Podcasts about prf

Por que a Rua 25 de Março entrou na mira de investigação de Trump após anúncio do tarifaço. 'Lista de Epstein': Trump vira alvo dos MAGA após negar teoria sexual que ele mesmo espalhou. Acidente entre carreta, micro-ônibus e ônibus deixa cinco mortos na BR-153, diz PRF. Mais do que genética: poluição, corrupção e desigualdade aceleram envelhecimento, revela estudo global. Médica espancada por fisiculturista foi encontrada caída, ofegante e sem falar; vizinho acionou a PM após ouvir barulho.

Manager's note:  The Pain Beat, launched and supported by a generous grant from the MAYDAY Fund, with additional funding from the Rita Allen Foundation, brings together the world's leading pain investigators with the purpose of sparking dialogue and debate around important ideas in pain research. Guided by Rebecca Seal, scientific director of The Pain Beat and Editor-in-Chief of Pain Research Forum, the podcasts feature open and spirited discussions about the hottest topics in pain and how the field moves forward.  For this episode, Adam Dourson and Lite Yang served as both creators and producers.  Juliet Mwirigi moderates a lively in person discussion with a diverse panel of preclinical and clinical experts at the USASP meeting in Chicago.  Where are we in understanding and treating migraine?  What  successes have we had and what challenges do we still face?   Podcast participants include: Andrew Russo, PhD, University of Iowa, US Gregory Dussor, PhD, UT Dallas, US Hadas Nahman-Averbuch  PhD, University of Washington in Saint Louis, US Levi Sowers, PhD, University of Iowa, US Yohannes Woldeamanuel, MD, Mayo Clinic, US Juliet Mwirigi, PhD, Washington University in Saint Louis, US PRF thanks Kevin Seal for creating the music.

Gymskador, Prf och hur du läker smartare – vi gästas av Torbjörn Ogéus, smärtspecialist och stamcellsforskare av rang. Vi nördar ner oss rejält i läkningsprocesser och behandlingar och när man ska välja vad. Ett avsnitt för alla som vill höra mer om vilka lösningar det eventuellt finns för långvariga skador. 

We've all seen it. Botox, filler, and quick fixes are everywhere, but are they the best solution? Today, facial plastic surgeon Dr. Cameron Chesnut unpacks taking a holistic approach to aesthetics. We talk the truth about Botox and filler, and discuss lasers, regenerative treatments, and minimally invasive surgical options.Timestamps:[1:45] Intro[4:05] Interview with Dr. Chesnut[11:04] What do you think most people are getting wrong in the aesthetic industry? [18:18] Can you define the term "minimally invasive" and how do you determine what's enough for somebody?[27:22] What does regenerative really mean within the context of aesthetics? [30:38] What is your take on microneedling? [33:51] If someone has "good skin", does it make sense for them to do microneedling?[36:28] Can you explain the difference between PRP and PRF? [39:17] Can you break down the different types of lasers, how they work, and if we should avoid specific ones?[49:35] What is the insignia lift rejuvenation and why is it different from a traditional lift? [51:26] Can you give your thoughts on Sculptra, the pros and cons and then BBL, broad band light? and is it what are its long -term effects?[56:09] What's the most effective way to get the lines around your mouth away or the deep set wrinkles in the forehead?[1:00:46] Are there treatments aside from laser that treat acne scaring? [1:03:16] Can we talk about jowls - I see my family jowls Curse starting to appear. Once they appear what's the best treatment?[1:06:32] What's the best procedure to help with droopy eyelids?Episode Links:Follow Dr. Cameron on InstagramJoin the Clinic 5C CommunitySponsors:Go to drinklmnt.com/wellfed and use code WELLFED to get a free 8-pack with any drink mix purchase!Go to boncharge.com/WELLFED and use coupon code WELLFED to save 15% off any order.Go to mdlogichealth.com/defend and use coupon code WELLFED for 10% off.Go to wellminerals.us/creatine and use code WELLFED to get 10% off your order.

Ep 54: The Truth About Tooth Decay, Periodontal Disease & Mercury Fillings—with Holistic Dentist Dr. Eric CorneliusLet's get real; if you're chasing wellness but ignoring your mouth, you might be missing a huge piece of the puzzle. In this episode, I chat with holistic dentist Dr. Eric Cornelius about the body-mouth connection, mercury fillings, and why oral health is foundational to everything else.We're diving into way more than just brushing and flossing. Dr. Eric breaks down:[11:15] Dental care: from ancient tools to cutting-edge holistic practices[14:45] How our teeth and jawlines have evolved and changed.[35:55] How everyday bacteria sneak into your bloodstream (and why toast is guilty, too)[40:25] The real damage soda is doing—not just to your teeth, but to global health mindsets[48:25] The truth about mercury fillings and what safe removal looks like We also talk about Dr. Cornelius's time working with a remote tribe in Kenya, and a story he shared that absolutely stunned me—about why one teen girl was upset he fixed her front teeth.

