Podcasts about PCP

O Chega apresentou uma moção de censura a Carlos Moedas, que como era expectável foi chumbada. A atuação do líder da Câmara de Lisboa, após o acidente no Elevador da Glória, tem despertado várias críticas. Deve Moedas pedir a demissão? Daniel Oliveira considera que está em causa a responsabilidade política e não a culpa perante o sucedido, Francisco Mendes da Silva afirma que a moção de censura é “extemporânea e desproporcionada”. Ouça a análise dos dois comentadores no Antes Pelo Contrário em podcast, emitido na SIC Notícias a 9 de setembro. Para ver a versão vídeo deste episódio, clique aquiSee omnystudio.com/listener for privacy information.

Listen as pulmonologist Peter Dicpinigaitis discusses his approach to the diagnosis and management of patients with refractory chronic cough in the context of a clinically relevant case and provides insights regarding emerging therapies.PresenterPeter Dicpinigaitis, MDProfessor of MedicineAlbert Einstein College of MedicineDivision of Critical Care MedicineMontefiore Medical CenterDirector, Montefiore Cough CenterBronx, New YorkLink to full program:https://bit.ly/4kweynG

In this episode of the Active Bariatric Nutrition Podcast, I discuss:Why reactive hypoglycemia happens after bariatric surgeryHow to spot the difference from dumping syndromeNutrition strategies to keep blood sugar steady & energy stableFueling tips for before, during, and after workouts so you don't crash mid-trainingWhy working with your PCP, surgeon, or endocrinologist and a Registered Dietitian is key in managing this conditionLet me know what you thought of the episode!If you want to learn more about how to adjust your plates based on your activity level, click here to download my FREE Active Bariatric Training Plates handout! To learn more about my new 6-week program, Bariatric STRONG which will open again in Fall, 2025, click HERE to join the waitlist as space is limited and will fill up fast! To learn more about my Bariatric Nutrition Coaching Programs, go to: www.activebariatricnutrition.comFollow Active Bariatric Nutrition at:Instagram - @activebariatricFacebook - Active Bariatric NutritionYouTube - Active Bariatric NutritionTikTok - ActiveBariatricNutrition

João Ferreira, candidato do PCP à câmara de Lisboa, afirma que Carlos Moedas tem de tirar responsabilidades políticas. Também critica Anacoreta Correia por ter assumido "culpa" pelo acidente. See omnystudio.com/listener for privacy information.

Alberto Gonçalves comenta a decisão do PCP em manter a festa do Avante! após a tragédia do Elevador da Glória.See omnystudio.com/listener for privacy information.

João Ferreira lembra histórico do Elevador da Glória e diz que há que ter em conta que já tinha havido descarrilamento. O candidato do PCP à Câmara de Lisboa quer investigação o mais rápido possível.See omnystudio.com/listener for privacy information.

Most people get something very wrong about the doctor—they're not meant for a lot of the things we try to use them for. With that in mind, let's talk about how to get the most out of your doctor visit.  We're going to take a look at what you can reasonably expect from a physician during a quick, infrequent visit with them. And then I'm wrapping up with some thoughts on health insurance—what you need to know and what you can expect when searching for a provider who can help you with your vestibular disorder. In this episode, we'll dig into: What most people assume incorrectly about their primary physician The No. 1 thing to avoid during a doctor visit 3 tips to keep in mind for your next medical visit Important information to bring & share with your PCP What you need to know about health insurance & out-of-network providers Since I don't have the power to change the healthcare system, I want to help you navigate it more easily. For even more tips, join us in Vestibular Group Fit (use code GROUNDED for a 15% discount)! Links/Resources Mentioned: Vestibular Group Fit (code GROUNDED at checkout!) More Links/Resources: ⁠The 4 Steps to Managing Vestibular Migraine ⁠The PPPD Management Masterclass⁠ ⁠What your Partner Should Know About Living with Dizziness⁠ ⁠The FREE Mini VGFit Workout⁠ ⁠The FREE POTS - safe Workouts⁠ ⁠Vestibular Group Fit (code GROUNDED at checkout for 15% off your first subscription cycle!) ⁠ Connect with Dr. Madison: ⁠@⁠⁠TheVertigoDoctor ⁠ ⁠@TheOakMethod⁠ ⁠@VestibularGroupFit⁠ Connect with Dr. Jenna @dizzy.rehab.therapist  Work with Dr. Madison 1:1, Vestibular Rehabilitation Therapy Vestibular Group Fit Small Group Coaching (offered throughout the year, sign up for our email list to learn when!) Why The Oak Method? Learn about it here! Love what you heard? Reviews really help us out! Please consider leaving one for us.  This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— living with vestibular disorder, vestibular support group, vestibular dysfunction, vestibular disorder, vestibular migraine, dizziness, DO, medical provider, PCP, primary physician, tips for going to the doctor, healthcare system, medications & supplements, diagnosis, meniere's disease, BPPV, lifestyle changes, dietary changes, exercises for vestibular disorder, insurance, out of network, HSA, FSA, doctors appointment, doctor visit

In this episode of the "Southern Medicine Podcast", Tatiana Havryliuk, MD, and Randy Glick, BSB/PM, MCP explore how a quick bladder scan can streamline care, reduce costs, and improve patient comfort as they discuss a case in which a patient with BPH presented to his PCP with progressive urinary hesitancy and suprapubic pain. Using point-of-care ultrasound (POCUS), his provider identified a significant post-void residual volume and managed his condition on-site, saving him a trip to the emergency department.  Dr. Tatiana Havryliuk is an emergency physician and founder of Hello Sono. With 15 years of experience using POCUS in diverse settings, from urban EDs to Everest Base Camp, she is dedicated to extending its benefits to more patients. With Hello Sono, she and her team support practices in building compliant, high-quality, and profitable POCUS programs through tailored education and implementation.

In the U.S., nearly two-thirds of women over 50 already have low bone mass, and almost one in five have osteoporosis. For many, that means a higher risk of fractures from everyday movements — twisting to grab a dish, hitting a bump on a lawn mower, or a simple fall.In this episode of The V Movement, Allison Craig, PT, unpacks why bone health is such a critical piece of women's health in the perimenopause and menopause transition. You'll learn:1. How estrogen protects bones — and why bone loss accelerates during menopause2. The surprising amount of bone mass women can lose in just a few years3. Why fractures of the spine and hip are life-changing — and often preventable4. The power of resistance training (with evidence from systematic reviews & meta-analyses)5. Simple, realistic ways to start strength training now — no gym membership required✨ Whether you're in your 30s and planning ahead or already postmenopausal, this is the time to take action. Strong bones mean independence, vitality, and confidence for decades to come.⭐️⭐️⭐️ Sign Up Now for our 8-week Menopause Masterclass Fitness & Wellness Series — a transformative program for women ready to feel strong, supported, and empowered through menopause.

Part 3 of our Terminus 2025 interviews continues with Everything Goes Cold, plus this week's edition of Into The Vault features Veronica Lipgloss and the Evil Eyes!Playlist: EKKSTACY - SadnessCemetery Sex - LeviathanBonnie Trash - Poison KissAversions - Water DisciplineThe Velveteers - On And OnCousines like Shit - Sober At The ClubVeronica Lipgloss and the Evil Eyes - DiscoVeronica Lipgloss and the Evil Eyes - Driving Thru The RainVeronica Lipgloss and the Evil Eyes - Strip Mall GlassThe Birthday Massacre - The Vanishing GameArt d'Ecco - True BelieverTebby & The Heavy - In My ShadowArtificial Go - YayaMotherhood - SunkLung - The SwimmerEverything Goes Cold - NadirDamsels, featuring PCP - private_affairsDebby Friday - Darker The BetterMoonlight Ransom - Find Your Way BackUnderground Wires - Moonlight Encounter (Suspicious)Fusilier - BirdsStefan Smulovitz - The PierBrian Eno & Beatie Wolfe - A Ceiling And A LifeboatNick Cave and The Bad Seeds - As The Waters Cover The SeaHermitess - The Birds Never LeftJolie Laide - Saw The WaveSunnsetter - The moon, and in the waterTalking Violet - Beach Baby

Passou a noite do 25 de abril a chorar agarrado à G3, no quartel de Mafra. Fez a primeira greve nas forças armadas. Foi corrido à pedrada nas campanhas de dinamização do MFA no Alentejo, por estar a tirar emprego aos locais. Luís Pinheiro de Almeida recorda a censura e a pancadaria quando o PCP tomou conta da sua agência noticiosa, onde trabalhava como jornalista ao mesmo tempo que era assessor de imprensa de Otelo. No dia 25 de novembro parecia um pistoleiro mexicano todo armado quando foi visitar o pai, que fazia anos: “Parabéns, pai, não posso ficar, estou em guerra”.See omnystudio.com/listener for privacy information.

