Podcasts about podell

Solo 401(k)s let you think beyond retirement.Full show notes here.The Concierge CPAWith Jackie MeyerIn this episode of The Concierge CPA, Dr. Jackie Meyer welcomes back David Podell, founder of Business Benefits Consultants, to unravel the evolving world of retirement planning and its strategic value for business owners.MORE Jackie Meyer and The Concierge CPA | MORE CPA Trendlines Streaming NetworkPodell explains the solo 401(k)'s advantages over simpler plans like SEPs or SIMPLEs, dives into common mistakes business owners make, and shares how smart structuring — including leveraging Roth contributions and defined benefit add-ons — can elevate retirement planning from compliance to strategy.“Putting money in these retirement plans pulls money out of the business and creates a personal net worth," Podell says.MORE > > >  

The Promoter 101 Podcast featuring Iconic Booking Agent Jonny Podell who has working with a with a legendary talent line up that includes: Allman Brothers Band, Cyndi Lauper, Erasure, Peter Gabriel, Rosie O'Donnell, Yaz, Teddy Pendergrass, George Harrison, Crosby, Stills, Nash & Young and David Blaine. Hosted By: Works Entertainments' Luke Pierce + Emporium Presents' Dan Steinberg Direct Link: https://tinyurl.com/5n94myyy Email Dan + Luke: steiny@promoter101.net Amazon: https://is.gd/cgLbBp Facebook: https://www.facebook.com/promoter101 Google Music: https://is.gd/onEmSt iHeartRadio: https://www.iheart.com/podcast/promoter101-29260148/ Instagram: https://www.instagram.com/steinypromoter101/ itunes: https://itunes.apple.com/us/podcast/promoter101/id1163910658?mt=2 LinkedIn‬: https://www.linkedin.com/company/promoter101 Soundcloud: https://soundcloud.com/promoter101 Spotify: https://is.gd/T5SPEC‬ Spreaker: https://www.spreaker.com/user/promoter101 Website: http://www.promoter101.net/ YouTube: https://www.youtube.com/promoter101

CBS Sports NFL staff writer Garrett Podell joined the show. Garrett has the Steelers taking Georgia offensive lineman Monroe Freeling. He thinks that edge rusher could be an option. Garrett would take Ty Simpson over Beck, Allar, and Nussmeier but wouldn't take him in the first round. He thinks Nussmeier is the QB3.

Hour 2 with Bob Pompeani and Joe Starkey from PNC Park for the draft: CBS Sports NFL staff writer Garrett Podell joined the show. Garrett has the Steelers taking Georgia offensive lineman Monroe Freeling. He thinks that edge rusher could be an option. Garrett would take Ty Simpson over Beck, Allar, and Nussmeier but wouldn't take him in the first round. He thinks Nussmeier is the QB3. Steelers insider Nick Farabaugh of PennLive joined the show. Nick thinks the Steelers could trade up for Makai Lemon or Vega Ioane. Nick thinks if the Steelers stay, they pick Omar Cooper. Nick thinks Carson Beck or Drew Allar could be an option starting at pick No. 99!

Ty Simpson's last seven games were not good and Garrett thinks should have went back to college. Garrett doesn't view him as a first-round pick. He thinks Simpson will be a second-round pick. Alabama was very talented still. Garrett doesn't think Caleb Downs will fall past the Cowboys (12).

Hour 3 with Joe Starkey: CBS Sports staff writer Garrett Podell joined the show. Ty Simpson's last seven games were not good and Garrett thinks should have went back to college. Garrett doesn't view him as a first-round pick. Garrett doesn't think Caleb Downs will fall past the Cowboys (12). The Pirates dominated the Washington Nationals 16-5.

Seth and Sean discuss what Garrett Podell of CBSSports.com has the Texans doing with the 28th overall pick in today's Mock Draft Injection.

Seth and Sean dive into who Garrett Podell of CBS Sports has the Texans picking with the 28th overall pick in today's Mock Draft Injection.

Seth and Sean see who Garrett Podell of CBS Sports has the Texans picking with the 28th overall pick and assess if it sounds like a guy Nick Caserio would actually trade down to try to get in today's Mock Draft Injection.

Hour 3 with Joe Starkey and Donny Football: Garrett gives Mike McCarthy's tenure in Dallas a B to B+. McCarthy calls plays, but Garrett said the offensive coordinator does have an impact in the gameplan, red zone packages, and third down plays. Crowley reported that Andrew McCutchen met with Bob Nutting on Thursday. Pitt is decreasing capacity by 17,000 and will have over 51,000 on gameday instead of 68,000.

Garrett gives Mike McCarthy's tenure in Dallas a B to B+. It was the first time the Cowboys won 12 games three years in a row since the 90s. Garrett thinks McCarthy bringing Dan Quinn into his coaching staff was big and he's been able to adapt. McCarthy calls plays, but Garrett said the offensive coordinator does have an impact in the gameplan, red zone packages, and third down plays.

Doug Podell is a legendary Detroit and Cleveland rock radio on-air talent and Program Director. Doug is wrapping up a spectacular, 50-year career on Friday, December 5th, with his final broadcast on iHeart's 106.7 WLLZ Detroit.You've heard me mention "The Doc of Rock" Doug Podell many times over the years. He's part of a stable of on-air personalities that were a huge influence on me. I'm grateful for him and his career and I'm excited to share this. Congrats, Doug! Our Sponsors:* Check out Secret Nature and use my code ZANE for a great deal: https://secretnature.com* Check out Uncommon Goods: https://uncommongoods.com/zaneSupport this podcast at — https://redcircle.com/the-eric-zane-show-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

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In this episod,e Steven is joined by David Podell, a true specialist in the world of defined benefit plans. More traditional retirement accounts get a lot of attention, and rightfully so. Solo K's and SEP IRAs are more universally applicable, but for the right business owner, a defined benefit plan can supercharge their ability to put away qualified money. David shares from his extensive experience working alongside taxpayers and other financial advisors to design, implement and execute defined benefit plans. This episode is a must-listen for any financial advisor who is a business owner or works with them. https://zurl.co/Hjl5Y

In this episode of Building the Premier Accounting Firm, Roger Knecht interviews David Podell about defined benefit plans and tax strategies for business owners. They explore how accounting professionals can better advise clients on tax planning beyo†nd basic preparation, focusing on strategies to maximize tax benefits through retirement plans. In This Episode: 00:00 Welcome to Building the Premier Accounting Firm 00:54 Introducing David Pudel 02:05 The Journey into Tax Strategies 04:02 Tax Preparation vs. Tax Planning 05:42 Strategies for Business Owners 07:05 Maximizing Deductions with Defined Benefit Plans 09:06 The Accountant's Role in Tax Planning 11:10 Balancing Profitability and Tax Mitigation 12:37 Effective Personal Tax Strategies for Business Owners 15:40 Compensation Strategies Beyond W2 17:23 Understanding Defined Benefit Plans 20:20 Flexibility in Funding Defined Benefit Plans 23:01 Employee Benefits and Vesting 26:05 Identifying Candidates for Defined Benefit Plans 30:14 Understanding Tax Mitigation Strategies 32:36 401(k) vs. Defined Benefit Plans 34:18 Key Differences with Key Man Insurance 36:41 Income Qualifications for Pension Plans 39:12 Identifying Suitable Clients for Tax Strategies 41:25 The Role of Accountants in Tax Planning Key Takeaways:

2nd hour of the G-Bag Nation: NFL Writer for CBS Sports Garrett Podell joins the Nation to talk Cowboys O-Line building secret weapon; CNote: Cowboys News of the Evening; Crusty's Corner: Mock Draft & Offensive questions full 2440 Tue, 01 Jul 2025 00:23:32 +0000 EGgvVzfDqEtKQDzdtMbGRe68sBLC9MWy sports GBag Nation sports 2nd hour of the G-Bag Nation: NFL Writer for CBS Sports Garrett Podell joins the Nation to talk Cowboys O-Line building secret weapon; CNote: Cowboys News of the Evening; Crusty's Corner: Mock Draft & Offensive questions The G-Bag Nation - Weekdays 10am-3pm 2024 © 2021 Audacy, Inc.

