Podcast appearances and mentions of paula james

Today I am interviewing Paula James who is the Regional Managing Partner Chichester for Irwin Mitchell LLP.   Paula has the great intent and focus in her leadership to develop happy and expert teams, and so we explored how Paula achieves this with her team. Her primary focus is to have the well-being of the individual at the heart of the matter, whether checking in on someone, taking the time to listen to her team to having specific days off to facilitate well-being, rest and refreshment, it is all about being people focused. She also helps them develop their career, with development plans truly aligned to the company and the individual, ensuring these sessions happen with lots of listening, allowing the team member to share their passions and dreams, and looking to how the company can facilitate this.   Watch the full interview on YouTube: https://www.youtube.com/watch?v=N_Ju8YlUVeA   Connect with Paula: LinkedIn: https://www.linkedin.com/in/paula-james-17242b51/ Email: paula.james@irwinmitchell.com   Helping SME's build resilient, high performing teams and businesses, quickly, so they can innovate, deliver, and thrive.   The SME's I work with typically struggle/suffer/ with one or more of these challenges: - no clear strategy - dysfunctional team dynamics - not knowing their vision or mission - feeling stuck and procrastinating - business not growing - leadership challenges   If you want support in helping your organisation thrive, do get in contact with me: https://www.julianrobertsconsulting.com

