Podcasts about physiologic

Welcome back to the Flex Diet Podcast. I'm your host, Dr. Mike T. Nelson. In this episode, I'm excited to announce that the Physiologic Flexibility Certification will be open from March 17th to March 24th, 2025.I'll also be heading to Parker University Talks in Las Vegas, where I'll be speaking alongside some incredible experts in the field.Today, we're diving deep into Physiologic Flexibility—the key to upgrading your performance by targeting homeostatic regulators like temperature, pH balance, expanded fuel sources, and oxygen/CO₂ regulation. These elements are critical for adapting to stress and pushing your resilience to the next level.I'll discuss practical applications for exercise, nutrition, and sleep and how to strategically apply stress to become more antifragile. Whether you're into high-tech solutions or prefer simple, low-tech methods, this episode has actionable insights to help you maximize your recovery and performance.Tecton Life Ketone drink! https://tectonlife.com/ DRMIKE to save 20%LMNT electrolyte drink mix: miketnelsonlmnt.comPhysiologic Flexibility Certification Course open Monday, March 17 to Monday, March 24: https://miketnelsons.samcart.com/products/physflex/Triphasic 2 book now available!Go to https://triphasic2.com/Episode Chapters:00:18 Physiologic Flexibility Certification Announcement00:43 Upcoming Events and Speakers01:57 Key Concepts of Physiologic Flexibility05:46 Understanding Antifragility10:52 Practical Applications and Interventions16:08 Conclusion and Contact InformationGet In Touch with Dr Mike:Instagram: https://www.instagram.com/drmiketnelson/YouTube: https://www.youtube.com/channel/UCn1aTbQqHglfNrENPm0GTpgEmail: https://miketnelson.com/contact-us/

The Snowflake FairyRobed in white comes Snowflake Fairy,braving wintry winds and ice,pearly "Maid of February,"whom the glistening frosts entice.Gladly welcome Snowflake Fairy,on your terrace give her room.She alone in Februarybraves the cold to shed her bloom.—Elizabeth GordonMusic by James Milor from PixabayInformation provided by:Flowers and Their Meanings: The Secret Language and History of Over 600 Blooms by Karen Azoulay (2023)https://www.bloomandwild.com/the-blog/snowdrop-flowers-meaninghttps://www.chicagobotanic.org/plantinfo/plant_profiles/snowdropsPlants That Kill: A Natural History of the World's Most Poisonous Plants by Elizabeth A. Dauncey and Sonny Larson (2018)Galanthus trojanus: a new species of Galanthus (Amaryllidaceae) from north-western Turkey by Aaron P. Davis and Neriman Ozhatay (2001). Botanical Journal of the Linnean Society, 137, pg. 409-412. DOI: 10.1006/boj1.2001.048.Peterson Field Guide to Medicinal Plants and Herbs of Eastern and Central North America (3rd ed.) by Steven Foster and James A. Duke (2014)https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:77118772-1/general-informationGalantamine for Alzheimer's disease and mild cognitive impairment by Clement Loy and Lon Schneider (2006). Cochrane Database of Systematic Reviews, 1. https://doi.org/10.1002/14651858.CD001747.pub3https://plants.ces.ncsu.edu/plants/galanthus-nivalis/Homer's Moly identified as Galanthus nivalis L.: Physiologic antidote to stramonium poisoning by Andreas Plaitakis and Roger C. Duvoisin (1983). Clinical Neuropharmacology, 6(1), pg. 1-6. [Abstract]. Collins Gem: Wild Flowers by Martin Walter (2002)https://en.m.wikipedia.org/wiki/Galanthushttps://www.woodlandtrust.org.uk/trees-woods-and-wildlife/plants/wild-flowers/snowdrop/

Welcome to the Mind Muscle Connection Podcast!In this episode, we're thrilled to welcome back Dr. Mike T. Nelson for his third visit to discuss how to support cognitive function, physiological flexibility, and more!We dive into practical steps you can take to enhance your daily movement, break free from sedentary habits, and integrate more physical activity into your life—leading to significant improvements in both body composition and mental clarity. Plus, Dr. Mike shares valuable tips on supporting cognitive function, the importance of recovery, and the concept of metabolic versus physiological flexibility.This episode is packed with actionable advice, so be sure to tune in!Let's talk about:IntroductionUpdate on Dr. Mike T. NelsonWalking and daily movementExercise energy expenditureCognitive functionPhysiologic flexibility vs. Metabolic flexibilityBody temperatureWhere to find Dr. MikeDr. Mike's Newslettter: HEREFollow me on Instagram for more information and education:  @jeffhoehn_FREE 30 Min Strategy Call: HEREBody Recomp Masterclass: HERENutrition Periodization Masterclass: HEREHow You Can Work With Me?: HERECoaching application: HERE

Die Menstruation ist nicht nur ein körperlicher Prozess – sie verändert auch das Gehirn. In dieser Folge erklärt Bent Freiwald, was dazu bekannt ist und warum wir bislang viel zu wenig darüber wissen. Hier geht's zum gleichnamigen Newsletter: Das Leben des BrainLinks zu Quellen und verwendeten Studien:1. Lifetime cumulative number of menstrual cycles and serum sex hormone levels in postmenopausal women2. The weird, bad history of tampon testing3. The Normal Menstrual Cycle and the Control of Ovulation4. The science of menstruation in 10 minutes5. Circadian rhythm of testosterone level in plasma. I. Physiologic 24-hour oscillations of the testosterone level in plasma6. Diurnal fluctuations in steroid hormones tied to variation in intrinsic functional connectivity in a densely sampled male7. Gonadal steroids regulate dendritic spine density in hippocampal pyramidal cells in adulthood8. Progesterone shapes medial temporal lobe volume across the human menstrual cycle9. Ultra-high-field 7T MRI reveals changes in human medial temporal lobe volume in female adults during menstrual cycle10. Menstrual cycle-driven hormone concentrations co-fluctuate with white and gray matter architecture changes across the whole brain Hosted on Acast. See acast.com/privacy for more information.

In this podcast, Dr. Valentin Fuster discusses a study on the long-term outcomes of two surgical approaches—anatomic and physiologic repair—for congenitally corrected transposition of the great arteries. The findings suggest that while the complex anatomic repair offers better survival and reintervention-free outcomes, patient selection is crucial, with careful consideration needed, especially for asymptomatic infants or those with preoperative pulmonary artery banding.

Send us a textAnnouncement: Between now and year-end, we will be releasing a 50/50 mixture of new episodes interspersed with old-favorites, due to the sudden loss of Cynthia's husband in November. We have a new episode coming next week, and will be back to our usual production schedule by New Year's. If you'd like to donate a gift to the GoFundMe that was set up for Cynthia and her family, you may do so here. Thank you to everyone for your beautiful messages, gifts and prayers.Please keep an eye out for new content and an expanded Down to Birth platform on Patreon, including a new Community feature where listeners can post questions for us and each other. To join and gain instant access to our entire library of video content, go to our Patreon and sign up.Onto the show:In this episode, we have Barbara Harper on the podcast with us. Barbara is a midwife, author, and the founder of WaterBirth International, which she founded exactly 40 years ago. She is a world-expert in birthing and to this day travels the globe educating obstetricians, nurses and midwives on physiologic birth.Few mothers are given the opportunity to birth their placentas in the water, but is it really necessary to move women post-birth into a bed to complete the third stage (placental birth) of labor?  In order to explain whether this is the right choice for any mother and baby, Barbara walks us through the most common causes of postpartum hemorrhage, how to prevent it, and the critical understanding of newborn transitional physiology: what she says is literally the most important moment in any human being's life.Is fundal massage necessary? When is the optimal time to cut the cord? What is the case for keeping the cord attached until the placenta is fully birthed? Is manual extraction of the placenta ever justified? These are some of the questions we answer in today's episode with Barbara.Barbara HarperWaterbirth International#100 | The Benefits of Water Birth: Interview With Barbara Harper of Waterbirth International#122 | Provider Green Lights: Interview with Barbara Harper on Holistic, Respectful & Supportive Birth Providers**********Our sponsors:Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort.Needed -- Our favorite nutritional products for before, during, and after pregnancy.Use promo code: DOWNTOBIRTH for all sponsors.Support Cynthia's family here: https://www.gofundme.com/f/support-cynthia-overgards-family-after-tragic-loss Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

In this episode of Happy Hour with Bundle Birth Nurses, Sarah Lavonne dives into the journey behind the creation of the Physiologic Birth Class. From working in a highly medicalized L&D unit to later experiencing a contrasting approach in a more affluent hospital, Sarah's nursing career shaped her vision for promoting physiologic birth. Driven by a desire to empower nurses, she designed this class to equip them with the knowledge and hands-on skills essential for supporting physiologic labor and birth. Thousands of nurses have since been trained and seen the impact on their practice while enhancing birth outcomes, decreasing cesarean rates, reducing trauma, and reshaping the culture of obstetric care. Sarah underscores the power of a nurse's deep understanding of birth physiology to provide truly patient-centered care. Helpful Links:Sign up for our most popular Physiologic Birth ClassMotion takes all the concepts taught in class and practically applies them to your practiceWe train hospitals! Drop your manager's info hereSign up for our monthly newsletter for news & free educationCheck out our physical products that you can use to apply to your physiologic birth practice

On this episode of Marni on The Move' series, Road To The Race: NYC Marathon 2024, Hosts Marnii Salup and Dave Mendelsohn Chat with Physiologist, Sydney Brackett of NYC Performance Lab in NYC. Syncing up about key physiologic tests you can do to level up your performance and dial up your fitness VO2 Max, Lactate Threshold, BMR and 3D Body Composition Analysis and more. Chapters 0:00 Intro 3:13 Understanding V02 Max Testing 6:05 The Imp Of Regular Testing For Athletes 8:53 Comprehensive Testing Service at NYC Performance Lab 11:49 The Role of Grip Strength in Longevity 15:08 Movement Analysis and Injury Prevention 18:02 Lactate Threshold Testing Explained 21:01 The Benefits of Data Driven Training 23:49 Recommended Tests For Athletes 26:57 Conclusion and Final Thoughts

Join me, Dr. Mike T. Nelson, on this episode of the Flex Diet Podcast as I introduce the Physiologic Flexibility Certification, a comprehensive course designed to enhance recovery and resilience. I summarize the 4 pillars of the course: temperature regulation, pH balance, energy sources and breathing. I also discuss the importance of integrating these systems to improve performance and resilience and address common misconceptions. The course is available from October 14th to October 21st, 2024. Tune in for insights into advanced aspects of nutrition, exercise, and recovery and how these can be applied to improve stress management and overall health.Sponsors:Tecton Life Ketone drink! https://tectonlife.com/ DRMIKE to save 20%Dr. Mike's Fitness Insider Newsletter: Sign up for free at https://miketnelson.com/.Episode Chapters:00:23 Physiologic Flexibility Certification Announcement01:08 Course Design and Overlapping Systems03:54 Four Pillars of Physiologic Flexibility05:18 Importance of Systems in Physiology08:20 Practical Applications and Examples13:09 Course Details and ConclusionGet In Touch:Instagram: https://www.instagram.com/drmiketnelson/YouTube: https://www.youtube.com/channel/UCn1aTbQqHglfNrENPm0GTpgEmail: https://miketnelson.com/contact-us/

In my experience hospital staff tend to be more supporting of a natural, hands off birth in the first stage of labor. They may still push for pitocin or cervical checks, but they still tend to leave you to labor on your own. And all that changes once a mom hits transition or starts to feel pushy, then even the most hans off birth may turn intervention heavy. You'll learn: What it means to support physiology and how walking into the hospital disrupts natural labor. The stages of labor and the difference between interventions from beginning to end. The three things you must know to support physiology at any stage or birth. ---- Join the unmedicated girlies and get informed with Unmedicated Academy

Let's get informed on postpartum hemorrhage, so you can make the best decision in the third stage of your birth. Bleeding is a completely normal part of the birth process, but how much is too much?? Hospital providers are terrified of PPH and are treating every single woman preventatively, even when she just had a physiologic birth and there is no reason to assume this stage of birth needs help as well. In this episode I discuss: The current definition of PPH versus the older definition that labels a normal amount of blood loss as concerning. How PPH is assessed and what can cause a hemorrhage in postpartum. If you birth in the hospital, you will have PPH actively managed. Know the difference between active vs expectant management. All of your options and how to avoid PPH ---- Start the 5 Day Empowerment Challenge Get informed on all the stages of hospital birth (and how to support physiology instead) inside Unmedicated Academy

This fascinating interview is with Dr. Eva Selhub who worked at Harvard with Herb Benson developing and understanding about the mind body connection to health. Dr. Selhub is an internationally recognized resiliency expert who has worked as a physician, author, executive coach, keynote speaker, and spiritual advisor. She has written many books, including Burnout for Dummies, Resilience for Dummies, Your Health Destiny, The Stress Management Handbook, The Love Response, and co-authored Your Brain on Nature. Life is filled with opportunities to practice new techniques for resilience, and many in the medical field have had ample chances to refine their skills in this area from personal challenges. This lived experience with investigations into problem-focused solutions is then commonly shared through science-based pursuits and practices. These mixed techniques increase what we know as personal or societal health through medicine. We all benefit from a more mentally and physically flourishing self and society. Dr. Eva Selhub, M.D. has fostered this idea throughout her career, culminating in a resilience strategy for modern times. Learn more about your ad choices. Visit megaphone.fm/adchoices

Rémi Coudroy, PhD, joins journal CHEST Podcast Moderator Alice Gallo De Moraes, MD, to discuss the results of a study into the physiologic effects of reconnection to the ventilator for 1 hour following a successful spontaneous breathing trial.

