20 Storytellers in Podcasting” by Podcast Business Journal. Listeners have described the show as a cross between “Coast to Coast” with Art Bell, “The Twilight Zone” with Rod Serling, “Unsolved Mysteries” with Robert Stack, and “In Search Of” with Leonard Nimoy.DISCLAIMER: Ads heard during the podcast that are not in my voice are placed by third party agencies outside of my control and should not imply an endorsement by Weird Darkness or myself. *** Stories and content in Weird Darkness can be disturbing for some listeners and intended for mature audiences only. Parental discretion is strongly advised.CHAPTERS & TIME STAMPS (All Times Approximate)…00:00:00.000 = Lead-In00:00:55.371 = Show Open00:04:12.885 = The Devil Tree Hauntings00:15:28.295 = History's Most Violent Ghosts00:36:32.777 = The True Story of the Alien Abduction Witch Trial00:45:55.817 = Evils of the Toybox Killer00:57:04.271 = The Truesdell Bridge Disaster01:07:45.917 = Why Do Innocent People Confess?01:15:48.277 = Show CloseSOURCES AND RESOURCES FROM THE EPISODE…“History's Most Violent Ghosts” by Robert F. Mason for Ranker: https://weirddarkness.tiny.us/3x42y575“The True Story of the Alien Abduction Witch Trial” by Marcus Lowth for UFO Insight: https://weirddarkness.tiny.us/bdhrv3hu“The Devil Tree Hauntings” posted at MiamiHaunts.com: https://weirddarkness.tiny.us/2sp2wakz“Evils of the Toybox Killer” by Jaclyn Anglis for All That's Interesting: https://weirddarkness.tiny.us/jep7tnxf“The Truesdell Bridge Disaster” by Kathi Kresol for HauntedRockford.com: https://weirddarkness.tiny.us/4c94hvjy“Why Do Innocent People Confess?” by Lea Rose Emery for Ranker: https://weirddarkness.tiny.us/bjtvenfv=====(Over time links may become invalid, disappear, or have different content. I always make sure to give authors credit for the material I use whenever possible. If I somehow overlooked doing so for a story, or if a credit is incorrect, please let me know and I will rectify it in these show notes immediately. Some links included above may benefit me financially through qualifying purchases.)= = = = ="I have come into the world as a light, so that no one who believes in me should stay in darkness." — John 12:46= = = = =WeirdDarkness® is a registered trademark. Copyright ©2025, Weird Darkness.=====Originally aired: July 24, 2023EPISODE PAGE at WeirdDarkness.com (includes list of sources): https://weirddarkness.com/ViolentHauntings

About this Episode When love turns toxic, it can be almost impossible to see clearly through the confusion, self-doubt, and emotional chaos that follow. If you've ever found yourself trapped in a cycle of hope, heartbreak, and uncertainty within a relationship, you're not alone—and there's a reason why breaking free can feel so overwhelming. The hidden dynamics of pathological partnerships and trauma bonds often keep people stuck, questioning their worth, and struggling to understand why things never seem to get better. In this episode, listeners are offered insight and validation as the conversation unpacks the complex nature of trauma bonds and toxic relationships. You'll discover how these destructive patterns form, what psychological traits might make someone more susceptible, and why distinguishing between harmful behaviors and truly pathological intentions is so important. With