Hello, beautiful people today on the Vitality Feed we have Paula James. Paula James is a movement specialist at the Art of Moving Well. She is a wealth of information and I'm thoroughly impressed with her knowledge with movement and I can't wait to dive into this today and share with you all of her knowledge to help you go throughout your day, working in a better posture. Please help me welcome P aula James. Hello, Paula. Hello, Caroline. Thank you, it's so nice to be here with you. Paula, can you just go through your background a little bit ? Sure, Caroline, thank you. It's such a pleasure to be here with you today. So I didn't start out in movement at all. I was a literature major and a freelance musician and having a marvelous time,  with music and culture. And then I was in a minor vehicle accident that left me with 10 years of low back and neck pain. So I made the rounds of doctors and chiropractors and PTs, a whole bunch of professionals, and I still hurt all the time. It was a few months of a regular yoga practice that took me out of pain. It was really learning how to move differently, how to distribute effort and movements throughout my body. And so I quit my day job and I went off to yoga teacher training and I, during that 10 years that I hurt, I really set the intention that wow, if I have to go through this for this long, but I didn't know how long it was going to be. It just kept going on. I thought, well, I at least want to map the territory so that I come out of it able to be useful to other people. So when I came out of pain, I went off to teacher training and  then I started training in the Feldon Christ method. And so everything was great. I was teaching yoga. I was out of pain. I was training in some other things. And then I was driving home one day from the studio and I watched an older woman cross the street and a few yards up on the sidewalk. She tripped up. And she didn't get up right away. So I parked and I went over to sit down next to her. It was the second time in a couple of weeks that she had fallen and it really came home to me. How so many of the things that I took for granted, not everybody has, and this woman wasn't likely to put on spandex and come to a yoga studio. And even if she did, I wasn't sure what I had that would really meet her. So I started shifting my focus for training to look at well, what's going on with arthritis with multiple sclerosis, with stroke survivors, with the pelvic diaphragm. And I shifted from teaching at a yoga studio to teaching at a rec department so that I got a different, you know, a wider cross section of the population. So I really been looking at well, what, what do we know from movement and alignment that will help people who've got real pain or limitations bridge back to being able to be active. And what have we got that will allow people with arthritis, osteoporosis to continue moving and exercising safely. So that another couple of decades from now they're still mobile because there's no value in pushing really hard now for the sake of burning calories and then doing irreparable joint damage so that you're not able to walk later or you're managing chronic pain. So I'm really looking at that longevity piece. How can people restore movement and ability and how can they remain safely active for the longterm? I mean, we're living like 80, 90 years now. How do you prep for that? And hence why you're on The Vitality Feed.  Basically to sum that up, you took your mess, and you made it your message, took action, and now you're spreading your message to help others. I have the best job. I get to meet people in their tender moments and together we get to find things that help resolve that. That they can really be out in the world again, doing things they enjoy. It's just, it's really fun. That is a very fulfilling  job for sure. Tell us a little bit about that statistics of the lack of movement, because I feel like there's an epidemic especially since all this pandemic . So, you know, it's interesting, I did a little looking into statistics in preparation for today, and I don't know if these are updated for, since the pandemic, but then the national institutes of health estimates that 25% of all north Americans suffer from chronic pain and that's across socioeconomic measures and including children That was when I was looking for statistics, I found some from earlier years. So in, in 2012, which is a, now, you know, a while ago that the NIH estimated that about 14% of adults in the United States had neck pain or problems, 20% with low back pain. 22% with arthritic conditions. And in general, any musculoskeletal pain disorder was 54%. Like, if you don't know, if you don't interact with people around pain, this is what surprises me. Then you don't know. Cause people, you know, they might say, oh, my neck hurts a little bit. Yeah.  I talked to people around physical pain all the time, and I can run it like an auction, you know, go into a group. Who's got neck pain. How about shoulder pain? Low back. How about knees? Hands go up all over the place. That's hysterical. You don't interact with people around that they don't know because nobody wants you to know that everyone wants to pretend everything is fine because they don't want to be perceived as weak and they don't want to not get invited to events. That's true. That is true. I guess most of the time we'll do try to hide that kind of thing, but it's amazing today, more than ever, because so many of our activities are stagnant. And I even noticed that with my kids growing up at sporting events, the big sisters and brothers would be doing the events, but the little they all hung around the outlets and it broke my heart because they weren't moving. They weren't out in the parking lot, throwing the football. They were sitting there playing games with each other, fighting over the plug and it's like, our bodies were meant to move. So thank God for people like you, because we need to get this country back into shape. Yeah.  And that's one of the things that I'm hearing consistently from folks.  Until the shutdown in, in March of 2020, I was teaching 12 classes a week in person. I saw about a hundred people a week. And then when everything shut down last March, I shifted to teaching online. And so I know because I've stayed in touch with a lot of the people, even though that did not continue with me over zoom, you know, a lot. They were going out for walks or to the gym. And also a lot of them were seeing people like massage therapists or acupuncturists or chiropractors. And of course, all that went out the window in the early days of the pandemic. So. Any of the extra complimentary care, anything that people have been getting to help them manage was gone. And, and then a lot of folks were working from home, so they didn't necessarily have a good ergonomic workstation. They were using their laptop sitting on the sofa and, and like you say, not, not getting out and moving very much. So I think any statistics I have from the NIH, if there, before. You know, a month ago, they're probably way out of date as far as what the current reality is like. I'm sure there's going to be its own epidemic of, of pain management. It's really kind of scary. And I think the average person has gained at least 15 to 20 pounds as well.  It's a sad state of affairs. Well, and I think too, the amount standing. So like one of my longtime students, um, is a high school teacher and I'm familiar with her posture because she's been, she's been coming to my classes for years, but she hasn't been coming since the shutdown because now she's teaching high school over zoom. But I've seen her a couple of times out in the world and her posture is much slumpy lumpier. Now she used to teach, standing up when she was teaching in person. And I'm sure she's mostly teaching, sitting down right now. And just, a lot of the uprightness really, you know, being in line with the axis of gravity right over her feet has, uh, it's, it's just really shifted in a way. That's not setting her up for a good next five or 10 years. I think I might've shared with you I've had back surgery. Um, it was really for nerve damage because I was completely losing my left, left leg sensation from my hip to my toes.  