How is each release of the TAR contributing to the final tension on the anterior and posterior fascia? Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan C. Ellis as they discuss their group's recent cohort study of tensiometry in 100 TARs.  Hosts:  - Michael Rosen, Cleveland Clinic - Benjamin T. Miller, Cleveland Clinic - Sara Maskal, Cleveland Clinic - Ryan C. Ellis, Cleveland Clinic, @ryanellismd Learning objectives:  - Review the steps of a TAR - Understand the changes in tension on the anterior and posterior fascia with each step of the TAR - Think about the application this data has to similar operations References:  Miller BT, Ellis RC, Petro CC, Krpata DM, Prabhu AS, Beffa LRA, Huang LC, Tu C, Rosen MJ. Quantitative Tension on the Abdominal Wall in Posterior Components Separation With Transversus Abdominis Release. JAMA Surg. 2023 Dec 1;158(12):1321-1326. doi: 10.1001/jamasurg.2023.4847. PMID: 37792324; PMCID: PMC10551814. https://pubmed.ncbi.nlm.nih.gov/37792324/ Miller BT, Ellis RC, Walsh RM, Joyce D, Simon R, Almassi N, Lee B, DeBernardo R, Steele S, Haywood S, Beffa L, Tu C, Rosen MJ. Physiologic tension of the abdominal wall. Surg Endosc. 2023 Dec;37(12):9347-9350. doi: 10.1007/s00464-023-10346-w. Epub 2023 Aug 28. PMID: 37640951. https://pubmed.ncbi.nlm.nih.gov/37640951/ Ramirez OM, Ruas E, Dellon AL. "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990 Sep;86(3):519-26. doi: 10.1097/00006534-199009000-00023. PMID: 2143588. https://pubmed.ncbi.nlm.nih.gov/2143588/ Hope WW, Williams ZF, Rawles JW 3rd, Hooks WB 3rd, Clancy TV, Eckhauser FE. Rationale and Technique for Measuring Abdominal Wall Tension in Hernia Repair. Am Surg. 2018 Sep 1;84(9):1446-1449. PMID: 30268173. https://pubmed.ncbi.nlm.nih.gov/30268173/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

The best way to avoid unnecessary interventions in labor is to optimize the conditions for physiologic birth to progress. How do we do that? In this episode, we are covering the 5 key practices that have been proven by research to support your body's natural blueprint for birth and reduce the risk of unnecessary interventions.Don't forget to check out the blog postResources mentioned:>>  Clear Your Birth Fears Guide>>  A Path to A Powerful Birth Class>>  FREE Birth Plan Template***If these topics light you up, please rate and review the show on Apple Podcasts, Spotify, or wherever you're listening.After you review the show - snap a pic and upload it here - and I'll send you a little surprise as a thank you.Your feedback helps this podcast grow, and I am so grateful for your support!Disclaimer: The information provided in this podcast is for educational and informational purposes only. Consult with a qualified healthcare professional for personalized advice.

Ever wonder how to make your body bounce back and strengthen? That's where the power of physiologic flexibility comes in. Diving headfirst into the Physiologic Flexibility Certification, you'll get a front-row seat to the intricate ballet of CO2 and oxygen in your body and learn why context is, without a doubt, the ruler of fitness protocols, along with the other key markers of physiologic flexibility I cover in the certification.Enrollment opens today, March 18, 20204 and closes at midnight, March 25, 2024: https://miket.me/PFC-podSponsors:Enroll in the Physiological Flexibility Certification March 18 - March 25: https://miket.me/PFC-podSee discounts for all the products I use and recommend: https://miketnelson.com/faves/Get a Free Sample Pack of all LMNT Flavours with your first box at  http://drinklmnt.com/mikenelson (automatically applied at checkout)Friends of Mike, create an account and get 25% off your first order of Tecton: https://blog.tectonlife.com/ambassador/dr-mike-t-nelson/Episode Chapters:(0:00:00) - Physiologic Flexibility Certification and Core Concepts(0:15:36) - Physiologic Flexibility Certification OverviewGet In Touch:Instagram: https://www.instagram.com/drmiketnelson/YouTube: https://www.youtube.com/channel/UCn1aTbQqHglfNrENPm0GTpgEmail: https://miketnelson.com/contact-us/ 

Join me, Dr. Mike T Nelson, as I embark on a journey through the heart of one of the most extreme environments on Earth with the awe-inspiring Akshay Nanavati, who's gearing up for a solo ski crossing of Antarctica. Together with performance nutrition experts Mike Chesney and UJ from Tecton, we unravel the intricate tapestry of mental and physical preparation required for such an endeavor. Akshay shares his riveting story of overcoming PTSD and transforming into an ultra-runner and explorer, all while we dissect the importance of ketones in fueling such monumental feats of endurance.Episode Chapters:(0:00:01) - Expedition Preparation With Ketones(0:11:16) - Antarctica Expedition and Key Tones(0:19:26) - Preparing for Solo Antarctica Expedition(0:27:58) - Benefits of Ketones for Endurance Expeditions(0:41:00) - Navigating the Pain Cave(0:52:34) - Monitoring and Improving Performance in Endurance(1:01:35) - Importance of Sleep and Expedition PreparationSponsors:See discounts for all the products I use and recommend: https://miketnelson.com/faves/Get a Free Sample Pack of all LMNT Flavours with your first box at  http://drinklmnt.com/mikenelson (automatically applied at checkout)Friends of Mike, create an account and get 25% off your first order of Tecton: https://blog.tectonlife.com/ambassador/dr-mike-t-nelson/Phys Flex Cert opens March 18: http://www.physiologicflexibility.comAkshay:  https://bliss.fearvana.com/greatsoulcrossing?r_done=1Episodes You Might Enjoy:Episode 167: The Physiologic and Psychologic Benefit of Doing Hard Things: Akshay Nanavati of Fearvana with Dr Mike T Nelson: https://miketnelson.com/the-physiologic-and-psychologic-benefit-of-doing-hard-things-akshay-nanvati-of-fearvana/Episode 226: A Deep Dive into Ketones, Astaxanthin, and Cognitive Enhancement with Dr. Hunter Waldman: https://miketnelson.com/deep-dive-into-ketones-astaxanthin-and-cognitive-enhancement-dr-hunter-waldman/Flex Diet Podcast: Dr. Dom D'Agostino on Red Light, Ketones, Fasting, Zapping Monkeys and More: https://miketnelson.com/dr-dom-dagostino-on-red-light-ketones-and-more/Get In Touch:Instagram: https://www.instagram.com/drmiketnelson/YouTube: https://www.youtube.com/channel/UCn1aTbQqHglfNrENPm0GTpgEmail: https://miketnelson.com/contact-us/ 

In today's episode, Cynthia and Trisha break down some of the current guidelines published by ACOG (the American College of Obstetricians & Gynecologists). You'll see many of these guidelines favor physiological birth and stand for minimal medical intervention in exactly the ways we recommend, which makes it  all the more perplexing why so many of today's obstetricians don't follow along. By understanding ACOG's position on common concerns in pregnancy and birth, you can feel more empowered to advocate for what you know is best for you and your baby.  Did you know that ACOG clearly and strongly states that the use of medical coercion is harmful and should never be practiced or that delivery of a baby is not warranted for suspected fetal macrosomia (big baby)? Or that ACOG knows that routine amniotomy (breaking the bag of water) is not necessary and suggests its use does not improve outcomes? Furthermore, ACOG states that ultrasound performed in late pregnancy is associated with an increase in cesarean section, with no evidence of neonatal benefit (yet how many OBs recommend third-trimester ultrasound)? Tune in to hear what this revered medical authority has to say, and stand tall in defense of your physiological birth plan. You'll see ACOG is on your side more than you might have believed, particularly in light of how today's American obstetricians tend to practice.**********Down to Birth is sponsored by:Needed -- Optimal nutritional products to nourish yourself before, during, and after pregnancyDrinkLMNT -- Purchase LMNT with this link today and receive a free sample kit.Silverette Nursing Cups -- Soothe and heal sore nipples with 925 silver nursing cups.Postpartum Soothe -- Herbs and padsicles to heal and comfort. Connect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Hosts:Pradip Kamat, Children's Healthcare of Atlanta/Emory University School of MedicineRahul Damania, Cleveland Clinic Children's HospitalCase Introduction:6-year-old patient admitted to PICU with severe pneumonia complicated by pediatric Acute Respiratory Distress Syndrome (pARDS).Presented with respiratory distress, hypoxemia, and significant respiratory acidosis.Required intubation and mechanical ventilation.Despite initial interventions, condition remained precarious with persistent hypercapnia.Physiology Concept: Dead SpaceDefined as the volume of air that does not participate in gas exchange.Consists of anatomic dead space (large airways) and physiologic dead space (alveoli).Physiologic dead space reflects ventilation-perfusion mismatch.Pathological Dead Space:Occurs due to conditions disrupting pulmonary blood flow or ventilation.Common in conditions like pulmonary embolism, severe pneumonia, or ARDS.Clinical Implications:Increased dead space fraction (DSF) in PARDS is a prognostic factor linked to severity and mortality.Elevated DSF indicates worse lung injury and inefficient gas exchange.DSF can be calculated using the formula: DSF = (PaCO2 – PetCO2) / PaCO2.Practical Management:Optimize Mechanical VentilationEnhance PerfusionConsider Positioning (e.g., prone positioning)Summary of Physiology Concepts:Bohr equation for physiologic dead space.Importance of lung-protective ventilation strategies.Monitoring and trending dead space fraction.Strategies to improve airway patency and mucociliary clearance.Connect with us!PICU Doc on Call provides concise explanations of critical concepts in pediatric intensive care.Feedback, subscriptions, and reviews are encouraged.Visit picudoconcall.org for episodes and Doc on Call infographics.

Many unmedicated birth moms report having orgasmic birth, but not all moms share the same sentiment. Physiologic birth can be both painful AND orgasmic but there are several reasons why you may have had an unmedicated birth without that orgasm at the end. In this episode I discuss: -How the definition of natural birth has become a lie -The differences and similarities between natural, physiologic, undisturbed, and unmedicated birth -What an orgasmic birth feels like -How orgasms and birth are similar -What to do to support and encourage an orgasmic birth Enter the Season 3 Giveaway and win a box of Frownies 1. Leave a rating and review of the podcast OR share about the podcast on social media and tag me @unapolgoeticallyunmedicated 2. Follow @Frownies, @UnapolgoeticallyUnmedicated on IG 3. Comment on the giveaway post your thoughts on the episode 4. Tag friends in separate comments for extra entries Want to order Frownies? use the code LIZZIE for a discount Next steps... Have questions? Birth Options Workshop: Get clarity on your next step, whether that is choosing a provider, deciding on a birth place or where to start with birth education. RSVP now. Ready to start your birth prep? Birth Prep Class: This 30 minute class will teach you what you can do now to help prepare your mind and body for an unmedicated birth. It's FREE ️ Want to work with me? Unmedicated Academy: The signature program for moms who want to be the boss of their unmedicated birth and be educated, informed and empowered. We will chat each week and you'll be blown away by how much support is inside. Join the empowered mom club Submit a question or testimonial for the show: Leave me a voice message

Women everywhere are talking about the Mrs World Pageant. This is the most attention this pageant has received in years all thanks to Ballerina Farms and her 8 Million followers. But is competing in a pageant at 12 days postpartum really truly empowering? In this episode I discuss: The empowering vs irresponsible debate on glamorizing the early postpartum days. How the homestead community feels deceived by Ballerina Farms and how all Instagram homesteaders are also boss babes. Mom shaming does effect those who are confident and secure in their decisions and know they are doing their best. What is normal? Physiologies normal is different than American's normal. Mentioned on the show: Farm House on Boone - No Knead Bread Farm House on Boone - Birth Video Ballerina Farms - the photo Start the EMPOWERED MOM CHALLENGE, 5 days of episodes and resources for you to take control of your birth now. xo, Lizzie

Additional content and educational resources at ICUedu.org

On July 30, 2023 we released an episode describing the hypertensive “rule of 55” otherwise known as the physiologic approach to hypertension management. The rule of 55 breaks down hypertension into either hyperdynamic/high cardiac output in origin, or systemic vascular resistance in origin. There is plenty of evidence to support this management approach. Late this evening, on November 30, 2023, Obstetrics and Gynecology released a new research letter ahead of print, providing more insights on the physiologic approach to hypertension management. In this episode, we will briefly cover this brand new publication, released just 2 hours ago, and provide clinical application perspectives.

Priya Bhaskar, M.D. is an Associate Professor of Pediatrics at UT Southwestern and an attending in the Cardiac ICU at Children's Medical Center Dallas. She completed her pediatric residency at Inova Children's Hospital in Virginia and critical care fellowship at UTSW prior to completing a 1 year CICU fellowship at Laurie Children's in Chicago. Prior to her current position here at UTSW she was a cardiac intensivist at Arkansas Children's Hospital. Her professional interests include extracorporeal support and education. She serves on the ECMO team as a core staff physician, and she has co-authored a review on this topic that we will use to guide our conversation. Learning Objectives:By the end of this podcast, listeners should be able to discuss:The general indications for VA-ECMO in pediatrics.The anatomic and physiologic rationale supporting various VA-ECMO cannulation strategies.Physiologic targets to ensure adequate oxygen delivery for patients on VA-ECMO.Hemodynamic complications of VA-ECMO such as left atrial hypertension and harlequin syndrome and general strategies in their management. Liberation strategies for VA-ECMO either to decannulation or conversion to ventricular assist device.How to support PedsCrit:Please rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.References:Bhaskar, P., Davila, S., Hoskote, A., & Thiagarajan, R. (2021). Use of ECMO for Cardiogenic Shock in Pediatric Population. Journal of clinical medicine, 10(8), 1573. https://doi.org/10.3390/jcm10081573Brown G, Moynihan KM, Deatrick KB, Hoskote A, Sandhu HS, Aganga D, Deshpande SR, Menon AP, Rozen T, Raman L, Alexander PMA. Extracorporeal Life Support Organization (ELSO): Guidelines for Pediatric Cardiac Failure. ASAIO J. 2021 May 1;67(5):463-475. doi: 10.1097/MAT.0000000000001431. Erratum in: ASAIO J. 2022 Jul 1;68(7):e129. PMID: 33788796.Xie A, Forrest P, Loforte A. Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation. Ann Cardiothorac Surg. 2019 Jan;8(1):9-18. doi: 10.21037/acs.2018.11.07. PMID: 30854308; PMCID: PMC6379183. https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx https://www.congenitalheartacademy.com/home Support the show

Nick and Fei are on their respective parental leaves (not planned, but we're having babies at the same time!)  In the meantime, we hope you enjoy some re-runs of our most loved episodes.  Check out the website for the Rosh Review question of the week.  Twitter: @creogsovercoff1 Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Proshad Efune, MD is an Assistant Professor at UT Southwestern. She completed both her pediatric critical care and pediatric anesthesia fellowships here at UT, and she now practices in both the operating room and the pediatric ICU here at Children's Medical Center in Dallas. She is interested in pre-operative management of critically ill children.Learning Objectives After listening to this episode, learners should be able to:Identify clinical scenarios at high risk for cardiovascular collapse surrounding endotracheal intubation.Discuss a clinical approach to minimize the risk of peri-intubation cardiovascular collapse in the following high-risk scenarios:Severe hypoxemiaSevere metabolic acidosisHypotension/septic shockObstructive lung diseaseHemorrhagic shockCardiac tamponadeHow to support PedsCritPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.To help improve the podcast, please complete our Listener Feedback Survey (< 5 minutes)!Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.Support the showSupport the show

Nick and Fei are on their respective parental leaves (not planned, but we're having babies at the same time!)  In the meantime, we hope you enjoy some re-runs of our most loved episodes.  Check out the website for the Rosh Review question of the week.  Twitter: @creogsovercoff1 Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