On this episode of "The Founder's Sandbox", Brenda speaks with Donovan Ryckis; CEO of Ethos Benefits, the nation's leading fiduciary benefits consultant in mid- -large market employers. Ethos Benefits was founded in 2016, after a chance request from a client of Donovan when he operated as a financial advisor--the client was faced with an increase in the companies' health insurance bill for the companies' employee plan that would have had a financial burden that threatened the sustainability of the company.   ‘Ethos' represents the guiding principle, character, or spirit of a person or organization. It's the ‘why' that drives decision-making and fuel's purpose.   Through Donovan's origin story we will have our eyes opened as business owners to the potential risks of employer sponsored healthcare plans and how to mitigate these risks. You can find out more about Donovan and Ethos at: www.linkedin.com/in/donovanryckis Upcoming master class on August 14th https://ethosbenefits.com/ https://businessofbenefitspodcast.com/ For a limited time only access the documentary: It's not personal, it's just  healthcare. https://ethosbenefits.com/documentary/     Transcript:  00:04 Welcome back to the Founder's Sandbox. I am Brenda McCabe, your host on this monthly podcast. It reaches  business owners and entrepreneurs who learn about building resilient, scalable, and 00:32 purpose-driven companies, all with great corporate governance. I am Brenda McCabe, and I am your host. And the guests that come to the podcast are not only those founders and business owners who are sharing their experiences, but also corporate directors,  investors,  and professional service providers who, like me, want to use the power of the private enterprise, small, medium, and large, to create change for a better world. 01:00 Through storytelling here and a recreated  sandbox,  my goal is to equip  one startup founder or one business owner at a time to build a better world through great corporate governance. Today, my guest is Donovan Rikas.  He is joining the podcast as CEO of Ethos Benefits, the nation's leading fiduciary benefits consultant in the mid to large market employer space. 01:29 So I'm absolutely delighted to bring in a professional service provider in  the employer benefits area, which  we're going to  unpeel  this  sector  today in the podcast. it's fascinating. So thank you, Donovan, for joining me today. Thank you, Brenda. Thanks for having me. Excellent. So  the company you and Chelsea, your wife and president of Ethos Benefits, 01:59 was founded in 2016, which wasn't that  long ago.  But it happened serendipitously.  You got a chance request because at that time, you were a financial advisor, right? Yes. When  your client was faced with an increase  in the company's health insurance bill for their employee plan,  pardon me, that would have had such a financial burden,  it would have threatened the sustainability of 02:27 the company and that's your client. So what did you do Donovan? What was the origin  of Ethos Benefits? Thank you. Yeah, so that's exactly right. I started as a financial advisor.  So Ethos Benefits was formerly a registered investment advisory, which was Jay Donovan Financial.  And one of the interesting things that are a little bit different on the security side versus the insurance world is 02:56 the ability to  license and designate yourself as a fiduciary advisor to your clients.  So that's really important and that's kind of where we started as financial advisors. So that essentially means that you're not gonna be commission-based with variable commissions based on what you wanna sell and the client doesn't really understand, right? You're gonna be  transparent with how you earn any compensation. 03:23 and you're not gonna have any conflicts of interest that might change  the recommendations or advice that you're giving them. So it's gonna be flat fee and you get to work with them directly instead of working for the financial institutions and the insurance companies kind of in the background that are actually the ones incentivizing. Cause  it's this odd relationship where it's like you think the financial advisor is working for you but they're actually incentivized by the institutions  that they're representing. Very important clarification because we do have a question 03:53 further on, which is, you know, what, what, how does the 401k management, right about employers 401 plan, mirror that of healthcare benefits? Yeah, for sure. You'll start to see some of those. So that's how we're working as financial advisors. And that's an important distinction as we get into an explanation of 04:22 the whole healthcare industry and how that works. So you're exactly right. I was working as a financial advisor, working with business owners  because they had more kind of complicated planning and tax structures and things that I could do to really make a difference.  And what I realized is when most of them had commission-based advisors, they'd rush to sell a product, mutual funds  with upfront loads and REITs that had  proprietary commissions and all this kind of stuff. And then they would leave without worrying about any of the 04:52 tax consequences,  you know, islets or trusts or even wills, right? Like all these extra things that business owners needed to set up their own personal wealth, but also their company, their 401k, maybe combining a defined benefit plan. So that was kind of the niche I chose.  And it was incredibly lucrative. I loved it.  Was doing exactly what I wanted to do until that client kind of asked me for that help, like you alluded to. 05:21 And it was 40 % increase on his health insurance. He said, my broker says, this is it. There is nothing else. Can you help? And I didn't know any idea. Like I had no idea about health insurance or what I do. But yeah, just- No, no. problem. 05:39 And certainly as a financial advisor, it kind of seemed like going backwards and beneath me. didn't really want to do it, but I was like, I could hear the panic in his voice. And I was like, yeah, absolutely. Just send me everything you have. And after about three weeks, basically making as many connections in the industry and learning as much as I could and trying different things, we basically mitigated that increase entirely. 06:05 And he actually came three points under where he was currently today before that increase. And we didn't take away any benefits from employees. We didn't put them in smaller  HMO networks. We didn't increase deductibles or increase their premiums. None of the usual tricks.  So this was a like for like solution. We actually improved the plan a bit and came in under.  And it really made me realize in that moment, it wasn't my experience or my education or my smarts that 06:34 may be able to do this,  it was a lack of conflicts  in compensation and incentives,  right? Because his broker does about $7 billion a year annually.  I didn't come in with more market knowledge, leverage, or experience. I just didn't have conflicts of interest and compensation. That's what  started me down this path.  And  back then,  you hadn't yet  created Ethos Benefits with that name. 07:03 So when I did a little bit of research,  I couldn't have been more delighted that you actually reached out to to be featured on the founder sandbox because of two reasons, you the word fiduciary, right?  It was in  your basically your call to action, right? Or your or the definition of company. So,  you know, you  are  the governance of a company goes way beyond making a profit for shareholders. 07:32 the duty of care, the duty of loyalty and the duty of obedience is really the underpinning elements of  fiduciary duty. And on your website, you say our ethos is simple fiduciary first. So we're going to appeal that in here in a minute here. So act in the best interest of those we serve,  no matter the cost. You also on the website,  you you had a purpose ethos represents the guiding principle. 08:01 character or spirit of an organization or a person is the why that drives decision making and feels purpose. So I,  I looked like I was reading what next act advisors may consult a firm is about is just really finding those purpose driven. So  with that, I wanted to just, you know, ask you,  what was that you had that first client that first aha moment, and 08:29 How long did it take you and did when did you realize that this could be a a career change for you, right? Rather than a financial advisor, you were actually actually a health care benefits advisor, right? Yeah, I mean, I think I think the first moment is, you know, being being a financial advisor was very lucrative. And I like the people I was working with. I liked working with entrepreneurs and business owners and and, you know, just 08:58 I found them inspiring and I was curious about the things they're doing. And  I think that kind of lifts everybody up when you keep a circle like that, right? Like you  push yourself harder, you learn, educate and do different things.  So I love the clients I was working with. Like I said,  maybe  working on personal wealth for individuals though, isn't the most rewarding thing you could be doing. seeing that... 09:25 Don't get me wrong, I was paid well enough. It would have took me a long time to figure out that it wasn't very personally fulfilling.  But seeing that first case, mean, the first thing I did when I got that successful proposal back, before I presented it to the clients is I was looking at the math  of what does this cost? What difference does this make per paycheck to all the individuals in this planet? And then I'd look at somebody, my God, this person's got a wife and two kids. Look at the difference in premium there. 09:54 I was calculating my work in return to the average American worker and realizing like me putting myself aside to  proactively, strategically go after this problem instead of making a decision for my own personal commission, looking at how much that impacted everybody. And that was powerful. 10:20 I'm going on 20 years in financial services and every aspect of it, I've seen people who prioritize commissions over, you know, a better product, a better outcome for an individual. But the idea that that could be done on scale to where you're now making that decision for yourself over 200, 500, 2000, 3000 employees, like that's pretty disgusting, right? So seeing that that kind of impact could be made. 10:49 I mean, it was  it was really not a question after that I knew I was transitioning my business. Excellent. Excellent. So  my own path  after 25 years in Europe  was quite an eye opening experience when I came back to the United States, I am a US citizen, but I had to get you know, I've been working for myself and I had to get self insured. So  I got back this is like 11:18 12 years ago, I got the Affordable Care Act for dummies from my local library.  I had not yet transferred my tax certification to the United States takes quite a few years when you've been gone so long.  So you because you do have to sub venture tax returns and all that. And then  I ran into I met Marshall Allen, the author of never pay the first bill and the other ways to fight the healthcare system and when 11:46 Marshall Allen actually spoke at  a graduate or alumni event of University Chicago. And  I was, you know, reading these books. And you know, eventually,  I got my own broker to help me get onto the exchange. But it every year has been  an experience.  I'm fortunate to be part of a  membership organization through which  for small  and medium sized businesses and I get  PPO through 12:14 I won't mention names, but  I was  blessed because just  and I'm 12 years in the United States, you have to knock on a lot of doors to actually get health care when you are a small business  owner  and really  understand what  you are paying for,  not only your premiums of what are the services  that are provided. So can you talk about  the average 12:44 premium for a family of four and some of the  numbers that you discovered  and believe  we as a country could actually improve  on the outcomes, healthcare outcomes with the actual spend we have today, right? Yeah, we're getting the numbers are pretty wild. mean, I feel like we're really kind of getting to a breaking point with it.  You know, 13:12 For what I work on, employer-sponsored healthcare, 186 million Americans are covered under employer-sponsored healthcare plan. These plans can average increases anywhere from seven to 10 % annually. We see a lot of reports that come out that kind of measure these things. Kaiser Family Foundation does one, Milliman Index is another one. So there's a lot of studies that kind of measure this annually and changes for employers across the board. 13:41 What we saw this year for 2025 was the average cost for a family of four under employer sponsored health care plan is $35,119, which is just an astonishing number. That is unaffordable for an employer. That's unaffordable for an employee. And it's unaffordable for them to split that cost as well, which is how these, yeah, that's how they're structured in some way or another. 14:11 And another number to know that kind of governs this is the ACA affordability percentage, which is essentially where employers have to contribute, they have to contribute enough to keep the premium under this amount, which is 9.02 % this year. So premium for one of your employees cannot exceed 9.02 % of their take-home pay. 14:39 And this is updated on an annual basis, correct? Correct. Yeah, it fluctuates a little bit, but it's always right at 9, 8.5, 9.2, it's balanced up and down. But that's a pretty astonishing number too. And I see a lot of companies that are basically designing their contribution just to stay under that. it's, obviously they'd love to do more, but with the way these costs increase annually, sooner or later, they get to that point. 15:07 where they're kind of designing it just to be under 9 % of the employee's income. Okay, that's  astonishing.  And I'm happy that you  are working nationwide now with employer benefits with companies that, what's the size of the companies that you typically sell to? So we only work with large employers these days. And if we have somebody come in a little bit under, we have some associate agencies that we can kind of refer them to. 15:36 I'd say our minimum is usually like 250 eligible employees all the way up to 5000. Yeah, so anywhere in that mix. Excellent. So when again, I first met you was unaware because you've basically become nationwide in the last what two, three years, right? I'd say around COVID. Yeah, I took off right. So when I was speaking with you spent some time on the website. 16:06 I was trying to understand the sales alignment. So how you reach customers, those employees that have 250 between 250 and 5,000 employees, right? My first reaction was, OK, Donovan, go in with either of these benefits. You do a cost down, right? You've done, you basically work yourself out of the job. You corrected me. So for my audience, so how? 16:32 does ethos benefits work for a company, right?  What is that?  Is it is it an annual  engagement  talk walk me through the work you Yeah, I mean, things are happening on a daily like when we break down our scope of services, we'll actually show them like,  these are daily, these are weekly tasks, these are monthly, quarterly and annual because there's so much happening.  So  we're talking about the employee benefit space. Yes, it's  the 17:01 kind of designing consulting for the annual premium for a 12 month period. I think that's what people first consider.  But there's also a ton of compliance factors that have to happen throughout the year that that company has to fill out, right? Could be anything from section  125s,  5,500s,  wrap documents, all kinds of notices and disclosures  that need to be done.  Also, you know, we deal with benefits administration. So that's... 17:29 How are the employees making elections, seeing premiums? Is that integrating into payroll?  So functions like that with eligibility in and out of the company  adjusting that.  But also we kind of discussed and talked about the fact that health care is incredibly complex. So all the same market influences, where the market's at, interest rates,  inflation, all that kind of stuff affects  health care rates just like any other company in the market. 17:58 but it also gets as granular as  new medical procedures, new drugs, new generic drugs that are now an option.  It can even go down, you know, locally or regionally to where we get a new CFO in a hospital group and that starts changing the reimbursement rates that they're requesting from the insurance. So we see that where kind of a CFO comes in and they start flexing, making life difficult in a particular region or with a hospital group. 18:28 So all these things are kind of coming together and changing every single day.  Also the fact of the sheer amount of bills,  claims that come through.  So what we see on average,  this is a pretty crazy number, but  what we see on average is 18 claims  per employee per year. Okay, that's a lot.  That's a lot. So if we had just a hundred employees, that'd be 1800. 