Yeah, no, never thought I'd agreed to back surgery, but the surgeon I had was super, super conservative. And he didn't do a lot of work in there. He just basically fixed the nerves. So I still have my three herniated disc, but I, when I worked in corporate, I petitioned the first standup desk. Well, if they offered me a standup desk, of course, they had to offer everyone stand up desk and the general manager used to walk by and he used to say, I spent thousands of dollars on stand-up desks and nobody uses them, but you. And I literally would stand up seven hours of the day. Yeah, it takes off, I don't remember the exact percentage, but it takes off a significant amount of pressure off your spine when you stand up. And I went home with less pain, which is what it's all about. Well, can look at this in the summit when I have the opportunity to share screen and hold up a skeleton and do visuals. The, um, so I used to be a musician, right? And if you think about any string instrument, it doesn't no matter how good you are, how hard you try, how much you practice if the instruments out of tune, you can't make it sound good. And sitting shortens the tissues in the front of the hips and lengthens the tissues in the back. And it doesn't matter how expensive or fancy your chair is or how well you're sitting up. You are setting yourself up for that kind of tuning and standing, has you in a much better balance of the tissue length front and back of the hips. Now, there are going to be some things again that we can look at in the summit about how can you stand up so that you're standing well and you're not creating new troubles. But, um, boy, I stand up as much as I can when I'm, when I'm working on the computer at home, because I feel less tired at the end of the day. Right. I'm less achy. And I'm less tired, if I stand rather than sit. It really is about this tissue length. So if muscles on one side of the joint are too short, then the muscles on the other side will be too long and they'll all be tight. You won't have as good blood flow. You won't have as much responsiveness. You'll just be in kind of a clench. And when the muscles are at their just right length, you're at the best place for having muscles that are supple, responsive, having good circulation, no trigger points, nothing pinching on a nerve. You're just in you're, you're just in a good tone for the tissue so that everything works well. So being too short and too long is going to create tension. And then that tension will interfere with circulation of blood, of lymph, of nerve messages. It's not an optimal situation. Not at all, it sounds painful. And speaking of which, what do most people complain about for pains or aches; like the three biggest issues ? So I'm teaching weekly classes right now on zoom and I kind of run some of them as an improv. And I just ask at the beginning of class, you know, so what do we need tonight? Who are there any body parts, any functions that need attention and the big winners are usually neck and low back. And since the arch of the neck is really closely related to the art to the low back, I really consider those the same request. You might be feeling the trouble more in one place or the other, but it's the same imbalance and it's the same set of activities that's going to address both and then hips and shoulders and then knees. And so those are the big winners that I hear. That makes sense. I totally agree with that. I tell people when I coach, I'm like little things, like, instead of looking down at your phone and when you're reading, looking down at your laptop, raise that up so that your eyes are parallel, and then you're not craning your neck because you just, I don't think people realize if you do this stuff, hours and hours every day, day after day, what kind of effect that's going to have on you longterm. Right. And you know, one of the effects that it has is actually on your bones. There are, there are images that are just scary, especially of young people cause they change faster that are actually growing, like horny deposits at the base of the skull because the head forward posture is so great.  You will deposit bone in response to pressure. And it could be the pressure of a push or the pressure of the pull. And if your head is forward so that the tissues are pulling at the back of the head to keep your head from falling down, you will actually deposit extra bone back there. So yeah, you can change the shape of your bony structure, as a result of posture, how you're sending pressure through and boy, well, you could change it back, but you might not live long enough to reverse some of those changes. And that would take a lot of effort, right? So you're, you're then going to be left with how do you, with the soft tissue team, you have managed the new shape of bones and you shaped those bones from postures. That just blew my mind. Holy cow. That is, that is crazy.  It just makes sense. Your body is an interesting, how it adapts to the pressure of your head leaning forward all the time. I did not know that. Wow. That is so interesting. What do you think about stretching? Stretching, cold stretching, warm? Like what, what is your opinion on it that, you know, what I'm much more interested in is to give a reset to the tissues? Um, so yeah, so before I was a movement teacher, I was a literature major and so I tend to relate to a lot of things. Situations in terms of characters, if your muscles have been holding you in a specific shape for awhile individual muscles might think they're on a mission to maintain a certain length. For example, if you're slumpy and your shoulders are forward, your pectoralis muscles might have concluded that it's their job to keep the upper arm close to the sternum. So now if you go in there right away and try to stretch, you basically setting up a fight and you're trying to ask that muscle to fail at its perceived mission. If you use the other arm to pull that upper arm in closer to the sternum so that you slack in those muscles, in the front of the chest, the pectoralis major. And if you hold that slack for a minute, the muscles conclude. Oh, mission accomplished. Okay. and I don't have to do the work, someone else is taking it over and now the spindle cells reset and they're ready for a new idea. And so now you can go into inviting length and stretching. But I think to, um, to just immediately jump into stretching or strengthening, you're setting up unnecessary conflict and a much kinder way is to go in and reset the tissues. It's very gentle. It doesn't take a lot of time. And then your arms and legs will feel much lighter. You'll be much more available for an upright torso and the muscles will be much more available to work together as a team. So then you can go about your run or your workout in the gym or anything, and you'll have a much more available and coherent team. That is also some new information for me. That is really cool. Wonderful. I took a risk because I have a set of these slackening activities for the hips in particular that I did with my adaptive class last week. And, um, and that's a chair class, so we mostly do things sitting in chairs in there, but I asked them to stand up for a good chunk of class. And I had someone email me that evening saying I'm standing straighter now than I have in eight years and was less pain. Wow. Yeah. And the other people say that they had less pain in their hips and today, cause we're doing this interview also on a Tuesday, a couple hours after I met with that group again, um, they wanted to review that same sequence of things because so many of them got such good results last week. So we, it is, a way of working with the tissues. That's very friendly and gentle and available. Even for people who are very compromised. Like I have people with multiple sclerosis in there and hip replacements and all sorts.  But I've also had people who come in like one young man that would come to class with his mom and then go to the CrossFit gym. And he said his best CrossFit workouts were always on Tuesdays after he'd had a gentle class with me. That doesn't surprise me whatsoever because I  a firm believer in what you put into things is what you get out, with movement and like I say, a reset, I'm going to have to learn about this reset, cause my curiosity is way peak. Oh yay. So, most people are always trying to get the best chair. Can you share your thoughts  a good chair? Yeah. So I'd be delighted to look at this in the summit. It's, you know, images of good chairs and, and good sitting postures. But what I really want to get across is, well, first of all, you need to be sitting well, you can slump on any chair, no matter how expensive or fancy or how many seconds. Adjustable things it has. So you need to use yourself well, and you really need to have at least three to four good sitting options. There's not one perfect way to sit that will solve all your problems. After 10 to 15 minutes in any shape, some of the muscles will start to fatigue. So at  again of the summit, we can look at what are some of the guidelines for a good sitting posture. And then you're going to want to have several in rotate among them. And I really like. We'd love people to be rotating between sitting and standing , because that is really going to be the best of all. But if you are sitting like I've gone to all day trainings that are not movement trainings and we're sitting all day. And so I have several different postures and I usually bring something to sit on to raise me up against and to lean back against the chair. Cause hotel banquet chairs are not any great example of ergonomics support.  