ReferencesJC mentioned that the diagnostic accuracy of 24 hour urine collection increases with more collections! Metabolic evaluation of patients with recurrent idiopathic calcium nephrolithiasisWe didn't refer to a particular study on sodium intake and the 24 hour urine but this meta-analysis Comparison of 24‐hour urine and 24‐hour diet recall for estimating dietary sodium intake in populations: A systematic review and meta‐analysis - PMC 24‐hour diet recall underestimated population mean sodium intake.Anna looking up ace i and urinary sodium Effects of ACE inhibition on proximal tubule sodium transport | American Journal of Physiology-Renal PhysiologyThe original FENa paper by Espinel: The FeNa Test: Use in the Differential Diagnosis of Acute Renal Failure | JAMA | JAMA NetworkSchreir's replication and expansion of Espinel's data: Urinary diagnostic indices in acute renal failure: a prospective studyHere's a report from our own JC on the Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury | American Society of NephrologyJC shared his journey regarding FENa and refers to his recent paper Concomitant Identification of Muddy Brown Granular Casts and Low Fractional Excretion of Urinary Sodium in AKIAnd Melanie's accompanying editorial Mind the Cast: FENa versus Microscopy in AKI : Kidney360 (with a great image from Samir Parikh)JC referenced this study from Schrier on FENa with a larger series: Urinary diagnostic indices in acute renal failure: a prospective study​​Nonoliguric Acute Renal Failure Associated with a Low Fractional Excretion of Sodium | Annals of Internal MedicineUrine sodium concentration to predict fluid responsiveness in oliguric ICU patients: a prospective multicenter observational study | Critical Care | Full TextA classic favorite: Acute renal success. The unexpected logic of oliguria in acute renal failure Marathon runners had granular casts in their urine without renal failure. Kidney Injury and Repair Biomarkers in Marathon RunnersCute piece from Rick Sterns on urine electrolytes! Managing electrolyte disorders: order a basic urine metabolic panelThe Urine Anion Gap: Common Misconceptions | American Society of NephrologyThe urine anion gap in context CJASNExcellent review from Halperin on urine chemistries (including some consideration of the TTKG): Use of Urine Electrolytes and Urine Osmolality in the Clinical Diagnosis of Fluid, Electrolytes, and Acid-Base Disorders - Kidney International ReportsRenal tubular acidosis (RTA): Recognize The Ammonium defect and pHorget the urine pH | SpringerLinkOutlineChapter 13- New part: Part 3, Physiologic approach to acid-base and electrolyte disorders - Do you remember the previous two parts? - Renal physiology - Regulation of water and electrolyte balance- Chapter 13: Meaning and application of urine chemistries - Measurement of urinary electrolyte concentrations, osmolality and pH helps diagnose some conditions - There are no fixed normal values - Kidney varies rate of excretion to match intake and endogenous production - Example: urine Na of 125/day can be normal if patient euvolemic on a normal diet, and wildly inappropriate in a patient who is volume depleted. - Urine chemistries are: - Useful - Simple - Widely available - Usually a random sample is adequate - 24-hour samples give additional context - Gives example of urinary potassium, with extra renal loss of K, urine K should be < 25, but if the patient has concurrent volume deficiency and urine output is only 500 mL, then urine K concentration can appropriately be as high as 40 mEq/L - Table 13-1 - Seems incomplete, see my notes on page 406 - What is Gravity ARF?- Sodium Excretion - Kidney varies Na to maintain effective circulating volume (I'd say volume homeostasis) - Urine Na affected by RAAS and ANP - Na concentration can be used to determine volume status - Urine Na < 20 is hypovolemia - Says it is especially helpful in determining the etiology of hyponatremia - Calls out SIADH and volume depletion - Used 40 mEq/L for SIADH - Also useful in AKI - Where differential is pre-renal vs ATN - In addition to urine Na (and FENa) look at urine osmolality - Again uses 40 mEq/l - Mentions FENa and urine osmolality - Urine Na can estimate dietary sodium intake - Suggests doing this during treatment of hypertension to assure dietary compliance - 24 hour urine Na is accurate with diuretics as long as the dose is stable and the drugs are chronic - Diuretics increase Na resorption in other segments of the tubule that are not affected by the diuretic - Points to increased AT2 induced proximal Na resorption and aldosterone induced DCT resoprtion - In HTN shoot for less than 100 mEq/Day - Urine Na useful in stones - Urine uric acid and urine Ca can cause stones and their handling is dependent on sodium - Low sodium diet can mask elevated excretion of these stone forming metabolites - 24-hour Na > 75 and should be enough sodium to avoid this pitfall - Pitfalls - Low urine sodium in bilateral renal artery stenosis or acute GN - High urine sodium with diuretics, aldo deficiency, advanced CKD - Altered water handling can also disrupt this - DI with 10 liters of urine and urine sodium excretion of 100 mEq is 10 mEq/L but in this case there is no volume deficiency - Opposite also important, a lot of water resorption can mask volume deficiency by jacking up the urine sodium - Advises you to use the FENa - THE FENA - < 1% dry - >2-3% ATN - It will fail with chronic effective volume depletion - Heart failure, cirrhosis, and burns - Suggests that tubular function will be preserved in those situations - Also with contrast, rhabdo, pigment nephropathy - Limitations - Dependent on the amount of Na filtered - Goes through the math of a normal person with GFR of 125/min and Na of 150 has filtered sodium of 27,000/day so if they eat 125-250 mEq their FENa will be 600-800 - Urine osm < plasma osm in face of hypernatremia indicates renal water loss due to lack of or resistance to ADH - In ATN urine OSM < 400 - In pre-renal disease it could be over 500 - Specific but not sensitive due to people with CKD who are unable to concentrate urine- Specific gravity - Plasma is 8-10% igher than plasma so specific gravity is 1.008 to 1.010 - Every 30-35 mOsm/L raises urine Osm of 0.001 - so 1.010 is 300-350 mOsm/L H2O - Glucose raises urine specific gravity more than osmolality - Same with contrast - Carbenicillin- pH - Normally varies with systemic acid-base status - PH should fall before 5.3 (usually below 5.0) with systemic metabolic acidosis - Above 5.3 in adults and 5.6 in children indicate RTA - PH goal 6.0-6.5 - Separate individual RTAs through FR of HCO3 at various serum HCO3 levels - Also can monitor urine pH to look for success in treating metabolic alkalosis - Look for pH > 7 - In treatment of uric acid stone disease - Want to shift eq: H + urate – uric acid to the left because urate is more soluble - PH goal 6.0-6.5

In this episode of the Flex Diet Podcast, I discuss physiologic flexibility and the Physiologic Flexibility Certification, which is the Level 2 to the Flex Diet certification. The main focus is on understanding the four pillars of homeostatic regulation in the body: body temperature, blood pH, the fuel system (carbohydrates and fats), and air (oxygen and carbon dioxide).This podcast is brought to you by the Physiologic Flexibility Certification course. In the course, which opens again today, September 18, to Monday, September 25, 2023, I talk about the body's homeostatic regulators and how you can train them. The benefit is enhanced recovery and greater robustness. We cover breathing techniques, CWI, sauna, HIIT, diet, and more.Episode notes:[0:30] The Phys Flex Cert[2:21] 4 Pillars of Homeostatic Regulation[7:55] Metabolic Flexibility[12:37] Temperature Regulation[17:58] pH Regulation[19:47] Air (Oxygen and CO2) Regulation 

The NP is seeing a 35 year-old well woman for a health promotion and physical exam woman. She has not complaints, is a nonsmoker, a light social drinker with 1-2 glasses of wine per month, and exercises about 30 mins 5 days a week. Her BMI is 22 and vital signs are unremarkable with BP= 110/70. Which of the following is an anticipated finding on her funduscopic exam?A. Retinal arteries wider than veinsB. Arteriovenous nickingC. Physiologic cup-to-optic disc ratio of less than 0.5 D. Blurred optic disc margins---YouTube: https://www.youtube.com/watch?v=Vmb7IXP68m4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=33Visit fhea.com to learn more!

August 18, 2023 Ray, Mark, and Scott discuss 3 questions that came into the Urology Coding and Reimbursement Group (see below for link to sign up free):Hello, I still need more clarification on billing CPT 52332 and CPT 52005 if in the description states that retrograde pyelogram was used/performed. Its correct to bill for both codes?Hello, I have a question regarding CPT code 99457 & 99458. I have a provider who is working with Starling pilot and wanted to start billing these codes. Can you please advise what are the guidelines for these codes? Thank you so much!Hello, I have a question regarding urodynamics. I have a new provider selecting code 51729 but when reviewing his documentation I do not see an urethral pressure profile study. What should the documentation include to capture this code? Are there certain values we should be looking for? Urology Documentation, Coding, and Billing CertificationFor Urologists and APPs (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Fellowship - Urology (DCB-FS) For Coders, Billers, and Admins (Click Here for Pricing, More Information, and Registration)Documentation, Coding, and Billing Specialist Certification (DCB-SC)Documentation, Coding, and Billing Master Certification (DCB-MC)Urology Advanced Coding and Reimbursement SeminarClick Here to Register Now  Las Vegas, December 1 & 2, 20238 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayNew Orleans, January 26 & 27, 20248 am - 4:30 pm Friday, 8 am - 3:30 pm SaturdayReserve your spot and save!As a Urology Coding and Reimbursement Podcast listener, you get access to a discount (limited-time offer).Use code: 24UACRS733Get signed up today and get peace of mind knowing you will be prepared for all the upcoming changes.The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com 

Dr. Mike T Nelson is an exercise physiologist, researcher, speaker, author, personal trainer, and coach. In the world of sports optimization, his approach to coaching world-class athletes is innovative and science-driven. Dr. Mike's years of research and coaching experience, paired with an open mind to new ideas, have garnered his clients amazing results. A teacher at heart, he also offers several key training opportunities and certifications to help athletes, coaches, and healthcare professionals to fully understand the physiology that drives meaningful changes. In today's episode, Dr. Mike T Nelson outlines the basics of physiologic flexibility and ways to train our metabolism to become more resilient and anti-fragile. Today on The Lab Report: 3:00 Mike T Nelson is back and so is the Flex Diet certification 7:00 Diet Wars and Keto 9:45 Physiologic flexibility and homeostatic regulators 14:00 Regulating respiration and pH 20:15 Controlling temperature, metabolism, and mental fortitude for resiliency 27:15 Advanced recovery methods and wearable devices 38:15 Volume vs. intensity 40:20 The Fireball Additional Resources: miketnelson.com Physiologic Flexibility Certification Course Subscribe, Rate, & Review The Lab Report Thanks for tuning in to this week's episode of The Lab Report, presented by Genova Diagnostics, with your hosts Michael Chapman and Patti Devers. If you enjoyed this episode, please hit the subscribe button and give us a rating or leave a review. Don't forget to visit our website, like us on Facebook, follow us on Twitter, Instagram, and LinkedIn. Email Patti and Michael with your most interesting and pressing questions on functional medicine: podcast@gdx.net. And, be sure to share your favorite Lab Report episodes with your friends and colleagues on social media to help others learn more about Genova and all things related to functional medicine and specialty lab testing. To find a qualified healthcare provider to connect you with Genova testing, or to access select products directly yourself, visit Genova Connect. Disclaimer: The content and information shared in The Lab Report is for educational purposes only and should not be taken as medical advice. The views and opinions expressed in The Lab Report represent the opinions and views of Michael Chapman and Patti Devers and their guests.  See omnystudio.com/listener for privacy information.

Research shows it can take 5-7 years to balance after having a baby, in this episode Katie, a functional practitioner who specializes in prenatal and postpartum health, shares about nutrient depletion, nervous system changes, digestion changes, hormonal changes, and how this can affect your physical and mental health in postpartum. Grab the free resources & meet the Mom 2 Mom Special speakers: ⁠⁠fiercelizzie.com/podcast/mom2mom⁠⁠ Find Katie on IG ⁠⁠@katengalvin Liked the episode? Share and tag us both! @katengalvin & @unapologeticallyunmedicated And if you have a minute, rate and review the show. Thanks for listening in!

[5:27] The biggest mistake when using temperature interventions[8:35][11:11] Tradeoffs in training[17:20] Training hot or cold first[21:56] How to get started[23:52] When to consider contrast therapy 

