Podcasts about phases

In this episode I break down the three essential phases of healing after an affair: Stop the Bleeding, Rehabilitation, and Healing.These stages are crucial for rebuilding trust and healing the pain of betrayal.The first phase is about managing the initial shock and emotional impact.In phase two, you'll do the deeper work of understanding what led to the affair and healing both individually and together.Phase three is where you begin to envision and create a new future, even if it looks different from what you expected.I'll explain why each phase is essential, how to avoid getting stuck, and why having the right support is key to moving forward.Struggling to decide whether to stay or go in your marriage and you're serious about finding that answer? Book a Truth & Clarity Session with a member of my team. We'll discuss where you are in your marriage and explore if there's a fit for you and I to work together so you can make - and execute - the RIGHT decision for YOU and your marriage.

What does it take to scale a B2B SaaS company from zero to $100 million in ARR? In the final episode of Season 6 of the Grow Your B2B SaaS Podcast, we explore this big question with two standout guests: Oji and Ezinne Udezue. They've worked with top tech companies like Typeform, WP Engine, and Twitter. They also co-wrote Building Rocketships: Product Management for High-Growth Companies. Beyond their resumes, they bring a unique perspective as a married couple with 20 years of partnership, both in life and in product leadership. This episode is full of sharp insights and practical strategies for anyone looking to build and grow successful SaaS products.Key Timecodes(0:00) - Knowing Your Ideal Customer Profile(0:09) - Most Important Task for Founders(0:59) - Closing Off Season 6 with a Bang(1:46) - Guest Welcome(1:53) - Diving Into Product Management(2:02) - Product Management as a Craft(3:19) - The Importance of Sharp Problems(4:44) - Why SaaS Founders Need Product Management(6:22) - Founders Thinking as Product Managers(7:54) - Misconceptions in Product Management(8:32) - Admin Layer of Product Management(9:27) - AI's Role in Product Management(10:19) - Calculated Decisions and Customer Needs(10:52) - AI as a Tool, Not a Replacement(11:13) - Scaling from Zero to $100 Million ARR(12:29) - Finding a Sharp Problem(13:46) - Sharpening Your ICP(16:05) - Building and Refining Your Product(18:13) - Signals Before Investing in Growth(19:38) - The Fundamentals of Product-Market Fit(20:36) - Creating a Unicorn vs. a Small Business(22:32) - Product Strategy Across Revenue Stages(25:41) - Strategic Moats and Distribution(26:11) - What is Product-Market Fit?(27:18) - Customer Investment as a Sign of Fit(28:23) - Phases of Growth in SaaS(30:56) - Virality vs. Network Effects(32:54) - When to Think About Virality and Network Effects(35:02) - AI as a Risk and Opportunity(36:18) - AI's Impact on Workflows(39:15) - Rethinking Business with AI(42:34) - Advice for SaaS Founders Starting Out(45:10) - Growing Towards 10 Million ARR(49:03) - Making Decisions When Not in the Room(51:01) - Summary of Key Points(51:26) - Building Rocketships Pro Edition(53:21) - Building a Community of Product Managers(53:57) - Closing Remarks and Call for Feedback

This week, we're diving into the weird, wonderful world of finding friends as an adult. Whether you just moved to a new city, went through a breakup, or simply woke up one day and realized your circle got smaller—this episode is for you. I'm talking about how to make new friends without it feeling like dating, why it's okay (and kind of magical) to go out alone, and how picking up new hobbies can transform your social life and sense of self. If you've ever Googled “how to make friends in your 30s” or stood awkwardly at a pottery class wondering if anyone will talk to you—yeah, same.---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok ShopEmily's Substack: third martini thoughts---Emily's Captivation: America's Sweethearts: Dallas Cowboys CheerleadersHannah's Captivation: The Four SeasonsShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

4 phases of soul transcends into 4 phases of spirt, to create 4 quadrants in personlity.

For more than 20 years, Ryan Worsley has been studiously, methodically, prodigiously, and obsessively honing his craft. Most recently, he was nominated by the Juno Awards for Recording Engineer of the Year (2020), but he was first recognized by the Western Canadian Music Awards in 2015 with his first award for Engineer of the Year. He has since won Producer of the Year twice (2019, 2022).Ryan's collaboration with Juno Award-winners Dear Rouge (Universal Music Canada) has been particularly fruitful. He produced, wrote, and mixed their LPs Black To Gold (2015), PHASES (2018), and Spirit (2022), resulting in five Top 10 singles on the Canadian Alternative Chart—including a #1 with “Fake Fame” in 2022.He also produced, co-wrote, and mixed Monowhales' Daytona Bleach, which earned four Top 10 singles on Canadian rock radio and contributed to the band's Juno Award for Breakthrough Group of the Year (2022).Ryan has worked with a wide range of artists, including Willow, Said The Whale (Arts & Crafts), Hotel Mira (Light Organ), Mathew V (604 Records), The Royal Foundry, and Shaun Frank.IN THIS EPISODE YOU'LL LEARN:Is knowing music theory problematic?Why it's a good thing to work with poor musiciansHow to keep objective when working multiple roles on a projectMaking songs grow and building excitementUnderstanding how radio affects your mixesAutomating your mix for impactBlending samples with real instrumentationAchieving natural dynamics in a songHow to pick samples efficientlyMaking your vocals feel controlled and polishedKnowing when to double vocalsHow to process layered vocalsUsing parallel processing on vocalsCompressing vocalsTo learn more about Ryan Worsley, visit https://www.echoplantsound.com/ryanLooking for 1-on-1 feedback and training to help you create pro-quality mixes?Check out my coaching program Amplitude and apply to join:https://masteryourmix.com/amplitude/ Want additional help with your music productions?For tips on how to improve your mixes, visit: https://masteryourmix.com/ Download your FREE copy of the Ultimate Mixing Blueprint: https://masteryourmix.com/blueprint/ Get your copy of my Amazon #1 bestselling books:The Recording Mindset: A Step-By-Step Guide to Creating Pro Recordings From Your Home Studio: https://therecordingmindset.com The Mixing Mindset: The Step-By-Step Formula For Creating Professional Rock Mixes From Your Home Studio: https://masteryourmix.com/mixingmindsetbook/ Check out our Sponsors:Download Waves Plugins here: https://waves.alzt.net/EK3G2K Subscribe to the show:Apple Podcasts: https://podcasts.apple.com/us/podcast/master-your-mix-podcast/id1240842781 Spotify: https://open.spotify.com/show/5V4xtrWSnpA5e9L67QcJej Youtube: http://www.youtube.com/@MasterYourMix...

Is death the end, or the beginning of something even more magical?In this enlightening episode of Uncover Your Magic, Ashley sits down with Julie Ryan, a psychic, medical intuitive, and bestselling author of "Angelic Attendance," to explore what actually happens when we transition from this life to the next. Julie brings decades of experience scanning bodies, connecting with spirits, and teaching others how to unlock their own "buffet of psychicness."Julie shares her incredible story of how she went from surgical device entrepreneur to energy healer and spiritual communicator. She explains the 12 Phases of Transition, how to communicate with dying loved ones (and even pets), and how spirit works through us to support healing, bring peace, and in some cases reverse disease. You'll also learn the surprising role our maternal ancestors play at the time of death, along with why "hopium" might be the most powerful medicine of all.Whether you're grieving, exploring, or stepping into your own intuitive gifts, Julie's grounded wisdom and extraordinary experiences will expand your understanding of life, death, and the unseen connections in between.This episode offers clarity, comfort, and a new way of looking at what comes next. A must-listen for anyone who longs for peace, guidance, and proof that love never dies.Episode Takeaways:08:30 How she went from inventor and businesswoman to intuitive healer (by following the breadcrumbs of curiosity)12:10 Julie explains how she “scans” people like a human MRI to identify imbalances and help the body heal.18:27 Julie shares how maintaining a high-frequency lifestyle influences healing, joy, and intuition.21:40 Healing Dogs, Discs & Bone Spurs. A behind-the-scenes at Julie's energetic work on Ashley's dog Harley31:25 How Julie Sees Past Lives34:44 The 12 Phases of Transition Explained41:14 Do We Live Many Lives At Once?53:05 Your Guardian Angel Has a Name. Julie reveals how we can connect with themConnect with Julie Ryan:WebsiteInstagramYouTubeListen to her podcast: Ask Julie RyanClaim your FREE copy of Angelic Attendants!Let's Connect!WebsiteFacebookInstagram Hosted on Acast. See acast.com/privacy for more information.