So I just do a little preparation to take good care of myself. And then on lunch breaks, I can go for a walk. And at the end of the day, I'm ready to go play. Right. I don't have to recover from the day of training. I'm from the event world and you're right about those chairs that are they're hard. Um, I'm an event junkie, so when I go to an event, my main objective is to get an end chair because I will go stand at the wall and come back and sit at the wall and then come back. So I, that is my goal is to always get an end chair. So I'm not disrupting people. I do the same thing either to get an end or to get a back row and especially right in even just emotional. Is, there's a lot of information coming at me. I feel like I can just handle it better if I'm standing up on my own two feet. If I'm sitting down the, the chance for me to feel overwhelmed is greater. If I'm standing and shifting my weight from foot to foot and I'm just more upright, then I feel a little more like, you know, I'm rising to meet the occasion instead of getting just deluge coming down on topof me. Yeah, I agree with that. More like a power pose. You're standing up you're at attention. I, that makes sense.  I just wanted to share with you one of the things for events that they're trying to implement  in the world is varied seating. So,  the objective is we used to do bean bags, standing tables, and then your typical rows of chairs at an event. The new age concept was to offer the three styles of seating.  I think it's hard to get focused when you're just in the same exact spot for me, it is, I need to move and vary it up. Otherwise you just, I don't know. I kind of fall asleep and you know, it's easy if you just keep moving around a little bit, it keeps the blood circulating, I guess. For me, I just get cold in there. I'm just sitting still on a banquet chair in a, in a hotel room that's cooled off to keep me awake and  I'm just cold. And then when I'm cold, my muscles are tensing up. And, for me, for attending events, the pandemic has been a real blessing because I can do a lot of it from home and I can be standing and I can be wiggling around and I have temperature control. And so  it's made a lot of things very available, in a very comfortable way. I, agree, I like to have multiple screens cause I can watch on one and type on the other, so yeah, there are a lot of benefits. Paula is going to be appearing as part of my summit and, she will be of course, presenting on the art of moving well , she is the movement specialist. So I'm excited about this because I think we all need this, human beings are meant to move, we're gathers and herders and hunters, and we need to move and we just do not and it's a sad state of affairs presently. So  what's a thing or two that we can start implementing? Well, one really quick, simple thing is your eyes are meant to move too. And so one of the real downsides of the pandemic and doing everything online is you're not looking at people across a room or down a hallway, and you're not walking across the parking lot to get to another place. So to give your eyes some breaks during the day, and be looking out the window, look across a Vista, right? Like it have a focal length. That's more than two feet in front of you and, and allow. Allow the eye muscles to adjust to that, get some sunshine for your eyes. To let your eyes rest on something in front of you, but be very aware of what you can perceive with your peripheral vision, so that you're aware more of the context and not only focused because that, that sharp focus , goes a little bit more with the sympathetic nervous system being engaged, right? That you're very focused where as the parasympathetic system, which is set up more for rest and digest and repair of tissues allows you to take in a bigger context. So if you can, a few times during the day, Well, certainly look out the window, give your, gave yourself a distance in a natural view, but also, um, just be aware of what you can proceed with your peripheral vision. It, um, it will be good for your eyes. It'll be good for your posture. And it also just be good for the nervous system to shift into. Oh, right. There's a larger context to my world. Not only this problem that I'm focusing on. That's so cool. I love that, that I never would have guessed that in a million years, you're just such a wealth of information for me. You know, and if I was going to get one more, I would say to, to take a few moments now and then to let your breathing be unhurried because not, not to necessarily be bossy and try to breathe, especially slowly or deeply or anything, but to allow yourself to breathe in and keep breathing in until it feels complete. So that you're not rushing the breath cycle to breathe out and keep breathing out until that feels complete. If a pause arises, allow all the time you need for the pause, because again, it's another cue for the nervous system that there's some leisure. There's the luxury of time here again. Quicker breathing tends to go with danger with the sympathetic nervous system being in charge. And even if you're rushing, especially if you're driving, right, you're not going to get anywhere faster by breathing faster. So even more stuck at a red light, you can be breathing slowly and then you don't have to arrive late as a crazy person. You can arrive at whatever time you do calm and at least well-regulated yourself. And so, um, just taking a few opportunities during the day to let your breathing be unhurried, to take all the time you need. For each moment in the breath cycle can also help give a big reset. That's a fantastic idea. Good point about your breath and something that I've noticed for me right before I got a breathing app was, um, I would hold my breath and I was not conscious of it until I started listening to all this information about breath work, which we will have, a meditation guru coming to the summit. We can look at this in the, in the summit because I can hold up the skeleton, but, and show you. I've been fascinated, the more that I regulate the tone of the tissues in the front and back of my hips, the deeper and easier my breathing because there are so many connections along the muscle and connective tissue between the back of the legs, back of the hips, up the spine, where the ribs connect and up that deep front between the hip flexors, the front of the spine, the breathing diaphragm. And so the more, I actually restore balanced tone to the front and back of the hips, the easier and more free my breathing becomes. You're like Google for the body movement. I seriously this has been amazing. I've learned so much . I can't wait to dive deeper with you during this summit. So my last signature question here for you, Paula, if there's one thing that you can eliminate from this world, what would it be and why? And it doesn't necessarily have to relate to our conversation. I said, I'm going to give you free reign of whatever you wish to say. Well, doesn't not relate. It's the impulse to have power over. And that is partly,  people to people, right. Person to person, the, the impulse to have power over another, I think is a way to not and not create with them. So there can be power with, and you can be powerful as an individual, but, but that desire to dominate and the way I see it, and in my work with individuals with pain is, is that idea of, you know, mind over matter, this power over the body, trying to boss it around is such a stupid way to approach this marvelous, intelligent organism that you could work with beautifully. Um, but I certainly have seen a huge difference in the quality of my relationships with other people who are willing to do power with, and we can both negotiate how we're going to interact and what's going to go on and the power over people who are usually stuck, if I use the writing analogy, they want to be the writer and the director and the producer of any interaction. And I have a bit part, and I'm supposed to read my part of the script that they wrote. Um, but other people who are more into power sharing, we can actually create things and there can be a lot of fun. Better for everybody. Again, then Paula,  good food for thought, for sure. I loved that, hmm. Interesting. Very interesting. Please tell,  our amazing listeners where they can connect with you. And I will also include this in the information for the show notes. Fantastic. I have a website art of moving well.com and I am on Facebook. I have a Facebook page art of moving well with Paula James and a Facebook group, which they can find by checking into the page. And also I'm on LinkedIn, Paula James art of moving well. Oh, right. And I want to thank you, Paula, for coming on the vitality feed today, you have been incredible, I mean, the amount of information that you shared and that isn't even privy to. I love learning, so this was stupendous for me.  I can't thank you enough for taking the time to share, your story and your knowledge with our audience. I really appreciate you. And, I am so excited that you are going to be joining me for my Home Office Hackathon to share with all our remote workers out there , some great hacks to make their day less painful and more productive the in their space. We do promise to offer some good tools and resources for everybody listening and until next time my friends remember,"Life has no remote get up and change it yourself." 