Sports Research Editor & Writer for CBS Sports Garrett Podell joins the Nation to talk Dallas' secret weapon for building it's O-Line full 941 Tue, 01 Jul 2025 00:33:01 +0000 caB5SAR2opy1QnO34PXy9eZaQailX9Ti nfl,dallas cowboys,sports GBag Nation nfl,dallas cowboys,sports Sports Research Editor & Writer for CBS Sports Garrett Podell joins the Nation to talk Dallas' secret weapon for building it's O-Line The G-Bag Nation - Weekdays 10am-3pm 2024 © 2021 Audacy, Inc. Sports

Garrett wrote a story about Aaron Rodgers fits with the Steelers. The Steelers offensive line was 4th worst in the NFL in pressure rate last year. The Steelers had the 4th highest rate under center last year, but Rodgers was in shotgun 70% of the time last year. Garrett thinks they have to let Rodgers run a lot of plays Rodgers likes. Establishing the run and play action is going to be critical. Garrett agrees with Austin the Steelers are a 10 or 11 win team with Rodgers.

Hour 2 with Joe Starkey: CBS Sports NFL writer Garrett Podell joined the show. Garrett agrees with Austin the Steelers are a 10 or 11 win team with Rodgers. Could Ben Cherington save his job with Don Kelly turning the Pirates around? Jon Heyman thinks Donnie Kelly could ALREADY earn an extension! The Pirates are 15-14 with Don Kelly. We need to see Henry Davis, Spencer Horwitz, and Nick Gonzales take big steps.

Hour 3 with Joe Starkey: Garrett thinks the George Pickens trade is a no-lose situation for Dallas and if they let him walk will get a comp pick. Garrett thinks Drew Allar is better than Will Howard. Pirates fire manager Derek Shelton after 5+ seasons. We think it's the right move and Joe thought a move could happen today. Shelton has the third worst winning percentage in baseball history by a manager with over 700 games.

Garrett thinks the George Pickens trade is a no-lose situation for Dallas and if they let him walk will get a comp pick. Garrett thinks Drew Allar is better than Will Howard. Garrett says a lot of people think Arch Manning will be a multi-year starter at Texas. Allar could be the top quarterback in the class. If the Steelers sign Aaron Rodgers, they would be off Garrett's top 10 worst QB rooms.

Garrett Podell of CBS Sports joins Wisconsin Sports Daily to discuss his latest mock draft for the Packers! Garrett breaks down why he picked certain players where, and why he had the Packers draft certain positions in certain rounds.

CBS Sports NFL writer Garrett Podell joined JR to discuss the biggest stories coming out of the NFL owners meetings, including if there's any chance Aaron Rodgers doesn't sign with the Steelers, the future of the tush push, what Brock Purdy's contract could look like and Jerry Jones claiming he doesn't know the name of Micah Parsons' agent.

 NFL Writer for CBS Sports Garrett Podell joined the show to talk about the Panthers offseason, the future of Kirk Cousins, and the lack of moves from the Cowboys

Seth and Sean see what Garrett Podell of CBSSports.com has the Texans doing with the 25th overall draft pick in today's Mock Draft Injection.

Start - Front Page 19:25 - Someone's jersey was hung upside down 25:40 - Garrett Podell joined to talk NFL 41:05 - Quick baseball talk

Full Episode Description:In this packed episode, we're joined by veteran New England sports writer Erik Manzelli for an in-depth look at the NFL's most compelling storylines. From the coaching carousel to quarterback dynasties, we're covering it all.We kick things off with a fascinating exploration of the NFL's coaching landscape, analyzing Pete Carroll's remarkable achievement of landing a fourth head coaching position in his 70s and what it means for aged wisdom in the modern NFL. We'll also dive deep into Jacksonville's exciting hire of offensive mastermind Liam Coen and discuss Bill Belichick's potential next moves.The conversation shifts to the ongoing debate about the NFL's 17-game schedule format. Is it helping or hurting the game? Erik shares insider perspectives on player impact, international expansion, and the future of the NFL season structure.In our quarterback segment, we examine Patrick Mahomes' quest to surpass Tom Brady's legacy, Josh Allen's rivalry potential, and Jared Goff's surprising evolution in Detroit. Plus, we'll explore how young quarterbacks like Joe Burrow are navigating the modern NFL's challenges.Whether you're a die-hard NFL fan or just love great football discussion, this episode delivers fresh insights and expert analysis you won't want to miss.Key Topics:Pete Carroll's lasting impact on NFL coachingJacksonville's future under Liam CoenThe 17-game schedule debateMahomes vs. Brady legacy discussionModern QB development and rivalriesInternational game impact on teamsThe Niners had to make some tough decisions, including releasing their longest-tenured player, defensive tackle Arik Armstead. However, they quickly bounced back by signing edge rushers Leonard Floyd and Yetur Gross-Matos, as well as former Cleveland Browns defensive tackle Jordan Elliott. They also traded for defensive tackle Maliek Collins from the Houston Texans to bolster their interior D-line.CBS Sports' Garrett Podell was impressed with the 49ers' efforts, giving them a solid B-grade for their early free agency moves. Podell highlighted Floyd's elite status, noting that he's one of only three players with at least nine sacks in each of the last three seasons, alongside 2023 Defensive Player of the Year Myles Garrett and Pro Bowler Haason Reddick. He also praised the potential of Gross-Matos, suggesting that the 49ers could help unlock his talent, similar to what they did with Charles Omenihu.While the 49ers did miss out on signing former Los Angeles Chargers linebacker Eric Kendricks, who ultimately chose to join the Dallas Cowboys, it's not a major setback for the team. Kendricks was intended to be a fill-in starter for the injured Dre Greenlaw, so his absence doesn't significantly impact the 49ers' overall roster improvements.Of course, the 49ers still have other needs to address, particularly on the offensive line and in the secondary. But their workmanlike efforts in free agency so far have not gone unnoticed, and they deserve credit for their strategic moves.As a side note, Podell gave the Cowboys a D-grade for their free agency moves. Ouch!Stay tuned for more updates on the 49ers' offseason moves and all the latest news from around the NFL. That's all for today's episode of the StatsBeast Sports Podcast. Until next time, keep it locked right here on StatsBeast!AmazonVenmo - @jason-Stclair-09262CashApp - $stclair316Pay Pal DonationNordVPNThanks-Jason