Episode 133: Neonatal JaundiceJennifer explained the pathophysiology of neonatal jaundice and how to treat it and described why screening for hyperbilirubinemia is important.    Written by Jennifer Lai, MS3, College of Osteopathic Medicine of the Pacific Western University of Health Sciences. Comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is neonatal jaundice? Jenni: Infant jaundice, also known as hyperbilirubinemia, is when there is a high level of serum bilirubin causing yellow discoloration of the newborn's skin and eyes. Bilirubin is a red-orange byproduct of hemoglobin catabolism that gives yellow pigment to skin and mucosa membranes. Arreaza: When we see jaundice on the eyes, it is actually the conjunctiva color we are seeing. So, the term “scleral icterus” should be changed to “conjunctival icterus,” but you may get corrected by unaware clinicians. Bilirubin actually binds elastin.What's the pathophysiology/ big picture?Jenni: The key problem is the accumulation of high levels of bilirubin in serum and if left untreated, it can bind to tissues and cause toxicity. There are multiple reasons why there might be too much bilirubin in the serum. Excess bilirubin can be due to a benign normal condition, but it can also be due to a pathologic reason. It is important to differentiate between these two because the management and treatment can differ significantly. Arreaza: Highly bilirubin means that it is being either overproduced or under-eliminated. Physiologic jaundice Most of the time, hyperbilirubinemia is benign and physiologic, with yellowing typically occurring between 2-4 days. Normally, there is a period of transition caused by the turnover of the fetal red blood cells and the immaturity of the newborn's liver to efficiently metabolize bilirubin and increased enterohepatic circulation. The most common reason is that the liver isn't mature enough to get rid of the bilirubin in the bloodstream or because the baby's gut is sterile, so it does not have the bacteria to convert the bilirubin to get it out of the body. In general, newborns have a higher level of total serum or plasma bilirubin levels compared to adults for the following reasons: Newborns have more red blood cells (hematocrit between 50-60), and fetal red blood cells have a shorter life span (85 days vs. 120 days) than those of adults. After birth, there is an increased turnover of fetal red blood cells, so there is more bilirubin.Bilirubin clearance (conjugation and excretion) is decreased in newborns, mainly because of a deficiency of the hepatic enzyme UGT.Increase in the enterohepatic circulation of bilirubin as the amount of unconjugated bilirubin increases due to the limited bacterial conversion of conjugated bilirubin to urobilin.Pathologic JaundicePathologic jaundice includes severe neonatal hyperbilirubinemia, extreme neonatal hyperbilirubinemia, and bilirubin-induced neurologic disorders. We determine the severity of the jaundice using the total serum bilirubin (TSB). It is defined as a TSB >25 (severe) and TSB >30 (extreme). Other concerning signs include a TSB over the 95% percentile, a greater than 5mg/dL/day or 0.2mg/dL/hour, or jaundice that lasts for more than 2-3 weeks. Potential pathologic causes include but are not limited to: Increased bilirubin production from increased hemolysis which is when the red blood cells in the baby are being destroyed faster than normal, this can be due to blood group incompatibilities where the mom's immune system starts to attack the baby's red blood cells (such as Rh incompatibility) or from RBC membrane defects (spherocytosis).Birth Trauma when the head gets bruised after a vacuum or forceps is used to remove the baby from the vaginal canalInfection which prevents the bilirubin from being metabolized and excretedProblems with bilirubin clearance either from enzyme deficiencies such as Crigler-Najjar or Gilbert syndromeObstructed biliary systems causing bile to get stuck in the liverArreaza: Indirect bilirubin is the one elevated in newborns, but if you see direct hyperbilirubinemia, then you have to think of an obstruction.Jenni: Severe hyperbilirubinemia can cause brain damage. The amount of bilirubin and the duration of bilirubin ultimately determine the severity of the brain damage. This is because the bilirubin blocks some mitochondrial enzymes from being able to function properly, also it inhibits DNA synthesis/protein synthesis, and can cause DNA damage. This can ultimately lead to acute bilirubin encephalopathy which is described as 3 different phases: Phase 1 with poor feeding, lethargy, hypotonia, and seizures, Phase 2 with increased tone in extensor muscles causing neck contractions (retrocollis and opisthotonos), and Phase 3 with generalized increased tone. If the bilirubin encephalopathy persists it can also ultimately cause cerebral palsy, sensorineural hearing loss, and gaze abnormalities.  How and when do we treat? No phototherapy:The goal of treating jaundice is to safely decrease the amount of bilirubin in the body. Oftentimes babies with mild hyperbilirubinemia don't get any treatment and we just watch and wait. In premature babies, there is an increased risk for brain toxicity because a lower amount of bilirubin can result in brain toxicity. For these babies, it is important to ensure there is adequate breast milk to both prevent and treat jaundice because it helps the baby get rid of bilirubin through the stool and urine. Arreaza: Indirect sunlight exposure of the baby.Phototherapy:Other babies get phototherapy or more commonly known as light therapy. Phototherapy light treatment is when the baby's skin is exposed to a special blue light which will help break down bilirubin and help with the excretion in stool and urine. The phototherapy should be continuous and placed on as much skin as possible and the treatment should be administered until bilirubin levels drop to a safe level based on the baby's hour-specific thresholds. Arreaza: Home phototherapy is an option (UV blanket) available for rent or purchase.Phototherapy is very safe, however, with any treatment, there are risks and potential side effects. Some of these include skin rashes, loose stools, overheating, and dehydration. Occasionally, babies turn a dark gray-brown color in their skin and urine, but this is temporary and usually resolves on its own. While the baby is receiving phototherapy, it is important to continue breastfeeding to ensure appropriate fluid hydration, but in babies that cannot get enough breast milk, they may need to supplement with formula or even potentially start IV fluids. Benefits of screeningIt is therefore essential for universal bilirubin screening for all newborns prior to discharge to identify newborns who are at risk for developing severe hyperbilirubinemia. Hyperbilirubinemia is extremely common in newborns, with nearly all neonates having a higher total serum bilirubin than adults. The reason we screen is that this reduces the risk of developing severe hyperbilirubinemia and ultimately brain damage. This universal screening also then decreases hospital readmissions for neonatal hyperbilirubinemia. Arreaza: So, we check at 12-24 hours in a typical pediatric unit. We use a bilimeter (transcutaneous) and if we suspect it is not accurate, we do a serum bili. Be aware of the accuracy of bilimeters.How do we screen? We do this prior to newborn discharge through a transcutaneous bilirubin device (TcB) or lab total serum bilirubin (TSB). The bilirubin level is used with the assessment of risk for the development of severe hyperbilirubinemia. Newborn bilirubin screening guidelines include TSB or TcB within 24-48 hours after birth or before discharge. TcB is the noninvasive test, but TSB is the gold standard for assessing neonatal bilirubin. Newborns with visible jaundice in the first 24 hours should be concerned for severe hyperbilirubinemia. These babies should be screened earlier because of the risk of pathologic causes of jaundice. In addition to the bilirubin test, physicians will clinically assess by examining the skin under ambient or daylight to assess whether there is a yellow discoloration of the buccal, gingival, or conjunctival mucosa. Additionally, if a baby presents with scleral icterus, pallor, bruising, hepatosplenomegaly, or cephalohematoma (enclosed hemorrhage), these can be clinical presentations of neonatal jaundice. Follow up:After screening, we recommend that babies be closely monitored if jaundice does occur as it can be well managed with early treatment. A quick way to assess this at home is to press gently on the baby's forehead and if the skin looks yellow where you press, it's probably jaundice. If your baby doesn't have jaundice, then the place where you pressed it should look lighter than normal. _____________________Conclusion: Now we conclude episode number 133, “Neonatal Jaundice.” Jennifer explained the pathophysiology behind the increased levels of bilirubin in babies. She reminded us that it is a physiologic process, but when the level of bilirubin is too high, then we need to start treatment. Treatments include indirect sunlight exposure of the baby, breastfeeding, and in some cases phototherapy, IV fluids, and even antibiotics and exchange transfusion in some cases. Dr. Arreaza reminded us of the importance of screening and monitoring “bili babies” in the clinic. This week we thank Hector Arreaza and Jennifer Lai. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! ___________________Links:Episode 17: Why does bilirubin deposit in the eyes? – The Curious Clinicians, https://curiousclinicians.com/2021/01/20/episode-17-why-does-bilirubin-deposit-in-the-eyes/.Ansong-Assoku B, Shah SD, Adnan M, et al. Neonatal Jaundice. [Updated 2022 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532930/.Mayo Clinic. “Infant Jaundice – Symptoms and Causes.” Mayo Clinic, 2018, www.mayoclinic.org/disease-conditions/infant-jaundice/symptoms-causes/syc-20373865.“Newborn Jaundice.” Nhs.uk, 19 Oct. 2017, www.nhs.uk/conditions/jaundice-newborn/#:~:text=Jaundcie%20in%20newborn%20babies%20is.Preud'Homme D., “Neonatal Jaundice.” American College of Gastroenterology, Dec 2012, https://gi.org/topics/neonatal-jaundice/.Wong R., et al. “Risk factors, Clinical Manifestations, and Neurologic Complications of Neonatal Uncomplicated Hyperbilirubinemia.” Up to Date, Last Updated: Jan 5, 2023, https://www.uptodate.com/contents/risk-factors-clinical-manifestations-and-neurologic-complications-of-neonatal-unconjugated-hyperbilirubinemiaRoyalty-free music used for this episode: “Gushito - Burn Flow." Downloaded on October 13, 2022, from https://www.videvo.net/

Active management of the third stage of labor refers to interventions that are taken to speed up the delivery of the placenta and reduce the risk of postpartum hemorrhage. This typically involves the administration of an oxytocic drug like Pitocin or Syntocinon to increase the contraction of the uterus and the use of techniques like fundal pressure and controlled cord traction to guide the placenta out of the uterus. Expectant management, on the other hand, is a more hands-off approach in which the placenta is left to detach and be delivered naturally, without the use of drugs, manual manipulations or interventions. This approach is usually used when there are no risk factors for postpartum hemorrhage and the mother and baby are both in good condition.In this episode, we have Barbara Harper on the podcast with us. Barbara is a midwife, author, and the founder of WaterBirth International, which she founded exactly 40 years ago. She is a world-expert in birthing and to this day travels the globe educating obstetricians, nurses and midwives on physiologic birth.Few mothers are given the opportunity to birth their placentas in the water, but is it really necessary to move women post-birth into a bed to complete the third stage (placental birth) of labor?  In order to explain whether this is the right choice for any mother and baby, Barbara walks us through the most common causes of postpartum hemorrhage, how to prevent it, and the critical understanding of newborn transitional physiology: what she says is literally the most important moment in any human being's life. In this episode we also answer questions like:  Is fundal massage necessary? When is the optimal time to cut the cord? What is the case for keeping the cord attached until the placenta is fully birthed? Is manual extraction of the placenta ever justified?This episode is incredibly powerful and loaded with essential birth knowledge. It is a must-listen for every woman who wants to give her baby the best possible start to life. If your provider doesn't support your plans for a hands-off third stage of labor, please send them this episode.Barbara HarperWaterbirth International#100 | The Benefits of Water Birth: Interview With Barbara Harper of Waterbirth International#122 | Provider Green Lights: Interview with Barbara Harper on Holistic, Respectful & Supportive Birth ProvidersConnect with us on Patreon for our exclusive content.Email Contact@DownToBirthShow.comInstagram @downtobirthshowCall us at 802-GET-DOWN Work with Cynthia: 203-952-7299 HypnoBirthingCT.com Work with Trisha: 734-649-6294 Please remember we don't provide medical advice. Speak to your licensed medical provider for all your healthcare matters.

Our modern disconnection from land and lineage mirrors the culturally normal- but biologically abnormal- separation between mother and baby, parents and children. The consequences of these intertwined attachment wounds are vast. But many of us are dreaming into a different way forward. Let us speak truthfully about what isn't working, divest from the systems that break our sacred bonds to the Earth and to one another, and heal into the wholeness that is our ancestral inheritance. Join me on my Costa Rica Forest Bathing Retreat in September.  RESOURCES: Aimee's website The Stoned Chrysalis Aimee on Instagram Medicine Stories Patreon (podcast bonuses!) Take our fun Which Healing Herb is Your Spirit Medicine? quiz Reclaiming Childbirth as a Rite of Passage: Weaving Ancient Wisdom w/ Modern Knowledge by Rachel Reed Related Medicine Stories episodes-  Episode 38 Healing Our Indigenous European Ancestors w/ Lyla June Episode 48 Matriarchy in Action & Ancestor-Assisted Birth w/ Emilee Saldaya Episode 51 Maternal Mammalian Ecstasy: The Ancient Hormonal Blueprint for Optimal Birth & Bonding w/ Sarah Buckley Episode 52 Decolonizing the Mind: You Belong to Your Ancestors w/ Tamira Cousett Episode 61 Revillaging: Maternal, Cultural, and Planetary Wellness are One w/ Rachelle Garcia Seliga Episode 75 Learning is Innate: Ancestral Childhood, Unschooling, and Healing w/ Akilah Richards Episode 76 Nature's Ancient Design: Exalting Life by Honoring the Physiologic Truths of Childbearing w/ Rachelle Garcia Seliga   My website MythicMedicine.love  Mythic Medicine on Instagram Instagram Medicine Stories Facebook group Facebook group Music by Mariee Siou (from her beautiful song Wild Eyes)

I'm kicking off the new year with a really important episode about physiologic birth. I was inspired to cover this topic by our guest from episode 168, CNM Gianna Fay. She wrote to me asking if I would be willing to cover it and my response was - sure… but how? It's not a topic that OB/GYNs are taught much if anything about. The term gets used a lot in the online space but it's not often defined. So I decided to roll up my sleeves and see what information I could find. I learned about it myself and I'm going to share that information with you today. In this Episode, You'll Learn About: -How normal physiologic birth is defined -Which factors disrupt physiologic childbirth -What are the benefits of normal physiologic birth -Whether any one position should be mandated or prescribed -What are the factors that influence physiologic birth -Why it's vital for your medical team to support your wishes -What makes it necessary to intervene --- Full website notes: drnicolerankins.com/episode190 Check out The Birth Preparation Course Register for the class How to Create a Birth Plan the Right Way Take a quick, fun labor pain quiz

1.08 S2 Splitting Cardiovascular system review for the USMLE Step 1 exam S2 splitting is a phenomenon where the closure of the aortic and pulmonic valves occur at different times, resulting in two heart sounds heard at what is normally S2. Four types of splitting: physiologic or normal splitting, wide splitting, fixed splitting, and paradoxical splitting. Physiologic splitting is normal and occurs when a person takes a deep breath and the difference between the closure of the aortic and pulmonic valves can be heard. Wide splitting is a symptom that is not normal and is associated with diseases that delay right ventricle emptying, such as right bundle branch block and pulmonary stenosis. It gets worse with inhalation. Wide split, worsened by inhalation Fixed splitting is similar to wide splitting, but it is not made worse when the patient inhales. It is seen in patients with an atrial septal defect. Fixed split, fixed in place Paradoxical splitting is a wide split that is fixed by inspiration and is caused by diseases that delay aortic valve closure, such as aortic stenosis and left bundle branch block. Paradoxially fixded by inspiration