practical guidance and real-life examples, this episode shines a compassionate light on the path toward healing, empowerment, and, for those who need it most, a way out. Affectionately known as Dr. Nae, Dr. Nadine Macaluso is a therapist specializing in trauma healing and personal transformation. Her life inspired the character Naomi Belfort in The Wolf of Wall Street. After overcoming personal challenges, she earned a Master's degree in counseling and a Ph.D. in Somatic Psychotherapy. Dr. Macaluso helps individuals recover from trauma bonds, C-PTSD, and shame. She is also the author of Run Like Hell: A Therapist's Guide to Recognizing, Escaping, and Healing From Trauma Bonds. Check out the transcript of this episode on Dr. Jessica Higgin's website. Episode Highlights  06:28 Dr. Nadine Macaluso's personal journey and the roots of her work on trauma bonds. 09:49 Defining trauma bonds and the role of intermittent reinforcement in toxic relationships. 13:35 Intent, power imbalance, and the pathological partner in trauma bonds. 16:11 Pathological intent vs. reactive behaviors and repair. 19:20 Understanding Cluster B personality disorders and their impact on relationships. 21:23 Empowering the victim over diagnosing the pathological partner. 24:11 Who is most susceptible to trauma bonds? 28:16 Questioning labels: Codependency, attachment, and rethinking victim narratives. 32:34 Attachment styles, developmental trauma, and their role in toxic relationships. 34:31 Cultural myths about love, media influence, and the hope that keeps people stuck. 37:20 Reducing shame, cognitive dissonance, and reconnecting with self. 42:47 The process of leaving: Safety, planning, and overcoming guilt. 44:30 Post-traumatic growth: Finding strength, hope, and empowerment after leaving a toxic relationship. Mentioned Run Like Hell (*Amazon Affiliate link) (book) Women Who Love Psychopaths (*Amazon Affiliate link) (book) Big 5 Personality Quiz  Essentia's website (*Affiliate link) Stratami™ Organic Mattress (This is the mattress we purchased) (*Affiliate link) Classic REM5 Active Mattress – (The mattress we wish we could have gotten for the cooling feature) (*Affiliate link) Evolve in Love (program) Evolve in Love – Next level – Book Your Discovery Call Connect with Dr. Nadine Macaluso Websites: drnae.com Facebook: facebook.com/drnaelmft X: x.com/i/flow/login?redirect_after_login=%2Ftherealdrnadine YouTube: youtube.com/c/TheRealDrNadine Instagram: instagram.com/therealdrnadine LinkedIn: linkedin.com/in/therealdrnadine TikTok: tiktok.com/@drnaelmft Connect with Dr. Jessica Higgins Facebook: facebook.com/EmpoweredRelationship  Instagram: instagram.com/drjessicahiggins  Podcast: drjessicahiggins.com/podcasts/ Pinterest: pinterest.com/EmpowerRelation  LinkedIn: linkedin.com/in/drjessicahiggins  Twitter: @DrJessHiggins  Website: drjessicahiggins.com   Email: jessica@drjessicahiggins.com If you have a topic you would like it to be discussed, please contact us by clicking on the “Ask Dr. Jessica Higgins” button here.  Thank you so much for your interest in improving your relationship.  Also, I would so appreciate your honest rating and review. Please leave a review by clicking here.  Thank you!   *With Amazon Affiliate Links, I may earn a few cents from Amazon, if you purchase the book from this link.

