Podcasts about PFO

RFK Jr.'s admission on Theo Von's podcast interview, Dawson's Creek Star James Van Der Beek's cause of death, Dr. Oz speaking up about the measles vaccine, Celine Dion's stiff person syndrome, a Big Brother star's stroke from a hole in her heart, and Montell Jordan sharing that he's cancer free all come together in this week's live show, and we're digging into what it really means for our health.We'll break down RFK Jr.'s admission of snorting illegal substances off a toilet seat and talk honestly about public bathroom germs and how infections actually spread. We're also honoring Dawson's Creek Star James Van Der Beek's cause of death from colorectal cancer and what this can teach about our own health.We'll also cover the rising measles numbers, and we'll clear up myths about stiff person syndrome, explain what a PFO is and how it can lead to a stroke, and end with good news by discussing Montell Jordan and the power of a simple PSA test. Join us live and bring your questions as we turn these trending medical headlines and celebrity health news into real health wins.#HealthHappyLifePodcast #DrFrita #DrFritaLIVE! #CelebrityHealthNewsHere are a few helpful resources to help on your journey to wellness:▶️ Subscribe so you will never miss a YouTube video.

Craniotomy Stroke Recovery: How a Massive Medical Event Reshaped One Man's Identity and Way of Living When Brandon Barre woke up after his stroke, half of his skull was missing. Doctors had performed an emergency craniotomy to save his life after a severe brain bleed. His left side barely worked. His memory felt fragmented. Time itself seemed unreliable; days, weeks, even months blurred together into what he later described as a kind of perpetual Groundhog Day. And yet, amid one of the most extreme medical experiences a person can survive, Brandon remained unexpectedly calm. This is a story about craniotomy stroke recovery, but it's not just about surgery, rehab, or timelines. It's about identity, mindset, and what happens when your old life disappears overnight, and you're forced to rebuild from the inside out. Life Before the Stroke: Movement, Freedom, and Identity Before his stroke, Brandon lived a life defined by movement and autonomy. He worked in the oil fields as an MWD specialist, spending weeks at a time on drilling rigs. Later, he left what he called “traditional life” behind and spent years traveling the United States in an RV. He found work wherever he went, producing music festivals, building large-scale art installations, and immersing himself in creative communities. Stability, for Brandon, never meant stillness. It meant freedom. Stroke wasn't on his radar. At 46, he was active, independent, and deeply connected to his sense of self. The Stroke and Emergency Craniotomy The stroke happened in Northern California after a long day of rock climbing with friends. Brandon didn't notice the warning signs himself; it was others who saw that his arm wasn't working properly. Later that night, he became profoundly disoriented. He was found the next morning, still sitting upright in his truck, barely conscious. Within hours, Brandon was airlifted to UC Davis Medical Center, where doctors removed a blood clot and performed a large craniotomy due to dangerous swelling. Part of his skull was removed and stored while his brain recovered. He spent 10 days in intensive care, followed by weeks in inpatient rehabilitation. Remarkably, he reports no physical pain throughout the entire process, a detail that underscores how differently each brain injury unfolds. Early Craniotomy Stroke Recovery: Regaining Movement, Losing Certainty Physically, Brandon's recovery followed a familiar but still daunting path. Initially, he couldn't walk. His left arm hung uselessly by his side. Foot drop made even short distances difficult. But what challenged him most wasn't just movement; it was orientation. He struggled to track days, months, and time itself. Short-term memory lapses made planning almost impossible. Writing, once a core part of his identity, became inaccessible. He could form letters, but not their meaning. This is a common but under-discussed aspect of craniotomy stroke recovery: the loss isn't only physical. It's cognitive, emotional, and deeply personal. “It's kind of like I'm in this perpetual day ever since the stroke… like Groundhog Day.” Technology as Independence, Not Convenience One of the quiet heroes of Brandon's recovery has been voice-to-text technology. Because writing and spelling no longer function reliably, Brandon relies on dictation to communicate. Tools like Whisper Flow and built-in phone dictation restored his ability to express ideas, stay connected, and remain independent. This matters. For stroke survivors, technology isn't about productivity. It's about dignity. Identity Reset: Slower, Calmer, More Intentional Perhaps the most striking part of Brandon's story is how little resentment he carries. He doesn't deny frustration. He doesn't pretend recovery is easy. But he refuses to live in constant rumination. Instead, he adopted a simple principle: one problem at a time. That mindset reshaped his lifestyle. He stopped drinking, smoking, and using marijuana. He slowed his pace. He became more deliberate with relationships, finances, and health decisions. He grew closer to his adult daughter than ever before. The stroke didn't erase his identity, it refined it. Taking Ownership of Craniotomy Stroke Recovery A turning point came when Brandon realized he couldn't rely solely on the medical system. Insurance changes, rotating doctors, and long waits forced him to educate himself. He turned to what he jokingly calls “YouTube University,” learning from other survivors and clinicians online. That self-directed approach extended to major medical decisions, including choosing monitoring over immediate invasive heart procedures and calmly approaching a newly discovered brain aneurysm with information rather than fear. His conclusion is clear: Recovery belongs to the survivor. Doctors guide. Therapists assist. But ownership sits with the person doing the living. A Message for Others on the Journey Toward the end of the conversation, Brandon offered advice that cuts through fear-based recovery narratives: Don't let timelines define you. Don't rush because someone says you should. Don't stop because someone says you're “done.” Every stroke is different. Every brain heals differently. And recovery, especially after a craniotomy, continues far longer than most people are told. Moving Forward, One Intentional Step at a Time Craniotomy stroke recovery isn't just about regaining movement. It's about rebuilding trust with your body, reshaping identity, and learning how to live with uncertainty without letting it dominate your life. Brandon's story reminds us that even after the most extreme medical events, calm is possible. Growth is possible. And a meaningful life, though different, can still unfold. Continue Your Recovery Journey Learn more: https://recoveryafterstroke.com/book Support the podcast: https://patreon.com/recoveryafterstroke Disclaimer: This blog is for informational purposes only and does not constitute medical advice. Please consult your doctor before making any changes to your health or recovery plan. Brandon's Story: Surviving a Craniotomy, Redefining Identity, and Recovering on His Own Terms He survived a stroke and craniotomy, then calmly rebuilt his identity, habits, and life one deliberate step at a time. Research shortcut I use (Turnto.ai) I used Turnto.ai to find relevant papers and sources in minutes instead of hours. If you want to try it, here’s my affiliate LINK You'll get 10% off, it's about $2/week, and it supports the podcast. Highlights: 00:00 Introduction and Background01:52 Life Before the Stroke03:32 The Stroke Experience11:03 Craniotomy Stroke Recovery Journey17:09 Adjusting to Life Post-Stroke28:46 Living Independently After Stroke35:09 Facing New Challenges: Aneurysms and Uncertainty42:13 Support Systems: Finding Community After Stroke47:06 Identity Shift: Life Changes Post-Stroke58:39 Lessons Learned: Insights from the Journey Transcript: Introduction and Background Brandon (00:00)next morning was still in the driver’s seat with my head on the steering wheel. and I couldn’t make either of my arms work I had been bleeding into my brain for 12 hours overnight they had to go ahead and do a, craniotomy. And so they took this whole side. It was a big craniotomy. They took that whole section of my skull out, put it in the freezer Bill Gasiamis (00:27)Before we begin today’s episode, want to take a moment to speak to you directly. If you’ve had a stroke, you already know this part. The hospital phase ends, but the questions don’t. You’re sent home expecting to get on with it. And suddenly you’re left trying to work out recovery, mindset, fatigue, emotions, sleep and motivation all on your own. You shouldn’t have to. That’s why I wrote my book, The Unexpected Way That a Stroke Became the Best Thing That Happened. Not to tell you what to do, but to walk beside you and show you the tools real stroke survivors use to rebuild their lives when the system stopped helping. and now with this book, you won’t have to figure it out alone. You can find that at recoveryafterstroke.com/book. All right, let’s get into today’s episode. Today, you’re going to hear from Brandon Barre. Brandon was 46 years old, active, independent and living an unconventional life when he had a stroke that led to a craniotomy. where part of his skull was removed to save his life. What stood out to me immediately about Brandon wasn’t just the severity of what he went through. It was the calm grounded way he approached recovery, identity and rebuilding his life. This is a conversation about stroke recovery. Yes, but it is also about mindset, ownership and what happens when you decide to take recovery into your own hands. Life Before the Stroke (01:52)Brendan Barre, welcome to the podcast. Brandon (01:54)Thank you, man. (01:56)You struggled a little bit getting here. There’s a couple of little things that caused a bit of a challenge for you. What are those things? Brandon (02:05)Well, I mean, first of all, I’m, I’m, I’m, even before my stroke, I was never very computer-y. Um, so using my phone for more than just making phone calls is kind of new to me. Um, so yeah, a new microphone, that was fun. And then I had made a bunch of notes, not realizing that I probably wasn’t gonna be able to see those notes. Um, you know, so that was also a little bit of a issue, but uh, but yeah, other than that, man. Not much, you know, I mean I’m here. (02:37)Yeah. I remember receiving your emails about, I’m not sure what day we’re on. I need to reschedule all that kind of stuff. Stuff that I used to do heaps. I remember in the early days of my kind of stroke recovery, I used to make appointments, put them in my calendar, get reminders about my appointments and still be confused about the day, the time and the location of the appointment. Brandon (03:04)Yes, absolutely. That’s a big thing for me too. know, and I mean even just, you know, remembering from minute to minute where of what day, what month and everything I’m in right now is a little bit tricky still. It’s getting better, but ⁓ but yeah, I still have a lot of trouble. I can always think of every month except for the month that we’re currently in. (03:24)Okay, so you have like a short term memory thing, is it? Or… The Stroke Experience Brandon (03:28)Yes, yes, have short-term memory issues. ⁓ A lot of times ⁓ I struggle to find, like I said, the date and everything else. ⁓ But I don’t know, man. It’s kind of like I’m in this perpetual day ever since the stroke, and I have trouble keeping track of exactly what that is on everybody else’s time frame. (03:53)Like a, like a groundhog day. Brandon (03:55)Yes. Yeah. You know, I mean, if I really work hard and think about it, I can figure out what day it is, but it takes a while generally to get the month. The day of the month isn’t quite as difficult anymore, but at the beginning I had trouble with the whole thing. (04:11)I hear you man, I totally hear you. I reckon there’s been a ton of people that relate to what you’re saying. ⁓ Tell me, day like before stroke? What’d you get up to? What type of things did you involve yourself with? Brandon (04:23)Well, ⁓ you know, I was, I was really involved in, ⁓ production of music festivals and, ⁓ doing that kind of work. ⁓ I’ve always kind of freelanced. Well, you know, I actually, ⁓ left traditional life in 2000 and ⁓ January 1st of 2012 and started traveling and, you know, living out of an RV and whatnot. Before that, I was in the oil field. I’ve worked as an MWD specialist on a drilling rig, which means that I used to ⁓ take down all the information about where the actual drill bit was underground and send that off to all the geologists and everybody else so they can make sure that the well was going in the right direction. And, ⁓ you know, I just really didn’t feel happy in life, man. So I decided to take off and see the states out of my RV. And that started about 10 years of travel. And then In 2019 I bought some property and started to kind of slowly come off the road and started to be on my property more often but you know it just yeah I don’t know man my life has been a lot of different transitions one thing to another I move around a lot in life. (05:25)you Yeah, so the RV was kind of just exploring seeing the country Doing that type of thing or was it going somewhere with a purpose say to get work or to? Hang out there for a little while. What was that all about? Brandon (05:57)A little bit of all of it. A little bit of all of it. I’ve always been able to find work where I go, you know, doing different things. But I kind of fell into music festival work, like setting up and tearing down for music festivals and building art installations, doing like mandalas out of trash and stuff like that. And just kind of always did kind of the artist thing, I guess you could say. Even before, while I was still in the oil field doing the traditional life thing, I was always very art motivated. (06:30)Yeah, when you talk about traditional life, you’re talking about nine to five kind of routine and working for the man type of thing. Is that what you mean by traditional life? Brandon (06:43)Yes, except mine was a little bit different. My work in the oil field involved me being on site on the drilling rig for up to six weeks sometimes. So it wasn’t really nine to five. I would stay gone for a lot more than that. But then when I would go home, I’d be off for three weeks, a month. So yeah, just ⁓ doing that. (07:07)Where were these oil rigs? Were they in the middle of a desert? Were they in the ocean? Brandon (07:13)No, they were all onshore and I worked a lot in like Pennsylvania, but also a lot in Texas ⁓ Just you know anywhere where they were doing natural gas drilling (07:27)And is that a remote kind of existence in that if you’re on the rig for six weeks, are you getting off it? Are you going into town? Are you doing any of that stuff? Brandon (07:38)Usually the rigs are within an hour of some type of small town usually a Walmart that type of thing So I would go and get groceries a couple of times a week You know me and the other guys would go out and get you know dinner times and whatnot but ⁓ but yeah, basically just sitting in a little trailer a directional trailer is what they called it because it was me and ⁓ Two two other three other guys two more ⁓ directional drillers and then one other MWD hand which is what I was and so there was a night shift and a day shift of two guys each. (08:16)12 hour shifts. Brandon (08:17)Yes. (08:18)Dude, hard work. Brandon (08:21)Yeah, I mean on paper it was hard work. In real life, I mean there were those really problematic jobs where you know everything went wrong but in most cases it was just you know taking a bunch of measurements on the computer whenever they would add another link of pipe to the drilling string and drill down further so every time they would add another length of pipe I would have to take more measurements. (08:47)I hear you. So not physical, but still mental. And you’ve to be on the go for a long amount of time. Brandon (08:56)Right, but yeah, I mean it did when I would have to go up on the rig floor to like change the tool out or to put something You know together or what not so there was a little bit of that but still not as physical as like a traditional drilling rig roughneck (09:04)Uh-huh. I hear you. Yeah. Everyone’s seen those videos on YouTube with those guys getting covered in that sludge and working at breakneck speeds so that they can make sure that they put the next piece on. Brandon (09:24)Yeah, yeah, no, I, you know, and I mean, I wore my share of that mud, but not near as much as a floor hand would. (09:34)I hear, I feel like you’re, ⁓ you’re toning it down and you’re making it sound a lot more ⁓ pleasant than what it might be. But I appreciate that, man. like the way you talk about things. I couldn’t imagine myself doing that, that level of physical labor. Maybe I’m just a bit too soft myself. Brandon (09:54)Yeah, no, I don’t know, man. I consider myself soft in a lot of ways, too, man. You know, it’s just, we’re all different in our softness. (10:02)yeah. ⁓ tell me a little bit about, ⁓ your stroke, man. Like what was that particular week? Like the day? Like how did the lead up happen? Bill Gasiamis (10:12)Let’s pause for a moment. If you’re listening to this and thinking, I wish someone had explained this part to me earlier. You’re not alone. One of the hardest parts of stroke recovery isn’t the hospital. It’s what comes after when the appointments slow down, the support fades and you’re left trying to make sense of what your life looks like now. That’s exactly why I wrote the unexpected way that a stroke became the best thing that happened. It’s not a medical book. It’s a recovery companion built from real experiences. real mistakes and real breakthroughs that stroke survivors discovered along the way. If you want something that helps you think differently about recovery and reminds you that you’re not broken, you can find the book at recoveryafterstroke.com/book. Let’s get back to the conversation with Brandon. Craniotomy Stroke Recovery Journey Brandon (10:59)Okay, so I was helping a friend in Northern California to clean a property that was owned by an artist who had died and we went on to his 10 acre property and we’re just cleaning up for his family. But he had like all kinds of art stuff everywhere and so it was kind of right up my alley and ⁓ We were just trying to get the property clean for these people and we decided to take off and go and do a little bit of rock climbing. so we took off early one morning and drove to a town called Willets, California where there’s good rock climbing and we spent the day doing rock climbing which was a fairly new thing to me but the guys that I was with were very experienced lifelong climbers. And so I was kind of the new guy and they were showing me the ropes and we climbed all day. I did really well, I thought, and didn’t really notice anything. No problems. ⁓ Got back in the car. We’re headed back to the house about an hour away, a friend’s house where we were all going to stay the night. And on the way there, I noticed that I was really thirsty and I stopped and I got two 40 ounce bottles of Gatorade and I drank them both immediately and like just downed them and still didn’t notice anything was a problem was in the truck by myself with my two dogs and eventually I guess about an hour later we got to the house And I went inside to hang out with everybody. And one of my friends said that my arm wasn’t working well. I didn’t notice it at all, but he said that my arm wasn’t working very well. ⁓ so ⁓ I just kind of went on with my life. a couple of, I guess about an hour later, I decided that I was really tired. and I could not quench my thirst so I just grabbed a whole bunch of water and went out to my truck and I was gonna go and lay down and sleep in the back of my truck for the night and ⁓ when I got out to my truck ⁓ by this time my friend had said that my arm was working fine again and he noticed that I he felt like I had gotten over whatever it was and so I went out to my truck got into the driver’s seat of the truck And that’s about the last of my recollection that night. next morning when I wasn’t up making breakfast before everyone else, they realized there was a problem because I was usually the first one up making breakfast and doing all that stuff and I wasn’t there. So my friend came out to my truck to check on me and I was still in the driver’s seat with my head on the steering wheel. I never even fell over. (14:05)Hmm. Brandon (14:17)And so this is 12 hours later. And so ⁓ he tried to wake me up and I was only halfway coherent and I couldn’t make either of my arms work and only one of my legs could I get any response from. So he realized there was a problem immediately, pushed me over into the passenger side of the truck got in and drove me an hour to the closest hospital, just a small little regional hospital. And they were pretty quick about realizing that I was having a stroke. And they didn’t even, I don’t even remember them putting me in a room. They brought me straight up to the roof and put me in a helicopter and helicopter and helicoptered me to UC Davis hospital in Sacramento. (14:59)Wow Wow Brandon (15:15)And I got into the hospital and within, I think about an hour and a half, they had called my mom and my brothers who were all in Louisiana at the time. And they had gotten permission to start treatment and they brought me into the surgery. at first they just (15:25)The The following is a video of the first year of Brandon (15:45)removed a three millimeter blood clot from my main artery on the right side. But then the swelling was so bad because I had been bleeding into my brain for 12 hours overnight that they had to go ahead and do ⁓ a, what do you call it? The craniotomy. Yeah, craniotomy. And so they took this whole side. It was a big craniotomy. (16:05)Craniotomy Brandon (16:12)They took this whole side, everything to the center of my forehead, above my eye, down to just above my ear, front to back. ⁓ They took that whole section of my skull out, put it in the freezer so that my brain had room. then I spent 10 days in intensive care recovering from that. And then they moved me to a rehab hospital where I spent four weeks. And yeah, so in that rehab hospital, yeah, immediately after the surgery, I couldn’t walk and I had pretty much no function on my left side, know, arm or leg. But by the time I got to the rehab hospital, I had gotten some control back, but I still couldn’t walk. ⁓ (16:44)Wow, man. Adjusting to Life Post-Stroke Brandon (17:10)And that about a week after I was in the rehab hospital is when I started to walk again without assistance. So that came back fairly quickly, but I still had really bad foot drop and my left arm wasn’t working. It was hanging, you know? And then, so they kept me in there, ⁓ you know, going through, I guess, regular rehab. (17:24)Thank Yep. Brandon (17:36)They the series of lights on the ground in front of me and I’d have to like run around and touch the different lights as they would activate and you know, I don’t know I mean, I guess it’s the same type of rehab stuff that most people go through and ⁓ (17:51)Yeah, it’s probably similar. Mate, ⁓ this is what I really want to know is what’s it like to experience having half of your skull removed? Can you somehow paint a picture of what it’s like to go through that process and how aware were you of it? Because you just had a stroke, right? So you’re in a bit of a challenged sort of healthy health state. Brandon (18:14)Right. No. Yes. ⁓ well, I think that that deliriousness was actually kind of helpful. First of all, I have not experienced any pain through the entire process. From the stroke, no pain from the craniotomy, no pain through rehab. I have not experienced any pain through this entire experience. None whatsoever. Now the doctors say that I might have lost some of that ability to sense it But you know, I mean whatever it took I Really, you know, I didn’t you know, whatever the reason was The effect of it was that I had a pretty fame pain free experience, you know (19:07)and you’re like looking in the mirror and seeing yourself and you know, like experiencing your head and how do you kind of deal with all of that? Brandon (19:21)Well, ⁓ I couldn’t feel a whole lot. I still have a lot of, or not so very much sensation on my scalp on that side. So, you know, but as far as looking in the mirror, that was kind of interesting. You know, it took a little while to get used to it, you know, and, it, ⁓ was definitely not something that I would recommend. Anybody else going through if they don’t have to you know, but ⁓ But I don’t know man. I mean, I’ve always tried to stay pretty positive about things and so, you know, I just Kept going, you know, I mean they shaved my head. I had dreadlocks for a very long time I had dreadlocks and And so this is all the hair that I’ve gotten since they put my skull back together, which was January or it’s actually It’ll be one year tomorrow since they put my skull back together. So, ⁓ my hair is coming back, which I’m really grateful for. About this time next year, I’m gonna start trying to put my dreadlocks back in. you know, but yeah, it’s, I don’t know, man. It’s really been an interesting ride. ⁓ You know, ⁓ learned a lot more about stroke than I ever thought I would need to. You know, I mean, I’m 48 right now. I was 46 when the stroke happened. So it wasn’t even on my radar, man. I wasn’t paying any attention at all. I didn’t know the anagrams or whatever. I didn’t know the symptoms of stroke. So I just kind of rolled with the punches as they came. I took it one step at a time. And that’s kind of the way it’s been with my recovery too. is I try to address one problem at a time so I don’t overwhelm myself. So after I started to get my leg back, I started to shift my influence to my shoulder and my arm. And at this point, I’ve got almost full range of motion back to the left side. I still can’t write. ⁓ Well, actually, technically, I can make my whole alphabet and all of my numbers with (21:16)Yep. Brandon (21:37)both hands at this point. trained myself to use the other hand and then about the time I was able to get that back the other hand started to come back online. So now I can do all that with both hands but words I’m word blind and numbers and letters don’t make a lot of sense to me. So even though I can make the shapes I have a lot of trouble associating the sounds of certain letters and the functions. of different numbers and letters, you know? That’s where a lot of my trouble is now, and that’s where most of my work is at the moment. (22:14)I hear you. So you sound like you’re very cool, and collected. How do you remain positive when you wake up from a stroke? You’re missing half of your skull. Your body doesn’t work on half the side. Is it your default? Do you have to work on that? Have you been working on being positive over? the decades that you’ve been on the planet, give us a bit of an insight into that part of you. Brandon (22:47)Okay, so yeah, I think I’ve always maintained a pretty positive demeanor, you know, I mean I’ve gone through some rough stuff in life, but I’ve just kind of kept going, you know, rolling with the punches. So I really don’t think that I have had much difficulty remaining positive through it. You know, there’s ⁓ definitely, you know, ⁓ days that I don’t feel as good as other days, you know, and you know, I definitely have… ⁓ things that I have to work through. have to, you know, I have to make an effort to remain positive, you know, at times. But my default has always been to be a pretty positive and happy person. So I think that that was really the majority of it is that I’ve always even in the light of extreme adversity, I’ve always been able to remain positive. You know, ⁓ so that that’s always been, you know, key even before the stroke. But (23:39)Yeah. Brandon (23:46)Yeah, I mean definitely waking up and realizing that half of my body didn’t work anymore was not fun, but it’s what I was given. I couldn’t change it, you know, only time and work was gonna change it. So I just kinda accepted it, you know, I mean, ⁓ one of the biggest things that helped me out was by the time I got out of surgery and started to get coherent, My mom and my brother had already flown from Louisiana to be with me in California at the hospital. And that was huge just to know that my family was there. And they stayed with me for the whole time that I was ⁓ in the hospital for the 10 days. And then when I went to the rehab hospital, they went home. ⁓ But yeah, so that was ⁓ just really, that was a big part of it too, you know, I mean. My mom and my brothers are pretty much the most important people in my life. Of course, my daughter as well. yeah, so, you know, to have them all there and just to have that support and have them there to help me because when I first came out, from the time I came out of surgery, I could still speak very clearly. So I did not know what I was saying. (24:56)Mm-hmm. Brandon (25:15)Nobody could tell like I wasn’t making a lot of sense, but I never lost my voice They think that that’s because of my left-handedness Because I’m left-handed I store things like that differently in my brain So because of that I was able to keep my speech even though I cannot write I can’t do you know I mean I can write my letters, but if I try to (25:32)Okay. Brandon (25:44)make a word this was yesterday (25:48)Aha! Lux- Brandon (25:50)But I can, yeah, it’s just scribble. It’s just scribble. Yeah, but, you know, if I try to like draw a letter or a number, I can do it, but I have trouble assigning it to its value. (25:53)Yeah. Understood. So before that, were quite capable of stringing sentences together, writing things down, doing all that kind of stuff. So that’s a very big contrast. Brandon (26:14)I have always been known. Huge contrast. (26:22)Is it frustrating that you can’t write in the way that you did before? it matter? Brandon (26:27)Yes, yes, I used to write all the time, know, poetry, things like that. I’ve always been considered, you know, a good writer, a good orator, public speaker, you know, that kind of thing was a big part of my life, for my whole life. And so to go from that to not being able to write a sentence on a piece of paper or even a word is really a big change for me. You know, and I mean I do use my phone for voice to text. If I wouldn’t have had voice to text, I really don’t know where I would be right now. (27:06)Is that how you communicate most things? Brandon (27:09)Yes, absolutely. it’s- if I can’t say it, like speak it, I have to use voice to text. I can’t spell- I can’t- I can’t spell my own name half the time. (27:17)Dude, I love that. Yeah, I hear you. I love voice to text. So I was told by a friend of mine about a product called Whisper Flow. I’m gonna have links in the show notes and in the description on the YouTube video, right? And it’s spelled W-I-S-P-R-F-L-O-W, Whisper Flow. And what you do is you program one key on your keyboard. And then what you do is you press that key and it activates Brandon (27:36)Yes. (27:52)the app and then you speak and it types beautifully. It types at all. And I’m a terrible like typist. I could never be one of those really quick secretary kind of people and take notes because I’m not fast enough, but it can type for me by speaking like beyond 99 words per minute, which I think is crazy fast. Living Independently After Stroke And I do it because it just saves a heck of a lot of time, me looking down at