Join us as we talk with Tanya Faisal all about ADHD and homeschool. We'll talk about what ADHD actually is, what it can look like, and how we can support our kids. Fall 2022 Season Sponsors   We are so grateful to our Fall 2022 Season Sponsors. Use the links below for their special offerings:   Blossom & Root and use code HSUnrefined15 for 15% off your purchase   Outschool and use code Unrefined for $20 off your first class    Night Zookeeper for a 7-day, risk-free trial, as well as 50% off an annual subscription  LTWs    Maren: Wakanda Forever   Angela: Bad Vibes Only by Nora McInerny   Connect with us!  Visit our website  Sign up for our newsletter and get our Top 100 Inclusive Book List We are listener supported! Support us on Patreon Follow us on Facebook, Instagram, Twitter and see video episodes now on Youtube Angela on Instagram: @unrefinedangela | Maren on Instagram: @unrefinedmaren and @alwayslearningwithmaren  Email us any questions or feedback at homeschoolunrefined@gmail.com   Complete Episode Transcript   [00:00:10] Angela: hi, we are Maren and Angela of homeschool, unrefined. Over the past 25 years, we've been friends, teachers, homeschool parents and podcasters, together with our master's degrees and 20 years combined homeschooling. We're here to rethink homeschooling, learning, and education with an inclusive and authentic lens. [00:00:29] At Homeschool Under You find, we prioritize things like giving yourself credit, building strong connections, respectful parenting, interest led playing and learning, learning differences, mental health, self care, and listening to and elevating LGBTQ plus and bipo voices. We are here to encourage and support you. [00:00:51] Whether you're a new homeschooler, a veteran, you love curriculum, you're an unschooler. Whether all your kids are at home or all your kids are in school, or somewhere in [00:01:00] between. Wherever you are in your journey, we're the voice in your head telling you, you're doing great, and so are your kids. This is episode 2 0 1, homeschool and ADHD with Tanya Feil. [00:01:13] Tonya and I talked about lots, the lots of things about adhd, what it actually is, what it looks like, and how we can support our kids with adhd. And then we'll end like we always do with our lt. Ws loving this. Before we get to that we wanted to just let everyone know about our December class in Patreon. [00:01:35] Mm-hmm. , it's gonna be called How We Winter Break. It's all about the importance of taking a winter break and our best tips for doing so. We're super excited about that because we really are passionate about it. It is, we love breaks, , we're passionate of all breaks. We are. It is Tuesday, December 6th at one o'clock. [00:01:53] If you join us on Patriot at the $10 level Central. Yeah. Yeah. One o'clock Central. Mm-hmm. . You will get information [00:02:00] and a Zoom link for that. Yes. , [00:02:03] we know finding a curriculum that meets your needs is tough, and that's why we're excited to partner with Blossom and Root. Blossom. And Root is a nature focused secular homeschool curriculum, focusing on creativity, science, nature, literature, and the arts. [00:02:20] Blossom and Root has been gently encouraging and supporting homeschooling families around the globe since 2000. Blossom and Root currently offers curricula for pre-K through fifth grade with new levels being added in the future. Additionally, a three volume inclusive US history curriculum told from a variety of viewpoints is currently in development as of August, 2022, volume one is available for purchase and volume two is available on presale. All profits from this history curriculum. A River of Voices will be used to support storytellers and artists from historically excluded communities. You can find [00:03:00] samples, scope, and sequences and information about each of their levels online at Blossom and Root dot. [00:03:07] You can also find them on Instagram at Blossom and Root. Blossom and Root has created a special discount for our listeners. Use the code Hs. Unrefined 15 at checkout for 15% off your purchase. We're so happy to be partnering with Out School this season because they are our favorite way to outsource. We know that kids who love to learn don't just prepare for the future. [00:03:30] They create it. That's why Out School has reimagined online learning to empower kids and teens to expand their creativity, wonder and knowledge. Empathetic, passionate teachers encourage learners ages three to 18 to explore their. Connect with diverse peers from around the world and take an active role in leading their learning out. [00:03:51] School has created a world filled with endless possibilities for every schooling journey. Explore over 140,000 fun and flexible [00:04:00] live online classes to find the right fit for your family and join us as we set learning free. Sign up today at Out schooler.me/homeschool unrefined, and get up to $20 off your first class when you enroll with the code Unre. [00:04:15] Angela and I love using technology to teach specific skills, and that's one reason we are excited to introduce you tonight, zookeeper. Is your child a reluctant writer? Do they struggle with reading? If your answer to either of these questions is yes, the Night Zookeeper may be just what you're looking for. [00:04:33] Night Zookeeper is an online learning program for children, ages six to 12 years old that uses a gamified and creative approach to help to keep kids engaged and focused on developing awesome reading and writing skills. I, while having fun at the same. Some of the features we love include the educational games, the personalized feedback on writing from real tutors and the super safe community pages where children [00:05:00] can work with each other and learn together. [00:05:02] If Night Zookeeper sounds like the perfect learning program for your child, you can try it for free by clicking on the link in the show notes. When you register it, you'll get a seven day risk free trial, as well as a huge 50% off annual subscription. That's a great deal if you ask. We are so excited to welcome back Tanya Fel, who is the creator of the YouTube channel project. [00:05:26] Happy Home. Tanya is a doctor and a lawyer turned homeschool parent who talks a lot about homeschool curriculum and adhd, and much more on her YouTube channel and on her social media. So please enjoy this conversation with Tanya. [00:05:42] Maren: Thank you so much, Tanya, for joining us today. We're so glad you're. It  [00:05:46] Tanya: is my pleasure to be back.  [00:05:49] Maren: Yes. All right. So do, maybe we should just start with a reminder. Maybe you can tell everyone a little bit about yourself, your story, and Sure. What [00:06:00] you are doing now.  [00:06:01] Tanya: So, I've been on social media, you know, in the world, the greater world for, I don't know, about seven years now. [00:06:08] I got on right as we started homeschooling, and I started my homeschool journey because my son was, you know, having trouble in kindergarten. And we had explored what could be causing that trouble and, you know, found out that it was adhd. And as all of that was happening, I thought it would be nice to find community. [00:06:28] And a lot of the information that I found initially was online. Mm-hmm. from moms who were going through it and. Sharing our story really was out of like gratitude to them. You know, it was like a, I realized how much that helped me and I thought, okay, so if I can share my experience, then it can help other people in the same way, you know, as a mom to mom, kind of, you know, parent to parent level. [00:06:51] Absolutely. Communication. So since then, I mean, I've continued the YouTube channel and the Instagram account under Project Happy Home, and we just talk [00:07:00] about all the day to day stuff. But also I focus on ADHD a little bit because mm-hmm. , that's really where our journey started. So  [00:07:08] Maren: did you know a lot about ADHD before you started, before you started homeschooling? [00:07:12] Or did you have knowledge of it or?  [00:07:14] Tanya: I come from a medical background, so I had knowledge of it, but I had no personal knowledge of adhd, you know, and it was, I, I think that even in the last five years, we've come a long way in like decreasing the stigma behind these different learning styles and learning abilities and learning, you know, Just modes of brain wiring. [00:07:36] You know, I think we've come a long way in like being able to be open about what challenges our kids are facing and what challenges we are facing, you know,  [00:07:45] Maren: as adults. Absolutely. Okay. So you, you started, you started really studying because you had a personal, your, your son, you realized, you realized he had adhd and so you did a lot of research and Yeah. [00:07:58] And, and [00:08:00] communication and communicating with other parents and things like  [00:08:03] Tanya: that. Yeah, because I, I mean, all the things I had read officially about adhd Yeah. Can one come from very different camps of thinking about whether you're gonna medicate or not medicate? Yeah. Whether it even exists or it doesn't exist. [00:08:16] But I found that the most helpful things that I learned were from parents. Mm-hmm. , you know, whether it was on like chat groups, on those official websites about adhd or whether it was like YouTube videos or Instagram accounts, because. I think that while professionals can have a lot of opinions about what is physiologically causing this and how we can treat it and everything, I think parents have the issue of like, so how do I get my child to Right. [00:08:44] Put their clothes in the hamper , right?  [00:08:46] Maren: Yes. You know? Yes. Okay. We're gonna get to that too. We're gonna get to things like that in just a minute. But first, let's maybe just start at the beginning and let's talk about what ADHD actually is, because it sometimes feels like [00:09:00] in intangible it's like, well, it's these behaviors. [00:09:02] Is it just these behaviors? That's what I think there's this perception, but what really  [00:09:07] Tanya: is it? So that's, I think, a hard question to nail down because there is disagreement about what it is if you're talking about it from a physiologic standpoint. Right? Yep. There's still a lot of medical disagreement about whether you actually have. [00:09:23] Physiologic changes in the brain or whether you don't. I find that amazing that that's still up idea. I do  [00:09:30] Maren: too. I do too. I think that's it. It's just amazing to me that there isn't more information out there or research or work on this right now. I think especially, especially now. But yeah, because it is you know, from my own study and research, and you can tell me what you've also learned because this is how we do it. [00:09:50] Like, we kind of just say, well, this is what I've learned and this is what you've learned and let's talk about it. But it's, for me, what I think about first is, is a [00:10:00] differently wired brain. Yeah. And especially. I think about the prefrontal cortex, which is at the, you know, the very front of your brain and how it's often less developed or and so it's possibly, it's possibly delayed. [00:10:14] And a lot of that prefrontal cortex part of your brain coincides with executive functioning emotional regulation kind of logic and understanding those, you know, understanding logic sometimes Yeah. And things like that. Is that what you have also found?  [00:10:29] Tanya: Yeah. I think that there's a lot of research indicate regardless of what is actually going on with neurotransmitters and the, you know, the way the brain is developing, maturing, yeah. [00:10:40] I think that they've definitely established a lack of working memory in these kids. That too. So, yes. Working memory, being that, exactly what you were talking about, that being able to take this short term knowledge, this short term instruction, this short term visual, and transforming it into a list of steps that [00:11:00] you mm-hmm. [00:11:00] you know mm-hmm. , if this, then all of these things, that connection and that has a lot to do with prefrontal cortex and how it connects to all of your other lobes, really. Right, right, right. So, I think regardless of what's going on, I think we should focus as parents on like, how does that manifest for us in our kids? [00:11:18] Like, what is actually happening? Because, like you said, we can ignore, you know, we can talk about the behaviors like the, the fidgeting or the lack of attention, and sort of forget about all the other pieces that come with that lack of working memory. Like, you know, the reaction times being slowed to someone's facial expression, the inability to realize that you've missed a step. [00:11:40] You know, in what you were supposed to do next then. And just all of these things that can be perceived as disrespectful and lazy and, you know, irresponsible. Mm-hmm. just being actual, you know, brain wiring like issues, right?  [00:11:56] Maren: Yes, yes. So it, yes, that has, that [00:12:00] has helped me a lot over the past few years to understand that it is, it is to me quite physiological. [00:12:07] Mm-hmm. Instead of choices, bad choices. Yeah. Or, or just a tendency to not be able to do things you don't wanna do. Like you have to step it up, you know? Yeah. And so it's much easier to understand when it is just, it, it, it does to me seem like now a much more physiological and, and real tangible thing. [00:12:27] Tanya: I think people should realize it. Like the, you know, it is a disability that if you are an adult and in a workplace and you can, you know, apply for accommodations. So we all hesitate to use the word disability, but I think it's important to realize that like medically and psychologically speaking, like it has qualified itself to receive help for adults. [00:12:51] You know, like people who are functioning, like working members of society. And I think that that is important because yes, labels matter, but [00:13:00] I think it's important because it's a real thing. The thing that offends me the most is when people say that ADHD isn't real. Yes. And that it's just behavioral and just choices. [00:13:10] And I think. To know that it's recognized officially by people who give out money , you know, to, like, that's a hard, a hard call for the government, you know, like, I think that that's important to realize that that is, it has passed that bar, that discussion should be over.  [00:13:25] Maren: Yes, absolutely. Yep. You are so right. [00:13:27] But, and I do think I get why it feels like, like I said, it does feel a little bit intangible, and I think sometimes that is, because it looks so different for everyone too. So it might not necessarily be just a, a, you know, not being able to complete a task or something. It might, like you said, might not, it might be more working memory not being able to remember or, you know, memorize things that you need to memorize, or it might be, you know, emotional dysregulation or things like that. [00:13:58] So it's sometimes [00:14:00] hard to pinpoint like, oh, this person definitely has ADHD because they have, they do this, this, and this, because it, you know, it can look so different. But also that's why probably getting a test is really, is really important. Yeah. So that you can, you can identify it and move forward. [00:14:17] Yeah. So I  [00:14:18] Tanya: was 95% sure that my childhood had ADHD when I took them in for their very expensive testing. Exactly. It wasn't covered by insurance . Don't get me started. Yeah. And, and it was a huge relief to me to know like, that he met these criteria and it wasn't just me thinking, you know, things about his behavior and stuff and just guessing. [00:14:42] Even as somebody with a medical background, I wanted to know exactly to the best of our ability. What was going on so that I could hone like how we addressed him and how we lived with him and, you know, how we as parents like adjusted our behavior to best help him. [00:15:00] Yes. I, I,  [00:15:02] Maren: I agree with you a hundred percent. [00:15:03] It felt so good for me too. I have kids with ADHD and since then I've been tested and, and have ADHD too. And so also, even though I knew same with you, probably 95% sure this is adhd it does feel validating. And also there's official things that can happen now too. Like you said. There are there are accommodations that can happen now for sure. [00:15:27] And so I feel Yeah, I I I am so glad we all got tested. So, and, but you're right. It is, it is really expensive and I think that that is something that I really hope changes in the future. Yeah. For people for sure. So what are, we've talked about a lot of the maybe things that are kind of hard for eight year, or maybe we call 'em symptoms or things that you see that make that maybe challenges for people with adhd. [00:15:54] What are some of the strengths that you've seen in anyone with adhd, maybe your son [00:16:00] or  [00:16:00] Tanya: anybody else? I think, you know, like you were saying, the, the weaknesses are the things that people pick up on the first. And just to go over, if anybody wants to know a list of those, it's easy to find online, but a lot of the things people notice first are in school, like when a child first has to sit on the line and they have issues sitting on the line, literally, and also paying attention and following directions, completing activities a. [00:16:24] Behavior and talking that can be deemed disrespectful. Mm-hmm. , I think if you flip a lot of that behavior on its head though, what it comes from is their strengths. Yes. Which is, you know, not wanting to be on the line for a very long time and to want to be creating and producing and doing things and actively learning. [00:16:43] And then, you know, in terms of the disrespect and stuff, sometimes it's just kids being really questioning a lot of things or questioning, not we say questioning authority, but I think sometimes they're just literally questioning the direction, like without any disrespect intended. You know, they are truly wondering [00:17:00] like, why is this the choice that you've made in this situation? [00:17:02] Like, why do I have to do it first and not second? Why do I have to stop this and do this now? And I think sometimes when kids with ADHD appear disrespectful, they're actually just being critical thinkers, you know? Really. Absolutely.  [00:17:15] Maren: Yep. And they're, and they don't,  [00:17:17] Tanya: Gauge that your face is showing irritation quickly enough to re reroute their next question. [00:17:26] Yeah. You know, in a school environment and stuff, I think sometimes when you ask the first question, everyone can be like, okay, maybe you're just asking, but then they ask another one and another one. That seems equally disrespectful. But I don't think that's it. I think that's the reaction time thing coming in where they're not reading your face for disapproval, they're just going on with their next thought. [00:17:44] Maren: Well, and, and I also think Kids with ad don't wanna just say kids, people with adhd can be highly motivated when they connect their big why to what they're doing. Exactly. And so I think for them it's like I, a child might just be [00:18:00] saying, I really need this information or order for me to move forward. [00:18:04] Tanya: Exactly. There're actually telling you what they need. They're telling you what they need. They're trying to be, I think in one way it's easier to look at it as they're trying to be respectful. They're trying to find the reason that gets them there. They search child. I think that, yeah, no child wants to be yelled at, even if they have this prior knowledge, like, yes, I get yelled at a lot and kids with ADHD get reprimanded so much more than kids without, and that's like a heartbreaking number of times, more. [00:18:32] You know, and I'm not gonna call myself perfect at all. I definitely will be impatient with certain things because it's a continuous kind of answering of the question. You're not gonna have, as a parent of a child with adhd. You're never going to be in the situation where I just say things the first time and my children just [00:18:49] You know, like, duck legs go in a And that's something, you know, to get used to. I always say that the most important thing with your kids, whether they have ADHD or not, right? Is that relationship, like [00:19:00] Absolutely. Do they feel when they look at you, and what do you feel when you look at them? Like, is it like this waiting for like disapproval? [00:19:07] Waiting for like disobedience mm-hmm. . Mm-hmm. . Or is it assuming the best of them? Like, I think of all the things I've ever come up with for myself, you know, how we come up with these things, these coping things. I came up with this mnemonic ABC. And so the A is just always ask the first time, like, don't expect them to not be doing it or not have done it, or not be listening. [00:19:31] Like don't yell the first time. You know, don't be annoyed the first time. Just ask like you would ask a friend or anything. And I always think when you ask, try to like touch them or really make sure that they're listening. Like they are not kids who are gonna respond well when you shout from, you know, downstairs to upstairs and expect them to like, just get it together. [00:19:51] Definit. So the A is just always ask. Mm-hmm. and ask like a nice person, you, yourself, you know? Right, right. And then the second one is [00:20:00] the B is just believe. Believe when you're asking that this is going to happen this time. Mm-hmm. . Mm-hmm. like as best as you can, like believe that they have the best of intentions and you do. [00:20:10] And we're gonna meet there, you know, and it might not happen the first time you ask or the second or the third, but you have to believe that will continue to believe. You have to. Yeah. You have to believe that they want to work with you. They want to be like the best they can be because they do like they do. [00:20:26] Absolutely. The C for me is always chuck it if it doesn't work, you know, or if you have a negative interaction or like you messed up and said things you didn't mean, or they just, you know, melted down and had things come outta their mouth that they don't mean or whatever. Just chuck it. Like don't carry it with you into the next thing that you have to do together. [00:20:48] And the next thing and the next thing because. It's in the end a small thing. Like you shouldn't feel horrible about yourself because you had a meltdown, because it's hard to be the parent of [00:21:00] any neuro atypical kid. It is. Absolutely. Yep. And then give yourself  [00:21:04] Maren: credit for  [00:21:04] Tanya: that. Yeah. And give yourself some grace. [00:21:07] It's so much easier to give them grace when you allow yourself some,  [00:21:10] Maren: you know, . Absolutely. Yep. So, yes, absolutely. And I was gonna say something about, oh yes, this I love the abc and Always Ask is so great because I think what can happen, especially with my children with adhd, messes happen all the time. I mean, I have mm-hmm. [00:21:27] You know, experiments are going on all the time. White because it's tactile, it is interest led. It is not, you know there's not necessarily a plan at a time, it's just things are happening and question. I think one of the strengths of someone with ADHD is they are often very inquisitive and eager to find answers, eager to find answers. [00:21:52] And so I think that's happening a lot in our house. And so that does create masses sometimes. And also there's a lot of creativity mm-hmm. Around [00:22:00] people with adhd. And so I think there's, you know, there's our projects everywhere too and things like that. And so to always ask to clean, to, you know, to, let's clean this up. [00:22:09] Could we clean this up now? Is great because when it happens a lot, sometimes my first reaction is, oh my goodness, again. Oh my goodness. And so I think this is really great to like just start. With Always ask . Yeah. You don't have to elevate it to, you know, level seven right away. Let's start with one. [00:22:31] You know, let's just stay, let's stay where, let's stay down there in the lower levels of, you know, your emotions because I think we know this is gonna happen and, and, and there it's because of the strengths. It's because of the strengths. Yeah. And then I also think like my, my kids' strengths are definitely in the beginning of those projects. [00:22:49] Mm-hmm. . And the strength is not in the cleaning up of those projects. Right. That still needs to happen, of course. And we need to build that skill and practice [00:23:00] it and continue to work on it. But my expectation should not necessarily be that they're gonna be as good at cleaning up as they are at starting this really interesting project. [00:23:13] Right. That's, you know, that's probably just not realistic. And so if my expectation is they get that good at cleaning up, I'm going to forever be frustrated.  [00:23:22] Tanya: Exactly. Yeah. And I think it's important to talk to them, especially as they get older, but really even as youngest five and six about mm-hmm. [00:23:30] how do they think you should get there? Like if you have a goal, like if they did this big invention box project and now you have like painter tape and paint cardboard pieces and everything scattered everywhere and you're feeling your blood start to like boil a little, you know, cuz you're at the end of a long day or whatever and you have to do other things. [00:23:48] I still think it's important to like sit with them and be like, okay, so like I think you can say what your needs are. Like I need this to be cleaned up. Yes. So that I can feel okay. Yes. You know, so that we can [00:24:00] get through everything and do other things in this living room space. And ask them though, cuz they are so creative, right. [00:24:08] Like, what do you think would be the best way that we could do this? Or what do you think would be the fastest way? Or do you think if we like, you know, set a timer, like who could like finish their half of the room fastest? And honestly, that makes it fun for them and for you. Like it allows you to like, you know, not be this ogre who's always upset. [00:24:27] You know, like it allows you to just be in it with them. Like, this is a problem, but we're gonna do this like in a together, like year going to be together when we like figure this out. We're  [00:24:38] Maren: in this together. It's not just you clean this up, this is your issue. Yeah. This is us together where it is a team. [00:24:44] Right. And then another thing that, you know, I was thinking of when you were, when you were just saying that Tanya, is that I've often like maybe started with let's, can you. At, you know, when they were much younger, they could help with a few things cleaning up, not the whole [00:25:00] cleanup. That's overwhelming. [00:25:01] It would deter them from ever doing a project again. Mm-hmm. , if they had to do the whole thing even with me. So it was like they could do 10%, 20% of it or whatever. And we have worked up over the years mm-hmm. For that, I don't know the, the stamina. To, to clean up a project or stamina to do anything that is of low interest to them. [00:25:25] Exactly, yes. That it just, we have to build that up. It can't be something that they just take on a hundred percent right away. Mm-hmm. Without I think almost like some scaffolding or .  [00:25:36] Tanya: Yeah. It's a, this guideposts along the way like this is that if the, the like, you know, first this, then this is tough. [00:25:44] That is that working memory piece, you know, it is then this, like, this happens and this happens and it hasn't, and when they're little like charts help and visuals and stuff, I think when they're older, absolutely. . I always have the high five, I think I talked about this last time, where everybody's, you know, responsible for five things before they see me in the [00:26:00] morning and you get a high five. [00:26:02] I'm just like high five. And that's all I say. Instead of saying, did you do this? Did you do this? Did you do this? You know, like they know what the five are. Everybody has it listed on their bathroom mirror and like you just, that's great. And you start the day with a high five, which I think is really nice. [00:26:16] And if they haven't done it, you haven't used any negative words to show them that you haven't, you just ask like high five. And then if they can't, they're like, they just run back up, you know? Which is really not, you know, negative, you know, it's like them having a code word almost.  [00:26:34] Maren: It's a code. I love that. [00:26:35] It's a code word. Instead of saying, oh, go back and brush your teeth. . Mm-hmm. . Yeah, because all kids get told what to do a lot just innately. Like whether we want that to happen or not, it just is. That's the way, that's the way it is. Kids. Get told what to do a lot. Someone with adhd maybe even more because they, they, you know, We have to repeat things a lot or, you know, they yet, like, [00:27:00] they forget or they get off task or they don't wanna do it or things like that. [00:27:03] So it just can multiply and multiply and it could be a day full of telling a child what to do. And so I love that the, as much as we can minimize that the better. And so if there's something written down that is so great because they do need the reminders. They will not remember five things Yeah. [00:27:20] In their brain, but they, they will remember to go look at the five things. Mm-hmm. . So anything that can be automated. Like that is so, so helpful. And things  [00:27:31] Tanya: like, you know, I feel like the bane of my existence is socks in general. Every time I bring up socks, I'm like, how many problems can I have with socks? [00:27:38] Mm-hmm. . But beyond them being left everywhere, one of our issues was getting out of the door and always having people who had not put their socks on. And then having this whole thing of like, me seeing they were putting sneakers on without socks and being like, take off your sneakers and go put socks on them. [00:27:52] And so now I just keep a basket of socks. Oh, that's great. Right there of everybody's size. And every time we do the [00:28:00] laundry, I just like toss a sock in there, you know, because that way I, we've automated this step, so, okay. I've established people have trouble remembering their socks. Mm-hmm. . And so now the socks are always there. [00:28:11] Now that whole thing is eliminated. Yes. It took the barest amount of effort on my part. And honestly, if they grow up and they still have an issue remembering socks, hopefully they remember to do this. Exactly. And then it solves the problem, you know? Yes. I find like a lot of people will say like, well, how long are you gonna be around and you can't do all these things for them. [00:28:30] And I'm like, I'm teaching them how best to do it for themselves too.  [00:28:35] Maren: You know, they can absolutely do this their whole lives. Yes.  [00:28:38] Tanya: They, they can absolutely have a post-it with five things on their bathroom mirror for the rest of their  [00:28:42] Maren: life. Yes. They had a problem. Yes, exactly. And we have to think outside the box on that, because I think we've been kind of trained. [00:28:49] We do. We just do life this way. This is what, this is what people do. People don't have baskets of socks in their, you know, in their joy. But they can Why, why can't they? And so I [00:29:00] think that's, I mean, you could call that almost an accommodation, but I, I don't even necessarily like the word accommodation cuz it's, it seems like you're, oops, sorry. [00:29:09] You're making an exception for you know, For a difference or something. But I think this is just like we all, we can all do things. Yes. It's a life hack. It's just we all do things that make our lives easier. Yeah. You know, we put our coffee right next to the coffee pot so we, you know, we don't have to walk across the kitchen to go get our coffee in the morning. [00:29:30] And so like, we're just making life easier in other ways that maybe, maybe someone else hasn't thought of before. And I think that is really  [00:29:38] Tanya: great. Once upon a time we didn't have room closets, but now we do to keep the broom there where we will be able to get it easily. I mean, it's the same thing. And we have a lot of hangups about making life easier. [00:29:50] We really do. Like I. I mean, even as adults, people are like, Ugh. Like, do you really need that extra thing or do you really need that? Like, is that, I'm like, why are you [00:30:00] so upset that someone has a special way of cleaning baseboards? Yes. Like if you make them clean their baseboards, hurray, you know, like this extra tool or whatever, whatever it is that makes you a little bit less stressed as you live life, I think. [00:30:12] Yes. No one should denigrate that. No,  [00:30:15] Maren: no kidding. I, I, I can't even agree with you more. I think you're so right and it also just takes away the shame of, of what a lot of kids might feel having adhd. It just takes away that shame. Like instead of saying like, I can't even go get the right socks at the right time. [00:30:33] I can't even do that. That can feel really bad for. . But really it's, it takes away that whole issue. It's like not even an issue anymore. And I think we can, we can translate that into homeschool in so many ways too. Mm-hmm. . I do like, I wanna think about kids when they can't sit still, like you talked about, they can't like sit on the line, but at homeschool it might be they can't sit on the couch, they can't sit, sit at the kitchen table or whatever. [00:30:56] But I do wanna encourage you that if you have a child like that, even if they [00:31:00] haven't been diagnosed with adhd, maybe they don't even have adhd. A, a child who can't sit still sometimes. They are so their brains are going, so, you know, they're, they're thinking about a million things. Maybe they're even so excited about whatever's going on. [00:31:16] And their reaction to that is moving around. So sometimes that's the case. But then also sometimes moving around is what is needed in order for their brain to focus. Yeah. So it could be, you know, one or the other. And so I think that's an a life hack for homeschool, for homeschoolers is to just think about how. [00:31:41] We don't all have to be doing homeschool the same way either. Just like we don't always have to have our socks and our drawers. We don't always have to do the plan that we, that we originally had for homeschooling our child is our children might be telling us they need something else. [00:32:00] Yeah. And so that's, it's not a bad thing. [00:32:02] It's actually great. It's great. I think it's, you're figuring out you're, yeah. I  [00:32:07] Tanya: think one thing that's good about social media is that we have so much access to different people's experiences. Yes. But another thing on the flip side is that it's bad. Right. Particularly when it's like a visual format like Instagram mm-hmm. [00:32:17] Mm-hmm. where so many things can look so beautiful. . Yeah. And so exactly, you know, little House on the Prairie and all of this stuff. And I think that it can make us feel bad about, about the socks in the hallway or whatever we're doing. Yes. That is working for us maybe, but not picture friendly. And you know, people have different experiences, like people have different family dynamics and different ages in their homeschool. [00:32:43] There's so many things. Mm-hmm. beyond ADHD or any neuro divergence that makes it different. I think I parent my kids pretty much the same. Mm-hmm. because of my eldest having adhd. Like I think I'm much better at being nice , honestly, like that's the word, because [00:33:00] my eldest has adhd. Like, I think, yeah, I had expectations for what motherhood would be like and what my children would be like and what my house would be like. [00:33:07] Mm-hmm. that are wildly different from what has happened. And in many ways it's been for the good, you know? Yes. Like, because it's have my son having ADHD has taught me that, you know, one, the way I'm perceiving a situation is not the same as the way someone else is perceiving the situation. Yes. That is very clearly brought home. [00:33:30] So true. And. That I can like pause and try to meet them in a, in a helpful way, in a non judgey way. Like I really try hard, I think I used to say things like, you always, you know, you always don't, or you always do this negative thing would follow. And that I have, I, I still doing things wrong, but that I don't say anymore ever to anybody. [00:33:53] Right, right. Because I think that it's really important to tell them, you know, like, we [00:34:00] are growing all of us together. I always tell my son, I'm exactly as old a mom as you are a kid. Like, so think of us in the same way though, right? Like, I am learning these things and so are you and we are all moving forward together. [00:34:13] I think we can all say that we can get better at things without saying that there's any perfect place to get to or that we're terrible where we are, you know? Yes. I think. That's important to know. Yeah.  [00:34:25] Maren: Definitely. And I, I always, I always think what I'm doing for my kids who are neuro divergent, it's actually good for everyone and vice versa. [00:34:37] What we're doing for everyone should be good for the person who's neuro divergent too. So I think we need to also just, I think we've kind of narrowed our idea of maybe expectations and the way we even, I don't know, communicate with each other or treat each other that I think can be much more inclusive. [00:34:56] And thanks to our neuro divergent, you know, the people, [00:35:00] the neuro divergent people in this world who's like, they're helping us understand even just how to, how to , I don't know, be better communicators with everyone. Yeah. Yeah. So I think yeah,  [00:35:14] Tanya: no, I wanted to say like, the one thing I would mention too is one reality of being a parent of someone with ADHD is that, you know, they will take negative comments so much harder Yes. [00:35:26] Than, and your typical child would, and that. As a parent, because I know, I, I know that I have said things that I would take back if I could, and I have responded in ways that I could take back if I could. And I have seen how much that affected my kid and then me responding in a way that was even more frustrated because I felt like he shouldn't have had that response. [00:35:53] Like it shouldn't be this extreme that I said this negative thing. And so it was like piling like one negative thing on top of another, like [00:36:00] the frustration with the initial event or whatever that happened. And then my frustration with his response and I think really learning about how Neuro atypical kids, particularly with adhd, can have this rejection sensitivity dysphoria. [00:36:15] Yes. This, this incredible feeling of pain and just anguish really about being reprimanded. Yep. Is, is really important to acknowledge and learn about. And I think when we realize how harmful some of the things we do can be caring parents, you know, which most of us are. Yep. It really shifts you. Yes. You know, like always remembering that shifts my responses into like a more even keeled response. [00:36:43] Maren: I think that is so important to remember. I was gonna just ask you about R S D or rejections sensitivity dysphoria because I think it is real . It is very real. And I think that for many reasons it's very real. And one of those would be that there's just a lot [00:37:00] of, you know just culturally. There is a lot of rejection for, for a child who, you know, learns differently. [00:37:09] And so there is this sensitivity to it towards it, and I think their brains are also geared towards that sensitivity too. And so, and I've seen that a lot in our house and I do think, like, it's, it's amazing how I have always thought of myself as being very encouraging, very positive, you know accepting and everything and have realized I have so much. [00:37:33] I mean, there are just so many opportunities to continue to get better at that . Even things that I never would've thought were in the realm of any kind of criticism they actually can be interpreted that way. Yeah. And so yeah, it's important.  [00:37:53] Tanya: They have documented like the response time too for ADHD kids. [00:37:57] Mm-hmm. is a little bit just milliseconds, [00:38:00] but like a little bit slower in terms of recognizing someone's facial expression and like responding appropriately. Yeah. And I think even that we don't realize, right, when we say something, and it might be neutral, but we say it with like a tightness in our tone or in a in our face, whereas our neurotypical child might immediately see that in like SCADA and do whatever we were saying. [00:38:20] Sure. The, you know, child with ADHD might just not have realized that we're serious in this moment and that you were close to reaching your limit for the day or anything like that, you know? So, you know, I think recognizing that difference Yes. Yes. Is so important in terms of being compassionate about, you know, how long it might have taken them to like move forward with the task you were asking them to do or whatever. [00:38:47] Maren: Yes. And I wonder if that, does that have anything to do? I'm just putting this together. Like, I know it's very, can be very difficult for someone with ADHD to transition, transition to different tasks. So it's [00:39:00] like this to this, like their brain is sometimes hyper focused on something. And so, and to be able to transition to something it can be quite difficult. [00:39:09] And so I wonder if sometimes that's the reasoning for that. There's just like, they're thinking of this thing and it, and it's really hard to change to the next thing, even if it's a, a, I don't know, a face, A face that they aren't noticing. Yeah. Yeah, so, but we, so yes, and we also need to be very conscious of that, like, transitions can be very difficult for for our ADHD kids too. [00:39:32] Like we, I know you talked well yes, you were talking about it's really hard for them to focus or sit down sometimes, but also sometimes our kids can get very focused, and this is when they're really into something. Their brain is, you know, kind of in this flow state almost when they're interested in what they're learning about. [00:39:52] And so I think when, well when we're homeschooling, I think this is a great gift because your kids are [00:40:00] gonna learn so much about the things that they're interested in. Yes. Like you can't really stop it from happening , but also you have to be very aware of Dere that Dere relaying. Yes. Yes. And giving them lots of support at the end of that time. [00:40:19] When it's time to move on to something else, giving them lots of you know, time to prepare for a change in what's gonna happen next. And then, yeah. So yeah.  [00:40:30] Tanya: People when they come to my house always make fun of me because I have the Alexa timers on everything. Yeah. So many things, you know, like half an hour before something, it'll be like, in 30 minutes we're gonna have our piano. [00:40:40] Listen in 15 minutes we're gonna have our, and, and for us that works. Some people like timers, you know, I've heard people tell me when they have a timer, their kid kind of freaks out. And I'm like, you should stick with timers in whatever way works for you. But I promise you there will be one that has to. [00:40:58] Has to be you. Yes. They might not like [00:41:00] seeing a visual timer, but they might like hearing that the time is coming. You know, they might not like having, I don't know, alarm go off, but they might like a touch on the shoulder being like, you know, we have about five minutes left. There's all these different things you can do. [00:41:14] Yes. But I think knowing how the, you know, that time is passing is important because time blindness is a real issue. It's real. Yes. Not realizing that time is passing when you're having a good time and not realizing that this time will pass when something not so entertaining is happening. It's frustration of being stuck somewhere. [00:41:35] Can be very high kids, adhd,  [00:41:38] Maren: very frustrating. It can be the ultimate frustration. Absolutely. I've also heard that even having a, an analog clock on the wall can be very helpful just visually to see the minutes moving. Yeah. Can be very helpful. We've never really relied on that as much, but I know some people just absolutely depend on that, on the visual. [00:41:58] So anyway, [00:42:00] and I know there's,  [00:42:00] Tanya: I have a different timer for each of them. That's the visual one. Nice. The kind where, you know, you turn the dial and it shows in red how much time is left, and then it just keeps going down. But I have a different one for each of them because when we first started to do it, and I tried to say like, okay, everyone's gonna work on math for 30 minutes. [00:42:18] The stress level for all the different children was very different. Yeah. Yeah. And it was hard to kind of manage nowadays, like I, I truly let them choose what they're working on at any given time usually. Sure. Like if we're at seat work, you can choose whatever seat work you have for the week. Yeah. [00:42:31] And go forth and conquer. I mean, if you feel like doing math all day, great. If you feel like doing English all day, I am not going to micromanage. Yeah. That's amazing. Having to do eight subjects a day. Yes. But I think that each of them having their own, I just say like, you know, use your timer to help you. [00:42:46] That's, and I don't use them anymore myself, like with them. Mm-hmm. , I'm like, how long do you think this should take you? Is a good question. And then they can say like, I think it'll take 20 minutes. I think it'll take 10. And I'll be like, try, you [00:43:00] know, try and see if you can do it instead of like, definitely get it done. [00:43:03] And if it goes off, I always remind them like, okay, well, you know, you can set it again for the same amount of time if you think you didn't get far, or you can set it for like two minutes and see if you can wrap it up, you know, and then it becomes, Like a challenge, not so boring and not so not such a disappointment to themselves, you know, that they didn't finish in time. [00:43:23] It's like, it's fine. It's totally your timer, like you use it however you  [00:43:28] Maren: want. That's so, that's so, so empowering, and it goes back to your, oh, you know, believe, believe in your, in your kids. And if they say, this is what I think I can do it in, then, you know, give them that power and, and let them try it. [00:43:42] Another thing that I've, I've definitely noticed with kids with ADHD and people including myself, is trying things is sometimes the best learning. I mean mm-hmm. , it's so powerful to put that prac, you know, the trying it's almost like, it's almost like an [00:44:00] experiment and you find out yourself firsthand if something worked or. [00:44:04] It doesn't matter how many people tell you you know, the best practice or the best way to do this, you just have to try it and make lots of mistakes. And and sometimes that's just it. It can look like a lot of tough life lessons. Mm-hmm. . But I would never call any of them fail failures. . It's just really moving forward in a, in it's moving forward in a different direction and learning which way works best for you. [00:44:30] And, and, and then it's the most effective way because you've learned this path is the way that works. Because I know I've experienced all the other 10 ways and those didn't work, and now I absolutely a hundred percent no. This is the way I wanna go with full confidence. And so I think kids with ADHD when they're given that, like you just gave 'em that opportunity to like make those choices. [00:44:51] It might not look like a success that day, but I would a hundred percent call it, you know, it a success because they've figured out what doesn't [00:45:00] work or what does work. I mean, who knows? You never know. Yeah.  [00:45:04] Tanya: One of the most helpful things recently has been we've been putting Pomodoro timers up on the tv. [00:45:09] Awesome. YouTube on my phone you can search Pomodoro timer. The whole concept is that, you know, you work for a certain amount of time and you take a break and then you work for a certain amount of time, take a break, and you do a couple cycles of like 25 5 or you know, 30 10 and then you take a big long break. [00:45:23] And I think my kids have had so much fun picking the to Pomo do timer for the day. Like some of them will have like a color move across the TV screen as you get to completion. Mm-hmm. . Mm-hmm. , some of them will have a wheel. Some of them will just have, you know, as smr, a Hogwarts study room or whatever. [00:45:37] Yes. And they love it. And they've named the different Pomo do timers. So some of them are like Simon and Fred and I don't know how, they're just like, graphics so great, but like everything you can do to make it seem like you are. Team environment with them. And yes, the things that are giving us difficulty don't necessarily have to be not fun. [00:45:58] You know, maybe [00:46:00] there's people who never need a Pomo door timer and they just know how to work for an hour time. Sure, sure. None of us in our house are those people. No. And so this is like a really fun thing. You know, you start the day and you're like, what are we gonna like watch today? Like, you know, who's the character? [00:46:14] What sound are we gonna be in? Are we gonna be in this slithering room? Are we gonna be in a Hufflepuff room? And so you have this easy but productive way to like, you know, help yourself along in like a way. And I think that's important forever, right? Yeah. For our adult life too. I mean, the things we need help with don't all have to be boring and dull and like,  [00:46:37] Maren: Yes. [00:46:38] And I've used, I've actually used a Pomodoro app like that too, as kind of, I kind of think of it as a body double too, which is a lot of ADHD years. Talk about having a body double, just meaning there's somebody could be somebody, something could be a dog, it could be any pet that's near you. That just, it, it's almost just like a [00:47:00] companion a little bit mm-hmm. [00:47:02] and helps you get your work done. And there's just something about that. I, you know, I often like to work in the same room with my dog and it's just because, I don't know. I can, I feel like I can concentrate more. And this is a real thing for people with adhd and I think those Pomodoro apps are sometimes I put on, oh, we put on YouTube you know, chill hop and it's just a raccoon, you know, going for a walk around a lake and there's music and  [00:47:26] Tanya: the love. [00:47:27] That one. I never thought about it in the way you're describing that. It's like a companion, but it totally is. It is.  [00:47:32] Maren: It is.  [00:47:33] Tanya: Yeah. It's like having a friend with you. Like I always tell my kids, and again, this is because my son, like always be your own best friend. Like, if you would never beat up your friend verbally, you know, for a mistake they made really, for almost any mistake. [00:47:47] And I think that's the way it should be for our own self-talk. You know? So for them, I'm always like, when we melt down, when we have a negative thing happen mm-hmm. , like, who's responsible for that? We are ourselves, like we are in control of [00:48:00] ourselves. When you melt down, you're in control of that. When I melt down, I'm in control of that, but. [00:48:04] We shouldn't then beat ourselves up for it. Yeah. Because we should be our own best friend. We should say like, Hey, that did not go well . Right. Well, like, it's okay. Like, you know, you are loved, you are with your people. It's going to be okay. You love them, you're a good person. Like it's fine. You know? Yeah. [00:48:23] Like nothing is the end of the world. And I think sometimes, especially when we first come into parenting a child with adhd and you first experience this pushback. Mm-hmm. , you can feel like it's the end of the world. You can feel like, look at all these other people at the park whose kids are just like doing the things and like coming when called and like not throwing a fit because the swings are occupied or whatever. [00:48:45] And I think really learning to understand that it's not the end of the world. That this is just, you know, an opportunity to honestly be so much closer to your kids. It really is like, Oh,  [00:48:58] Maren: totally. I, [00:49:00] I, I can't agree with you more. And I do think, like, I do remember that feeling, especially when our, our oldest was diagnosed with adhd. [00:49:07] It was our first, you know, experience in the family with the diagnosis. And the psychologist just said, you know, she's probably never gonna, you know, when she gets changed at a restaurant or, you know, at a store is not gonna be able to count it right then and there and make sure it's the right amount because it's just, you know, it's too, it's too fast. [00:49:24] And, you know, it's just the, the whole environment is, is too stimulating. And it would just be, it, it's overwhelming at that point to like count the change. Right. And I just thought, oh no, in my mind just, just despair. But. I now think , oh my goodness, what a small price to pay for the brilliance of that ADHD mind in our family, and the contribution this amazing human is bringing to the world and continues and will continue to bring to the world. [00:49:59] I'm just like [00:50:00] so grateful for that. And I know, I, I just think kids with ADHD minds just are so brilliant, creative, innovative I think they're gonna be the change makers of the world. They're  [00:50:14] Tanya: often so friendly. Yes. They're so willing in spite of all of the, the negative kind of comments and reprimands and things. [00:50:23] They're so willing to have a good time. I think. Yes. You know? Yeah. On for sure. Larger scale. I, in our little co-op group, we have kids of all different, A small little group, but one of the moms in my group and a mom who has I think, incredibly well behaved children, you know? Mm-hmm. has four kids who are lovely little boys, and she did me like an enormous kindness because one day she came up and said, you know, I love seeing how Gabriel, who's so much older than the rest, you know? [00:50:48] Mm-hmm. definitely just like brings them like an idea, like there's a game, you're in an open field, there's nothing to do, but like, there's a game. There's a whole like adventure [00:51:00] planned, you know? It's always spontaneous and it's always something that engages everyone and involves people and. I see that so often with other kids, with adhd, like his friends, they come up with so many, you know, like interesting things. [00:51:13] Yeah. Like not the usual, we're never going on just a bike ride. We're never just, you know, at the park there's always like some sort of LA adventure going  [00:51:21] Maren: on . Exactly. Yeah. They may not sit for the lesson that you had in your mind that thought you thought were was gonna be this great, you know, experience. [00:51:30] But then later on the day they might come up with this great discussion topic that you have for like 45 minutes and you're like, whoa. That was like mind blowing compared to, you know, what I had planned. And so I just think if we can let go of our own expectations in those ways, they're like, the learning is really limitless. [00:51:51] All right. And  [00:51:51] Tanya: letting go of our own idea of how it should be. Yep. What it should look like.  [00:51:55] Maren: Exactly. All right. All right, Tanya. Well, thank you so much for being [00:52:00] here. I love talking with you about this so much. So I appreciate it so much. Where can we Great to talk to you too. Good, good. Where can we find you? [00:52:08] Tanya: The best place to find me are on Instagram at Project Tappy Home and on YouTube, project Tappy Home. YouTube has actually just started the the, I don't know what you call them, but the, where you have like a hashtag thing where it's at something. Oh, yeah. So you can use those now on YouTube and find people. [00:52:26] But if you wanted to hear about ADHD in particular because you have a child with adhd or you look ways to manage one thing or another. Mm-hmm. , I have a specific ADHD playlist on there. Awesome. And then everything else is homeschool related pretty much. Okay.  [00:52:41] Maren: Great. Well, thank you so much. Thanks so much. [00:52:45] Angela: Let's move on to our l t. Ws Loving this weeks. Angela, what do you loving this week? All right. I am loving an audiobook, . Nice. It is called Bad Vibes Only. Ooh, I'm [00:53:00] Nora McInerney. Okay. Nora, I just recently found her and love her, so she has her own podcast called Terrible Things for Asking. [00:53:11] Okay. Yes. And she talks about grief and she's also. Funny. So those two things kind of go together on her podcast. But I don't always listen to her podcast. But her book is just, it's just a series of essays, sort of memoirish love that. She's written a few different books, so I'm probably gonna go back, I don't know if this is similar to her other books, because she's. [00:53:35] Okay. She's a little bit younger than us. She's probably, I don't know, late thirties, maybe 40. Okay. She's a Minnesotan, so, and her voice is like so comforting to me. So she has that Minnesota accent, but also I love it. It's like, Also her voice is soothing. Mm. So I just love listening to her and I loved her book. [00:53:57] I related to like all the essays, [00:54:00] I related to them completely. And she's so great. It was funny and fun to listen to. It was like a fun listen. So I love that. And also, she's a great follow on Instagram. She's one of my new favorites and I think her Instagram handle is Nora Bali. And Okay. She's good there too. [00:54:18] So. And her pockets. Yeah. Favorite all the things that you just described are just that, just like you know, checks off a lot of boxes that I would like and a good audiobook. So yes. Like, I think you would like it mar because it's an easy, fun lesson. It's great. It will take your mind off other things, but also like [00:54:37] It's relatable. So awesome. Super relatable. Okay, . So, okay. What are you loving? Me? Okay, I'm loving. You know the box office winner, black Panther, Wakanda Forever? Oh yeah. You saw it? I did. Okay. Yes. Have you seen it yet? No. Okay. But a couple people in my family have. It's amazing. It is. Okay. So amazing. [00:54:59] And I [00:55:00] mean, I, because I love the first one so much too. I just, I came in like just on fire for this, and it did not disappoint. It did not disappoint at all. In fact, I was blown away. Oh, wow. Especially by the acting of the. The whole story is surrounded. I mean, it's based on the women. It is. It is a women led cast. [00:55:29] These actors are fa No, I just, I know that oftentimes Auction movies like this don't usually get the Oscar, you know? So you know, the actor, the actors don't get nominated or whatever. Yeah. I just think they need to, I really hope that changes this year, especially Angela Bassett. Oh yeah. I heard like best performance ever. [00:55:55] Her. That's awesome. And Latisha Wright who plays Surey, who, you know, [00:56:00] stepping up into this, you know, her new role. And it is just phenomenal. I I, it's so great. I love that they just put, you can tell they just put their all into this movie that everybody who was involved in it just mm-hmm. just doesn't fit it. [00:56:14] Nailed it. It was so great. That's awesome. I'm so glad to hear because it. Big shoes to fill it. And after, of course, after Chad Boot Chadwick Mosman died, you wonder how they're gonna handle that. So I'm just so glad they Yes, I do wanna see that. Definitely. Yeah. You're gonna love it. And I know you don't, you might not go to all the Marvel movies. [00:56:33] No. This is the one, but I will This one. Yes, you would. This one. And anybody else, if you're in that, you know, in that situation where you're like, I, I'm not gonna go see, you know, like Avengers five or whatever, . That's totally, I get that. But this is, you will, I think you're gonna really love this one. Okay. [00:56:49] That's awesome. That's a great story too. It just, you know, the story in and of itself, just this movie is so great. Mm-hmm. . So even if you haven't seen any of 'em, you'll love it. Yeah. Okay. [00:57:00] All right. Well thank you to our three sponsors, blare Out School at Night Zookeeper. Be sure to check out all of their links in our show notes. [00:57:10] This podcast is created and hosted by Angela Se and Marron Go. We are listeners supported to get extra content and the Back to School Summit free with your membership. Go to patreon.com/homeschool unrefined. Subscribe to our newsletter and get our free top 100 inclusive booklist@schoolunrefined.com slash newsletter. [00:57:33] You can find Mar on Instagram at unrefined and at always Learning with Mar. Find Angela at unfi. Angela. [00:57:42] [00:58:00]