Making the right power moves matter so much in our lives that it tends to overpower us and blind us from what we truly desires to receive in life. This episode opens up the conversation to our money habits and pushes us to grasp more of a foundational hold of our financial awareness. It’s time to create a clear roadmap of our wealth because the Banking industry doesn’t provide us with the depth of funds like the infinite banking concept. It’s time to planet our seeds in intentional areas worth our time and money. Meet the Co-host Paula Smith James has a Bs degree in Hospitality Management with special training in Food and Beverage from Moneague University College in Jamaica and received state license with the state of Florida as a life insurance agent. Currently in “IBC” Infinite Banking Concept at Infinite Wealth Strategist. As a professional interest and focus is on “IBC” Infinite Banking and current project includes project Infinite Banking Policies spendthrift Trust. In addition serving as in a nonprofit organization as a Office Administrator for Levy Ministry International as a volunteer of Levy Ministry International and is honored with the recognition for the implementation of a food pantry as a way to contribute to the community of West Palm Beach Florida which we feed over 100 families each week. Check out her website and the other inspirational ways to find your financial freedom below http://paula.liveiws.com/ https://vimeo.com/430843124 http://paulaj.weeklymarketingwebinars.org/ Meet the host Mahatma Starseed is the founder of Elite Motivation411. As a holistic business coach, Mahatma assist you in focusing on how to approach your career, health, home life and the way you educate yourcellf and your family and/or tribe. You can connect for one on one Spiritual Growth Consulting or Group workshops.      Check out the links below to see how to keep in touch with Mahatma             Follow up with your own private unfoldment. Schedule a session below https://calendly.com/emotivation411-calendly/empowerment   More Scared Services below   https://linktr.ee/EliteM411                                                         Find out more about us on IG/FB  @Mahatma_starseed and elitemotivation411 on YOUTUBE   --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/mahatmastarseed/message

