Podcasts about patients

Dr Eugene Manley grew up in Detroit in the 1980s cycling through emergency rooms 20 to 30 times a year with asthma and anaphylaxis while hospital staff talked past his family and buried them in paperwork they could not decode. He responded by earning a BS in mechanical engineering an MS in biomedical engineering and a PhD in molecular biology cell biology and biochemistry. Along the way he tore his ACL training for a jiu jitsu black belt worked 86 straight days in a lab during his doctorate and learned how academic and clinical systems punish people who refuse to shrink.In this episode Manley walks through a recent post surgery ordeal at Mount Sinai Queens where staff falsified records attempted an illegal discharge and nearly sent him home on the wrong blood thinner. He explains how medical racism shows up in charts staffing and decision making and why measurable equity fails without accountability. Listeners hear how his STEMM and Cancer Health Equity Foundation builds pipelines for underrepresented students challenges clinical trial design and teaches patients how to protect themselves when institutions lie. RELATED LINKS• Eugene Manley Jr• STEMM and Cancer Health Equity Foundation• Village Voice• LUNGevity FoundationFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Katie Beth Hand shares her journey as Patient Nine in the Eledon clinical trial, receiving donor islet cells and a targeted immunotherapy that may functionally cure her type 1 diabetes. Free Juicebox Community (non Facebook) Eversense CGM Medtronic Diabetes Tandem Mobi ** Use code JUICEBOX to save 40% at Cozy Earth  CONTOUR NextGen smart meter and CONTOUR DIABETES app Dexcom G7 Go tubeless with Omnipod 5 or Omnipod DASH * Get your supplies from US MED  or call 888-721-1514 Touched By Type 1 Take the T1DExchange survey Apple Podcasts> Subscribe to the podcast today! The podcast is available on Spotify, Google Play, iHeartRadio, Radio Public, Amazon Music and all Android devices The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here or buy me a coffee. Thank you! *The Pod has an IP28 rating for up to 25 feet for 60 minutes. The Omnipod 5 Controller is not waterproof.  ** t:slim X2 or Tandem Mobi w/ Control-IQ+ technology (7.9 or newer). RX ONLY. Indicated for patients with type 1 diabetes, 2 years and older. BOXED WARNING:Control-IQ+ technology should not be used by people under age 2, or who use less than 5 units of insulin/day, or who weigh less than 20 lbs. Safety info: tandemdiabetes.com/safetyinfo Disclaimer - Nothing you hear on the Juicebox Podcast or read on Arden's Day is intended as medical advice. You should always consult a physician before making changes to your health plan.  If the podcast has helped you to live better with type 1 please tell someone else how to find it!

Two Women Inspiring Real Life with Stephanie Coxon and Kathy Anderson-Martin – Ever receive a bill for a medical procedure or hospital stay and have no idea what you are paying for? Trouble getting an appointment with your medical provider – even when you're sick? When you did have an appointment, did you feel like you spent more time getting your parking pass validated than actually talking...

When a doctor hands your child a diagnosis, it can be a relief - finally, an explanation for their behavior! But sociologist Dr. Allan Horwitz has spent decades studying how psychiatric diagnoses are made, and what he's found raises serious questions about how much weight that label should carry. In this episode, Dr. Horwitz walks through how the Diagnostic and Statistical Manual (DSM) - the manual that defines every mental health diagnosis - was built less on scientific research than on professional politics, institutional pressure, and the practical needs of insurance companies.  He traces how depression went from a diagnosis given to a small fraction of the population to one of the most common diagnoses in the world, and explains exactly what happened to reliability when the DSM-5 was tested in real clinical conditions.  He also looks at how the same behaviors get labeled very differently depending on a child's age, race, class, and cultural background - and why that matters for every parent trying to figure out whether a diagnosis is actually helping their child. This episode won't tell you to reject diagnosis outright. But it will give you the critical knowledge to ask better questions when a label is offered for your child. Questions This Episode Will Answer What is the DSM and why does it matter for my child?  The DSM is the manual psychiatrists and psychologists use to diagnose every mental health condition. It determines what insurance will cover, what services your child can access, and what label follows them through school and into treatment. Who created the DSM and who controls it?  The American Psychiatric Association publishes the DSM, but its diagnostic criteria were largely shaped by a small group of people - predominantly white men with ties to pharmaceutical companies - whose process looked more like sausage-making than science. Why is DSM-5 criticized by researchers?  Field trials for DSM-5 showed reliability had actually declined from earlier editions. For some of the most common diagnoses, including major depression and generalized anxiety, agreement between clinicians was barely better than chance. Is a psychiatric diagnosis actually reliable?  Reliability means two different clinicians would give the same patient the same diagnosis. Research on the DSM-5 shows this is far less consistent than most parents assume - and a reliable diagnosis still isn't necessarily a correct one. Are children being overdiagnosed with mental health conditions?  Research shows that the youngest children in a classroom are significantly more likely to receive a psychiatric diagnosis than their older classmates, especially for ADHD - suggesting that what's being measured is developmental maturity, not a mental disorder. Does the DSM apply equally to children from different cultural backgrounds?  The DSM was built on a Euro-centric framework, and critics argue it pathologizes behaviors that are normal or valued in many Global Majority cultures. This has real consequences for how children from different backgrounds get diagnosed and treated. Why do mental health diagnoses focus on the individual instead of their circumstances?  The DSM is deliberately designed to identify disorders within a person rather than look at the conditions around them. It makes sense that a person going through a relationship breakup might feel sad, angry, and/or uncertain about the future.  That doesn't mean they're ‘depressed.'  Dr. Horwitz explains what that choice costs - and who pays the most. What You'll Learn in This Episode Why diagnosis serves the psychiatric profession and the insurance system in ways that don't always help the person being diagnosedHow the shift from psychoanalysis to the DSM-3 in 1980 dramatically expanded who could be diagnosed with depression - and why that shift was driven by professional rivalry, not new scienceWhat reliability and validity actually mean in psychiatric diagnosis, and why the numbers from DSM-5 field trials alarmed even people inside the systemHow the people who built the DSM criteria handled disagreements - and why the process Dr. Horwitz describes is so different from what most parents imagineWhy a child's birthdate relative to their classmates can predict their likelihood of receiving a psychiatric diagnosisHow socioeconomic status shapes not just whether a child gets diagnosed, but when they take their medication and whyWhat the removal of the bereavement exclusion in DSM-5 tells us about the direction the system is headingWhy the same behaviors that get a child diagnosed with ADHD in the US might get that child's family into therapy in the UK insteadWhat Dr. Horwitz thinks would actually make a difference for children's mental health - and why the most effective interventions are rarely the ones being offered Your Triggers Aren't a Diagnosis. But They're Worth Understanding. This episode makes the case that the mental health system focuses on only what's happening inside a person instead of looking at the broader circumstances around them - mostly to sell us more drugs.  In reality, our struggles are a combination of the challenges we've experienced in the past (and how we've learned to handle them), and our situation today.  We have to see both pieces to make sense of where we've been, and learn new tools for what's happening now. When your child's behavior sends you into a reaction you regret later, a diagnosis or prescription may not help as much as understanding what's underneath that reaction and where it came from.  That's exactly what the Taming Your Triggers workshop is built to help you do. In 10 weeks, you'll learn why you react the way you do, how to meet your own needs so you have more capacity for your kids, and how to respond from your values instead of your history. Enrollment is only open for a couple more days, until midnight Pacific on Wednesday, March 4. Click the banner to learn more Jump to highlights: 02:14 Introduction to today's episode 03:44 Why do we diagnose mental illness, and whose interests does the diagnostic system serve? Dr. Allan Horwitz explains that diagnoses maintain psychiatry's legitimacy and prestige as a medical profession, regardless of the knowledge behind each diagnosis. 05:10 Patients now often expect specific diagnoses before treatment even begins. 14:27 People experiencing sadness from job loss or relationship endings can benefit from medication, but to get prescriptions, you need a diagnosis of a disorder, even when the response is completely expectable given the circumstances. 15:39 The DSM locates suffering within individuals rather than examining broader social circumstances. 19:00 Wrapping up. 21:25 An open invitation to join the Parenting Membership.

Why You Should Listen:  In this episode, you will learn about the role of Supportive Oligonucleotide Therapy, or SOT, in the treatment of Lyme disease and vector-borne infections. About My Guest: My guest for this episode is Dr. Clayton Bell.  Clayton Bell, MD is a leading integrative and functional medicine physician dedicated to helping patients achieve deep, lasting wellness.  Dr. Bell works with Lyme and vector-borne infections, integrative cancer support, environmental medicine including mold, mycotoxins, heavy metals, and detoxification; hormones, cardiometabolic and GI health, and mind-body balance.  Combining his Western medical training with functional, integrative, environmental, and Ayurvedic approaches, he focuses on uncovering the root causes of health concerns.  Patients benefit from personalized, whole-person treatment plans that empower the body's natural healing ability and support sustainable wellness from the inside out.  Dr. Bell provides online consultations that offer accessible, holistic care tailored to each individual's needs. Key Takeaways: What place does SOT have in the treatment arsenal for chronic Lyme disease? What is AOT or Antisense Oligonucleotide Therapy? What testing is acceptable for a practitioner to request an SOT for a patient? What testing is offered by Biocentaur? How does SOT work in the body? How does the practitioner determine which SOT to request when many infections may be positive? What SOTs are available for vector-borne infections and viruses? What are the foundational steps to prepare a patient for an SOT? Do certain therapies need to be stopped before testing and while doing SOT? How important is immune modulation or creating immune tolerance to the microbes? What is the SOT administration process? How are Herxheimer reactions addressed with using SOT? Can the SOT push back one infection and then lead to another becoming the dominant focus of the immune system and symptom presentation? How long should there be between SOTs?  Is there a maximum number of SOTs that can be done? Can SOT reach all potential reservoirs of infection in the body? What role do biofilms play in the context of SOT? Have any specific SOTs been helpful in the contents of EDS, PANS/PANDAS, or Long COVID? What role might SOT play in neurodegenerative conditions? Can SOT resolve autoimmunity, inflammation, or oxidative stress? When SOT does not appear to work, how does the practitioner troubleshoot potential reasons? - What is the cost of SOT? Connect With My Guest:  MetaMedical.life Related Resources: RGCC North America RGCC International RGCC Vector-Borne and Virus SOTs available RGCC Provider Map Interview Date: February 24, 2026 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode229. Support the Show: To support the show and Buy Me a Coffee, visit https://betterhealthguy.link/BuyMeACoffee. Additional Information: To learn more, visit https://BetterHealthGuy.com. Follow Me on Social Media: Facebook - https://facebook.com/betterhealthguy Instagram - https://instagram.com/betterhealthguy X - https://twitter.com/betterhealthguy TikTok - https://tiktok.com/@betterhealthguy Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority. 

Keywordslongevity, wellness, health management, nutrition, exercise, sleep, community, proactive health, plastic surgery, recoveryIn this enlightening conversation, Dr. Bill Bruno, MD, a plastic surgeon and wellness expert, shares his journey from a health scare to advocating for proactive health management. He emphasizes the importance of nutrition, exercise, sleep, and community in achieving longevity and overall wellness. Dr. Bruno discusses how patients can take charge of their health by being informed and proactive, and he provides insights into building a personal health blueprint that includes essential lifestyle changes and regular health screenings. The conversation highlights the interconnectedness of physical health, mental well-being, and social connections, urging listeners to be intentional about their health choices.Learn more about Dr William Bruno and his Longevity Blueprint TakeawaysDr. Bruno had a personal health scare that changed his perspective on wellness.Most doctors do not provide adequate nutritional guidance to patients.Patients should be proactive in managing their health and asking questions.Nutrition, exercise, and sleep are the foundational pillars of health.Tracking health metrics can lead to better health outcomes.Creatine and Omega-3 are essential supplements for longevity.Community and social connections play a vital role in health.Sleep is crucial for recovery and overall health.Patients often overlook the importance of protein in recovery.Intentional living and setting specific health goals are key to success.Chapters00:00 Introduction to Longevity and Wellness02:43 The Importance of Proactive Health Management05:35 Building a Longevity Blueprint08:25 Nutrition: The Foundation of Health11:34 Exercise and Movement for Longevity14:08 The Role of Sleep in Recovery17:17 Community and Social Connections20:20 Optimizing Recovery After Surgery23:07 Intentional Living and Health GoalsIf something stirred in you today, this may be your invitation.Book a Wise Divine Health Strategy Call at danairvine.com.

The future of optometry is being shaped in real time. Clinical scope continues to expand. Diagnostic technology grows more advanced. Patients expect greater access and clarity. Business models are evolving. Private equity is entering the conversation. Leadership opportunities are becoming more visible.

Karina vous dévoile les décisions de justice les plus improbables.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

In this episode, Dr. Geralda Xavier, Regional Chief Medical Officer at Atlantic Health System, shares how her team reduced length of stay and improved throughput through multidisciplinary collaboration, while navigating workforce fatigue, financial pressures, and a continued focus on quality, safety, and equity in 2026.

177 Hospice, Caregiving, and Long-Term Care Planning with Raymond Levine Host Marie Betcher, a former hospice nurse and longtime registered nurse, interviews Raymond Levine, Raymond explains he designs long-term care plans that can help pay for caregiving either at home or in a facility, addressing the common misconception that long-term care insurance is only "nursing home insurance." They discuss caregiver stress and the need to support caregivers with respite and practical help. Raymond outlines how long-term care policies generally work as a pool of money over a set period, often with inflation or cost-of-living features, and notes that benefits may not cover 100% of costs depending on the plan and setting. Raymond advises making incremental home modifications in advance to support aging in place and reduce falls. The episode ends with Raymond offering Zoom, phone, and in-person meetings, directing listeners to his website tools and FAQ features, and Marie encouraging listeners to subscribe and share. 00:00 Welcome + Medical Disclaimer  00:29 Meet Your Host Marie Betcher  00:46 Raymond Levine's Backstory: Army, Vietnam & Career Path 02:43 What Raymond Does: Long‑Term Care Planning Meets Hospice Reality 04:21 Caregiver Burnout: Supporting the Family, Not Just the Patient 05:50 Does Long‑Term Care Insurance Pay for In‑Home Care or Facilities? 07:28 What Hospice Covers Under Medicare (and What It Doesn't) 11:00 How Long‑Term Care Policies Work: Pools of Money, Inflation Riders & Costs 16:08 Affordable Options When Money's Tight: Life Settlements, Reverse Mortgages & Hybrids 20:12 Avoiding Crisis: Planning, Home Modifications & Real‑World Care Logistics 22:09 Hospice Isn't a Daily Caregiver: Building a Care Team https://raymondlavineofficial.com/   If you want to help, you can donate to help support Hospice Explained at the Buy me a Coffee link   https://www.buymeacoffee.com/Hospice  Hospice Explained Affiliates & Contact Information Buying from these Affilite links will help support this Podcast.  Maire introduces a partnership with Suzanne Mayer RN inventor of the  cloud9caresystem.com,  When patients remain in the same position for extended periods, they are at high risk of developing pressure injuries, commonly known as bedsores. One of the biggest challenges caregivers face is the tendency for pillows and repositioning inserts to easily dislodge during care.(Suzanne is a former guest on Episode #119) When you order with Cloud 9 care system, please tell them you heard about them from Hospice Explained.(Thank You) Marie's Contact Marie@HospiceExplained.com www.HospiceExplained.com   Finding a Hospice Agency 1. You can use Medicare.gov to help find a hospice agency, 2. choose Find provider 3. Choose Hospice 4. then add your zip code This should be a list of Hospice Agencies local to you or your loved one.

Loy is a massage therapist in Toronto who learned through trial and error how to obtain clients through the internet. She started using her knowledge to help other therapists fix their websites to reflect who they actually are and to speak directly to their clients. This patient pathway that Loy has created ensures that when someone lands on your website, they will become a patient. Due to an unforeseen situation, Loy is going to be diving deeper into this side of her business and she's ready to help you become successful online! Check out Loy's website if you need a website audit at loylinking.com2rmtsandamic.com

Sat, Feb 28 4:18 PM → 4:55 PM Pediatric burn patient with flyout Radio Systems: - Fairfax County Project 25

In this episode, Dr. Geralda Xavier, Regional Chief Medical Officer at Atlantic Health System, shares how her team reduced length of stay and improved throughput through multidisciplinary collaboration, while navigating workforce fatigue, financial pressures, and a continued focus on quality, safety, and equity in 2026.