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Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

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Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

“Tough conversations aren't about fixing everything immediately — they're about understanding each other enough to keep moving forward.”What does it really mean to be present in a tough conversation? In this episode, we explore how presence—not just words or timing—shapes the quality and outcome of difficult conversations in leadership and relationships.Key takeaways:Why fully showing up physically and emotionally is the first act of care in a tough conversationHow presence helps shift from reactive responses to genuine listening and connectionThe importance of preparing not just your message but the timing and emotional space for dialogueWhy tough conversations are rarely “one and done” — they require patience and ongoing managementHow managing expectations about resolution can reduce pressure and open space for understandingTune in to explore how practicing presence and patience in tough conversations can transform leadership and deepen connection in all your relationships. Ready to transition from managing to truly growing your center? Learn more at https://schoolsofexcellence.com/profit/Connect with Gene at https://genehammett.com/Mentioned in this episode:The 6 Money Leaks in Schools™Turn Financial Blind Spots into Immediate Profit. Find Your Hidden Profits with The 6 Money Leaks in Schools™ Your school is silently losing thousands every month – money that should be yours. This proven diagnostic reveals exactly where your profit is escaping and how to reclaim it.Click here to learn more about Money LeaksThe 6 Money Leaks in Schools™Turn Financial Blind Spots into Immediate Profit. Find Your Hidden Profits with The 6 Money Leaks in Schools™ Your school is silently losing thousands every month – money that should be yours. This proven diagnostic reveals exactly where your profit is escaping and how to reclaim it.Click here to learn more about Money Leaks

Send us a textMany direct-to-consumer brands get stuck in the early stages of growth. This video breaks down the four phases every brand faces, from founder-led growth to omnichannel expansion. Understand what holds back revenue at $50K, $250K, and beyond.Ready to grow faster on Amazon? Book a call and let the experts take over: https://bit.ly/4jMZtxu#DirectToConsumer #EcommerceGrowth #BrandScaling #StartupTips #amazonDTCTimestamps:00:00 - Why Direct-to-Consumer Brands Struggle00:27 - Phase 1: Founder Growth Explained01:23 - Phase 2: The Paid Media Trap02:55 - Phase 3: Lifetime Value and Conversion Rate Focus04:46 - Phase 4: Omnichannel Expansion06:13 - Secret Phase 5: Becoming a Household Name06:51 - When Should You Hand Over the Reigns?----------------------------------------------Follow us:LinkedIn: https://www.linkedin.com/company/28605816/Instagram: https://www.instagram.com/stevenpopemag/Pinterest: https://www.pinterest.com/myamazonguys/Twitter: https://twitter.com/myamazonguySubscribe to the My Amazon Guy podcast: https://podcast.myamazonguy.comApple Podcast: https://podcasts.apple.com/us/podcast/my-amazon-guy/id1501974229Spotify: https://open.spotify.com/show/4A5ASHGGfr6s4wWNQIqyVwSupport the show

In this episode, we're flashing back to our interview with Natalia Benson and diving into the sparkly, spiritual world of crystals, manifestation, and alignment. Whether you're a seasoned crystal girlie or just curious about how people are using rose quartz to call in love and citrine to boost abundance, we're breaking down how these tools can help you get intentional about what you want—and attract it. From setting intentions during a new moon to cleansing energy and trusting the universe's timing, this is your guide to getting in alignment and calling in your best life.We're so thrilled to be joined by astrological expert and women's empowerment coach, Natalia Benson! Natalia shares her struggles with self-confidence in her early twenties and how that led to the goddess she is today. We discuss how to attract the life you want and the proper ways Natalia practices manifestation and alignment in her daily life. Natalia even breaks down how she was able to manifest her current relationship and she called that energy in. She even does a live practice with Hannah and Emily. We hope you gals enjoy!Love Natalia? Check out her socials:Follow Natalia Benson on InstagramListen to the Natalia Benson PodcastVisit Natalia's website to work with her and explore her guidesWant to know more about your Saturn Return? Check out our previous episode referenced in this interview.---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok ShopEmily's Substack: third martini thoughts---Emily's Captivation: Love IslandHannah's Captivation: The Wild RobotShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In this live episode from the LSI conference in California, Etienne Nichols is joined by Ashkon Rasooli to break down what it really takes to build a high-performing quality management system (QMS) in medtech—from startup chaos to post-market scale. Ashkon shares a phased approach to aligning QMS implementation with product development, explains the concept of "enforcement points," and reveals how founders can reduce the burden of compliance by starting small and planning ahead. If you're navigating regulatory requirements while trying to stay innovative, this episode is your roadmap to smarter, leaner quality.Key Timestamps00:02 – Introduction to Greenlight Guru and medtech process integration01:15 – QMS evolution from startup to commercialization03:00 – Phase-based product development overview (Phases 0–6)06:35 – Why QMS should follow product needs, not just regulatory triggers09:10 – Agile vs. proceduralism in quality systems11:50 – Building a quality culture during the feasibility phase15:25 – When to implement QMS controls and how to prepare for “enforcement points”18:40 – Investor-driven and regulatory QMS triggers21:10 – How early QMS planning saves time and reduces future remediation26:20 – Ashkon's final advice for startups: start small and stay proactiveStandout Quotes"You've got to take the BS—being burdensome—out of QMS."Ashkon Rasooli redefines QMS as a project management tool, challenging the notion that compliance must be a burden. This quote encapsulates his philosophy of proactive, phased implementation that actually enhances product development."Start small and do a little bit at a time—it won't seem like a burden."A practical mantra for startups, this advice underscores how a gradual, well-aligned QMS rollout can prevent last-minute fire drills and wasted effort.Top TakeawaysUse the "Phase 0–6" Model to Guide QMS Rollout – Align QMS implementation with the stages of product development to ensure each step supports the next.Don't Wait for Enforcement Points – Start building your QMS before regulators or investors demand it to avoid remediation-heavy implementations.Prioritize Culture Before Controls – In early feasibility, focus on aligning your team with medtech's safety responsibilities, rather than formal procedures.Procedures Should Support Outcomes, Not Just Check Boxes – Avoid proceduralism by tying every process back to its intended quality objective.Regulatory Strategy = Investor Strategy – QMS maturity is increasingly scrutinized during due diligence. Treat it as a value driver, not just a cost.ReferencesAshkon Rasooli on LinkedInGreenlight Guru – Quality management software for medical devicesEtienne Nichols on LinkedIn – Connect with the hostISO 13485 vs. ISO 9001 – Explains how medical device quality systems build on general standardsISO 14155 Overview – Relevant for clinical validation proceduresMedTech 101: What Are “Enforcement Points”?In the context of QMS, enforcement points are moments when external stakeholders (regulators or investors) require proof of formalized processes. Think of it like a driver's license checkpoint—you may be cruising just fine, but at that moment, you must prove you're compliant. The earlier you prep for them, the smoother your...