Episode Title:Defined Benefit Plans Demystified: Expert Insights for Young CPAs with David PodellEpisode Summary:Co-host Hannah shares her experiences with tax planning and defined benefit plans, setting the stage for guest expert David Podell from Business Benefits Consultants. David demystifies defined benefit plans, emphasizing their relevance and tax advantages. The discussion covers identifying client opportunities, the importance of advisory roles, and resources for further learning.Episode Notes:"You could increase your retirement benefit, take money out of the business pre-tax, and I'm going to save you this on your taxes." -David PodellThe finer details of this episode:●       Common misconceptions about defined benefit plans and their relevance in modern financial strategies.●       Importance of collaboration with financial advisors, third-party administrators, and attorneys in implementing defined benefit plans.●       Resources available for CPAs to deepen their understanding of defined benefit plans and tax strategies.●       Encouragement for young CPAs to engage with clients and explore tailored financial solutions.Episode resources:●       Summit Virtual CFO by Anders website: https://www.summitcpa.net/●       Email us with questions or if you'd like to be a guest on the show: youngcpasuccessshow@anderscpa.com●       We're hiring! Check out our open positions: https://www.summitcpa.net/career-opportunities●       Check out Business Benefits Consulting! https://businessbenefitsconsultants.com/Timestamps:Introduction to the Episode (00:00:00)The host welcomes listeners and introduces the podcast's purpose for young accounting professionals.New Format Announcement (00:00:23)Hannah discusses the new episode format after attending a podcast convention, aiming for shorter content.Guest Introduction (00:01:00)Hannah introduces David Podell, an expert on defined benefit plans and tax planning.Complexity of Defined Benefit Plans (00:02:57)David explains the confusion surrounding defined benefit plans due to their complexity and lack of understanding.Multiple Players Involved (00:04:42)Discussion on the various professionals needed to manage defined benefit plans effectively.Trigger Words for Advisory Conversations (00:06:18)David shares key phrases that indicate a client may benefit from defined benefit plans.Selling a Business and Tax Structuring (00:08:13)Hannah discusses using defined benefit plans for tax benefits when selling a business.Retirement Planning and Asset Building (00:09:37)The benefits of using defined benefit plans for retirement savings while minimizing taxes.Plan Design Considerations (00:10:37)David emphasizes the importance of tailoring plan designs to meet specific client needs.Learning Resources for Defined Benefit Plans (00:12:46)David suggests resources for understanding defined benefit plans and associated terminology.Acronyms and Terminology Clarification (00:15:03)Discussion on common acronyms in the industry and the need for clear understanding.Importance of Coordination Among Advisors (00:16:25)The significance of having a coordinated approach among various financial advisors.Final Thoughts and Call to Action (00:19:09)David encourages listeners to evaluate clients who may benefit from defined benefit plans.Value of Defined Benefit Plans (00:20:06)Discussion on how defined benefit plans can enhance retirement benefits and provide tax savings.Call to Action (00:20:41)Encouragement for listeners to engage and ask questions about defined benefit plans.Contact Information (00:20:57)Details on how to reach Business Benefits Consultants for further inquiries and support.Gratitude and Reflection (00:21:30)Acknowledgment of the guest's insights and the value added to the listeners' understanding.Career Development Opportunities (00:21:41)Information on job opportunities for young CPAs at Summit Virtual CFO and Anders CPAs and Advisors.

Garrett Podell of CBS Sports joined the show to talk the Cowboys HC position and NFL playoff news.

Garrett Podell who covers The NFL and the Cowboys for CBS Sports joins the show to talk about the Cowboys win over the Panthers and the future in Dallas

Join us in this enlightening episode as Dana Podell, a renowned pelvic health physical therapist and yoga therapist from Chicago, unveils her journey from traditional healthcare burnout to the success of her private practice. Discover Dana's transformative strategies for client acquisition, maintaining a balanced schedule, and effectively merging diverse skills into a comprehensive service offering. This episode is packed with actionable insights for wellness entrepreneurs facing similar transitions. Learn how Dana not only tripled her patient list in under three months but also exceeded her financial goals through smart marketing and thoughtful scheduling. We'll dive into the crucial mindset shifts that are essential for turning expertise into enterprise, including the roles of coaching, community, and self-promotion. Whether you're a health practitioner or a wellness entrepreneur, Dana's story provides valuable lessons on expanding your reach while preserving your well-being. Don't miss out on these strategies that could redefine your approach to wellness and business. Key Links: Follow Dana on Instagram: @danaptyoga Visit Dana's website: danaptyoga.com Key Takeaways: Integration of Skills: Learn how to blend various qualifications for a holistic service delivery. Client Acquisition Strategy: Transform class attendees into dedicated clients with effective storytelling and engagement. Importance of Scheduling: Adopt a structured daily routine with breaks to boost productivity and prevent burnout. Value of Coaching: Explore how business coaching can fast-track your growth and ease the stress of entrepreneurship. Marketing Effectiveness: Fine-tune your messaging to strike a chord with your target audience, enhancing both engagement and sales. Tune in to learn how you can replicate Dana's success in your own wellness practice! Follow me on Instagram →  igniteyourwellnessbusiness Ready to work with me? Book a coaching call on my website! → https://igniteurwellness.com/business-coach-for-health-coaches/ Get the free guide with the 6 Figure Workshop System so you can sign more wellness clients into your business: https://igniteurwellness.com/6-figure-lead-generation-workshops/ --- Support this podcast: https://podcasters.spotify.com/pod/show/ignite-ur-wellness-biz/support

Hour 3 with Joe Starkey: CBS Sports NFL writer Garrett Podell thinks Davante Adams would be a good fit in Pittsburgh. The Steelers scheme and personnel is contributing to the poor amounts of offense. Steelers insider Mark Kaboly of The Pat McAfee Show believes this could be the last hurrah for Justin Fields in Las Vegas and thinks Russell Wilson will start next week against the Jets.

The Cowboys running attack found success against the Steelers and Garrett shared what he saw on tape how the team can improve. The Steelers scheme and personnel is contributing to the poor amounts of offense.

In this insightful podcast episode, tax mitigation expert David Podell shares his expertise on creative pension plan designs and defined benefit plans to help high-net-worth individuals reduce their taxable income. Learn how cash balance plans can significantly enhance your retirement savings and unlock large deductions while maintaining flexibility. David explains the importance of working with the right financial advisors, CPAs, and consultants to optimize your tax-saving strategies and avoid common pitfalls like overfunding your retirement plan. Discover how you can secure your financial future with these advanced tax planning techniques. Disclaimer: Not advice. Educational purposes only. Not an endorsement for or against. Results not vetted. Views of the guests do not represent those of the host or show. Do your due diligence. Click here to join PodMatch (the "AirBNB" of Podcasting): https://www.joinpodmatch.com/drchrisloomdphd We couldn't do it without the support of our listeners. To help support the show: CashApp- https://cash.app/$drchrisloomdphd Venmo- https://account.venmo.com/u/Chris-Loo-4 Spotify- https://podcasters.spotify.com/pod/show/christopher-loo/support Buy Me a Coffee- https://www.buymeacoffee.com/chrisJx Click here to schedule a 1-on-1 private coaching call: https://www.drchrisloomdphd.com/book-online Click here to check out our e-courses and bookstore here: https://www.drchrisloomdphd.com/shop Click here to purchase my books on Amazon: https://amzn.to/2PaQn4p For audiobooks, visit: https://www.audible.com/author/Christopher-H-Loo-MD-PhD/B07WFKBG1F Follow our YouTube channel: https://www.youtube.com/chL1357 Follow us on Twitter: https://www.twitter.com/drchrisloomdphd Follow us on Instagram: https://www.instagram.com/thereal_drchrisloo Follow us on Threads: https://www.threads.net/@thereal_drchrisloo Follow us on TikTok: https://www.tiktok.com/@drchrisloomddphd Follow our Blog: https://www.drchrisloomdphd.com/blog Follow the podcast on Spotify: https://open.spotify.com/show/3NkM6US7cjsiAYTBjWGdx6?si=1da9d0a17be14d18 Subscribe to our Substack newsletter: https://substack.com/@drchrisloomdphd1 Subscribe to our Medium newsletter: https://medium.com/@drchrisloomdphd Subscribe to our email newsletter: ⁠https://financial-freedom-for-physicians.ck.page/b4622e816d⁠ Subscribe to our LinkedIn newsletter: https://www.linkedin.com/build-relation/newsletter-follow?entityUrn=6992935013231071233 Thank you to our advertisers on Spotify. Financial Freedom for Physicians, Copyright 2024 --- Support this podcast: https://podcasters.spotify.com/pod/show/christopher-loo/support