A superb note on CPR and DNR orders, patients' vs doctors' preferences for statins, more on GLP-1s, another LAAC story, and some closing cautionary notes on PFA are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Addressing Inadequate Documentation of Unilateral DNR https://jamanetwork.com/journals/jama/fullarticle/2829203 Video: Can We Talk About CPR? https://www.youtube.com/watch?v=yTCRfY3ETvI Personal Reminiscences of CPR's Origin https://www.ajconline.org/article/S0002-9149(03)00977-9/pdf II Public Preferences for Statin Therapy Measuring Public Preferences for Statin Therapy https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2844660 III GLP-1 RA News ACHIEVE Trial https://doi.org/10.1016/S0140-6736(26)00202-3 IV New Trial in GLP-1 for Patients with AF Seminal-AF Trial https://clinicaltrials.gov/study/NCT06499857 V Relationship between Spontaneous Echo Contrast and LAAC Outcomes OCEAN-LAAC Trial https://doi.org/10.1016/j.jacep.2025.09.028 News Release on Upcoming LAAOS-4 trial  https://www.phri.ca/watchman/ Reading the "Smoke" -- Editorial on OCEAN-LAAC https://www.jacc.org/doi/10.1016/j.jacep.2025.10.029 VI Concluding Remarks on My Talk at Western AF Delayed Myocardial Ischemia and Malignant Arrhythmias After PFA https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.125.077983 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington

CardioNerds (Dr. Jenna Skowronski [Heart Failure Council Chair], Dr. Shazli Khan, and Dr. Josh Longinow) are joined by renowned leaders in the field of AHFTC (Advanced Heart Failure and Transplant Cardiology) and mechanical circulatory support, Dr. Jeff Teuteberg and Dr. Mani Daneshmand to continue the discussion of advanced heart failure therapies by taking a deep dive into the world of durable LVADs (Left Ventricular Assist Devices). In this episode, we will review the history of ventricular assist devices, the basics of LVAD function, selection criteria for LVAD therapy, and surgical nuances of LVAD implantation. Audio Editing by CardioNerds intern, Joshua Khorsandi. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls There have been significant advances in the field of MCS/LVAD therapy since the first implanted LVAD in the 1960s, to the first FDA approved device in the early 2000's, to now the HM3 LVAD, with the most important change being a centrifugal flow/magnetically levitated design that led to minimized hemocompatibility-related adverse events (HRAE's) (MOMENTUM 3 trial comparing HM2 and HM3).  The REMATCH trial in 2001 was a pivotal trial for LVAD therapy, demonstrating that in a population of patients with advanced HF (70% IV inotrope dependent), LVAD therapy significantly improved survival at both 1 and 2 years as compared to medical therapy alone.    MOMENTUM 3 trial was a landmark trial for the HM3 device, showing that in a population of end stage HF patients (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.  There are both patient-specific factors and surgical considerations when it comes to candidacy for LVAD therapy.  RV function prior to LVAD is a key determinant for success post-LVAD  Many patients being considered for LVAD may not have robust RV function, however, predicting RV failure after LVAD is exceedingly difficult.   In general, it doesn’t matter how bad the RV may look on imaging; we care more about the pre-LVAD hemodynamics (look at the PAPi and RA/wedge ratio).   What happens in the OR may be the most important determinant of how the RV will do with the LVAD!  Notes Notes drafted by Dr. Josh Longinow.  1. Historical background of heart pumps and LVADs  LVAD Evolution   FDA approval year  2001  2008  2012  2017  Pump  HeartMate XVE   HeartMate II  Heartware HVAD  HeartMate III  Flow/Design Features  Pulsatile Technology   Continuous flow Axial design  Continuous flow  Centrifugal design  Continuous flow   Full MagLev + Centrifugal design  The 1960's ushered in the first ‘LVADs', when the first air-powered ‘LVAD' was implanted. It kept the patient alive for four days before the patient expired.   The first generation of LVADs were pulsatile pumps   The first nationally recognized, FDA approved LVAD was the HeartMate XVE (late 1990s to early 2000s, REMATCH trial). The XVE pump used compressed air (pneumatically driven) to power the pump.   Prior to the XVE, OHT was the standard of care for patients with advanced, end-stage heart failure.   The second and third generations of LVADs were non-pulsatile, continuous flow devices and included the HVAD, HM2, and HM3 devices.   MOMENTUM 3 was a landmark trial for the HM3 device, showing that in a population of sick patients with end stage HF (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.   The only pump that is currently FDA approved for implant is the HM3, although other pumps are in clinical trials (BrioVAD system, INNOVATE Trial).  2. What are LVADs, and how do they work?   In simplest terms, the LVAD is a heart pump comprised of several key mechanistic components:   Inflow cannula  Mechanical pump   Outflow cannula  Driveline  Controller/Power source  The HM3 differs from its predecessors (HM2 and HVAD) in several key ways;   HM3 is placed intrapericardial whereas the HM2 was placed pre-peritoneal.   Perhaps most importantly, the HM3 is a fully magnetically levitated, centrifugal flow pump, whereas the HM2 is an axial flow device.  Axial flow pumps are not magnetically levitated, leading to more friction produced between the ruby bearing's contact with the pump rotors, and higher rates of hemocompatibility related adverse events (HRAEs, i.e. pump thrombosis) and the HM2 was ultimately discontinued in favor of the HM3 (MOMENTUM 3 trial).  3. What do the terms ‘Destination Therapy' (DT) or ‘Bridge to Transplant' (BTT) mean when it comes to LVADs?   When LVADs first came on the stage, EVERYONE was a BTT; these early pumps weren't designed for long term use (I.e. REMATCH Trial, Heartmate XVE)  Destination therapy means the LVAD was placed in leu of transplant because there are contraindications to transplant   REMATCH trial brought about the concept of “Destination therapy”, comparing outcomes in patients (with contraindications for transplant) who received an LVAD vs optimal medical therapy  Bridge to transplant means we are placing the LVAD in a patient who may not be a transplant candidate at this moment in time (is too sick, or conversely, not sick enough), but may be down the line   Bridge to recovery is another term used when the LVAD is being placed for a patient we think may have a recoverable cardiomyopathy  4. What are some factors we should consider when assessing a patient’s candidacy for LVAD, in general, and from a surgical perspective?   Patient factors   Older age might push us towards thinking LVAD rather than transplant  In general, age > 70 is the cutoff for transplant, but this is not a hard cut off and varies institution to institution    In general, think about things that help predict recovery after a major surgery; Frailty and Nutritional status are important, we try to optimize these prior to LVAD implant   Right ventricular function remains the Achilles heel of LV support  We know that needing temporary RV support post LVAD puts you on a different survival curve than patients who don’t need RVAD support  Studies have not been able to successfully predict who will develop RV failure after LVAD implantation  What happens in the time between when the patient goes to the OR and when they get back to the ICU is an important determinant who might develop RV failure post LVAD   Surgical techniques such as implanting the HM3 in the intra-thoracic cavity, rather than intra-pericardial may help maintain LV/RV geometry to help optimize the RV post LVAD   Surgical considerations for LVAD candidacy  Small, hypertrophied LV: HM3 inflow cannula is small, but small hypertrophied ventricles tend towards chamber collapse during systole causing suction, needing to run slower with lower flow rates  Chest size/diameter: pumps have gotten so small now, that for adults, these have become less of a consideration  BMI: low BMI used to be more of a concern with the older pumps due to where they were placed, and the relative size of the pump itself, not so much now with the smaller HM 3 pumps  Calcified LV apex: would increase risk of stroke, bleeding   Driveline tunneling becomes a concern in the super obese population, higher risk for driveline infections (might tunnel these driveline's shorter, and to a less fatty region of the abdomen, could even tunnel out the thoracic cavity in the super obese to limit skin motion)    5. Is there a role for MCS (i.e. temporary LVAD such as Impella) in pre-habilitation of patients prior to LVAD surgery?   The theory of being able to improve systemic perfusion, decongest the organs, and make the patient feel better prior to surgery makes sense, but becomes problematic due to the lack of a hard end point/time for prehabilitation which might risk delays in surgery   More likely that it can lead to delay in the surgery, with less-than-optimal benefit; you don't want to prolong the wait for surgery and increase the risk for complications prior to surgery    An Impella 5.5 is currently FDA approved for 2 weeks of support, not 2 months so timing is important to keep in mind  It’s unlikely that you will take a patient and convert them from a malnourished, cachectic person in 2 weeks’ time   6. Is there a role for LVAD therapy in the younger patient population? Should we be thinking of LVAD up front for these patients, with the goal of transplanting down the line?   Recovery may be more likely in certain populations, particularly younger females with smaller LV's; in those populations, perhaps bridge to recovery should be the focus, optimizing them on GDMT etc.   The replacement of transplant, with MCS (LVAD) in young patients has become a topic of discussion, because these pumps have become better and better, with the thinking that an LVAD could bridge a patient for 10 years or so, and they could get a transplant later   It is still a big unknown, but several concerns exist  Patients who get LVADs might end up with complications that become contraindication to transplant down the line (stroke, sensitization etc)   Patients and providers are more hesitant because of the more recent iteration for the UNOS criteria for OHT listing which no longer gives patients with an uncomplicated LVAD higher priority, and therefore they could end up waiting a longer time for a heart after undergoing LVAD  References Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443. doi:10.1056/NEJMoa012175  Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019;380(17):1618-1627. doi:10.1056/NEJMoa1900486  Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol. 2015;65(23):2542-2555. doi:10.1016/j.jacc.2015.04.039  Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233-1242. doi:10.1001/jama.2022.16197  Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67(3):723-730. doi:10.1016/s0003-4975(99)00042-9  Kittleson MM, Shah P, Lala A, et al. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: A report from the REVIVAL Registry. J Heart Lung Transplant. 2020;39(1):16-26. doi:10.1016/j.healun.2019.08.017  Mehra MR, Netuka I, Uriel N, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023;330(22):2171-2181. doi:10.1001/jama.2023.23204  Mehra MR, Nayak A, Morris AA, et al. Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device. JACC Heart Fail. 2022;10(12):948-959. doi:10.1016/j.jchf.2022.08.002  Bhardwaj A, Salas de Armas IA, Bergeron A, et al. Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella. ASAIO J. 2024;70(8):661-666. doi:10.1097/MAT.0000000000002170 

AI is no longer theoretical for clinic owners.A PT in Ohio just received a 12-visit self-pay package from a patient who found her through AI search.That changes the conversation.In this episode, we explore:How AI platforms decide which clinics to recommendWhy your digital footprint matters more than everThe role of frequency in modern marketingWhether AI-sourced patients are more decisive and cash-friendlyWhy positioning matters (and whether PTs need a “shared enemy”)What CrossFit, cult brands, and political movements can teach clinic ownersWhy attention—not ads—is the new marketing currencyThis episode reinforces a core truth:Attention → Trust → ActionYou can't shortcut trust.You can't buy authority.You earn it through presence and frequency.???? Connect with the CrewFollow Tony Maritato on YouTube:https://www.youtube.com/c/MedicareBillingFollow Dave Kittle on YouTube:https://www.youtube.com/@thedavekittleshow/featuredFollow Jimmy McKay on YouTube:https://www.youtube.com/@ptpodcasts

Dr. Andy Southerland and Dr. Shyam Prabhakaran explain the significance of these guidelines and why they are important.  Show citation:  Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. Published online January 26, 2026. doi:10.1161/STR.0000000000000513  Show transcript:  Dr. Andy Southerland: Hello everyone. This is Andy Southerland from the University of Virginia. And for this week's Neurology Minute, I've just been speaking with my colleague, Shyam Prabhakaran, from the University of Chicago, who was the Chair of the 2026 AHA/ASA guidelines for the early management of patients with Acute Ischemic stroke published in the January 2026 online version of the journal, Stroke. So Shyam, in our brief Neurology Minute today, why don't you just give a plea about why these guidelines are so important? Dr. Shyam Prabhakaran: Thanks, Andy. These guidelines are the first guidelines since 2019, so a lot has happened. So when you look at these guidelines, you'll see a lot of new recommendations. In fact, I think the majority have been revised in some way or another. And I'd point to the actual guideline document, which is in the journal Stroke online January '26, and the print version will be for the March edition of the journal Stroke. In addition to that, I'd say because you want to have interpretability and ease of practice, there are a bunch of derivatives on the AHA website that are very useful. They include case studies, they include figures and workflows that could be really useful for you to have these conversations. And there's even a slide deck that was prepared by our AHA ambassadors. There are these young whippersnappers that did a great job putting together a slide deck for anyone to use. They can use that to have conversations locally or anywhere they want. I encourage people, read the guidelines, but then also use the derivative products that people spent a lot of time on developing. Dr. Andy Southerland: Thank you, Shyam. I think that's a great message from the Chair of the writing group, that when you look at these guidelines, they can seem daunting. But the way you all have provided all these additional resources and analogs for people to interpret it and apply it in their own stroke centers and practice, I think folks definitely will be running out to do that, just to seek out the full guideline, and let's apply all this great new evidence to better care for our patients. So Shyam, thanks again for joining us for this week's Neurology Minute. 

"We print education sheets that we have, and we say, 'Just ignore this part that says cancer. You're getting this med but for a different indication.' And then you have to really point out what our goals of care are. You're using the information that, as oncology nurses, we like and love, but we're having to cross it out and say, 'Just read this portion and just do this here.' And that can be challenging for the nurse and probably confusing for the patient," ONS member Brandy Thornberry, RN, OCN®, outpatient infusion and VAD supervisor at Logan Health in Kalispell, MT, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about education for patients receiving antineoplastic drugs for non-oncology indications. Taylor also spoke with ONS members Lizzy McMahon, BSN, RN, OCN®, and Jennifer Lynch, BSN, RN, TCTCN™, about general antineoplastic treatment education and tailoring education in the stem cell transplantation setting. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by February 27, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge of best practices for educating patients receiving antineoplastic therapies across oncology, non‑oncology, and stem cell transplant settings. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 259: Patient Education for Health Literacy and Limited English Proficiency Episode 197: Patient Learning Needs and Educational Assessments Episode 183: How Oncology Nurses Find and Use Credible Patient Education Resources Episode 179: Learn How to Educate Patients During Immunotherapy Episode 173: Oncology Nurses' Role in Stem Cell Transplants for Pediatric Sickle Cell Disease ONS Voice articles: Online Tool Helps You Apply Health Literacy Principles to Written Patient Education Personalized Patient Education: Ensure Effective, Inclusive, and Equitable Patient Education With These Five Strategies Policies and Procedures for Written Patient-Facing Cancer Education Materials Oncology Nursing Forum article: An Integrative Review of Patient Education During Inpatient Hematopoietic Stem Cell Transplantation ONS Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library Patient Education Sheets: Cancer Care, Explained To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode McMahon: "A great question would be to ask the patient what they already know and what they're most concerned about or what their biggest questions are. This way, the nurse can tailor their education to make sure to focus on what the patient doesn't know yet and what they're most concerned about, while still touching on all the required education topics. … It's also important for nurses to continually be assessing the patient's readiness to learn throughout the education session, looking for nonverbal cues or verbal signs that the patient is overwhelmed or anxious because this is going to interfere with their ability to take in new information." TS 3:49 Thornberry: "A lot of the education sheets and the products for them explain it like, 'This is cancer,' and more of an oncology perspective, so occasionally [non-oncology patients] can show up and be confused by it. I do feel like they come a little bit less prepared than our oncology patients. Our rheumatologists and neurologists, they sure try, but they just don't have the support in that realm either. They're full of every question you can imagine. They've never been to an infusion room. They don't know what to bring. Can they drink water and have their meds beforehand? It's a full gamut of really preparing them to get these for autoimmune or rheumatology-type issues." TS 14:12 Lynch: "I really want to spend time with those patients to make sure that we are not assuming that they are coming to us with any knowledge or experience. I want them to be able to come to us with questions and trust their healthcare team and really sit down with them and say, 'Okay, you don't have cancer, but we're using the word chemotherapy where we're talking about cancer drugs.'… And we're going to probably spend more time going over some of the basics about blood stem cells, types of cells that they grow into, how your body fights infection, what they're going to be at risk for. The side effects can be pretty scary when you're talking about them, especially back to back. So making sure that we are delivering the information that doesn't put them in a panic mode… A lot of reassurance, as well, and just taking into consideration that, yes, this might have this whole other layer of anxiety to it because of the unknown." TS 32:22

New AHA/ACC guidelines overhaul pulmonary embolism management with a five-tier risk classification, endorsing ED discharge for low-risk patients and DOACs as first-line therapy. A JAMA trial confirms IV acetaminophen adds modest but real pain relief when combined with morphine. A large cohort study shows SGLT2 inhibitors dramatically reduce kidney, cardiovascular, and liver complications in diabetic cirrhosis patients.