Are you focused on the right part of your financial journey? In this episode, we break down the three phases of wealth - Make, Maintain, and Multiply - and show how they apply differently throughout life. From starting your career to entering retirement, we'll help you identify where your time, energy, and money will have the biggest impact. ⁠⁠⁠⁠Jump start your journey with our FREE financial resources⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Reach your goals faster with our products⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Take the relationship to the next level: become a client⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Subscribe on YouTube for early access and go beyond the podcast⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠Connect with us on social media for more content⁠⁠⁠⁠⁠⁠⁠ Bring confidence to your wealth building with simplified strategies from The Money Guy. Learn how to apply financial tactics that go beyond common sense and help you reach your money goals faster. Make your assets do the heavy lifting so you can quit worrying and start living a more fulfilled life. Learn more about your ad choices. Visit megaphone.fm/adchoices

Jenny had severe health problems and had tried everything to no avail. Being a practitioner in the alternative health realm already, she could not figure out what was going on. After years of trial and error, she began to heal subconscious thoughts she believed were related to her symptoms. We discuss the multifaceted program she first developed for herself and then refined to be able to offer it to the public. She and her team work a lot with POTS, MCAS, Lyme Disease, Mold sensitivities, Food sensitives as well as other problems that the traditional medical community doesn't have a lot of answers or treatments for. Important points: ·       Root vs trigger memories ·       Comfort measures vs healing ·       Phases of chronic illness ·       Medical to holistic to functional ·       Clearing the slate and Rewiring beliefs ·       How 100% of her students finish the program ·       Daily support instead of periodic   About Jenny Peterson Jenny's primary focus is to help clients identify and release unconscious stressors that are preventing their body from healing and teach how to trust rather than fear their own bodies. She firmly believe that everyone can heal themselves, her team assists in providing the tools to make that happen. She has over 20 years of holistic studies, certification, and experience working with clients including See more at https://www.themindbodyrewire.com   -------------- Support the Podcast & Help yourself with Hypnosis Downloads by Dr. Liz! http://bit.ly/HypnosisMP3Downloads Do you have Chronic Insomnia? Find out more about Dr. Liz's Better Sleep Program at https://bit.ly/sleepbetterfeelbetter Search episodes at the Podcast Page http://bit.ly/HM-podcast --------- About Dr. Liz Interested in hypnosis with Dr. Liz? Schedule your free consultation at https://www.drlizhypnosis.com Winner of numerous awards including Top 100 Moms in Business, Dr. Liz provides psychotherapy, hypnosis, and neurodivergent supportive psychotherapy to people all around the world. She has a PhD in Clinical Psychology, is a Licensed Mental Health Counselor (LMHC) and has special certification in Hypnosis and Hypnotherapy. Specialty areas include Anxiety, Insomnia, and Deeper Emotional Healing. A problem shared is a problem halved. In person and online hypnosis and CBT for healing and transformation.  Listened to in over 140 countries, Hypnotize Me is the podcast about hypnosis, transformation, and healing. Certified hypnotherapist and Licensed Mental Health Counselor, Dr. Liz Bonet, discusses hypnosis and interviews professionals doing transformational work.

Welcome back to the shoooow!This week's episode is a re-release of an oldie but a goodie, where I chat about what it actually means to live the bodybuilding lifestyleAppreciate your patience during this short hiatus while I compete, new episodes will be back soon

We're not talking about "Levels", we're talking about "Phases". Which phase are you in?

In this episode of the Main Street Business Podcast, Mark J. Kohler and Mat Sorensen walk you through the full business lifecycle—showing you how to start lean, systemize operations, scale smart, and exit on your terms. Get ready for real-world strategies that actually work.Here are some of the highlights:Mark shares his experience in the startup phase, emphasizing the importance of not suffocating the business.Mat highlights how scaling a business involves scaling people, not just systems.Mark & Mat discuss the challenges of duplicating oneself in the business and the importance of having a clear vision.The need for a balanced approach to scaling, including personal financial planning.The challenges of finding the right person to take over the business and the importance of understanding key performance indicators.The optimization phase, focusing on efficiency and systemizing to make money.How to evaluate your team and ensure you have the right people in place to support scaling the business.Start planning for your eventual exit, even if it's years away, by working on improving financials and operations. Grab my FREE Ultimate Tax Strategy Guide HERE! Are you ready to get certified in EVERY strategy I teach? Start your journey with a FREE 15-minute demo to explore the Main Street Tax Pro Certification. You don't want to miss this! Secure your tickets for the most significant tax & legal event of the year: Tax and Legal 360 Looking to connect with a rock star law firm? KKOS is only a click away! Check out our YOUTUBE Channel Here: https://www.youtube.com/markjkohler Craving more content? Check out my Instagram!

Hey everyone! In today's PT Snacks Podcast episode, we're diving into the essentials of incorporating plyometrics in rehab. We'll cover what plyometrics are, how and when to use them in rehabilitation, and the importance of smart progression. We'll break down different phases of plyometrics, from initial stages focusing on basic landing mechanics to advanced stages tailored for sport-specific demands. Plus, I'll share some red and green flags to watch for during training and highlight some valuable free resources from the NSCA and MedBridge. Don't forget to check the show notes for a special discount on MedBridge subscriptions!00:00 Introduction and Podcast Overview00:34 Today's Topic: Programming Plyometrics in Rehab01:34 Understanding Plyometrics03:24 Phases of Plyometric Training06:15 Examples and Dosage of Plyometric Drills08:39 Monitoring Progress and Adjustments10:02 Resources and Final ThoughtsSupport the showWhy PT Snacks Podcast?This podcast is your go-to for bite-sized, practical info designed for busy, overwhelmed Physical Therapists and students who want to build confidence in their foundational knowledge without sacrificing life's other priorities. Stay Connected! Never miss an episode—hit follow now! Got questions? Email me at ptsnackspodcast@gmail.com or leave feedback HERE. Join the email list HERE On Instagram? Find unique content at @dr.kasey.hankins! Need CEUs Fast?Time and resources short? Medbridge has you covered: Get over $100 off a subscription with code PTSNACKSPODCAST: Medbridge Students: Save $75 off a student subscription with code PTSNACKSPODCASTSTUDENT—a full year of unlimited access for less!(These are affiliate links, but I only recommend Medbridge because it's genuinely valuable.) Optimize Your Patient Care with Tindeq Looking for a reliable dynamometer to enhance your clinical measurements? Tindeq ...

We're pulling back the curtain on our wellness journey—from the inside out. Hannah and Emily share what finally pushed us to embrace a more active lifestyle, how working with a nutritionist shifted our mindsets around food, and the simple habits that are making us feel stronger, less stressed, and more energized. From upgrading our supplements to prioritizing heart health, we're diving into all the changes that are helping us feel more grounded and in tune with our bodies. If you're curious about where to start or just need a little inspo to get back on track, this one's for you.---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok ShopEmily's Substack: third martini thoughts---Emily's Captivation: Lash Sensational Sky High Mascara in True BrownHannah's Captivation: Costco Realgood chicken burritosShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

You do not need a 85-page defensive Powerpoint plan. But you do need a plan. And one-page is more than enough to keep your business disciplined in the early Phases. This episode makes the case and explains one key data source you need to have to make even a 1-page plan useful. Your Host: Dr. James F. Richardson of Premium Growth Solutions, LLC www.premiumgrowthsolutions.com Please send feedback on this or other episodes to: admin@premiumgrowthsolutions.com

Chat and live music from the trad titans Beoga, whose new album ‘Phases' has just been released Official website: www.beogamusic.com (for copyright reasons the full tracks performed during this interview cannot be made available in the podcast)