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

Some injuries never really leave you…unless you change how you heal them.That's something I got to dig into with Dr. Christopher Meadows, a double board-certified physician and regenerative medicine expert at Clinic 5C. Dr. Meadows has been chief resident, helped build a residency program, and now spearheads orthopedic regenerative therapies that skip the scalpel and address the root of healing.From football injuries and quitting soda in middle school to mini-liposuctions and stem cell protocols that target your body's natural repair systems, this conversation hits a whole different gear. We also talk about knees, tendons, aging, sleep, protein, inflammation, PRP vs PRF, and how stem cells may soon revolutionize neuro and spinal cord recovery.Whether it's fat-derived stem cells or platelet-rich fibrin, this is what medicine looks like when it's evolving. “The idea behind regenerative medicine is to take advantage of the body's natural healing process and apply it to something that's been notoriously difficult to treat.” ~ Dr. Christopher MeadowsAbout Dr. Christopher Meadows:Dr. Christopher Meadows is a double board-certified physician in Physical Medicine & Rehabilitation and Electrodiagnostic Medicine. A former UCLA football player turned regenerative therapy expert, Dr. Meadows leads the orthopedic arm of Clinic 5C in Spokane, Washington. He's passionate about helping patients heal and perform using their own biology, whether that's through adipose-derived stem cells, PRF injections, or personalized treatment stacks. His work bridges elite sports performance and long-term longevity care, all with a no-fluff, data-driven approach.Connect with Dr. Meadows:- Clinic Website: https://www.clinic5c.com/ - Instagram: https://www.instagram.com/meadows.md Connect with Chris Burres:- Website: https://www.myvitalc.com/ - Website: http://www.livebeyondthenorms.com/ - Instagram: https://www.instagram.com/chrisburres/ - TikTok: https://www.tiktok.com/@myvitalc - LinkedIn: https://www.linkedin.com/in/chrisburres

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

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

Às vésperas do leilão da BR-101 ES, marcado para 26 de junho na B3, em São Paulo, a situação da rodovia é destaque nesta edição do “Direção Segura”. A maior parte das mortes registradas nas rodovias federais do Espírito Santo ocorre justamente nessa região, mesmo em trechos já duplicados. O diagnóstico é da Polícia Rodoviária Federal do Espírito Santo (PRF-ES).Na última semana, em reunião na Assembleia Legislativa do Espírito Santo), o policial rodoviário federal (PRF) e chefe da delegacia de Linhares, Carlos Alessandro Ravani, apresentou dados sobre os cinco primeiros meses de 2025 em relação ao ano anterior na 101. Entre janeiro e maio, mais de 60% dos óbitos foram na BR-101. Entre janeiro e maio as rodovias federais registraram 67 óbitos – o mesmo período de 2024 marcou 73. Do total anual em 2024 (176), 114 óbitos, o correspondente a quase 65%, foram na BR-101. Ouça a conversa completa!

Ingmar genießt mütterliche Nestwärme und betrinkt sich mit der Familie und anschließend holt er den Prf.Dr.Dr. Humor heraus um einen eigentlich ganz kleinen harmlosen Spruch auf Threads zu analysieren. Für Mutti! Prost! Hosted on Acast. See acast.com/privacy for more information.

Vampyrbehandlingar: PRP och den nyare varianten PRF. Vad är skillnaden, vilken är mest effektiv och varför är det kanske inte så magiskt som det låter? Kroppsegna material, risker med kontaminering och varför vissa blodplasma ser ut som äcklig lemonad. Dessutom: när det faktiskt kan vara värt det och varför vissa produkter hör hemma på rumpan. Hosted on Acast. See acast.com/privacy for more information.

Nesta edição do “Direção Segura”, a inspetora da Polícia Rodoviária do Espírito Santo (PRF-ES), Ludmilla Tavares, traz o alerta da instituição para os acidentes com motociclistas no Espírito Santo.Entre os motivos para aumento de sinistros estão, segundo a PRF-ES, o desrespeito às leis de trânsito (excesso de velocidade) e imprudência. A PRF alerta. “Motociclista é extremamente vulnerável. O condutor é o para-choque do caso de sinistros”, alerta. Entre as soluções estão, por exemplo, a conscientização dos condutores e a educação para o trânsito. Ouça a conversa completa!