What if the reason you’re not healing isn’t that you need another diagnosis? 0:08 It’s that your cells aren’t receiving the right signals. Because the body doesn’t run on diagnosis, it runs on 0:16 communication. And peptides are one of the most powerful, most misunderstood 0:21 tools we have for cellular signaling, immune balance, tissue repair, gut 0:27 lining support, metabolic control, brain signaling, sleep cycles, and even sexual 0:35 wellness. Today, I’m going to do what most people won’t. Define peptides in 0:41 plain English for you. break them into categories by what they’re best at and 0:47 tell you which ones are FDA approved on the list and which ones are commonly 0:53 used off label or investigational with the evidence that actually says these 1:00 work. This is going to be a powerful episode and if you’ve ever felt like you’re hearing hype without clarity, 1:07 this one’s for you. So, as usual, grab your cup of coffee or tea and settle in 1:13 as we talk about peptides that can fit into your healing journey. We’re going 1:19 to have a short word from our sponsor. You know, we got to do that. That’s how we stay on the air here. So, we will be 1:26 right back after this. Did you know sweating can literally heal your cells? 1:32I nfrared saunas don’t just relax you. They detox your body, balance hormones, 1:37 and boost mitochondrial energy. I’m obsessed with my health tech sauna. And 1:42 right now, you can save $500 with my code at healthtechalth.com/drmuthqen25. 1:54 All right, here we go, guys. I am excited to dive into peptides with you. 2:00 So understanding peptides is foundational, right? And I’ve been 2:06 studying peptides now for about nine years. Um, and I find that they are 2:13 incredible. Um, so I want to break down for you what peptides actually are, what 2:19 they do, and some of the top peptides that are available today, and how they 2:25 can be utilized. Because I think it’s really important. And I think it’s it’s there’s a lot of confusion out there about what these things actually are and 2:32 are they safe? Are they not? When do we use them? What’s the science behind them? So, we’re going to dive in and 2:38 we’re going to talk about all things peptides. So, let’s get ready here. Here we go. So, peptides are short chains of 2:45 amino acids and they typically range anywhere from 2 to 50 amino acids and 2:51 they’re linked by peptide bonds. So think of them as the superglue that holds the amino acids together. They sit 2:58 between the amino acids and they are full proteins in terms of their size and 3:04 their complex structure. And what makes peptides particularly interesting in 3:10 medicine is their role as signaling molecules. They’re essentially the 3:15 body’s text messages carrying specific instructions to cells and tissues. And 3:21 unlike our proteins which often serve as structural roles or act as enzymes, 3:28 peptides typically function as hormones, neurotransmitters and growth factors and 3:33 they bind to specific receptors on the cell’s surfaces or within the cells and 3:39 they trigger this effect. It’s like a cascade effect of a biochemical reaction 3:45 that ultimately changes the cellular behavior. So basically, it’s changing 3:50 the way the body’s cell structure acts. And this is why peptides can be so 3:56 incredibly powerful and therapeutic when you introduce the right peptide signal. 4:02 Now, you could theoretically redirect cellular processes toward healing, 4:07 towards metabolism, immune balance, tissue repair. Any of those things can 4:14 be manipulated to do a certain thing once we add the peptide. The challenge 4:19 in peptide medicine though lies in distinguishing between those peptides that have been rigorously studied, 4:26 proven safe and effective and approved by regulatory bodies like the FDA versus 4:31 those that exist in what we call the gray zone of a promising clinical data. 4:36 But they really lack human validation so far. And this distinction is critical because the presence of a plausible 4:43 mechanism does not guarantee safety or efficacy in living humans. So, this is 4:50 really important and we’re going to dive in and look at some of the research on all of these different peptides that are 4:56 available and I’m excited to say there’s some amazing peptides being studied right now that unfortunately are not 5:01 available. But I can’t wait to see them hit the market for us because it is going to be a gamecher as far as health 5:09 and longevity. So there is a quality control issue and there is a hidden 5:14 variable in peptide medicine with this and it’s one of the most underappreciated aspects of peptide 5:21 therapy particularly for non-FDA approved peptides. It’s quality control. 5:26 When we discuss pharmaceutical medicines, we take for granted that the pill contains what the label says. Not 5:32 always true depending on where it comes from. You guys, if you’ve heard my episodes before talk about how many of our medications are made in China and 5:41 have been contaminated with other things, you will realize that that is not always true. So, just because it has 5:48 the FDA stamp of approval on the medication, it still does not necessarily mean it’s safe and we still 5:54 need to do our homework on it. So, sorry for digressing on you guys, but you know, when we get a medication, we we 6:00 think that what the amount says is what is there, doesn’t have contaminants, it’s manufactured with good 6:06 manufacturing practices. You’ll see that listed as GMP on the bottle, and it’s been stored properly, it’s been 6:12 maintained stable, and with research peptides and compounded formulations, 6:17 none of this can be assumed. So, I will share a story with you. There was a gentleman that was purchasing these 6:24 peptides online from a research facility and um did not know that they were 6:30 coming from China and he was ordering a particular growth hormone peptide and 6:35 after a little while he had he had done fine for the few first few bottles. After a little while he started having 6:42 some complications. He started getting really irritable and angry and ragy and 6:47 he didn’t quite know what was going on. And so he decided to go get some testing done. He had some blood testing done and 6:53 his testosterone level was over 5,000. So for those of you who know what testosterone level should be for a guy, 7:00 they really shouldn’t be any higher than about 1,00200 would be absolute max that we’d want to see. Now he was taking 7:06 testosterone but not to that degree. And prior to adding this peptide, his 7:12 testosterone was very stable. What they ended up finding out was the peptide that he was getting, whoever was 7:18 manufacturing it added testosterone to the peptide. They felt like if if it had growth hormone, that was great, but if 7:25 it had growth hormone and tes testosterone, all the better. And he didn’t know that. And this is the 7:31 problem that we can have with peptides if you don’t source them properly. if you’re not working with somebody that 7:37 knows how to source them and can prove that they are what they say they are. Um, I’m sure there’s a whole bunch of 7:42 studies out there too of people getting these peptides and paying hundreds of thousands of dollars for them over their 7:48 lifetime and finding out they were nothing more than just sterile water. So, you really do need to be careful 7:53 with your quality control. Now, this kind of leads us right into the next topic that we’re going to talk about and that’s the manufacturing question, 8:00 right? The FDA approved peptides are manufactured in facilities subject to 8:05 the FDA inspection rules following our GMP regulations and these facilities 8:11 must validate their manufacturing process, demonstrate consistency batch to batch, test for purity and potency. 8:18 They need to test for bacterial endotoxins and sterility and they need to maintain detailed records. So, when a 8:25 pharmaceutical company submits a drug application, the FDA inspects the manufacturing facility as part of the 8:32 approval process. If you’re getting peptides from a different country, none of that is happening. And there are some 8:38 ways for us to determine if that is what you’re getting. Typically, the rule of thumb is if your peptides are coming 8:44 with a different colored top, every one of them has a different colored top. Those are typically being sourced out of 8:49 China. I wouldn’t say that’s 100% but that’s kind of the rule of thumb that people follow. So compoundingies these 8:56 are thearmacies that make our bio identical hormones. They can make medications in any dose or strength or 9:02 route. There are thousands of them in every not that not in every state but 9:08 there are thousands of them around the country right now. So these compoundingies are registered as 503A 9:15 facilities. They do traditional compounding for individual prescriptions, right? Like they can make 9:20 thyroid, they can make LDN, they can make estrogen. You can also have a 503b 9:27 facility, which is an outsourcing facility. And these companies produce larger batches of products. They’re they 9:34 have some oversight, but they’re less stringent than for FDA approved 9:40 manufacturers. And state boards of pharmacy regulate a 503A pharmacy. And 9:45 the FDA can inspect the 503b facility, but doesn’t preapprove any of their 9:52 compounding products. So, they can inspect it, but they don’t approve them. So, research chemicals and these 9:58 suppliers operate essentially with no oversight. They explicitly market products for research use only, not for 10:06 human consumption to avoid FDA regulation. If they put that on their 10:12 product, they don’t have to comply to what the FDA is saying. And there is no required manufacturing strategies or 10:19 standards, no required testing, no required sterility assurance, and no enforcement mechanisms if products are 10:26 mislabeled or contaminated. So basically, they don’t have the liability, but that doesn’t mean that 10:31 all of them are badies or bad suppliers. It just means they don’t have to comply 10:37 to the FDA rules. Now, there are many of these companies that I’ve seen and I’ve talked to that do do a lot of this. They 10:44 do test their product for sterility. They do test their product to make sure it is what it says it is. They don’t 10:51 have to, but they do. So, if you’re going to decide to use a company that 10:56 has research only, not for human consumption, at least ask for their 11:02 proof of testing so that you know that the product you’re getting is what it says it is and that it’s clean. Because 11:08 this is where we run into the problem is in purity. So in purity peptide 11:13 synthesis can produce not just the targeted peptide but also related 11:19 peptides with deletions, substitutions, truncations or truncations of amino 11:25 acids. Sorry. And this high performance liquid we call it uh chromatography can 11:30 separate these related impurities and quality and quantify the actual target 11:35 of the peptide content. So a certificate of analysis is what you want to ask these companies for. This shows the HPLC 11:44 the testing mechanism with greater than 95% or ideally 98% purity which 11:51 indicates a higher quality product. So this certificate of analysis can be fabricated may not represent the 11:57 specific batch being sold. It happens. We need to know not everybody is honest. Not everybody, you know, does what they 12:03 say and it does what’s right. But at least you at least they’re giving you something and you have some security. 12:10 and then choose a company that was referred to by someone else that has done some homework as well. In in 12:16 commercial research, there’s independent testing and they research peptides and this has been really shocking 12:23 variability that they’ve seen. Some products contain 50% or less of the 12:29 claimed peptide and some contained primarily degradation of the product or manufacturing impurities and some 12:36 contained bacterial endotoxins at levels that could cause fever and systemic 12:42 inflammation if it was truly injected. And I would also worry with some of those problems, you know, depending on 12:48 what impurity or bacterial endotoxin was there. If you’re using a product to boost your immune system and your immune 12:54 system is already compromised, these bacterial endotoxins can actually make you sicker instead of what you want it 13:02 to do, which is making you better. So, sterility is always an issue with anything that is manufactured, 13:08 especially things that we’re doing as an injection. Peptides are intended for injection. They must be sterile. They 13:16 must be kept safe. And pharmaceutical manufacturers conduct this sterility testing on every batch. 13:22 Compoundingarmacies should conduct sterility testing particularly for high-risisk compounded 13:28 sterile preparations and research chemical suppliers may or may not conduct any testing. So injecting 13:35 non-sterile material can cause local infections, abscesses at the injection 13:41 site and or if the bacteria enters the bloodstream could potentially be 13:46 life-threatening and you could have sepsis. Now, excuse me. We saw this 13:52 happen in a compounding pharmacy uh gosh, it’s probably been 10 years ago 13:57 now, I think. um they unfortunately had a strep uh contamination in their 14:03 product and they weren’t testing it. It was a large compounding pharmacy out of Florida and they were making products 14:08 that were being injected into the joints and um these people got very very sick 14:14 and some of them died and um some of them got very very injured by this uh 14:21 complication that happened. So it’s not like this doesn’t happen. It does, but it doesn’t happen often. And that’s what 14:28 we have to know about. And so, when we’re talking with you guys about storage and stability, it’s really 14:34 important to make sure you maintain your peptides well. So, many peptides are unstable at room temperature. They 14:41 require refrigeration or freezing. We tell everyone to make sure you’re refrigerating your peptides. That way, 14:48 there’s no question about it. when it stays cold um it prevents or slows down 14:54 the process of uh bacteria growing in it. So some of these peptides actually 14:59 degrade very rapidly in the solution and they must be reconstituted immediately before use and reconstitution of the 15:07 peptides really has limited stability often just days to weeks not months. So 15:13 improper storage, temperature, um changes during shipping or prolonged 15:19 storage of a reconstituted product can lead to degradation into inactivity or 15:25 potentially even a harmful breakdown of the product itself. So if you have a product that’s been sitting in your 15:30 refrigerator for a month or two months or 3 months or 6 months, just throw it away. It’s not going to be any good. 15:37 you’re not going to actually get the peptide and the uh potency that you’re looking for anyway out of it and the 15:44 potential of you introducing an endotoxin, a bacterial endotoxin is quite high at that point. So you just 15:50 really don’t want to take the risk, excuse me. So what practitioners, what 15:56 should we do and what should patients do? Well, for any peptide therapy, we 16:03 want to source our verification. know where the peptide product comes from. Is 16:08 it an FDA approved product? Is it a 503b compounding? A research chemical 16:14 supplier? Is there a certificate of analysis? Request and review this COA. 16:20 And you want it to show purity greater than 95% but ideally greater than 98%. 16:27 You want that identity be identity to be confirmed by mass spectromedy. Uh 16:33 sterility testing should be done. Bacterial endotoxin testing should be done. Batch number matching of the 16:39 product that you received should be done. Proper storage. You want to know that this has been refrigerated or 16:46 frozen as directed once it’s been mixed. Look at the expiration dates for reconstituting your peptides. Track that 16:53 reconstitution date and discarded accordingly like we just talked about. Monitor for your adverse effects. Even 17:01 with the perfect quality control, monitoring for adverse effects is essential with questionable quality and 17:08 vigilance is really critical here. I know it’s frustrating for a lot of patients when they have to get several 17:15 bottles and they only last a week or two. right here, you guys. This is why 17:21 they only last a short period of time because once they’re mixed, they start 17:26 to degrade and they won’t be good and you won’t get the benefit from it. So, 17:31 it’s really important with these research peptides specifically, practitioners should recognize that all 17:38 recommending products without quality assurance violates the fundamental medical principle of first do no harm. 17:45 If a patient is determined to use research peptides despite counseling, providing guidance on quality 17:52 verification, requesting those COAs, using pharmaceutical grade sources when available, proper testing, this all 17:59 reduces harm, but doesn’t constitute necessarily that recommendation. Now, 18:06 that being said, today it’s very difficult to find peptides by the compoundingies because of what the FDA 18:13 has done. So most of the peptides that are available to us have been labeled 18:18 not for human consumption, not because they’re not good products, but because 18:25 of what the FDA did. And this is how these companies have been able to 18:31 continue to provide peptides to the medical community. And if you know you 18:36 have a good company, then you’re, you know, you’re still taking the risk, right? But at the end of the day, the 18:42 reason they’re doing that is to protect themselves from the FDA, from liability. Um, so just kind of know that there is 18:50 some talk in the community with um Bobby Kennedy that this is going to change and 18:55 they are going to bring peptides back to the compounding pharmacies. Now, we don’t know which ones they’re going to 19:01 bring back. Uh, will it be all of them? Will it just be some of them? What’s going to happen here? Um, is it going to 19:07 go to the pharmaceutical companies like our GLP1s did? We don’t know what that’s going to look like quite yet. Um, but it 19:14 is coming and that is positive news. So, let’s talk now about FDA approved 19:21 peptide medications. So, this is the metabolic revolution, right? GLP1 19:28 and our dual increeting agonists. This is an exciting time. GLP-1s are amazing. 19:35 Um, a lot of people are skeptical, a lot of people love them, a lot of people hate them. Whichever side of the fence 19:42 that you’re on, I understand. But I want to talk about the science of it today 19:48 and what it actually means for people. So, the story of GLP1 glucagon like 19:54 peptide one represents one of the most significant advances in metabolic 19:59 medicine in the past several decades. GLP-1 is an accretin hormone. It’s 20:05 gutder derived peptide that potentiates insulin secretion in response to food 20:11 intake. And the body naturally produces GLP-1 in the intestinal L cells, but it 20:17 rapidly degraded by the enzyme DPP4 giving it a halflife of only about 2 20:24 minutes. So this rapid breakdown made in therapeutically impractical until 20:31 research was developed and modified the analoges that resist the enzyme degradation. So for those people who 20:39 never feel full when they’re eating, never feel satisfied when they’re done, this is because their body is either not 20:46 producing enough GLP1 or it’s not getting the signal right. And this is a 20:51 leptin issue. This is an insulin issue. It’s a GLP-1 issue. It’s a complicated 20:56 issue. This is not anything that the person is doing wrong. It’s what is happening to their body. And so GLP1s 21:03 have really revolutionized this. So one particular GLP-1 that we have is 21:09 semiglutide. And this GLP-1 agonist is what changed everything in the world of 21:16 metabolic medicine. Semiglutide is marketed as ompic for type 2 diabetes 21:23 and it’s marketed as WGOI for chronic weight management. It is a modified 21:29 GLP-1 analog with 95 or sorry 94% amino acid sequence uh homology to human 21:37 GLP-1. So it means that it’s it’s just like our own GLP-1 that we make. This 21:42 modification includes specific amino acid substitutions and the addition of C18 21:50 a fatty acid chain which allows the peptide to bind to albumin. Now this 21:56 albumin binding dramatically extends the half-life to approximately one week 22:01 enabling one weekly dosing which is a major advantage over the earlier GLP-1 22:07 agonists that require daily or twice daily injections. The mechanism by which 22:13 semiglutide works is multiaceted. At the pancreatin level, it binds to GLP-1 22:20 receptors on the pancreatic beta cells enhancing glucose depending sorry 22:27 enhancing glucose dependent insulin secretion. This glucose dependency is 22:33 crucial. It means the peptide only stimulates insulin release when blood glucose is elevated. This dramatically 22:41 reduces the hypoglycemic risk compared to insulin or even uh sulfuras. 22:47 Simultaneously semiglutide suppresses glucagon secretion from pancreatic alpha 22:53 cells further improving glycemic control. This is really amazing because 23:00 over the years when we’ve used insulin, which is also a peptide by the way, you 23:05 had to dose it just right because if you didn’t, you would produce so much insulin that it would crash the blood 23:12 sugar and then somebody would have too low of a blood sugar. They’d be hypoglycemic and they’d have to eat more 23:18 sugar and then they’d have to modify the insulin again and the person would be going up and down, up and down, up and 23:24 down all day long. And that created a lot of problems for people and so this 23:30 helps to stabilize that so it is not such an intense change. Now in the GI 23:36 tract semiglutide delays the gastric emptying particularly pronounced during 23:41 the initial weeks of therapy. This slowing of the gastric emptying contributes to the sensation of being 23:48 full and early satiety that patients often describe. However, this effect 23:54 tends to attend to weight over time as the body adapts through the appetite 24:00 suppressing effects generally persist through central mechanisms. So, when we 24:05 talk about what is actually happening, we’re slowing that digestive process down. That’s why people aren’t so 24:11 hungry. It’s why they’re not eating so much. This is why people can develop constipation with these products because 24:17 it’s slowing the body’s digestive tract down. Now some people will call this 24:22 gastroparesis. Um gastroparesis is actually different. 24:28 It is when we lose control over what’s happening in the in the colon like the 24:34 nerves and things like that just stop working. I have never seen that with the GLP1s that we prescribe in micro doing. 24:42 um it’s been documented. It can happen, but again it a lot of it is dosing and a 24:48 lot of it is staying on top of your client and what’s happening and what’s going on and what you’re doing and making sure that they do have good 24:54 motility still. So a lot of these things can be mitigated if you have problems 24:59 with them. Now one of the most profound effects of semiglutide occur in the 25:05 central nervous system. GLP-1 receptors are widely distributed in the brain 25:10 particularly in the hypothalamus and the brain stem area where we are involved in 25:15 appetite regulation. So when when wilding and colleagues published their 25:20 landmark step one trial in the New England Journal of Medicine in 2021, 25:25 they demonstrated that participants receiving 2.4 4 milligrams of semiglutide weekly achieved an average 25:32 weight loss of 14.9% of their body weight over 68 weeks. Now, I want you 25:39 guys to really understand this. We’re talking roughly 15% body weight loss 25:45 over a year, longer than a year. 52 weeks is a year, right? This is 68 25:50 weeks. So, it took longer for them to lose. We’re not talking about giving 25:55 somebody a dose to lose 15% of their body mass in a month or two. That that 26:01 is not healthy for any of us. That is not what we’re talking about doing here. Now, they compared this to placebo and 26:08 the placebo was only 2.4%. So, that is a significant difference. 26:14 And even beyond the numbers, patients reported something very qualitatively different, a reduction in what’s now 26:21 called food noise. Everybody knows what food noise is. We’ve talked about this long before GLP1. It’s that craving. 26:28 It’s that part of your brain that just keeps thinking about I want to eat something. You know, that was actually 26:34 reduced and they didn’t expect to see that happen. Now, this refers to the constant mental preoccupation with food, 26:42 the intrusive thoughts about eating, the difficulty in feeling satisfied. Semi-glutide appears to appears to 26:49 modulate reward pathways in the misolyic system reducing hedonic eating and food 26:57 cravings. Now there are also great cardiovascular effects of semiglutide 27:02 that extend beyond weight loss. Uh the sustained six and select trials 27:07 demonstrated significant reductions in major adverse cardiovascular events uh 27:14 mace in high-risisk populations. The select trial published in 2023 showed 27:20 that semiglutide reduced cardiovascular death, non-fatal myioardial inffection 27:25 and non-fatal stroke by 20% in adults with overweight or obesity and 27:31 established cardiovascular disease but without diabetes. So this suggests that 27:37 mechanisms beyond glucose control and weight loss possibly including 27:42 anti-inflammatory effects, improvements in endothelial function and favorable 27:47 changes to lipid profiles. Now I will tell you the clients that I work with that are on GLP1, 27:53 they will tell you that their inflammation has been significantly reduced. We are also seeing really 28:00 amazing results in lipid profiles. um part of its weight loss, but there is a 28:06 component to this that is lowering the triglyceride levels because it’s related to sugar and how the body’s processing 28:11 it. And we’re seeing better profiles, less need for statins as a result of 28:17 that. If if you want to listen to my episode on statins, I have one on that. Uh they are not my favorite medication. 28:24 I think it’s overprescribed and overused um and not really affecting or 28:29 addressing the problem. So these things can really be helpful. There’s also some 28:34 uh ramblings going on with GLP-1s saying that they may be able to help with 28:40 addiction in the future because of where they’re finding it affecting the brain and how it affects the food noise and 28:47 the cravings that we have for food and the addiction for food. Could it potentially help with other addictions 28:53 down the road? We’ll have to wait and see on that one. So semiglutide’s FDA prescribing information also includes a 29:00 box uh boxed warning about thyroid sea cell tumors. So in rodent studies 29:06 semiglutide caused dose dependent and treatment duration dependent sea cell 29:12 tumors at clinically relevant exposures. So while it’s unknown whether or not 29:17 semiglutide causes uh thyroid cancer tumors in humans and the rodent thyroid biology 29:26 differs significantly from humans, the drug is contraindicated in patients with a personal or family history of 29:33 medillary thyroid carcinoma or in patients with multiple endocrine neopl neoplasia syndrome type two. it is 29:42 uh contraindicated for safety effects with that. Um I have seen endocrinologists okay GLP1s to be used 29:50 in patients who’ve had other forms of thyroid cancer just not the meillary 29:55 thyroid cancer. So there is possibility there. Now the most common side effects 30:00 are gastrointestinal. It’s nausea affects about 20 to 44% of patients 30:06 depending on the formulation with diarrhea, vomiting, constipation, abdominal pain, and also frequently 30:13 reported in clinical trials. I see this in my clinic, too, especially dose dependent. Um, and it happens early on 30:20 when you’re first starting the medication, but seems to settle out over time. The one that I would add to this 30:26 that I don’t think they have on here is an increase in acid reflux. We also see that quite often uh especially in people 30:33 who suffer with acid reflux to begin with. Now these effects are typically most 30:40 pronounced during the escalation and they like I said often improve over time 30:45 but more serious but less common adverse effects include acute pancreatitis. 30:51 The medication needs to be discontinued immediately if this is confirmed. You can see some diabetic retinopathy 30:57 complications in patients with pre-existing retinopathy and acute kidney injury. Um, this usually happens 31:05 secondarily to dehydration from the GI effects. There are some gallbladder disease um that can occur and people who 31:13 have a sensitive gallbladder will describe uh discomfort with that. I’ve 31:18 even seen some people who’ve had their gallbladder out on GLP1s at the higher doses complain of similar pain that they 31:25 used to have when their gallbladder was in. So, really important to just kind of monitor these symptoms and work closely 31:32 with somebody that understands them and can be on top of them quite quickly if this happens. Excuse me. From an 31:39 integrative medicine perspective, semiglutide really represents a powerful tool, but it’s not a standalone 31:46 solution. Remember, the medication addresses one aspect of the metabolic dysfunction, the signaling systems 31:53 controlling appetite and glucose homeostasis, but it doesn’t address the root cause that led to the metabolic 32:00 disease in the first place. Patients who rely solely on the medication without addressing the ultrarocessed food 32:07 consumption, the ccadian disruptions, the chronic stress, the sleep apnea, or 32:12 underlying hormonal imbalances often experience weight regain when the medication is discontinued. 32:20 The drug is also not a substitute for addressing the emotional and psychological drivers of eating 32:26 behavior, including the unresolved trauma that may manifest as emotional eating. I think this is really important 32:33 because we don’t address the trauma issue enough with clients and we need to 32:38 be looking at that. There is a huge trauma effect out there these days that is I don’t want to say leading to or 32:45 causing but it is definitely contributing to chronic illness and it’s not being talked about enough. So we 32:52 really need to be talking about this and addressing this trauma aspect. Now the next GLP that one that I want to talk 32:59 about is trespathide. This is a dual agonist. It takes center stage. It is my 33:05 favorite GLP one. Trisepatide is marketed as Mangjaro for type 2 diabetes 33:11 and Zepbound for chronic weight management and it represents the next 33:16 evolution in increantbased therapy. This is a dual agonist a 39 amino acid 33:23 synthetic peptide structurally based on the human glucose dependent insulin tropic peptide so GIP sequence but 33:31 modified to activate both the GIP receptors and the GLP1 receptors. So the 33:37 addition of the GI GIP agonism to the GLP1 agonism appears to create this 33:46 synergistic effect that goes beyond simply adding the two mechanisms together. So the GIP like GLP-1 is an 33:55 increant hormone secreted by what is called the K cells in response to nutrient intake. It enhances glucose 34:02 dependent insulin secretion but it also effects on atapost tissue metabolism 34:09 potentially improving the insulin sensitivity in fat cells and influencing 34:14 how the body stores and metabolizes fat. So some research suggests that GIP may 34:20 also have effects on energy expenditure though this remains an area of 34:26 investigation. So basically what we’re saying is this drug may actually help 34:32 people who are insulin resistant or insulin sensitive, not just somebody who 34:38 has problems with glucose control. So, this is super exciting because it opens 34:43 up the door for all of these people for decades that we’ve been trying to manage with insulin resistance and trying to 34:50 prevent diabetes and honestly most of the time have been unsuccessful 34:56 unless you can keep your diet at 50 grams of carbs or less a day, which is extremely difficult. Um, and take some 35:04 supplements that may or may not work and or take some metformin that may or may not help. this drug actually really 35:11opens that up and helps in that capacity. So there was a clinical trial 35:17 called the surmount clinical trial which demonstrated that trespathide produces 35:22 even more substantial weight loss than semiglutide. In the surerount one trial published by uh J tree I might have said 35:31 that wrong. I apologize if I slaughtered your name and colleagues in the New York England Journal of Medicine in 2022. 35:38 Participants receiving the highest dose of trespide, which is 15 milligrams, achieved an average weight loss of 20.9% 35:47 of their body weight over 72 weeks, compared to 3.1% with placebo. This 35:54 level of weight loss approaches what’s typically only seen in beriatric surgery. So, this is amazing because if 36:02 this medication works and we don’t have to do beriatric surgery, stomach stapling basically, um, oh my gosh, it’s 36:11 amazing. There are so many complications and risks that go with stomach stapling and the different procedures that they 36:17 do these days. People don’t absorb their nutrients properly. They have to do liquid nutrients. It’s very complicated. 36:24 It’s very challenging. Many of these people gain their weight back. Um, and 36:30 this procedure is not fun to go through. So, if we could change that and change 36:35 the lives of people who’ve really been struggling, it is amazing. And I will tell you that I have seen this work. I 36:42 have seen people lose 100 150 pounds on these medications over a year or two 36:50 period of time. It is definitely slower than beriatric surgery on some standpoints, but that is okay. You don’t 36:56 want that rapid weight loss. It’s not good for you. It’s not healthy for you. It doesn’t look well. You know, we want 37:03 to do this safely and effectively in the best way that we can possibly do that for you. Now, the adverse effect profile 37:10 is similar to semiglutide. It’s dominated by gastrointestinal effects. 37:15 Nausea, diarrhea, decreased appetite, vomiting, constipation. These were all commonly reported in the surmount 37:22 trials. And like semiglutide, tricepide carries a blackbox warning regarding the 37:27 thyroid sea cell tumors based on the rodent data and it shares the same contra indications in patients with a 37:34 family history of thyroid cancer and men too. So the mechanism behind why 37:40 tepatide often produces more substantial weight loss than GLP-1. The agonism 37:45 alone remains under investigation, but it may relate to the complimentary effects on the different aspects of 37:51 energy homeostasis or to GIP’s effects on atapost tissue and potentially on 37:58 central central nervous system pathways that GLP1 alone doesn’t fully address. 38:03 Now patients often report even more profound reductions in food noise with tricepide compared to GLP1 and uh sorry 38:12 GLP1 the agonists through this is anecdotal and hasn’t been regularly 38:17 quantified in quality studies. So I’ve done both uh personally and in my 38:22 practice. I really like trespide better than semiglutide. For me I had too many side effects with semiglutide. uh I had 38:30 less side effects with trespathide. I also plateaued on semiglutide which I 38:35 didn’t really care for. And with Tresepide, I haven’t plateaued and I’ve been able 38:42 to lose about 25 pounds in um a year and a half and I’ve been able to maintain 38:49 that. Um and I continued to use it because I do have a strong family history of cardiovascular disease. And 38:56 if this could help me so that I don’t follow my family lineage with cardiovascular disease, I am all for 39:03 trying to do that. I’ve watched too many of my family members suffer from this. I’ve lost my dad at a very young age. I 39:09 lost my grandfather at a young age to it. All of their brothers to this. And I don’t want to be that same person. So 39:16 that is why I chose to do that. And I think it’s really important for us to take a look at that and understand that. 39:24 Now, I know this has been a really long podcast and I don’t typically do podcasts this long. I have a whole host 39:31 of information on additional peptides. So, I’m going to break this up for you 39:36 guys and I’m going to do another episode and we’re going to pick up where we left off here with these peptides so that we 39:43 can actually start to dive into different peptides as well. So, check 39:48 out my next podcast show when we’re going to dive into the peptides that 39:54 talk about sexual wellness, immune function, and all the other cool things 39:59 that we can do with peptides. So until then, remember to like, share, and 40:04 subscribe. It really helps us get out to other people and share our information, 40:10 and join us for our next episode as we continue the talk about peptides. 40:15 Welcome to Let’s Talk Wellness Now, where we bring expert insights directly to you. Please note that the views and 40:21 information shared by our guests are their own and do not necessarily reflect those of Let’s Talk Wellness Now, its 40:28 management, or our partners. Each affiliate, sponsor, and partner is an 40:34 independent entity with its own perspectives. Today’s content is provided forformational and educational 40:40 purposes only and should not be considered specific advice, whether financial, medical, or legal. While we 40:48 strive to present accurate and useful information, we cannot guarantee its completeness or relevance to your unique 40:56 circumstances. We encourage you to consult with a qualified professional to address your 41:01 individual needs. Your use of information from this broadcast is entirely at your own risk. By continuing 41:08 to listen, you agree to indemnify and hold Let’s Talk Wellness Now and its 41:14 associates harmless from any claims or damages arising from the use of this 41:20 content. We may update this disclaimer at any time and changes will take effect 41:26 immediately upon posting or broadcast. Thank you for tuning in. We hope you 41:31 find this episode both insightful and thought-provoking. Listener discretion 41:36 is advised.The post Episode 256 – How Peptides Work, Benefits, and FDA-Approved vs Off-Label Use Explained first appeared on Let's Talk Wellness Now.