Earlier this year, clinical practice guidelines for the diagnosis and management of von Willebrand disease (VWD) were published in Blood Advances. The guidelines (https://bit.ly/2OIfKLE) are a collaborative effort from the American Society of Hematology, the International Society on Thrombosis and Haemostasis, the National Hemophilia Foundation, and the World Federation of Hemophilia. Guideline author Paula James, MD, of Queens University, Kingston, Ont., reviews some of the recommendations in these guidelines with host David H. Henry, MD, in this episode. Case discussion A patient presents with the complaint of heavy menstrual bleeding, which could indicate a bleeding disorder such as VWD. How does one diagnose or rule out VWD? Tests to order include CBC, prothrombin time (PT), and partial thromboplastin time (PTT). Results of CBC, PT, and PTT could be normal, which would necessitate special testing to specifically look at factor VIII and von Willebrand factor (VWF). A patient’s family history may be helpful, as most types of VWD are autosomal dominant, though two subtypes are recessive. Diagnostic evaluation of VWD VWF is the chaperone protein for factor VIII in the intrinsic pathway, which is measured by the PTT. In more severe forms of VWD, the PTT is prolonged because of factor VIII. VWF is measured separately because it is not reflected in the PT or PTT. The recommendation is to measure VWF antigen and employ a functional assay to see how well VWF binds platelets. The recommendation in the new guidelines is to use the GPIbM assay rather than the ristocetin cofactor assay. Many labs in the United States are still using the ristocetin cofactor assay. However, in Canada, Europe, and other parts of the world, many labs have moved to a newer assay that is automated. It has a much lower coefficient of variation and fewer issues with measurement of VWF in Black populations, which is a major issue with the cofactor assay. Types of VWD Type 1 VWD is characterized by a decreased amount of VWF. Type 1 patients have low VWF antigen and low platelet-dependent VWF function to a similar degree, with low or normal factor VIII. Type 2 VWD is characterized by aberrant VWF. The functional assay is a lot lower than VWF antigen. The platelet-dependent function to VWF antigen ratio cutoff is 0.7. Further testing is warranted to determine subtypes (2A, 2B, 2N, or 2M), including VWF multimers. Genetic testing can be helpful to further delineate subtypes. Type 3 VWD is characterized by the absence of VWF. The patient will have a VWF antigen level of 0, platelet-dependent VWF function of 0, and a reduced factor VIII level (usually less than 10%). Pregnant patients with VWD There is a protective adaptation in pregnancy, in which factors normalize in the third trimester, which works to prevent hemorrhage at delivery. This protective effect is because of the hormonal changes of pregnancy, and it is seen in patients with milder forms of VWD. WVF levels peak within 8-24 hours after delivery and then slowly return to baseline. There is a risk of delayed postpartum hemorrhage once VWF levels return to baseline, which tends to happen 7-14 days postpartum. Procedural planning: Desmopressin challenge test Desmopressin causes the release of VWF from the Weibel-Palade bodies of the endothelium, and it can be used as prophylaxis or treatment of bleeding in type 1 VWD. The desmopressin challenge test is used to check how the patient responds to desmopressin when well, to predict the patient’s response after an anticipated procedure. The test involves measuring VWF levels before desmopressin is given and at 1 hour, 2 hours, and 4 hours after desmopressin administration. The idea is to measure the magnitude of increase in VWF levels and observe how sustained that increase is to predict the patient’s response to desmopressin after future procedures. There is a subset of patients with type 1 VWD who have increased clearance of VWF that causes their decreased VWF levels. They may not have a sustained plateau in the VWF level after desmopressin, which emphasizes why testing as far as 4 hours after desmopressin administration is important. The dose of desmopressin given in this test is typically 0.3-0.4 mcg/kg. Recommendations for preprocedure prophylaxis for type 1 VWD Minor procedures (e.g., wisdom tooth extraction) The patient should receive an antifibrinolytic agent, such as tranexamic acid or aminocaproic acid, 2 hours before the procedure, followed by desmopressin 30-60 minutes prior to the procedure. After the procedure, the patient should continue to receive the antifibrinolytic agent for 3-4 days. Major procedures/surgeries (e.g., gallbladder removal) The guidelines do not recommend desmopressin for major procedures because patients need to be fluid-restricted for approximately 24 hours after administration because of the risk of hyponatremia. Desmopressin is a synthetic analog of vasopressin, which results in the accumulation of free water similarly to vasopressin. The guidelines do recommend giving VWF-containing concentrate to increase VWF and factor VIII to greater than 50% from baseline for at least 3 days. VWF concentrates can be given every 12 hours or as continuous intravenous infusions. Tranexamic acid should be given as an adjuvant both prior to the procedure and in the days following. Cryoprecipitate is not recommended because it can’t be virally inactivated.  Preprocedure prophylaxis in type 2 or 3 VWD Desmopressin does not work for most patients with type 2 or 3 VWD. So even for minor procedures, these patients will need to receive VWF concentrate coupled with antifibrinolytics. Show notes written by Sheila DeYoung, DO, a resident at Pennsylvania Hospital, Philadelphia. Disclosures Dr. Henry has no relevant disclosures. Dr. James disclosed relationships with Baxter/Baxalta/Shire, CSL Behring, Bayer, and Octapharma. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