Welcome, writers and book lovers. The Bleeders is a podcast about book writing and publishing. Make sure you subscribe to the companion Substack: https://thebleeders.substack.com/welcomeToday's guest is Sarah Fay, memoirist, writing coach, and Substack strategist. Her debut memoir, Pathological, chronicles her 25-year journey through the mental health system. In this episode, Sarah shares how she manifested her dream agent, her surprisingly fast path to publication (during the pandemic no less!), how she found the structure for Pathological, why she decided to serialize her second memoir, and more. Plus, she offers tips for thriving on Substack (and why it might be better than an MFA), along with practical advice on book PR. Follow Sarah on Substack @sarahfay.The Bleeders is hosted by Courtney Kocak. Follow her on Instagram @courtneykocak and Bluesky @courtneykocak.bsky.social. For more, check out her website courtneykocak.com.Courtney is teaching some upcoming workshops you might be interested in:How to Build a “Platform” for Writers Who Shudder at the Thought: https://writingworkshops.com/products/how-to-build-a-platform-for-writers-who-shudder-at-the-thought-zoom-seminarCreating Your Podcast: https://www.roadmapwriters.com/products/creating-your-podcast-0Podcasting for Writers: How to Start, Sustain & Grow Your Podcast: https://writingworkshops.com/products/podcasting-for-writers-how-to-start-sustain-grow-your-podcast-4-week-zoom-workshopStart a Newsletter to Supercharge Your Platform, Network and Business: https://writingworkshops.com/products/start-a-newsletter-to-supercharge-your-platform-network-business-zoom-seminarLand Big Bylines by Writing for Columns: https://writingworkshops.com/products/land-big-bylines-by-writing-for-columns-zoom-seminarThe Multi-Passionate Writer's Life: https://writingworkshops.com/products/the-multi-passionate-writers-life-zoom-seminar-with-courtney-kocak

Megyn Kelly is joined by Jordan Peterson, co-founder of Peterson Academy and author of "We Who Wrestle with God," to discuss the insane leftist policies that drove men and boys away from the Democratic party, how they're still missing the point even after Trump's landslide win, how it is "too little too late" for schools and universities to salvage their reputation, the decline of the Ivy League status, how young people are the more politically divided by gender than ever before, how Dems don't understand why there's this split and still think everything is about abortion, Andrew Tate's “pathological masculinity" and the wrong messenger to men and boys, why Dems are misguided about what makes Trump popular, what Olivia Wilde got wrong about him in the character based on him in “Don't Worry Darling,” what Peterson learned about Chris Pine after the movie came out, how Disney dropped the ball on Snow White, challenges young women face in the dating world, the issue with the mentality of “settling,” and more.More from Peterson: https://petersonacademy.com/Herald Group: Learn more at https://GuardYourCard.com  Done with Debt: https://www.DoneWithDebt.com  & tell them Megyn sent you!FYSI: https://FYSI.com/Megyn  or call 800-877-4000 Follow The Megyn Kelly Show on all social platforms:YouTube: https://www.youtube.com/MegynKellyTwitter: http://Twitter.com/MegynKellyShowInstagram: http://Instagram.com/MegynKellyShowFacebook: http://Facebook.com/MegynKellyShow Find out more information at: https://www.devilmaycaremedia.com/megynkellyshow

Have you ever asked your child to do a simple task, only to be met with an explosive reaction? In this episode, we interview Lydia Rex, Connected Families Certified Parent Coach, about Pathological Demand Avoidance (PDA), also known as Pervasive Drive for Autonomy. Lydia will help you step into your child's shoes and understand how […]

Sarah roped Susie into watching Love is Blind and now they have to talk about it (even though Susie is mad about it). We discuss the particular hellscape that is a reality tv reunion and the trauma it provides. We discuss why bangs are never the answer and you should never get a tattoo when you're in the throes of life's worst moments. Sarah talks about Belle Gibson who became a successful influencer, cookbook author, and lifestyle blogger based on a lie that she had terminal cancer she was treating homeopathically. We find out why young people aren't getting romantically involved and debate whether that's a bad or good thing. And we hear why reality tv causes insecurity in men and women in different ways. Plus, Susie explains what a "bed party" is and why people are spending lots of money for an instagram picture