In this episode, Board Certified Dermatologist Dr. Jen Haley unpacks the science and solutions behind the most common cosmetic eye concerns: under-eye bags, dark circles, droopy eyelids, and hollowing.   What's Inside: The causes behind tired-looking eyes-from genetics and lifestyle to aging and anatomy At-home and topical treatments, including vitamin C serums, retinol, caffeine-infused eye creams, and holistic remedies Integrative and in-office options: PRF (platelet-rich fibrin), hyaluronic acid fillers, and the latest in laser and energy-based therapies How neuromodulators like Botox can impact eyelid position and muscle tone-plus what you need to know about long-term use The role of Upneeq and other prescription treatments for droopy lids Pro tips for prevention, maintenance, and maximizing results safely   Whether you're seeking a refreshed look or simply want to understand the latest advances in eye rejuvenation, this episode delivers actionable insights for radiant, youthful eyes!   PRODUCTS / RESOURCES:   Follow Dr. Jen Haley on Instagram @drjenhaley - instagram.com/drjenhaley Connect on LinkedIn:  http://linkedin.com/in/jennifer-haley-md-faad-a4283b46 Visit her website at drjenhaley.com Book a consultation with Dr. Haley here:  https://app.minnect.com/expert/DrJenHaley Dr. Haley's favorite skincare:  https://www.alumiermd.com/join?code=5HUKRDKW   #radiancerevealedpodcast

Marina Silva, ministra do Meio Ambiente, sofre ataque machista no Senado e se retira de comissão. Lula volta ao trabalho, mas cancela viagens ao Nordeste. Ex-diretor da PRF confirma que Justiça deu ordens para blitz nas eleições. Trump suspende emissão de vistos para estudantes. Projeto inédito sequencia genoma de mais de 400 espécies brasileiras. Pesquisadores revelam que ouro represado nas profundezas da Terra está ‘vazando’. E Elza Soares vai ganhar cinebiografia estrelada por Taís Araújo. Essas e outras notícias, você escuta No Pé do Ouvido, com Yasmim Restum.See omnystudio.com/listener for privacy information.

Trama golpista: ex-diretor da PRF confirma ordem para blitz, mas nega direcionamento a região e fiscalização de eleitores em 2022. Fraude no INSS: governo negocia com MPF duas opções de ressarcimento a aposentados. Lula está bem após quadro de labirintite, segue medicado e deve despachar do Alvorada nesta terça. Glucomanano: 10 benefícios do suplemento conhecido como 'ozempic natural' e um alerta. Especialista tira dúvidas AO VIVO sobre o IR 2025; acompanhe nesta terça (27), às 16h30.

O prazo para a declaração do Imposto de Renda Pessoa Física 2025 termina nesta sexta-feira às 23h59 minutos. Dez milhões de contribuintes ainda não prestaram contas ao fisco. O contribuinte que não fizer a declaração à Receita Federal pode ser multado, ter o nome sujo e ter o CPF irregular, por exemplo.O Giro de Notícias mantém você por dentro das principais informações do Brasil e do mundo. Confira mais atualizações na próxima edição.

Pedestres também são atores envolvidos no trânsito! Ainda no clima do "Maio Amarelo", a inspetora da Polícia Rodoviária Federal do Espírito Santo (PRF-ES), Ludmila Tavares, esclarece as dúvidas sobre a forma correta de se fazer a travessia na faixa de pedestres. A PRF explica que o pedestre deve cuidar da sua segurança e andar com muita atenção, pois não possui acessórios ou equipamentos de proteção contra as situações de risco que enfrenta no dia a dia no trânsito. Além do próprio pedestre, o papel dos motoristas é de igual importância no quesito travessia segura. As dicas são: reduza a velocidade e redobre a atenção ao se aproximar de uma faixa de travessia ; avalie as condições de segurança antes de conceder preferência ao pedestre; acompanhe pelos espelhos retrovisores a movimentação de outros veículos; dê passagem aos pedestres nas travessias devidamente demarcadas onde não houver semáforo; e aguarde a completa travessia dos pedestres para colocar seu veículo em movimento. Ouça a conversa completa!

O programa Arauto Saúde dessa edição recebeu o Professor de Direito e ex Comandante da PRF, Silvio Erasmo Souza da Silva, que falou sobre a prevenção de acidentes e responsabilidades ao dirigir.

O programa Arauto Saúde dessa edição recebeu o Professor de Direito e ex Comandante da PRF, Silvio Erasmo Souza da Silva, que falou sobre a prevenção de acidentes e responsabilidades ao dirigir.