UW Professor Gerald Pollack, Ph.D. shares insights from his groundbreaking research on exclusion zone (EZ) water—also known as the fourth phase of water—including how it forms and its vital role in human health. He also reflects on navigating a successful academic career while challenging prevailing scientific paradigms. Joining us for a warm reunion is co-host Xavier Figueroa, Dr. Pollack's former postdoctoral student.Reference Linkshttps://informedchoicewa.substack.com/https://www.pollacklab.org/https://www.amazon.com/Fourth-Phase-Water-Beyond-Liquid/dp/0962689548https://www.amazon.com/Cells-Gels-Engines-Gerald-Pollack/dp/0962689521/ref=sr_1_1?sr=8-1See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Today, Julie Ryan, a psychic medium and medical intuitive and I explore her journey into the world of spiritual healing and intuition. Julie shares her experiences of connecting with spirit, scanning bodies for medical insights, and facilitating healing. The discussion delves into the process of developing intuitive abilities, the accuracy of medical intuition, and the importance of self-healing. Julie emphasizes that everyone has the potential for intuition and healing, and she provides insights into how spirit communicates and guides individuals in their healing journeys. In this conversation, Julie Ryan discusses her book 'Angelic Attendents: What really happens as we transition from this life into the next' and the insights she gained about the dying process and the afterlife. She shares her personal experiences with death, the comforting presence of spirits during transition, and some of the 12 phases of transition that everyone goes through. Julie emphasizes the importance of understanding the dying process to alleviate fear and provides guidance on how to communicate with spirits. She also touches on her teachings in mediumship and psychic abilities, encouraging listeners to connect with their own spiritual guidance. Find Julie: askjulieryan.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Today, Julie Ryan, a psychic medium and medical intuitive and I explore her journey into the world of spiritual healing and intuition. Julie shares her experiences of connecting with spirit, scanning bodies for medical insights, and facilitating healing. The discussion delves into the process of developing intuitive abilities, the accuracy of medical intuition, and the importance of self-healing. Julie emphasizes that everyone has the potential for intuition and healing, and she provides insights into how spirit communicates and guides individuals in their healing journeys. In this conversation, Julie Ryan discusses her book 'Angelic Attendents: What really happens as we transition from this life into the next' and the insights she gained about the dying process and the afterlife. She shares her personal experiences with death, the comforting presence of spirits during transition, and some of the 12 phases of transition that everyone goes through. Julie emphasizes the importance of understanding the dying process to alleviate fear and provides guidance on how to communicate with spirits. She also touches on her teachings in mediumship and psychic abilities, encouraging listeners to connect with their own spiritual guidance. Find Julie: askjulieryan.com Learn more about your ad choices. Visit megaphone.fm/adchoices

In this unfiltered episode of Funky Friday, K. Michelle sits down with Cam Newton to confront hard truths—from the challenges Black women face to the realities of love, surgery, and success. She opens up about her college journey, the pain behind plastic surgery, and her bold move into country music. Cam and K. Michelle dive deep into relationships, co-parenting, public perception, and what it really means to build a Black family legacy. Raw, real, and revealing—this one pulls no punches.00:00- Introduction and Banter01:44- Welcome to Funky Friday02:29- Meet K. Michelle03:15- K. Michelle's College Journey05:57- Struggles and Successes11:55- Life After College20:30- Cam Newton's Personal Life24:22- Challenges of Public Perception41:00- The Importance of Black Family Structure54:50- Awkward Church Sermons55:37- Family Accountability56:31- Expressing True Desires56:53- Clickbait Culture58:22- Success and Happiness58:40- Relationship Dynamics01:01:11- Cheating and Double Standards01:07:04- The Burden of Truth01:15:36- Misunderstandings and Boundaries01:21:37- Dating Outside Your Race01:34:22- Navigating Modern Dating01:40:21- The Art of Sending Hints01:40:43- Meeting Your Significant Other01:42:16- The Reality of Successful Men and Relationships01:43:38- The Build-A-Bear Phenomenon01:46:14- Phases of a Relationship01:47:43- The Struggles of Co-Parenting01:48:09- Desire for a Big Family01:49:46- Challenges in the Music Industry01:52:35- Navigating the Country Music Scene02:02:32- Plastic Surgery and Self-Love02:13:50- Entrepreneurial Ventures02:17:55- Question of the Day: Dating the Homie02:22:49- One Pinky, One Finger, One Thumb = One Love ​

An tseachtain seo, pléimid na heachtraí a thit amach le mí anuas  – tá Trump agus Musk ag troid lena chéile, téann Kneecap ó shluaite ag Coachella go cúirteanna i Westminster, agus an cheist mhór - an bhfuil na hUltaigh na OGs de Phrotastúnachas Soiscéalach? Tchífidh muid ag Féile na Gealaí sibh!Ceol na míosa: Phases le Beoga Scannán na míosa: Sinners 

The title explains it all but we discuss where focusing on this type of specific training falls in a much larger area of performance, nutrition, training, and sleep.Article LINK: https://drive.google.com/file/d/11-xcw23uN4BgoQbUxSwrSaJ9jbxUi1DK/view?usp=sharing #complicatedsimple #resultsthatgiveback #researchreview 

Today, we sit down with naturopathic doctor Lara Briden to discuss all things women's health. We talk about the different phases of a woman's menstrual cycle and why hormonal birth control doesn't actually "regulate the period" despite what doctors may say. Dr. Briden also tells us about the difference between artificial hormones and the natural ones produced during a woman's cycle and just how dangerous these artificial hormones can be. And she shares some tips for women struggling with period pain or irregular cycles and what they can do to improve their health. Buy Dr. Briden's book, "Metabolism Repair for Women": https://a.co/d/7oyZU6u Share the Arrows 2025 is on October 11 in Dallas, Texas! Go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠sharethearrows.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for tickets now! Sponsored by ⁠⁠Carly Jean Los Angeles⁠⁠, ⁠⁠Good Ranchers⁠⁠, and ⁠⁠EveryLife⁠⁠. Buy Allie's new book, "Toxic Empathy: How Progressives Exploit Christian Compassion": ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://a.co/d/4COtBxy⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ --- Timecodes: (02:30) Birth control pill & menstrual cycle (12:35) Breaking down menstrual cycles (22:25) Phases (26:00) Progesterone (40:55) Progestins vs progesterone (45:10) Fixing your period (53:10) Birth control affecting metabolism (57:00) Perimenopause & hormone therapy --- Today's Sponsors: Seven Weeks Coffee — Experience the best coffee while supporting the pro-life movement with Seven Weeks Coffee; use code ALLIE at ⁠⁠⁠⁠⁠⁠https://www.sevenweekscoffee.com⁠⁠⁠⁠⁠⁠ to save up to 25% off your first order, plus your free gift! Good Ranchers — Go to ⁠⁠⁠⁠⁠⁠⁠https://⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠GoodRanchers.com⁠⁠⁠⁠⁠⁠⁠ and subscribe to any of their boxes (but preferably the Allie Beth Stuckey Box) to get free Waygu burgers, hot dogs, bacon, or chicken wings in every box for life. Plus, you'll get $40 off when you use code ALLIE at checkout. A'del — Try A'del's hand-crafted, artisan, small-batch cosmetics and use promo code ALLIE 25% off your first time purchase at AdelNaturalCosmetics.com Shopify — Shopify is the commerse platform behind millions of businesses around the world. Get started with your own design studio to turn your big business idea into profit. Go to shopify.com/allie to sign up for your $1 per month trial and start selling with Shopify today! --- Related Episodes: Ep 976 | Birth Control: What the Media Won't Tell You https://podcasts.apple.com/us/podcast/ep-976-birth-control-what-the-media-wont-tell-you/id1359249098?i=1000650764644 Ep 1133 | Birth Control Made Her Blind; IVF Made Her Pro-Life | Guest: Chelsey Painter Davis https://podcasts.apple.com/us/podcast/ep-1133-birth-control-made-her-blind-ivf-made-her-pro/id1359249098?i=1000688650828 --- Buy Allie's book, You're Not Enough (& That's Okay): Escaping the Toxic Culture of Self-Love: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://alliebethstuckey.com/book⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Relatable merchandise – use promo code 'ALLIE10' for a discount: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://shop.blazemedia.com/collections/allie-stuckey Learn more about your ad choices. Visit megaphone.fm/adchoices