the keyboard and all that kind of stuff. My left hand does work, but I can type with it, but often my left hand, you know, we’ll miss the key and I’ve got to go back and do corrections and all that kind of stuff. So voice to text, this comes such a long way and everyone needs to know, especially if they’ve had a stroke and one of their limbs is affected, especially if it’s their… they’re riding limb or if they have a challenge like you, everyone needs to know about the fact that technology can really solve that problem. I’m pretty sure, I know this sounds like an ad for Whisper Flow, it probably is, but I’m not getting paid for it. I think they cost, it costs about hundred bucks a year to have this ⁓ service. So it’s so affordable and it does everything for you just at the touch of one button on your computer. And for some people you can also use it on your phone. But I think phones are pretty awesome at doing voice to text already. So you don’t really need ⁓ it for the phone, but you definitely need to check it out for the computer. Brandon (29:27)Okay, yeah, well, you know, I pretty much have my phone. I don’t have a computer, so… But, ⁓ it does sound like an amazing product, and I am looking to get myself a computer because I really, ⁓ like, I haven’t touched a keyboard since my stroke. So, it would be nice to get myself a laptop with a keyboard so that I could start working on trying to see how that interface works for me. (29:33)Yeah. Yeah. How was the transition out of hospital and rehab back to your place? and how long after the initial strike did you end up back at home? Brandon (30:04)Okay, so, when I, I left the hospital after, or I’m sorry, after 10 days in intensive care, they put me in the rehab hospital and I was there for four weeks. After that, they still didn’t think that I was ready to live by myself yet. So I had to, ⁓ rent a house in Joshua tree from a friend of mine who lived on the property in another house. And so I had a whole house to myself still which allowed me to keep my independence. But I still had somebody close enough to holler if I needed anything. And so I kind of, you know, baby stepped by renting a house, you know, for a while. And, And I have property in Northern Arizona where I normally would take my off time when I wasn’t traveling. But, ⁓ But, ⁓ because of the stroke, I wasn’t able to go back to that property for quite a while. And only about Christmas of last year did I start to be able to spend some more time on my property, you know. But at this point, I’m still renting the house in Joshua Tree and starting ⁓ to branch out a little bit more, do a little bit more traveling, things like that. Now with that said… I have been ever since the stroke happened about two months after the stroke I went back to my first music festival. So I didn’t have half of my skull. I had to wear a helmet for six months. And so here I am at a music festival with all of my friends and I’m in a helmet with half of my skull missing. But I still was able to be there and then ⁓ you know, be a part of the festival. So I got back to the activity that I enjoyed pretty fast. (32:07)What genre of music? Brandon (32:09)Well, it’s actually the Joshua Tree Music Festival in particular, which is the only music festival that I’m really involved with anymore. ⁓ They do world music. We get artists from all over the world in. And that’s kind of one of the reasons I’ve continued to be a part of this music festival and really haven’t been that big of a part of the other ones is because I’m always learning about new music when I go there. And that’s a big important part of it to me. (32:40)Understood. So your transition back to living alone took a little bit of time. You’re renting a place. Are you alone there? Are you living with anyone else? How is the home set up? Brandon (32:55)I have a home all to myself but there is a shared home on the other or on the property that a friend of mine lives in and he’s actually the one that I’m renting from so yeah (33:09)So you have access to support to help to people around you if necessary. Brandon (33:15)if I need it. also another big part of one of the symptoms of my stroke is that I don’t recognize my own disabilities. I have a lot of trouble with that. So I generally do not ask for help with things, which in a lot of cases has made me a lot stronger and I think been a big part of a speedy recovery. But at the same time, I can put myself in some kind of sketchy situations at times. (33:43)It’s not, are you sure it’s not just your male ego going, I can do this, I don’t need help. Brandon (33:49)I mean, I’m sure that that does tie into it, I’m certain. But yeah, that’s one of the things that I’ve struggled with from the beginning. And I didn’t recognize the left side of my body as my own. I thought it was somebody else’s. That wasn’t very long, just for maybe the first couple of weeks. But that was a very interesting sensation, that I felt like there was somebody else there. (34:06)Wow. Yeah, it just feels like it’s my, I kind of describe my left side as if it’s because my star sign is Gemini, right? So now I describe it as being the other twin, like the other part of me, which is me, but not me. And it’s so strange to experience 50 % of my body feeling one way and then 50 % of my body feeling a completely different way, which is Brandon (34:25)Yeah. Facing New Challenges: Aneurysms and Uncertainty (34:44)the only way I remember and then tying them together, like bringing them together has been a bit of a wild ride, like just getting them to operate together. When they have different needs, my left side has different needs than my right side. And sometimes one side is getting all the love and the other side is missing out. And I’m always conflicted between where do I allocate resources? Who gets… how much of my time and effort and who I listen to when one of them’s going, my left side’s going, I’m tired, I’m tired. My right side’s going, the party’s just started. Let’s keep going. Don’t worry about it. Brandon (35:25)I have to deal with that. Of course, my left gets a lot tighter than my right side, but I don’t know. think I’ve done a pretty good job of giving it that care. And a big part of where I measured my success was getting my shoulder back online and being able to pronate and go above my head. It took months to get my hand over my head. But But at this point, you know, I’m pretty much back to physically normal except for the fine motor skills on my right, on my left side. You know. (35:59)Sounds like things are going really well in really small increments. And if you’re only, what, two years post stroke, sounds like recovery is gonna continue. You’re gonna get smaller, more and more small wins and they’re gonna kinda accumulate and make it pretty significant in some time ahead. Brandon (36:17)Right. It’s a year and a half. So my stroke was on the 4th of November of 2024. (36:32)Yeah. Do you know in this whole time, did you ever have the… like, this is too hard, I don’t want to do this. Why is this happening to me kind of moment? Did you ever have any of that type of negative self talk or thoughts? Brandon (36:50)no, I mean, I suppose there probably were moments, but I don’t pay a lot of attention to those kinds of moments. You know what I mean? I do kind of even without the stroke, maintain a pretty positive mental attitude, you know, and I think that that’s been one of my biggest blessings through this. ⁓ yeah. So yeah, that’s never really been a good emotion. (37:12)I get a sense that you have those moments, but you don’t spend a lot of time there. Is that right? Is that what you just sort of alluded to that you have those moments, you just don’t give them a lot of time. Therefore they don’t really have the opportunity ⁓ to sort of take up residence. And then you just move on to whatever it is that you’re getting results with or makes you feel better or… ⁓ supports your project which is ⁓ recovery or overcoming or… Brandon (37:48)Yes. No, I completely agree. ⁓ You know, I mean, speaking of which, four days ago, I got ⁓ a phone call from the doctors. ⁓ They found an aneurysm in my brain. So I have to go and meet with a neurosurgeon on Tuesday to discuss what we’re going to do about a brain aneurysm. So I thought, you know, I was just about back to normal. And here I go into another situation. But again, until I know what’s going on, there’s no point in worrying about it, you know? So I’ll know more about it on Tuesday, but until then, I’m not spending a whole lot of time wondering, you know, am I just going to have an aneurysm and collapse tonight? You know? (38:36)that tends to be my default as well. I was really good as a kid. ⁓ When I was being cheeky and not doing my homework for school, I would go to bed and I would remember, I haven’t done my homework. And then I’d be like, yeah, but you can’t solve that problem now. Now you got to sleep, right? So you got to worry about that in the morning after you’ve had a good night’s sleep and you wake up and then deal with it. And that was a strategy to help me forget about that. minor problem, which back then, if you haven’t done your homework as a teenager, that was a big problem. If your teachers found out, if your parents found out, but the idea was that, don’t I just pause all of the overthinking? Why don’t I just pause all of the rumination and all the problems and all that stuff that it could cause for now. And I’ll worry about it when there’s a opportunity to have the resources to do something about it. And the classic example was in the morning, I would have an hour before school where I could reach out to one of my friends, take their homework, copy their homework, and then hand in my homework. Brandon (39:46)Absolutely. Yep, that was very much like me in school. (39:51)Yeah, not much point worrying about things you can’t change or control in the moment. Just pause it, deal with it later. I had a similar situation with my bleed in my brain, because I had a number of different bleeds and it was kind of in the back of my mind a little bit. What if it happens again? But it actually never stopped me from going about life from bleed one through to bleed two. was only six weeks, but like through blade two to blade three, it was about a year and a half. But I got so much done. I was, we were just going about life. was struggling with memory and all different types of deficits because of the blood clot that was in my head. But I never once kind of thought about what if something goes wrong, unless I was traveling. to another country, because we did go to the United States when I was about almost a year after the first and second bleed, we went to the United States. And then I did worry about it from a practical sense. It’s like, if I have a bleed in Australia, I’m near my hospital and then they can take over from where they left off previously and healthcare is paid for here. So there was no issue. But if I’m overseas and something goes wrong, I’m far away from home, we got to have the expensive insurance policy. Cause if something goes, I want to be totally covered when I’m in the United States, we don’t know the system. don’t know all these things. So that was a practical worry that I had, but I didn’t worry about my health and wellbeing. Do you know? I worried about the practicality of having another blade in the airplane because then I’m in the middle of the ocean. over halfway between Australia and the United States. And that’s eight hours one way or another or something. And I thought about that, but I didn’t think about how I would be personally ⁓ negatively impacted by the medical issue. I just thought about the, do we get help as quickly as possible if something were to happen? So I know a lot of people have a stroke and they, Brandon (41:55)Right. Support Systems: Finding Community After Stroke (42:18)⁓ They overthink about what if it happens again and they’re constantly kind of got that on their mind, but I was dealing with just the moments that made me feel like perhaps I should do something about this headache that I’m getting. I dealt with things as they appeared, as they turned up, I didn’t try to plan ahead and solve every problem before it happened. Brandon (42:24)Yeah. Yes, I agree. I’m very much the same way. You see, before my stroke, I didn’t have medical insurance. I hadn’t seen a doctor since my early 20s. just, I was, I was, I had always been extremely healthy. You know, I’ve always been very physically active, you know, and, so it just, I never really, I never really ⁓ went out and looked for medical. I just didn’t need it, you know? And so, When the stroke happened, I was very lucky to get put on California’s healthcare plan. And they’ve taken care of all of my medical bills. ⁓ You know, I’ve never pulled a single dollar out of my pocket for all the rehab, all the doctors since. And I mean, I have doctors still once every week, two weeks at the most, doctor visits, you know? And so I’m extremely fortunate. that it happened to me where I was, you know, because not all states here are like that, but California is extremely good. So, you know, I’m really grateful that it worked out the way it has because it could have been a whole different situation, man. (44:00)I have heard some horror stories about medical insurance for people who are not covered, have a stroke and then they leave hospital with like a $150,000 bill or something. Is that a thing? Brandon (44:13)Yes, it really is. I mean, I was extremely fortunate. By the time I got out of that first 10 days with the helicopter ride and everything else, I was close to $2 million in bills. (44:25)Dude, that’s mental. Brandon (44:26)Yeah. And, ⁓ yeah, I mean, it just doesn’t really, I mean, you know, I mean, I’m not a big fan of, the way that the medical system works money wise. think it’s all just paper or fake money, just fake numbers, you know, but yeah, I don’t know. I just, ⁓ I was extremely fortunate that it all happened the way that it did and that California is so good and they really do take care of their citizens, you know, so. (44:54)Yeah, I love that. Brandon (44:55)Yeah, very fortunate. (44:57)You know, in your recovery, did you have somebody that you kind of leaned on for support that was a confident, ⁓ that was like a mentor or did you have somebody like that in your life that was really helpful in your recovery? Brandon (45:15)Actually in about the year before my stroke I lost the three gentlemen that I had always considered my mentors, older guys that I’ve known for years. They all three passed away the year before my stroke. So I really kind of felt on my own. You know, I have a lot of friends, you know, but ⁓ but after my stroke I really don’t have the brain space for like Facebook or anything like that. So I really, closed down my very active Facebook account and when I did that, I lost so many people that would have been my support because I just, they weren’t there, you know, in real life. They’re only there on the computer, you know? And so, but luckily, you know, I’m a part of the community in Joshua Tree. So I had a lot of support from people there and… ⁓ Then I have probably four or five other friends that are scattered around the United States that I keep in touch with pretty closely. But I went down from talking to hundreds of people a month and all of that on the internet to really a very small closed social circle, you know? And then in addition to that, surprisingly, people that I’ve known for years just are not very good at accepting the differences in who I am as a person since the stroke, you know? And so, you know, I hate to say it, but a lot of friendships have kind of gotten a lot more distant since the stroke. you know, it’s just, I mean, it is what it is. You know, people have to do what they feel is right for themselves, you know? But yeah, I really… ⁓ Identity Shift: Life Changes Post-Stroke (47:06)Yeah. Brandon (47:07)I don’t have a very large support network. You know, I just basically kind of take care of a lot of it myself. You know, I mean, I did two and a half months of outpatient rehab with a occupational therapist. And what’s the other one? Occupational and physical therapy. (47:33)Mm-hmm. Brandon (47:33)So I did occupational and physical therapy for about two and a half months after I got out of the hospital. And that was all really good and helpful. And ⁓ I’m really grateful for those therapists that worked with me. And they helped me get ⁓ basically back to a normal cadence because I was having trouble putting one foot in front of the other. And they really helped me work on my cadence and getting my walk back to fairly normal. ⁓ My arm. has been mostly me. It has never been able to be rushed. It takes its own time. So even with the physical therapy, my hand coming back, it works at its own pace. That was never really influenced that much by physical therapy. And then my actual use of my hand, I was balled up. I was curled up and balled up to the wrist. after the stroke and eventually I got to where I could hold it out flat and I still tremor a lot there but it’s a lot better than it was and but yeah all of that had to come back at its own pace the physical therapy and stuff was helpful for a lot of other aspects of my recovery but that was all just taking its own time and coming back as I guess as it did my brain learn to re-communicate (48:58)Yeah, it sounds, it sounds like you’re kind of really well made up somehow, like you picked up the skills early on in your life to be able to deal with this situation. The way that you do is just amazing. Like it’s seems like it’s second nature, the way that you go about approaching the problems, the challenges, the difficulties, know, the missing half your skull, all that thing. It just seems really innate that you have that within you. you, people are listening and going, you know, that’s not me or I didn’t experience that or I’m overthinking things. Do you think that’s the way that you’re approaching things is teachable, learnable? Can people change the way that they’re going about ⁓ relating to their stroke or dealing with their stroke or managing it. Brandon (49:53)⁓ you know, I think that that you’re going to find that a lot of people, can be taught and a lot of people, can’t be taught. You know, some people’s nature just is not going to be able to handle that. But other people, you know, I think that you can go through very real processes to gain, ⁓ knowledge base, you know, to be able to start working with it. You see another big aspect of my recovery. is that I immediately after my stroke and getting out of the hospital moved eight hours away from UC Davis Hospital where my original care providers were. So I had to go through a whole new medical plan, a whole new set of doctors and everything else. And that changed on me like three times over the first six months. So I really couldn’t rely on the doctors for support either. because they were changing so often I would just meet one and the next thing I would know I would have a new doctor coming in or a new healthcare plan and so it took about six months for me to start seeing the same healthcare providers routinely so I went to YouTube University man I found you I found several other people that had these just these huge amounts of information you know, on how to handle my own recovery. So I took a lot of my own recovery into my own hands. And actually, ⁓ a week ago, I was talking to my neurologist, who is a really amazing lady, and, you know, and had to tell her pretty much that same story that, you know, I couldn’t leave it up to the doctors to fix me. I had to take care of myself. because of my situation and switching insurance and everything else that I went through, there was just not that much option. ⁓ so, you know, and she was like, I wish that all of my patients had that kind of an outlook. You cannot rely on the medical system to fix you. You know, we were talking about what can help people. I think that’s a really big thing that could help a lot of people is to realize that you have to take care of your health care decisions. You know, they found a PFO in my heart, a ⁓ Framon Parabot. (52:24)A patent for Ramen Ovali. Hole in your heart. Brandon (52:28)Yes, yeah, they found that and they wanted to fix it and I was like, you know, I’m 47 years old. This is a one-time thing. So I opted to have a loop recorder installed, a loop recorder to measure my heart rhythm and everything and send messages to the doctors at nights about my heart. So that because I thought that was a little bit less invasive. For my age, the last thing I want is for later in life, my body to start having problems with an implant that’s in my heart. So I decided not to go with that and to go with the less invasive loop recorder, which is still implanted under the skin in my chest, but it doesn’t affect my heart. (53:08)Thank you. Brandon (53:21)It just sends the information about my heart rhythm to the doctors so that they can keep track. (53:26)and it can be easily accessed and removed. Brandon (53:30)Exactly, exactly. So, you know, I mean, if I have another stroke or if I find through the little device that I’m having trouble with that PFO, you know, then I’ll get the PFO closure done. But until then, I didn’t want to just jump straight to that, you know, three months out of my out of my stroke. You know, I want to make sure that that’s the problem. because they did pull a 3mm blood clot out of my brain. So there’s a good chance that that went through the PFO and into my brain. But I was also way outside of my normal activity range trying to rock climb the day before. So there’s just, there are too many variables about the experience for me to just want to go and have something installed in my heart permanently, you know? (54:28)I hear you. What about the aneurysm? Where is that? What’s the long-term kind of approach to that? Brandon (54:35)Don’t know yet. I do not know anything about it. I’ll find out more information on Tuesday They said it’s not it’s not in the same part of my brain that my stroke was So that’s a good thing and there’s a good chance that it may have been there for a long time before the stroke So we just don’t know I don’t know anything about it So that I’m gonna go and meet with this neurosurgeon and decide what we’re gonna do about it (54:42)that’s right. Brandon (55:03)I think the most likely option, as long as it’s not big, is that they just wait and they monitor it. But there’s also a process where they coil it. They put a coil of platinum into it and pack it off so that it can’t become a problem later. And then the third scenario is that they take another piece of my skull off and go in and actually put a clip on it. to stop the blood from going into it. So I may actually have to have my skull open back up again. But, again, there’s no point in thinking about it now. I’ll think about it after Tuesday when I figure out where this thing is, what size it is, and all the details of it, you know? (55:46)Yeah. I love it. I love it. I love that man. That’s a great way to approach it. Also, ⁓ I love your comment about YouTube University. I love the fact that people find my podcast sometimes when they’re in hospital because clearly they realize I need to ⁓ learn more about this, understand it and ⁓ straight away they’ve got answers because of YouTube. it’s such a great service. It’s free. If you don’t want to pay for a paid service and all you got to do is put up with ads that you can skip through most of the time. So I think that’s brilliant. ⁓ What about your identity, man? People have a lot of kind of ⁓ examples of how they have a shift in their identity, how they perceive themselves, how they fit into the world. Did you feel like you have a shift in your identity or the way that you fit into the world? What’s that like for you? Brandon (56:46)Well, I mean, I definitely do feel like there was a big shift. Now at the core, I feel like the same person. know, mentally, I still feel like I know who I am, but it definitely has shifted my priorities in life a lot. ⁓ I did not raise my daughter and I developed a much closer relationship to her since the stroke. and we’ve been spending more time together and just really working on our relationship together. She’s 28 years old. So, you know, that has really been an amazing aspect of my stroke recovery is that I’m closer with my daughter than I ever was. But yeah, I mean, you know, I do things a lot differently. I was a heavy smoker, a heavy drinker, and a heavy marijuana user. I don’t smoke marijuana, don’t smoke cigarettes, and I don’t drink alcohol anymore. So huge change in my lifestyle as well. ⁓ But you know, I just I’m not as much of a hurry as I used to. I was always accused of my mind working on too many levels at one time, you know, and had too much on my plate, too much going on in my brain all the time. Now. My brain doesn’t keep up as well. So I struggle to stay on one subject, much less juggle multiple things in my brain. So it’s really kind of slowed down my whole mental process. But I think that again, that’s in a good way. I think that ⁓ I needed to slow down a little bit in a lot of ways. Lessons Learned: Insights from the Journey (58:31)I hear you. With the alcohol, marijuana and the smoking. So you might’ve been doing that for decades, I imagine, smoking, drinking. Brandon (58:43)Yes. (58:44)how do you experience your body differently now that it doesn’t have those substances in it anymore? Like, cause that’s a mass, that’s probably one of the biggest shifts your consumption of, we’ll call them, I don’t know, like harmful ⁓ things, you know, like how, so how do you relate to yourself differently now that those things are not necessary? Brandon (59:12)You know, I never really had like an addictive aspect. So I really don’t, I don’t feel like, ⁓ I mean, I don’t feel like it’s changed me a whole lot. I just had to take the daily habits out. But after spending a month in the hospital, all of the physical wants, all of the physical aspects of it were already taken care of, you know? So I just had to kind of maintain and not go back to old habits. So really, I mean, I don’t feel like it was that big of a difference. But now physically, I’ve always been an extremely skinny person. You know, I’m six foot one and I’ve always weighed 135 to 145. Now I weigh 165. So I did put on some weight after stopping all that. But other than that, really don’t notice a lot of ⁓ physical differences. Now, I have not coughed since my stroke. I used to wake myself up at night coughing, but for some reason, like literally when I had the stroke, I have not coughed since. Now I clear my throat a lot more and I have a lot of, we’re trying to figure out why, but I have a lot of problems with my sinuses. and stuff like that all on the side that I my injury was on this side but on the side the mental side like where it’s all mental stuff that changed the you know all of that I have problems with my sinuses and drainage and things like that so right now I’m seeing an ear nose and throat specialist and we just did a cat scan of my sinuses so I’ll see on the 13th of this next month I’ll get more information on about what’s going on there. ⁓ really, if that’s all I have to deal with is a one-sided sinus infection, I’m okay with that, you know? (1:01:23)Brandon, you’re all over it, man. I love your approach. It’s ⁓ refreshing to hear somebody who’s just so all over getting to the bottom of things rather than kind of just letting them kind of fester, which kind of leads me to my next question is you seem to have gained a lot of learning and growth from all of this. So what… ⁓ What are some of the insights that you gained from this experience that you didn’t expect? Brandon (1:01:54)⁓ No, I’m really not sure, man. I’m really not sure. I mean, again, I feel like pretty much going back to the same person. I mean, I have, I think, a little bit more respect for the human lifespan. You know, I was one of those people that always felt like, since I’ve never died, I can’t tell you that I’m going to die. Even though everybody else on the planet has to die, I never necessarily felt like that. I definitely feel mortal now, you know? I used to tell everybody that I still felt 25, but as soon as I had my stroke, felt 48. I felt every bit of my age. So it kind of cured me of that. You know, I pay a lot more attention to like, you know, things like, setting up my daughter for the future, you know, and like, Purchasing property for her and things like that to make sure that she’s gonna be taken care of when I’m not here anymore Things that I never paid attention to beforehand, you know, I always just lived in the moment Really didn’t care about the rest But now I’m more prone to put the work into my vehicle before it breaks down Instead of just waiting for it to be on the side of the road to fix it You know, I just I I think that I handle my life responsibilities more like a grown up than I used to, you know, but ⁓ but really, I don’t know, I’d say overall though, it’s still really difficult question to answer, man. I don’t I don’t feel like I live a lot differently. I feel like I’m still the same person, you know. (1:03:35)You nailed it, man. You answered it beautifully, especially the part about mortality. That’s a hap that happened to me. I realized at 37 that, ⁓ I actually might not be around in 12 months, six months, three months. So who knows like tomorrow. And that made me pay attention to my relationships and make sure that they were mostly mended healed. Reach. I reached out to people who I needed to reach out to. cut off people who I didn’t need to continue connecting with. Brandon (1:03:51)Right? (1:04:05)You know, like I realized that this, I’ve got to attend, attend to certain things that I hadn’t been attending to because if, ⁓ if the shit hit the fan, if things go really ugly, then I wouldn’t be able to attend to those things. And I, now that I had the ability to do it, was my responsibility to do that. Brandon (1:04:28)Absolutely, absolutely. I completely agree. I did the same thing. I cleared out a lot of the people that really weren’t being, you know, or that weren’t adding benefit to my life and causing problems in my life. I cleared all of that out. I started to focus more on the core group of people that were a big part of my life and, you know, my recovery and just, you know, who I am as a person. And just, you know, it really made me take a better look at the life that I had created for myself and and ⁓ and Just take care of the things that I should be taking care of and don’t pay as much attention to the things that weren’t serving me (1:05:12)Yeah, it’s a great way to continue moving forward. Your daughter, does she live nearby or does she live in another state? Brandon (1:05:21)She lives in another state. She lives in Alabama right now, but we’re starting to consider her coming out here to Arizona. Her and her boyfriend have lived there for several years, but the only reason she was living there is because her grandparents lived there on her maternal side, and she was very close to them for her whole life. But they passed, both of them, over the last several years. And, you know, she enjoys her work. She enjoys her friend group. But she also feels like she might need to go and explore a little bit more and move out of her comfort zone. So she might be a little bit closer sooner. Her and her boyfriend might actually move out here. we’ll just, know, only time will tell, but it’s just, it’s a fun thought, you know? (1:06:08)Yeah, I hear you. So we’ve shared a whole bunch of amazing things on this episode right now. The last question I want to ask you is there are people watching and listening that had either been listening for a little bit of time. They’ve just started their stroke recovery or they’r