celebrating their kid going to college.Listen to more podcasts like this: https://wavepodcastnetwork.comJoin our Candy Club, shop our merch, sign-up for our free newsletter, & more by visiting The Brain Candy Podcast website: https://www.thebraincandypodcast.comConnect with us on social media:BCP Instagram: https://www.instagram.com/braincandypodcastSusie's Instagram: https://www.instagram.com/susiemeisterSarah's Instagram: https://www.instagram.com/imsarahriceBCP on X: https://www.x.com/braincandypodSponsors:Get 20% OFF by going to https://www.honeylove.com/braincandy! #honeylovepodGet up to 35% off PLUS 2 free gifts using code BRAINCANDY at https://shopbeam.com/BRAINCANDYSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Chapters 00:00 Introduction and Current Work 02:51 Shockwave Therapy: Efficacy and Mechanisms 06:07 Understanding Tendon Pathologies 09:00 Calcification and Adaptation in Tendons 11:55 The Role of Shockwave in Clinical Practice 15:12 Platelet-Rich Plasma (PRP) Insights 18:06 Stem Cells and Tendon Healing 20:57 Adjuncts in Tendon Rehabilitation 23:48 Heel Wedges: Evidence and Application 27:06 Loading Strategies for Tendinopathy 30:04 Compression and Tendon Mechanics 32:56 The Importance of Loading in Rehabilitation 35:51 Tendon Stiffness: Heavy Loads vs. Plyometrics 42:01 Understanding Tendon Loading Mechanisms 45:25 Isometric vs. Eccentric Loading for Tendon Adaptation 48:23 Maximal Eccentrics: Techniques and Applications 51:45 Fluid Movement and Tendon Health 55:35 The Role of Metabolism in Tendon Adaptation 01:01:10 The Complexity of Tendon Pathology 01:06:29 The Dynamics of Fluid Movement in Tendons 01:11:11 Plyometrics vs. Isometrics: Strain and Adaptation 01:14:05 Blood Flow Restriction Training and Tendon Adaptation 01:18:21 Metabolic Factors in Tendon Healing   Takeaways Peter Malairis is a full-time professor at Monash University. Recent research shows shockwave therapy is ineffective for tendon pain. Calcification in tendons may be an adaptive response. PRP injections do not outperform placebo treatments. Stem cell therapy lacks sufficient evidence for tendon healing. Adjunct therapies should be accessible, cheap, and safe. Heel wedges have shown significant effects in treating Achilles tendinopathy. Loading strategies must be tailored to individual patient needs. Tendon stiffness is primarily improved through heavy loading. Fluid movement within tendons is essential for adaptation. Loading the tendon heavier leads to better fluid movement. Isometrics are crucial for early rehabilitation stages. Heavy maximal eccentrics are key for long-term adaptation. Fluid movement impacts stress relaxation in tendons. Tendon stiffness increases with appropriate loading. Metabolic health is essential for tendon adaptation. Pathological tendons may require different loading strategies. Fluid movement can help reduce pain and improve function. Plyometrics may not provide sufficient strain for adaptation. Blood flow restriction can be effective for tendon rehabilitation.     Notes: https://jackedathlete.com/podcast-131-tendons-with-peter-malliaras/

An episode that defies the norms.Here's what's in store for today's episode: * Today, hosts Matt and Angela explore the intriguing and often debated world of Pathological Demand Avoidance with special guest Richard Woods.* Pathological Demand Avoidance, also known in more affirming circles as Persistent Drive for Autonomy, describes a strong need to question and resist demands, often co-occurring with autism. This trait can manifest as an intense drive for control, leading individuals to navigate the world in ways that prioritize autonomy and flexibility over compliance.* Most of what we know about PDA autism—and the stereotypes surrounding it—are heavily focused on children. In reality, PDA exists on a spectrum, and many adults also experience its traits, often in ways that go unrecognized or misunderstood.* Many neurotypicals see PDA as indistinguishable from Oppositional Defiant Disorder (ODD), when in reality, PDA is often the underlying factor in these cases, driven by a need for autonomy rather than intentional defiance.* We explore the validity of Theory of Mind in relation to PDA and the problems with pathologizing demand avoidance.* Our hosts and special guest discuss the misconception that PDA traits fade with age—when in reality, PDA individuals learn to accommodate themselves and establish clear boundaries as they grow into adulthood.* We explore the overlap between PDA and ODD, and why Richard believes that PDA isn't a form of autism, but rather a distinct profile of neurodivergence.