Wondering what to do on your puppy's first night home?You're bringing your new puppy home, you're excited, you've got everything ready, and you already have great plans on how your new puppy will fit right into your family. But wait, do I know what to do that first night?  Maybe you're coming home late and don't have much time to make them feel safe and comfortable before bedtime.  You're probably wondering:Where should my puppy sleep that first night?Do I put them in the crate even if I haven't introduced it yet?Is it okay not to use the crate?No worries, in this episode, I walk you through exactly what to do that very first night.Note: If you've watched my three part series: The 3 Phases to Bringing Your New Puppy Home, this episode fits into Phase 02: Settle In.Whether you've been preparing for weeks or just thought of it now (we've all been there!), you'll leave this episode knowing exactly what to do, and what you don't need to worry about (yet!).In this episode I talk about:What to expect for your puppy's first night home.Where crate training and potty training fits in.Where your puppy should sleep that first night.What you can do to make them more comfortable without overwhelming them.What else you should be prepared for.Enjoying this podcast?  Please rate and review it wherever you listen.  This helps other puppy parents find it.Other resources mentioned and related to this episode:The 3 Phases to Bringing Your New Puppy Home: Getting a new puppy is exciting but overwhelming.  This free three part video series will help you know how to Prepare, how long to let your puppy Settle In, and when it's time to Get to Work.Complete Guide to Potty Training Your Puppy: Know exactly what to do when to help potty training feel easier with quicker results. It includes a tracker to help you find patterns and prevent accidents. YOUR New Puppy:  My signature new puppy course that has helped hundreds of new puppy parents raise their puppies into well-mannered, happy dogs.  Includes live support from me so you don't have to do this alone!What's Next?Feeling a little unsure about what to do next with your new puppy? You're not doing anything wrong! You're just a human trying to raise a dog.That's exactly why I created YOUR Perfect Puppy — my digital program that gives you a clear plan to follow and direct support from me every step of the way. From potty training and basic cues to building trust and confidence, we'll cover everything you need to raise your well-mannered dog with less stress and more joy.And because puppyhood doesn't stop after four weeks, you'll also get ongoing access to Playtime Paws Academy — my membership community with weekly live calls, a private forum, and an entire library of enrichment activities to help you navigate real-life challenges as they come up.Click here to check out YOUR Perfect Puppy.  I'd love to support you through this journey.

“I keep starting over. Why can't I just stick with it?” If that thought hits a little too close to home—you're not alone. In this episode, we're unpacking the real reasons people keep falling off track, and what it actually takes to build consistency that sticks. We cover: ✔️ The dopamine hit of “Day 1” and why the all-or-nothing mindset keeps you stuck ✔️ How emotional eating and escape habits sabotage your best intentions ✔️ Why identity-based goals are more powerful (and sustainable) than outcome chasing ✔️ The truth about discipline that no influencer is telling you ✔️ Why chasing fads leads to burnout—and how the L5 Method helps you build real, lasting results without starting over again If you're tired of restarting, this episode will give you the mindset shift and tactical clarity you've been missing. APPLY FOR COACHING: https://www.lvltncoaching.com/1-1-coaching SDE Method app: https://www.lvltncoaching.com/sde-method-app Macros Guide https://www.lvltncoaching.com/free-resources/calculate-your-macros Join the Facebook Community: https://www.facebook.com/groups/lvltncoaching FREE TOOLS to start your health and fitness journey: https://www.lvltncoaching.com/resources/freebies Alessandra's Instagram: http://instagram.com/alessandrascutnik Joelle's Instagram: https://www.instagram.com/joellesamantha?igsh=ZnVhZjFjczN0OTdn Josh's Instagram: http://instagram.com/joshscutnik   Timestamps: 00:00 Introduction to the Fitness League and Episode Overview 05:31 The Evolution of Mindset in Fitness 10:35 Simplifying Habits for Sustainable Change 17:17 Realistic Expectations in Fitness Goals 20:40 The Misconception of Muscle Mass and Fitness Standards 24:50 The Skewed Perception of Fitness 27:59 The Pilates Skinny Talk Era 32:20 The Dangers of Skinny Talk 36:05 Overcomplication in Health and Fitness 41:37 The Role of Identity in Fitness Communities 43:19 The Need for Belonging in Diets 43:51 Identity and Dogmatism in Fitness 45:17 The Impact of Injury on Identity 46:21 Phases of Life and Shifting Identities 47:13 Reestablishing Identity in Fitness 49:44 Understanding Discipline and Motivation 51:18 The Role of Environment in Behavior Change 52:44 Creating Motivation Through Action 54:21 The North Star Concept of Motivation 55:40 Surroundings and Their Influence on Growth

In this essential episode, Lindsey breaks down the 10 distinct phases of eating disorder recovery, drawing from Carolyn Costin's research while adding her own spiritual and practical insights. From the initial denial phase of "I don't think I have a problem" all the way to complete recovery, this roadmap helps you identify exactly where you are in your journey and what comes next. If you've ever felt confused about your progress or wondered if you're "doing recovery right," this episode provides the clarity you've been searching for. The 10 Phases of Recovery (Quick Reference) Phase 1: "I don't think I have a problem" - Complete denial, "this is just who I am" Phase 2: "I might have a problem, but it's not that bad" - The "I'm fine" and "not sick enough" phase Phase 3: "I have a problem but I don't care" - Awareness without motivation to change Phase 4: "I want to change but don't know how and I'm terrified" - The breakthrough moment Phase 5: "I tried to change but couldn't" - Previous attempts didn't work, feeling hopeless Phase 6: "I can stop some behaviors but not all" - Partial progress, selective recovery Phase 7: "I can stop behaviors but thoughts remain" - Actions changing, mindset lagging Phase 8: "Often free from behaviors and thoughts, but something feels missing" - The spiritual component gap Phase 9: "Free from behaviors and thoughts, surrendered control" - Nearly complete freedom Phase 10: "I am recovered" - 6+ months of complete freedom, helping others Key Insights You'll Gain On Recovery Reality (4:00-5:00) "The secret to recovery isn't forgetting the pain existed or diminishing the damage that occurred. It's allowing it to be there, but that pain and damage no longer controls and defines every ounce of who you are." On Getting Stuck in Phases (18:00-19:00) "We can get trapped in wanting recovery to go perfectly, that we stay in one of these phases too long because we're not sure that we've mastered it yet. Every single day is an opportunity to grow and move forward." On the Missing Ingredient (13:00-15:00) "There's gonna be days where your promise to yourself, your commitment to yourself is just not enough... There's gonna be days where you need a higher motivator." On Progress Over Perfection "These different phases of recovery are all about progression over perfection. You don't have to master each phase - you just have to keep moving through them." Why This Framework Changes Everything Eliminates confusion about where you are in recovery Normalizes the non-linear nature of healing Provides hope when you feel stuck or lost Identifies specific support needs for each phase Prevents perfectionist paralysis in recovery Highlights the importance of spiritual/soul work in lasting freedom Perfect for Women Who: Feel confused about their recovery progress Wonder if they're "doing recovery right" Have tried recovery before and want to understand what went wrong Are considering getting professional help but aren't sure they're "ready" Want to understand the long-term recovery journey Need hope that complete freedom is actually possible Are supporting someone else in recovery Throughout this episode, Lindsey weaves in her own experience spending extended time in various phases, particularly Phase 3 ("I have a problem but I don't care") and Phase 8 (feeling like something was missing until she incorporated spiritual surrender). Her vulnerability about getting stuck and her insights about the soul component of recovery make this more than just clinical information. Ready to Move to Your Next Phase? If you're in Phases 4-5 (wanting change but scared or having tried before), this is the perfect time to get personalized support. Lindsey specializes in meeting women exactly where they are and creating a path forward that honors your unique situation and fears. Apply for coaching: www.herbestself.co/services Personalized recovery roadmap based on your current phase Support through the scary transitions between phases Tools to accelerate your progress without perfectionist paralysis Spiritual integration if that resonates with your journey Connect & Continue Your Journey Her Best Self Society: Join our private Facebook community at www.herbestselfsociety.com Instagram: @thelindseynichol Website: www.herbestself.co  If This Replay Helped You Please rate, review, and share this episode. Many women have told us this single episode provided the clarity that shifted their entire recovery journey. Your review helps more women discover this roadmap when they're feeling lost and confused about their progress. Tag a friend who needs to hear this framework - sometimes knowing exactly where you are is the first step to moving forward. Remember: You don't repeat what you repair. Identifying your phase isn't about judgment - it's about empowerment. Every phase serves a purpose, and every phase leads to the next when you're ready to move forward. Your recovery is possible. Your freedom is waiting. And now you know exactly where you are on the path to get there.