In this episode look at some rarer diagnoses, how they come to light and how they can be hard to live with and diagnose.Links: Pyrrole Disorder (not recognised in conventional medicine): https://www.healthline.com/health/pyrrole-disorderAcademic analysis of pyrroles (deep dive): https://academic.oup.com/labmed/article/55/3/334/7271490Patent foramen ovale: https://www.mayoclinic.org/diseases-conditions/patent-foramen-ovale/symptoms-causes/syc-20353487Migraines and PFO: https://www.migrainedisorders.org/diving-into-the-connection-between-migraine-and-patent-foramen-ovale/Ehlers-Danlos Syndrome: https://my.clevelandclinic.org/health/diseases/17813-ehlers-danlos-syndromeSave your life in slow motion and those of others by subscribing now and sharing. Thank you for listening and for your support. It means a lot to me. Hosted on Acast. See acast.com/privacy for more information.

This week on The BiG Scuba Podcast, Gemma and Ian chat to Jason Pritchard. Adventure has always been at the heart of who Jason is. Ever since His first dive back in 2009, he has been captivated by the mysteries of the ocean — from uncovering hidden wrecks to exploring the unknown. What started as curiosity soon became a calling. By 2018, Jason had earned his certification as a professional instructor, and today, as a PADI Course Director. He is very proud to help shape the next generation of divers through calm, safety-first guidance and real-world experience. For Jason, shipwrecks are the ultimate adventure. Each one tells a story, a blend of history, danger, and discovery frozen in time beneath the waves. Diving isn't just a pastime; it's stepping into another world, one where every shadow might hold a secret waiting to be found. In 2022, he faced his toughest challenge yet: a life-threatening bend caused by a PFO. That experience could have ended his diving journey, but instead, it reshaped it. It taught him discipline, patience, and a deep sense of gratitude for every single dive he makes. These days, Jason is diving deeper, exploring legendary wrecks like Scapa Flow, advancing his technical diving, and preparing for the next frontier: rebreathers. Jason recently become Sidemount qualified, adding another level of flexibility and efficiency to his dives. Beneath the waves, Jason finds peace, focus, and an endless sense of wonder. No matter how far he travels or how deep he explores, Jason will never lose sight of the simple joy of discovery. Every puddle, big or small, holds its own adventure. That spirit of curiosity keeps Jason pushing boundaries, chasing secrets, and living the ultimate underwater journey. Social Media Links Insta/Tiktok @jason_inthe_argonaut , Insta @themidlandsidc, FB @Jason Pritchard The BiG Scuba Podcast is proudly supported by Narked at 90 – "Beyond Technical." Whether you're new to diving or thinking about moving into tech, they can help guide you with the best kit and advice.

Moderator: Theodoros Mavridis (Dublin, Ireland) Guests: Diana Aguiar de Sousa (Lisbon, Portugal), Mira Katan (Basel, Switzerland) Embolic stroke of undetermined source (ESUS) continues to challenge clinicians as its definition and diagnostic approach evolve. In this episode, Theodoros Mavridis is joined by Diana Aguiar de Sousa and Mira Katan. They explore the epidemiological, clinical and mechanistic nuances of ESUS, discuss insights gained from major clinical trials, and examine current therapeutic strategies. The conversation also highlights advances in detecting covert embolic sources, the emerging relevance of atrial myopathy, the role of PFO closure, and the promise of biomarkers in shaping future patient care.

Chime In, Send Us a Text Message!On episode 88 we release a recent conversation with Mark Brodie as a rebroadcast from a Know Stroke Substack Live event with co-host David Dansereau. Mark connected with us after listening to our episode on PFO which also is believed to have caused his stroke. As part of his recovery journey Mark and his family had to learn how to find resources to help with his aphasia as a deficit from his stroke during covid shutdowns.Mark's Top Stroke Recovery Resources Mentioned:Just Ask (Aphasia Support ), Stroke Onward , Stroke Awareness Oregon , Mid Atlantic Aphasia , National Aphasia Synergy (shirt Mark mentioned he was wearing!), National Aphasia Organization , American Stroke AssociationThis is a fitting episode to release for World Stroke Day as the topics and themes covered include all areas of stroke care from knowing the stroke warning signs, to caregiver support, the public stigma around aphasia, use of technology and home therapy,  to the power of community and especially the importance of stroke support organizations that helped Mark restore balance and find his voice again after stroke.Other Episode Mentions: Therapy apps: Tactus Therapy , Constant Therapy Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! DRYYP SaunaFind out more about Mike's new business venture, DRYYP Sauna.Stroke Support Organization (SSO) SurveyIf you support stroke survivors and care partners-please take this survey!Believe in BalanceDavid's Fall Screening and Conditioning Program Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack

Chime In, Send Us a Text Message!Episode 87 Our Guest: Stran Smith 2025 'Draft Pick' for Abbott HeartMates ProgramStran is a legendary tie-down roping cowboy from Childress, Texas. He competed professionally for over 20 years, appearing 11 times at the National Finals Rodeo (NFR), and won the PRCA World Championship in 2008. In 2025 he was inducted into the rodeo Hall of Fame. In this episode, Stran shares his incredible journey from being a professional cowboy to overcoming a life-altering stroke. He discusses the challenges of co-authoring a book, his involvement with the Abbott HeartMates Program and the importance of community support during any type of heart or health related recovery. Stran emphasizes the significance of connection and encouragement for stroke survivors and highlights the HeartMates program as a vital resource for those facing similar challenges. His story is one of resilience, purpose, and the unwavering belief that there is hope and light ahead if you don't give up.More on his stroke: At age 32 he suffered a stroke caused by a previously undetected patent foramen ovale (PFO)—a small opening between the upper chambers of the heart. Doctors initially told him he'd likely never ride again.  He underwent PFO closure using the Abbott Amplatzer Occluder, which enabled his remarkable return to competition and eventual world championship.Abbott HeartMates: In May 2025, Abbott introduced Stran as one of its newest “HeartMates”—heart health champions who share inspiring stories of recovery and resilience. Learn more about Abbott's HeartMates Program and community. https://www.abbott.com/corpnewsroom/healthy-heart/as-abbott-hear Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! DRYYP SaunaFind out more about Mike's new business venture, DRYYP Sauna.Stroke Support Organization (SSO) SurveyIf you support stroke survivors and care partners-please take this survey!Believe in BalanceDavid's Fall Screening and Conditioning Program Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack

Jani Valdivia is from Peru and is based in Tampa, Florida where he works as a neurosurgeon.He is also a member of the AIDA Science and Medical Committee and a competitive freediver himself.Juani also appeared on episodes #99 and #135.In this episode we discuss:Catching up with Juani.Juani was on Long Island, Bahamas at the time of the interview, preparing for Vertical Blue, 2025.Remote assessment of an injured freediver.An example scenario of a remote assessment, using lung squeeze.The Slow Controlled Forced Exhale technique.Assessment for DCI related or DCI-like symptoms.MFSCO2 (Mask - motor memory, Fins - fine motor skills, Snorkel - Speech, C - coordination/balance, O - orientation, 2 - vision, eye sight and eyes)Juani already did a real-world assessment on Donny.What is Telemedicine?A question from Patreon member Jorg about telemedicine.Shout out to Johnny Sunnex.A question from Patreon member Andrew Ferris about what Juani wishes every new freediver knew about their body from the start.On tracking variables such as resting heart rate and heart rate variability, blood pressure, body weight, etc.A question from Patreon member Christian Stein, about how freediving interacts with the nervous system.On over-training and sleep deprivation.Study suggesting ROS (reactive oxygen species) peak, increase after 3 days of diving.Defining what is DCI (Decompression Illness).The importance of being prepared for DCI-like issues.What is PFO and what does it mean for the freediver?An incident Donny experienced after a dive.What is supraventricular tachycardia and can valsalva manoeuvre fix it?Better post-black out care for freedivers.A question from Patreon member Adrian about research on freediving's effects on brain health and cognitive function.A question from Patreon member Tony Scafidi about fast dive times making a squeeze more likely.Jauni's non-profit organisation for freediving research and awareness (UNU Freediving Foundation).Donny is hosting the first ever Living Freediving Retreat in Dahab, Egypt from October 5 - 11.For all episodes of the Freedive Cafe Podcast, visit www.freedivecafe.comFor freediving courses and training in Dahab, Egypt, visit www.freediveandthrive.comTo support on Patreon: www.patreon.com/freedivecafe

A patent foramen ovale (PFO) is present in approximately 25% of all adults. Author David M. Kent, MD, MS, of Tufts Medical Center and JAMA Associate Editor David Simel, MD, MHS, discuss how to evaluate the likelihood that a PFO was causal in a patient with a cryptogenic ischemic stroke, and closure of a PFO to lower the incidence of recurrent strokes for affected patients. Related Content: Patent Foramen Ovale and Stroke Patent Foramen Ovale and Dysarthria in a Man in His 60s Management of Patients With a Patent Foramen Ovale With History of Stroke or TIA Heterogeneity of Treatment Effects in an Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale After Stroke Transesophageal Echocardiogram Detecting a High-Risk Patent Foramen Ovale ----------------------------------- JAMA Editors' Summary

Jeroen is from Belgium. He is a passionate health-care provider working as an intensive care unit nurse, with a love for technical innovation, teaching and diving, and a former business owner in composites resins 3D-shaping for the nautical and entertainment industry.Jeroen is perhaps best known to us in the freediving community in his role as freediving medic in some of the biggest freediving competitions in the world. Today's discussion is a wide-ranging and thorough exploration of freediving medical safety. In this episode we discuss:Jeroen is a freediver, intensive care unit nurse and freediving medic.He also organises safety in a water stage movie studio in Brussels, working with some famous actors.Prospecting the dive location.Dealing with therapeutic use exemptions of drugs that could be detected on a doping test.Rescue protocols for certain incidents.The use of the pulse oximeter to detect problems in the diver. Following up with athletes and incident reporting.Doing scientific research, gathering information during competition periods.Specific rescue protocols for black outs and squeezes / barotraumas, etc.Most divers do not respond to the ‘Blow Tap Talk' protocol after an underwater black out.Training the other members of the freediving safety team.The authority to stop the competition.What is DCI (Decompression Illness)Decompression sickness and arterial gas embolism (AGE). What is the difference?How are these conditions treated?The hot topic of in-water recompression as treatment.There are no guaranteed safe decompression tables.The use of breathing oxygen in-water after deep dives as a preventative measure to prevent DCI and as general recovery.Shout out to the Patreon supporters and thanks for contributing your questions.An example of the individual nature of symptoms DCI cases.Some examples of difficult decisions being made: Hanako Hirose, Petar KlovarWhat is oedema?The responsibilities of the freediving governing bodies to do better for the safety of the athletes.What is a PFO (patent foramen ovale)?Questions from Patreon supporters Tom, and Racso and Sean.Should you ever dive alone?Why does he freedive?For freediving courses, workshops and retreats in Egypt and Europe visit www.truedepthfreediving.com!For all episodes of the Freedive Cafe Podcast, visit www.freedivecafe.comFor freediving courses and training in Dahab, Egypt, visit www.freediveandthrive.comTo support on Patreon: www.patreon.com/freedivecafe

Hey, great to bring you Episode 107 with Stratis Kas and Lionel Wolowitz. Huge thanks to XDEEP for sponsoring Speaking Sidemount.In this episode, I catch up with Stratis Kas and Lionel Wolovitz. You may remember Stratis has been on the show twice before to discuss his cave exploration in Greece and his book "Close Calls". The latter proved somewhat prophetic, as Stratis recently experienced an Arterial Gas Embolism (AGE) following a series of "deepish", long-duration dives in Mexico. The incident was life-threatening, and Stratis credits his dive buddies, Lionel and Ruben, along with the medical teams in Playa del Carmen, with saving his life.In my conversation with Stratis and Lionel, we discussed the trip, the dives leading up to the incident, and the incident itself. Stratis recounts his thought processes, the mistakes made, and then reflects on the incident. He then hands over to Lionel, who gives his account of the rescue, what they saw, how they cared for Stratis, and the terrifying transfer to the hospital and medical/chamber treatment.Stratis and Lionel are incredibly open about the mistakes they made and why they feel these happened. They share the lessons learned and how we all can take something from this incident.As a postscript, following the recording of this episode, Stratis went to DAN Europe for testing and discovered he has a Type 3 PFO that will require surgery before he can return to diving. The PFO was likely causal in the DCI incident; now, questions remain around the other factors and how they may have contributed to the incident. More to come...Enjoy SteveThanks to Stratis and LionelImage Credit - Joram MennesOur Show Sponsor XDEEP - https://www.xdeep.eu/Sidemount Fundamentals eBook - https://www.sidemountpros.com/storeLionel mentioned the RescuEAN Pod, which would have made a significant difference in their rescue efforts - more here: https://www.rescuean.com/

Chime In, Send Us a Text Message!Episode 81: Managing PFO after Stroke: A discussion on diagnosis, treatment options including the patient perspectives and quality of life decisions with David Thaler,MD of Tufts Medical Center.This conversation in collaboration with the SAYA Consortium explores the relationship between patent foramen ovale (PFO) and stroke, particularly in young adults. Our expert guest, Dr. David Thaler, a vascular neurologist with Tufts Medical Center, discusses the definition of PFO, its diagnosis, and its implications for stroke risk. The discussion highlights the importance of understanding cryptogenic strokes, which often have no identifiable cause, the PFO paradox and how a PFO is often discovered with cryptogenic strokes, the diagnostic tests and the management options available for patients with PFO. The conversation emphasizes the need for patient education and awareness regarding stroke risks and prevention strategies. In this conversation, Dr. Thaler discusses the implications of PFO closure in recurrent stroke prevention, medical management and the importance of patient choice and quality of life, plus the outcomes of the RESPECT Trial. Co-host David Dansereau shares his patient experience as a stroke survivor with PFO who elected for device closure.  The dialogue highlights the evolving landscape of PFO research and the significance of understanding individual patient risks and lifestyle choices.More About Our Guest: David Thaler,MD-Tufts Medical CenterShow mentions:  Lester Leung,MD,  Katelyn Skeels, SAYA Consortium, RESPECT Trial , Co-Host David's Book ClosureThanks to: Rory Polera (guest on Ep.69), stroke survivor and interview outline reviewer with SAYA ConsortiumAdditional Education: Support Our Show! Thank you for helping us to continue to make great content. We appreciate your generosity! Support the showShow credits:Music intro credit to Jake Dansereau. Our intro welcome is the voice of Caroline Goggin, a stroke survivor and our first podcast guest! Please listen to her inspiring story on Episode 2 of the podcast.Connect with Us and Share our Show on Social:Website | Linkedin | Twitter | YouTube | Facebook | SubstackKnow Stroke Podcast Disclaimer: Our podcast and media advertising services are for informational purposes only and do not constitute the practice of medical advice, diagnosis or treatment. Get Our Podcast News Updates on Substack

In this episode, we speak with Jason Harrelson, founder of Harrelson Trumpets, about his controversial yet innovative approach to trumpet making, focusing on personalization and client-specific designs. Jason shares his extensive history with serious health issues, including frequent strokes and heart attacks caused by a congenital heart defect (PFO) and only having one carotid artery. He details the struggles and triumphs of relearning life skills after a major stroke in 2012, the road to recovery, and the eventual successful heart surgery. Despite a challenging journey, Jason's passion for music and commitment to his craft have remained strong. He now aims to educate and inspire others through master classes and clinics, while also continuing to advance trumpet design through his company, Harrelson Trumpets. Episode Highlights:01:15 Early Days and Unique Trumpet Designs02:40 Personalization and Client Reactions05:55 Health Challenges and Musical Passion08:55 Living with a Hidden Disability09:55 Experiencing Heart Attacks and Strokes13:30 The Major Health Event of 201219:15 Seeking Medical Help: The Importance of Finding the Right Doctor20:40 Understanding PFO and Aura Migraines23:15 The Role of Trumpet Playing in Health25:40 The Road to Recovery: Overcoming Strokes and Surgery31:10 Relearning Life Skills and Trumpet Playing37:05 Future Aspirations and Final ThoughtsResources Mentioned:Harrelson TrumpetsConnect With the Guest:InstagramYouTubeYou've been listening to Trumpet Dynamics, telling the story of the trumpet, in the words of those who play it. To learn more about the show, and to join the Trumpet Dynamics tribe, visit us on the web at trumpetdynamics.com.And be sure to tap the subscribe button on your phone so you're always up to date with new episodes as they release.Thank you for listening!

Tali (Luxembourg, 2024 - 21:43), Kim Hale (ASL Interpreter, Loyal Listener - 38:59)   Our Bonus Episode 3 is all about you, the listener.     First, we go through some of the corrections and comments left on our youtube page - using the contributions of our listeners to look back on Season 1.   Then we sit down, in person, with Tali (Luxembourg, Eurovision 2024) and explore what post-Eurovision life is like for a contemporary artist.   Finally, we sit down with loyal listener Kim Hale for a game looking back on the season that we're calling, Have You Learned Nothing!?     Have You Learned Nothing!?   Loreen, Euphoria (Sweden 2012) - https://www.youtube.com/watch?v=Pfo-8z86x80   Jamala, 1944 (Ukraine 2016) - https://www.youtube.com/watch?v=VCG2rw4ZXTY   Stefane and 3G, We Don't Want To Put In (Georgia 2008) - https://www.youtube.com/watch?v=VCG2rw4ZXTY

In the October 8, 2024, issue of JACC, Dr. Casper Bonison and colleagues present a study on the risks of ischemic stroke recurrence after PFO closure, revealing that while the four-year risk remains higher than the general population, it mirrors clinical trial findings. They emphasize the importance of careful patient selection and the need for further research into closure techniques and associated stroke risk factors.

In this episode, Dr. Valentin Fuster highlights groundbreaking research from the October 8, 2024 issue of JACC. Key studies delve into the evolving diagnostic criteria for myocarditis, the prognostic value of subclinical atherosclerosis, the arrhythmic risks in non-ischemic cardiomyopathy, and the implications of PFO closure on ischemic stroke risk, underscoring the importance of advanced imaging techniques and clinical criteria in modern cardiovascular care.

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Dr. Warrick Bishop, a cardiologist, discusses highlights from a medical conference he attended. He focuses on two key topics - the impact of climate change on cardiovascular health, and the treatment of patent foramen ovale (PFO), a common heart condition. Climate change is linked to increased inflammation, coagulation, heat stress, electrolyte imbalances, and air pollution - all of which can negatively impact heart health. Studies have shown that reducing secondhand smoke exposure can significantly lower heart attack risk in affected communities. PFO is a hole in the heart that typically closes at birth, but remains open in about 25% of people. This can allow blood clots to pass from the venous to arterial circulation, potentially causing strokes. Minimally invasive procedures can be used to close the PFO and prevent this complication. Doctor Bishop shares his own experience of having a PFO-related stroke, which resolved without lasting symptoms. He plans to have his PFO closed as a preventive measure.