Part II: How Telehealth is Redefining Clinical Practice and Patient Access Join us for part two of a two-part interview with Dr. Brandon Welch, founder and CEO of doxy.me; a platform that has facilitated over 8 billion minutes of care across 1 million providers in 176 countries. With the administration signing the Consolidated Appropriations Act on February 3, 2026, extending Medicare telehealth flexibilities through December 2027, and patient demand driving unprecedented adoption, virtual care has moved from emergency response to fundamental transformation of clinical practice. Brandon examines how the proliferation of telehealth is reshaping medicine itself: clinical workflows, patient-provider relationships, access equity, and sustainable practice models. Drawing from his book Telehealth Success, he delivers actionable strategies for healthcare leaders navigating the five pillars determining telehealth ROI: patient engagement, clinician efficiency, technology scalability, financial viability, and regulatory compliance in an era where patients expect care everywhere. • Five-pillar framework for achieving sustainable telehealth success across organizations • Financial sustainability models leveraging the two-year Medicare telehealth extension through 2027 • Clinical practice transformation reshaping how medicine is delivered and experienced • Provider success strategies addressing burnout, workflow integration, and practice transformation • Access and equity insights from 176-country, 1 million+ provider implementation Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

This issue will review: 1.     Real-World Prospective Validation and Economic Evaluation of Deep Learning-based Diabetic Retinopathy Detection from Fundus Photographs: A Systematic Review and Meta- Analysis 2.     Orforglipron, an oral small-molecule GLP-1 receptor agonist, for the treatment of obesity in people with type 2 diabetes (ATTAIN-2): a phase 3, double-blind, randomised, multicentre, placebo-controlled trial 3.     FDA removal of SI for GLP-1s – FDA Announcement Neil Read/John Comment 4.     Effectiveness and Safety of Statins in Type 2 Diabetes According to Baseline Cardiovascular Risk: A Target Trial Emulation Study 5.     GLP-1 Receptor Agonists and Risk of Optic Nerve or Vision-Threatening Events in Patients with Type 2 Diabetes or Cardiometabolic Diseases: A Meta-Analysis of Randomized Controlled Trials  Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 25 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update   discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. For more information about each of ADA's science and medical journals, please visit Diabetesjournals.org. Hosts: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Chair-Department of Family Medicine, Abington Jefferson Health

In today's episode, we sat down with Megan Kruse, MD; and Sophia O'Brien, MD. Dr Kruse is a breast medical oncologist at Cleveland Clinic in Ohio. Dr O'Brien is an assistant professor of clinical radiology in the Divisions of Nuclear Medicine and Breast Imaging, as well as the associate program director of the Diagnostic Radiology Residency, at Penn Medicine in Philadelphia, Pennsylvania.In our exclusive interview, Drs Kruse and O'Brien highlighted the various roles of imaging modalities in breast cancer diagnosis and treatment decision-making, noting the unique role of 18F-fluoroestradiol (FES)–PET/CT in lobular breast cancer, how future evolutions of breast imaging may influence FES-PET/CT use, and the importance of strong collaborations between medical oncologists and nuclear medicine physicians.