Take advantage of our new ambassador roll with Ark! Use Code JIGSANDBIGS to save 10% on Rods, Reels, and Baits too! https://arkrods.com/JIGSANDBIGSJ&B June Multi Species Scavenger Hunt: https://share.fishingchaos.com/tournament/fBJvQQmnNjVwaOpJ7QIwJ&B June No Limit Slot Tourney: https://share.fishingchaos.com/tournament/wy44HGz2lIPlMbO7HK0HWant to support the show?BECOME A JIGHEAD HERE:https://rebrand.ly/bf8612And/OrBuy me a coffee here: https://buymeacoffee.com/jigsandbigsSubscribe to J&B on YouTube: https://www.youtube.com/channel/UCQgjclBaAYEl0Xrw9JKYNQgSubscribe to American Vet Fishing on YouTube:https://www.youtube.com/@american_vet_fishing8741BUY HEAT YOUR MEAT: https://heatyourmeat.net/Call the J+B Hotline! 1+ (413) 324-8519Or email jigsandbigs413@gmail.com(Questions, comments, FTG, Stories from the bait shop, Broke on the Boat submissions, and more)Check out our LINKTREE: https://linktr.ee/jigsandbigsThanks to our Show Partners!- Hookset Hoodlums - https://www.hooksethoodlums.com - Use code JIGSANDBIGS10 for 10% off at checkout!!!- Dark Horse Tackle - https://darkhorsetackle.com?sca_ref=4963595.Ulm8078KDd [Save 15% off your first box in a Weekend Warrior or Dabble Pack month-month subscription using code JIGSANDBIGS15 at checkout or put together a BYOB and use the code JANDBBYOB25! - Omnia Fishing - https://omnia.direct/OmniaE-GiftCard [Save 15% off your FIRST order at Omnia Fishing!]- A-Bay Lure - https://abaylure.com [Use code Jigsandbigs to save 20% on your entire order]- Bay House Apartment - https://shorturl.at/fpRX8- The Ship Motel - https://theshipmotel.com/- Reaction Tackle - https://www.reactiontackle.com/JIGSANDBIGS- Three Belles Outfitters - https://rebrand.ly/zsdnchi- Torege Polarized Sunglasses - https://rebrand.ly/i2cqymx [Use code jigsandbigs10 to save 10% at checkout!]

Have a question you want me to answer on the podcast? Ask Here!In this episode, Coach Jamie Kirschner addresses the painful experience of betrayal, particularly focusing on a young girl's feelings of hurt after her pastor's infidelity. Through biblical examples, including King David and Jesus, she explores the themes of trust, forgiveness, and the process of grieving. The conversation emphasizes the importance of maintaining faith, seeking support, and understanding that healing is a journey that involves acknowledging one's feelings and moving forward with hope.Chapters00:00 Introduction to The Beautiful Movement00:08 AMA: How Do I Recover from Betrayal?00:36 Coach Jamie's Response01:19 2 Biblical Examples of Betrayal08:02 What Do You Do When Someone Betrays You? 1. Forgive08:49 2. Spend Extra Time with Jesus09:47 3 Phases of Grief10:02 Phase 1: Denial10:42 Phase 2: Confrontation11:24 Phase 3: Accommodation11:42 3. Just Because Your Pastor Hurt You, Doesn't Mean Others Will12:31 Empowerment and Moving Forward Ladies! Don't forget to grab your conference tickets before June 15, 2025! Ticket prices will be going up after June 15 from $10 a ticket to $20 a ticket! And for those of you in the US and have bought your ticket before June 15, I have a special gift I want to send you in the mail AND I am going to put your name in a drawing (1 name per ticket) to win one of our super cute conference tees!UncommonTEEN.com/conferenceCONNECT WITH COACH JAMIE LIFE COACHING for Christian Teen Girls SUBSCRIBE ON YOUTUBE! PODCAST RESOURCES ABOUT MERCH The UncommonTEEN App is available on the Apple Store! It looks like Google is going to take a bit longer.

In Part 2 of our conversation with Lynnsey Robinson, we go deeper into the woo (and the why) — decoding what our dreams are really trying to tell us, how to approach tarot as a tool for self-reflection (not fortune-telling), and how to actually use affirmations so they don't feel like empty words. We talk about what it means when you keep having the same dream over and over again, how tarot can help you get unstuck, and why slapping “I am confident” on your mirror isn't enough if your subconscious isn't on board. It's part intuition, part psychology, and all good vibes.---Follow Lynnsey RobinsonBook with Lynnsey---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok Shop---Lynnsey's Captivation: Rewatching TV shows like: Heros, How I Met Your Mother, Lost with her kidsEmily's Captivation: Something Beautiful by Miley CyrusHannah's Captivation: Deli BoysShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

"If you take a step back and ask, how has the last 10-15 years panned out? The truth of the matter is that Southeast Asia has not done as well as it should have based on the reports and projections that existed earlier. There have been fundamental flaws from a culture standpoint with respect to how the ecosystem has been shaped. I think there has been too much of a mirror of what's happening in Silicon Valley and figuring out how to replicate those concepts in Southeast Asia, whereas there should have been a better, more localized, customized, regional model to suit the culture and concepts in this region. We've mirrored our fundraising, our entire ecosystem to be too much like Silicon Valley - blitzscaling style model, power law style investing which in hindsight, maybe were not the right approaches. There's also been an over-reliance on funding." - Mohan Belani, CEO & Co-founder of E27, Partner at Orvel Ventures Fresh out of the studio, Mohan Belani, CEO and co-founder of E27 and partner at Orvel Ventures, joins us to explore his 15 years of journey shaping Southeast Asia's startup ecosystem. In the conversation, Mohan reflected on the evolution of Southeast Asia's ecosystem through different eras and offered his perspectives in how startups need to navigate the current funding winter in Southeast Asia. He also shared the spark that inspired him to set Orvel Ventures and how the investment thesis will fit better for the Southeast Asia region. Last but not least, he offered his vision what great would look like for Orvel and E27 in the next decade. Episode Highlights: [00:01:00] The Spark from Silicon Valley [00:03:00] Foundational Lessons for Entrepreneurs [00:07:00] The Origin of E27 [00:10:00] E27's Evolution into a Regional Powerhouse [00:13:00] Navigating the Phases of Southeast Asia's Ecosystem [00:17:00] Media as Ecosystem Infrastructure [00:20:00] Building Regionally with Roadshows [00:22:00] Hard Lessons from Regional Expansion [00:23:00] Adapting to Emerging Tech Waves [00:25:00] Misaligned Expectations & the Silicon Valley Mirror [00:28:00] The Birth of Orvel Ventures [00:33:00] The Orvel Ventures Investment Model [00:36:00] Red Flags & Green Flags in Founders [00:40:00] Rethinking Exit Pathways in SEA [00:45:00] Promising Sectors in 2024 [00:48:00] Thoughts on Governance Failures [00:52:00] The Need for Critique in SEA Media [00:54:00] Vision for E27 and Oval Ventures [00:57:00] Closing and Echelon 2025 Profile: Mohan Belani: https://www.linkedin.com/in/mohanbelani/ CEO and co-founder of E27: https://e27.co Partner, Orvel Ventures: https://orvel.vc Podcast Information: Bernard Leong hosts and produces the show. The proper credits for the intro and end music are "Energetic Sports Drive." G. Thomas Craig mixed and edited the episode in both video and audio format. Here are the links to watch or listen to our podcast. Analyse Asia Main Site: https://analyse.asia Analyse Asia Spotify: https://open.spotify.com/show/1kkRwzRZa4JCICr2vm0vGl Analyse Asia Apple Podcasts: https://podcasts.apple.com/us/podcast/analyse-asia-with-bernard-leong/id914868245 Analyse Asia YouTube: https://www.youtube.com/@AnalyseAsia Analyse Asia LinkedIn: https://www.linkedin.com/company/analyse-asia/ Analyse Asia X (formerly known as Twitter): https://twitter.com/analyseasia Analyse Asia Threads: https://www.threads.net/@analyseasia Sign Up for Our This Week in Asia Newsletter: https://www.analyse.asia/#/portal/signup Subscribe Newsletter on LinkedIn https://www.linkedin.com/build-relation/newsletter-follow?entityUrn=7149559878934540288