CardioNerds Cofounder Dr. Amit Goyal is joined by Dr. Douglas Salguero (Internal medicine resident), Dr. Francisco Ujueta (Cardiology fellow), and Dr. Priscilla Wessly (Chief cardiology fellow) from the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami to discuss a rare case of isolated non-compaction cardiomyopathy. Expert commentary is provided by Dr. Christos Mihos (Director, Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Medical Center). Audio editing by CardioNerds Academy Intern, Shivani Reddy.   CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - Non-Compaction Cardiomyopathy Episode Schematics & Teaching The etiology has been a constant debate since 1980. It has been debated among researchers and clinicians whether LVNC is a physiologic or a pathologic manifestation. Waning et al., classified 327 unrelated patients into 3 categories: 1) genetic, 2) probably genetic, or 3) sporadic, identifying the most common mutations: MYH7, MYBPC3 and TTN in the genetic LVNC patients, which mostly encode for sarcomere, Z-disc and nuclear-envelope proteins. This supports the hypothesis that the inherited phenotype can arise from a gene mutation possibly during embryogenesis, disrupting the physiologic compaction of normally developing myocardium, which progresses from the base to the apex of the cardiac tissue. It is estimated that genetic LVNC accounts approximately 18-44% of cases, with autosomal dominant transmission being the most common form of inheritance. Physiologic remodeling with prominent trabeculations may be noted in athletes and pregnant women, in comparison to pathologic remodeling which may be encountered in patients with cardiomyopathy (e.g. pressure or volume load).  (1) There is no pathognomonic signs or symptoms in LVNC. LVNC patients may encounter various potential clinical characteristics. Presentations are myriad and include heart failure symptoms (HFrEF or HFpEF), ventricular tachycardia (VT/VF), atrial fibrillation, thromboembolism including cerebrovascular accident (CVA), and syncope. In a cohort of 95 probands with LVNC investigated in Europe, as many as 32.3% had an ICD/CRT-D implantation, with 11.8% experiencing a cardiovascular death and 18.2% having an appropriate ICD shock. (2) Imaging plays a key role in diagnosis for LVNC. The identification and diagnosis of LVNC is evaluated using 2D echocardiography. The initial proposed method by Chin et al., evaluated the size of the trabeculation in the center. (3) The most commonly used criteria, Jenni et al. (4), entail the following four finding: Two-layer structure, with a thin compacted layer and a thick non-compacted layer measure at end-systole at the parasternal short-axis view. LVNC is defined by a ratio of N/C > 2 Absence of co-existing cardiac structural abnormalities Prominent, excessive trabeculations and deep intra-trabecular recesses Recesses supplied by intraventricular blood on color doppler Cardiac MRI has increased the diagnostic accuracy in the diagnosis of LVNC. It has been suggested that a NC/C ratio of > 2.3 in diastole distinguished pathological non-compaction, with sensitivity of 86% and a specificity of 99%, respectively. Although studies have shown an increase specificity with cardiac MRI, caution is needed as it may overestimate the presence of LVNC. Late gadolinium enhancement which suggests myocardial fibrosis or scar has been shown to have some prognostic value in LVNC patients. (5) Management for LVNC is multifaceted. As above,LVNC has a variety of presentations and prevailing manifestations will differ among patients. Therefore, the diagnostic and management approach much be personalized for a given patient...