18:56 basically accounts payable  into the company. And that's part of our job too, because as you might imagine, hospitals make tons of mistakes on the bills, about 80 % of the bills have mistakes.  And then we also have to make sure that those are coming in at fair reimbursement rates to the company, because what hospitals bill is a spectrum for the exact same procedure. And the only difference is the payer. It's not the patient, it's not the complexity, it's not the physician, like it's literally 19:25 just the insurance card that can affect that difference in reimbursement rates. So all these things kind of come together where, yes, it  very much is a daily  task for me and my team on different things that we're working on. And- Are you an advocate in any way for the employees? Yes,  very much. So, you know, it's two, there's two complicated ecosystems at the same time that we're trying to navigate. 19:52 One is certainly the healthcare finance, which is what we're working with the company. But healthcare delivery for employees and members is just as complicated and confusing as far as where do I go? What is this gonna cost? What's the next step? Can I get a second opinion? How would that work? Right? And also helping navigate them to their highest cost or their lowest cost, highest quality and understanding what that is and giving them options to seek care at. 20:21 at lower prices if that's available. Excellent.  So your  delivery platform, is it like a customer success team  that  is assigned solely to that client? How does it work? Yeah, so it's kind of different. every employer is starting at a different place. They also have different ideas of where their end place or where their goal is. 20:49 healthcare delivery, kind of working on some things like that, there might be a couple of different ways we handle it. One might be having a direct  primary care provider. So the idea of a direct  primary care provider is basically same day, next day appointments with your primary care physician  and 30 to 60 minute visit times, not the average, which is seven minutes with a PCP, which is what most people get across the country.  And  with that DPC provider, you can also do things like 21:18 stitches,  blood work, get generic meds. So we're talking about more of a comprehensive service when you actually need it, not  the 14, 18 day  primary care. So that might be one of the ways we help with healthcare delivery.  It might be a nurse concierge where they have a nurse that they can help find providers,  navigate them. That might be a part of it.  So it kind of depends. then also  a lot of the times are 21:47 Our team will basically act as a care coach, where if they have anything going on, they can just call us. We'll help them set appointments, navigate them towards care, help them with their ID problems. Fantastic. Anything else you'd like to share or shed some light on the service offering of ETHOS benefits? So we're going to jump into a legal question in a minute here. 22:13 Yeah, I mean, it always just depends on the employer.  what I would say is generally they find everything we do to be  more comprehensive. And I think that's just the nature of the fact that we're not seeking compensation from the insurance providers or working with the client, because  it's my belief that we don't have a single thing to sell to an employer.  Employers have a health care problem. And we're here to solve that and work through that in any 22:42 way that they need at that given time.  So we're not,  you know, pushing those solutions are having those conflicts.  It's an excellent segue down into  current lawsuits  that are popping up with respect to,  first of all 401k, lawyer, and now healthcare benefits. So before we jump into that some specific cases, you know, for my listeners, what does fiduciary mean? 23:12 in your business model, right? Please. Yeah. So fiduciary for us is certainly always acting in the best interest of those that you represent. It's the highest standard of care.  So you mentioned a couple of things  earlier, loyalty, obedience. I think the biggest thing where companies may think they're acting as a fiduciary and they're not, because while we carry that duty to our employers and our clients, 23:40 Employers have that duty to all of their employees. And that's something that are kind of educating them because a lot of them don't realize it. But  I think the big duty that is  left out or misunderstood is the duty of prudence.  Okay. So did they go far enough in investigating solutions and understanding the problem and working through it and having a committee within the company to kind of help go through that? Because what I mean, in a compensation package, there is nothing more important 24:10 than the cost of health care and the options in health care, right? And how those decisions are being made.  So I see the duty of  prudence being the kind of  most 24:23 I, the duty with the most opportunity, let's say, maybe, maybe the most misunderstood because  the employer sometimes think, well, you know, the broker came in and he showed me one or two other options.  This is the least worst option. Therefore that's what we're doing. And I think that's enough. Right.  And that is not the case.  And it's only until there's a 40 % increase due, right. It doesn't employer say  my business is not sustainable. 24:51 So actually healthcare is what not the number two or number three expense  in the company's PNL today. Correct. Right. So walk me through some of these  recent lawsuits.  Yeah, I think we have companies like J &J and JP Morgan. Speak to me about that. 25:14 Yeah, J. J. J. P. Morgan, Wells Fargo. A lot of them are almost they're copied and in some parts of the complaint,  because it's very much the same thing. the first one we saw was  Lewandowski versus Johnson and Johnson. And this is for their health care plan. You know, they're a Fortune 50 company.  I think they somewhere around 160,000 employees. 25:42 and they have a benefits committee and a benefits team of 16 or 18 people. So a big team of people to help make these decisions, understand them and vet them. And the lawsuit is basically for their decision of pharmacy benefit manager. So a pharmacy benefit manager essentially sets the price for any drugs that employees could get within the plan. And it lays out 35 or so specific examples of drugs 26:12 but basically they agreed to pay  up to  13,000 times  the cost of the drug that's available, just cash pay.  employee and employer funds are agreeing to pay that kind of multiple on a drug that's available without insurance, much, much cheaper.  And the  lawsuit is brought by the plaintiffs, who are they? 26:40 am Lewandowski. So she's she's the plaintiff. And then I believe as it's developed, other employees have kind of came on. So 13,000 was it do you know, I know that you're not directly involved in this case. Nor should you speak to it if that is the case. But is the transparency of the data? Can you get that data if you were an employee to then understand the 27:09 multiples that your employer plan has agreed to pay to the pharmacy benefit. I'm aghast. 13, I think the number is 13,226. So when this came out last January, the first thing I did is I read through the whole complaint. It was like 130 pages went through all these. So for all the drugs that were mentioned, I ran 27:40 J &J's prices, again, Fortune 50, 150, 160,000 employees. So you would assume they're getting leveraged prices, they're making great decisions, all those kinds of things. I ran those prices against what my clients were paying. And in the smallest, like I think our smallest in my book of business, like 100 insured employees somewhere around there, they were paying 94 % less. 28:06 for the same, for one fill of all the same drugs. So the math worked out to be like 135,000 for J &J for one fill of each of those. And my clients were like 3000 or 4000, don't know, it's all my LinkedIn. posted the public letter as soon as it came out. But I basically price referenced them. So it's not a question of leverage or buying power, know, all the ridiculous things you hear. 28:34 when you're talking to  an insurance broker for these types of decisions,  it's literally, it comes down to that question of prudence. Like,  how did you vet these decisions?  Do you know how the pharmacy benefit manager is getting paid? Do you know what these drug benchmarks are against the cash price?  And that's  where I think this lawsuit is gonna be a slam dunk. Like, there is no reason for a company that size with that big of a benefits committee to hire such a conflicted PBM, is what they call it. 29:04 You heard it here on the founder sandbox. So stay tuned for  any other  lawsuits that are  worthy of mention. Do all of them? Are they all related to the pharmacy benefit manager conundrum?  There's there's all kinds of lawsuits. I think the PBMs are the lowest hanging fruit because it's so easy to benchmark. But certainly the same arguments exist with  hospital reimbursement rates. 29:33 And we're starting to see those as well. Excellent. Well, thank you  for sharing  a bit more  details on  the  recent,  I guess,  health care benefits in the news, right? Lawsuits.  Going to get a little bit technical here. 29:57 because you allowed me to.  the framework of the CAA of 2020 and 2021, that's the minimum set of standards for activities to benchmark health care plans.  And so  what are they?  Because it then leads into  some of the common sense strategies  that employers can deploy immediately.  So can you walk? Because this is just as yesterday, it's actually during the pandemic. What's the CAA? 30:27 of 2020, 2021. Thank you. Yeah. So that's the interesting part of this. So the reason I said a decade ago, over a decade ago, I was waiting for these health care lawsuits to happen. It's because Arissa has always stated that  employers have this fiduciary responsibility, just like they had with  401k. The problem has been, and the reason these lawsuits didn't come sooner, is that health insurance companies  make this data hard to access. 30:56 different carriers were released different amounts.  And there was no set of compliance standards for employers to understand this is how I go about making it, making these decisions and benchmarking these decisions, right? Like  it was all just too vague, too opaque. The data was too gagged and withheld from the employers.  So the starting point of how do I know I'm being prudent or not, that's kind of what wasn't known prior to the  CAA of 2021. 31:27 So  the CAA  basically defined a set of minimum standards  that you have to do to even pretend like you're being a prudent fiduciary for your healthcare plan. So there's four things, but there's three main things. I'll mention the fourth thing as well, because there's funny stuff about that.  So the first one  should be the most obvious, and  it's kind of our founding story, which is understanding 31:53 your broker compensation before you enter into any arrangement or agreement for your upcoming plan. So that should not only be how much,  it should be when, what type of bonus is there. If you're looking at carrier A, B, and C, really what it says is you should know what is their compensation for carrier A, B, and C before you make an arrangement, because they will be different. And that will change the recommendation, the advice, the conversation that you're having with that broker. 32:23 is critical. That is so critical. And  in reading these transparency commission  disclosures from  brokers, it is wild, the stuff that they put in there and how conflicted their advice is.  One of them that I looked at last week said, broker acknowledges that their parent company has equity in the insurance carriers that they're recommending. Oh my gosh. So they're essentially saying, 32:52 We are an insurance company that's going to bias our recommendations to the own companies we have equity in. It's like, that's no longer a party you should take advice from, right? 33:07 Okay, so that's part one.  Yeah, no, this is this is  and you know,  I without it's gonna get too technical because the gag clause and  the prescription DC reporting so that you know, basically CAA has provided the set of benchmarks, right, which  you need to at least checkmark right before you actually do. 33:35 engage or decide on your employer benefit plan.  Yeah. To be in compliance with your fiduciary duty, particularly that of prudence. Yeah.  Yeah. And I think companies shouldn't look at as a checkmark. I think if they apply it with a good faith effort, they'll see like, oh,  it's not compliance. This is a framework  for making better decisions.  Right.  And that's what it's meant to do. It's meant to say, 34:05 Know your compensation, know your drug benchmarks,  and  eliminate any gag clauses to your data because you need your data to make decisions. So I think if companies make a faith effort, they'll automatically get better outcomes. That's the way here. Excellent. Well, thank you, Donovan. I want to give me this time to actually  speak about  how to contact you,  your company. But more importantly, 34:34 There is  you're hosting a webinar on August 14, which is right around the corner. Can you  give us some more details?  The details will be in the show notes,  but speak to the event that ethos benefits is hosting on August 14 2025. Thanks. Yeah, thank  you.  Yeah. So on the 14th, we're doing a fiduciary workshop masterclass, which is basically understanding what your 35:03 what your duties are, how to get through them, how to navigate them, how to have this framework for decision making and document that process as well. And it's all geared towards just achieving those better outcomes for your company, eliminating any of these risks and really creating positive results for your people. Excellent. And any information with respect to how to reach out to you beyond the- Yeah, sorry. the registration is on a banner on the top of our 35:33 on our homepage. So ethos benefits.com. If you connect with me on LinkedIn, LinkedIn,  Donovan, ragas, you can find it there as well.  Great. Well, I'm coming to the  part of my podcast, which  brings us back to the sandbox.  In my work, I'm all about working with purpose driven, scalable, and resilient companies. 36:00 And so I ask my guest, what is the meaning of each of those terms? What does purpose mean to you? 36:08 Purpose, what does it mean to you? That's such a big question that you can go a lot away from. You know, I feel like purpose should be almost like a hidden driver. It's almost not like a well-considered thing. It's just kind of driving you forward.  I think our purpose  is progress,  right? Like if something can be done better, it should be and just kind of moving forward with that. 36:35 We're trying to move one company at a time, but also the industry and better outcomes  for the country. 36:43 And that good feel factor when you get up in the morning and know that you're doing good, right? Yeah, absolutely. Let's just sleep well at night. Right? Yes. Amazing. How about resilience? You did share with me off  camera that yeah, while you abandoned the financials,  advisory role, it took almost five years, right to really find product market fit, right  and build this because it's a very unknown right industry. 37:12 unknown service within a very, very  complex industry, right? Yeah. So resilience for you, what does that mean?  Yeah, I think you're right. You know, it took us a while because we were sharing such a wildly different message than what people were hearing from their brokers. And sometimes they look at you and be like, well, you're small, they're big, that must mean they're right, right.  So I think resilience is being able to go from 37:42 failure to failure without any loss in energy, right? So when something doesn't go your way and you have an obstacle, an outcome that is less than desired, it's about being able to push on still without losing any of your optimism or energy. And that's all we do. So. Thank you for what you do. And scalable. What does scalable mean? 38:07 Scalable is certainly about having an actual documented process. I think when you're getting into something new as a company or a new system or procedure process, if it's not something that everybody in the company could repeat in the same way that I do, just inherently the way I do it because of my background and education, if it's not repeatable for everybody and everybody doesn't understand the purpose for those steps, 38:36 the outcomes from those steps, like the end result, it's definitely not gonna be scalable. Thank you. Final question. Did you have fun on the sandbox today? I did. Thank you so much for having  me. Thank you, Donovan.  So to my listeners, if you liked this episode with Donovan Rikas from Ethos Benefits,  sign up for the monthly release of founders, business owners, corporate directors, and professional service providers that share their experiences. 39:06 and how to build with strong governance a resilient, scalable, and purpose-driven company to make profits for good. Signing off for this month, thank you very much. Have a great day.  