In episode 03, our Flow team unpacks disordered bleeding. We hear from a member of the bleeding disorders community about her experience with diagnosis and managing a bleeding disorder through pregnancy; and we speak to Dr. Paula James, hematologist, superhero, and founder of Let's Talk Period! Program Notes: Menstruators can experience a variety of disorders related to their reproductive health. Jessica & Christie speak with Dr. James of Let's Talk Period about symptoms, diagnosis and treatment options for bleeding disorders that impact menstruation.  Tune in for an inspiring focus on patient advocacy, Christie's Tips for preparing for a doctor's appointment - and a brief look at the horrific history of “hysteria”. Let's Talk Period https://letstalkperiod.ca/ Christie's Blog Posts / Tips: Preparing for Appointments https://www.howtotalktoyourdoctor.com/blog1/appointmentexpectations https://www.howtotalktoyourdoctor.com/blog1/9-tips-to-prepare Send us a question / share your story! www.bloodstreammedia.com/contact Find our Hosts' on Instagram:  @jessicalaurenrichmond @howtotalktoyourdoctor Recommended Instagram Account: https://www.instagram.com/flowwithyourflow/ FLOW is sponsored by Takeda, the manufacturer of a treatment for adults with von Willebrand disease. To see if this treatment might be right for you and your needs, visit: https://ssshare.it/1Kk8 Connect with BloodStream Media: Find all of our bleeding disorders podcasts on BloodStreamMedia.com BloodStream on Facebook  BloodStream on Twitter    Check out Believe Limited's Other Work: BloodFeed: bloodfeed.com Bombardier Blood: bombardierblood.com Hemophilia: The Musical: breakingthroughhemophilia.com My Beautiful Stutter: mybeautifulstutter.com/ Stop The Bleeding!: stbhemo.com Teen Impact Awards: teenimpactawards.com The Science Fair: thesciencefair.org