Plusieurs débats au cœur de l'actualité, les Grandes gueules ont le choix, en débattre ou non : Les dossiers médicaux de millions de patients piratés Remaniement gouvernemental : le placement des fidèles

Episode GB034-02 Using the Facebook Live Producer? Be patient! Betty asks: “Why does Facebook stop my live recordings before I’m ready?” Listen https://www.askawebgeek.com/wp-content/uploads/geek-bytes-034-02-fb-producer-patient.mp3 Download Episode You can roll back.You can try it out and even give feedback.You can rage quit. Seriously though, Facebook is always testing out new features and you could be in a test group!Be patient. …or rage quit. – What are YOUR questions? How can we HELP YOU? – BONUS: CJ’s FREE Video Workshop Ask a Web Geek: Join our FB group: See Ask a Web Geek (@FB) Jump into our ongoing conversations! What are YOUR questions? How can we HELP YOU? More Resources: More Resources & links at Jungle-Studios.com/resources BONUS Trainings and Resources! Refer to / Browse https://jungle-studios.com/meet-cj Related Episodes GB034-02 – Using the Facebook Live Producer? Be patient! by CJ Gilbert | Feb 27, 2026 | Geek BytesEpisode GB034-02 Using the Facebook Live Producer? Be patient!Betty asks: "Why does Facebook stop my live recordings before I'm ready?"You can roll back.You can try it out and even give feedback.You can rage quit. Seriously though, Facebook is always testing out new... GB034-01 – Use your website better! Make it work for YOU! by CJ Gilbert | Feb 25, 2026 | Geek BytesEpisode GB034-01 Use your website better! Make it work for YOU!You say: What? My website? What do you mean I can USE it better? Isn't it just a pretty business card?- Use my FREE 7-pt Video Workshop to Make Your Website Work for Your Business!-- Video 1 - Welcome--... New Topics Discussed Weekly Join our Facebook Group Today! Want to Join Us? Join our FB Group to Ask a Question and Participate LIVE Play / Watch / Listen 1.) Join Us on Facebook 2.) Watch on YouTube 3.) Follow Us on Twitter 4.) Listen by Podcast Apple Podcasts | Google Podcasts | RSS

Interview with Tamara Roberts, RN

Today we're talking about MAID (medical assistance in dying) in America and Canada, how Gavin Newsom helped his mother die, we're taking a look at some pro-choice propaganda from a new TV show, and discussing the State of the Union-Hallow: https://www.hallow.com/lila Enter into prayer more deeply this Lent with the Hallow App, get 3 months free by using this link to sign up! -Presidio Healthcare: Healthcare and doctors who share your values. If you're in TEXAS visit: https://www.presidiocare.com/ If you're NOT in Texas, visit: https://www.prolifeproviders.com/

Patients are afraid to show up to medical appointments, while workers are being detained, deported or losing their visa statuses.Guests:Sahida Martinez, promotora, EnlaceJadhira Sanchez, director of community health, EnlaceSteph Willding, CEO, CommunityHealthJordan Herring, Postdoctoral scholar, Emergency medicine, StanfordHannah Janeway, Emergency medicine physician, Los AngelesLaura Messineo, CNO, WorldWide HealthStaff Solutions Learn more and read a full transcript on our website.Want more Tradeoffs? Sign up for our free weekly newsletter featuring the latest health policy research and news.Support this type of journalism today, with a gift. Hosted on Acast. See acast.com/privacy for more information.

In this episode of Healthy Wealthy & Smart, Dr. Rachel Zoffness, MS, PhD, a leading pain scientist, discusses the complexities of pain, emphasizing that it is not merely a physical issue but a biopsychosocial phenomenon. She shares insights from her upcoming book, 'Tell Me Where It Hurts,' which aims to debunk myths surrounding pain and provide a comprehensive roadmap for healing. Dr. Zoffness highlights the importance of understanding the various factors that contribute to pain, including emotional and social aspects, and advocates for a multidisciplinary approach to pain management. The discussion also emphasizes the power of hope and the need for improved medical school education on pain science.   Takeaways   ·      Pain is not just a physical phenomenon; it is biopsychosocial. ·      Understanding pain requires knowledge of biological, emotional, and social factors. ·      96% of medical schools lack dedicated pain education. ·      Patients with chronic pain need a roadmap for healing. ·      There is always a recipe for pain, and it can be changed. ·      Movement is a crucial ingredient in managing pain. ·      Engaging in joyful activities can reduce pain perception. ·      A multidisciplinary approach is essential for effective pain management. ·      Hope is a central theme in treating chronic pain. ·      Pain management should focus on empowering patients.   Chapters   ·      00:00 Introduction to Pain Science and Its Misconceptions ·      06:03 The Biopsychosocial Model of Pain ·      11:43 Understanding the Pain Recipe ·      17:50 Transforming Medical Education and Clinical Practice ·      23:51 Hope and Empowerment in Pain Management   More About Dr. Zoffness:   Dr. Rachel Zoffness is a pain scientist, pain psychologist and thought-leader revolutionizing the way we understand and treat pain. She's an assistant clinical professor at UCSF, lectures at Stanford, and consults on the development of pain management programs around the world. She was trained at Brown, Columbia, UCSD, and Mt. Sinai Hospital, and is a Mayday Fellow. Her new book, Tell Me Where It Hurts, drops March 2026 and will be translated into more than 25 languages.   Resources from this Episode:   Dr. Zoffness Website Dr. Zoffness in Instagram Buy "Tell Me Where it Hurts" on Amazon   Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month   Follow Dr. Karen Litzy on Social Media: Karen's Instagram Karen's LinkedIn   Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Dr. Andy Southerland talks with Dr. Shyam Prabhakaran about the 2026 AHA/ASA guidelines for the early management of acute ischemic stroke, highlighting key recommendations, the role of advanced imaging, and the importance of thrombolysis and thrombectomy.  Read the related article in the journal Stroke.  Disclosures can be found at Neurology.org. 

Are you trapped in hustle mode and afraid of what happens if you slow down?In this episode, Dr. Sana Yusuf jumps right into stepping away from the relentless “hustler” mentality that shaped her academic and professional journey, and into a space where fulfillment is measured by flexibility and presence, not just financial milestones. With refreshing honesty, Dr. Yusuf explains why extreme wealth no longer defines her sense of security. Her practice now covers what matters most: family, stability, and the freedom to breathe. She delves into the exhausting impact of constant gratitude and positivity, revealing how coping habits formed by early traumas can lead to minimizing struggle rather than truly processing it. From navigating the mental weight of multiple business obligations to the life-changing decision to sell her second practice, Dr. Yusuf shares what it really takes to let go and prioritize quality of life over unending hustle.The conversation shifts gears to reveal what works (and what doesn't) in dental practice marketing today. Dr. Yusuf gives a behind-the-scenes look at everything from unsuccessful yearbook ads to surprisingly effective targeted mailers and the evolution of her social media strategy. She also reflects on the pitfalls of chasing volume over vision, emphasizing her desire for a practice known for its distinct strengths, not price wars. Dr. Yusuf discusses the hard-earned lessons of setting boundaries with staff and patients and what she'd do differently after partnership challenges. Plus, you'll hear how her journey is guiding her toward a more focused, identity-driven future and the boundary-setting advice she wishes she'd received sooner.What You'll Learn in This Episode:How to recognize when gratitude becomes a survival mechanism, not a solutionThe realities of selling a practice and when it's worth walking awayWhich marketing strategies really deliver for dental practices (and which flop)The importance of niche identity versus chasing growth at any costLessons in staff management, pay negotiations, and setting boundaries with your teamHow to avoid common pitfalls in partnerships and contractsWays to prevent burnout by structuring work hours and communication more intentionallyTechniques for adapting marketing tactics as industry platforms and demographics evolveDr. Yusuf's practical tips for balancing ambition with wellbeingDon't miss this honest, behind-the-scenes episode highlighting the power of boundaries, the truth behind “staying positive,” and the beauty of building a practice that prioritizes depth over constant hustle!‍Sponsors:‍Oryx: All-In-One Cloud-Based Dental Software Created by Dentists for Dentists. Patient engagement, clinical, and practice management software that helps your dental practice grow without compromise. Click or copy and paste the link here for a special offer! https://thedentalmarketer.lpages.co/oryx/Guest: Dr. Sana YusufPractice Name: Sana Dental StudioCheck out Sana's Media:‍Website: https://sanadentalstudio.comEmail: admin@sanadentalstudio.comInstagram: https://www.instagram.com/sanayusufdmd (personal)https://www.instagram.com/sanadentalstudio (practice)‍Host: Michael AriasJoin my newsletter: https://thedentalmarketer.lpages.co/newsletter/‍Join this podcast's Facebook Group: The Dental Marketer Society‍Love the Podcast? Subscribe on Your Favorite App! https://lnkfi.re/TDMPod‍

Some people win by volume. Others win by precision. The key is knowing which one you are. Show Notes In this episode of Shark Theory, Baylor breaks down a powerful analogy that explains why different approaches to success can both be effective. There are two types of soldiers in war: the militia and the snipers. The militia are the frontline forces. High volume. High activity. Constant motion. They kick in doors, move quickly, and engage often. In life, this looks like the salesperson making hundreds of calls, the entrepreneur trying multiple ventures, the person who believes momentum comes from sheer action. Then there are the snipers. Snipers are strategic. Patient. Highly selective. They don't fire often, but when they do, it's intentional. They position themselves carefully. They anticipate movement. They wait for alignment. In life, this looks like someone who studies trends, aligns with specific audiences, and moves only when the shot is right. Neither approach is wrong. The problem happens when militia try to be snipers, or snipers feel pressured to operate like militia. When you chase someone else's style instead of owning your own, frustration follows. Baylor shares how understanding his own "sniper" approach in speaking allowed him to position strategically, align with the right audiences, and command higher fees rather than chasing every opportunity. The deeper lesson is this: wars are not won by one style alone. They're won by understanding roles, strengths, and timing. In some areas of your life, you may be high volume. In others, highly precise. The key is awareness. Know your lane. Own it. And be the best at it. What You'll Learn in This Episode The difference between volume-based and precision-based strategies Why neither approach is superior The danger of copying someone else's style How positioning creates leverage Why patience is a competitive advantage How to identify which bucket you operate in Featured Quote "Some people win by firing a thousand shots. Others win by making one count. Know which one you are."

We're marking Rare Disease Month 2026 by highlighting the powerful story of Shanthi Hegde, a young patient advocate working to transform how bleeding disorders are understood, treated, and supported. This work is fueled by her own arduous journey with two rare bleeding disorders and immune dysregulatory syndrome, and an extended diagnostic odyssey marked by dismissal, underdiagnosis, and structural bias. “I was told many times by many providers that these disorders are not common in Indians and that my bruises were there just because I'm brown.” Admirably, Shanthi pushed past this mistreatment, advocated for her medical needs, and devoted herself to tackling a range of issues confronting rare disease patients from mental health access to affordable drug pricing to research equity. In this remarkable Year of the Zebra conversation with host Lindsey Smith, you'll also learn about: Shanti's work with the Hemophilia Federation of America; How gaps extend beyond treatment to include insurance coverage, provider training, and substance use care; What clinicians can do to improve the work they do with rare disease patients. Join us for a conversation that connects patient voice to system change, and explores what real equity for rare disease communities will require. Mentioned in this episode:Hemophilia Federation of AmericaShanthi's LinkedIn Profile If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Have you ever left a doctor's appointment with a prescription but still felt like something was missed? If you have Hashimoto's, you are not alone. In this episode, Dr. Aaron Hartman, a triple board-certified physician, breaks down why bad medical advice and Hashimoto's are more connected than most patients realize, and exactly what you can do about it. You will learn: Why medical error affects autoimmune patients more than you think The four root causes behind every autoimmune disease What kind of provider to look for when you feel stuck Hit play to get started.   Episode 129 about LDN with Pharmacist Steve Anderson   Dr. Hartman's book "UnCURABLE - From Hopeless Diagnosis to Defying All Odds"   JOIN THE HEALTH WITH HASHIMOTO'S COMMUNITY Unlock your wellness journey with the free Health with Hashimoto's community! Join a supportive community that's here for you every step of the way. The Health with Hashimoto's community is on Skool: https://www.skool.com/health-with-hashimotos/about   Find all links on my resource page: https://healthwithhashimotos.com/resources/   ABOUT THE PODCAST & ESTHER: The Health with Hashimoto's podcast will help you explore the root causes of your autoimmune condition and discover holistic solutions to address your Hashimoto's thyroiditis. It is hosted by Esther Yunkin, a registered nurse, holistic health educator, and Hashimoto's warrior.   This podcast is for informational and educational purposes. Please discuss any questions or concerns with your healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Products mentioned are not intended to diagnose, treat, cure or prevent any disease.

Free DNA Activation Masterclass + 21-Day Abundance Meditation: https://masterclass.samuelbleemd.com/dnaPeptides I use personally to regenerate, heal, and stay sharp: https://limitlesslivingIn this episode, Dr. Samuel B. Lee, MD sits down for a raw and unfiltered solo conversation about the hidden realities of modern psychiatry, the illusion of “chemical imbalance,” and the forgotten truth of the superconscious soul. From working inside elite institutions like Cedars-Sinai and the University of Washington Medical Center to witnessing firsthand the numbing of children and elders in psychiatric facilities, his story is a testament to courage, awakening, and spiritual integrity.Dr. Lee shares how going through his own diagnoses—major depression, anxiety, paranoia, addiction, even a manic episode that led him to call off his wedding became the very initiation that opened his awareness beyond the DSM-5 and into the spiritual dimensions of healing. This episode dives deep into the limitations of symptom-based psychiatry, the concept of the superconscious mind, and why true healing requires reconnecting to the soul not suppressing it.Sacred Truths & Lessons from This Episode:• You Are Not Your Diagnosis• The “Chemical Imbalance” Theory Was Never Proven• Numbing Symptoms Is Not the Same as Healing the Soul• Society May Be Sick Not the Child• Your Superconscious Mind Holds the Key to Transformation• Healing Begins When You Reclaim Your Spiritual SovereigntyDr. Lee vulnerably explores what happens when elders are medicated into numbness at the end of life, when children are labeled instead of understood, and when psychiatrists are pressured to prescribe instead of connect. He reveals why he walked away from a lucrative partnership at one of Los Angeles' largest psychiatric hospital firms and chose instead to speak from his soul.This is not just a critique of a system. It's a call to remember what psychiatry originally meant: healing the psyche the soul.