Garrett Podell of CBS Sports joins the show to talk about Bryce Young being benched and week 3 of the NFL.

JONATHON E. STEWART is a screenwriter best known for Pixar / Disney's Cars 3, Smallfoot, Angry Birds 2 and 2020 Scooby-Doo reboot SCOOB. With writing partner Eyal Podell, Stewart has written screenplays for Dreamworks, Universal, Warner Bros., Paramount, ABC Studios, STX, Paramount Animation, Sony Animation, Fox Animation, Netflix Animation and served on Pixar's Braintrust from 2013-2014. Stewart's inspired-by-true-LGBTQ-events TV drama pilot Grace sold to ABC Studios in the fall of 2016, and modern update on the Dickens classic Two Cities in fall 2017. In 2012, Podell & Stewart's screenplay Seuss—a biopic about the legendary author—earned the #2 slot on Hollywood's Black List. Stewart is also currently working with New York Times best selling author and lifestyle entrepreneur, Lewis Howes, to develop a feature inspired by world-renowned jazz violinist, composer and educator, Christian Howes. Stewart's venture, NarrativeDrive.org, aims to mentor new, diverse and previously undiscovered voices in screenwriting, ultimately serving to have their work translated to the screen. www.jstew.com https://www.narrativedrive.org/ @JEStew3 Learn more about your ad choices. Visit megaphone.fm/adchoices

Dan Bernstein, Laurence Holmes and Leila Rahimi were joined by Garrett Podell of CBS Sports to discuss expectations for the Bears in a more competitive NFC North.

In the third hour, Dan Bernstein, Laurence Holmes and Leila Rahimi were joined by Garrett Podell of CBS Sports to discuss expectations for the Bears in a more competitive NFC North. Dan, Laurence and Leila then reacted to Sky rookie forward Angel Reese being named to the WNBA All-Star team. Later, Rahimi explained why she's taking Bears general manager Ryan Poles' comments about being impressed by rookie Caleb Williams in practice at face value.

Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. In this episode, Lyell Jones, MD, FAAN, speaks with Jamie E. Podell, MD, an author of the article “Traumatic Brain Injury and Traumatic Spinal Cord Injury,” in the Continuum June 2024 Neurocritical Care issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Podell is an assistant professor in the department of neurology, program in trauma at the University of Maryland School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Traumatic Brain Injury and Traumatic Spinal Cord Injury Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @jepodell Transcript Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier, topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening.   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Jamie Podell, who has recently authored an article on traumatic brain injury and traumatic spinal cord injury in the latest issue of Continuum on neurocritical care. Dr Podell, welcome. Thank you for joining us today. Why don't you introduce yourself to our audience and tell us a little bit about yourself?   Dr Podell: Thanks, Dr Jones. It's great to be here. As you mentioned, I'm Dr Podell. I'm neurocritical care faculty at University of Maryland Shock Trauma. I have a primary interest in traumatic brain injury, both from a research and clinical perspective. I previously have more of a cognitive neuroscience background, but I think it kind of ties into how I think about TBI and outcomes from traumatic brain injury. But what I really like doing is managing acutely ill patients in the ICU, and I think TBI really affords those kinds of interventions, and it's a really rewarding kind of setting to take care of patients. Dr Jones: Yeah, and I really can't wait to talk to you about your article here, which is fantastic. For our listeners who might be new to Continuum, Continuum is a journal dedicated to helping clinicians deliver the best possible neurologic care to their patients, just like Dr Podell was talking about. We do that with high quality and current clinical reviews, and Dr Podell's article - it's a massive topic - traumatic brain injury and traumatic spinal cord injury. And, you know, as we start off here, Dr Podell, we have the attention now of a massive audience of neurologists. If you had one most important practice change that you would like to see in the care of these patients who have trauma, what would that practice change be? And, I think, maybe, we'll give you two answers, because you cover TBI and you cover spinal cord injury. What would be the most important practice changes you'd like to see?   Dr Podell: So, this isn't that specific, but I think it's really important. I think we need more neurologists, and specifically neurointensivists, managing these patients. I think there's a lot of variability across institutions and how acute severe TBI and spinal cord injury patients are managed. They're often in surgical ICUs, and neurology may be involved in consultation but not in the day-to-day management. But I think what we're seeing is that, you know, there's a lot of multisystem organ dysfunction that happens in these patients, and that has a really strong interplay with neurologic recovery and brain function. And I think, you know, neurointensivists are very well equipped to think about the whole body and how we can kind of manipulate and really aggressively support the body to help heal the brain with special attention to, kind of, the nuance of any individual patient's brain injury. Because TBI is extremely heterogeneous and there's not just a cookie-cutter script for how these patients can be managed, I think, you know, people like neurologists, neurointensivists who have a lot of attention to the nuance - that's really helpful in their management.   Dr Jones: I'm so glad you said that, and not just because I'm a neurologist who's a fan of neurologists, but I do think there are some corners of neuroscience care where neurologists could be a little more present - and trauma definitely seems like one of those, doesn't it?   Dr Podell: Yeah, I think it's tough, because some patients with severe TBI and spinal cord injury can have a lot of multisystemic trauma with, you know, pulmonary contusions, intraabdominal pathology - you need to go to the OR for their other injuries, and so I think it really makes sense to have kind of a collaborative multidisciplinary approach to these patients, but I think neurologists should play a very big role in that approach, however that's done (there are lots of different ways that it's done). But I think having a primary neurology-trained neurointensivist – I know I'm biased, but I think that's where I'd like to see the field moving.   Dr Jones: And, obviously, neurocritical care is an intuitive place for neurological trauma care to start, and even with the sequelae of downstream things, I think neurologists could be more engaged. I wonder if neurology hasn't historically been as involved because it's sort of gravitated to surgical specialists. And I think part of it is, you know, trauma is not usually a diagnostic mystery, right? The neurologist can't pretend to be Sherlock Holmes and try to figure out what's going on when it was pretty clear what the event was, right?   Dr Podell: Right. Yeah, I agree with both of those points. I think, for one, I think postacute care is also a big area where neurologists can be involved more - and patients kind of fall through the cracks. A lot of times, these patients will just follow up with a neurosurgeon and get a repeat head CT and it'll look stable. We started implementing post-TBI neural recovery clinics, which I think other places are starting to do as well, and I think that's kind of a good model for getting neurologists involved - but also, rehab specialists are involved in that. But in terms of, yeah, the diagnostic mysteries and stuff, I think there still can be some, though, with TBI. Yes, obviously, the initial primary insult is obvious, but the secondary pathology that can happen in patients is really nuanced, and it is so variable, and, sometimes, it does take that detective eye to see, “Oh, this patient has one cerebrovascular injury, their risk of stroke to this territory? How are we going to manage it? and thinking about all the kind of sources of secondary decline that are possible. I think it takes that neurology detective sometimes to think about, too.   Dr Jones: Yeah. We never stop pretending to be detectives, right?   Dr Podell: Yeah.   Dr Jones: And on a related note, you know, in your article, you mentioned some of the novel serum and electrophysiologic and imaging biomarkers that are being used to care for these patients. How are you using those in your practice, Dr Podell?   Dr Podell: That's a good question. I think, unfortunately, as with a lot of clinical care, the clinical care does kind of lag behind the research and what we know what we can learn about these patients and their outcomes through retrospective studies. So, to be completely honest, you know, even the serum studies that I mentioned in the article (like GFAP, UCH-L1) - those kind of things, that's not clinically available at our institution. We don't use those. I think a lot of the imaging biomarkers that we see, some of them are coming from more advanced imaging – like, we're talking about FMRI - that requires a lot of post processing (so, again, we're not necessarily using that clinically). But what I would say is that we use imaging to kind of try to predict what complications patients might be at risk of and to try to predict their clinical course. And I think it comes down to trying to break down the heterogeneity of these patients and to try to kind of lump them into different bins of, “What's this patient at risk for?”, “What's their trajectory going to be like?”, “When can I start peeling back how aggressive I am with this patient?”. And, so far, I don't think any of the markers that we have are really clear black-white prescriptive indicators of what to do (I don't think we're quite there yet). So, again, I think we just kind of use all of the data in combination to come up with a management plan for these patients. I think some of the markers, (like some of the electrophysiologic markers), looking at EEG for things like background can provide prognostic information, especially in patients who are comatose that you're wondering about if they're going to wake up (so a lot of this can inform family discussions). But, you know, we used to think that grade three diffuse axonal injury on MRI portended a very poor prognosis (and in the past, some surgeons and ICUs might use that to limit care in patients), but more and more, we're finding that even that is quite nuanced and we're detecting more and more diffuse axonal injury on images in patients who then wake up, or have already woken up and they have the MRI later, and you're like, “Hmm, they had DAI. It's a good thing you didn't get the MRI early and decide not to move forward with aggressive care”. But, I think, in a patient who's comatose and you don't have a good explanation, sometimes, looking for those additional biomarkers to explain what kind of injury pathology you have can just provide more information for families.   Dr Jones: Yeah, and that's a great point that comes up in a lot of our articles and interviews (that the biomarkers really do have to be in a clinical context). So, if I understand you correctly, really, no individual biomarker that has emerged as a precise predictor or prognosticator for outcomes - but you do talk a lot about recent advances in the care of these patients. What would you want to point out to our listeners that's come up recently in the care of trauma?   