Erica and Steve wash down seven hot dogs with a gallon of PCP!The Horror Hippies on Social Media:Instagram: http://instagram.com/thehorrorhippiesErica Nelson on Social Media:Instagram: http://instagram.com/ericablair___Steven Hugh Nelson on Social Media:Instagram: http://instagram.com/stevenhughnelson/IMDb: https://www.imdb.com/name/nm3841612/

Asking questions about mental health is not easy. What's even harder is asking those questions well. But here's the truth: community providers are uniquely positioned to spot the early warning signs of mental health struggles, including suicide risk. In fact, youth who attempt or die by suicide are far more likely to have contact with their PCP compared to a mental health provider in the months leading up to the event. Are providers identifying kids at risk? Are they asking the right questions in ways that open the door to real answers? In this episode, we confront this critical reality in front of a live audience. We are bringing practical tools to the hands of providers in our community. The way providers screen for emotional and mental health challenges can mean the difference between silence and survival. This episode was recorded in front of a live audience as our first community podcast experience. Stay tuned as we announce more opportunities like this across the region. This episode was cosponsored by The Liv Project: a nonprofit organization determined to take the conversation about youth mental health out of the shadows. For this episode, we have three incredible experts. Honey Beuf is the Co-Founder of The Liv Project, Liv's Mother, as well as an educator and advocate. She was on the podcast previously to share the story behind their documentary ‘My Sister Liv.' You can listen to that episode here. Susan Caso, MA LPC, is the Mental Health Advisor for The Liv Project, as well as a licensed therapist and author. Gina Herrmann, MD, is a pediatrician with Arvada Pediatric Associates. Some highlights from this episode include:  How specific word choices or ways to phrase a question can make a huge difference in creating a safe space for children  Ways primary care providers can support families of children experiencing suicidal thoughts  Steps PCP offices can take to implement helpful mental health support processes  Understanding the support systems that exist in communities around the globe  For more information on Children's Colorado, visit: childrenscolorado.org. 

In this reflection episode we hear from PCP listeners who generously share their stories of survival with reflections, questions and advice. It's a vulnerable conversation with an emotional ending but we hope it helps people find the kindness and compassion for themselves that we work on for ourselves. Thank you to everyone who contributed, we feel so lucky to have you in the area with us!

Jesse P. Pollack: The Acid King ( Ricky Kasso )Real stories. Real teens. Real consequences.A murder in a small Long Island town reveals the dark secrets lurking behind the seemingly peaceful façade in this latest installment of the Simon True series.On June 19, 1984, seventeen-year-old Ricky Kasso murdered Gary Lauwers in what local police and the international press dubbed a “Satanic Sacrifice.”The murder became the subject of several popular songs, and television specials addressed the issue of whether or not America's teens were practicing Satanism. Even Congress got in on the act, debating Satanic symbolism in songs by performers like AC/DC and Ozzy Osbourne. “The country is in crisis!” screamed the pundits. After all, it was the height of the Reagan era and Nancy Reagan's “just say no” campaign was everywhere. But what this case revealed were bigger problems lurking at the heart of suburban America.Ricky Kasso wasn't a bad kid, but he was lost. To feel better, he started smoking pot, moving on from that to PCP and LSD. He ended up living on the streets and thinking he had nothing to lose. Gary Lauwers went from being a victim of bullying to using drugs to fit in, and finally robbery—but then he made the mistake of stealing from Ricky, and from that moment on, his fate was sealed.A few months later, Gary went into the woods behind the park with Ricky and two other boys. Only three of them came out.The subsequent police investigation and accompanying media circus turned the village upside down. It shattered the image of an idyllic small town, changed the way neighbors viewed each other, and recast the War on Drugs.Become a supporter of this podcast: https://www.spreaker.com/podcast/the-opperman-report--1198501/support.

Join heart surgeon Dr. Philip Ovadia and his clinical team to learn how you can prevent heart attacks. We'll dive in to lab work, CACs, what to do when your PCP is pushing unwanted drugs, and which numbers really make the difference.Send Dr. Ovadia a Text Message. (If you want a response, you must include your contact information.) Dr. Ovadia cannot respond here. To contact his team, please send an email to team@ifixhearts.com Like what you hear? Head over to IFixHearts.com/book to grab a copy of my book, Stay Off My Operating Table. Ready to go deeper? Talk to someone from my team at IFixHearts.com/talk.Stay Off My Operating Table on X: Dr. Ovadia: @iFixHearts Jack Heald: @JackHeald5 Learn more: Stay Off My Operating Table on Amazon Take Dr. Ovadia's metabolic health quiz: iFixHearts Dr. Ovadia's website: Ovadia Heart Health Jack Heald's website: CultYourBrand.com Theme Song : Rage AgainstWritten & Performed by Logan Gritton & Colin Gailey(c) 2016 Mercury Retro RecordingsAny use of this intellectual property for text and data mining or computational analysis including as training material for artificial intelligence systems is strictly prohibited without express written consent from Dr. Philip Ovadia.