Dr. Lakshmi Rajdev and Dr. Manish Shah join the podcast to discuss the updated guideline on immunotherapy and targeted therapy in unresectable locally advanced, advanced, or metastatic gastroesophageal cancer. They share first-line and subsequent-line recommendations for both gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma based on actionable biomarkers including PD-L1 expression, MMR and/or MSI, CLDN18.2 expression, and HER2 status. They note the importance of the algorithms and tables in the guidelines that provide visual illustrations and quick reference guides of the evidence-based recommendations. They also comment on ongoing and recently presented trials that may impact future guidelines in this space. Read the full guideline, "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update" at www.asco.org/gastrointestinal-cancer-guidelines" TRANSCRIPT This guideline, clinical tools and resources are available at www.asco.org/gastrointestinal-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  https://ascopubs.org/doi/10.1200/JCO-25-02958      Timestamps ·       00:00 – 02:15 Introduction and Overview ·       02:16 - 08:20 First-line treatment for patients with pMMR/MSS, HER2-negative gastroesophageal adenocarcinoma ·       08:21 –10:29 First-line treatment for patients with pMMR/MSS, HER2-positive gastroesophageal adenocarcinoma ·       10:30 – 14:39 First-line treatment for patients with dMMR/MSI-H, gastroesophageal adenocarcinoma ·       14:40 – 18:03 First-line treatment for ESCC ·       18:04 – 22:04 Second- and third-line therapy for gastroesophageal adenocarcinoma and ESCC ·       22:05 – 24:38 Importance of guideline ·       24:39 – 27:45 Outstanding questions and future research   Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts.   My name is Brittany Harvey, and today I am interviewing Dr. Lakshmi Rajdev from the Icahn School of Medicine at Mount Sinai and Dr. Manish Shah from Weill Cornell Medicine, co-chairs on "Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline Update." Thank you for being here today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you for having us. It is wonderful. Brittany Harvey: And then just before we discuss this guideline, I would like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Rajdev and Dr. Shah, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then to dive into what we are here today to talk about, Dr. Shah, I would like to start first with what prompted the update to this guideline, which was previously published in 2023, and what is the scope of this updated guideline? Dr. Manish Shah: Yes, terrific. So even in the last few years, the pace of drug development in gastroesophageal cancers has just been astounding. So, what prompted this guideline is actually the practice-changing results for a new biomarker, CLDN18.2 hat was based on the GLOW and SPOTLIGHT studies, as well as a practice-changing study in HER2-positive disease where we added pembrolizumab to trastuzumab and chemotherapy for tumors that are HER2-positive and PD-L1 CPS 1 or greater. And then there were also new studies and new approvals in esophageal squamous cell cancer that you will hear about as well. So there were several studies, overall more than 5,000 patients were reported on, and that led to several new therapies, new indications, and it really necessitated this guideline. Brittany Harvey: Excellent. It is great to hear about all of these exciting updates in this space. So then to next review the key recommendations of this guideline by clinical question that the expert panel addressed. So, Dr. Rajdev, what is the recommended first-line treatment for patients with proficient mismatch repair, microsatellite stable, HER2-negative gastroesophageal adenocarcinoma? Dr. Lakshmi Rajdev: Thank you for that question. So historically, we have sort of used fluoropyrimidine and platinum doublets, which yielded a survival of about one year. More recently, immunotherapy and targeted therapy options have improved outcomes in patients with advanced esophageal and gastric adenocarcinoma, as well as squamous cell carcinoma. Patients with gastric and GE junction adenocarcinoma have a high rate of actionable alterations, so it is imperative that physicians test the following biomarkers upfront so that it can help guide therapy. The markers recommended by the ASCO panel are HER2, MMR or MSI, CLDN18.2, and PD-L1. And also, it was recommended to use NGS if feasible in this patient population. HER2, as we know, is expressed in about 15% to 25% of patients; PD-L1 expression occurs in about 80% of patients; MSI-high, deficient MMR is present in about 5% to 8% of patients; and CLDN18.2 expression is present in about 40% of patients. There is, of course, biomarker overlap. About 13% to 22% of CLDN18.2 patients are also PD-L1 positive. For patients with pMMR or microsatellite stable HER2-negative disease with PD-L1 expression greater than 1 and absence of CLDN18.2, the panel recommended a first-line therapy with fluoropyrimidine and platinum-based therapy in combination with immunotherapy. These recommendations stem from large phase 3 trials, and the agents approved in the United States are pembrolizumab, nivolumab, and tislelizumab. It has been shown that immunotherapy benefit is greater in patients with higher PD-L1 expression, and it is not possible to comment on the individual PD-L1 cutoff scores and sort of identify the optimal PD-L1 cutoff score that sort of balances benefits and harms. But what is recommended is that immunotherapy-based treatments can be offered in patients with a CPS score of greater than 1. With regard to the choice of immunotherapy agents, that is pembrolizumab, nivolumab, or tislelizumab, these agents are considered to have similar efficacy, and the selection of an agent could be based on dosing schedule, cost considerations, toxicity, and the method of administration. Typically, clinicians should avoid withholding the start of chemotherapy while awaiting biomarker testing, depending on the clinical scenario. Now, for patients with pMMR microsatellite stable disease that is HER2-negative with PD-L1 expression less than 1 and positive CLDN18.2 expression, zolbetuximab-based treatments or in combination with chemotherapy is recommended, and this is based on two global phase III randomized controlled trials, the GLOW and the SPOTLIGHT. And across both studies, the hazard ratio for the overall survival was 0.78, and similarly, there was also an improvement in progression-free survival favoring the zolbetuximab group compared to the chemotherapy group alone. An important note is that nausea, vomiting is commonly associated with zolbetuximab-based treatments, and the panel recommended prophylactic antiemetics, adjusting zolbetuximab infusion rates, pausing infusion temporarily, using non-prophylactic antiemetics, and hydration intravenously prior to discontinuation of zolbetuximab-based chemotherapy. So effective handling of the GI-related symptoms with zolbetuximab is recommended prior to discontinuation of therapy. Now, for patients with pMMR microsatellite stable HER2-negative gastric, GE junction adenocarcinoma with PD-L1 expression greater than 1 and CLDN18.2 positivity, the ones with the dual expression with CLDN18.2 as well as PD-L1 chemotherapy, the choice of therapy can be based on the degree of PD-L1 expression, the toxicity profile, the burden of symptoms, and the anticipated improvement in symptoms associated with response to treatment, the patient comorbidities, the prior medical and treatment history. So this decision needs to be made on a case-by-case basis, and these are some of the factors that we suggested that could potentially influence the choice of therapy. For patients with pMMR microsatellite stable disease that is HER2-negative and a PD-L1 expression less than 1 and an absence of CLDN18.2 expression, first-line therapy with fluoropyrimidine and platinum-based chemotherapy is recommended. So you can see we have segmented out patients based on PD-L1 expression, pMMR and microsatellite stable disease expression, and also based on CLDN expression. Brittany Harvey: Absolutely. And that first point you noted, I think is really important, that biomarker testing is really critical for treatment decision-making in this space. So then the next subgroup of patients that the panel looked at, Dr. Shah, what first-line therapy is recommended for patients with proficient mismatch repair, microsatellite stable, HER2-positive gastroesophageal adenocarcinoma? Dr. Manish Shah: So this was an update from a few years ago. So we have known for 15 years now that if you are HER2-positive, you should get trastuzumab plus chemotherapy. That was based on the ToGA trial. And the update now is based on a trial called KEYNOTE-811, where it examined the addition of pembrolizumab to trastuzumab and chemotherapy versus trastuzumab and chemotherapy, and there was a progression-free and overall survival benefit. And again, here, the biomarkers are important. If your CPS PD-L1 is less than 1, we would not recommend Pembrolizumab in that setting, so you would still get trastuzumab and chemotherapy. But if it is 1 or greater, the PD-L1 CPS score, then we do recommend pembrolizumab unless there is a contraindication to immunotherapy. The take-home message really is from the onset of diagnosis, please check your biomarkers. And I will just, it is worth repeating, it is important to check your PD-L1 status, HER2 status, mismatch repair status, and CLDN18.2 status. And then the optimal therapy, and it is outlined in the publication, is really biomarker-driven. We know that if we are able to hit the target that is overexpressed, we are going to have a better outcome. And Dr. Rajdev did mention where there is overlap, there can be a lack of data, and that is where we are with both PD-L1 positive and CLDN positive. Here we do have data in HER2-positive cases where if you are both HER2-positive and PD-L1 positive, you would combine trastuzumab and pembrolizumab for the best outcomes. Brittany Harvey: Understood. I really appreciate you detailing what is most important for each individual biomarker combination that patients may have. So then following that, Dr. Rajdev, what does the expert panel recommend for first-line treatment for patients with esophageal squamous cell carcinoma that is not amenable to definitive chemoradiation? Dr. Lakshmi Rajdev: There are three phase III randomized clinical trials that have influenced practice in patients with esophageal squamous cell carcinoma examining the benefit of immunotherapy in this patient population. The RATIONALE-306 was a randomized trial of tislelizumab plus chemotherapy with platinum and fluoropyrimidine or paclitaxel versus placebo with chemotherapy. And then you have the KEYNOTE-590, which compared pembrolizumab plus chemotherapy versus chemotherapy alone. And then you have CheckMate-648, which included comparisons of nivolumab plus chemotherapy versus nivolumab plus ipilimumab or chemotherapy. And the primary endpoints for these studies were overall survival, and they did look at subgroups with PD-L1 expression. They used TPS score greater than 1% in CheckMate-648 and PD-L1 CPS greater than 10 in KEYNOTE-590. The bottom line is that the overall hazard ratio for overall survival across this patient population was 0.72. So clearly, there is benefit in patients that express PD-L1 CPS greater than 1 for benefit for the addition of immunotherapy. Now, the benefit again in patients with a PD-L1 expression less than 1 remains limited, and so the panel has made a recommendation for using immunotherapy in combination with platinum-based chemotherapy in patients with a PD-L1 greater than 1. Again, we know that it is hard to make recommendations on what PD-L1 cutoffs are recommended in this patient population, meaning that should it be limited to patients with a PD-L1 of 1 to 4 or greater than 10? I think that the general consensus that has been gleaned from the data is that the higher the PD-L1 expression, the greater the benefit. I do want to comment on another option that is available in patients with squamous cell carcinoma compared to adenocarcinoma, and that is the combination of nivolumab and ipilimumab. Now, in CheckMate-648, nivolumab with ipilimumab was also recommended as a treatment option in patients that have a PD-L1 score of greater than 1. There was a survival benefit demonstrated with this combination compared to chemotherapy alone. And an important observation in this study is that, although there was a slightly increased rate in early death, but there was really no significant difference in PFS and OS compared to chemotherapy alone. Importantly, the treatment appeared to be pretty well tolerated by the study population. There was a notable difference in the objective response rate, which was 35% in the nivolumab plus ipilimumab group compared to patients receiving nivolumab and chemotherapy, where it was 53%. So superiority is, so the importance of chemotherapy in patients with esophageal squamous cell carcinoma is to be noted. However, there is no difference in overall survival and progression-free survival when using the combination of nivolumab and ipilimumab, and thus it affords a chemotherapy-free option for this patient population with esophageal squamous cell carcinoma and a CPS with a score of greater than 1. Brittany Harvey: Understood. I appreciate you reviewing the evidence underpinning those recommendations as well. So then the next patient population that the guideline panel addressed, what first-line therapy is recommended for patients with deficient mismatch repair, microsatellite instability-high, gastroesophageal adenocarcinoma or esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: The rate of MSI-high expression is about 3% to 7% across different studies. Now, the KEYNOTE-158 was a tumor-agnostic study in patients with non-colorectal cancers, and again, the problem with the MSI-high population, given that it is so rare, the numbers in the individual studies are fairly small. But consistent outcomes do emerge, indicating high response to immunotherapy. So in KEYNOTE-158, a response rate of about 46% was noted. The number of patients was small, it was about 24. In CheckMate-649, which is a study of chemotherapy plus or minus nivolumab in patients with advanced gastric adenocarcinoma, there was again a very small number of patients, and patients that were MSI-high or deficient MMR did experience substantial benefits with the addition of immunotherapy, with hazard ratios in the order of about 0.38. In KEYNOTE-062, again, it was a very small number of patients, again about 6% or so, and similar to CheckMate-649, a substantial benefit was noted in combination with chemotherapy, but also there were benefits noted with pembrolizumab alone. The RATIONALE-305 again was a study of tislelizumab in combination with chemotherapy and similarly showed benefits to the combination of chemotherapy plus immunotherapy in this patient population. I think that we are all aware of the dramatic benefits of immunotherapy in this particular subset of patients, deficient MMR MSI-high, and also we have seen in CheckMate-649 they did have a subset of patients that received nivolumab and ipilimumab. And in this patient population, they noted unstratified hazard ratio of 0.28. So I think that the overall consensus is that immunotherapy is a very important treatment modality in patients with deficient MMR MSI-high disease, given that a lot of the trials in gastroesophageal adenocarcinoma have utilized chemotherapy-based options, that is certainly a recommendation of the panel to use chemotherapy in combination with immunotherapy. However, on a case-by-case basis, the panel recommended immunotherapy alone as well, and given the high response rates noted in trials across different diseases as well as noted in this disease as well. Brittany Harvey: Certainly. And I appreciate you both for reviewing these first-line recommendations. So moving to later lines of therapy, Dr. Rajdev, what recommendations did the expert panel make for second or third-line therapy for gastroesophageal adenocarcinoma and esophageal squamous cell carcinoma? Dr. Lakshmi Rajdev: So, I think that the RAINBOW trial that investigated the utility of the addition of ramucirumab as second-line therapy has been around since 2014, and those results have led to the addition of ramucirumab to taxane-based therapy in the second-line setting. Based on the utilization of oxaliplatin and platinum-based therapy in the front-line setting, there may be patients that have an underlying neuropathy, and so we wanted to really include treatment options for this patient population so that an agent that is less neurotoxic could also be recommended in combination with ramucirumab. The RAMIRIS trial is one such trial where ramucirumab was combined with FOLFIRI, and it demonstrated benefit in combination with ramucirumab. So we have listed that as a potential treatment option for patients in the second-line setting who may have an underlying neuropathy or even for whatever reason that based on the toxicity profile, that needs to be the preferred option by a physician, that recommendation is new from the older guidelines that we have. With regard to the utility of PD-1 inhibitors, there really has been no benefit noted in the second-line setting with regard to overall survival or progression-free survival, so no recommendation is made for that option. I think an important study that has been recently presented is the DESTINY-Gastric04 trial, which really has been practice-changing and has led to the recommendation for trastuzumab deruxtecan in patients that have HER2-positive metastatic gastric or GE junction adenocarcinoma. Now, this is a phase III trial in patients who retained HER2-positive disease after progressing on front-line trastuzumab-based treatments, and the comparator for this trial was trastuzumab deruxtecan versus ramucirumab plus paclitaxel. There was significant improvement and progression-free survival in patients that received trastuzumab deruxtecan. The patients that were excluded from the trial are patients that have pulmonary problems, interstitial lung disease; that is one of the toxicities of this particular agent, and close monitoring and prompt initiation of therapy such as glucocorticoid treatment in patients who develop this toxicity was also highlighted by the panel. So to summarize, the new guidelines highlight the possibility of FOLFIRI plus ramucirumab as a second-line option and then trastuzumab deruxtecan as a later-line option in patients that still retain HER2 expression. And that is very important because the trial did retest patients whether they expressed HER2. As we know, in a substantial number of patients, there is downregulation of HER2, and there is emerging data that the benefit for subsequent HER2-directed therapies is best noted in patients that still retain HER2 expression. Brittany Harvey: Great. So as our listeners have heard, there are many recommendations and new treatment options for advanced gastroesophageal cancer. Dr. Shah, earlier you highlighted the importance of biomarker testing, but I would like to hear in your view, what is the importance of this guideline and how will it impact both clinicians and patients with gastroesophageal carcinoma? Dr. Manish Shah: So as we have discussed throughout this podcast, the treatment for gastroesophageal cancer, both adenocarcinoma and squamous cell cancer, is increasingly complex, increasingly biomarker-driven. And I think the value of the guideline is to place all of that into context. So it provides the data for why certain biomarkers are important, what therapies should be indicated. Not only that, but if you are able to review the guideline, it provides the details of each of these studies and summarizes them in a meta-analysis fashion to sort of give you the context, because sometimes the individual studies can be maybe a little bit discordant or confusing and the guideline attempts to harmonize all that. And then also, I think the tables are very, very interesting because they give you actual numbers in terms of how many patients over a thousand would this benefit or how many patients over a thousand would this cause harm in terms of nausea, vomiting, or other things like that. So it gives you context for helping clinicians and patients weigh the potential benefits of the novel treatment strategies against the potential adverse events. And then finally, the guideline does also provide an algorithm that you are able to follow based on the biomarkers, and those are in figures 4 and 5. So I think overall, it is a very comprehensive guideline. It intends to make more manageable a very complex subject, and you know, I really encourage our listeners to review it after listening to the podcast. Dr. Lakshmi Rajdev: If I can add to that, I think that what is also really good about the guidelines is there are quick summaries. So if someone is busy in the clinic, of course, there is the opportunity to review the data supporting the guidelines in great depth in the manuscript, but what is also really good is that there are good summaries. In the event that you are very busy, you can easily identify what the recommendations should be for that particular patient based on these summaries. Brittany Harvey: Absolutely. Listeners are encouraged to review the full guideline, including those tables and figures that may be more helpful when they are looking for something quick to look at in the clinic as well. So, as you both mentioned, there have been a number of recent practice-changing trials in this area. So I imagine there is still a lot of ongoing research as well. So Dr. Shah, what are the outstanding questions regarding treatment options for patients with locally advanced unresectable, advanced, or metastatic gastroesophageal carcinoma? Dr. Manish Shah: I think we touched upon it a little bit. The guidelines are based on the data available, and they are primarily examining one novel therapy with chemotherapy in a specific biomarker population. But as you know, the biomarkers are not either/or; you are not either CLDN18.2 positive or PD-L1 positive. A portion of patients could have dual biomarkers, and you know, I think that we are generating data on how to manage those patients. At the recent GI Symposium in January this year, the ILUSTRO trial was presented by Dr. Shitara, which looked at combining zolbetuximab and chemotherapy with immunotherapy for dual-positive biomarkers, and that is leading to a phase III study that has begun to enroll. So unanswered questions are: how do we manage dual-positive biomarkers? The other thing that was mentioned is that the current data for mismatch repair deficiency involve chemotherapy plus immunotherapy. Only squamous cell cancer is there a study with a positive non-chemotherapy kind of backbone, that is CheckMate-648 that Dr. Rajdev mentioned. As we move forward, it will be good to get data on non-chemotherapy options in certain biomarker-positive populations. And then finally, another update, which is likely to be practice-changing, is the HERIZON-GEA-01 study that looked at zanidatamab, which is another biparatopic antibody that targets HER2, and that is likely to change practice. And as that data gets published, we may look to even do a rapid update for the current immunotherapy and targeted therapy guideline that is just being published. Dr. Lakshmi Rajdev: So, if I can add to that, there are numerous ADCs that look very interesting. There are bispecific antibodies; in fact, the zanidatamab is a bispecific antibody showing improved activity in patients with HER2-positive disease. So I think there are studies from Asia looking at CLDN CAR T-based therapies. So, I think that there are a lot of novel agents and a lot of excitement in the field. We know that the bemarituzumab study, unfortunately, the FGFR2 inhibitor failed to demonstrate any benefit, but I think that there are other agents that are being explored, so there are newer targets, newer agents, ADCs, bispecifics that could potentially change the field in the future. Brittany Harvey: Yes, we will look forward to the data to address these unanswered questions and new agents and inform future guideline updates. So, I would like to thank you both for all of your work to review the evidence here and update this important guideline, and for your time today, Dr. Rajdev and Dr. Shah. Dr. Lakshmi Rajdev: Thank you. Dr. Manish Shah: Thank you. Brittany Harvey: And finally, thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/gastrointestinal-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you have heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