This is a follow up birth story with baby #4 with Jenna Slot of the oh so popular episode 41 where we discuss her surprise PFO diagnosis.  That episode was republished just before this one in Episode 194. In Jenna's words: "We'll talk about my 4th birth story, which started with my water breaking in the elevator at work (work for me is as a labor and delivery nurse!).  I also talk about becoming an exclusive pumper when he refused to nurse (or couldn't nurse) because that was a hard pill to swallow after having successfully nursed 3 babies.  Also, my mom was at this birth and then shortly after was diagnosed with stage 4 pancreatic cancer, so I was also dealing with immense grief during my postpartum period.  I think both grief and exclusive pumping are topics worth discussing when they are present in pregnancy and postpartum!!" 3 Key takeaways from the podcast that listeners will learn today: Point 1 - sometimes a baby will not nurse even if you try absolutely everything.  And it's ok to feel sad about that! Point 2 - late epidurals and....why not!?! Point 3 - All birth stories are different. How unique my 4th one was compared to the first 3.  3 Keywords that people would want to search when looking for content that you would provide in this episode: Point 1 - regarding water breaking and confirmation - manicure, ferning Point 2 - exclusive pumping, lactation consulting, issues transferring milk Point 3 - late epidurals Favorite baby product or new motherhood product? What would you buy for someone who was currently pregnant or a new parent?:   I LOVED the solly wrap and the ergo carrier.  Summary of guest experience – Who are you?  I'm an L&D nurse in West Michigan.  I'm also a recently graduated and credentialed Women's Health Nurse Practitioner.  I live near Grand Rapids, MI.   Instagram: www.instagram.com/Jennaslot Pinterest: www.pinterest.com/Jennaslot XOXO -Heids We have seats available in Birth Story Academy. Join today for $20 off with code BIRTHSTORYFRIEND at https://www.birthstory.com/online-course!  Resources: Birth Story Academy Online Course Shop My Birthing Workbooks and Guides I'm Heidi, a Certified Birth Doula, and I've supported the deliveries of over one thousand babies in my career. On the Birth Story Podcast, I'll take you on a journey through your pregnancy by providing you education through storytelling. I provide high-level childbirth education broken down to make it super digestible for you because I know you are a busy parent on the go. Plus, because I am so passionate about birth outcomes, you will hear from many of the top experts in labor and delivery. Connect with Me! Instagram YouTube My Doula Heidi Website Birth Story Media™ Website

Since we're reporting on the ground from Malmo, our regularly scheduled episode will come out at the end of the week to coincide with Eurovision 2024! Until then we'd love to share two previous episodes we think set this year's contest up well. This is our episode about Sweden's takeover of Eurovision and global pop, in advance of them hosting this year's contest.   Dr. Alban, Hello Afrika, One Love (26:30), Deborah Ann Woll, (HBO's True Blood, Netflix's Daredevil, (37:13)   This week, we're talking about the Swedish domination of pop music. How  this tiny country took over one of the world's largest entertainment industries is a story with a ton of twists and turns-- and, of course, Eurovision is at the center of it. First we deep dive into that history and try to figure out what it is about Sweden that has made it such a pop power house.   Then we talk to EuroDance star Dr. Alban, who has sold over 16 million records worldwide, and who was part of the original group of artists at Cheiron studios-- the hit factory that launched Ace of Base, The Backstreet Boys, 'NYSNC, and Britney Spears.   Finally, we sit down with Deborah Ann Woll, star of True Blood and Daredevil, for a game we're calling "Victory is Oh, So Swede," where we try to figure out what gives those Swedish Eurovision songs their extra edge.   VICTORY IS OH, SO SWEDE: Empty Room, Sanna Nielsen, 2008- https://www.youtube.com/watch?v=SjQFiFXH2IU Ring Ring, ABBA, 1973- https://www.youtube.com/watch?v=TL0EoXdpOqg Charlotte Nilssen, Tusen och en natt, 1999 - https://www.youtube.com/watch?v=wMtcHdzr1c8 Charlotte Nilssen, Take Me To Your Heaven, 1999 - https://www.youtube.com/watch?v=u0xypjODpY4 Mans Zelmerlow, Hope and Glory, 2009 - https://www.youtube.com/watch?v=HBifUBqFkwA Carola, Fangad Av En Stormvin, 1991 - https://www.youtube.com/watch?v=4Ml6pJqc_bw Herreys, Diggy-Loo Diggy-Ley, 1984 - https://www.youtube.com/watch?v=ls2Lq07iWPM Loreen, My Heart is Refusing Me, 2011 - https://www.youtube.com/watch?v=UjrVoonz4WE Loreen, Euphoria, 2012 - https://www.youtube.com/watch?v=Pfo-8z86x80 Loreen, Tattoo, 2023 - https://www.youtube.com/watch?v=Vul5zgC5Yvg  

In our second hour, Jane and Greg kick things off with Rebecca Meunick from The National Wildlife Federation to talk about PFA's, PFO's and what other states are doing to curtail them, states that are not Wisconsin. We then shift gears to a discussion about raccoons and their ability to cause chaos and misery and we should see them as an threat with tiny opposable thumbs. Finally we give kudos to Luke Bryan for being fun, funny and finally getting "some viral"! As always, thank you for listening, texting and calling...we couldn't do this without you! Don't forget to download the free Civic Media app and take us wherever you are in the world! If you're new to our show and listening to us as a podcast, remember to subscribe and rate us, those ratings go a long way! To learn more about the show and all of the programming across the Civic Media network, head over to https://civicmedia.us/shows to see the entire broadcast line up. Follow the show on Facebook, X and YouTube to keep up with Jane and the show! Guest: Rebecca Meunick

A beginner's guide to all things Eurovision from the rules and politics to the most famous acts to come out of the biggest music event in the world! We also discuss our thoughts on 2024's competition along with experts AJ and Caitlin of the podcast, 'Talking Trash: Eurovision'! Check out 'Talking Trash: Eurovision' podcast: https://linkin.bio/talkingtrasheurovision/ Join us on Patreon and follow us on social media: https://linktr.ee/cctvpops References: ISAAK - "Always On The Run" (Germany): https://www.youtube.com/watch?v=twhq3S4YHdQ&pp=ygUQaXNhYWsgZXVyb3Zpc2lvbg%3D%3D Slimane - "Mon Amour" (France): https://www.youtube.com/watch?v=9pNPhNJL7aQ&pp=ygUWZnJhbmNlIGV1cm92aXNpb24gMjAyNA%3D%3D ABBA - "Waterloo": https://www.youtube.com/watch?v=4XJBNJ2wq0Y&pp=ygUNYWJiYSB3YXRlcmxvbw%3D%3D Celine Dion - "Ne Partez Pas Sans Moi": https://www.youtube.com/watch?v=w6b7BHGkKQA&pp=ygUWY2VsaW5lIGRpb24gZXVyb3Zpc2lvbg%3D%3D Olivia Newton-John - "Long Live Love": https://www.youtube.com/watch?v=1eOMLWh0YIE&pp=ygUdb2xpdmlhIG5ld3RvbiBqb2huIGV1cm92aXNpb24%3D Maneskin - "Zitti E Buoni" (Italy): https://www.youtube.com/watch?v=RVH5dn1cxAQ&pp=ygUTbWFuZWtpc24gZXVyb3Zpc2lvbg%3D%3D Loreen - "Euphoria" (Sweden): https://www.youtube.com/watch?v=Pfo-8z86x80&pp=ygURbG9yZWVuIGV1cm92aXNpb24%3D Sam Ryder - "SPACE MAN" (UK): https://www.youtube.com/watch?v=RZ0hqX_92zI&pp=ygUUc2FtIHJ5ZGVyIGV1cm92aXNpb24%3D Daoi og Gagnamagnio - "Think About Things" (Iceland): https://www.youtube.com/watch?v=1HU7ocv3S2o Olly Alexander - "Dizzy" (UK): https://www.youtube.com/watch?v=mvs92WfR8lM&pp=ygUZb2xseSBhbGV4YW5kZXIgZXVyb3Zpc2lvbg%3D%3D Chanel - "SloMo" (Spain): https://www.youtube.com/watch?v=jSQYTt4xg3I&pp=ygUcY2hhbmVsIGV1cm92aXNpb24gZXVyb3Zpc2lvbg%3D%3D Sarah Bonnici - "Loop" (Malta): https://www.youtube.com/watch?v=-IIxDNyIBdE&pp=ygUVbWFsdGEgZXVyb3Zpc2lvbiAyMDI0 Conchita Wurst - "Rise Like a Phoenix" (Austria): https://www.youtube.com/watch?v=SaolVEJEjV4&pp=ygUaY29uY2hpbnRhIHd1cnN0IGV1cm92aXNpb24%3D Subwoolfer - "Give That Wolf A Banana" (Norway): https://www.youtube.com/watch?v=adCU2rQyDeY&pp=ygUWd29sZiBiYW5hbmEgZXVyb3Zpc2lvbg%3D%3D Baby Lasagna - "Rim Tim Tagi Dim" (Croatia): https://www.youtube.com/watch?v=EBsgTJQFl9k&pp=ygUXYmFieSBsYXNhZ25hIGV1cm92aXNpb24%3D Joost Klein - "Europapa" (Netherlands): https://www.youtube.com/watch?v=gT2wY0DjYGo&pp=ygUQam9vc3QgZXVyb3Zpc2lvbg%3D%3D Konstrakta - "In Corpore Sano" (Serbia): https://www.youtube.com/watch?v=nBtQj1MfNYA&pp=ygUba29uc3RyYWt0YSBldXJvdmlzaW9uIDIwMjIg Kaleen - "We Will Rave" (Austria): https://www.youtube.com/watch?v=Kqda15G4T-4&pp=ygUPcmF2ZSBldXJvdmlzaW9u SABA - "SAND" (Denmark): https://www.youtube.com/watch?v=3pCtdFnv9eQ&pp=ygUXZGVubWFyayBldXJvdmlzaW9uIDIwMjQ%3D Mustii - "Before The Party's Over" (Belgium): https://www.youtube.com/watch?v=WCe9zrWEFNc&pp=ygUXYmVsZ2l1bSBldXJvdmlzaW9uIDIwMjQ%3D Eden Golan - "Hurricane" (Israel): https://www.youtube.com/watch?v=lJYn09tuPw4&pp=ygUWaXNyYWVsIGV1cm92aXNpb24gMjAyNA%3D%3D LUNA - "The Tower" (Poland): https://www.youtube.com/watch?v=IhvDkF9XZx0&pp=ygUWcG9sYW5kIGV1cm92aXNpb24gMjAyNA%3D%3D Gate - "Ulveham" (Norway): https://www.youtube.com/watch?v=UipzszlJwRQ&pp=ygUWbm9yd2F5IGV1cm92aXNpb24gMjAyNA%3D%3D Raiven - "Veronika" (Slovenia): https://www.youtube.com/watch?v=uWcSsi7SliI&pp=ygUYc2xvdmVuaWEgZXVyb3Zpc2lvbiAyMDI0 Nemo - "The Code" (Switzerland): https://www.youtube.com/watch?v=kiGDvM14Kwg&pp=ygUbc3dpdHplcmxhbmQgZXVyb3Zpc2lvbiAyMDI0 Natalie Barbu - "In The Middle" (Moldova): https://www.youtube.com/watch?v=Jom9sNL5whs&pp=ygUXbW9sZG92YSBldXJvdmlzaW9uIDIwMjQ%3D Bambie Thug - "Doomsday Blue" (Ireland): https://www.youtube.com/watch?v=ZGRXRrlIspY&pp=ygUXaXJlbGFuZCBldXJvdmlzaW9uIDIwMjQ%3D Dons - "Hollow" (Latvia): https://www.youtube.com/watch?v=8TIji6Ac8b4&pp=ygUWbGF0dmlhIGV1cm92aXNpb24gMjAyNA%3D%3D LADANIVA - "Jako" (Armenia): https://www.youtube.com/watch?v=_6xfmW0Fc40&pp=ygUXYXJtZW5haSBldXJvdmlzaW9uIDIwMjQ%3D

This episode of "Heart to Heart with Anna" features a very special heart mom. Kelsi Rogers talks about the surprising circumstances around her son's heart condition. Born with an electrical problem in his heart, Jett has already faced life-and-death situations several times in his short life. Not even three years old yet, he has undergone an ablation and an open-heart surgery.Tune in to find out what kind of heart defect Jett has, why the ablation was so extensive, and what kind of surgery eventually saved his life.Following the interview with Kelsi Rogers, co-editors Megan Tones and Anna Jaworski read the last half of Chapter Seven: Facing My Mortality from their new book The Heart of a Heart Warrior Volume Two: Endurance.Links mentioned in this podcast:HeartFelt: https://www.facebook.com/heartfeltscreeningTiny Tickers Trot: https://runsignup.com/Race/Events/CA/Chico/TinyTickersTrotBaby Hearts Press: https://www.babyheartspress.com (for more information on the book The Heart of a Heart Warrior and more!)To sign up for a Baby Hearts Press Book Study, visit our website here: https://www.babyheartspress.com/volume-2Become a Supporter of the Podcast: https://www.buzzsprout.com/62761/supporters/newSupport the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

Dr. Alban, Hello Afrika, One Love (26:30), Deborah Ann Woll, (HBO's True Blood, Netflix's Daredevil, (37:13)   This week, we're talking about the Swedish domination of pop music. How  this tiny country took over one of the world's largest entertainment industries is a story with a ton of twists and turns-- and, of course, Eurovision is at the center of it. First we deep dive into that history and try to figure out what it is about Sweden that has made it such a pop power house.   Then we talk to EuroDance star Dr. Alban, who has sold over 16 million records worldwide, and who was part of the original group of artists at Cheiron studios-- the hit factory that launched Ace of Base, The Backstreet Boys, 'NYSNC, and Britney Spears.   Finally, we sit down with Deborah Ann Woll, star of True Blood and Daredevil, for a game we're calling "Victory is Oh, So Swede," where we try to figure out what gives those Swedish Eurovision songs their extra edge.   VICTORY IS OH, SO SWEDE: Empty Room, Sanna Nielsen, 2008- https://www.youtube.com/watch?v=SjQFiFXH2IU Ring Ring, ABBA, 1973- https://www.youtube.com/watch?v=TL0EoXdpOqg Charlotte Nilssen, Tusen och en natt, 1999 - https://www.youtube.com/watch?v=wMtcHdzr1c8 Charlotte Nilssen, Take Me To Your Heaven, 1999 - https://www.youtube.com/watch?v=u0xypjODpY4 Mans Zelmerlow, Hope and Glory, 2009 - https://www.youtube.com/watch?v=HBifUBqFkwA Carola, Fangad Av En Stormvin, 1991 - https://www.youtube.com/watch?v=4Ml6pJqc_bw Herreys, Diggy-Loo Diggy-Ley, 1984 - https://www.youtube.com/watch?v=ls2Lq07iWPM Loreen, My Heart is Refusing Me, 2011 - https://www.youtube.com/watch?v=UjrVoonz4WE Loreen, Euphoria, 2012 - https://www.youtube.com/watch?v=Pfo-8z86x80 Loreen, Tattoo, 2023 - https://www.youtube.com/watch?v=Vul5zgC5Yvg  

A declaração de Lula sobre o conflito em Gaza. A reação do governo Netanyahu. O depoimento dos investigados na trama golpista. A condenação de Daniel Alves por estupro na Espanha. E maisLink para as matérias:Como a fala sobre Israel impacta Lula interna e externamenteMarcelo Montanini - 19 de fevereiro de 2024https://www.nexojornal.com.br/expresso/2024/02/19/lula-persona-non-grata-israel-impacto-brasil A reação mundial ao plano israelense de uma ofensiva em RafahSuzana Souza e Aline Pellegrini - 20 de fevereiro de 2024https://www.nexojornal.com.br/podcast/2024/02/20/plano-israelense-rafah-reacao-mundialQuais temas mobilizam o G20 sob a presidência do BrasilMarcelo Montanini - 20 de fevereiro de 2024https://www.nexojornal.com.br/expresso/2024/02/20/temas-reuniao-g20-brasilMauro Vieira critica Conselho de Segurança em reunião do G20Da Redação - 21 de fevereiro de 2024https://www.nexojornal.com.br/extra/2024/02/21/mauro-vieira-critica-conselho-seguranca-onu-reuniao-g20Bolsonaro fica em silêncio durante depoimento à PFDa Redação - 22 de fevereiro de 2024https://www.nexojornal.com.br/extra/2024/02/22/bolsonaro-silencio-depoimento-a-pfO peso da condenação de Daniel Alves para a cultura do futebolMarcelo Roubicek - 22 de fevereiro de 2024https://www.nexojornal.com.br/expresso/2024/02/22/condenacao-daniel-alves-impacto-futebol

Working through PTO, private equity interest in cardiology, off-label PFO closure, and more.

A decade ago, Oklahoma's countryside was literally infested with 626 massively-polluting CAFOs – “Concentrated Animal Feeding Operations.” These are nightmarish creatures of industrial agribusiness, each one caging thousands of chickens, hogs, or cattle in huge concrete and steel buildings, and producing rivers of excrement. Imagine living next to one!But – hallelujah! – responding to the outrage of rural neighbors, environmentalists, and animal rights advocates, Oklahoma's political honchos have since stepped in with regulations to eliminate 90 percent of those CAFOs. Wow! How'd they do that?The old-fashioned way: Political fraud. At the behest of chicken lobbyists for factory farm giants like Tyson Foods, state lawmakers – Hocus-Pocus! – let CAFOs rebrand themselves as PFOs, “Poultry Feeding Operations.” It's the same old stink by a new name – only worse. The state's PFO designation let's corporate profiteers get away with providing fewer protections for Oklahoma communities they subject to the overwhelming stench, contamination, flies, disease, and other nasties inherent in caging more than 300,000 birds at a time in one spot.For example, merely switching a factory's registration from a federal CAFO to a state PFO lets these industrial polluters locate right across the road from family homes, bringing such constant odor, debris, and disease that people can't open their windows or play in their yard. The PFO scheme also eliminates a requirement that neighbors have to be notified when a chicken factory proposes to locate next door, and state officials even outlawed legal protests against their rubber stamping of water permits for these polluters.This is Jim Hightower saying… Here's a solution: Require that a PFO chicken factory be installed next door to the Capitol building—share the stink!Do something* Our friends at Farm Aid are working on reforming and restructuring industrial agriculture in a number of different ways— check out their full archive of actions, resources and news.* Need local inspiration? The people of Pierce County in western Wisconsin are currently fighting a CAFO expansion— and winning, so far. Learn from their work here, and check out the Friday Signpost we wrote about them.Enjoyed this post? Please consider sharing with friends and on social media!Jim Hightower's Lowdown is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit jimhightower.substack.com/subscribe

1:07- Deep Dive- Eurovision and Contemporary Pop 21:43 Joker Out (Slovenia 2023) 39:58 Killer Notes or Killer Nodes with Telly Leung This week we're discussing Eurovision's relationship to contemporary pop-- and specifically what it is about the rules of the world's largest song competition that complicate its relationship to the charts. We cover rules around back-up singers, auto-tune, the orchestra, and use of tracks. Then, we talk to pop rock darlings Joker Out, who represent a new wave at Eurovision-- their hit song Carpe Diem garnered a tremendous amount of streams across platforms. They followed that up with Novi Val, releasing an English language version with music legend Elvis Costello.   Finally, Telly Leung (Broadway's Allegiance and Aladdin, Glee, Netflix's Warrior) stops by. In addition to being a broadway star, Telly is also a professor of vocal performance-- and he uses his knowledge of vocal technique to analyze some of Eurovision's most dramatic vocal showcases. It's a game we're calling Killer Notes or Killer Nodes.   Mentioned:   One Step Further - Bardo Album Version: https://www.youtube.com/watch?v=-Qy6S7LvtNc Eurovision Version: https://www.youtube.com/watch?v=MSAoeFYipxc   Loreen - Euphoria: https://www.youtube.com/watch?v=Pfo-8z86x80   Reiley - Breaking My Heart: https://www.youtube.com/watch?v=04C8E7PUMQo    Joker Out's Carpe Diem: https://www.youtube.com/watch?v=vfTiuZaESKs   From "Killer Notes or Killer Nodes":    Dancing in the Rain, Spain 2014, Ruth Lorenzo: https://www.youtube.com/watch?v=-OtuM3Zvkeo   Harel Skaat, Milim, Israel 2010: https://www.youtube.com/watch?v=Tj0qaNnLk9M   Playing with Fire, Ovi and Paula Seling, Romania 2010- https://www.youtube.com/watch?v=J9EtMZXeQZw   Manel Navarro Do It For Your Lover 2017 - https://www.youtube.com/watch?v=SwS45HBhzTs (the song), https://www.youtube.com/watch?v=UWP67FyGwUI (the fail)   Bulgaria Krassimir Avramov 2009 - Illusion - https://www.youtube.com/watch?v=pL3VuL1Vy7w

Learn about managing morbidity - staying active, vigorous, and capable to have as much of a human life as possible for as long as you can. You need to dance with your granddaughter, care for your chickens, and farm your fields. Managing Morbidity: Memento Mori We all die, and as lifters this means we all complete our last PRs. There is a day, and you may have reached it or may reach it soon (you will reach it at some point) when you won't hit any more PRs. This is okay. This is part of the deal. At some point, the strength curves bends and then comes down. For Karl, he still thought he might be able to hit some PRs. He moved to a more rural location, felt the heaviness of his 258 pounds, but he still thought maybe if he hit a good stretch of training he could hit another PR. Then he had a stroke. He had a transient ischemic attack (TIA). The word transient is key - he hasn't experience long-term, permanent effects from the stroke. The stroke occurred due a congenital issue - patent foramen ovale (PFO) - an open oval hole in the wall of the heart. Migraines are common for people with this issue. He confronted the reality that he will never hit another PR again. Managing Morbidity: Staying Active & Vigorous We don't strength train, though, to just stave off death or sickness or even compress morbidity into the smallest possible portion of our lives. We train FOR something (or multiple things). We train for health. We train to dance with out granddaughter. We train to take care of our chickens. Some train for glory, others to take their medicine, others to compete. It's really a remarkable thing, to walk into a gym multiple times a week, year-after-year-, and fight against iron and gravity. While Karl, now walking around 50 pounds lighter, misses looking like he lifts when he walks around. But everyday activities are easier. Certain things open up to him - such as getting clothes that fit easily or may even - gasp - going for a run. Managing Morbidity: Training as an Athlete of Aging Okay, PRs are behind you. What do you do now? Sully and Noah had a great podcast series discussing this in greater detail. Right now, Karl is completing LP and seeing where that ends. He might spend some time pursuing hypertrophy. He might go for a run. He'll definitely attend to his field to grow food and tend his chickens. You need to accumulate hard sets. That's what strength training boils down to. It's not that the reps, sets, technique, or exercise selection don't matter. It's just that, at the end of the day, you need to accumulate hard sets consistently over time. Check out the Barbell Logic podcast landing page. Get Matched with a Professional Strength Coach today for FREE! No contract with us, just commitment to yourself: Start experiencing strength now: https://store.barbell-logic.com/match/ Connect with the hosts Matt on Instagram Niki on Instagram Andrew on Instagram Connect with the show Barbell Logic on Instagram Podcast Webpage Barbell Logic on Facebook Or email podcast@barbell-logic.com

#26 Host Boots Knighton invites guest Jacque Avalon, a nurse, to share her inspiring story of thriving post open heart surgery. Jacque's journey began when she went to the emergency room with chest pain, which turned out to be a rare condition called double chambered right ventricle. It took some advocacy and prompting from Jacque's primary care physician for a full work to be completed. This led to the discovery of her Double Chambered Right Ventricle, and other structural challenges with her heart. Jacque underwent open heart surgery and was surprised by a few things along the way. She took these struggles in stride. You'll be thrilled to learn the impressive feat she accomplished a year after open heart surgery. It was something she dared not attempt pre-surgery, and was able to do once her heart was repaired. Its a testament to the fact that it's possible to aim even higher when congenital heart constraints have been resolved..Jacque's story emphasizes the importance of perseverance and resilience after undergoing major heart surgery. There were intense moments on her path, when things were incredibly challenging, but there was also another side.If you are looking for something specific - here's where you'll find it:[06:20] Stressors were taking a toll. And the chest pain wasn't going away.[11:25] Results from the TEE (transesophageal echocardiogram): Rare adult condition: DCRV, VSD, PFO.[15:44] Preparing for Open Heart Surgery- who will make your health decisions if you can't? [22:43] Anesthesia slows blood circulation. Your options to prevent blood clots.[26:44] Unbearable pain, unforgettable feeling.[35:35] Value of attending Women Heart and the reflections it brought to the surface.[36:17] Coming to terms with the changes - a physical scar in a day and at an age with such an emphasis on appearances.[41:29] Advice to others facing open heart surgery.Links mentioned in this episodeWomen Heart - www.womenheart.orgSmidt Heart Institute at Cedars-Sinai in LA - www.cedars-sinai.org/programs/heart.htmlA Little More About Today's GuestJacque Avalon is a 31-year-old registered nurse based in Los Angeles CA. She was born with a congenital heart disease that was left untreated until September 2020. She had open heart surgery at the age of 28 after finding out that she had a rare congenital heart defect among adults called DCRV (double-chambered right ventricle).How to connect with JacqueInstagram: @apple.jacqs**I am not a doctor and this is not medical advice. Be sure to check in with your care team about all the next right steps for you and your heart.**How to connect with BootsEmail: Boots@theheartchamberpodcast.comInstagram: @openheartsurgerywithboots or @boots.knightonLinkedIn: linkedin.com/in/boots-knightonBoots KnightonIf you enjoyed this episode, take a minute and share it with someone you know who will find value in it as well. You can share directly from this platform or send them to:

Although strokes are complex events involving both the brain and heart, diagnosis and treatment of potential strokes is not always managed by brain and heart doctors working together. Because of this, patients may be having unnecessary procedures and risking future health events. Ekaterina Bakradze, M.D., a stroke neurologist, and Mustafa Ahmed, M.D., an interventional cardiologist, discuss the complexity of stroke diagnoses and management, emphasizing the importance of a multidisciplinary team. The doctors explain how one common cause of stroke called PFO – a hole in the heart – is not always the culprit of a patient's neurological health condition. Learn more about their work at the UAB Heart Brain Clinic.