We introduce Doug Kerr to the community! Doug is the chief medical officer at Generation Bio, the company investigating non-viral gene therapy. Listen in to learn more about this fascinating science AND Jessica Richmond, co-host of FLOW, will join us to share a preview of her conversation with Dr. Paula James, hematologist, and founder of Let’s Talk Period during the March FLOW episode. A great listen!   Program Notes:  Check out Generation Bio: https://generationbio.com/  Subscribe/listen to FLOW, straight talk about extreme periods: https://www.bloodstreammedia.com/shows/flow  Let’s Talk Period: https://letstalkperiod.ca/  Follow Amy on Instagram Follow Jessica on Instagram

This week I am in conversation with Paula James who teaches women over 40 and a few amazing men to move more comfortably and remain safely active as they age. In Paula’s own words we are ‘ Beautifully Designed for This Planet’ but sometimes, we may experience our physical body as a burden or as a vehicle for pain or trouble. However, with support and upgraded habits, physical movement can be a source of pleasure and delight

With the race season in a state of upheaval, more and more runners are testing their limits in solo efforts. One of these runners is Windsor, Nova Scotia's Paula James. The 46-year-old didn't let her spring race cancellation derail her plans to showcase her fitness.  Last weekend she ran 2:47:50 in her unofficial, and solo, marathon debut. This week we speak with Paula about her evolution from a sprinter to a road runner, and about her lifelong love affair with the sport.  Learn more about The Shakeout Podcast and Canadian Running Magazine on our website https://runningmagazine.ca/category/shakeout-podcast/ Follow The Shakeout Podcast on Twitter https://twitter.com/ShakeoutPodcast Instagram https://www.instagram.com/shakeoutpodcast/ and Facebook https://www.facebook.com/theshakeoutpodcast/ Subscribe to our weekly show on Apple Podcasts https://podcasts.apple.com/ca/podcast/the-shakeout-podcast/id1224828899243

Each week Canadian Running Staff writer Maddy Kelly and Shakeout host Kate Van Buskirk bring you a weekly recap of the news, results and drama from the exciting world of running. This week on The Rundown we recount impressive solo performances by Paula James, Zach Bitter and Molly Seidel.  We also discuss changes to Strava meant to improve the user experience. Learn more about The Shakeout Podcast and Canadian Running Magazine on our website https://runningmagazine.ca/category/shakeout-podcast/ Follow The Shakeout Podcast on Twitter https://twitter.com/ShakeoutPodcast Instagram https://www.instagram.com/shakeoutpodcast/ and Facebook https://www.facebook.com/theshakeoutpodcast/ Subscribe to our weekly show on Apple Podcasts https://podcasts.apple.com/ca/podcast/the-shakeout-podcast/id1224828899243

Paula James, MD, FRCPC and Professor in the Department of Medicine, Division of Hematology at Queen’s University joins us to share insights about the groundbreaking research conducted in her lab with Master’s student, Victoria Candy which explores why female genetic carriers of hemophilia A often experience abnormal bleeding. Listeners gain insight into the research process Continue Reading

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- Open University classics lecturer Paula James explains why Holkham Hall was chosen as a focus to study the significance of mythology and its function in art and culture.

Open University classics lecturer Paula James explains why Holkham Hall was chosen as a focus to study the significance of mythology and its function in art and culture.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

How an episode of Buffy the Vampire Slayer parallels the myth of Pygmalion.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- How an episode of Buffy the Vampire Slayer parallels the myth of Pygmalion.

Open University academic Paula James explains the links between Buffy the Vampire Slayer and classical mythology.

Transcript -- Open University academic Paula James explains the links between Buffy the Vampire Slayer and classical mythology.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

How an episode of Buffy the Vampire Slayer parallels the myth of Pygmalion.

Transcript -- How an episode of Buffy the Vampire Slayer parallels the myth of Pygmalion.

Open University academic Paula James explains the links between Buffy the Vampire Slayer and classical mythology.

Transcript -- Open University academic Paula James explains the links between Buffy the Vampire Slayer and classical mythology.

Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.

Transcript -- Chris Emlyn-Jones, Valerie Hope and Paula James reveal the enduring importance of myth.