3 Phases of God's Plan for Unity in the Church 1. The Grace of Unity, v. 11 2. The Growth of Unity, v. 12 3. The Goal of Unity, v. 13

How One Man Lost Over 300 Pounds Without Any Cardio with Jamie Selzler Lessons learned. (2:02) What episode got him hooked? (3:23) His highest recorded weight. (4:30) Obesity is a disease. (6:21) Food became overpowering. (10:17) The moment he feared for his life. (11:58) Keeping promises to yourself. (16:01) How did the process change his relationship with himself? (19:53) Having the foot on the gas. (21:56) Consistency and discipline TRUMP motivation. (23:26) His #1 message to coaches and trainers. (27:38) The importance of having a team. (30:34) EVERYONE deserves love, respect, compassion, and empathy, NO MATTER their size. (32:48) Celebrate every win and success. (34:04) What would Mom have done? (40:27) Input goals ONLY, not output goals. (42:05) His GLP-1 experience. (48:02) A HUGE opportunity for trainers and coaches. (59:10) The importance of having a support system. (1:01:48) A parting message for those in his shoes. (1:10:46) Related Links/Products Mentioned Visit Legion Athletics for the exclusive offer for Mind Pump listeners! ** Code MINDPUMP for 20% off your first order (new customers) and double rewards points for existing customers. ** June Special: Shredded Summer Bundle or Bikini Bundle 50% off! ** Code JUNE50 at checkout ** Listener Live Podcast with Jamie – Mind Pump # 2574 – Question #4 Aspire Fitness KY DMAIC - The 5 Phases of Lean Six Sigma Mind Pump Podcast – YouTube Mind Pump Free Resources Featured Guest/People Mentioned Jamie Selzler (@jselzler) Instagram Jamie Selzler (@jamselz) TikTok Coach Josh Bowen (@buffgandhi) Instagram Mike Matthews (@muscleforlifefitness) Instagram Dr. William Seeds (@williamseedsmd) Instagram  

Kerri Snook from Bouchette Design joins Ettie this week as guest co-host and they jump right in to talk about recent projects from Kerri, personal transformation, and AI influenced decks changing the Kickstarter landscape. The question of the episode is from a listener seeking advice for an overly zealous shopping compulsion. (Don't worry! We don't give financial advice on this podcast and aren't about to start now!) The deck of the week is the Phases and Forests Oracle deck by Katharine Ryalls. Also note that you can follow Katherine's project on Kickstarter for their upcoming mini edition of the Phases and Forests Oracle! You can support Kerri by signing up for the newsletter on her website and check out her current Kickstarter campaign for the Enchanted Divination Journals! On instagram, you can also follow her shop and her personal design page. Follow Ettie on Instagram and buy a personal reading from them in the Wildly Tarot Shop, and for bonus content support the podcast on Patreon!

Dave Bell, Founder of Dave's Auto Center, joins us to share his real journey from growing up in poverty to starting a successful shop and building a loyal social media following. He walks us through how he made the leap from being an operator in the business to becoming a true owner, why mentorship matters so much to him, and the one quality that separates great technicians from the rest.Check out the full video version of the podcast on YouTube!About the EpisodeHost: Jay Goninen, WrenchWay, jayg@wrenchway.comGuest: Dave Bell, Dave's Auto Center, davescompleteauto@gmail.comSponsor: ASE - Automotive Service ExcellenceLinks & ResourcesGet notified of new episodes --> Join our email listAbout WrenchWay:For Technicians & Students: wrenchway.com/solutions/technicians/For Shops & Dealerships: wrenchway.com/solutions/shops/For Instructors: wrenchway.com/solutions/schools/Connect with us on social: Facebook Instagram X LinkedIn YouTube TikTok

If the next great war is fought in space, Even Rogers wants the U.S. to be ready. On this episode of Valley of Depth, the True Anomaly CEO and former Air Force weapons officer joins us to break down how he's building autonomous systems for space superiority and why space is the next warfighting domain. A graduate of the Air Force Weapons School, Even brings rare tactical and strategic insight into how the U.S. must fight and win in orbit. In this episode, we unpack the doctrine, technology, and strategy shaping the next phase of military competition in space. We cover: Why 2007 was the turning point for space as a warfighting domainHow to think about offense, deterrence, and domain control in orbitWhat the Space Force needs—and why $60B is the real numberThe role of private industry vs. the primes in defense innovationGolden Dome, missile defense, and the future of space-based interceptors…plus how we may one day have Guardians stationed permanently in space.Check out Valley of Depth #007 on YouTube, Apple, or Spotify. • Chapters •00:00 - Intro00:57 - Payload Pro01:39 - True Anomaly's mission02:51 - How Even started the company04:02 - $220m Series C05:48 - When did space become a place to defend?09:20 - The challenge to US space dominance11:16 - What made Even realize that the US was unprepared?16:05 - What does space superiority look like?17:49 - What does space warfare actually mean?21:48 - The R&D the Space Force needs24:01 - What it meant to form the Space Force27:11 - The cultural shift on the Space Force30:49 - Current US Space capabilities and gaps32:44 - Why was the Space Force budget cut despite its importance?35:06 - Primes and the US's space capabilities37:12 - Procurement for the space domain41:29 - Space components of the Golden Dome43:35 - Phases of a ballistic missile44:56 - Intercepting missiles at its boost phase46:15 - What to prioritize today for space superiority49:20 - Guardians in space51:20 - Moon & Mars52:40 - Lessons learned for the next True Anomaly mission56:01 - What is the strategic impact True Anomaly is hoping to have?57:31 - Will NASA blur the lines between civil and military? • Show notes •True Anomaly's socials — https://x.com/the_trueanomalyEven's socials — https://x.com/jollyrogerstaTrue Anomaly's website — https://www.trueanomaly.space/Mo's socials — https://twitter.com/itsmoislamPayload's socials — https://twitter.com/payloadspace / https://www.linkedin.com/company/payloadspaceIgnition's socials — https://twitter.com/ignitionnuclear /  https://www.linkedin.com/company/ignition-nuclear/Tectonic's socials  — https://twitter.com/tectonicdefense / https://www.linkedin.com/company/tectonicdefense/Valley of Depth archive — Listen: https://pod.payloadspace.com/ • About us •Valley of Depth is a podcast about the technologies that matter — and the people building them. Brought to you by Arkaea Media, the team behind Payload (space), Ignition (nuclear energy), and Tectonic (defense tech), this show goes beyond headlines and hype. We talk to founders, investors, government officials, and military leaders shaping the future of national security and deep tech. From breakthrough science to strategic policy, we dive into the high-stakes decisions behind the world's hardest technologies.Payload: www.payloadspace.comIgnition: www.ignition-news.comTectonic: www.tectonicdefense.com

In this episode, join us for PART 1 of our interview with a certified hypnotherapist, Lynnsey Robinson, to talk all things hypnotherapy, manifestation, and how to actually shift your mindset to start living the life you want. We dive into what hypnotherapy really is, how your subconscious might be sabotaging your goals, and what it means to live in alignment. Plus, we unpack the difference between manifesting with intention vs. just being slightly delulu. If you've ever repeated affirmations in the mirror while crying or tried to “act as if” but ended up just acting confused — this one's for you.---Follow Lynnsey RobinsonBook with Lynnsey---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok Shop---Lynnsey's Captivation: Rewatching TV shows like: Heros, How I Met Your Mother, Lost with her kidsEmily's Captivation: Mission ImpossibleHannah's Captivation: NonnasShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

In today's episode, we are delving deep into the manifestation process, but not the kind where you simply think positively and hope for the best. I am talking about a sacred, grounding, 5-phase journey that aligns your energy, your healing, your expansion, and ultimately your reality.The process we are unpacking today includes these 5 phases:1. Ask and Align2. Heal3. Expand4. Integration - The Sacred Pause5. Receive - where the Universe mirrors the inner work you have done externallyWhy is this so important? If you understand the process and which phase your in you can support yourself better. You can reach for the things, tools, resources that will help you through each phase with more ease and grace. Also SO many people get manifestation wrong, I want to clear up the process so more people understand how it actually works when you are in co-creation with the Universe. Connect with me on the Socials:Instagram: @Pam_RoccaTik Tok: @Pam_RoccaWebsite: www.pamrocca.comWork with me:Channeling Session:https://calendly.com/divinehealth/60-minute-intuitive-channeling-sessionIntuitive Oracle Reading: https://calendly.com/divinehealth/60-minute-intuitive-oracle-card-readingIntuitive Reiki SessionIn-person:https://calendly.com/divinehealth/in-person-intuitive-reiki-healing-session-60-minsEnergy Work Sessions - Energy Healing: https://calendly.com/divinehealth/energy-healing-sessionIf you enjoyed this episode, please let me know so I can create more of the content you love. Also, please share the podcast with anyone you know who would love this community, these tools, information and free resources. Have the most love-filled week and shine on my friends.

In this episode of The Birth Lounge podcast, HeHe shares untraditional aspects to consider when creating your birth plan, or birth preference sheet, as HeHe likes to call it. This episode emphasizes the importance of understanding the phases of labor, choosing the right people in your birth space, considering all available tools and medications, and planning for postpartum care. HeHe also shares insights on maintaining flexibility and making informed decisions during labor. Tune in to learn how to create a thoughtful and comprehensive birth preference sheet that prioritizes your autonomy and informed consent. 00:00 Introduction: The Rush to Labor 00:24 Untraditional Birth Plan Considerations 01:47 The Importance of Birth Preferences 03:44 Understanding the Phases of Labor 04:45 Early Labor: Managing Time and Anxiety 09:09 Free Class: Avoiding C-Sections and Reducing Tearing 11:06 Choosing Your Birth Team 17:46 Preparing Your Partner with Dad Daze 21:33 Pain Relief Options in Labor 28:31 Medical and Non-Medical Tools for Labor 31:39 Postpartum Planning and Preferences 36:07 Conclusion: Empowering Your Birth Experience INSTAGRAM: Connect with HeHe on IG  Connect with HeHe on YouTube BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: Get HeHe's free class on how to avoid a c-section here: https://www.thebirthlounge.com/csection https://www.thebirthlounge.com/daddaze https://www.justtheinserts.com/  

Commanders OTA's Phase 3 has begun, which brought up the question, "What exactly happens during the first 2 phases?" ... Logan and Craig breakdown what happens during the first 2 phases, why it's constructed that way, and why the media only begins to get access during phase 3 To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

This week, we're diving headfirst into the pop culture pool—no life jackets necessary. We break down the buzzy new movie Sinners, give a (slightly unhinged) deep dive into why Emily's takes on cinematography deserve an Oscar, and celebrate a historic moment: Hannah has finally watched The White Lotus. From prestige TV to big-screen aesthetics, one thing becomes clear—Emily's opinions are the gold standard. Sorry, we don't make the rules... Emily just enforces them.---Stream Hannah's album, PHASES!Watch Emily's Short Film, All We Were!Emily's TikTok Shop---Emily's Captivation: SinnersHannah's Captivation: That Ain't No Man That's The Devil by Jessie MurphShop CLEARSTEM and 15% off with the code GALSGUIDE at checkout---Welcome to The Gal's Guide — a weekly dating and lifestyle podcast created to empower radical self-love and bold relationships. Join us, long-distance best friends Hannah Adams and Emily Aleece Burton, for amusing and vulnerable conversations with insightful guests as we cover topics like love and dating to your own self-love, healing, spirituality, and always remembering the importance of gal pals. Want to request a topic or work with us? Send us an email at hello@thegalsguidepod.com or visit us on our website at thegalsguidepod.com---FOLLOW US!Instagram: @thegalsguidepodSecret Facebook Group: The Gal ScoutsEmily: @emilyaleeceHannah: @hannahadamsmillerAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Feeling stuck in your online business, like you're almost at that breakthrough but not quite there? Or perhaps you're eager to finally step off the sidelines and into the game of entrepreneurship? This is an important episode, as we dive into the two most challenging phases of online business that trip up countless entrepreneurs.  In this episode, you'll discover how to pinpoint exactly where you are on this journey right now. More importantly, we reveal how you can overcome these challenging phases quickly, as you confidently claim your title as the Digital CEO you're destined to be!  We just released the replays of my free 3-day training for digital course creators, called Your First Digital Product, which was the largest free masterclass that we've ever hosted! For a limited time only, you can get the replay at www.jameswedmore.com/fdp, but hurry as it's only available until May 28th.  Save the date, because May 29th we kick off our live virtual extravaganza that happens just once a year, our 3-part live week-long training experience, The Rise of the Digital CEO. You register and get on the waitlist NOW at www.businessbydesign.net/!  Before you go, snap a screenshot of the episode playing on your device, post it to your Instagram Stories and tag us, @jameswedmore and @jeunejenni. In this episode you'll hear:  A look at Phase One, “The Sidelines", where too many get stuck and how you'll know when you're really in business  A powerful example of a BBD student and the way she got in the game and is crushing it  What is really preventing people from stepping out onto the field of business and doing the work  Phase Two and what you need to understand about offer alignment in this phase  Our thoughts on the two key parts of the beta phase: testing and running it   What separates those who succeed in the long run from those who don't My candid message about what has me so excited about the global online education market and our upcoming live training experience, The Rise of The Digital CEO  For full show notes and links, visit: www.mindyourbusinesspodcast.com/blog/763 

In this solo episode, Light Watkins breaks down the real reason most people struggle with change—it's not a lack of motivation or discipline. It's the lies we keep telling ourselves without realizing it.Drawing from over two decades of personal practice and coaching thousands of people through lasting transformation, Light outlines the five distinct phases that every meaningful change journey goes through. More importantly, he reveals the hidden trap that keeps you stuck in each phase—sometimes for years.This isn't about blowing up your life or waiting for a crisis to force change. It's about waking up to the quiet moment when you realize you're tired of your own BS. That's when the real work begins.You'll learn why your big plans often collapse after a week, how the “busy” excuse is just fear in disguise, and why real transformation requires putting something on the line—your money, your time, your reputation. Light also explains the crucial mindset shift that turns change from a short-term goal into a new way of life.Whether you're stuck in a loop of starting over or just feeling called to level up in a sustainable way, this episode offers a grounded, step-by-step map for getting unstuck and moving forward. It's not about changing everything overnight—it's about choosing the next right action and building momentum one honest choice at a time.Tune in for relatable stories, hard-earned wisdom, and a powerful framework to help you finally become the person you know you're meant to be.Send us a text message. We'd love to hear from you!