Dr Podell: Yeah. I think the evidence basis for severe TBI is limited because, again, there's so much heterogeneity and different things going on with different patients, but some of the evidence that has come out more recently involves, kind of, indications for surgical procedures and the timing of those procedures. Some of that is still kind of expert consensus-based. But, for example, doing a secondary decompression for elevated ICP with the DECRA and RESCUEicp trials. We do have better high-quality evidence that doing a secondary decompression for more refractory, elevated ICP can improve both mortality and functional outcomes in patients, so that has kind of become more standard of care. Additionally, I think timing for spinal cord injury, neurosurgical procedures - that's been a topic that's been studied in more evidence-based to perform earlier decompressive surgeries. And then, I think, you know, more and more is emerging just about the pathophysiology of secondary injury - and some of those things haven't necessarily translated to what to do about it - but we've learned about things like cortical spreading depolarizations being associated with worse outcomes in traumatic brain injury, and we've also identified that ketamine or memantine can both actually stop those cortical spreading depolarizations. But the overall impact of managing them is still unknown, and the way that we detect those, it requires an invasive electrocorticography monitor which not all centers have. So, I think, one of the important things as we move forward in TBI care is, as we get this better mechanistic understanding of some of the pathophysiology that's happening in these TBI patients, figuring out a way to be able to translate that across all clinical settings where you can actually do the monitoring invasively - that's also an issue we see. Even intracranial pressure monitoring is pretty standard of care, but not all centers do that, and we have to be able to apply practice recommendations to centers where there isn't necessarily access to the same things that we have at large academic trauma centers.    Dr Jones: Got it. Obviously, there's a lot of research in this area, a lot of clinical research, and I'm glad you mentioned the secondary injury - things that are happening at the tissue level are important for us to think about. As the care of patients with trauma has evolved (and I'm thinking now of patients with spinal cord injury), we still see patients who receive high-dose corticosteroids in the setting of acute spinal cord injury - and obviously, that's something that's evolved. Can you tell our listeners a little bit more about what they should be doing when they're seeing a patient with a traumatic spinal cord injury?   Dr Podell: Yes. So, the steroids story for spinal cord injury is kind of interesting. There were a series of trials called the NASCIS trials that looked at corticosteroids and spinal cord injury, and they were initially interpreted that high-dose steroids had a beneficial effect on spinal cord injury recovery - but then, kind of in relooking at the data and recognizing that these were kind of unplanned subgroup analyses that showed benefit, and then looking at kind of pooled reanalysis and meta-analysis of all the data out there, it was determined that there actually was no clear benefit from steroids and that there was a clear incidence of more complications from high-dose steroids. So, in general, corticosteroids are not recommended for spinal cord injury. Same for traumatic brain injury, too (even though some people will still give steroids for that) - there was a CRASH study that looked at corticosteroids in TBI and found worse outcomes in TBI (so there actually is high-level evidence not to use steroids in that case). That's not to say that there's not an inflammatory process that's going on that could be causing secondary injury - I think that's still, really, you know, an area of active research is to try to figure out what is the balance between potential adaptive mechanisms of inflammation that are happening versus more maladaptive sources of secondary injury from inflammation and how and when do we target that inflammation to improve outcomes. So, there's still, I think, more to come on that.   Dr Jones: And, you know, we are guided by evidence, obviously, but also, we learn from our experience as clinicians. You work in the neurocritical care unit. You take care of all patients with critical neurologic problems. When it comes to TBI and spinal cord injury, what kind of management tips or tricks have you learned that would be good for our audience to hear?   Dr Podell: I think the way that I would sum it up is that you should be very aggressive - supportive care early on, and then thoughtfully pull back and let the brain and spinal cord heal itself. And, you know, the patients come in with TBI (for example) very sympathetically aroused. They do need sedation, they need blood pressure support, they need mechanical ventilation - they need help kind of maintaining homeostasis. And other autonomic effects with spinal cord injury happen, too - you get neurogenic shock (you need very aggressive management of blood pressure, volume assessments), you know, in both cases in trauma patients, managing things like coagulopathy - but, you know, over time, usually, these things start to, kind of, heal themselves to some degree. And then, kind of thoughtfully figuring out when you can peel back on the different measures that you're doing to support them through their acute injuries. Different protocols have been developed, and the Brain Trauma Foundation has developed evidence-based guidelines that have improved (just having a protocol, we know, improves) trauma outcomes overall at centers - but I think those protocols are just guidelines, and you really have to pay attention to the individual patient in front of you. For TBI, for example, our guideline will say to aggressively manage fever within the first seven days with surface cooling. But in a patient that, for example, developed kind of a stroke or progressive cerebral edema even on day five (or something) you're looking at them, and on day seven, they're still having a lot of swelling in their brain, I'm not going to peel off the temperature management. So, there is nuance - you can't just kind follow a rule book in these patients.   Dr Jones: Got it. And I think that point about aggressive support early is a good takeaway for any listeners who might be engaged in the care of these patients. You know, I imagine working in that setting and taking care of patients who are in the midst of a devastating injury - I imagine that can be pretty challenging, but I imagine it could be pretty rewarding as well. What drew you to this particular area of interest, Dr Podell, and what do you find most exciting about it?   Dr Podell: A lot kind of converged for me in this area. I went into neurology thinking I would be a cognitive neurologist. I had more of a neuroimaging background and an interest in neural network pathology that certainly happens to patients with TBI (and patients with TBI often will have neuropsychiatric and neurocognitive problems after injury). But then, during residency, I found myself. My personality clicked in the ICU, and I just liked managing sick patients - I liked the pace of it, I also really liked it. It's kind of a team sport in the ICU with multiple people involved - the bedside nurses, respiratory therapists, neurosurgeons, trauma surgeons - all working together to figure out the best management plan for these patients, so you don't feel alone in managing them. And not all outcomes are good, obviously, but you can see people get better even during their course of their ICU stay - and that's really, really rewarding. And I think what we're seeing even in the literature following patients out longer and longer, the recovery trajectory for TBI is different than what we see in other neurologic injuries (like stroke, where the longer you go - up to ten, twenty years, even - people are still improving). I think the idea that you can keep hope alive for a lot of these patients and try to combat any kind of nihilism - obviously, there's a time and place for that after a really devastating injury, but I've seen a lot of patients who are really, really sick, needing therapeutic hypothermia, barbiturate coma, decompression, still then recovering and being able to come back into the ICU and talk to us.   Dr Jones: We might have some junior listeners who are thinking about behavioral neurology or neurocritical care, and it's probably - I don't know if it's reassuring, or maybe concerning, to them to know that they might swing completely to the other end of the spectrum of acuity, which is kind of what you did.   Dr Podell: Yeah, and what I'm trying to do now is, I'm very interested in autonomic dysfunction that happens in these patients. It's related a lot to multisystem organ dysfunction and, I think, may contribute to secondary injury, too, with changes in cerebral perfusion, especially in patients who have storming or even just the early autonomic dysregulation that happens early on. I think it's induced by neural network dysfunction from the brain injury, kind of similar to the way that there are other phenotypes that would be induced by neural network dysfunction (like coma).  So, we're trying to look at MRIs of acute TBI patients and trying to identify what structural imaging pathology then gives rise to these different kinds of clinical phenotypes - trying to bring it back to this neuroscience focus.   Dr Jones: Well, that gives us and our listeners something to look forward to, Dr Podell. And again, I just want to thank you for joining us, and thank you for such a great discussion on the care of patients with TBI, and spinal cord disorders and thank you for such a wonderful article.   Dr Podell: Thank you very much. It is my pleasure.   Dr Jones: Again, we've been speaking with Dr Jamie Podell, author of an article on traumatic brain injury and traumatic spinal cord injury in Continuum's latest issue on neurocritical care. Please check it out. And thank you to our listeners for joining today.   Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this article. Thank you for listening to Continuum Audio.  