* Additionally, we discuss how neurotypicals often struggle to differentiate CPTSD symptoms from autism, as many have never encountered a healthy, healed autistic person.* The discussion then shifts to how the world is not designed for autistic or disabled people in general, and how this lack of accessibility and understanding can exacerbate PDA traits, making self-advocacy and autonomy even more crucial.* We talk about labels, how they affect our ability to get our needs met, and what Richard's "post-autistic identity" entails in the broader conversation around neurodivergence and self-definition.* Finally, we reflect on the importance of self-advocacy, community, and embracing neurodivergence beyond medical labels, as well as the role of monotropic focus in the autistic experience.“May your stimming activities be many, and your flow states long.” About Richard Woods:Richard Woods is the leading Demand Avoidance Phenomena (Pathological Demand Avoidance) authority (by academic work and experience) and Author.He is attributed as autistic, but has a "post-autistic identity" as he is no longer basing his identity on psychiatric categories.“I tend to view PDA as literally about the management of stress. A lot of people express these features because they are distressed and or stressed by the demands being placed upon them. And often with autistic people, it seems to be more of a cognitive style. We're to be stressed when you put us in a very chaotic, very high-demanding world.” - Richard Woods“The modern life isn't built for autistics. It's so much noise, so much sound, so much that is visual and tactile. It's not built for disabled people in general.” - Richard Woods “That's the thing [about autistic kids] - when we have a safe person, when we have that anchor person, it frees us to be more objective, or to object rather, because it's safer to object. As opposed to a total stranger, you may not feel safe saying, ‘no, I don't want to do that. But with someone you trust, you say, ‘no, there's no way I'm going in there. You can't make me do that.' That's not going to happen, because you know you're not going to be met with that judgment and the criticism that comes along with that of a stranger.” - Matt In this episode, we take a deep dive into the world of Pathological Demand Avoidance (PDA) autism, a lesser-known but important part of the spectrum. From the intense need for autonomy to the challenges of navigating a demand-heavy world, we explore what PDA really is—and what it isn't. Join Matt and Angela as they break down common misconceptions, discuss how PDA presents in adults, and chat with expert Richard Woods about the affirming perspective of Persistent Drive for Autonomy. Have you experienced PDA traits in yourself or others? Share your thoughts with us using #AutisticCultureCatch on social media!Show Notes:There is substantial debate over what PDA is. Presently my view PDA is not an "autism profile"/ autism subgroup/ autism subtype, or anything of the kind. For a short 800 word overview of current debates on PDAby Richard Woods, please see below:https://www.researchgate.net/publication/354386742_Pathological_demand_avoidance_PDA_Its_four_schools_of_thoughthttps://tinyurl.com/4wynmydzRichard Woods ORCiD: https://orcid.org/0000-0002-8292-632Xhttps://www.pdasociety.org.uk/resources/identifying-features-ofpathological-demand-avoidance-using-the-diagnostic-interview-forsocial-andcommunication-disorders/https://monotropism.org/dinah/https://dlcincluded.github.io/MQ/Pathological Demand-Avoidance" (PDA) in Frontiers in Education, please see the call for papers below for more information:http://fron.tiers.in/rt/40032Related Shows:Reframing DSM Diagnosis Ready for a paradigm shift that empowers Autistics? Help spread the news!Follow us on InstagramFind us on Apple Podcasts and SpotifyLearn more about Matt at Matt Lowry, LPPJoin Matt's Autistic Connections Facebook GroupLearn more about Angela at AngelaKingdon.com Angela's social media: Twitter and TikTokOur Autism-affirming merch shop This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.autisticculturepodcast.com/subscribe

In this episode, Dr. David Puder, alongside experts Anthony Bateman, Dr. Brandon Unruh, and Robert Drozek, delves into the complexities of treating pathological narcissism with Mentalization-Based Therapy (MBT). They explore practical strategies to help individuals with Narcissistic Personality Disorder develop self-awareness, emotional regulation, and healthier relationships. Learn how MBT can transform the therapeutic journey for those who often feel misunderstood or resistant to change.