FOLLOW UP: CAR FINANCE CLAIMSThe Supreme Court has ruled on car finance claims follow last years shock appeal decision that could have meant that lenders were liable for billions in compensation for mis-selling car finance schemes. The court has ruled that dealers do not have to work solely for the benefit of customers, which covers most claims, however if the commission rate is excessive then there is a possibility of a claim. What wasn't covered in this is claims where the dealer and lender could increase the interest on their PCP or HP deal without telling the customer. Anyone who signed up to this is still able to claim. To read all about this complicated matter, click this link here from MoneySavingExpert. FOLLOW UP: RENAULT GROUP ANNOUNCE NEW CEOJust over a week after the interim CEO was announced, Renault Group have found their new permanent CEO, Francois Provost. He has been at the company for 23 years, with his latest position being head of procurement, partnerships and public affairs. Click this Autocar article link to learn more. JLR LOSE ON CEO AND FIND ANOTHERAdrian Mardell is to retire from JLR, after 35 years at the company. The surprise news came out last week and by Monday the company announced his replacement, PB Balaji, who is the chief financial officer of Tata Motors. If you want to read more, click this Autocar link here. STELLANTIS MAKE A BIG LOSSFirst half year results are in for Stellantis and it is brutal. They have made a loss of £2 billion pre-tax. Tariffs are being blamed for a lot of it, but also a slow uptake on their B-segment offerings. The new CEO, Antonio Filosa, has said he will make tough decisions to help turn results around. To find out more, click this Autocar link here. PORSCHE TAKES PROFITS HITPorsche's operating profits dropped €2 billion in the first half of 2025. Once again tariffs are being blamed, but also they continue to lose market share in China. The company is looking at ways to save money, on top of the job cuts it has previously announced. You can read more on this, by clicking an Autocar article link here. HELSINKI REPORTS NO FATALITIES ON ITS ROAD NETWORK IN A YEARHelsinki has not had a road traffic fatality, for over a year. Reasons for this excellent news are a combination of improved infrastructure, all road users working together, reduced speed limits, improved public transport and targeted police efforts. To find out more, click this yle article link here. TESLA FOUND PARTIALLY RESPONSIBLE FOR FATAL CRASHA jury has found Tesla partially liable for a fatal accident that also caused life changing injuries to a passenger of a struck vehicle, after Autopilot was engaged. The driver of the Tesla vehicle claims he thought the driver assistance system would handle things whilst he retrieved his dropped phone. Tesla is to appeal the ruling. You can read more

PSD, Livre e PCP são contra mudança defendida por Carlos Moedas para polícias municipais alargarem âmbito das detenções. Chega critica autarca, mas defende revisão da lei.See omnystudio.com/listener for privacy information.

In this episode of The Broker Link, Josh Slattery breaks down key carrier updates that will impact Medicare Advantage and Part D plans in 2026. Highlights include:

 If you bought a car as far back as 2007 with a loan organised through your car dealership, you could be eligible for a payout.  The regulator, the Financial Conduct Authority, is consulting on a compensation scheme - and it's thought up to 40% of motorists who entered personal contract purchase (PCP) or hire purchase agreements between 2007 and 2021 will be eligible for a payout.  Niall Paterson talks to Sky's business correspondent Gurpreet Narwan about who might be eligible.  He also speaks to Adrian Dally, director of motor finance at the Finance and Leasing Association, who argues the payout levels look too high at this stage.  Producer: Emily Hulme Editor: Wendy Parker 

Presidente da ULS Algarve estranha motivações da greve de 7 de agosto de médicos, enfermeiros e outros. "Sindicatos afetos à CGTP e ao PCP estão a fazer prova de vida". Urgências, diz, vão responder.See omnystudio.com/listener for privacy information.

Do you have a primary care provider? Do you only think of your doc when you're sick? Dr. Swofford joined us to talk about why having a trusted PCP is so important.

⭐️⭐️⭐️ Sign Up Now for our 8-week Menopause Masterclass Fitness & Wellness Series — a transformative program for women ready to feel strong, supported, and empowered through menopause.

This episode is a little different to our others. PCP aims to guide us all about how we can better support the kids in our lives. Sometimes though the weight of doing better can be too much. In this honest chat we talk about sometimes needing to just survive and how best to do that without feeling like a gladiator constantly fighting in the arena. We hope this helps lighten that burden and we can't wait to hear your reflections, questions and advice.

Evan Steele, Founder and CEO of online reputation management company rater8, emphasizes the importance of online reviews for healthcare providers and how patients are increasingly relying on reviews to select a doctor. The key to generating reviews is to actively ask for feedback and acknowledge receipt of comments. Negative reviews and low-star ratings can encourage practices to respond to comments, improving the patient experience and demonstrating to patients that the practice cares. Evan explains, "Now, you look in your insurance guide to see which providers in your area accept the insurance. There's a Facebook group. You might ask, Who do I go to see for my shoulder that hurts for an orthopedic surgeon? You ask your friends and family, your PCP gives you some names, and you start going down the list. And what's changed is if you call that first doctor on the list and they don't have great reviews, you might not even call them, but let's say you call them and they have a convenient time, and a location is convenient, but the next doctor has 150 reviews, 4.9 stars." "You read the comments, patients love this doctor. Even if the appointment time is not convenient for you or the drive is a little further than the most convenient location, you're going to book an appointment with that doctor. Just like I would never even think of dining at a 3.8-star rated restaurant. I wouldn't trust my health, my life, and my well-being to a 3.8-rated doctor. So I think people are making decisions now based on online reviews and even going out of their way and being inconvenienced to make sure they get the right doctor." #rater8 #ReputationManagement #PatientFeedback #PatientEngagement #PracticeGrowth #TrustMarketing #PatientAcquisition #PatientProviderRelationship rater8.com Download the transcript here

Evan Steele, Founder and CEO of online reputation management company rater8, emphasizes the importance of online reviews for healthcare providers and how patients are increasingly relying on reviews to select a doctor. The key to generating reviews is to actively ask for feedback and acknowledge receipt of comments. Negative reviews and low-star ratings can encourage practices to respond to comments, improving the patient experience and demonstrating to patients that the practice cares. Evan explains, "Now, you look in your insurance guide to see which providers in your area accept the insurance. There's a Facebook group. You might ask, Who do I go to see for my shoulder that hurts for an orthopedic surgeon? You ask your friends and family, your PCP gives you some names, and you start going down the list. And what's changed is if you call that first doctor on the list and they don't have great reviews, you might not even call them, but let's say you call them and they have a convenient time, and a location is convenient, but the next doctor has 150 reviews, 4.9 stars." "You read the comments, patients love this doctor. Even if the appointment time is not convenient for you or the drive is a little further than the most convenient location, you're going to book an appointment with that doctor. Just like I would never even think of dining at a 3.8-star rated restaurant. I wouldn't trust my health, my life, and my well-being to a 3.8-rated doctor. So I think people are making decisions now based on online reviews and even going out of their way and being inconvenienced to make sure they get the right doctor." #rater8 #ReputationManagement #PatientFeedback #PatientEngagement #PracticeGrowth #TrustMarketing #PatientAcquisition #PatientProviderRelationship rater8.com Listen to the podcast here

Listen to this Pretty Comprehensive Pod on PCP. Alyssa and Callum cover:EpidemiologyTaxonomy (PCP vs PJP?)Diagnosis TreatmentNote this pod episode also includes some Positively Jolly Puns on PJPNotes for this episode here: https://idiots.notion.site/115-Yeasts-Pneumocystis-jirovecii-ac05a01902b8457688b40c07020f2c2cSend us a textSupport the showQuestions, comments, suggestions to idiotspodcasting@gmail.com or on Bluesky @idiots-pod.bsky.socialPrep notes for completed episodes can be found here (Not all episodes have prep notes).If you are enjoying the podcast please leave a review on your preferred podcast app!Feel like giving back? Donations of caffeine gratefully received!https://www.buymeacoffee.com/idiotspod

Os dois blocos avançam, mas sem PCP nem Chega. Lisboa será palco de uma contenda entre frentes de esquerda e direita. Será inédito? José Manuel Fernandes, publisher do Observador, é o convidado.See omnystudio.com/listener for privacy information.

Os dois blocos avançam, mas sem PCP nem Chega. Lisboa será palco de uma contenda entre frentes de esquerda e direita. Será inédito? José Manuel Fernandes, publisher do Observador, é o convidado.See omnystudio.com/listener for privacy information.

Today's episode is with Dr. Averie Thayer who is an occupational therapist and the owner of Living Revived Therapy located in Nashville, TN.  She is a beautiful soul who shares her story on what made her choose this direction in her career, the history of OT, and much more.  She has experience in orthopedic rehab, neurological conditions, geriatric and memory care, pediatric and hand therapy.  What I absolutely love and admire about her is that she is a doctor who gets to the root cause and doesn't just focus on fixing the symptoms temporarily.  We talk about health insurance, direct primary care services, **then my damn SIM card in the sound board corrupts but after that we great audio :)**, insurance company corruption, why she started “Living Revved Therapy” and why she chose the name, the holistic healthcare movement, how to know if you have the right PCP and what are the red flags, aging the right way, I talked about my fainting spells as a child and the medication issues I had, Averie brings up a great point about the toxic part of this wellness journey, why gatorade is BAD, sourdough, morning routines, advice on how to live optimally so you FEEL good, the negatives of EMF, the importance of the sun and the difference in day time and night time rays, Barbara O'Neill (someone everyone should know), homemade remedies for cleaning, for the first time ever I share my vaccine injury, the MTHFR gene and it's importance especially for kids, folate vs. folic acid, pelvic floor therapy importance, + more.  Thank you SO much Averie for coming on and sharing all your knowledge and perspective on things.  I guarantee you this one episode will help so many people with a million different things and open their eyes to the importance of going back to what God gave us and living revived!!INSTA—https://www.instagram.com/averie_dunay/https://www.instagram.com/livingrevivedtherapy/Averie's Company— Living Revived Therapyhttps://www.livingrevivedtherapy.comHopewell Family care—integrative medicine based in Nashvillehttps://hopewellfamilycare.comCasey Means—GOOD ENERGY bookhttps://www.caseymeans.com/goodenergyElectroytes Averie Drinks—https://drinklmnt.comElectrolytes I drink (I don't use relyte anymore)—https://bodyhealth.com/collections/perfect-amino-electrolytesCREATE CREATINE20% off CAMILLATHEMOMZILLA code and https://trycreate.co/CAMILLATHEMOMZILLABarbara O'Neill Book “SUSTAIN ME--https://barbaraoneill.com/products/sustain-me-by-barbara-o-neill?srsltid=AfmBOorp_dkkXB_Yl1GSZgqa7uNcQZynofx383h-oRRuvskdj_gyRCCE

Samantha Rux from OSF HealthCare joined Wake Up Tri-Counties to talk about primary care services available through OSF HealthCare medical facilities and school physicals, sports physicals, and health wellness visits for kids returning to school in August. OSF HealthCare is emphasizing the value of consistent, compassionate primary care for all age groups. The organization highlights that Primary Care Providers (PCPs)—including doctors, nurse practitioners, and physician assistants—play a critical role in keeping families healthy, from annual physicals to managing chronic illnesses. By building relationships with a dedicated provider, patients benefit from continuity of care, personalized advice, and a trusted partner in their wellness journey. OSF HealthCare encourages community members to prioritize routine visits, ensuring both preventive care and timely attention to any developing health needs. Patients rely on them for annual checkups, preventative care like vaccines, and support during illness. This ongoing relationship helps detect issues early and ensures tailored, consistent care. While some PCPs are doctors, others bring advanced training as nurse practitioners or physician assistants. Choosing a primary care provider means having a dedicated partner in maintaining your overall well-being across life's many stages. For more information, contact your local OSF HealthCare facility or visit their website. If you need to establish a primary care provider, you can find a list of providers with OSF HealthCare here. Primary Care Providers can conduct physicals and wellness visits for schoolchildren. You can schedule an appointment with a PCP by calling 309-852-7500 or through the MyChart app. 