Garrett Podell of CBS sports joins the show

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Ariane Lewis, MD, who served as the guest editor of the Continuum® June 2024 Neurocritical Care issue. They provide a preview of the issue, which published on June 3, 2024. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Lewis is a professor of neurology and neurosurgery and director of the Division of Neurocritical Care at NYU Langone Medical Center in New York, New York. Additional Resources Continuum website: ContinuumJournal.com Subscribe to Continuum: shop.lww.com/Continuum More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access to exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the Show Notes. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Ariane Lewis, who recently served as Continuum's guest editor for our latest issue on neurocritical care. Dr Lewis is a Professor of Neurology and Neurosurgery at NYU, where she serves as the Director of the Division of Neurocritical Care. Dr Lewis, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Tell us a little bit about yourself. Dr Lewis: Thank you so much for having me, Dr Jones. It was a pleasure to be an editor of this issue, and I'm really excited for it to come out. As you mentioned, I'm a Professor of Neurology and Neurosurgery at NYU. I'm also a fellow of the American Academy of Neurology and a fellow of the Neurocritical Care Society. I serve on the Ethics Law and Humanities Committee for the AAN. I was a past chair of the Ethics Committee for the Neurocritical Care Society and also the past chair of the Ethics Committee at NYU. Dr Jones: So, pretty diverse professional interests. And I was going to ask you about the ethics - that feels like something that ties in pretty well to neurocritical care. I imagine that expertise comes in handy, right? Dr Lewis: Yes, absolutely. My area of expertise is related to brain death and ethical, social, and legal complications related to brain death determination. Dr Jones: Got it. And when we were talking before we started recording here, you're from the New York area and a lifelong Yankees fan, is that right? Dr Lewis: Yes, that's correct. Dr Jones: How are they going to do this year? Dr Lewis: We're hoping we're going all the way. Dr Jones: Okay. Dr Lewis: In a while. Dr Jones: Our listeners heard it here first. So, the issue – let's get into the neurocritical care topics – phenomenal issue, full of detailed diagnosis and management strategies for patients with, you know, all manners of severe neurologic disorders requiring critical level of care. With your perspective (which is a unique perspective) - you've just edited a full issue on neurocritical care, you got to delve into all the topics - what were you most surprised to learn, Dr Lewis? Dr Lewis: Well, you know, I think that one of the most exciting things about this issue is the fact that, in addition to dealing with the typical topics related to neurocritical care - like hypoxic ischemic brain injury and stroke and intracerebral hemorrhage and subarachnoid hemorrhage, of course - the issue delves into some very unique topics related to neurocritical care. There's an article written by Dr Barry Czeisler that focuses on emergent management of tumefactive and aggressive demyelinating disorders, Dr Casey Albin wrote about neuromuscular emergencies, and doctors Maciel and Busl wrote about neuroonc emergencies – and I think that these areas are really important areas for neurologists and trainees to know about, and they're not talked about all that often. And these topics are often focused on, of course, by other subspecialties, but the perspective of a neurointensivist related to these topics is infrequently addressed. So I think that these are really the most exciting aspects of this issue, because it's something so unique in terms of the spin on these topics. Dr Jones: Fantastic. And what else can we look for in this issue? What other topics can our listeners and readers expect to find there?  Dr Lewis: So, the issue starts off with the examination and workup of the neurocritical care patient. Dr Sarah Wahlster and Nick Johnson from the University of Washington did an awesome job really bringing the reader into the topic of neurocritical care as they address an overview of neuroemergencies, red flags related to life-threatening conditions, herniation syndromes, vascular territories, and mechanisms and management of acute neurodeterioration, and they summarize monitoring modalities in neurocritical care and clinical and radiographic scales and scores that are commonly used in neurocritical care – and that's a really nice overview to introduce the reader to this issue. The rest of the issue focuses on a wide range of topics pertaining to the emergent management of neurocritical care issues, including hypoxic ischemic brain injury (which was addressed by Dr Steinberg from the University of Pittsburgh),  management of stroke due to large vessel occlusion (which was addressed by Dr Leslie-Mazwi from the University of Washington), management of ICH (addressed by Dr Murthy from Weill Cornell), and then also management of spontaneous subarachnoid hemorrhage (addressed by Dr Soojin Park). Dr Clio Rubinos addressed emergent management of status epilepticus. Emergent management of TBI and spinal cord injury was addressed by Dr Podell and Dr Morris from the University of Maryland. And then neuroinfectious emergencies – which, again, is another unique topic in this issue – was  addressed by Dr Reynolds from Mount Sinai. And then the issue concludes with a paper that focuses on prognostication and neurocritical care by Dr Susanne Muehlschlegel from Johns Hopkins University.  Dr Jones: Yeah. And what a great list of authors and expertise. And really, you know,  having seen these articles, really just phenomenal guidance on a lot of different subtopics. And I imagine – you know, this is a dynamic area, there's a lot of evidence – but, you know, sometimes, there are controversies or debates or unresolved questions in the field. Having just reviewed and edited the issue, what do you think the biggest debate or controversy is in neurocritical care right now?  Dr Lewis: So there's definitely a lot of controversies that are addressed in each of these individual articles. For example, in the paper on subarachnoid hemorrhage, Dr Soojin Park provides a summary that compares the guidelines on management of subarachnoid hemorrhage that were written by the Neurocritical Care Society and the American Health Association / American Stroke Association in 2023 and really walks through what's similar and what's different between these guidelines. For the most part, they are very similar, but there are areas of differences. Additionally, in terms of management of acute neuroemergencies related to neuromuscular issues (in some cases, it's not clear whether to treat patients with IVIG or with plasmapheresis), Dr Casey Albin creates a nice summary addressing these issues in terms of what are the pluses and minuses associated with each of these medications. Additionally, there are a number of novel therapies that are not traditionally considered for various neuroemergencies that are walked through in each of the individual articles. For example, in the paper that focuses on management of status epilepticus, Dr Rubinos addresses alternative therapies, like immunomodulatory agents or neuromodulation, for management of super-refractory status epilepticus. So, I think, in addition to addressing the more traditional therapies for various neuroemergencies, the issue really goes above and beyond to address novel interventions.  Dr Jones: That's fantastic. And obviously, it continues to be a rapidly evolving area.  When you look out to the horizon – and the next generation of care for patients with critical neurologic illness – what do you see on the horizon? What should our listeners and readers be aware of to watch out for?  Dr Lewis: I think one thing that is really important to be aware of related to patients with neuroemergencies is the Curing Coma Campaign (which is organized by the Neurocritical Care Society), which focuses on research in terms of improving the clinical management, the prognostication, and the care of patients and addresses the goals for  improving recovery for patients who are comatose. And obviously, coma can be due to a wide range of different etiologies (many of which are described in this issue), and so I think that their work as we move ahead will be incredibly important and interesting to see how things evolve in that domain. Dr Jones: We will be on the lookout for the Curing Coma Campaign – sounds like a great initiative. And, I think, medicine is a team endeavor, right? We were talking about the Yankees earlier (baseball) as a team sport – so is medicine. When you think about the importance of teams, it's hard to imagine a setting where it's more critical to have, you know, well-functioning teams than in the neuro ICU. But there's also parts of the team (people on the team) who are outside the neuro ICU – and I'm thinking of other neurologists, our listeners and readers who might work in the inpatient setting, but not in this really specialized environment. When you think about those neurologists, is there a key message for those hospitalist neurologists or inpatient neurologists that you would want to share from your perspective as a neurocritical care specialist?  Dr Lewis: So, I think it's imperative for all neurologists to have an understanding of the existence of various neuroemergencies and the identification of when a patient is  having a neuroemergency so that they can escalate the management if it's something beyond their skills or expertise to somebody who is capable of appropriately managing the patient. Each of these articles walks through the differential diagnosis, the identification of the neuroemergency, the first steps in terms of management, the laboratory workup, and then the subsequent steps as well. And I think that, you know, for all neurologists, really, the key things to know about (even if you're not specializing in  neurocritical care) is how to identify a neuroemergency and what needs to be done as the first steps in terms of intervening and diagnosing these emergencies. Dr Jones: Great message, and that's one of the key things we learn in training, right,  is when to recognize that someone's sick and you need to escalate their level of care. What about – you know, I imagine the neurocritical care field is a relatively small community, and you know a lot of these folks – any key message that you would want to share with that audience? Dr Lewis: So, I think that this issue is still really important for all neurointensivists (in addition to for general neurologists and trainees), because of the fact that every article  really addresses in depth each of these aspects of neurocritical care and provides tidbits of information that not every neurointensivist would know. So, I think that the issue is beneficial both for trainees, general neurologists, and people who have expertise in the field of neurocritical care. Dr Jones: That's a great point. I think the fact that it is such a rapidly changing and broad field (you mentioned all the different article topics that are in the issue), it's a challenge to stay up to date on everything. And I think that's what this issue really brings  to the neurointensivist – is, you know, this is all (as of what's the latest in 2024) for the care of patients with critical illness. It's all there, right?  Dr Lewis: Absolutely. I think, you know, the issue is unique because neurocritical care is unique in that our role involves taking care of patients with a wide range of different neurologic disorders. So, the issue touches upon stroke (both ischemic and hemorrhagic). It touches upon seizure management. It touches upon management of traumatic brain injury. It addresses demyelination (so types of aggressive MS and other demyelinating disorders), neuromuscular issues, neuroonc issues – so I think that, really, there are so many subspecialties within neurology that it's important for them to have awareness of the emergencies that can emerge within their individual field. Dr Jones: So, we know that neurocritical care is pretty specialized work, and I imagine the expertise and the resources are not necessarily going to be available in every community. Are you aware, Dr Lewis, of any disparities in access or outcomes to neurointensivist expertise?  Dr Lewis: Yeah, absolutely. Unfortunately, as you look internationally, first, there are many places that don't have neurointensivists, so patients with neuroemergencies are being taken care of, in some cases, not even by general neurologists, but by specialists just in medicine. Additionally, the resources are often not available in terms of having an intensive care unit, having nurses with a good ratio to care for neurocritical care patients, having access to therapists who can participate in rehab and promote rehab, for patients having access to medications that are necessary, having access to various interventions (such as access to neurosurgeons who can do neurosurgical procedures or placement of an external ventricular drain), or other monitoring modalities are not available and accessible. So, all of these issues – in terms of resources, in terms of funding, in terms of other issues related to the existence of protocols as to how to  manage patients in the neuro ICU – all impact the outcome for patients in neurocritical care. Additionally, social issues and cultural issues can impact the outcome for patients in the neuro ICU. So, there's a lot of issues pertaining to equity in terms of the management of neurocritical care patients around the world.  Dr Jones: Those are great points. I know you and I both work with trainees in our field,  and when I talk to residents who are interested in neurocritical care, I think part of what draws them in is when they are exposed to it and they see how much, you know, the value of what their expertise brings to the outcome for that patient. I mean, it really does make a difference to understand the brain when you're caring for people with these critical neurologic disorders – and I think that's part of the appeal, right?  Dr Lewis: Yeah, absolutely. I think that people who are interested in going into the field of neurocritical care are interested in the more fast-paced aspect of neurology, rapid decision making, dealing with emergencies, also dealing with prognostication,  discussions (unfortunately, at end of life) – so that's really the kind of individual who turns to the field to specialize in. Dr Jones: And what about you, Dr Lewis? What drew you to this, you know, pretty high-pressure, intense, dynamic environment?  Dr Lewis: So I think, actually, you know, all the buzzwords you just used are really the things that made me want to go into neurocritical care. I am interested in much more  fast-paced management of patients, and, you know, unfortunately, obviously emergencies happen, and I find them to be exciting to be able to manage patients in that setting. And, you know, as you mentioned earlier, in the neuro ICU, it's a very multidisciplinary team, and I really enjoy being able to work with nursing, social work, care management, therapists, a variety of consultants – and addressing very acute issues with these individuals as a team in the ICU setting is really very rewarding.  Dr Jones: Yeah, and I hear that from others who are drawn to the field, and I think you really have to have kind of a broad skill set to manage actively, you know, critically ill patients, but also do the communication competencies and other things that are necessary. So, anecdotally, I would say I see more interest among trainees in this field. I don't know if you've seen the same thing in your world. Dr Lewis: Yeah. I think that, you know, as you mentioned, it's really important to emphasize that being a neurointensivist does not  just require expertise in the medical aspects of care for these patients, but really, also it's very important to ensure that we  promote education related to communication and neuroprognostication. So, our last article on this issue (by Dr Susanne Muehlschlegel) addresses prognostication and includes a variety of different details about how to address uncertainty, how to implement family and patient-centered prognostication and promote shared decision-making – and these topics are so important for everyone to know about when they're communicating with patients and families to address goals of care and to prognosticate. Dr Jones: Yeah. Thank you. And before we wrap up our discussion here, Dr Lewis, in addition to being a neurointensivist and being an expert on ethics and all of your clinical and research work, you do editorial work. You have editorial responsibilities not only for this issue of Continuum, but also at Seminars in Neurology and at “The Green Journal”.  For our listeners who might be interested in that career pathway, how did you get into that?  Dr Lewis: I very much enjoyed writing, and so I published a lot. And then I think that, you know, making connections is incredibly important and really looking out for those types of opportunities. Once you build a semblance of expertise in an area, then that often tends to lead to opportunities. So, I'm a Deputy Editor for the Disputes and Debate section of the Neurology journal. I'm also a Deputy Editor of Seminars in Neurology. I edited a book with Dr Jim Burnett on advances in neuroethics related to death determination by neurologic criteria, areas of controversy and consensus. And then I've also been a Guest Editor for a number of other journals, like the AMA Journal of Ethics that focused on socially situated brain death, a neurosurgical focus issue on primary and secondary infections of the brain, and a issue of Seminars in Neurology focused on ethics in neurology. Dr Jones: You must have like a twenty-eight or twenty-nine-hour day, Dr Lewis. I don't know how you do all that. I wasn't even aware of all those things that you do, but I can tell you, having looked at this issue, your editorial skills are off the charts. I really want to thank you not just for a wonderful issue, but for joining us today and for such a thoughtful, fascinating, and thorough discussion on the field of neurocritical care.   Dr Lewis: Thank you so much. I'm so excited for all the readers to look at our issue and learn about all of these different topics.  Dr Jones: Again, we've been speaking with Dr Ariane Lewis, Guest Editor for Continuum's most recent issue on neurocritical care. Please check it out. And thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practice - and right now, during our Spring Special, all subscriptions are 15% off. Go to Continpub.com/Spring2024, or use the link in the episode notes to learn more and take advantage of this great discount. This offer ends June 30, 2024. Thank you for listening to Continuum Audio.