What happens when patients become true partners in healthcare innovation? In this episode of Moving Medicine Forward, we speak with Dr. Karin Hehenberger, physician, scientist, transplant recipient, and Founder & President of Lyfebulb, about how lived experience can reshape chronic disease care.Diagnosed with type 1 diabetes as a teenager, Karin's journey through medicine, biotech, and ultimately organ transplantation inspired Lyfebulb's mission to empower patients through education, community, and innovation. We explore why patient voices must be included early in development, how patient entrepreneurs are driving real‑world solutions, and why reducing isolation is essential to better outcomes.01:00 Welcome & Guest IntroductionMeet Dr. Karin Hehenberger and the mission behind Lyfebulb.02:10 Living With Chronic Illness Karin's early diabetes diagnosis and how it shaped her path into medicine and research.05:35 When Disease Progresses Anyway Facing kidney failure and vision loss despite careful disease management.06:45 Transplant & New Perspective How kidney and pancreas transplants led to a renewed purpose.07:55 Founding Lyfebulb Why patient education, connection, and innovation are central to empowerment.10:45 Patients as Partners Moving beyond “patient‑centric” language to true collaboration.12:20 Patient‑Driven Innovation Innovation challenges and real solutions created by patients for patients.17:55 The Power of Community Reducing isolation to improve emotional health and daily disease management.22:45 Industry & Research CollaborationWhy patient insight must be integrated early—not as a checkbox.27:15 Rethinking Chronic Disease A vision for managing chronic illness without constant mental burden.31:15 Learn More How to get involved at LyfeBulb.comb

In this episode we are talking about uncertainty and risk along with patient preferences for communication. Segment 1: The attitudes of individuals with or at risk of adult-onset genetic conditions on reproductive genetic testing: A systematic review Shanice Allen is a PhD student from the Sheffield Institute for Translational Neuroscience (SITraN) at the University of Sheffield. The aim of her research is exploring the attitudes and experiences of individuals with or at-risk of genetic MND on reproductive genetic testing, and explore how and if clinicians discuss these options with these individuals. This will help us identify any barriers to accessing reproductive services. LinkedIn: https://www.linkedin.com/in/shanice-allen-9a89661a5/   In this segment we discuss: - The attitudes toward reproductive genetic testing in adult-onset genetic conditions. - Experiential knowledge and perceived disease severity in shaping reproductive decision-making. - Ethical themes including guilt, eugenics, and concerns about pregnancy termination. - Findings supporting more tailored, longitudinal genetic counseling approaches.   Segment 2: Assessing patient communication preferences for reclassified variants of uncertain significance in a general genetics clinic Eden Brush, MS, CGC is a pediatric and inpatient genetic counselor in the Division of Clinical Genetics at Columbia University Irving Medical Center. She completed her graduate training at Columbia University as part of the class of 2024. She is passionate about rare disease advocacy, narrative medicine, and disability justice.   In this segment we discuss: - Patient communication preferences for reclassified variants of uncertain significance (VUS) and patient-driven practice insights - Factors that emphasize the utility of shared responsibility, the need for standardized recontact systems, and the importance of equity-focused implementation strategies. - How VUS reclassification type impacted patient-preferred disclosure methods.    Would you like to nominate a JoGC article to be featured in the show? If so, please fill out this nomination submission form here. Multiple entries are encouraged including articles where you, your colleagues, or your friends are authors.   Stay tuned for the next new episode of DNA Dialogues! In the meantime, listen to all our episodes Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Dialogues”.    For more information about this episode visit dnadialogues.podbean.com, where you can also stream all episodes of the show. Check out the Journal of Genetic Counseling here for articles featured in this episode and others.    Any questions, episode ideas, guest pitches, or comments can be sent into DNADialoguesPodcast@gmail.com.    DNA Dialogues' team includes Jehannine Austin, Naomi Wagner, Khalida Liaquat, Kate Wilson and DNA Today's Kira Dineen. Our logo was designed by Ashlyn Enokian. Our current intern is Stephanie Schofield.

In this episode, Lillian Erdahl, MD, FACS, is joined by Jessica Liu, MD, MS, MPH, from the Department of Surgery, Harbor UCLA Medical Center. They discuss Dr Liu's recent article, “Identifying Diagnostic Gaps and Mitigation Strategies for Older Adult Emergency General Surgery Patients: A Scoping Review,” in which the authors identified the current diagnostic issues, clinical tools, and clinician feedback strategies in the older adult emergency general surgery (EGS) setting. While challenges unique to older adults exist, variability in the use of tools to improve identification of older adult conditions in EGS and gaps in feedback to improve diagnosis remain.   Disclosure Information: Drs Erdahl and Liu have nothing to disclose.   To earn 0.25 AMA PRA Category 1 Credits™ for this episode of the JACS Operative Word Podcast, click here to register for the course and complete the evaluation. Listeners can earn CME credit for this podcast for up to 2 years after the original air date.   Liu, Jessica K MD, MS, MPH; Peters, Xane D MD, MS; Remer, Sarah L MD; Beestrum, Molly MLIS; Cooper, Zara MD, FACS, MPH; Russell, Marcia M MD, FACS; Hall, Bruce L MD, FACS, PhD; Ko, Clifford Y MD, FACS, MSHS, MS. Identifying Diagnostic Gaps and Mitigation Strategies for Older Adult Emergency General Surgery Patients: A Scoping Review. Journal of the American College of Surgeons 241(5):p 904-916, November 2025. | DOI: 10.1097/XCS.0000000000001480   Learn more about the Journal of the American College of Surgeons, a monthly peer-reviewed journal publishing original contributions on all aspects of surgery, including scientific articles, collective reviews, experimental investigations, and more.   #JACSOperativeWord   Copyright © 2026 by the American College of Surgeons (ACS). All rights reserved.   The contents of these materials may be cited in academic publications but otherwise may not be reproduced, disseminated, or transmitted in any form by any means without the express written permission of ACS. These materials may not be resold nor used to create revenue-generating content by any entity other than the ACS without the express written permission of the ACS. The contents of these materials are strictly prohibited from being uploaded, shared, or incorporated in any third-party applications, platforms, software, or websites without prior written authorization from the ACS. This restriction explicitly includes, but is not limited to, the integration of ACS content into tools leveraging artificial intelligence (AI), machine learning, large language models, or generative AI technologies and infrastructures. 

In this episode, April Welker and Kym Davis, Dental Hygiene Coaches at Dental Care Alliance, discuss how structured hygiene coaching strengthens patient education, clinician engagement, and quality of care. They share how investing in culture, leadership, and professional development helps reignite passion, improve retention, and elevate outcomes across dental practices.This episode is sponsored by Dental Care Alliance.

Are you providing your patients with a 5-star treatment? It starts with your front office. Kiera breaks down what a full rollout of peak client care looks like, identifying five different points to utilize as soon as that patient walks through the door (or calls). Episode resources: 5 Star Treatment Planning Document Subscribe to The Dental A-Team podcast Schedule a Practice Assessment  Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners, this is Kiera. And today, I am so excited. Today is gonna be one of my absolute favorite topics, and it is getting more patients to say yes to treatment. You guys, I obsess about this, and I talk about it a lot, and I just feel that these are some really good things. And so I wanted to go through our five-star treatment planning process with you today, so that way you guys are able to help more patients say yes, be able to maximize your practice.   Because at the end of the day, a patient who comes into your practice, they want to do dentistry. There is a treatment coordinator that I worked with for years and she always says like, Kiera, my thoughts are when I go in and I treatment plan, like the reason is patients are gonna say yes to me because they're at the practice, they want to get this help. And I just think having that mindset helps so much. And so this is a five-star treatment planning and we've actually created it for the entire practice. And   one I'm gonna go through is,   specific and then we actually broke it down for our front office team, our clinical team and our doctors of this process of five star treatment planning. And what's really fun is when we implement this into a practice, we do a full rollout with the team. And then what we do is actually once they complete it, they actually get to check off their stars. And there's actually way you can become five star certified in Dental A Team. So if you're new to the podcast, welcome. I'm Kiera. Dent really is my last name. I'm obsessed with all things dentistry and I'm obsessed with teams and doctors having their best life possible.   Our team is so committed to you, to your practice, to making sure that you are thriving and not just surviving. And so really giving you guys tips and tricks that you can go implement into your practice to help more patients say yes, to be able to help your team be so thorough and so productive and really making life easier. So we love to hear from you. I love pen pals. You can always reach out Hello@TheDentalATeam.com. And if you're ever curious of, I wonder what consulting could look like in my practice.   Be sure to book a call. It's complimentary. We go through your practice with you. We assess your practice. We give you a roadmap, whether you work with us or don't, to make sure that you are always being able to positively impact your team, your life, and your community. Because our goal is to positively impact the world of dentistry in the greatest way possible. So with that, five-star treatment planning. So these are the quick five stars that we go. And like I said, then it's broken down more in depth of what each department needs to do. ⁓   The first one is going to be more for front office team members. And it also can be for clinical team if we're actually having them present treatment in the back. And so the first star is when we go into it, we're going to smile and assume the yes. So before we even walk into the room, we have confidence. We know that we're going to go into it. We know that we're going to have patients say yes to us and we smile.   We are going to assume that the patient wants to do dentistry. Why are we going through and saying like, my gosh, this is a big case. my gosh. I don't know if they're going to accept. my gosh. my gosh. Stop that. Why are we doing that? There's absolutely no reason to do that. Patients are at the dental practice and just because they don't love the dentist doesn't mean that they don't want to have healthy mouths and healthy teeth and being able to have confidence. I say our mouths are the coolest thing ever. We get to smile with them. We get to talk with them. We get to eat with it.   Like there's so much value to it. Like it truly is, I think, the gateway to our confidence. It's the gateway to our health. And so being able to help patients have that. So I'm always going to assume, like my mantra is, everyone says yes to Kiera and there's always a solution and we will find it together. So we go in and we have that and we're going to assume the yes. We also gonna use what I call the three E's and that is edification, empathy and energy. So I'm gonna watch the patient and I'm going to edify the doctor, which is star number two.   I'm going to have empathy for what they're going through and not just assume it's run of the mill, just because it's a crown for us, doesn't mean that that might be life altering for our patients. But we're not going to put negativity out there. We're still going to be able to have empathy and positivity for them and help them see that this is the best place for them to get their treatment done and then making sure our energy matches. You guys, I come in really high. I have a lot of energy. So many people are like, Kiera, we want to consult with you because we love your energy and our team needs that. Well, guess what? Our whole team has to have that because this is who I am.   And sometimes you need to have energy and like, need to get too excited on the podcast and I need to rally you. But for some of you, I remember there was a doctor who's like, Kiera, you're like a little much for my team. And my team's more like, hey, how are you? Well, guess what? That team is actually a better fit with Britney Stone. Britney is a much better match energy wise than I am. And so just making sure that we mimic and mirror the patient across from us. So star number one is smile and assume the yes before we even walk into it.   Star number two is we want to rave about the doctor and repeat a perfect handoff. So we want our patients to feel like they're on the winning team. And I think about it, if I'm going in like, I'm going in for surgery. And if that treatment coordinator who's presenting to me, so I've met the doctor, they've diagnosed the treatment to me. Okay, so all that needs to happen before we get to this spot. But the doctor told me, Carrie, you need to come back for surgery. If that front office person that I'm talking to about my financials said to me, gosh Carrie, you're so lucky.   ⁓ Dr. Kressler is absolutely incredible and you're going to get such great care. I've seen him do this surgery multiple times. I know you're in the best hands and truly I'm here to make sure that you're taken care of. We're super excited for you and I know you're going to have great results. Like even me saying that I feel this whoosh of like confidence of OK, got it like I am making the absolute best decision I possibly can. And so this is what we do. So number start number one is smile and assume the S use our three E's. Number two is rave about the doctor. Help them see that we're on the winning team.   and use that perfect hand up. It'd be like, awesome, Kiera, you are so lucky. Dr. Jones is so incredible. He's done this treatment so many times and we're gonna get you taken care of. Dr. Jones wants to see you back for a crown. We need to get you scheduled in about two weeks. We need to do about 30 minutes and we're also gonna get your cleaning scheduled for that. This is gonna be amazing. Doctor is incredible. And then we move to the third star, is schedule the appointment first and give two options. We wanna get the commitment.   So a lot of times treatment coordinators will like come in like, how was your visit today? Meh, I'm at the dentist. Why don't we control this narrative? I'm going to smile like, Hey, it's so great to see. I'm so excited to get you helped out. Dr. Jones is so incredible. You've made a great choice. And I know he's going to take great care of you. We're to get you scheduled for that crown in two weeks. It's going to take us about 30. It's going to take us about an hour and a half. I hope a crown's not 30 minutes. It's going to take us about an hour and a half. And we're also going to get that cleaning scheduled. perfect. First things first, let's get you scheduled.   I've got Monday or Wednesday, which works best for you. That's when Dr. Jones does all of their crowns. I've got Monday or Wednesday, which works best for you. The reason I wanna move right into scheduling is because this is gonna help me get a commitment. And I believe that words are free and we should use them to our advantage. So when I'm going through this, let's just make it very easy for the patient. We smile and assume the yes, we rave about our doctor and talk about our perfect handoff, and then we move right into scheduling. Now the patient might be like, well, I wanna know what this is going to cost. I say, absolutely.   I want you to feel so solid and rock solid confident moving forward. Dr. Jones is extra busy. So we always just make sure we get you on the schedule, make sure we get that appointment set. I'm to go over all the financials. I want you to be super confident with that. But we'll just get you scheduled since the schedule is so busy. I've got Monday or Wednesday, which works best for you. Now, if they push back again, don't stress, talk to them. But this way they're able to see the flow, how we're going to do this. Because for me, what I'm also doing on that is I'm putting emphasis of we are doing treatment. And the question is how we want to pay for it, not the question of are we doing treatment or not.   I'm not forcing a patient, I'm not making them doing it, but sequence does matter when it comes to treatment planning. And you guys, I am a dang good treatment coordinator. 50, 60, $70,000 cases paid in full same day. It is not something that is hard, but it is something that's finesse. And I do believe that it's an art, not a like set in stone science. It's an art, it's a feathering. It's a reading the patient, it's understanding. And I'm giving you guys literally how I do this and how it's worked for so many practices.   practices we've been able to add multiple millions annually by doing this process. So we schedule first, get them scheduled. Then after that, we're going to present the total treatment. So star number four is point to the amount. I don't say it out loud saying 10 grand is very loud and obnoxious and obtrusive. Pointing to it doesn't feel as bad. And I'm going to use the art of silence. So that's star number four in our five-star treatment planning. So once the patient's scheduled, we're gonna present the treatment, all right? So we're gonna go through that crown and that cleaning.   It looks like it's going to be this amount. This is what your insurance is estimated. I'm pointing with my fingers. I go down and your out of pocket total will be blank this when we see you on Wednesday. What questions do you have for me? I want you to be super confident moving forward. And then I zip my lips and I'm silent. And the patient usually will say, perfect. Nope, no questions. I'll see you then. Or they'll say, ⁓ I'm curious about that. Like that was a little bit more than I was thinking. Do you have any options? I promise you they will say that.   But instead of me right here, which is where I think most treatment coordinators and failing goes wrong is when they say, ⁓ my gosh, so do you have questions about financing or do you have any questions about this? One, I don't ever want a patient to say no to me. So I don't ever use the questions of do you want to, or do we want to do this, or do you have questions? I say, what questions do you have for me? Let's get you scheduled, not do you want to schedule? And these are just small little nuances, but if you watch yourself and you listen to yourself and doctors, same thing in your exams.   and clinical team members, same thing when we're back there. We're so obsessed with this like quick, yes, no, yes, no, yes, no, I wanna get you in and out versus I want to actually solve, I want to actually schedule patients and I want to actually be thorough with my patients. So what questions do you have? Words are free, use them to your advantage, use the art of silence and don't talk, zip your lips, but people get nervous and they don't want you to break up with them and they don't wanna be rejected so they start talking and they're like, my gosh, we can talk about finances, we can talk about, do you actually wanna just for free?   This is how discounts come about. This is how doctors are like, my gosh, I just gave that, it's a way for free. Stop talking. Let them process and let them ask, what questions do you have for me? I want you super confident moving forward. And I stop and I smile. And I truly do. And I might feel awkward, that's okay. But remember, I'm assuming the yes, they're going to say yes to me. Why wouldn't they say yes to me? And my second mantra is there's always a solution. And we together, me and this patient are going to find it because my job is to make them healthy, happy, and like total full care of health.   So then we go on to star number five, and that is over objections, okay? So objections do come, but objections to me are like, just remember that they need more information. We haven't educated them on something. That's all it is. They're not rejecting you. And so I say, go beyond the no with air quotes two times. And I do it as an S because I just want to find out and I want to dig to the root. I'm not forcing these patients, but 99 % of the time an objection just means I need to educate them more. I need to answer their questions. I haven't filled them in on something and that's all it is.   So we become a word ninja, we go past it, let's find a solution. And then if I've gone past it two times and I've really done my best, then I schedule them on a two, two, follow-up. So I call them in two days, two weeks, two months. So no matter what, they're still gonna talk to me and I'm going to make sure that they get the success. So that's our five star.   And when you start tracking it, we track it as well. We look to see our patterns and it helps our treatment coordinators get better and better. So now you're like, well,   But Kiera, that's great. Now let's talk about the objections. Cause I got my fifth star. My fifth star means I got to go past objections twice. Well, let's talk about some objections. Number one is a lot of people do think about just insurance. So they're like, okay, well, what about insurance? I like to explain that insurance is a coupon. So like just like Kohl's cash or coupons at the store. Well, you still want to buy the carrots, even though they're not on sale. And so what we do is we use our insurance and we maximize every single penny of it. but we also don't want to just wait on insurance and have insurance dictate because it's never going to be cheaper.   or more predictable than it is today. So we wanna make sure that we your treatment taken care of, you're worth it, you deserve it. And we're gonna squeeze every single dang penny out of that insurance company that we can. But we just have to recognize that dental insurance is different than medical insurance. And dental insurance is a coupon, medical insurance, we pay our deductible and they cover everything else. So that's why, and so our job is to help you out with this. We're gonna get you scheduled for this. I've got Monday or Wednesday, which works best. And we're gonna make sure that you're taken care of with that. Schedule.   If they're like, I need to check my work schedule. Fantastic, no problem. I, Kieran, you gotta be careful, use your words. I, Kieran, would hate to forget about you. The truth is, I literally will. I've got like 100 patients coming today. So I would hate to forget about you and let you slip through the cracks. Let's just pop you on the schedule and if that doesn't work when you get home, me a call and I'll happily change it for you. That's it. Then you're like, okay. If I say, oh John, I would hate for you to forget about this, he'll be like, I'm not gonna forget. But if I'm like, oh, I would hate to forget about you, patient's like, yeah.   Don't forget about me, Keir, put me on that schedule. It's all about psychology and making these patients feel like VIPs. I truly believe our patients are VIPs. I love them so much and I want them to get the best dental care possible. So that's what I'm gonna do for schedule or for work. Now if it's cost, I remind them and truth be told, it will never be cheaper or more predictable than it is today. So let's get you scheduled, let's figure this out, let's work through the solutions. I have so many solutions with you. Like let's work through it. What solutions do you have? Like this didn't happen overnight, we don't have to solve it overnight.   We do need to get going on it so it doesn't get worse. We present the other side of the problem. This is what happens if we choose to wait. And I just want you to know your options, you're worth it. Let's get this taken care of. There's always ways that we can work on cost. You guys, there's thousands of ways. We can do less treatment. We can split it up. We can do layaway, whatever your practices processes are. But usually it's not cost. Usually it's fear. And I'll say, let's talk about it. Do we have savings or do we wanna talk about third party financing?   I'm not gonna give them care credit to go home and apply for. Let's just apply right now. Let's find out what our options are. Let's see what we've got here that we were able to find out. And then like, I don't want you to have to go home and make this hard. Let's make this easy to where you feel confident and we're able to find the solution for you.   How many times do we actually spend the time to do that? To me, that's VIP care. I can't tell you how many times I've watched treatment coordinators like, here's the application, go home and do it. Well, guess what? They're not. That's hard. Let's make this easy for them. Let's find the easiest way for them to say, yes, that's VIP customer service. And I know you might be like, here, I'm so busy. Guess what? This is the fastest, easiest way to fill your schedule. How many of you want to make phone calls to fill that schedule? I don't. I'd much rather sit here and do five minutes of care credit with you rather than chasing you down, trying to do care credit, figuring it out. That's way harder.   Choose our heart here. And then spouse. Spouse like, need to talk to my spouse. Absolutely. I 100 % want you to chat with your spouse. What questions you think that they'll have? I want to make sure that you're fully prepared and confident to answer those. Well, I think they'll want to know about costs. I think they'll want to know about the... They'll tell you. They will tell you. Or if they're like, oh no, I'm like, hey, I really hate to try and like relay things to my spouse that I don't know about. I'm happy to get them on a phone call so that way we can talk about this openly. I'm here as a resource for you.   more than happy to do that with you. Now there's two ways you can do this. There's pressure or there's like confidence of I'm genuinely wanting to help you out. And truth be told, like I know this is so much easier. I think in all of treatment planning, I'm thinking how's the easiest way for this patient to say yes. How's the easiest way for me to help them. And this is where we're going to go. These are how I'm going to go past these objections. And I think for so many of us, we just want to like one and done. I did my job, check the box versus like it's outcomes over activity.   my outcome, I'm trying to get as many patients scheduled as possible, not the activity of I presented treatment plans. It's very different. So if I know my goal is not just to present treatment plans, my goal is to have like 80 % success. Well, then I'm going to look at this and I'm going to work through this and I'm going to check off all five stars and I'm going to become an expert. But realizing that I have to continually improve on treatment planning is going to be a great piece for you.   So this is the five-star treatment planning. And like I said, we have it for every single position. This was more of a front office. We have it for doctors. We have it for clinical team members, but this is a great way for you guys to increase your case acceptance, help more patients. And remember, 80 % of treatment planning is psychology, 20 % skill. So when we go through this, I think this is going to really be able to help you guys, guide you guys. And I know it will because I've done it for so many practices. So let's do it for yours. And if you need help, there are practices where we literally just do treatment planning consultations.   We consult them, we work with the front office team members, and what we do is we listen to the treatment plans, we help them out. And I've done this with many offices for multiple years. And it's crazy because in those practices, they're like, what happened? You guys also became like so successful and people were noticing that. And they're like, well, it all started when we hired this consultant and they've added multiple millions, but dollars are nice. Lives changed is better. And how many lives have we been able to help? How many people we've been able to help?   because we chose to be word ninjas, we chose to use our words to the best of our ability. We chose to listen and to see and to look at the results we're getting and change our processes and not be so set and like, well, this is what I do. I tell everyone that we coach, I don't actually care. There's no script. Like, yes, you guys can have this email us. Hello@TheDentalATeam.com   But more than that, what I care about is that you're able to help these patients and that we get the outcomes, the results. We're after results. We're not after the task. So if your results are crushing it,   You don't need to change anything, but if they're not and we're not getting the results we want, then change. And I would hope that you and your practice take on that none of us are perfect. All of us are here to expand, to grow, to evolve. And that's what we're here to do. We're here to help and serve more patients. So reach out if we can help you guys. Hello@TheDentalATeam.com. Go implement this, go change more people's lives, go become treatment planning masters. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