This week on Dopey! It's the long-awaited episode with Chasing Heroin host Jeanine Coulter, recorded live at Jeremy's house during Dopeywood!Janine tells the full, raw, and very dopey story of her descent into addiction: from being a straight-A Supreme Court hopeful, to getting obsessed with exercise and binge eating, to discovering coke in a redneck bar in Georgia, all the way to living in an abandoned cell phone store in Oceanside, California smoking heroin off foil.Janine talks about doing meth that was pink, accidentally getting strung out at 30, and finding herself in a cinderblock junkie jungle gym run by tweakers. She reflects on her arrest record, her failed attempts at controlled drinking, and how it all somehow led to a decade of recovery, a podcast, and a damn TED Talk on post-traumatic growth.PLUS: a touching email from a listener who outran the cops with a trunk full of weed and somehow lived to tell the tale. A beautiful PCP voicemail and much much more on a brand new epiksode of that good ol Dopey Show!Don't forget: DopeyCon 6 tickets are out on Patreon. Leave a review. Send a voicemail. And follow us on youtu

Listen as Michael S. Benninger, MD, describes his approach to the diagnosis and management of chronic cough and refractory chronic cough in the context of a clinically relevant case.PresenterMichael S. Benninger, MDProfessor of Otolaryngology-Head and Neck SurgeryLerner College of MedicineThe Cleveland ClinicPresident, International Association of PhonosurgeryCleveland, OhioLink to full program:https://bit.ly/4kweynG

Listen in as Joseph Kim, MD, MPH, MBA, and Colten Bracken, MD, FAAFP, discuss how to integrate comprehensive diabetes management to improve the quality of their obesity care delivery, including: Documenting obesity as a diagnosis for patients with diabetes when appropriateStreamlining processes to ensure patients return for follow-upDedicating a care manager to initiate patient outreachImplementing pharmacotherapy strategies to help patients control their A1C and achieve weight loss simultaneously.PresentersJoseph Kim, MD, MPH, MBAPresidentQ Synthesis, LLCNewtown, PennsylvaniaColten Bracken, MD, FAAFPBoard of Directors for RHAU & UAFPOwner/Medical DirectorMain Street Family Medicine, PLLCEnterprise, UtahLink to full program: https://bit.ly/3IBFZi5

Marc Sappington liked to get wet! Hey, who doesn't? The problem for Marc was that he smoked so much damn PCP that he started hearing voices. What were these voices saying? Well they weren't trying to get him to do his taxes I'll tell you that much. Support Lil Stinkers at https://www.patreon.com/lilstinkers to get every episode AD FREE and a week early PLUS weekly bonus content. Get your Lil Stinkers merch today at https://www.lilstinkerspod.com Follow us on Twitter and Instagram: Jon DelCollo: @jonnydelco Jake Mattera: @jakemattera Mike Rainey: @mikerainey82  

In this episode, Palak J. Trivedi, BSc, MBBS, PhD, MRCP, ESEGH​, discusses the most recent developments in primary biliary cholangitis (PBC) treatment, including cutting-edge data on new and emerging agents and how these updates may be integrated into your practice. Topics include:Steatotic liver disease and PBCVibration-controlled transient elastography (VCTE) and discordant biochemical responses in PBCPPAR agonists and IBATs for PBC treatment Presenter:Palak J. Trivedi, BSc, MBBS, PhD, MRCP, ESEGHAssociate ProfessorNIHR Birmingham BRCUniversity of BirminghamConsultant Hepatologist, Liver UnitUniversity Hospitals BirminghamBirmingham, United Kingdom Link to full program: https://bit.ly/4lKaO2HFollow along with the slides: https://bit.ly/44PPBysGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify. 

In this episode, Palak J. Trivedi, BSc, MBBS, PhD, MRCP, ESEGH​, discusses the most recent developments in primary biliary cholangitis (PBC) treatment, including cutting-edge data on new and emerging agents and how these updates may be integrated into your practice. Topics include:Steatotic liver disease and PBCVibration-controlled transient elastography (VCTE) and discordant biochemical responses in PBCPPAR agonists and IBATs for PBC treatment Presenter:Palak J. Trivedi, BSc, MBBS, PhD, MRCP, ESEGHAssociate ProfessorNIHR Birmingham BRCUniversity of BirminghamConsultant Hepatologist, Liver UnitUniversity Hospitals BirminghamBirmingham, United Kingdom Link to full program: https://bit.ly/44ySoL3Follow along with the slides: https://bit.ly/3IvwQrjGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

It's another mixed bag of your questions, taking everything from investing in offshore funds to evening up pension funds between spouses and lots more besides! Shownotes: https://meaningfulmoney.tv/QA19  00:57  Question 1 Hello Pete & Roger I am a regular listener to you show, love it and keep up the good work. My question is… I have a full 6 months emergency fund, I have no credit card debt or personal loans, I have a mortgage and I have just started investing 5% of my wages every time I get paid into the Vanguard all world tracker fund (keeping it simple) I have a new car every 4 years on PCP (so I basically lease it) as I always chop in for a new car and never pay the balloon payment at the end, this PCP is at 8%. I would like to hear your thoughts on weather investing is still okay to do along side this, the reason for having a new car is that I use it until the warranty expires and then change due to rising repair costs and hassle free motoring. I have brought older cars outright in the past and always ended up costing me more in repairs over the years. I am planning on leasing my cars for the permanent future so if I do not start investing now I will never have a chance to invest, and I do not see leasing at car as a loan as such, more of a permanent lease. Feel free to shorten my message to suit and excited to hear your thoughts, all the best. Adam 10:10  Question 2 Hello Pete and Rog! First of all, a huge thank you for all the valuable content you share – I really appreciate it! Keep up the fantastic work!  I had a quick question that's a bit technical (apologies in advance!), but I was wondering if you might be able to cover the topic of UK-registered funds when investing in a GIA on the podcast? I've heard that non-UK registered funds are taxed at the income tax rate rather than the capital gains tax rate. Is the best approach to check the ISIN against the list of UK-registered funds, even if the investment is made through a non-UK exchange (e.g., Amsterdam or Ireland)? Also, when a new client comes to you with non-UK registered funds, how do you typically address this issue? Thanks again for all that you do – really appreciate it!  Best, your #1 Fan! 14:00  Question 3 Hi Pete / Roger Thank you for your great work with your Q&As. Your cashflow ladder idea is great advice but when I look at graphs of cautious, balanced, growth funds they all go up and down at the same time. Over the last 10 yrs every time there has been a big market fall all the funds I looked at (at all risk levels) recovered with 32 months max. If 2-3 years cash is held on the 1st rung of the ladder why shouldn't I hold the rest in growth/agg funds? The cash rung will ride out the fall / recovery so I may as well put my money in a fund with the most growth potential? What am I missing? Stephen 19:57  Question 4 Hi Pete and Roger, Thanks for all you do. Your Podcasts and YouTube content has helped me get to retirement early. I have a number of investments in my Pension which are there to continue to grow hopefully over time. I have a well diversified portfolio mainly using trackers. I want to try to drop a particular individual investment from my portfolio that forms part of the Magnificent Seven, and is therefore part of a lot of the trackers I have. Unless I buy the FTSE Global index as individual shares can you see a way I cannot be in this one companies shares? Not sure there is an answer. Much appreciated, Chris 24:11  Question 5 Hello Love your podcast, I thought I was fairly clued up on pensions/finances but I have learnt so much more from your podcast. I recommend it to everyone! Especially my husband, who has so far failed to do so, he leaves the finances to me (which is probably why we are in this position as he has not addressed his pension). My question is: Our pension pots are very unequal, we're both 47.  I have 2 DB pots (combined are due to pay out circa 14k from age 65). I am also on track to have around 750k in a private pension by the time I am 57, and am planning to retire at this point.  My husband currently only has around 18k in a private pension, and is retraining as a teacher so he will only have a small DB pension not accessible until 68. He will therefore need to continue working for a few years after I retire.  I will need around a 2k a month in retirement, but I am thinking I can take up to £67k per year from my pension (so to remain in the 20% tax band). Use 24k for myself, and then we pay the remaining 43k into husbands private pension (or however much his earnings allow). If he is a higher rate tax payer by then, he would gain a 40% uplift on this or if not he will still get the 20% uplift back so we aren't losing out.  One of the main reasons for doing it would be to even the pensions out so that we can both withdraw tax efficiently in future, rather than me having to withdraw from my pension for both of us and so paying more tax. It seems like a no brainer but please let me know if I have missed something really obvious. Thanks in advance! Sarah 29:02  Question 6 Hello gents, If you pay a charity and claim gift aid within a given tax year, does that take your income down when calculating benefit calculations? E.g. if I earn £101k p/a and I give £2k to charity and (gift aid it), does that effectively bring my income below the £100k threshold for child government support like free childcare hours? Thanks, David

In this part 1 reflection episode we discuss how the evidence can guide us regarding many of the challenges neurodivergent kids face. We cover questions about masking, rejection sensitive dysphoria, neurodiversity and emotional sensitivity, fitting in, medication and many more. Thank you for the wonderful questions, reflections and advice that the amazing PCP community sent in. We hope you like it and we can't wait to dive into this topic even further in the next reflection episode.