Hour 2 with Joe Starkey and Paul Zeise: CBS Sports staff writer Garrett Podell joined the show to recap the Steelers draft. Garrett likes the value the Steelers got in Roman Wilson and Payton Wilson. If he can stay healthy, Payton Wilson brings great value to the Steelers. Not having an ACL is an issue, but he was the best linebacker in the class. Garrett thinks the Bengals had the second best draft in the division. West Virginia offensive line coach Matt Moore joined the show to talk about Zach Frazier. Moore said Frazier limping off the field on the final play of his WVU career embodies who he is as a tough player and person. Moore on Frazier:  "He set the bar here from a work ethic standpoint." "He changed the way things were when we first got here. Now I have an o-line room that wants to play and study like him."

CBS Sports staff writer Garrett Podell joined the show to recap the Steelers draft. Garrett likes the value the Steelers got in Roman Wilson and Payton Wilson. If he can stay healthy, Payton Wilson brings great value to the Steelers. Not having an ACL is an issue, but he was the best linebacker in the class. Garrett thinks the Bengals had the second best draft in the division. 

CBS Sports NFL staff writer Garrett Podell joined the show. He had one of the most accurate mock drafts of anyone last year and thinks Alabama tackle JC Latham would be a good pick at 20. Graham Barton is an inside piece at center after playing tackle at Duke. He thinks Jackson Powers-Johnson is the best center available and Zach Frazier will be available in the second round. 

Hour 2 with Joe Starkey and Paul Zeise: Our Steelers draft questions. Antionio Brown is the best value pick the Steelers ever made. Who are some of the best and worst in Steelers history? CBS Sports NFL staff writer Garrett Podell joined the show. He had one of the most accurate mock drafts of anyone last year and thinks Alabama tackle JC Latham would be a good pick at 20. Graham Barton is an inside piece at center after playing tackle at Duke. He thinks Jackson Powers-Johnson is the best center available and Zach Frazier will be available in the second round. 

In this episode of the "From Busy to Rich" podcast, Andy, Wes, and special guest Dave Podell discuss the importance of growth, specialization, and taking risks in business. Dave shares insights into his company's focus on large deductible tax strategies and the journey of continuous evolution in their field. The trio emphasizes the value of overcoming fear, trying new things, and the role of coaching in navigating uncharted territories. They highlight how specialization can lead to a broader market reach and the significance of engaging in high-energy activities that indicate potential growth areas. CLICK HERE TO WATCH THE VIDEO VERSION. In today's episode we will cover: Dave's company's specialization in large deductible tax strategies for business owners The importance of continuous evolution and adaptation in business The significance of trying new things and taking risks The role of coaching and seeking guidance in navigating new territories The impact of specialization on attracting referrals and expanding the marketplace Comparing specialization to that of a brain surgeon Finding energy in one's work and identifying high-energy activities for career decisions We hope you enjoy this episode, and would love to hear your feedback by leaving a review. If you're an advisor and want to further explore these or other topics you can learn more at www.wesyounglive.com. Perhaps you've been following us for a while, and you're ready to transform your practice. If so then we would love to have you at our upcoming Transform University class - click here for information on how to sign up.