In this episode of The Thriving Dentist Show, Gary Takacs and Naren Arulrajah explain how AI is changing the way patients find and choose a dentist in 2026. They break down how Google AI, ChatGPT, Gemini, and AI Overviews now shape search results, and why dentists must show up in Google Maps, organic SEO, and AI generated answers to stay competitive. You will learn what EEAT means for your dental website, why expert written content builds trust, and how AI driven search impacts dental marketing strategy and online visibility. Gary also shares why tracking new patient calls is still the most important marketing metric, and how to measure real ROI instead of chasing rankings alone. If you want more new patients, stronger Google rankings, and a clear plan for AI powered dental marketing, this episode delivers practical guidance you can act on right away. For a complimentary Marketing Strategy Meeting visit ekwa.com/td and for a Coaching Session with Gary visit thrivingdentist.com/csm.

In this episode we discuss different pain management options w/ Dr. Kurtis Biggs.    Are you heading to AAOS 2026 in March? Stop by booth 830 and chat with the consultants at St. John Associates Physician Recruiting. Their orthopedic surgery team, one of the top national recruiting teams in the ortho market, has over 30 years of combined experience in the market and hundreds of matches in all ortho subspecialties. Their services are always free to job seeking physicians. Stop by booth 830 at AAOS 2026 in New Orleans, March 3rd through the 5th or visit them at StJohnJobs.com/ortho.    

This week, we explore a new standard of care for high-risk HER2-positive early breast cancer, long-acting therapy for people with HIV facing adherence challenges, a first-in-class trial of a p53 reactivator, and tecovirimat for mpox. We review group B streptococcal disease and a revealing case of prosthetic joint infection. Perspectives examine the role of folate therapy, Medicare drug-price negotiation, AI in medical education, and incidental findings.

In this lecture, Dr. Dave Rakel explores the placebo effect—"the ability to stimulate self-healing without deception"—and reveals how perception, connection, and empathy are among the most powerful healing mechanisms available to practitioners.Dr. Rakel unpacks the neuroscience of perception, showing how our conditioned minds create physical responses that determine health or disease. He shares groundbreaking research: optimists live six years longer than pessimists, stress perception correlates with fibromyalgia pain severity, and how we view food (guilt vs. celebration) affects cortisol and weight gain.Through compelling studies, he demonstrates that therapeutic touch activates healing more effectively than pills, that clinician empathy measurably shortens the duration of the common cold and boosts immune markers (IL-8 and neutrophils), and that perceiving a caring connection can equal 8mg of morphine for pain relief. This guest speaker Master Class is part of the Kharrazian Institute Functional Medicine Education Program. To become a Certified Functional Medicine practitioner, visit https://kharrazianinstitute.com/⁠. Try our 7-day free trial, no credit card required. 0:00 - The Placebo Effect: Self-Healing Without Deception8:20 - Perception Science: How Beliefs Create Physical Responses16:15 - Stress Perception & Disease: The Cortisol Cascade22:50 - Why SSRIs Barely Beat Placebo26:35 - Psychedelic Placebo Study: 65% Had Spiritual Experiences34:10 - Why Touch Beats Pills: Manual Therapy vs. Drugs42:30 - The Clinician Effect: Empathy = 8mg Morphine46:50 - Common Cold Study: Empathy Reduces Duration & Boosts Immunity55:40 - Patient 406: The Cost of DisconnectionSupport this show http://supporter.acast.com/solving-the-puzzle-with-dr-datis-kharrazian. Hosted on Acast. See acast.com/privacy for more information.

"I was told I needed a multi-level fusion. I didn't even know disc replacement existed." Nick's back pain started in his early 20s. After a discectomy in his mid-20s, he returned to an active life — until years later when severe sciatica came back and began affecting everything from his ability to put on a belt or sit in a chair.  Multiple surgical consultations led to the same recommendation: spinal fusion. But Nick, an active CPA, soon-to-be dad, and lifelong athlete, wasn't willing to accept that as his only option. In this episode, Nick shares what happened when he pushed for clarity instead of settling for a single answer. Through additional opinions and independent research, he discovered a motion-preserving alternative to fusion, called artificial disc replacement.  That realization ultimately led him to VSI and Spine Surgeon Dr. Ehsan Jazini, where Nick learned he was a candidate for a three-level disc replacement. Today, he reports zero back pain since surgery and has returned to skiing, running, swimming, weightlifting and living without restrictions.  This conversation explores important questions for anyone facing spine surgery:  How do you know if you're being told about all your options?  When should you get a second—or fourth—opinion?  What is the difference between spinal fusion and artificial disc replacement? What does recovery look like after multi-level disc replacement surgery? If you've been told spinal fusion is your only option, or if you're scheduling your life around your back pain, this episode could change your path forward. Ready to explore your options? Visit VSIspine.com to schedule a consultation with a spine specialist who can discuss both fusion and disc replacement candidacy.

Jenny Opalinski has spent more than a decade inside hospitals where people lose the ability to speak, breathe, swallow, and sometimes survive. A medical speech language pathologist by training, she worked in ICU, neuro rehab, and long term acute care settings, including a Level 1 trauma center, where she watched clinicians absorb 10 to 15 traumatic events in a single shift and then get told to move the crash cart faster next time.That lived reality pushed her to co found The Wellness Shift, an advocacy and education platform focused on healthcare worker burnout, suicide, and assault. In this conversation, Opalinski walks through the moment that changed everything for her: standing in a hospital hallway listening to a family wail after a failed code, followed by a debrief that addressed logistics and ignored grief entirely.She also explains how that work led to Humanity Rx, her podcast about the human cost of medicine, and Dragon's Breath: Calming Tricks for Big Feelings, a children's book that translates evidence based breathing and regulation strategies into language kids can actually use. The episode covers moral injury, time scarcity, false wellness, respiratory muscle training, and why empathy keeps getting treated as an optional expense instead of clinical infrastructure.RELATED LINKSJenny Opalinski on LinkedInThe Wellness ShiftHumanity RxDragon's Breath: Calming Tricks for Big FeelingsAspire Respiratory ProductsFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship email podcasts@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Prostate artery embolization may be performed by interventional radiologists, but its indications are rooted in urologic evaluation. In the second installment of our 2026 PAE University Series, Dr. Chris Beck is joined by Dr. Art Rastinehad of Northwell Health, a urologist with formal interventional radiology training, to share how his dual background informs both when to offer PAE and how to execute it thoughtfully. --- This podcast is supported by an educational grant from Guerbert. --- SYNPOSIS Dr. Rastinehad discusses his path from urology into IR and how that combined training shapes his current hybrid practice. He outlines a practical BPH consult framework grounded in urologic evaluation, emphasizing appropriate imaging, careful patient selection, and the importance of ruling out malignancy before proceeding with embolization. From his perspective, durable outcomes begin with disciplined workup and clear counseling around expectations, including sexual side effects and alternative treatment options. The conversation then turns to procedural strategy. Dr. Rastinehad reviews anatomic considerations, large-gland and technically challenging cases, and his experience incorporating liquid embolics into PAE. He compares glue and particles, detailing workflow decisions, medication strategy, and post-procedure management. Throughout, he highlights scenarios where PAE may not be the most appropriate intervention and how other BPH tools may better serve the patient. The episode concludes with a discussion of the future of PAE, including questions of training, collaboration between specialties, and reimbursement; underscoring the value of cross-specialty insight in contemporary BPH care. --- TIMESTAMPS 00:00 - Introduction01:26 - Interventional Urologist with IR Roots04:13 - Leaving Urology for IR: Fellowship Life, Case Volume & Mentors08:45 - Building a Hybrid Urology/IR Practice14:32 - PAE Benefits, Sexual Side Effects & Why MRI Matters17:39 - BPH Consult Playbook22:17 - Anatomy Deep Dive24:27 - Edge Cases & Big Glands28:24 - Why Glue?35:39 - Glue vs Particles39:40 - Post-PAE Follow-Up41:28 - Antibiotics and Medications46:18 - Tough Cases50:53 - The Future of PAE --- RESOURCES Early Outcomes of Prostatic Artery Embolization using n-Butyl Cyanoacrylate Liquid Embolic Agent: A Safety and Feasibility Studyhttps://pubmed.ncbi.nlm.nih.gov/39074551/ Dr. Rastinehad's Websitehttps://drrastinehad.com/

Most people think lab tests are only useful once something is wrong. But what if your blood work could show you where your health is headed—years before disease ever develops? In today's Office Hours, I break down how to read your labs through a functional medicine lens—so you can spot early dysfunction, connect the dots between symptoms and biomarkers, and take control of your health before problems escalate. In this episode, I walk you through: • Why “normal” lab ranges often miss early warning signs • The key markers that reveal the most about metabolic health, inflammation, thyroid function, nutrients, and cardiovascular risk • How functional medicine focuses on optimal ranges, patterns, and trends—not just disease thresholds • What your labs can tell you about symptoms like fatigue, brain fog, weight gain, and gut issues • How to track your numbers over time and ask smarter questions to shift from reaction to prevention Labs aren't just for diagnosing disease—they're a roadmap to optimizing your future health. When you understand your numbers, you stop guessing and start making data-driven decisions that build resilience and longevity. Visit ⁠functionhealth.com for 160+ lab tests at just $365 a year. Join the 10-Day Detox to Reset Your Brain and Metabolic Health https://drhyman.com/pages/10-day-detox Have a question you'd love answered on Office Hours? Submit it here

Mary Roach describes the process of tissue donation, focusing on corneal transplants and the meticulous, respectful recovery of bone and skin to benefit many patients awaiting procedures. 4