Listen as expert faculty answer your most pressing questions on optimizing immunization in clinical practice.Topics covered include:Practical methods for improving confidence in vaccinesHow to educate patients on vaccine development and safety monitoring Effective strategies to tailor recommendations, such as motivational interviewingWays to navigate clinical encounters and address vaccine hesitancyPresenters:Robert H. Hopkins, Jr., MD, MACPProfessor of Internal Medicine and PediatricsUniversity of Arkansas for Medical SciencesCollege of MedicineLittle Rock, ArkansasLitjen (L.J.) Tan, MS, PhDChief Policy and Partnership Office, Immunize.orgChair, National Adult Influenza Immunization SummitCo-Chair, Global Influenza InitiativeSt Paul, MinnesotaLink to full program: https://bit.ly/3I5jBh0Get access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

A Netlabelday 2025 special Bark At The Moon...with tracks by...Brooklyn Station, Tom Toms, One Dub Connection, Y. K. Beats, High Snow, Cheese N Pot-C, Dub Dillah, Iliaque, Marwood Williams, Bist, Vejas, B4, Brioskj, Sascha Müller, Goodmvn Records, Rootsman Selecta, Lyda Aguas, DDO, Floating Mind, Valovoima, Humona Brooklyn Station - The Bounce [Pharmacom Records] [...] The post PCP#864… Bark At The Moon…(Netlabel Day 2025 Part 1 of 2) appeared first on Pete Cogle's Podcast Factory.

Sydney has been doing stand-up for over 20 years, ever since he was left shirtless and feeling cheap after a Destiny's Child music video model audition. Sydney has written for all kinds of great shows like The BET Awards, CBS's The Neighborhood, HBO's Game Theory and many others. He recently just released his first full comedy special "My Cup is Full" which was put out by 800 Pound Gorilla Media. To celebrate the release, Sydney was nice enough to come on the show! Doc and Sydney talk about his family thinking he should go to the NBA, getting into modelling, moving to LA, starting stand-up, starting comedy writing, winning Funniest Wins, spending a lot of money, working with Ali Siddiq, working with Bomani Jones, and of course his stand-up special. Meanwhile on the rest of the show Doc and Mike plan their 4-part series on James Brown, his love of shotguns and PCP. Introduction: 0:00:18 Birthday Suit 1: 17:52 Ripped from the Headlines: 21:58 Shoutouts: 32:13 Sydney Castillo Interview: 39:09 Mike C Top 3: 1:39:39 Birthday Suit 2: 1:58:39 Birthday Suit 3: 2:00:31

Listen in as Joseph Kim, MD, MPH, MBA; Manish Shah, MD; Martha Grugel, MA, discuss how they manage the prior authorization process for antiobesity agents to improve the quality of their care delivery, including:The information to collect during patient visitsThe available resources to help you submit prior authorizationsThe supporting documents that are often necessary to accompany prior authorizationsHow to address denials and appealsWhen to access manufacturer-based or foundation-based financial assistancePresentersJoseph Kim, MD, MPH, MBAPresidentQ Synthesis, LLCNewtown, PennsylvaniaManish Shah, MDClinical Associate Faculty MS1 PreceptorUniversity of Florida College of MedicineGainesville, FloridaMartha Grugel, MAMedical AssistantWesley Chapel, FloridaLink to full program: https://bit.ly/45P0v8z

After a virus wipes out most of England, a few survivors fight off the infected and would-be rapists. Listen as we discuss watching comedies in theaters, clever graffiti during a zombie apocalypse, and the effects of PCP. Then we find out if 28 Days Later stands the Test of Time.

Idiopathic intracranial hypertension (IIH) is characterized by symptoms and signs of unexplained elevated intracranial pressure (ICP) in an alert and awake patient. The condition has potentially devastating effects on vision, headache burden, increased cardiovascular disease risk, sleep disturbance, and depression.  In this episode, Teshamae Monteith, MD, FAAN speaks with Aileen A. Antonio, MD, FAAN, author of the article “Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Antonio is an associate program director of the Hauenstein Neurosciences Residency Program at Trinity Health Grand Rapids and an assistant clinical professor at the Michigan State University College of Osteopathic Medicine in Lansang, Michigan. Additional Resources Read the article: Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @aiee_antonio Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics.  Hi, how are you? Dr Antonio: Hi, good afternoon. Dr Monteith: Thank you for being on the podcast. Dr Antonio: Thank you for inviting me, and it's such an honor to write for the Continuum. Dr Monteith: So why don't you start off with introducing yourself? Dr Antonio: So as mentioned, I'm Aileen Antonio. I am a neuro-ophthalmologist, dually trained in both ophthalmology and neurology. I'm practicing in Grand Rapids, Michigan Trinity Health, and I'm also the associate program director for our neurology residency program. Dr Monteith: So, it sounds like the residents get a lot of neuro-ophthalmology by chance in your curriculum. Dr Antonio: For sure. They do get fed that a lot. Dr Monteith: So why don't you tell me what the objective of your article was? Dr Antonio: Yes. So idiopathic intracranial hypertension, or IIH, is a condition where there's increased intracranial pressure, but without an obvious cause. And with this article, we want our readers---and our listeners right now---to recognize that the typical symptoms and learning about the IIH diagnostic criteria are key to avoiding errors, overdiagnosis, or sometimes even misdiagnosis or underdiagnosis. Thus, we help make the most of our healthcare resources. Early diagnosis and management are crucial to prevent disability from intractable headaches or even vision loss, and it's also important to know when to refer the patients to the appropriate specialists early on. Dr Monteith: So, it sounds like your central points are really getting that diagnosis early and managing the patients and knowing how to triage patients to reduce morbidity and complications. Is that correct? Dr Antonio: That is correct and very succinct, yes. Dr Monteith: And so, are there any more recent advances in the diagnosis of IIH? Dr Antonio: Yes. And one of the tools that we've been using is what we call the optical coherence tomography. A lot of people, neurologists, physicians, PCP, ER doctors; how many among those physicians are well-versed in doing an eye exam, looking at the optic disc? And this is a great tool because it is noninvasive, it is high resolution imaging technique that allows us to look at the optic nerve without even dilating the eye. And we can measure that retinal nerve fiber layer, or RNFL; and that helps us quantify the swelling that is visible or inherent in that optic nerve. And we can even follow that and monitor that over time. So, this gives us another way of looking at their vision and getting that insight as to how healthy is their vision still, along with the other formal visual tests that we do, including perimetry or visual field testing. And then all of these help in catching potentially early changes, early worsening, that may happen; and then we can intervene more easily. Dr Monteith: Great. So, it sounds like there's a lot of benefits to this newer technology for our patients. Dr Antonio: That is correct. Dr Monteith: So, I read in the article about the increased incidence of IIH, and I have to say that I completely agree with you because I'm seeing so much of it in my clinic, even as a headache specialist. And I had a talk with a colleague who said that the incidence of SIH and IIH are similar. And I was like, there's no way. Because I see, I can see several people with IIH just in one day. That's not uncommon. So, tell me what your thoughts are on the incidence, the rising incidence of IIH; and we understand that it's the condition associated with obesity, but it sounds like you have some other underlying drivers of this problem. Dr Antonio: Yes, that is correct. So, as you mentioned, IIH tends to affect women of childbearing age with obesity. And it's interesting because as you've seen that trend, we see more of these IIH cases recently, which seem to correlate with that rising rate of obesity. And the other thing, too, is that this trend can readily add to the burden of managing IIH, because not only are we dealing with the headaches or the potential loss of vision, but also it adds to the burden of healthcare costs because of the other potential comorbidities that may come with it, like cardiovascular risk factors, PCOS, and sleep apnea. Dr Monteith: So why don't we just talk about the diagnosis of IIH? Dr Antonio: IIH, idiopathic intracranial hypertension, is also called pseudotumor cerebri.  It's essentially a condition where a person experiences increased intracranial pressure, but without any obvious cause. And the tricky part is that the patients, they're usually fully awake and alert. So, there's no obvious tumor, brain tumor or injury that causes the increased ICP. It's really, really important to rule out other conditions that might cause these similar symptoms; again, like brain tumors or even the cerebral venous sinus thrombosis. Many patients will have headaches or visual disturbances like transient visual obscurations---we call them TVOs---or double vision or diplopia. The diplopia is usually related to a sixth nerve palsy or an abducens palsy. Some may also experience some back pain or what we call pulsatile tinnitus, which is that pulse synchronous ringing in their ears. The biggest sign that we see in the clinic would be that papilledema; and papilledema is a term that we only use, specifically use, for those optic nerve edema changes that is only associated with increased intracranial pressure. So, performing of endoscopy and good eye exam is crucial in these patients. We usually use the modified Dandy criteria to diagnose IIH. And again, I cannot emphasize too much that it's really important to rule out other secondary causes to that increased intracranial pressure. So, after that thorough neurologic and eye evaluation with neuroimaging, we do a lumbar puncture to measure the opening pressure and to analyze the cerebrospinal fluid. Dr Monteith: One thing I learned from your article, really just kind of seeing all of the symptoms that you mentioned, the radicular pain, but also- and I think I've seen some papers on this, the cognitive dysfunction associated with IIH. So, it's a broader symptom complex I think than people realize. Dr Antonio: That is correct. Dr Monteith: So, you mentioned TVOs. Tell me, you know, if I was a patient, how would you try and elicit that from me? Dr Antonio: So, I would usually just ask the patient, while you're sitting down just watching TV---some of my patients are even driving as this happens---they would suddenly have these episodes of blacking out of vision, graying out of vision, vision loss, or blurred vision that would just happen, from seconds to less than a minute, usually. And they can happen in one eye or the other eye or both eyes, and even multiple times a day. I had a patient, it was happening 50 times a day for her. It's important to note that there is no pain associated with it most of the time. The other thing too is that it's different from the aura that patients with migraines would have, because those auras are usually scintillating and would have what we call the positive phenomena: the flashing lights, the iridescence, and even the fortification that they see in their vision. So definitely TVOs are not the migraine auras. Sometimes the TVOs can also be triggered by sudden changes in head positions or even a change in posture, like standing up quickly. The difference, though, between that and, like, the graying out of vision or the tunneling vision associated with orthostatic hypotension, is that the orthostatic hypotension would also have that feeling of lightheadedness and dizziness that would come with it. Dr Monteith: Great. So, if someone feels lightheaded, less likely to be a TVO if they're bending down and they have that grain of vision. Dr Antonio: That is correct. Dr Monteith: Definitely see patients like that in clinic. And if they have fluoride IIH, I'm like, I'll call it a TVO; if they don't, I'm like, it's probably more likely to be dizziness-related. And then we also have patient migraines that have blurriness that's nonspecific, not necessarily associated with aura. But I think in those patients, it's usually not seconds long, it's usually probably longer episodes of blurriness. Would you agree there, or…? Dr Antonio: I would agree there, and usually the visual aura would precede the headache that is very characteristic of their migraine, very stereotypical for their migraines. And then it would dissipate slowly over time as well. With TVOs, they're brisk and would not last, usually, more than a minute. Dr Monteith: So, why don't we talk about routine imaging? Obviously, ordering an MRI, and I read also getting an MRV is important. Dr Antonio: It is very important because, one: I would say IIH is also a diagnosis of exclusion. We need to make sure that the increased ICP is not because of a brain tumor or not because of cerebral venous sinus thrombosis. So, it's important to get the MRI of the brain as well as the MRV of the head. Dr Monteith: Do you do that for all patients' MRV, and how often do you add on an orbital study? Dr Antonio: I usually do not add on an orbital study because it's not really going to change my management at that point. I really get that MRI of the brain. Now the MRV, for most of my patients, I would order it already just because the population that I see, I don't want to lose them. And sometimes it's that follow-up, and that is the difficult part; and it's an easy add on to the study that I'm going to order. Again, it depends with the patient population that you have as well, and of course the other symptoms that may come with it. Dr Monteith: So, why don't we talk a little bit about CSF reading and how these set values, because we get people that have readings of 250 millimeters of water quite frequently and very nonspecific, questionable IIH. And so, talk to me about the set value. Dr Antonio: Right. So, the modified Dandy criteria has shown that, again, we consider intracranial pressure to be elevated for adults if it's above 250 millimeters water; and then for kids if it's above 280 millimeters of water. Knowing that these are taken in the left lateral decubitus position, and assuming also that the patients were awake and not sedated during the measurement of the CSF pressure. The important thing to know about that is, sometimes when we get LPs under fluoroscopy or under sedation, then these can cause false elevation because of the hypercapnia that elevated carbon dioxide, and then the hypoventilation that happens when a patient is under sedation. Dr Monteith: You know, sometimes you see people with opening pressures a little bit higher than 25 and they're asymptomatic. Well, the problem with these opening pressure values is that they can vary somewhat even across the day. People around 25, you can be normal, have no symptoms, and have opening pressure around 25- or 250; and so, I'm just asking about your approach to the CSF values. Dr Antonio: So again, at the end of the day, what's important is putting everything together. It's the gestalt of how we look at the patient. I actually had an attending tell me that there is no patient that read the medical textbook. So, the, the important thing, again, is putting everything together. And what I've also seen is that some patients would tell me, oh, I had an opening pressure of 50. Does that mean I'm in a dire situation? And they're so worried and they just attach to numbers. And for me, what's important would be, what are your symptoms? Is your headache, right, really bad, intractable? Number two: are you losing vision, or are you at that cusp where your optic nerve swelling or papilledema is so severe that it may soon lead to vision loss? So, putting all of these together and then getting the neuroimaging, getting the LP. I tell my residents it's like icing on the cake. We know already what we're dealing with, but then when we get that confirmation of that number… and sometimes it's borderline, but this is the art of neurology. This is the art of medicine and putting everything together and making sure that we care and manage it accordingly. Dr Monteith: Let's talk a little bit about IIH without papilledema. Dr Antonio: So, let's backtrack. So, when a patient will fit most of the modified Dandy criteria for IIH, but they don't have the papilledema or they don't have abducens palsy, the diagnosis then becomes tricky. And in these kinds of cases, Dr Friedman and her colleagues, when they did research on this, suggested that we might consider the diagnosis of IIH. And she calls this idiopathic intracranial hypertension without papilledema, IIHWOP. They say that if they meet the other criteria for modified Dandy but show at least three typical findings on MRI---so that flattening of the posterior globe, the tortuosity of the optic nerves, the empty sella or the partially empty sella, and even the narrowing of the transverse venous sinuses---so if you have three of these, then potentially you can call these cases as idiopathic intracranial hypertension without papilledema. Dr Monteith: Plus, the opening pressure elevation. I think that's key, right? Getting that as well. Dr Antonio: Yes. Sometimes IIHWOP may still be a gray area. It's a debate even among neuro-ophthalmologists, and I bet even among the headache specialists. Dr Monteith: Well, I know that I've had some of these conversations, and it's clear that people think this is very much overdiagnosed. So, that's why I wanted to plug in the LP with that as well. Dr Antonio: Right. And again, we have not seen yet whether is, this a spectrum, right? Of that same disease just manifesting differently, or are they just sharing a same pathway and then diverging? But what I want to emphasize also is that the treatment trials that we've had for IIH do not include IIHWOP patients. Dr Monteith: That is an important one. So why don't you wrap this up and tell our listeners what you want them to know? Now's the time. Dr Antonio: So, the- again, with IIH, with idiopathic intracranial hypertension, what is important is that we diagnose these patients early. And I think that some of the issues that come into play in dealing with these patients with IIH is that, one: we may have anchoring bias. Just because we see a female with obesity, of reproductive age, with intractable headaches, it does not always mean that what we're dealing with is IIH. The other thing, too, is that your tools are already available to you in your clinic in diagnosing IIH, short of the opening pressure when you get the lumbar puncture. And I need to emphasize the importance of doing your own fundoscopy and looking for that papilledema in these patients who present to you with intractable headaches or abducens palsy. What I want people to remember is that idiopathic intracranial hypertension is not optic nerve sheath distension. So, these are the stuff that you see on neuroimaging incidentally, not because you sent them, because they have papilledema, or because they have new headaches and other symptoms like that. And the important thing is doing your exam and looking at your patients. Dr Monteith: Today, I've been interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Thank you again. Dr Antonio: Thank you. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