Alex Cooper from Call Her Daddy launches her own network called “Unwell” and media habits of Gen Z, nope, Apple was not censoring, Rob breaks down Glenn Beck's RSS feed (although the takedown was all about a trademark issue. MacWhisper! Podcast Audio Quality Grader, Squadcast joining Descript and all kinds of libsyn PR releases! Chuck Cargile as New Chief Financial Officer, Libsyn's Advertisecast signs Exclusive Ad partnership with Beautiful Stories from Anonymous People podcast! Predictive Contextual Targeting for Enhanced Podcast Advertising Precision and Effectiveness And stats! Geographic and user agent! Audience feedback drives the show. We'd love for you to contact us and keep the conversation going! Email thefeed@libsyn.com, call 412-573-1934 or leave us a message on Speakpipe! We'd love to hear from you! SIGN UP FOR OUR NEWSLETTER HERE! Quick Episode Summary (3:17) PROMO 1: 7sumwhere (3:37) Rob and Elsie conversation (5:17) Libsyn welcomes Chuck Cargile as new chief financial officer (8:40) Libsyn's Advertisecast signs exclusive partnership with Beautiful Stories From Anonymous People (10:52) Best practices for getting your podcast artwork ready (16:10) Apple did not censor Glenn Beck (19:10) MacWhisper! (21:01) Follow up for Feedswaps (26:39) PROMO 2: The Strokecast, the PFO episode (27:33) Alex Cooper from Call Her Daddy launched her own network called "Unwell" (29:17) The media habits of Gen Z (33:00) Oh! A way to grade your podcast! (34:12) Squadcast joins Descript (35:08) When a podcast doesn't update on 3rd party apps (39:02) The difference between evergreen and timely (41:07) Libsyn introduces predictive contextual targeting (46:34) Promo 3: The Next Feed (48:56) Stats! Geographic and user agents (53:45) Where have we been and where are we going! Featured Podcast Promo + Audio PROMO 1: 7sumwhere PROMO 2: The Strokecast, The PFO episode PROMO 3: The Next Feed Where have we been and where are we going Thank you to Nick from MicMe for our awesome intro! Podcasting Articles and Links mentioned by Rob and Elsie Leave us voice feedback! Libsyn CFO Announcement 08.10.23 PDF AdvertiseCast Beautiful Anonymous Exclusive - PDF Chris Gethard 'Beautiful/Anonymous' Podcast Inks Libsyn Deal - Variety Glenn Beck on X: "I have a feeling these “issues” with @Apple and others will keep happening the more we're over the target. https://t.co/RvATfZdUzJ" / X Rob @ podCast411 (Go Flyers - Chiefs) on X: "@glennbeck @Apple @theblaze Hi Glenn - I looked at your RSS feed raw code - and I can see the issue - this is not an apple conspiracy - it is just something broken with your feed. Have your team email me rob at libsyn dot com - Nothing that Apple podcast team did wrong just a tech issue on your side." / X Was Glenn Beck censored by Apple Podcasts? Host of 'Call Her Daddy' podcast taps TikTokers Alix Earle, Madeline Argy for new media company - Tubefilter Podcast Grader by Streamlit SquadCast Joins Descript: Now you can record, edit, and publish all in the same place - SquadCast.fm

Alex Cooper from Call Her Daddy launches her own network called “Unwell” and media habits of Gen Z, nope, Apple was not censoring, Rob breaks down Glenn Beck's RSS feed (although the takedown was all about a trademark issue. MacWhisper! Podcast Audio Quality Grader, Squadcast joining Descript and all kinds of libsyn PR releases! Chuck Cargile as New Chief Financial Officer, Libsyn's Advertisecast signs Exclusive Ad partnership with Beautiful Stories from Anonymous People podcast! Predictive Contextual Targeting for Enhanced Podcast Advertising Precision and Effectiveness And stats! Geographic and user agent! Audience feedback drives the show. We'd love for you to contact us and keep the conversation going! Email thefeed@libsyn.com, call 412-573-1934 or leave us a message on Speakpipe! We'd love to hear from you! SIGN UP FOR OUR NEWSLETTER HERE! Quick Episode Summary (3:17) PROMO 1: 7sumwhere (3:37) Rob and Elsie conversation (5:17) Libsyn welcomes Chuck Cargile as new chief financial officer (8:40) Libsyn's Advertisecast signs exclusive partnership with Beautiful Stories From Anonymous People (10:52) Best practices for getting your podcast artwork ready (16:10) Apple did not censor Glenn Beck (19:10) MacWhisper! (21:01) Follow up for Feedswaps (26:39) PROMO 2: The Strokecast, the PFO episode (27:33) Alex Cooper from Call Her Daddy launched her own network called "Unwell" (29:17) The media habits of Gen Z (33:00) Oh! A way to grade your podcast! (34:12) Squadcast joins Descript (35:08) When a podcast doesn't update on 3rd party apps (39:02) The difference between evergreen and timely (41:07) Libsyn introduces predictive contextual targeting (46:34) Promo 3: The Next Feed (48:56) Stats! Geographic and user agents (53:45) Where have we been and where are we going! Featured Podcast Promo + Audio PROMO 1: 7sumwhere PROMO 2: The Strokecast, The PFO episode PROMO 3: The Next Feed Where have we been and where are we going Thank you to Nick from MicMe for our awesome intro! Podcasting Articles and Links mentioned by Rob and Elsie Leave us voice feedback! Libsyn CFO Announcement 08.10.23 PDF AdvertiseCast Beautiful Anonymous Exclusive - PDF Chris Gethard 'Beautiful/Anonymous' Podcast Inks Libsyn Deal - Variety Glenn Beck on X: "I have a feeling these “issues” with @Apple and others will keep happening the more we're over the target. https://t.co/RvATfZdUzJ" / X Rob @ podCast411 (Go Flyers - Chiefs) on X: "@glennbeck @Apple @theblaze Hi Glenn - I looked at your RSS feed raw code - and I can see the issue - this is not an apple conspiracy - it is just something broken with your feed. Have your team email me rob at libsyn dot com - Nothing that Apple podcast team did wrong just a tech issue on your side." / X Was Glenn Beck censored by Apple Podcasts? Host of 'Call Her Daddy' podcast taps TikTokers Alix Earle, Madeline Argy for new media company - Tubefilter Podcast Grader by Streamlit SquadCast Joins Descript: Now you can record, edit, and publish all in the same place - SquadCast.fm

Learn from an interventional cardiologist with particular training and interest in structural heart disease about the increased risk for strokes and the treatment options available for patients diagnosed with a patent foramen ovale (PFO); commonly known as a "hole in the heart."

Join Pacific Mammal Research (PacMam) scientists to learn about different marine mammals each episode! We discuss a little about the biology, behavior and fun facts about each species. Have fun and learn about marine mammals with PacMam! This week: Ringed seal Presenters: Cindy Elliser and Katrina MacIver Music by Josh Burns References: General https://www.fisheries.noaa.gov/species/ringed-seal https://www.nwf.org/Educational-Resources/Wildlife-Guide/Mammals/Ringed-Seal https://animaldiversity.org/accounts/Pusa_hispida/ https://www.adfg.alaska.gov/index.cfm?adfg=ringedseal.main New research Reimer et al 2018 – ringed seal and climate change https://esajournals.onlinelibrary.wiley.com/doi/full/10.1002/eap.1855?casa_token=rjEuyFVtuNcAAAAA%3A9fIYA23r6nCvn01HzCZ3NfWs6OJbUXDkMBm-0aR3q-0BvIHOm0nAqSVPZa-vT7mF3XGFN1_CtTU2mtx4   Kunnasranta et al 2021 - review https://www.sciencedirect.com/science/article/pii/S0006320720309666   Kelly et al 2010 – home ranges https://link.springer.com/article/10.1007/s00300-010-0796-x   Riget et al 2013 - PFO pollution https://www.sciencedirect.com/science/article/abs/pii/S0045653513010989   Koivuniemi et al 2016 - photo-ID https://www.int-res.com/abstracts/esr/v30/p29-36/

In this episode, Dr. Daniel Correa sits down with Peloton instructor and actor Bradley Rose. Bradley shares his experience of having a stroke at age 32 and the events that led to his diagnosis, treatment, and recovery as well as the barriers he faced to receive the care he needed. Next, Dr. Correa speaks with Dr. Sarah Song, associate professor and stroke specialist at Rush University Medical Center in Chicago, and member of the Brain & Life Editorial Board. Dr. Song provides information about the type of stroke that Bradley experienced—transient ischemic attack—along with stroke treatments and prevention, and how to navigate going back to work and participating in activities.   Additional Resources  Learn more about transient ischemic attacks  Learn more about stroke   Brain & Life podcast: Timothy Omundson on Stroke Recovery and His Return to Television   Brain & Life Books series: Navigating the Complexities of Stroke   We want to hear from you!  Have a question or want to hear a topic featured on the Brain & Life Podcast?  Record a voicemail at 612-928-6206  Email us at BLpodcast@brainandlife.org  Social Media:    Guest: Bradley Rose @BradleyRose23 (Twitter); Dr. Sarah Song @Stroke_doc (Twitter)  Hosts: Dr. Daniel Correa @neurodrcorrea 

How are patent foramen ovale and migraine connected? A foramen ovale is a "hole" between the top two chambers of the heart. This hole closes shortly after birth, but in some individuals it stays open and is known as patent foramen ovale. Studies show that adults with this cardiovascular condition are more likely to have migraine. Tune in as Dr. Alexander Postalian dives into the latest research exploring how PFO closure procedures may or may not benefit a person living with both conditions. Thank you to our 2023 education sponsor, Lundbeck *The contents of this podcast are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD and the speaker do not recommend or endorse any specific course of treatment, products, procedures, opinions, or other information that may be mentioned. Reliance on any information provided by this content is solely at your own risk.

In our second CHD Spotlight episode, we'll discuss holes in the heart—atrial septal defects (ASDs), ventricular septal defects (VSDs) and more!Today's CHD Spotlight is on the most common type of heart defect commonly referred to as "holes in the heart." This episode features Dr. William Novick—an internationally-known cardiothoracic surgeon and the head of the Novick Cardiac Alliance, a nonprofit organization providing life-saving heart surgeries to children around the world.In this episode, Dr. Novick shares the names of some specific congenital heart defects (they are commonly referred to as "holes in the heart") and the treatment used to help people born with these heart defects survive and thrive.  He also discusses some heart defects which commonly have a hole in their heart, as well.Former appearances by Dr. Novick on "Heart to Heart with Anna”Healing the Hearts of Croatia, Libya, Ecuador and Beyond: https://www.buzzsprout.com/62761/902730-healing-the-hearts-of-croatia-libya-ecuador-and-beyondDoctor Burnout in the CHD Community: https://www.buzzsprout.com/62761/2486885-doctor-burnout-in-the-congenital-heart-defect-communitySupport the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

In this episode, host Dr. Michael Barraza interviews Dr. Rehan Quadri, interventional radiologist, about the definition, indications and techniques for treating clot in transit.  We begin by defining and describing when to treat clot in transit. Traditionally, the definition is the washing machine mobile clot in the right atrium (RA) or right ventricle (RV). In these situations, the next place for the clot to travel is the pulmonary artery (PA). Mortality in these cases can reach as high as 30%, which is why these cases are considered emergencies. There is another category of clot in transit where a clot is partially adhered to a vessel wall, catheter, or heart valve. They are most commonly diagnosed via an echocardiogram, or found incidentally on a CT angiogram. They commonly present as catheter malfunction with symptoms resembling SVC syndrome. Dr. Quadri explains his usual method for retrieving clot in transit, though he notes each case is complex and different depending on the etiology and the overall status of the patient. In general, unless there is a massive PE, he treats the clot in transit before the PE. He always ensures with the preoperative echocardiogram that there is no interatrial shunt or patent foramen ovale (PFO). At the beginning of the case he checks PA and RA pressures.  He uses a 24 French Inari Flowtriever with FLEX technology, which helps with tough angles. He uses ICE guidance in all clot in transit cases. To help with orientation when using the ICE catheter, he recommends pointing it anteriorly while entering the RA, then using the Eustachian ridge, an echogenic line in the RA, to confirm you are in the RA and indicating that you should see the tricuspid valve as you advance. He uses the FlowSaver device, and always has 2 units of blood in the room just in case. At the end of the case, he remeasures the PA pressures, then injects through the Inari sheath to verify that there is no residual before finally doing a pulmonary arteriogram. He sends all the clots to pathology, and has seen that the morphology is usually mixed, with some organized fibrin in addition to acute thrombus.

The Podcast Forbidden Door (special episode of The Don Tony Show, brought to you by Blue Wire) has opened in a way no one including Don Tony ever expected. Two totally different worlds collide as Don Tony went one on one with Misha Montana: Award Winning Adult Film Star, producer, Xtreme Pro Wrestling personality, speaker, advocate, counselor, and oh yeah - Matt Riddle's Girlfriend

Patent Foramen Ovale – Update on Device Closure Guest: Jason H. Anderson, M.D. Host: Paul A. Friedman, M.D. Joining us today to discuss patent foramen oval (PFO) is Jason Anderson, M.D., assistant professor of pediatrics at Mayo Clinic in Rochester, Minnesota. Dr. Anderson specializes in interventional structural heart disease. Tune in to learn more about PFOs and an update on device closures. Specific topics discussed: Why consider closing a PFO? How is it best diagnosed -- and pearls for diagnosis? Post procedure -- what should the non-interventionalist be aware of in terms of care or potential complications? What is the patient experience when coming in for a PFO device closure? Are there certain characteristics of PFO closure devices that make you choose one device over another? Is there an age cut-off to your recommendation to undergo PFO device closure? Some patients may have allergies, such as a nickel intolerance, does this effect the choice of device or option to proceed with catheter-based closure? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV. NEW Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Update on indications and methods for Patent Foramen Ovale (PFO) closure Incidence, outcome, acute and chronic treatment of Spontaneous Coronary Artery Dissection (SCAD) Mythbusters: The earlobe crease Host: Rick Grobbee Guests: Carlos Aguiar, Lorenz Raeber and Jacqueline Saw Want to watch that episode? Go to: https://esc365.escardio.org/event/802 Disclaimer: This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Rick Grobbee, Nicolle Kraenkel and Jacqueline Saw declared to have no potential conflict of interest to report. Carlos Aguiar declared to have potential conflict of interest to report: personal fees for consultancy and/or speaker fees from Abbott, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, Lilly, Novartis, Pfizer, Sanofi, Servier, Tecnimede. Davide Capodanno declared to have potential conflict of interest to report: Sanofi, Daiichi Sankyo, Terumo, Medtronic, Chiesi. Lorenz Raeber declared to have potential conflicts of interest to report: Consultation/speaker fees from Abbott, Amgen, AstraZeneca, Canon, Medtronic, Novo Nordisk, Occlutech, Sanofi. Research grants to the institution by Abbott, Biotronik, Heartflow, Sanofi, Regeneron. Emma Svennberg declared to have potential conflict of interest to report: Institutional research grants from Bayer, Bristol-Myers, Squibb-Pfizer, Boehringer- Ingelheim, Johnson & Johnson, Merck Sharp & Dohme.

On Episode 22 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the November 2022 issue of Stroke: “Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging” and “Five-Year Results of Coronary Artery Bypass Grafting With or Without Carotid Endarterectomy in Patients With Asymptomatic Carotid Artery Stenosis.” She also interviews Dr. George Ntaios about his article “Incidence of Stroke in Randomized Trials of COVID-19 Therapeutics.” Dr. Negar Asdaghi:         Let's start with some questions. 1) What is the actual incidence of stroke after COVID-19? 2) In the setting of acute ischemic stroke, can the volume of ischemic penumbra be estimated with just a regular MRI study of the brain without any vascular or perfusion imaging? 3) And finally, can a patient with significant carotid stenosis go through coronary artery bypass graft surgery? We're back here to answer these questions and bring us up to date with the latest in the world of cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The November issue of Stroke is packed with a range of really exciting and exceedingly timely articles. As part of our Original Contributions in this issue of the journal, we have a post hoc analysis of the Treat Stroke to Target, or the TST, randomized trial by Dr. Pierre Amarenco and colleagues. We've talked about this trial in our past podcast, and the main study results that were published in New England Journal of Medicine in January of 2020. TST randomized patients with a recent stroke or TIA to either a low target of LDL cholesterol of less than 70 milligram per deciliter or a target LDL of 90 to 110. The main study showed that the low LDL target group had a significantly lower risk of subsequent cardiovascular events without increasing the risk of hemorrhagic stroke. So, from this, we know that achieving a low target LDL is possible and is actually better than the LDL target of 90 to 110 post-stroke. But in the new paper, in this issue of the journal, in a post hoc analysis of the trial, the TST investigators showed that it's not just achieving that magic low target LDL of less than 70 that's important in a reduction of cerebrovascular disorders, but it's also how we achieve it that determines the future of vascular outcomes. So, in this analysis that compared patients on monostatin therapy to those treated with dual cholesterol-lowering agents, that would be a combination of statin and ezetimibe, and showed that in the low LDL target group, only those patients treated with dual therapy had a significant reduction of subsequent vascular events as compared to those in the higher LDL category. But the same was not true for patients on statin monotherapy, even though they had all achieved a low target LDL. Think about this for a moment. Both groups, whether on statin monotherapy or on dual anti-cholesterol treatments, achieved the same low target of LDL, but only those on dual therapy had a lower risk of subsequent vascular events as compared to those that were in the higher LDL target group. Very thought-provoking study. In a separate paper by Dr. Shin and colleagues out of Korea, we learned that survivors of tuberculosis, or TB, are at a significantly higher risk of ischemic stroke than their age- and risk factors–matched non-TB counterparts. The authors used data from the Korean National Health Insurance Services and studied over 200,000 cases diagnosed with TB between 2010 and 2017 and compared them to a pool of over one million non-TB cases for matching. And they found that the risk of ischemic stroke was 1.2 times greater among TB survivors compared to matched non-TB cases after adjusting for the usual confounders, health behavioral factors, and other comorbidities. Now, why would TB increase the risk of stroke? The authors talk about the pro-inflammatory state of this condition, thrombocytosis, that is a known complication of chronic TB amongst other putative and less clear mechanisms. But what is clear is that findings from a large-scale population-based cohort such as the current study support an independent association between TB and ischemic stroke. As always, I encourage you to review these papers in addition to listening to our podcast today. My guest on the podcast today, Dr. George Ntaios, joins me all the way from Greece to talk to us about the much discussed topic of the risk of stroke in the setting of COVID-19. Dr. Ntaios is the President of the Hellenic Stroke Organization and an experienced internist who has been fighting this pandemic in the front lines since the beginning. In an interview, he talks about his recently published paper, his experience, and the lessons learned on balancing scientific rigor against the urgency of COVID-19. But first, with these two articles. In the setting of a target vessel occlusion in patients presenting with an acute ischemic stroke, distinguishing the ischemic core from the ischemic penumbra is of outmost importance. The success of all of our reperfusion therapies heavily lies on our ability to differentiate between the tissue that is already dead, which would be the ischemic core, from the tissue that is not dead yet but is going to die unless revascularization is achieved. That is the ischemic penumbra. Over the past two to three decades, there's been lots of debate over how these entities of dead tissue versus going-to-die tissue are best defined, especially when we're making these distinctions under the pressure of time. We don't even agree on the best imaging modality to define them. Should we rely on CT-based imaging? Do we stop at CT, CT angiogram? Should we do single-phase CTA or multiphase CTA? When do we perform CT perfusion, and what perfusion parameters best define core and penumbra, or should we rely on MRI-based modalities altogether? These questions have all been asked and extensively studied, which is why, as a field, I think, we have at least some agreements today on the basics of core and penumbra definitions. And I also think that overall we are becoming better at doing less imaging to be able to predict tissue outcomes in real time. And there's definitely a growing interest in trying to estimate tissue fate based on a single-imaging modality. So, I think you're going to find an Original Contribution in this issue of the journal, titled "Estimating Perfusion Deficits in Acute Stroke Patients Without Perfusion Imaging," really interesting. In this paper, Dr. Richard Leigh from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, in Bethesda and colleagues evaluated patients with acute ischemic stroke enrolled between 2013 to 2014 in the NINDS Natural History of Stroke study. A little bit about the study: It enrolled stroke patients presenting to three hospitals in Washington, DC, and Maryland with serial MRI scans during the acute and subacute time period after ischemic stroke. For this particular paper, they included patients who received MRI and perfusion-weighted imaging and included only those who were thrombolized. That was their way of ensuring that all patients in their study were in the hyperacute stage of stroke. They then looked at their MR imaging, specifically the fluid-attenuated inversion recovery, or FLAIR, images, for a presence of something called hyperintense vessels in the ischemic territory. Now, this is an audio-only podcast, so unless you're Googling FLAIR hyperintense vessels on MRI, to follow along, I have to take a bit of time explaining this entity. What do we mean by FLAIR hyperintense vessels? We are not just talking about the T2 hyperintense signal that's sometimes noticeable at the site of proximal occlusion. For example, in the setting of an M1 occlusion, we may be able to detect a T2 hyperintense signal at the site of M1 on FLAIR. That's not the point of this paper. The point is to look throughout the area supplied by that said target occlusion, in this case all of the MCA, and see whether there is hyperintense signal in all arteries in that potentially ischemic tissue and how the area delineated by these FLAIR hyperintense vessels could potentially correspond to the area of perfusion deficit on conventional perfusion imaging. It turns out that these hyperintense vessels actually map a pretty large area. So, this is the point of this study. The investigators developed a FLAIR hyperintense vessel scoring system and called it NIH, obviously, because this was a National Institutes of Health study, FHV, which stands for FLAIR hyperintense vessel, scoring system. And the score is based on presence of these hyperintense vessels in three vascular territories: ACA, MCA, or PCA. Now, seeing that MCA is a larger territory, they had to further divide it into four sub-regions: frontal, insular, temporal, and parietal. So, in total, we have six regions now. Each of them would get a score of zero if there were no hyperintense vessels in them, and a score of two if there were three or more FLAIR hyperintense vessels in a single slice, or if there were three or more slices that contained FLAIR hyperintense vessels. And, of course, a score of one would be anything in between. So, we have six regions in total, each maximum getting two points, to give us a composite score of maximum 12 for this scoring system. So, they wanted to see whether there's a correlation between the FLAIR hyperintense vessel score and the volume of perfusion deficits that is detected by conventional perfusion imaging, which is their main study result. But before we go there, it does seem like a lot of work to learn all these regions and count all these hyperintense vessels in these six regions and come up with an actual score. So, they had to do an interrater reliability to see how easy it is to score and how reliable are these scores. So, they had two independent reviewers for their study. On average, the scores of these two independent reviewers differed by one point for a κ of 0.31, which is quite a low interrater reliability. But when they looked at a more liberal way of assessing interrater reliability, where partial credit was given, when the raters were at least close in their scoring, the κ improved to 0.65 for a moderate degree of agreement. So, what that means is that it's not easy to learn the score, and potentially I can give a score and another colleague can give a different score. So, we have to keep that in mind. But I want to emphasize that in the field of stroke neurology, we are kind of used to these poor interrater reliability agreements in general. For example, the interrater reliability of the ASPECTS score, a score that is commonly used in our day-to-day practice, and especially in the acute phase, we communicate the extent of early ischemic changes by using the ASPECTS score, has a pretty poor interrater reliability, especially in the first few hours after the ischemic stroke. So, we can make due with a κ of 0.65. Now on to the results of this study. They had a total of 101 patients. Their median age was 73. The median FHV, which is that FLAIR hyperintense vessel score, in their entire cohort was four. And close to 80% of patients enrolled in their study had some perfusion abnormalities on their concurrent perfusion-weighted imaging. Now, briefly, they defined perfusion deficits as areas with delay in the relative time to peak map, or TTP maps, after applying a six-second threshold to these TTP maps. Of note, half of those patients with a perfusion deficit had a significant perfusion deficit, which meant that they had 15 cc or more of perfusion deficit. OK, now on to the main study results. Number one, the score obtained by NIH FLAIR hyperintense score highly correlated with the volume of perfusion deficit. In fact, every one point increase on the NIH-FHV score was approximately equal to 12 cc of perfusion deficit. That's a really useful way of thinking about this score. Each score translated in 12 cc of perfusion deficit. Number two, when they looked at the predictive ability of this score in predicting the presence of significant perfusion deficit, that is 15 cc or more of perfusion delay, the area under the curve was 0.9, which is quite high. This is quite reassuring that the FHV score was sensitive and specific in predicting the presence of significant perfusion deficit. Next finding, how does this score do in predicting a significant mismatch? They calculated mismatch ratio by dividing the perfusion volume to that of ischemic core as measured by diffusion volume as it's done conventionally, and then did the same for the score with the exception that instead of using the perfusion volume, they actually used this score and divided it by diffusion volume. And it turns out that FLAIR hyperintense mismatch ratio had a strong predictive capability in predicting the mismatch ratio of 1.8. So, in summary, if this score is validated in larger studies, it can potentially be used as a quick and dirty way of calculating the amount of perfusion deficit in the setting of target vessel occlusion. And, of course, it can also be used as a predictive way of presence of significant perfusion deficit, which is perfusion deficit of over 15 cc. This is all without the need to do actual perfusion imaging. Now, all we've got to do is to get comfortable with this scoring system and, of course, be able to multiply it by 12 to give us a quick guesstimate of the perfusion volume. And one final word on this is that I think the future of stroke imaging is not in doing more images, but to be able to extract more information from less imaging in the acute setting. Stroke physicians were frequently consulted to see patients that are scheduled to undergo coronary artery bypass graft surgery, or CABG. The stroke consult would be for the optimal perioperative management of an often incidentally found carotid disease. Now, why do I say we were frequently consulted? Because at least anecdotally in my own practice, I feel that over the past decade, the number of these consults has substantially reduced. Why is that? Well, let's dive into this topic and review some of the literature. First off, around 40% of patients who have active coronary artery disease and are scheduled to undergo CABG have concurrent carotid disease, and about 10% of CABG patients have evidence of hemodynamically significant carotid disease. And seeing that the risk factors for coronary artery disease are similar to those causing carotid disease, these high percentages are not surprising at all. But the question to ask is, can we put a patient with significant carotid disease through cardiac surgery? What is the perioperative risk of stroke in this situation? And importantly, should the carotid disease be surgically treated during carotid surgery? This is referred to as synchronous carotid endarterectomy, or CEA plus CABG. Or the carotid disease should be treated either surgically or endovascularly before CABG? We refer to this as staged carotid surgery or post-CABG. This is known as reverse staged carotid surgery. All of these questions are asked from the stroke physicians in that consult, and, like many of you, I have struggled to find the evidence to answer some of them. So, let's briefly review some of the current literature on this topic. The CABACS trial, the acronym stands for the Coronary Artery Bypass Graft Surgery in Patients With Asymptomatic Carotid Stenosis, was a randomized controlled trial that included patients undergoing CABG who are found, exactly like that consult, to have an asymptomatic carotid disease of equal or greater than 70% stenosis. The carotid disease for this trial had to be amenable to carotid endarterectomy, or CEA, and the patients were randomized to either receive synchronous CEA plus CABG or just go through with the CABG alone. The trial started in 2010 and planned to enroll over a thousand patients, but was stopped, unfortunately, prematurely in 2014 due to slow recruitment and withdrawal of funding after only 129 patients were enrolled from 17 centers in Germany and Czech Republic. The original study was published in this journal in 2017. So, what did it find? In their intention-to-treat analysis, the primary outcome of any stroke or death at 30 days was 18% in patients receiving synchronous CEA plus CABG as compared to only 9% in patients receiving isolated CABG. Ouch, a double risk of stroke in those who had concurrent surgical treatment of their carotid disease in addition to CABG. Now, this was an underpowered study, and the results should be understood in that context, but it really didn't appear that synchronous CEA plus CABG would decrease the rate of stroke in the first 30 days. Now, how about the long-term outcomes of these patients? We know that asymptomatic carotid disease carries a cumulative annual risk of stroke, and it's important to see if the risk of subsequent stroke was lower downstream if the carotid was already fixed early on. So, in the current issue of the journal, the CABACS trial investigators, led by Dr. Stephan Knipp from the Department of Thoracic and Cardiovascular Surgery in Essen, Germany, and colleagues are back with the five-year results of this trial. How did synchronous CABG plus CEA do as compared to CABG alone? Well, by five years, the rate of stroke or death was 40% in the combined group and 35% in the CABG-only group. This was not a statistically significant difference. Now, when they broke down the primary outcomes, the rate of death from any cause was similar in the two groups. By five years, the mortality rate was 25% in the combined group and 23% in the CABG-only group. And the same was true for the rate of nonfatal strokes. And also the cumulative rate of nonfatal strokes from year one to year five was similar between the two groups, which meant that the higher stroke risk early on in the CABG plus CEA group was not counterbalanced by decreased rate of stroke later on during the long-term follow-up. And finally, they looked at the rate of disability-producing stroke. First of all, after the first year, no new disabling strokes were observed in either group. That's great news. However, in the early period, unfortunately, close to half of strokes that had happened after the combined CEA and CABG were disability-producing, and about a third of strokes that happened after CABG alone were also disability-producing. So, in summary, even though this study is quite underpowered, it appears that performing synchronous CEA plus CABG increases the preoperative morbidity and mortality in patients with asymptomatic carotid disease without providing any long-term benefits to these patients. Coronaviruses are important human and animal pathogens. By now, I think it's safe to say that most of the population of the world has heard of at least one of the members of the coronavirus's family, which was first identified in late 2019 as the cause of a cluster of cases of pneumonia in Wuhan, China. In the early months of 2020, COVID-19, the disease caused by this novel coronavirus, would rapidly spread to involve much of the world. And on March 11 of the same year, the World Health Organization declared COVID-19 a pandemic. Today, over two and a half years have passed since that day, and an avalanche of scientific papers have since been published about COVID-19, not just in medicine, but in each and every imaginable field of life. Neurology's, of course, no exception. The clinical presentation of COVID-19 largely depends on the severity of the disease and may range from a simple asymptomatic infection to a severe, lethal, multi-organ disease. In the world of neurology, a myriad of neurological symptoms, from loss of sense of taste and smell to headache, all the way to encephalopathy and seizures, have been reported in association with this disease. Early in the pandemic, some studies suggested that COVID-19 is indeed a risk factor for stroke. Like many severe infections, COVID-19 can potentially cause a prothrombotic state and can be associated with thromboembolic events. But most of these earlier studies were smaller observational studies that were completed in an inpatient setting, including those with severe COVID. In fact, to date, we still don't have an accurate and reliable estimate of stroke incidence among patients with COVID-19. On the other hand, stroke is the second leading cause of death globally and the fifth cause of death in the US. In the United States, every 40 seconds, someone has a stroke, and every four minutes, someone dies of a stroke. So, I think the question that everyone should be asking is, has COVID-19 changed this statistic? In this issue of the journal, in the study titled "Incidence of Stroke in Randomized Trials of COVID-19 Therapeutics: A Systematic Review and Meta-Analysis," Dr. Ntaios and colleagues aim to get us a step closer to answering this very important question. Dr. Ntaios is an Associate Professor of Medicine at the University of Thessaly in central Greece, and he's the current President of the Hellenic Stroke Organization. It is my great honor to have Dr. Ntaios today in our podcast to discuss this paper and all things stroke-related COVID-19. Good afternoon, George, and welcome to our podcast. Dr. George Ntaios:          Thank you for the invitation, Negar, and for highlighting our work. It's a pleasure to be here with you today. Dr. Negar Asdaghi:         Thank you for being here, and congrats on the paper. George, can you start us off by discussing the pathophysiological mechanisms through which COVID can potentially cause a stroke? Dr. George Ntaios:          Well, one of the most attractive things about stroke, which makes it fascinating for all of us, is its complexity. So many different pathologies can cause stroke, and, quite frequently, identifying the actual cause of stroke can be really challenging. And in a similar way, the pathophysiological association between COVID and stroke seems to be, again, complex. Different pathways have been proposed. Internal, we talk about two broad mechanisms. One is the vascular inflammation and thrombosis, and the other is cardioembolism. And there are several pathways which are involved in vascular inflammation and thrombosis: activation of the complement, activation of the inflammasome, activation of thrombin, increased production of [inaudible 00:24:47] constriction, state of stress, platelet aggregation, vascular thrombosis. So, collectively, this thromboinflammation could lead to damage of the neurovascular unit and consequently to stroke. And in a similar way, there are several cardiac pathologies which can cause stroke in a COVID patient, like acute left ventricular dysfunction, which can be caused, again, by several mechanisms, like coronary ischemia, stress-induced takotsubo cardiomyopathy, myocarditis inflammation, or also as a result of direct effect of the coronavirus at the myocardial cell. And, of course, we should not forget about atrial fibrillation, which seems to be more frequent in COVID patients. So, we see that the proposed mechanisms behind the association between COVID and stroke, that is, vascular thromboinflammation on one hand, or cardioembolism on the other hand, are complex, but whether these derangements they have a clinically relevant effect or they are just biochemical derangements without any clinical effect is a debate. For example, the incidence of myocarditis in COVID is about 0.2%. That is, in every 500 COVID patients, you have one patient with myocarditis. But myocarditis has a very wide clinical spectrum ranging from subclinical elevation of myocardial enzymes to full and life-threatening disease. So, obviously, the incidence of severe myocarditis is even lower than 0.2%. And the same is true also for the incidence of myocarditis after COVID vaccination. The CDC estimates that one case of myocarditis occurs every 200,000 vaccinations, with the number being slightly higher in young men after the second dose. And this is extremely rare, and the huge majority of these myocarditis cases, they're mild. So, this is about ischemic stroke. Now, with regard to hemorrhagic stroke and its association with COVID, again, it seems to be, again, very rare. The best estimate that we have comes from the Get With The Guidelines – Stroke Registry and is about 0.2% and involves mainly patients who are already on anticoagulants. So, they had already a risk factor for ICH. So, again, whether all these pathophysiologic derangements in COVID patients, they have a clinical meaningful association with stroke risk or not, I think it's a matter of debate. Dr. Negar Asdaghi:         Wow, George, it was a simple question, but it seems like the answer was not that straightforward. Let me just recap some of the things you mentioned. So, first of all, the answer is not straightforward and depends on whether we're talking about ischemic stroke or hemorrhagic stroke. There seems to be a lot of connecting points, at least, so to speak, between COVID and either forms of stroke. But you touched on two major sort of broad mechanisms. One is the idea of vascular thromboinflammation that goes along the lines of many sort of hyperacute, hyperinflammatory processes that can occur, especially in the setting of severe COVID. You touched on activation of thrombin, complement activation, platelet aggregation, sort of an activation of that microvascular or vascular unit in a sense. And then a second mechanism you touched on is the impact of COVID on the myocardium on sort of many different pathways. Again, you talked about acute left ventricular dysfunction, stress-induced myocarditis, and the impact of COVID on perhaps increasing the rate of atrial fibrillation. Again, these are all very complex associations, and some could be already present in a patient who is perhaps of an older age, and COVID is just a modifier of that risk factor that was already present in that particular person. And you also touched on how COVID can potentially increase the risk of hemorrhagic stroke, but the study seems to suggest that those patients already had risk factors for the same. And perhaps, again, COVID is a modifier of that risk factor. All right, so with that information, a number of studies early on, especially, in the pandemic and later, some meta-analyses, have aimed to estimate the incident rate of stroke post-COVID. Can you please briefly tell us what were their findings, and how is your current paper and current meta-analysis different in terms of methodology from those earlier studies? Dr. George Ntaios:          Yes. Well, it all started from this letter to the editor at the New England Journal of Medicine. It was published very early in the pandemic during the outbreak in New York. And in this letter, the authors had reported that within a period of two weeks, they had five young patients with COVID and large artery stroke, which they commented that it was much higher than their typical, actually their average, of 0.7 cases during a two-weeks period within the last year. And remember that back then, we knew literally nothing about COVID. So, this letter was really a huge, loud alert that something is going on here and that perhaps our hospitals would be flooded with COVID patients with stroke. So, subsequently, several reports were published aiming to estimate the incidence of stroke in COVID. Rather contradictory with the incidence, estimates are ranging from as low as 0.5% to even 5%. However, these estimates could well be inaccurate. They were observational studies. Most of them were limited to the inpatient setting. Most of them were single-center studies. Most of them, if not all, were retrospective studies. So, there was really a high risk of registration and assessment bias, as well as reporting bias. And also remember that back then during the outbreak, people were really reluctant to visit the hospital, even if they had a serious condition like stroke, an urgent condition, which means that the real incidences could be even higher. So, it was our feeling that these estimates were perhaps inaccurate. And there are also some meta-analyses of these studies which estimate that the incidence of stroke in COVID is about 1.5%. But, of course, any meta-analysis is as good as the studies it includes. So, we tried to find a way to have a more accurate estimate than these estimates. And we followed a different methodology. We studied randomized trials of COVID therapeutics, and we looked for strokes reported as adverse events or as outcome events. And the good thing about randomized trials is the rigorous assessment and reporting of outcomes in adverse events. So, we think, we believe, that this methodology provides a more reliable and a more robust estimate of stroke incidence in COVID patients. Dr. Negar Asdaghi:         OK. George, it's very important what you just mentioned, so I wanted to recap for our listeners some of the things you mentioned. It all started with a letter to the editor of New England Journal of Medicine on a report of five young patients that had large vessel occlusion in the setting of COVID. And then, basically, the floodgates opened in terms of all these observational studies that basically reported the same. And subsequent to that, meta-analyses that were completed containing those observational studies predominantly gave us an incident rate of 0.5 to 5%. That's much, much higher than basically the non-COVID–associated incidence rate of stroke in the population-based studies, and basically suggested that COVID-19 is indeed a major risk factor for all types of stroke. So, that's where it all started. And, as you alluded to, these numbers had to be reverified in bigger settings, more controlled setting. And you already answered my next question, which is the difference between those studies and prior meta-analyses to the current meta-analysis is that you basically took the simple question and started looking at it in a controlled setting of randomized trials. And you already answered this question of the methodology, but I want to recap. You took basically patients included in randomized trials of therapeutics for COVID-19, various therapies for COVID-19, and you did a meta-analysis to see what were the incident rate of stroke as an outcome in these trials. So, with that, could you please tell us a little more about the population that you had in this meta-analysis in terms of their age, the types of therapies that these randomized trials had looked at, and the duration of the follow-up, please? Dr. George Ntaios:          The follow-up included 77 randomized trials, which corresponds to more than 38,000 COVID patients. The mean age of these patients was about 55 years of age, and they were followed for an average of 23 days after study enrollment. With regard to the set strategy, I think it was not strict at all. I would rather say it was very liberal. We allowed trials of any drug in COVID patients of any age, of any severity, coming from any setting: outpatient, inpatient, either general ward or intensive care unit. And from any country. I don't think that we could achieve a wider inclusion than this strategy did. And the huge majority of patients, more than 95%, they were hospitalized patients. So, by definition, they had severe COVID disease. And the drugs studied in these trials included everything that was actually tried in COVID, including tocilizumab, IL-6R inhibitors, steroids, remdesivir, chloroquine, azithromycin, ritonavir, interferon, ivermectin, and many other drugs. So, I think we tried to include as many trials as possible. Dr. Negar Asdaghi:         OK. So, let me see if I got it. You basically included 77 randomized trials. It is a younger population of patients in these trials, median aged 55. You had a total of over 38,000 patients. It's a great sample size for this meta-analysis. And importantly, the duration of follow-up is median of 23 days. And it's just about any treatments we've heard that have been tried for COVID, from dexamethasone to remdesivir and ivermectin. And a rigorous methodology. So, I think we're ready to hear the primary results of this meta-analysis. How many strokes happened in these patients? Dr. George Ntaios:          In the overall population, that is both in the hospital and in the outpatient setting, there were totally 65 strokes in these 38,000 COVID patients, which corresponds to one stroke every 600 COVID patients or else an incident of only 0.16%, 0.16%. This is very low, much lower than the previous estimates. And, of note, all strokes occurred in hospitalized patients. There were no strokes at all in the ambulatory COVID patients. So, just to repeat the result, we just found that only one patient will have a stroke every 600 COVID patients who are either hospitalized or are ambulatory. Dr. Negar Asdaghi:         OK. So, I need to have these numbers, I think, committed to memory, especially when we speak to family members and patients in the hospital. Ninety-five percent of the patient population of this meta-analysis were inpatient COVID. So, by definition, they must be sicker in terms of the severity of their COVID disease. Out of 38,000 patients, you had 65 events of stroke. So, these are very, very important numbers, a lot basically lower than the incidence rate reported from prior studies. So, I wanted to ask you about the sensitivity analysis that was done in the meta-analysis. Dr. George Ntaios:          Yes. When we designed the analysis, we were expecting that we would find numbers was similar to those reported before. So, we thought that perhaps a sensitivity analysis would be able to increase the confidence and the robustness of the results. That's why we did this sensitivity analysis. However, it proved that the number of strokes, the number of outcome events was much lower than what expected. So, the power for those sensitivity analysis to show a meaningful conclusion was low. So, actually, that's why we don't comment at all on those sensitivity analysis because there were so few strokes to support such an analysis. Dr. Negar Asdaghi:         OK. So, basically, you had a priori design the meta-analysis based on the assumption that the incidence rate of stroke would be a lot higher, but then later on, when the incidence rates was lower, then the sensitivity analysis didn't really give any meaningful data to us. So, I mean, I think we already talked about this, but I want to ask you, why do you think that the incidence rates were so much lower in your analysis than the prior meta-analysis? Dr. George Ntaios:          I believe that our estimate is quite accurate. I think that the reports of stroke incidence published during the pandemic possibly overestimated the association. I think that the early concern that we all had in the beginning, that we would be flooded with strokes during the pandemic, was not confirmed. I think that we can support with decent confidence that stroke is a rare or perhaps very rare complication of COVID. Dr. Negar Asdaghi:         Right. That's great news. That really is great news, and we take every bit of good news in these trying times. George, something that was not touched on in the paper, but I want to ask you and basically get your opinion on this matter, is a much talked about concept in the COVID literature of how COVID could potentially modify certain risk factors. There are much talk about how people with pre-existing diabetes or obesity can potentially develop more severe COVID and, hence, have more complications of COVID, including stroke. What is your clinical experience on this matter, and do you think there are certain predictors of development of COVID-associated stroke? Dr. George Ntaios:          That's a very good point. For the last two years, I was involved in the hospitalization management of COVID patients. So, what we see is what is also described in the literature, that there are certain patient characteristics that predispose them to severe COVID. For example, obesity, for example, older age, pregnancy. Perhaps our analysis was not designed to respond to this question. The data available on the studies that were included, they could not support such an analysis. So, I cannot provide information from our study. But the fact that all strokes in our study, they occurred in hospitalized patients and none of them occurred in ambulatory patients, confirms what is known, that those strokes occurred in patients who, by definition, they have severe COVID disease. So, they confirm this putative association that perhaps severe COVID is associated with stroke rather than just mild COVID. Dr. Negar Asdaghi:         All right. Thank you. And I just want to end with this simple question that I get asked often, and I want to see how you respond to patients or their loved ones when you're asked this question: "Doctor, did COVID give me a stroke?" How should we answer that question? Dr. George Ntaios:          Yes. As we discussed, I think that stroke is a rather rare or perhaps very rare complication of stroke and certainly less frequent than we initially thought. And in those stroke patients who had already other pathologies which can cause stroke, I would be rather reluctant to attribute it to COVID. I would be perhaps more willing to do so in younger patients, but again, only after exhaustively looking for another cause, like PFO, dissection, etc. I mean, the concern is that if we as the treating stroke physicians assume that the stroke is caused by COVID, then we might discourage patients from doing the necessary diagnostic workup to find the actual cause of stroke. And if it happens, then perhaps an underlying pathology may be missed, which means that the patient will remain vulnerable to stroke recurrence. So, in general, I'm rather very reluctant to say that the stroke is caused by COVID unless a really thorough diagnostic workup shows nothing else at all. Dr. Negar Asdaghi:         All right. Very important message now to all practicing clinicians is don't stop at COVID. Don't just say simply, "Oh, this is COVID. COVID gave you a stroke." Keep looking for potential causes of stroke. Still do put that patient in the category of potentially ESUS or cryptogenic stroke if no other causes are found. And keep in mind that stroke is rare or, as George said, a very rare complication of COVID. Dr. George Ntaios, this is an exceedingly timely topic and a very important contribution to the field. Congratulations again on your paper, and thanks for taking the time to chatting with us today. Dr. George Ntaios:          Thank you for the wonderful discussion, Negar, and for the focus of our work. Dr. Negar Asdaghi:         Thank you. And this concludes our podcast for the November 2022 issue of Stroke. As always, please be sure to check out the table of contents for the full list of publications, as we can only cover a fraction of the incredible science published in this journal each month. And don't forget to check our fantastic Literature Synopsis. In this month's issue, we read a short summary of the ACST-2 trial published in Lancet on the results of a randomized comparison of stenting versus endarterectomy in asymptomatic carotid disease patients with over 60% of carotid stenosis. We also have the results of the CASSISS randomized trial, which was published in JAMA earlier this year, and it studied the effect of stenting plus maximal medical therapy versus maximum medical therapy alone on the risk of subsequent stroke and death in patients with symptomatic intracranial stenosis, either in the anterior or in the posterior circulation. CASSISS did not show that stenting was superior to maximum medical therapy, and sadly, these patients remain at a substantial risk of recurrent stroke despite being on best medical therapy. But I wouldn't be too despondent about the future of interventional therapy for intracranial atherosclerotic disease. After all, we've come a long way since Dr. Charles Thomas Stent, an English dentist, started experimenting with products to advance the field of denture making around 1865. The work that Dr. Stent had started would be continued by his two sons, both dentists, to eventually make its way to products to create surgical tools. But it would be another 100 years before the first percutaneous coronary procedure was completed in 1964. And in honor of Dr. Stent's pioneering work, the device used to keep the coronaries open was named, you guessed it, stents. Today's stroke care cannot be imagined without the use of various stents, and there's no doubt the future is promising for ways in which we will be able to safely treat intracranial atherosclerotic disease amongst all other vascular disorders. And what better way to keep our enthusiasm than staying alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

To effectively treat stroke and prevent stroke, you need to know just what is literally happening in a patient's head. CT Scans and MRI scans are tools most of us are familiar with. Generally if you suspect a stroke is possible, you need these two scans done. There's another tool out there, too, that's cheaper, more portable, and involves no radiation. It's called Transcranial Doppler Ultrasound. It's a great complement to the other scans, and it can provide impressive insight to supplement the information from the radiologists. A skilled practitioner is a great complement to the care team. I first talked about this technology in my conversation with Dr. Aaron Stayman a few years back (Is my Brain Pregnant? Ultrasound and Stroke: Transcranial Doppler Ultrasound). It's fascinating stuff. The problem is that it does require a skilled technician or someone specifically trained in the technique. Despite the work of advocates like Dr. Stayman and Dr. Mar Rubin, there just aren't enough of those techs. Dr. Mark Hamilton of Nova Signal has a solution. His robotic machine automates the whole process, makes it faster, more reliable, and cheaper while giving more accurate results in a lot of scenarios. The Nova Signal solution has the potential to make this technology available to patients and medical practitioners around the world. Drs. Rubin and Hamilton join me in this episode to discuss the technology, the research, and the device itself. If you don't see the audio player below, visit http://Strokecast.com/TCD to listen to the conversation.   Click here for a machine-generated transcript Who are Drs. Rubin and Hamilton? Dr. Mark N. Rubin is a vascular neurologist and associate professor of neurology with the University of Tennessee Health Science Center Department of Neurology. He specializes in vascular neurology and is experienced in stroke and cerebrovascular disease, and an experienced sonographer and expert interpreter of carotid duplex ultrasound and transcranial Doppler ultrasonography. He received his medical degree from University of Illinois College of Medicine and completed his Adult Neurology residency and fellowships (Neurohospitalist and Vascular Neurology) at the Mayo Clinic. Robert Hamilton, Ph.D. is the Chief Scientific Officer and Co-Founder of NovaSignal. He is an accomplished entrepreneur, engineer, and clinical researcher with a passion for innovative technologies that allow for increased access to care. Robert, a biomedical engineer by training, is an expert in image/signal processing and machine learning, with extensive experience in cerebral blood flow, traumatic brain injury, stroke, and other neurological disorders. Robert co-founded NovaSignal based on technology he developed during his Ph.D. During his tenure at the company, Robert has supported the entire lifecycle of the NovaSignal autonomous ultrasound platform from idea to commercialization with regulatory clearances in the US, Europe, and Canada. Additionally, Robert has designed and completed several clinical trials supporting the use of the technology in different neurological conditions and has acted as principal investigator on federal grants and contracts totaling more than $25M from the Department of Defense, National Institutes of Health, and the National Science Foundation.  Finally, Robert has achieved greater than 100 citations of his work in peer-reviewed publications and conferences and holds over 50 patent assets related to the core technology developed during his PhD studies. TCD vs Traditional Ultrasound When most of us think of ultrasound in medicine, we think of the sonograms of developing children, where parents and doctors swear they can see a human being in those black and white lines. Personally, they seem more like those Magic Eye pictures from the 90s. Traditional ultrasound can also capture pictures of the heart, the blood vessels in the neck, and the condition of other organs in the body. It can be another way of getting a picture of the structures at play. And then you can frame those pictures or make them your Facebook profile picture. TCD is different. The goal is not to capture a picture of the structures of the brain. The goal instead is to understand blood flow through the brain. The technology helps practitioners understand the rate of flow, where there may be leaks or disruptions, if stuff is flowing with the blood that shouldn't, the direction of flow, and whether things are shunting (or crossing) between the veins and arteries that shouldn't. That shunting is at the core of the recent study Nova Signal was part of and that we talk about in this conversation. There are several reasons shunting can occur, but one of the most common is a PFO, or a hole in the heart. I talked in more detail about just what a PFO is in the last episode here: http://Strokecast.com/Anna TCD is a great technology for helping doctors understand the dynamic flow of blood in each individual patient. And it doesn't involve the dedicated rooms or radiation that might come with CT  or MRI Scans. NovaGuide™ 2 Intelligent Ultrasound The Nova Guide 2 Intelligent Ultrasound is the device we talked about in this conversation. While TCD is a great tool, it does take a while to get the scan just right, and we face a dearth of practitioners who are able to do it. The Nova Signal solution is simpler. It's small and automated. The device can orient itself and complete a scan much quicker than a human can. The research shows it's more accurate, too. It doesn't take up much space in a medical facility and can easily be brought from one patient to another. Plus, an operator can perform a lot more scans per hour or get back to other tasks more quickly. With hospitals perpetually understaffed these days, that speed makes a lot of financial sense. And since, in stroke, time is brain, it can make a lot of medical sense, too. Nova Signal vs Transthoracic Echocardiography The information about the presentation at the International Stroke conference is here: https://eventpilotadmin.com/web/page.php?page=IntHtml&project=ISC22&id=1176 This is the data we talked about a lot in the conversation. The Nova Signal device was significantly better at detecting the vein-artery shunts indicative of PFO and other conditions than the gold-standard  evaluation technique using Transthoracic Echocardiogram. This matters in stroke because when we talk about shunting in tests we're usually talking about very small bubbles. Outside of the test context we're usually talking about clots and other stuff sneaking across from veins to arteries, bypassing the body's filters. When they do that they can go to the brain and cause a stroke. Accurate detection of shunting allows physicians to make more appropriate treatment recommendations and decisions. Hack of the Week Cultivating a sense of gratitude, as unlikely as it may seem, is something that helps a lot of folks deal with the challenges pf post stroke life. Simply being alive means thing can get better. And being alive in the 21 century with the medical resources available is a huge asset to the community. Of course those medical resources are not evenly distributed within the US and around the world, but they exist, and that's a start. Develop a sense of purpose. After stroke, it can be hard to see a way forward, especially if you have severe disabilities. People who succeed in their recovery, or in their goals in general, typically have a pretty strong "Why?" driving them. Achieving their goals gets them closer to something important to them. In the dark times, when you find yourself feeling it's just not worth it, your why -- your sense of purpose can give you a reason to push through. We sometimes ask, "Why should I go on?" almost rhetorically to express or pain. For some folks, though, it can be an exercise to identify the things that matter to you. So ask yourself that question, but assume there is an answer. And write down everything that could be an answer. Cultivate the sense of purpose to get through the darkness. Links Where do we go from here? To learn more about Nova Signal and the research around TCD, visit http://NovaSignal.com Share this link with someone you know by giving them the link http://Strokecast.com/TCD Share a recent win (we all have them) at 321-5Stroke or by email Don't get best…get better.

Anna Kerry went from yoga fan and enthusiast to Yoga teacher. Then the pandemic hit. A   year later, at age 35, she had a stroke due to as PFO. In this episode she shares her story. She tells us how yoga got her through stroke recovery and how it informs her work today. Anna talks about the relationship between trauma and yoga, and she talks about the impact stroke has had on her life with her husband. As Anna has gone through this journey and continued both her studies and her teaching, she developed a yoga program specifically for stroke survivors. And Anna explores the power and near sacredness of her own yoga mat. If you don't see the audio player below, visit http://Strokecast.com/Anna to listen to the conversation.   Click here for a machine-generated transcript Who is Anna Kerry? In Anna's own words: I had a stroke aged 35 in March 2021. I've had a regular yoga practice for about 10 years and decided I loved the practice so much that I wanted to learn how to teach and share my love of yoga. I qualified in Aug 2020 and had only been teaching for around 7 months when I had a stroke. As the stroke came out of the blue I had to dig deep into my yoga practice to help me through and believe that my yoga practice has helped my mindset and my mental health during this traumatic time. I'm now in a position where I want to help other stroke survivors through their recovery so I designed The Life After Stroke Programme -- a 6 week programme designed to help stroke survivors regain their life and confidence through a holistic and embodied approach to recovery. What is a PFO? Anna's stroke was caused by a PFO. She found that out a month after her stroke, and she will likely get it fixed eventually. A PFO is a hole in the heart. Roughly 25% of the population has one. I have one. Guests Misha Montana and Christine Lee both had PFOs that led to their strokes. After we are born, our blood follows a path through the heart. It comes in the right side. When the heart beats, the blood on the right side heads out of the heart to the lungs. There, it drops of CO2, picks up oxygen, filters out clots, and heads to the left side of the heart. It will pour into the left side and when the heart beats, it sends that oxygen-rich blood on to the brain and other parts of the body. Then that blood drops off its oxygen, picks up CO2, and heads back to the right side of the heart to start the whole cycle over. Before we are born, though, the process is different. While we are developing in our mothers' uteruses, we don't breath air. All the oxygen and nutrients we need to build fingers and toes and kidneys and hearts and brains comes from the umbilical cord. Since we're not breathing air, there's no point in sending blood to the lungs. Instead, in utero it goes straight from the right side of the heart to the left side of the heart through a hole in the middle. That hole is called a Patent Foramen Ovale, or a PFO. It normally closes on its own shortly after we are born. A quarter of the time it doesn't close after birth, and that allows unoxygenated, unfiltered blood to sneak across the heart, skip the lungs and drag a blood clot to the brain. So, if you've had a stroke, and you have a PFO, should you have surgery to close that hole? Maybe. Christine and Misha had their PFOs closed. I did not. Anna is waiting to get her PFO closed. I talked about this issue in a lot more detail with Dr. David Thaler. You can listen to that conversation at http://Strokecast.com/pfo. A Place of Her Own Anna Kerry has a special place in this world -- it's her yoga mat. At first glance, it's just a piece of material, but once she is on her mat it becomes a portal to take her to another special place. The mat allows her to center herself. It's a place she can experience joy and agony; happiness and anger; tears and laughter; and everything in between. When Anna is on her mat she can take a break from the rest of the world so that she can deal with the rest of the world. It triggers a mind shift to put her in a place where she can process things and, well, do yoga. Lots of us have things like a yoga mat. Maybe it's a special blanket or a childhood toy. Maybe it's a trinket that takes us back to a trip we took years ago or it's a gift from a lover or friend. Perhaps it's a special chair that holds our memories of the past. Once we touch or engage with that thing -- whatever it is -- we can feel a change in our own energy. Is that a bit woo-woo? Not really. Perhaps it is a metaphysical portal to a different plane of time and energy. Or perhaps it's another example of the core principle of neuroplasticity -- cell that fire together, wire together. Our brains work on patterns and shortcuts. That's why therapy works. The more repetitions w get in PT, OT, or Speech Therapy, the more we drive new neural pathways so we can walk, speak, or bake cookies again. Repeating a process reinforces those connections until we can almost do it automatically. A special place -- like Anna's yoga mat -- can do that, too. Sitting down on that mat can kick off those routines in the brain that shift us to a different place. The object starts the program running in our brains, and our brains do the rest. And the really great thing about Anna's yoga mat is that when life dictates, she can roll up her special place and take it with her. Other Yoga Themed Episodes Teaching Yoga after a Stroke with Leslie Hadley  Leslie Hadley went from Corporate executive to yoga teacher to stroke survivor and back to yoga teacher. Along the way she added life coach and tapping expert to her repertoire. She joins us in this episode to share her journey and explain what tapping and the Emotional Freedom technique is. Stroke, Naps, Gratitude, and Yoga with News Anchor Kristen Aguirre Kristen worked as a news anchor in Denver, survived a stroke, and was fired. She worked to pick up the pieces of her life, returned to the anchor desk back east and found gratitude is the key. Win of the Week Shelly shared her win of the week with us. You can hear it in the episode. Here's what she had to say: My name is Shelly, and I had a stroke four months ago. I was at the hospital for two weeks of acute rehab. I came home in a wheelchair, but I've been working really hard, and this week I did my farthest walk -- 4.2 miles. Things are still not 100% for sure. My arm isn't working that well. I can't feel in the arm. But the leg -- I've just been walking so much that I think things have improved. The more I've done, the more I think things improve. I didn't understand that when I first had the stroke. In physical therapy, when they would say that I could learn to walk without feeling, but as I've done it and now people can't always tell that I had a stroke when I walk, so that's been exciting for me. Thanks for letting us be part of your recovery, Shelly! What is a recent win you've had? Maybe you walked a lot. Or said a complete paragraph out loud. Or got a new job. Or slept a whole night. Or chewed and swallowed regular food without incident. Or booked a new OT appointment. I want to know what's gone well with you, big or small. And I want to share it with the listeners. You can record a brief message telling me who you are, when your stroke was and what you accomplished. You can do this with the voice memo feature on your phone or another recording process and email that recording to Bill@strokecast.com. Or you can do it the simple way. Simply call (321) 5stroke, any time day or night, and leave a voicemail describing your win. I'll share wins in future episodes so we can all celebrate with you. Hack of the Week Anna explained we need to take time to check in with ourselves. Yoga breathwork is one way to do that. It doesn't need to be yoga, though. Anna offered 3 key ways to do this. First, don't shy away from your feelings. A therapist can help you explore them further. Stroke is trauma. Grieving is natural. Clinical Depression is a common result of stroke (see http://Strokecast.com/depression for more information). It's a major life change and it's perfectly normal to feel feelings about it. Ignoring them won't make them better. Therapists can help. Neuropsychologists are also available with special training to help folks with brain injuries (see http://Strokecast.com/karen for more details). Second, acknowledge and recognize anger, anxiety, and other uncomfortable feelings. Those feelings are trying to tell you something. Talk to your anxiety like it's a small child. It wants attention and it's throwing a tantrum. Why? Third, offer yourself kindness and compassion. You're not an expert in this new body, brain, and life. You'll get things wrong, and that's okay. Forgive yourself for not having it all figured out. Links Where do we go from here? To learn more about Anna Kerry and her work, follow her on Instagram @theikosyoga and check out her website at https://theikosyoga.com/. Share this episode with someone you know by giving them the link http://Strokecast.com/Anna Send in your win of the week to Bill@Strokecast.com or call 321-5stroke Don't get best…get better.

Remember, we welcome comments, questions and suggested topics at thewonderpodcastQs@gmail.com   S3E29 TRANSCRIPT:----more----   Mark: Welcome back to the wonder science based paganism. I'm Mark. Yucca: And I'm Yucca. Mark: And today we're here to talk about a situation that really. Affects many of us in the pagan community generally. And in the nontheist pagan community specifically, which is what do we do about longtime friends or members of our family who are hostile to. Our way of being they, they disapprove of, of atheism or they disapprove of paganism, Or they disapprove of both because as we were saying before we started recording, we kind of get it from both ends. So, This is something that many of us struggle with. And especially those who have left more authoritarian kinds of religious contexts. It's not uncommon for parents or relatives or friends to be to be caught up in this idea that you must be the way that they want you to be, or or there's something wrong with. Yucca: Right, right. Or just the, the programming that you know, in, in some beliefs that, you know, they love and care about you, but they're really worth, you're gonna go to hell. Right. And they truly believe that the stuff that you're doing is gonna make you suffer for eternity or, you know, something like that. Mark: right. Which is in theory, that's a. of generous and charitable thing to think about someone else, but when you really get down to it, Yucca: That's pretty patronizing. Mark: it, it, it is. And it's also I mean, it's something that. I would think, well, okay. I, I have the perspective of having been raised with no religion. So I can't really, I can't speak with any authority about this, but it seems to me that it it's an additive to the health of a person to get out from under that. Extortion right. To get out from under that, the threatening nature of the story of heaven and hell. And I think that there is a lot of resentment that happens on the part, particularly of parents who raised you a particular way. And then you say, well, I'm not that way. Some other way. And. They as, as people that are in an authoritarian framework because they practice an authoritarian religion, the fact that you've rebelled can lead to a lot of anger. It's, it's not just about wanting, what's good for you. It's about wanting them to be obeyed. Yucca: yeah, it's a commentary for them on, on their self worth and, and you know, how good a job they did and, and all of that. Mark: Right. Right. So it's a tangled web and in some cases, more reasonable parents can be talked with parents, siblings, relatives, whatever they are. In more reasonable cases. You, we can talk with them. We can explain that we are following a path that makes us happy and that we see as fulfilling and that we really just need them to let us do that. Yucca: Right. Mark: In other cases, things are so bad that you really need to distance yourself. And that I can speak with, with some authority because my parents were incredibly toxic people, both of them. And I they're both dead now, but my mother, I hadn't seen for 16 years before she died and my father for more than 20. So, I just didn't have anything to do with them. Yucca: Well, and, and you, you split or you cut that off. Long before the, the pagan part of your life began even right. Mark: Yes. Yes. But, and, and I don't know, I mean, going into the specifics of my particular situation, aren't important, but one of the ironies to me is that I was raised in this non. context. And then my father married, my stepmother, who was a devout Catholic, and suddenly he was a Catholic, even though he was a scientist. Yucca: mm-hmm. Mark: And I don't know, I could go on for some time about hypocrisy and my father, but rather than do that, because it won't be of interest to anyone but me. The, the disapproval of the pagan stuff definitely did creep in late. You know, when I made a couple of sporadic attempts to try to get along with them but there clearly was no interest on their part to engaging me at all. All they wanted me to do was a reflective mirror. To the glory of their narcissism and I wasn't gonna do that. So, so I cut it off and it can be very hard because particularly for parents, because we carry with us a, a societal archetype about mom and dad, we an idealized vision of what mom could be like, what dad. Coming to grips with the fact that, that ain't, what you've got is a long, slow and painful process. Because you know, deep inside us, everybody wants a mother. Right. And if you figure out that you don't really have one, that's super painful. Yucca: right. So I think a, a good place to start and we can circle back around. There's so much to talk about in this, but is thinking about your own needs in a relationship. And being able to really reflect on that and see what your needs and what your boundaries are because we're. And, and I think some of this is, is more, there's a lot of gender issues going on as well. But I know at least for, for my side is, is being a woman that we're not really supposed to have boundaries, right. We're supposed to give, give, give, and a relationship is about what you can give and you're not, and you're selfish and that, I don't think this is true, but this is what we are taught is that we're selfish to, to. And stand by those boundaries. And at the end of the day, I think that's very unhealthy. Right. I don't think that that's gonna serve us very well, and you've got to, to be able to take care of yourself. Mark: right, Yucca: And so that's the first thing to figure out is what do you, what do I need? Mark: And it's particularly challenging in those authoritarian contexts where the parents are very, you know, power over dominant, because what they will tell you is you don't have any rights. You don't have a right to privacy. We, we have the right to know everything about you. We have Yucca: for your own good Mark: Yeah for your, for, for your own good. We, you know, we have the right to search your room. We have the right to read your diary. We have the right to do whatever we wanna do. However, invasive, it may seem because we have the right to own. You. In effect. And especially once if you come out of that context as an adult, it can be incredibly challenging to tell your parents, you know, my religious life, not really your business, you don't need to go into great detail about your non theist pagan, worldview and practice. If you know that it's gonna send them ballistic, you can just tell them. Sorry. I, I'm not interested in talking with you about that. Let's talk about something where we can connect, Yucca: Right. And so hopefully, hopefully they'll be able to leave it. There will be sometimes for some people, the, the case where they, they can't right where the, the parent or, and we're saying parent, but it may be somebody else. Right. But, but often it's gonna be a parent just because of that, that power dynamic there, but that they might not be able to, to let go of that. And that might just be something that, that you'll need to draw firmer Bo boundaries with. Mark: Right. Particularly, I'm thinking about going to church. Yucca: Right Mark: You know, there may come a time when you do now. I mean, you may decide that discretion is the better part of valor, and you'll just kind of suck it up and go to church with them when you visit them or whatever that is. But you can also very legitimately decide. I don't want to put any more energy into this institution that I find toxic. And sorry, mom, I'm not going to church with you this week. I don't do that anymore. Yucca: Right. Or if you've got your own kids, that's gonna especially be an issue with parents or parents in laws that, you know, they have a very strong idea about how you should be raising your family or whatever it is. And you may not wanna put your, put your kids through the same thing that you were put through or that your partner was put through. Mark: Right. Yucca: And Mark: there's harm. There's potential harm there. If you're trying to raise your kids, you know, with body positivity and a sense of gender equality and, and inclusiveness for lots of different kinds of people and sex positivity and all those kinds of good progressive values that will make them healthier people as adults. may very well have to say, no, I'm not gonna let you take my kid to Sunday school. I'm not gonna do it. That's gonna fill their head with stuff that I don't want 'em to have. And you know, maybe, maybe this is a deal breaker for you, but if you wanna see your grandkids, we have to have some agreements about how you will talk with them about these things. Yucca: Right. And that can be a really tricky thing when it is the, your partner's parents and the partner, and you have different approaches to the boundaries with those. With those parents. And that can be a big issue even when there aren't kids involved. Right. As you know, how do you dealing with the other person's family? Mark: Well, that then is a, an issue in your relationship, Yucca: yes, right. And that's Mark: it's not just a thing about your relationship with the in-laws, it's a thing in your relationship, you know, how are you gonna stick up for me? In relation to your parents' disapproval of whatever, because you're my partner and I expect you to stick up for me. Yucca: right. So those are, those are things to, to figure out. Right. And, and it sounds like mark you and I share a lot of views on. Where those boundaries might be, but for the listener, that's a, that's a personal thing to figure out, right. Maybe we seem kind of extreme to you or, or like we're taking it too easy, but really starting by figuring out how do you really feel about it now? How do you think you should feel? How do you really feel and is that what you do want to feel? Right. And if it isn't, do you wanna work on. On practice, a ritual to try and shift that right. And to try and change what, what some of your positions are, but you gotta figure out where you're at and be clear about where you're at, Mark: and what you want. Yucca: what you want. Yeah. To be fair to yourself and to the other people in the relationships, right. To be clear with them. So that it's, you know, they're not guessing about what your boundaries. Mark: Right. Yucca: Today it's okay. But tomorrow it's not. Okay. You know, you gotta be clear. Mark: that sends a terrible signal to everybody. If you're kind of, Kneely mouthed about these things and sort of trying to walk a knife edge for one thing, no one will thank you for it. You know, the people that you're trying to protect will think that you're insufficiently, you know, Viewing to their line and the people whose, whose boundary setting, you know, who need you to set boundaries are gonna see you as weak and ineffectual and not very committed to what you say you're committed to. So it's important. It really is very important to understand, okay, this is my life. What do I want? What do I want out of this relationship? Is that possible? Out of this relationship. And if it's not, then maybe you have to make some hard decisions about ending communication or, or strongly controlling communication. I know people who will not let their in-laws go off with their kids, Yucca: Mm-hmm Mark: they will only let the in-laws visit when they are present. Yucca: sure. Right. Mark: And. That's just how it is for them and the in-laws aren't happy about it. I, yeah, I Yucca: see the grandkids. Mark: right. Yeah. Yucca: That's the condition. Yeah. Mark: yeah. And maybe that's. You know, and this takes courage. It bears saying, you know, drawing these kinds of boundaries takes courage and, you know, you can end up getting a screening voice on the other end of the phone. You can end up getting long screened emails that tell you what a terrible person you are, because you're, you know, trying to deprive them of their grandchildren or whatever the is. Especially when you're a parent, you have to think not only for yourself, but for your kids. And think about the wounds that, that religious background put in you, that you're working to transcend what a favor you can do for your children by not letting them be wounded that way. Or, or buffering them as much as possible from the, the messages that the society gives them about, about their sexuality, about their gender, about their body shape, about their color, about Yucca: whatever it is. Yeah. And, and we do know that with. With our kids one day, they, they will be exposed to those Mark: mm-hmm Yucca: but but that buffering could give them some time to develop and have some literal brain development and self esteem and all of those things to develop first before some of they have to be, you know, smacked in the face with somebody being racist or sexist or whatever it is to them. Mark: Right. And they know that you're in their corner. Yucca: Yeah, Mark: Because you're affirming who they are in all ways. So when they are confronted with that kind of bigotry, they can come back to you for support Yucca: right. And maybe have some tools to deal with it that they wouldn't have had when they were five or when they were nine or whatever it is yeah. That they can deal with. There's another component that I think is really important to bring in, in this piece of the, the self-reflection and the drawing your boundaries is to really be mindful about what is actually in your control and what isn't in your control. And when you're setting those boundaries, are you actually setting boundaries for yourself or are you trying to control somebody else's behavior? Mark: Mm-hmm. Yucca: And just be, just be mindful and clear about that because that's something that can be a little bit slippery sometimes. Mark: And people can use things that are in their control in very subtle ways to make it hard for you to draw a boundary or stand up for yourself. One of the things that my parents did is I had to go to their house. It was the only, the only way that I could ever see them or my siblings cuz I'm the oldest of seven was to go to their territory, a house that ran by their rules, where they were the authorities Yucca: Mm-hmm. Mark: and it became quite clear. That, that was one of the many ways in which they were deliberately disempowering me as well as, you know, bad mouthing me to my siblings and all that kind of stuff. Yucca: Right. Hmm. Mark: So, you know, maybe. You know, maybe you set some conditions on the relationship, you know, if you want, see me, come see me. Right.  Yucca: Or neutral territory, Mark: yeah. Well, we'll, we'll, we'll meet at the aquarium and look at fish. Yucca: yeah. Well, that that actually leads to kind of the second part that I, that I wanted to talk about which we've started with the, what do you do when the relationship actually is very toxic, right? That's what we've been talking about, but there's also, and I hope this is gonna be a little bit more common of a situation than what we've been talking about, the situation where it's just uncomfortable. They have a particular set of beliefs and you have a different set of beliefs and you don't really kind of agree with each other and maybe you don't really wanna talk about it, but how do you still be able? So you've, you've set boundaries and they're respecting those boundaries. How do you then get to still have a meaningful relationship and share things with them without, without this your choices and their choices about. You're religious and, and personal lives being a relationshiper. And when you brought up the aquarium, that was one of the things that I was thinking about. You know, I have some siblings who are not pagan, right? My family's very split. We have half of us who are pagan and the other half who are, are quite Christian. Right. And you know, we still love each other deeply and share things, find things that we both value. And share those particular things. And they are things that I think are, are pretty pagan personally. Right. Let's go look at the fish together. Let's go on a nature walk like to me, like, yeah, that's, that's super pagan, but they're not gonna frame it that way. I'm gonna frame it that way, but I'm not gonna rub it in their face. Right. I, I'm not gonna be like, oh yeah, you know, we're gonna go do our pig, anything. Also speaking of query, you've got an aquarium shirt on don't you Mark: Oh, oh, I do Monterey bay aquarium. Yeah. It's Monterey bay aquarium a collection of sharks, Yucca: Ah, sharks are great. So, Mark: know, that sharks predate trees. Isn't that amazing. Yucca: It makes sense when you say it, but wow. Yeah, we went to the aquarium. I took the kids to the aquarium recently, and this week we went to the zoo. And they, they lost their minds with light, with all of the animals. Mark: Mm-hmm Yucca: So, but their favorite though, were the PFO. So there was a P H with her little chicks following behind. And even though it was like there's lions and polar bears, they got to actually like interact with the, with the peacocks and they just were so happy. So anyways, Mark: Cool. Yucca: Yeah. Mark: So, yeah. I think really understanding, maybe even drawing a Venn diagram, you know, what, what are we sharing common? What are our common interests and passions? You know, if we both really love gardening, we can do some gardening together and you know, that doesn't, or, or, you know, or hunting. Yucca: mm-hmm Mark: Um, I'm not trophy hunting. I would hope because that's. Awful, but you know, food hunting going out and, you know, getting, getting stuff to eat what, whatever it is Yucca: That was my brother. Yeah. Mark: Whatever it is that you share an interest in and are willing to kind of meet them in the middle, Yucca: Mm-hmm. Mark: then you can build a relationship around those kinds of things. It's so much harder to build a relationship that's spending all of its time, dealing with stuff where you don't meet eye to eye. Yucca: Yeah. Or trying to prove things to each other, Mark: Right. Yucca: right. I mean, if you both, if, what you're, if what if your Vinn diagram has debate club in the middle, maybe that's different. Right. But , but otherwise, you know, that you can spend your energy, you've got a limited amount of energy to spend on things. So what's it gonna be, right? Is it gonna be those shared things that you, that you love and can you have a relationship with this person without needing to, to agree on. Certain things. And I think that that's a good approach for not just family members or close friends, but also the community at large. Right. Are you in a community that, that generally has a different take than you do? Well, what, what is it that you do share together? Right. And connecting with each other on that really human level makes it so that that's a wonderful experience to have. First of all, but also later on, when you have a disagreement, you see each other as human, because you had that connection about, you know, the park or the gardening or the library or whatever it is. Mark: right. Yeah. And to me that also brings up the, the necessity of finding support for yourself. Yucca: Mm-hmm, Mark: Because when you have these kinds of challenges in your family, finding support from people of common values and views, and also potentially from professional therapists, right. Becomes really important. As you're working to kind of emerge from the shadow of a family that. In most cases has felt like it can tell you what to do and what to believe and who to be and all that kind of stuff. It's really important that you find people that are gonna help you stay strong in your boundaries. Stay clear about your priorities and enable you to be yourself, right? People who affirm you in who you are.  Yucca: We've already been waving it in a little bit, but do we wanna talk about some strategies and activities? Mark: Sure let's do that. Yeah. Why don't you start. Yucca: yeah, so, I mean, we mentioned things like the, the zoo and aquariums and parks and all of that, but For the, the family members that, that you can have that more accommodating relationship with. What are some activities that you would suggest Mark: Well, what comes to mind immediately to me is, you know, finding, finding neutrally. Posed places like a zoo, for example, doesn't really have a whole ideological piece to it other than animals are cool, Yucca: Yeah. Mark: which is something that generally, you know, people can agree on whether or not they're pagans or Christians or whatever it is. What's more challenging is when. There isn't a choice of, of venue. Like, you know, being invited over for Christmas, Yucca: Mm-hmm Mark: you know, what do you do there obviously? I mean, especially if you have children, the children are gonna be really amped about the presence and probably the sweets and you know, all the other things that tend to go along with celebrating Christmas and it can be very hard. To be in that context, if somebody starts, you know, saying grace over dinner or, you know, going on about Jesus Yucca: Mm-hmm Mark: and my take on that has always been it's similar to my take on, you know, going to theist pagan rituals. It's like your house, your rules. I'm not gonna pray with you, but I will sit quietly. I'm not going to protest. And that is kind of the strategy that I encourage. Now, if somebody gets all bent outta shape at you, because you don't close your eyes and bow your head or say amen, then they probably are more controlling than you can deal with in that way. Yucca: Right. Yeah. Then we're kind of back to the, the start of the conversation. Mark: Right. Yucca: Yeah. Another thing to, to consider when you are going to say like the Christmas situation. And especially if there, if there are kids involved is making a list, a priority list, right. Of what, what is your top thing that you're gonna have your boundary? Right. Is, are you going to be, you know, do you have certain dietary restrictions? That is the thing that you need to be just really vigilant about, and then you kind of let the other stuff slide because you're a guest, right? Or, but, or what is it? The, what is the, what are the things and how important are they to you in this situation, right? Where are you willing to be giving a little bit in this, this situation where you. in their space, in their home versus what is the big picture of overall Mark: Right. And the other thing you can do of course, is you can invite people to come have Christmas at your house, Yucca: mm-hmm Mark: and then you can maybe make your statement of gratitude to the earth for all the wonderful things that spring from it and keep us alive. And. Sort of leave it in the lap of the people who have come over as guests, if they feel a need to jump in with a statement about Jesus. Well, maybe that's okay. Maybe you can have both varieties of invocation. It seems as though in many cases, accommodation can be made unless. Unless the primary orientation of the people that you're negotiating these boundaries with is about control and anger at lack of control, because you're an adult, you don't need somebody else to control you. Maybe they haven't got their mind around the fact that you're an adult yet. But it's time, right? You're an adult, especially, you know, you got your own kids, like, come on. Yucca: Yeah. Mark: I'm I'm not 10 anymore. It's time. It's time for you to respect that. I can have my own opinions about things and live my own life. Yucca: Right. Well, and this gets into other philosophies, but, and with mine, They don't need to be controlling the 10 year old either. Mark: Mm-hmm Yucca: They, they are people too and get their own opinions. Now, do you need to keep them safe from not burning themselves on that stove or, you know, that's, there's levels there, but, but you don't magically become a person when you turn 18. You've been a person the whole time, right? Yeah. Mark: right. As soon as you're old enough to have. Tastes and opinions, which probably means by the time you're six months old, something like that. Then it's time for those Yucca: before. Mark: tastes and opinions to be respected. Right. And they don't have to be explained, you know, it's like, if you don't like strained carrots, you just don't like strained carrots. We're not gonna feed you strained carrots anymore. And This is something that for, for parents of previous generations, particularly can be very hard to get their mind around because the traditional parenting model in our society is quite authoritarian. And in patriarchal, it's very much about, you know, the man ruling the roost and. being in a power hierarchy where the children are at the bottom Yucca: Right. Mark: and if Yucca: And even a hierarchy within the children based on age and gender and all of that. Yeah. Mark: Right, right. Absolutely. So, so hopefully that's dying out at least in some places. But. Those places are not everywhere, you know, and we certainly see plenty of toxic masculinity around us expressing itself in that same sort of outraged way of, you know, how dare you have your own opinion, how dare you be your own person? How dare you not count how to my wishes. Yucca: yeah. Mark: And so once again, it, it really comes down to this thing where you have to balance out what do I get out of this relationship versus what am I being what's being demanded of me? Because I mean, that was really, that was really what. What settled it for me, all I was getting from my relationship was with my parents was criticism and anger and efforts at control and gas, lighting and mockery. And it had been that way since I was a little tiny kid. Yucca: Hmm. Mark: And it was like, you know what? You don't have anything good to offer me. I don't, I'm gonna stop drinking from this particular tap because it tastes really bad. Yucca: Right. And you didn't know him anything. Mark: Nope. Yucca: Right. And that, that's one of the stories that is, well, you know, we, we raised you and sacrificed for you and guilt, guilt, guilt, guilt, guilt. But it at really at. They are responsible for their emotions and you're responsible for yours Mark: mm-hmm yeah. Yucca: you know, it's, you don't have to be, and you probably wouldn't have ever been able to make them happen anyways, Mark: Oh Yucca: it's a choice on their part. Right. No matter what you do. Mark: they were miserable people and that, I mean, that's part of. I think what infuriated them so much about me is that I was not interested in being miserable. You know, I just didn't wanna be the way they were. So, you know, getting away from my example, particularly, I think. Especially in, you know, some of the, like really conservative, evangelical versions of Christianity. It's like the default position is sort of moral superiority and anger at everybody who doesn't follow along. That's that's not a particularly healthy. Thing to draw from, if that's, what, if that's what you're getting from your parental relationship, then maybe it's time not to have that relationship. Yucca: Yeah. Mark: Or to distance it a lot and say, you know, I'll visit you once a year or, you know, I'll talk with you on the phone every six months or whatever it is. There are gradations of estrangement, right? But what I found was that I came away from every communication feeling, yucky feeling really devalued and gaslit to the degree of being told that I was crazy and all that kind of stuff, it was just like, no, I don't need this. I got better use for my time. Life is short. Yucca: right. Mark: And it doesn't mean that I haven't gone through lots of pain over that loss over time. And I, even though they're dead, I can still, you know, have pain over the loss of the idealized parent. You know, the dad that actually valued me, the mom that actually loved me, you know, I can still grieve those ideas. I'm not, sorry. I don't think I missed out on anything by not communicating with them over all those years before they died. Yucca: Hmm. Yeah. Mark: So remember, it's your life? Yucca: Right. Mark: Yeah, it's your life and you get to live it. You get to make the decisions that seem to be best to you. And some of them are gonna be fuckups, but that doesn't matter, you know, that's, that's the nature of being a human. Having someone else tell you how you're supposed to think and act is not something you need in your life. Yucca: right. Because they're not in your shoes. They're not you. Mark: Nope. Yucca: actually, nobody really knows what they're doing. Mark: yeah. Yeah. Yep. Yucca: It might seem like it. But I think about this a lot. Do you remember being a kid and looking at adults and thinking that they knew what the hell they were doing and now that you're adult an adult. Do you feel like, you know what you're doing? Nobody does. Right. Mark: well, I mean, Yucca: to some degree, but Mark: But, but parents often represent themselves as these competent authority figures to their children, because that's where they get the authority to say, don't do that. Right. And. Yeah, it's all affront. And you, you talk with any parent that will be honest with you about it, and they'll tell you it's all affront it's like, I Yucca: terrified. I dunno what the hell I'm doing? Mark: right, right, Yucca: I'm messing them up. That's what? That, what we all worry. Mark: right. Yucca: Yeah. Mark: Well, In my experience, the thing that somebody needs more than anything else as they're growing up is the sense that there is some adult somewhere who finds them valuable and lovable and is in their corner. No matter what if there's one such person, whether it's an uncle or a grandparent or a family friend, just one such person, it makes all the difference in the world. Yucca: Yeah. Mark: So be that for your kids. Yucca: Mm-hmm or your niece or your nephew, or Mark: Right? Yucca: right. And for yourself too, Mark: Yeah. Yucca: right? Mark: Yeah. And that can be the hardest of all of those challenges because we hold ourselves to such impossible standards. And that internal critic voice that we've talked about before, it can be so incredibly cruel. Yucca: Mm-hmm Mark: Just really over the top cruel, you would never talk to another person the way that that voice will talk to you. So it's a good idea to find ways to curb it, get it, to get it to calm down and shut up. Yucca: Yeah, well, you know, this was really fun. We, we went kind of all over the place with this and it was a, it was a great conversation. Mark: Yeah, I think so too. I really appreciate it. Thank you, Yucca. Yucca: Yeah. Likewise. Mark: Okay. We'll be back next week. 

Misha Montana was a single 31-year-old mum working in the adult film industry when she experienced an ischemic stroke which later revealed a PFO which was resolved by heart surgery. The post Stroke & Heart Surgery Recovery – Misha Montana appeared first on Recovery After Stroke.

Nessa semana falamos sobre cassação do Mamãe Falei, 04 Transão na PF, inflação, Mendonça, as novas dos Malditos Milicos, novas movimentações para as Eleições 2022, a polêmica em torno da fala do Lula sobre aborto e as escolas NFT do MEC. Colabore com o nosso trabalho através do PicPay ou Padrim. PARTICIPANTES:------------------Ana Raíssa - https://twitter.com/annarraissaDiego Squinello - https://twitter.com/GarotoDoKikaoRodrigo Hipólito - http://twitter.com/lhamanalamaVictor Sousa - http://twitter.com/erro500 COMENTADO NO EPISÓDIO------------------Cassação do Mamãe Falei04 Transão prestou depoimento na PFO pedido do Daniel SilveiraMaior inflação desde 1994 surpreendeu Banco CentralO pedido de vista do MendonçaPlanalto teria oferecido cargos pelo morte de milicianoMilicos criaram rede de desinformaçãoR$ 56 milhões em picanha, filé mignon e salmão35 mil comprimidos de ViagraR$ 3,5 milhões em próteses penianasCandidato de consenso?Belo será candidato a deputado federalO engajamento nas redes sociaisLula e o aborto | 'recuo' da falaAlckmin oficializado como vice | padrinhoMarreco e seu hub em SPMarreco na Brazil ConferenceCiro Gomes no WazePesquisa Ipespe (2-5/04)A estranha pesquisa Datafolha pro RJA quase CPI do MECAs escolas fakes do FNDEBOLSOLÃO DO ASFALTO DICAS CULTURAIS------------------[vídeo] Ex-Drogado[filme] King Richard - Criando Campeãs[podcast] Plano-sequência[série] O que fazemos nas sombras Tem algum feedback sobre o episódio?------------------E-mail: podcastmid@gmail.comTwitter: @podcastmidInstagram: @podcastmid

What would motivate you to ride more than 200 miles per day on a bike for a year?For ultracyclist Amanda Coker, it was to heal from a traumatic injury, to inspire others and to prove the naysayers wrong. She shares her story with Kelly and Maria of biking 86,573 miles in 365 days, and how bullies in childhood and during her record-setting year fueled her to rise to the challenges. Sign up for your free consultation on health, leadership and life coaching with Kelly or Maria at ChampionsMojo.com/cm-coaching.Catch up on EVERY episode at ChampionsMojo.com.MORE ABOUT AMANDA COKERAmanda Coker is one of the most-decorated ultracyclists in the world, best known for her 2017 Highest Annual Mileage Record (also known as HAM'R) when she rode her bicycle 86,573.2 miles in 365 days. That is an average of over 237 miles per day. Amanda owns 15 other World Ultracycling Association sanctioned world records, including the highest month mileage record cycling a mind-boggling 8012.5 miles and the 100,000 mile record in 423 days. In October of 2021 Amanda became the first woman to ride more than 500 miles solo in 24 hours solo. She rode 512.5 miles, breaking 10 other women's cycling records along the way. Amanda is a member of the TWENTY/24 women's professional cycling team.Episode Topics and MentionsTriathlonsHAMM'R, Highest Annual Mileage RecordPatent foramen ovale (PFO), heart conditionTraumatic brain injuryNighttime paralysisPTSDStravaBullyingUltracyclingAmanda Coker CoachingNutritionRestTakeawaysKellyWhen we do something that is difficult, we are inspiring others -- even if we don't realize it.Remember that moving your body and having access to movement is a gift and privilege.MariaTurn negativity into motivation that fuels you to continue succeeding.Break down bigger goals into smaller, micro-goals.Quote of the Week“Keep setting short goals on the way to reaching your long-term goals.” -- Amanda CokerSubscribe to the Champion's Mojo podcast on Apple Podcasts, Spotify and Google Play.Have something you want to share with us? Email it to hello@championsmojo.com.Support the show (https://www.patreon.com/championsmojo)

Season 3 Episode 6 -On The Road!Before we get to our "Stroke in the News" this week we would be remiss not to pause and reflect that this episode is being recorded asynchronously amidst the backdrop of war in Ukraine. As we all finally sense an end to the COVID-19 crisis, we find ourselves in the midst of another one, and the extent of which is still unclear. It is hard to put into words what it means to watch the invasion of a sovereign nation, and honestly we've all struggled with the immediate human costs and certainly more lives will be senselessly lost.  Also realizing the  potential implications of the Russian invasion of Ukraine, we have found hope in the strength of the Ukrainian people and we stand with them in support of democracy. In the news...Boston Accents?  Give us a review if you like the  pure content of this podcast, but don't pick on Bostonians (and David)  please if you find Boston accents "irritating"- this was in the news this week...Resources mentioned in this episode:ISC Stroke Connection- Post Acute Rehab After Stroke-Getting it Right and why I believe they should have worked harder to offer this free for survivors.  My opinions here on The Know Stroke Blog Healthline reporter Cathy Cassata article on Peloton Instructor Bradley Rose Stroke with PFO spotlight UConn. Health PFO Closure ArticleCaroline and Travis Boston Marathon episode with link to updated fundraising pagehttps://www.buzzsprout.com/1751132/9933604Mike and I will be presenting at the Rehab Tech SummitMarch 4-5th (Neuro Edition) Use code KNOWSTROKE for 10% off admission at checkout-Rehab Tech Summit: https://rehabtechsummit.com We also wouldn't be able to get these episodes churned out so quickly without our great podcast producer Jake Dansereau. Thank you Jake!Music Credit and Podcast Production by Jake Dansereau, connect at JAKEEZo on Soundcloud  @user-257386777Please connect with us on social.  We appreciate your comments.  We are here to help you!Connect with Team EnableUs and the Know Stroke Podcast Hosts:https://www.enable4us.comhttps://twitter.com/Enable__Ushttps://www.instagram.com/enable.us/For more information about joining our show or advertising with us visit: https://enable4us.comSupport the show (https://paypal.me/SmartMovesPT)