SHR # 2945:: Become Antifragile: Physiologic Flexibility - Dr. Mike T. Nelson, Ph.D - The concept of being antifragile eludes many people. Antifragile may seem like a play on words, but it's not. Antifragile harnesses damage for its hermetic effects and makes the being stronger and more durable than the un-theatend un-damaged being. There's a reason the time-tested saying "That which does not kill you makes you stronger". Learning to leverage the techniques that make one antifragile not only physically but from a nutritional standpoint is the scope of today's show. Brought to you by Mike T. Nelson - MikeTNelson.com - CARL RECOMMENDS: superhumanradio.net/carl-recommends - - View and download all shows at https://superhumanradio.net - Visit us on Instagram: @superhumanradio - Support SHR - https://superhumanradio.net/make-a-donation

Commentary by Dr. Valentin Fuster

In this episode, we review the high-yield topic of Physiologic Changes in Pregnancy from the Obstetrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Timestamps: Listen in to learn more about:[4:30] Akshay's recent Iceland expedition[6:50] How he keeps his mind from going in a downward spiral when things get hard[14:51] The duality of fear and nirvana[19:26] How Akshay spent 10 days in utter darkness[29:39] Learning to accept the unkowns[34:10] Akshay's thoughts on psychedlics to guide enlightenment[41:00] Developing a positive relationship with suffering[43:45] Progress and the development of new problems[45:59} Ways to suffer better[54:54] Praising effort not the result[1:00:27] The work lies in the day-to-day[1:03:06] Akshay's next adventure in AntarticaConnect with AkshayWebsite: FearvanaInstagram: @fearvanaAkshay's book: "Fearvana: The Revolutionary Science of How to Turn Fear Into Health, Wealth and Happiness."About  Akshay from Fearvana.com:After moving to Austin, Texas from Bombay, Bangalore and Singapore, I overcame a lifestyle of drug addiction that killed two of my friends in high school. When I then decided to join the United States Marine Corps, two doctors told me that boot camp would kill me, thanks to a blood disorder I was born with. But I wasn't about to let that stop me. Not only did I complete boot camp (with a twisted ankle, no less), but I was chosen as the honor graduate in Infantry school and went on to spend 7 months in Iraq where my job was to walk in front of our vehicle convoys to find explosives before they could destroy our vehicles.That was just the beginning of my understanding of the positive power of fear and struggle. In 2012, I left a comfortable corporate job to drag a 190-pound sled 350-miles across the world's second largest polar ice cap for a month. I've swam through underwater caves, almost been killed by a falling boulder while glacier caving, experienced severe altitude sickness while climbing in the Himalayas, and suffered through heat exhaustion while running across countries. But my greatest struggle came many years after the war. I was diagnosed with post-traumatic stress disorder (PTSD), and consequently struggled with depression and alcohol addiction that drove me to the brink of suicide. I then spent years studying neuroscience, psychology and spirituality to not only heal my own brain, but figure out what does it take to live a happy, succesful and meaningful life.That is when I rejected the label of PTSD assigned to me and created a new one – Fearvana. I define Fearvana as the bliss that results from engaging our fears to pursue our own worthy struggle. I then wrote a book about the concept called “Fearvana: The Revolutionary Science of How to Turn Fear Into Health, Wealth and Happiness.”Flex Diet Podcast SponsorThis podcast is brought to you by the Physiologic Flexibility Certification course. In the course, I talk about the body's homeostatic regulators and how you can train them. The benefit is enhanced recovery and greater robustness. We cover breathing techniques, CWI, sauna, HIIT, diet, and more. Enrollment opens Monday, September 5 and closes at midnight Monday, September 12.For more on this topic:Human Outliers Podcast: Keto & 2700 km Through Antarctica - Akshay Nanavati & Dr. Mike Nelson - Episode 282Aubrey Marcus Podcast: Akshay Nanavati On The Advantage of Fear | AMP #234Special Forces Experience: Pilgrimage in Costa Rica (plant medicine and more)Flex Diet Podcast Episode 111:  My Plan Medicine Experience with Ayahuasca and Kambo in Costa Rica 

You may have heard of coping in labor or pain management techniques, but when we say physiologic coping, do you understand what we mean?Physiologic birth has been all the rage the past few years, with everyone trying to get back to birth being a normal and physiologic process. It is an amazing movement in the right direction, but we realized something was missing. Coping. How can we help out patients' psyche to be able to progress in labor if we can't help them cope?In this episode of Happy Hour with Bundle Birth Nurses, Sarah will walk you through what Physiologic Coping is and how she plans to teach it next year in Akumal, Mexico to 400 L&D nurses.Have a topic request? Click here!

As always, feel free to send us questions, comments or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through instagram or twitter, @nicupodcast. Or contact Ben and Daphna directly via their twitter profiles: @drnicu and @doctordaphnamd. Papers discussed in today's episode are listed and timestamped below.enjoy!_______________________________________________________________________________________Show notes and articles can be found on our website: www.the-incubator.org/070-journal-club/This episode is sponsored by Chieisi

Joining us today at Maximal Being Fitness, Nutrition, and Gut Health is Nitasha Strait, a licensed marriage and family therapist, a certified sex therapist, an AAMFT approved supervisor, and also owner and CEO of The Better You Institute. Topics - Sex as a topic- Gender- Ethical non-monogamy- Physiologic sexual dysfunction versus psychosocial sexual dysfunction- Sexual compatibilityDoc Mok an advanced GI doctor specializing in nutrition, gut health, and cancer. Joining him is the podcast's layman, Jacky P, smashing the broscience on this week's podcast. Their guest If you enjoy the podcast, would you please consider leaving a short review on Apple Podcasts/iTunes? It takes less than 60 seconds, and it really makes a differenceReach out to us at team@maximalbeing.comOr https://www.maximalbeing.com/site/contactFREE STUFF3 NUTRITION HACKS (that Your Doctor Won't Tell You) FREE e-book: https://www.maximalbeing.com/3-nutrition-hacksThe Perfect Human Diet: A FREE 5 part training video: https://www.maximalbeing.com/the-perfect-human-dietWE CAN HELP YOUSign-up for our Kombucha Course: https://www.maximalbeing.com/kombuchaThe Meal Prep Bootcamp Course: https://www.maximalbeing.com/offers/oGLXwoof/checkoutNeed a Sustainable Nutrition Solution for Gut Health: https://www.maximalbeing.com/sustainable-nutrition-solutionOur sponsorsEmerson Ecologics (10% OFF All Supplements): https://wellevate.me/maximal-beingiHerb supplement BDB5528 and receive 10% off your orders: https://www.maximalbeing.com/iherbResourceshttps://www.maximalbeing.comhttps://thebetteryouinstitute.com/SocialFacebook: https://www.facebook.com/maximalbeing/Twitter: https://twitter.com/maximalbeingInstagram: https://www.instagram.com/maximalbeings/Pinterest: https://www.pinterest.com/maximalbeing/Linked'in: https://www.linkedin.com/in/maximal-being-13a5051a1/YouTube: https://www.youtube.com/channel/UCi7KVUF8U-gfhOE1KSNAqIgSupport the show

Joining us today at Maximal Being Fitness, Nutrition, and Gut Health is Nitasha Strait, a licensed marriage and family therapist, a certified sex therapist, an AAMFT approved supervisor, and also owner and CEO of The Better You Institute. Topics - Sex as a topic- Gender- Ethical non-monogamy- Physiologic sexual dysfunction versus psychosocial sexual dysfunction- Sexual compatibilityDoc Mok an advanced GI doctor specializing in nutrition, gut health, and cancer. Joining him is the podcast's layman, Jacky P, smashing the broscience on this week's podcast. If you enjoy the podcast, would you please consider leaving a short review on Apple Podcasts/iTunes? It takes less than 60 seconds, and it really makes a differenceReach out to us at team@maximalbeing.comOr https://www.maximalbeing.com/site/contactFREE STUFF3 NUTRITION HACKS (that Your Doctor Won't Tell You) FREE e-book: https://www.maximalbeing.com/3-nutrition-hacksThe Perfect Human Diet: A FREE 5 part training video: https://www.maximalbeing.com/the-perfect-human-dietWE CAN HELP YOUSign-up for our Kombucha Course: https://www.maximalbeing.com/kombuchaThe Meal Prep Bootcamp Course: https://www.maximalbeing.com/offers/oGLXwoof/checkoutNeed a Sustainable Nutrition Solution for Gut Health: https://www.maximalbeing.com/sustainable-nutrition-solutionOur sponsorsEmerson Ecologics (10% OFF All Supplements): https://wellevate.me/maximal-beingiHerb supplement BDB5528 and receive 10% off your orders: https://www.maximalbeing.com/iherbResourceshttps://www.maximalbeing.comhttps://thebetteryouinstitute.com/SocialFacebook: https://www.facebook.com/maximalbeing/Twitter: https://twitter.com/maximalbeingInstagram: https://www.instagram.com/maximalbeings/Pinterest: https://www.pinterest.com/maximalbeing/Linked'in: https://www.linkedin.com/in/maximal-being-13a5051a1/YouTube: https://www.youtube.com/channel/UCi7KVUF8U-gfhOE1KSNAqIgSupport the show

Connect with Dr. Mike T. Nelson: Website: https://miketnelson.com/ Check out Dr. Mike T. Nelson's Flex Diet Certification Course: https://flexdiet.com/   Connect with Ben:   RESOURCES:   Grab our FREE Fat Loss Fix Guide: https://www.bslnutrition.com/fat-loss-fix-guide/   Connect with Ben:   Join our Nutrition Community: https://www.smartnutritionmadesimple.com   Subscribe to our Youtube Channel: www.SmartNutritionMadeSimpleTV.com   Connect with us on Instagram: https://instagram.com/bslnutrition   As always, if you love what you hear on this show, then do me a favor and subscribe, leave a positive rating and review and share this episode with a friend or loved one whom you think could benefit. AND, if you want to talk about working with me personally, I'd love to chat, just schedule your free nutrition strategy call over at www.bslnutrition.com/levelup