After so many requests from the amazing PCP community we are diving back in to talk about neurodiversity and how we can better support these beautiful kids. We discuss how movies, beliefs and a deficit approach can cause harm and limit potential. We dive into how we can help neurodivergent children and teens feel safe and experience success using the science in the real world. We can not wait to hear your reflections, questions and advice on nurturing neurodiversity as it's our favourite part of the podcast.

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I'm looking forward to sharing with you some of our community's questions that have come in over the past few weeks…   Lina: Hi Dr. Cabral, My neck has been feeling very fatigue for the past months. My spinal X-ray revealed a mild C5-6 disc space narrowing with endplate osteophyte formation. I am applying castor oil onto this area daily as I believe it help disintegrate bone spurs. Can you please provide guidance on what more I can do to break up these bone spurs and strengthen that area of my neck? Besides neck exercises which I am doing, are there any dietary suggestions or supplementation that would help. I am very grateful for all you do for us in this community. With much thanks, Lina                        Heather: Hello Dr. Cabral! I am a 47-year-old woman who has been experiencing double vision upon waking that usually lasts until around 11 AM, It does not happen every day but has been happening for a year and a half. It also happens when I have alcohol. I went to my optometrist and he said everything looked good, I went to my PCP and he wanted to run labs. No red flags, so he wanted to do an MRI on my brain. I decided to run the big five labs instead and found out I was low on all the B vitamins, had SIBO & Candida. I did The 21 day detox, completed the CBO protocol and will be starting a heavy metal detox next week. As of writing this I still am experiencing the double vision intermittently. Thank you!                                                                                                                                  Thomas: Thanks for all your work. It has been a very helpful resource for my family and I as we continue to improve our health. My question is about SPMs (specialized pro-resolving mediators). Can you speak about their efficacy or the lack thereof and whether you've personally used them or use them in your practice?          Michelle: Hi! Thank you for your show, I've learned so much from listening to your podcast! I'm just wondering your thoughts on a dental procedure. After my last dentist appointment I was told I needed two root canals or if I wanted to spend a little more I could have two implants. My question is, which one is safer? I've heard root canals can cause problems like low grade infections lasting a long time but I haven't heard anyone talk about any bad side affects from implants. Thank you for all you do. Michelle                                                                                                                                        Savannah: Hypothyroidism runs in my family both my mom and dad have it and both my grandmothers had it. I was diagnosed in my early 20's but I haven't been on medicine since having my son in 2023 and was wondering what's the best protocol of supplements and foods to help keep the thyroid healthy or heal it if possible. Thanks!   Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3418 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Antron Singleton, also known as Big Lurch, is a Dallas-born rapper and member of hip-hop group Cosmic Slop Shop. He is currently serving a life sentence for allegedly chomping a hoe back in ‘02 after/during an apparent PCP bender. I didn't know he liked to get wet. If you like Lil Stinkers and want to support us, you can do so by going to Patreon.com/lilstinkers. For either $4/month or $40/year, you get every episode early, ad-free episodes Patreon exclusive episodes, Mini Stinkers episodes, live AMAs, live episodes, road trip vlogs, live book club meetings and all the other weirdo nonsense that we engage in. If you'd like a Kustom Kumquat Hour, treat yourself and get one for yourself or the psychopath you love at OnPercs.com/store. We'll be happy to record an episode just for you. We're happy to discuss anything and everything you'd like for your own personal Trash Night. Also, once we hit 3500 Patrons, we're having a picnic at Spahn Ranch, the former home of the Manson Family. Follow us on Twitter and Instagram: Jon Delcollo: @jonnydelco Jake Mattera: @jakemattera Mike Rainey: @mikerainey82  

As a teenager, Chris Cornell was traumatized by a bad PCP trip that turned him into a recluse for years. Music pulled him out of the darkness when he discovered his four-octave voice by accident – A voice he used to incredible effect as the frontman for both Soundgarden and Audioslave. But the darkness never really went away – it was there in his hometown of Seattle, where tragedies closed the chapter on grunge, and in his music, which was authentic to the very end. This episode contains themes that may be disturbing to some listeners, including suicide. If you're thinking about suicide, or are worried about a friend or loved one, call the Suicide Prevention Lifeline at 800-273-8255. This episode was originally published on May 22, 2024. To see the full list of contributors, see the show notes at www.disgracelandpod.com. To listen to Disgraceland ad free and get access to a monthly exclusive episode, weekly bonus content and more, become a Disgraceland All Access member at disgracelandpod.com/membership. Sign up for our newsletter and get the inside dirt on events, merch and other awesomeness - GET THE NEWSLETTER Follow Jake and DISGRACELAND: Instagram YouTube X (formerly Twitter) Facebook Fan Group TikTok To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices