Podcasts about PFO

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.

Szanowni Państwo, zapraszamy na czwarty odcinek z tegorocznej serii zastępstw. Tym razem o kwalifikacji pacjentów do zamknięcia PFO opowiada lek. Paweł Maeser.Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.

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.

Folge 14 aus Michis und Beas podcastigem Podcastparadies widmet sich schrecklichen Pop Culture News aus der Kategorie “Männer mit zuviel Macht und Geld”, danach beantworten die werten ungewrangelten Hosts eine Reihe von Publikumsfragen, die sich thematisch von FPÖ-Wahlwerbung bis Depressionen erstrecken. Außerdem: der letzte Dirtea wurde getrunken, Nippel wurden geflippelt, eine Partei mit dem Namen “Evelyn und die Brexit-Boys” gegründet und eine Dating-App mit dem Namen “Fatigue” getrademarkt. Eine neue Royal Member of the Komplett Verpasst Monarchy wurde gewürdigt, schreckliche Männer in Zügen wurden outgecalled und Laufbretter beiseite gestellt. Wer Freunde finden will gründet am besten eine Sekte (wie Jesus das auch getan hat) und ansonsten gilt immer und überall: Augen auf bei der Partnerwahl. Links: Mahmood Soldi: https://www.youtube.com/watch?v=M-aoyPa41Ic  Mahmood & Blanco - Brividi: https://www.youtube.com/watch?v=blEy4xHuMbY  Aminata Love Injected: https://www.youtube.com/watch?v=-usdXbeGHi8  Teya & Salena - Who The Hell is Edgar: https://www.youtube.com/watch?v=8uk64V9h0Ko Loreen - Euphoria: https://www.youtube.com/watch?v=Pfo-8z86x80  Loreen  Tattoo: https://www.youtube.com/watch?v=BE2Fj0W4jP4 Tattoo Acoustic: https://www.youtube.com/watch?v=zU-rDV6LiH4  Urban Symphony Rändajad: https://www.youtube.com/watch?v=gi0FEO2tFFA  Fornication Song: https://www.youtube.com/watch?v=koIZS8NP8WM  Wir im Internetz:  komplettverpasst@gmail.com https://www.youtube.com/channel/UCLaBL5QZptCBva9XpSsNPKQ https://www.instagram.com/komplettverpasst_podcast/

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

Did you know that nearly 10% of the population in Singapore suffers from migraines? Emerging research now suggests a potential link between migraines and the presence of a hole in the heart, known as a patent foramen ovale (PFO). More than half of all infants are born with a PFO, and in most cases, it closes on its own within the first few months of life. However, in some people, the ‘hole' remains open.  Dr Rohit Khurana, Consultant Cardiologist, Harley Street Heart and Vascular Centre, Singapore explains. See omnystudio.com/listener for privacy information.

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

We reckon Alfie Langer should be in the NRL Immortal ranks. Plus, has Barnaby Joyce now endeared himself to ordinary Australians, following his PFO? And, all the hype of Super Bowl!! See omnystudio.com/listener for privacy information.

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

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.

May 15th I had a min stroke and was diagnosed with a birth defect called PFO… in this episode I explain what happened and how it will affect me goin forward --- Send in a voice message: https://anchor.fm/derek-stevenson3/message

In this podcast, expert clinicians will discuss management selection for embolic stroke with a PFO.

In this podcast, expert clinicians will discuss treatment options for embolic stroke due to a PFO.

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)

Umbrella H&S: session1, PFO

Mindy shares her two postpartum experiences.  Going into her first birth, she was hoping for a natural labor, but ended up being induced and getting an epidural.  She felt present and in control, but still had to overcome feeling like this wasn't a “real” birth experience.  Her postpartum bliss was interrupted when doctors heard a murmur in the baby's heart, and he was diagnosed with a congenital heart defect, specifically VSD (ventricular septal defect), PFO (patent foramen ovale), and mitral valve malformation.  He went on to have open heart surgery at 13 months old.She became pregnant with her second baby in February 2020, a month before the pandemic lockdown began.  She describes her postpartum experience, and that baby, as so easy.  She said the biggest challenge was parenting her first, who of course was used to having all the attention on him.Here are a few of the resources mentioned in the episode:The Children's Heart Foundation: https://www.childrensheartfoundation.org/Their "It's My Heart" book is available here:https://www.childrensheartfoundation.org/about-chds/resources.htmlThe support group that gave her a gift bag in the waiting room is Mended Little Hearts: https://mendedhearts.org/The Facebook group she found very early in her journey:Babies and children with VSD (ventricular septal defect) and CHD support https://www.facebook.com/groups/268526583311618Mindy's email is: mindyseamail (at) gmail (dot) com  Join us on the Facebook group to talk more about this episode and all things postpartum: https://www.facebook.com/groups/fourthtrimesterpostpartumstories/

Friends, Cardio_Cast is back with a way challenging topic with the latest updates, enjoy listening to this episode and you can download the slides like before by clicking the following link;http://ecardiocast.com/wp-content/uploads/2021/10/PFO.pdf

Ken's guest is Matt Wenrick, environmental engineer, exploring the details of cleaning up the mess left behind from past chemicals, biological agents, leaks, Superfunds, and PFOs, including biocumulation, biolatilization, and other B words.Listeners question include a series of Facebook responses to the telling question, “What bothers you about Pennsylvania?”What “sticks in Ken's craw” this week?  Libertarian “Top Ten” listsGuests:Pennsylvania Constitution: https://www.paconstitution.org/State Police taking over small town policing: https://whyy.org/articles/half-of-pa-municipalities-rely-fully-on-state-police/Vehicle inspections: https://www.nbc12.com/2019/12/18/mechanics-react-gov-northams-proposal-eliminate-state-inspections/Vehicle inspections: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwiv7fuJ6MDmAhWNhOAKHZzmApAQFjAAegQIAxAC&url=https%3A%2F%2Flibertasutah.org%2Fpolicy-papers%2Fsafety_inspections.pdf&usg=AOvVaw2MXheK878QbPTLQkRi2oBE Commercials:Petition to teach the Pennsylvania Constitution to our kids: https://www.pennsylvaniaproject.com/petition-in-support-of-teaching-the-pennsylvania-constitution-to-our-children/Amendment 16: http://AmendmentSixteen.comFreedom Financial Tax: 866-401-1090Libertarian Party of Pennsylvania: http://LpPa.orgIron Will Tattoo Club: https://ironwilltattoo.clubSteven Werley Digital Marketing: https://www.stevenwerley.comToastmasters International: http://toastmasters.org 

In this bonus episode David recaps the busy launch month of May for the Know Stroke Podcast.  He is without his co-host for this episode as Michael was in route back to the US from Ireland.  David also dives a bit deeper into his why in this episode and what has moved him to continue his mission along with TEAM EnableUs to improve outcomes for stroke survivors and caregivers.  David discusses why recently he's been moved to reshare his story and reads  his 2016 FDA testimony for better treatment options for patient with congenital heart defects and stroke.  He  announces a new book project and the next phase of expanding stroke survivor stories.  Since his stroke David has worked with  hundreds of stroke survivors that have been on similar PFO closure journeys and his personal statement to the FDA provides insight why it still matters to him especially in May of each year.Here's the recap from David last Know Stroke blog post which summarizes each episode of the May podcast launch.https://knowstroke.wordpress.com/2021/05/27/what-moved-you-in-may/To learn more about PFO, stroke and share your own story search David's blog for PFO:https://knowstroke.wordpress.com/?s=PFOTo get on the KnowStroke Mailing list for book updates and early chapter releases subscribe here to receive our know stroke member news:https://us2.campaign-archive.com/home/?u=5915bdd2b1236434932c74f03&id=d83247bfbdPlease SHARE and Subscribe!Please share our podcast, write a review and rate each episode! We have provided links to your favorite podcast players under each episode to help us spread the word.Thank you!Please Support the Show: https://paypal.me/SmartMovesPTWant to Be Our Guest?We also invite all stroke thrivers to join us so together we can share success to help you manage your own condition and maximize your true potential and care. Want to join us as a stroke thriver guest and tell your stroke story on our website or this podcast? Let's Chat!Contact us here: www.enable4us.com/survivor-storiesComplete our know stroke patient survey at https://know-stroke.orgMusic Credit to JAKEEZo on Soundcloud  @user-257386777For more information about joining our show or advertising with us visit: https://enable4us.comSupport the show (https://paypal.me/SmartMovesPT)