In this episode of Clinical Unfiltered, Dr. Sausha chats with Dr. Nathan Estrin about the game-changing role of Platelet Rich Fibrin (PRF) in dentistry, especially for periodontal procedures. Nathan breaks down how PRF works, its advantages over Platelet Rich Plasma (PRP), and how using a patient's own healing factors can boost surgical results. They dive into the nitty-gritty of the blood-drawing process, centrifuge techniques, and even how to create "sticky bone" for better healing, all while highlighting the cost-effectiveness of incorporating PRF into dental practices.

Saiba mais sobre tudo que a World faz para promover uma internet mais confiável, segura e humana em world.org/brasil Hoje, No Pé do Ouvido, com Yasmim Restum, você escuta essas e outras notícias: AVC e insuficiência cardíaca matam Francisco, o papa das Américas e da simplicidade. Universidade de Harvard processa governo dos EUA. Silvinei tentou apagar rastros de ação da PRF nas eleições de 2022. Pedro Lucas diz a aliados que deve recusar convite para ser ministro das Comunicações. Academia anuncia mudanças no Oscar 2026. Sony mostra aperfeiçoamento no sistema de resfriamento do PS5 Pro. E aos 100 anos, morre Wilson Augusto Figueiredo; e Cristina Buarque, aos 74 anos.See omnystudio.com/listener for privacy information.

In this episode of the Smarter Not Harder Podcast, Dr. Cody Kriegel takes us deep into the world of biological dentistry — a rapidly growing field that connects oral health with overall wellness. From root canals to cavitations, mercury fillings to ceramic implants, Dr. Cody shares his clinical experience, personal journey, and powerful patient transformations that reveal just how interconnected your mouth is with the rest of your body. You'll also hear why he believes traditional dentistry is due for a major paradigm shift, and how modern technology like CBCT, PRF, and laser therapy are revolutionizing oral care. Join us as we delve into: + How root canals can lead to chronic inflammation and systemic issues + What cavitations are — and why they're more common than you think + Ceramic implants, ozone, and PRF: the future of minimally toxic dentistry + Real-life stories of healing after dental detoxification This episode is for you if: - You've had a root canal or metal fillings and wonder how they may affect your health - You're interested in a more integrative, biologically sound approach to dentistry - You struggle with unexplained chronic symptoms and want to explore overlooked causes - You want to know what questions to ask your dentist to make smarter, safer choices You can also find this episode on… YouTube: https://youtu.be/hjhstA75So8 Find more from Dr. Cody Kriegel: Vios Dental: https://viosdental.com/ Vios Dental Instagram: https://www.instagram.com/vios_dental/ Dr. Cody's Instagram: https://www.instagram.com/codykriegeldds/ Find more from Smarter Not Harder: Website: https://troscriptions.com/ | https://homehope.org Instagram: @troscriptions | @homehopeorg Get 10% Off your purchase of the Metabolomics Module by using PODCAST10 at https://www.homehope.org Get 10% Off your Troscriptions purchase by using POD10 at https://www.troscriptions.com Get daily content from the hosts of Smarter Not Harder by following @troscriptions on Instagram.

In this episode, Dr. Mary Alice Mina discusses the differences between PRP (Platelet Rich Plasma) and its offshoots, including PRF (Platelet Rich Fibrin). She debunks common myths surrounding PRP, explains its effectiveness in treating hair loss and skin rejuvenation, and provides best practices for achieving optimal results. The episode also highlights the safety of PRP treatments and the current standing of PRF in cosmetic procedures. Key Takeaways: - PRF is being marketed as the next generation of PRP. - PRP is a well-established treatment in regenerative medicine. - There is substantial scientific backing for PRP's effectiveness. - PRP treatment is not standardized like pharmaceutical products. - Multiple sessions of PRP are often required for best results. -Results from PRP treatments take time to manifest. - PRP is generally safe but requires proper medical handling. - Hydration and timing can influence PRP effectiveness. - PRF is primarily beneficial for wound healing, not cosmetic use. - Current data supports PRP over PRF for cosmetic procedures.   Follow Dr. Mina here:-  https://instagram.com/drminaskin https://www.facebook.com/drminaskin https://www.youtube.com/@drminaskin https://www.linkedin.com/in/drminaskin/ For more great skin care tips, subscribe to The Skin Real Podcast or visit www.theskinreal.com Baucom & Mina Derm Surgery, LLC Email - scheduling@atlantadermsurgery.com Contact - (404) 844-0496 Instagram - https://www.instagram.com/baucomminamd/ Thanks for listening! The content of this podcast is for entertainment, educational, and informational purposes and does not constitute formal medical advice.

Get Dr. Mina's free PDF on How to create Healthy Skin Habits here. Download the free eBook 'Skincare Myths Busted' here. Dr. Mina and Dr. Amelia K Hausauer dive deep into the world of Platelet-Rich Plasma (PRP) therapy — breaking down what it is, how it works, and why it's become a go-to in dermatology. From treating hair loss and skin rejuvenation to supporting microneedling, stretch marks, and wound healing, they explore the wide range of applications for PRP. Dr. Hausauer also unpacks the key differences between PRP and Platelet-Rich Fibrin (PRF), shares insight into safety and patient outcomes, and emphasizes the importance of working with a knowledgeable provider. The conversation covers techniques like microneedling with PRP (hello, vampire facial), various injection methods, and the exciting future of regenerative medicine. Whether you're curious about incorporating PRP into your treatments or want a deeper understanding of its potential, this episode is a must-listen.    Key Takeaways: - PRP is derived from the patient's own blood and is rich in signaling molecules. - The field of PRP has evolved significantly over the last decade. - Regeneration is becoming a key focus in modern medicine. - Patients are increasingly interested in natural healing methods. - PRP is most commonly used for hair regrowth and skin treatments. - The effectiveness of PRP can vary based on individual patient factors. - Optimizing platelet levels can enhance PRP treatment outcomes. - Timing and diet can influence the effectiveness of PRP treatments. - Microneedling with PRP can significantly improve skin texture and collagen production. - Injecting PRP can be beneficial for targeted areas like scars and under-eye skin. PRP is most effective when integrated into a comprehensive treatment plan. - Microneedling enhances the release of growth factors from PRP. - Stretch marks can be treated with PRP, often in combination with other modalities. - Safety is paramount; choose a qualified provider for PRP treatments. - PRF differs from PRP in preparation and application, affecting its use. - PRP can accelerate healing in post-surgical and acne scarring cases. - Building a relationship with your provider enhances treatment outcomes. - The medical community is evolving with new regenerative therapies. - PRP has a low risk of allergic reactions due to its autologous nature. - Future advancements in regenerative medicine are promising and exciting. Dr. Amelia K. Hausauer is the Director of Dermatology and Head of Aesthetic Medicine at Aesthetx, a hybrid dermatology and plastic surgery practice in Northern California. She is a key opinion leader for early pipeline innovation and development of multiple injectable and regenerative therapies as well as an active research investigator. Dr. Hausauer spearheaded one of the largest clinical trials using PRP for hair growth and served as the chief editor for Platelet Rich Plasma (PRP) and Microneedling in Aesthetic Medicine. She has published over a dozen articles in peer reviewed journals and teaches throughout the world on cutting-edge techniques in injectable medicine. Earning a bachelor's degree from Stanford University and medical doctorate from University of California San Francisco, Dr. Hausauer completed residency at New York University then an American Society for Dermatologic Surgery cosmetic surgery fellowship.   Follow Dr. Hausauer here: https://www.instagram.com/drhausauer https://www.instagram.com/aesthetxmd https://www.aesthetx.com/   Follow Dr. Mina here:-  https://instagram.com/drminaskin https://www.facebook.com/drminaskin https://www.youtube.com/@drminaskin https://www.linkedin.com/in/drminaskin/ For more great skin care tips, subscribe to The Skin Real Podcast or visit www.theskinreal.com Baucom & Mina Derm Surgery, LLC Email - scheduling@atlantadermsurgery.com Contact - (404) 844-0496 Instagram - https://www.instagram.com/baucomminamd/ Thanks for listening! The content of this podcast is for entertainment, educational, and informational purposes and does not constitute formal medical advice.

1. **Skin Boosters**: These treatments are ideal for individuals with dehydrated skin or those needing a boost, especially as we age or experience hormonal changes like menopause. Skin boosters work on superficial layers of the skin, providing hydration and refreshing the skin without permanent effects.2. **Collagen Stimulation**: Treatments like **Sculptra** and **Radiesse** are emphasized for their ability to stimulate collagen, which helps with skin rejuvenation. Melissa explains that while topicals can assist, they aren't as effective as treatments that reach deeper layers of the skin. Collagen-building injectables and devices (e.g., radiofrequency microneedling) are highlighted as long-term solutions.3. **Radiofrequency Devices**: Devices using radiofrequency (RF) are gaining traction for their skin-tightening and fat-remodeling effects, with minimal downtime. These treatments work by delivering energy to different skin layers to stimulate collagen production and promote tighter, firmer skin.4. **Exosomes**: Melissa explains how exosomes, derived from stem cells, can accelerate skin healing, reduce inflammation, and stimulate collagen production. These are used in professional treatments like microneedling for enhanced rejuvenation. Exosomes function as a director, orchestrating cellular activities for regeneration.5. **Platelet-Rich Fibrin (PRF)**: A favorite among professionals, PRF (including the "Plated" version Melissa recommends) works by harnessing the body's own stem cells and growth factors to rejuvenate the skin. It's applied topically or used in treatments like microneedling for a robust anti-aging effect.6. **Growth Factors**: While similar to exosomes, growth factors are naturally occurring proteins that support cell growth and tissue repair. They're used to improve skin healing and collagen production and are included in various skincare products and professional treatments.7. **Aesthetic Education and Safety**: The conversation wraps with Melissa emphasizing the importance of education in the aesthetic space. She mentions **AestheticsHQ**, a platform designed to help people better understand and select the right treatments, providers, and devices for their specific needs. The platform aims to streamline the process of learning about aesthetic treatments while ensuring safety and personalized care.For Aesthetic Providers:  - Want to grow your practice and reach more clients? Join Aesthetics HQ and become a featured provider. **http://refer.aestheticshq.com/6N8ct8to sign up and connect with a wider audience.  Links & Resources: http://refer.aestheticshq.com/%0AKatarinaForster%0AThanks,%0AThe%20Aesthetics%20HQ%20team%0AAesthetics%20HQ,%201111B%20S.%20Governors%20Avenue,%20#6393and follow on Instagram: aesthetic_hq_Support the showConnect with Me:Katarina's Instagram: https://www.instagram.com/your.master.aesthetician/Podcast Instagram:https://www.instagram.com/unwrittenbeautytalks/Katarina's Website: Code UNWRITTEN for 10% off https://www.yourhonestglow.com/Interested in being a guest? Email: honestglow.master.esthetician@gmail.com

Is natural beauty really natural? In this episode, we deep dive into the world of aesthetics, particularly using natural skin rejuvenation using biostimulation—what works, what doesn't, and how to enhance your look without going overboard. We're breaking down fillers (getting them and dissolving them), skincare treatments like microneedling, Exosomes,  PRP, and PRF, plus the latest in laser therapies. Whether you're into at-home skincare or in-office treatments, this episode spills it all. Tune in for the ultimate guide to a fresh, natural glow! Timeline of what was discussed: 00:00 Introduction 01:06 Beauty or Blemish  11:46 Natural Approach to Beauty & Aesthetics 13:28 Getting Filler  16:08 Dissolving Filler + Filler Migration 21:07 Audio Announcement 21:28 Popular Natural Beauty Procedures or Treatments 22:22 At-Home Skincare 25:21 Microneedling 27:34 Exosomes + Platelet-Rich Plasma (PRP) 29:02 Platelet-Rich Fibrin (PRF)  30:15 Broadband Light Therapy (BBL) 32:26 Laser Resurfacing 35:55 Sculptra 39:31 Exilis + Vaginal Rejuvenation ___________________________________________________________________ Submit your questions for the podcast to Dr. Azi on Instagram @morethanaprettyfacepodcast, @skinbydrazi, on YouTube, and TikTok @skinbydrazi. Email morethanaprettyfacepodcast@gmail.com. Shop skincare at https://azimdskincare.com and learn more about the practice at https://www.lajollalaserderm.com/. The content of this podcast is for entertainment, educational, and informational purposes and does not constitute formal medical advice. © Azadeh Shirazi, MD FAAD.  

Confira nesta edição do JR 24 Horas: Um laudo preliminar sobre a morte da adolescente Vitória Regina de Sousa, assassinada na Grande São Paulo, revelou que a jovem teria sido vítima de abuso antes de ser morta. Esse laudo preliminar obtido pelo jornalista Roberto Cabrini indica que, no momento em que o corpo de Vitória foi encontrado, ela já estaria morta havia cinco dias. Possivelmente, a jovem passou dois dias viva na casa usada como cativeiro, onde também teria sido dopada, torturada e abusada. E ainda: PRF faz a segunda maior apreensão de ecstasy da história da corporação no Paraná.

Confira nesta edição do JR 24 Horas: Uma facção criminosa pode estar por trás do assassinato de Vitória Regina, de 17 anos, na Grande São Paulo. Na tarde desta quinta-feira (6), Gustavo dos Santos, ex-namorado da jovem, se apresentou de forma espontânea na delegacia. E ainda: PRF divulga balanço que registra 83 mortos e 1.300 feridos em estradas federais durante o Carnaval.

In this episode we have my buddy Scott Balkan from Dialed Archery come back on to talk all about the new sight that Dialed has come out with called the PRÜF! It's everything the Arxos was but improved! I will be running the PRÜF for the 2025 season and I think you should too! Podcast brought to you by:WCB: SEBH15 for 15% offAsio : SEBH for 15% offSummit: SEBH15 for 15% offBowtique: SEBHP for free shippingBergy Bowsmith: SEBH10 for 10% offG5 OutdoorsPrime ArcheryDialed ArcheryAce Hardware Social CircleScoutekCamo DustBohning Archery

Join Jon and Nicole as they delve into the latest trends in aesthetics, and dive deep into the world of PDGF (platelet-derived growth factor). This episode covers the benefits, usage, and comparative advantages of PDGF over PRP and PRF, and includes personal experiences with the treatments. Learn about treatment stacking, the science behind PDGF, and the evolving field of aesthetics and wellness.On Fill Me In: An Aesthetics Podcast, Jon LeSuer NP-C and Nicole Bauer FNP-BC dive deep in the world of aesthetics. As aesthetic nurse practitioners with their own medical practices, Jon and Nicole fill you in on everything in their field.Follow Fill Me In on Instagram!https://www.instagram.com/thefillmeinpod/Follow Nicole on Instagram:https://www.instagram.com/aestheticnursenicole/Follow Jon on Instagram:https://www.instagram.com/injectorjon/Exhibit Medical Aesthetics website:https://exhibitmedicalaesthetics.com/Tox and Pout Aesthetics website:https://toxandpout.com/Jonathan LeSuer, MSN, NP-C Jonathan LeSuer graduated from Le Moyne College with his Bachelor's in Nursing in 2014 and a Family Nurse Practitioner degree in 2017. He began his career at St. Joseph's Hospital as a Registered Nurse on a cardiac medical-surgical unit. He transitioned to the Nurse Practitioner role in 2017, working for Hospitalist Medicine, where he became the coordinator for the team's Physician Assistants and Nurse Practitioners. In 2020, he started his career as an Aesthetic injector and quickly found out that this was his passion. On March 15th, 2022, he opened Tox & Pout Aesthetics. He is now a Master trained injector & National trainer for Allergan Aesthetics, offering Botox, Dysport, Hyaluronic acid fillers, Kybella, SkinViVe skin booster, and Sculptra. Jonathan is known for his empathy, profound bedside manner, and outgoing/warm personality. He has a deep love for aesthetics, and his patients' confidence is his main priority. Nicole Bauer, MSN, APRN, FNP-BC. Family Nurse Practitioner Nicole graduated with her Associates in Applied Sciences and began her journey as a registered nurse 10 years ago in 2014. She worked hard to combine her love for beauty with her passion for caring and healing others, attending aesthetics school while working as a hospital night nurse. After graduating as a licensed aesthetician, Nicole left the hospital where she had been for 3.5 years and began working as a registered nurse for a plastic surgeon. An experience of over 6 years that would leave her with so much knowledge and respect for the aesthetic world. It was during those 6 years that she pursued her Master's Degree and obtained her license as a Family Nurse Practitioner, leading the way for where she is now; owning a state of the art medical aesthetic practice and being a national Allergan Trainer. Nicole takes pride in treating her patients holistically, focusing on facial balancing and enhancing one's natural beauty. She believes education stands as the cornerstone of aesthetics and is why she is dedicated to both training others while always focusing on expanding her own knowledge as well.  Producer of Fill Me In: Joseph Ginexi#RegenerativeMedicine #PDGF #Skincare #Microneedling #injector #Aestheticmedicine #aesthetics #aestheticnurse #SkinRejuvenation #botoxcosmetic #filler #PRF #PRP

Kiera and Britt have a deep discussion on the ins and outs of hygiene right now, including what's on hygiene grads' minds, the right ranges for skill sets, how different practices are staying scrappy amid the dearth of hygienists, and more. Episode resources: Sign up for Dental A-Team's Virtual Summit 2025! Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript Kiera Dent (00:00.822) Hello, Dental A Team listeners. This is Kiera. And today I have Brittany Stone, the one and only No BS Britt. And today I'm asking her to play Hygiene Britt. If you didn't know, it's actually fun. It is. And it was funny because yesterday, Britt and I actually like had, we were heavy in Dental A Team mode. And then I called Britt back probably like a minute later and I said, Hey Britt, can you be Hygiene Britt for me? Cause I have a hygiene question.   Britt (00:26.988) you   Kiera Dent (00:29.102) So Britt, welcome to the show today. How are you?   Britt (00:32.308) I'm good, how are you doing?   Kiera Dent (00:34.23) I'm great. How does it feel to be hygiene Britt? Like go from, mean, you're Dental A Team's operations manager, you're also consultant, like all the things. How does it feel like go back into that clinical space sometimes?   Britt (00:45.678) I mean, hygiene are roots, man. Like that's the beginning. So it feels to me, I know you guys haven't known me as like hygienist. Like, yes, I know hygiene stuff, but you never worked with me clinically as a hygienist. But to me, I'm like, yeah, that's me.   Kiera Dent (00:54.872) true.   Kiera Dent (01:00.91) I'm glad because it is fun. I actually was talking to Jason last night after you and I had chatted and I said, Jay, it was actually really fun to talk to Britt about like where we started. I mean, I'm dental assistant, Kiera, office manager, Kiera, treatment coordinator, Kiera. No one's known me as that in Dental A Team. And so I'm just going to throw it out there because you never know who's listening to the podcast and who would ever like take me up on this idea. But if there's someone out there,   that would love to allow Dental A Team to come in for one day and go back to our roots. So Britt, we probably have to do this in Arizona, because I think you're only licensed in certain states, right? Okay, so Arizona offices, if you know someone in Arizona, all of our crew will be there in March and there might be a few other times, but I think it'd be funny to see a Dental A Team take over. Like how would it be for Tip to be an assistant?   Britt (01:35.318) Yeah, currently still just Arizona. My OG state over here.   Kiera Dent (01:52.462) me to either be an assistant or a treatment coordinator, and Dana to go back into hygiene and just see like how it would run. if anybody's open to letting us come back into our, like put the scrubs on and just see like, shoot, we'll cover for a day for you guys.   Britt (02:01.198) .   Britt (02:06.358) It would be like a good and wild time all at the same time because I think we're all a little bit more maybe assertive than we might have been in some of our olden days in those positions.   Kiera Dent (02:14.038) Hahaha   Kiera Dent (02:18.316) I agree. And this is why I want to see like what would Dental A Team do if we were all put into one office at one time. So anyway, if you're interested, email me Hello@TheDentalATeam.com This isn't a passive ask. This is like, I really think it'd be so fun. We've talked about it so many times, like what would it be like? So, Hey, if you're ever interested in Dental A Team.   Britt (02:23.046) Yeah.   Britt (02:35.982) Usually what we do is we say if we could all only be one role, so no doubling up on roles, this is the game Kiera likes to play, who would be which role within the office is usually how this goes. yeah, not to say we don't get along, we would have a fantastic time, but you'd get a lot of ideas that they would run quick, I'll tell you that.   Kiera Dent (02:45.118) I do.   Kiera Dent (02:49.762) and   Kiera Dent (02:55.608) Thank   Kiera Dent (02:58.99) Well, and I'm like, believe it or not, I would actually not go for office manager. So I'm out on that. Shelby will probably take on office manager role, even though she's never done it, she'll do great. But it is kind of funny, Tiffany, we were talking the other day and I said, Tiff, I remember being a dental assistant and I had hours of time sitting there like root canals, crown preps, where I just thought of all these ideas and Tiff's like, I would like, I literally would hate if you actually went back to that and had that much time to think of ideas.   Britt (03:08.014) Thank you.   Kiera Dent (03:26.904) Fair enough. anyway, throwing it out there, Britt and I have a good time, but truly I do think it'd be fun if an office allowed us to come and just like see what would happen if all of us went back into it. You might hate it. Don't worry, doctors. You can still keep like one or two main assistants. Like we won't fully do it, but like we're, we think we'd be the A team. I'm just curious if we'd actually be rated A, B, C or D going back in as a whole team. Exactly. But on that note, pivoting into what we want to chat about.   Britt (03:47.327) Put our money where our mouth is. Is that what you're saying?   Kiera Dent (03:55.96) Britt and I wanted to get on the podcast and I really wanted Britt to be on this podcast with me because Britt is a hygienist and believe it or not, I have had actually some clients ask Britt and Dana like, hey, if you ever want to like leave consulting and come back to hygiene, hey, poo poo on you, that's terrible, don't do that. We don't poach your people, don't poach ours. But it is interesting because I do know that hygiene is a hot topic and so I thought Britt, if we came on the podcast today and we actually chatted about...   Britt (04:08.174) Thank   Britt (04:12.056) you   Kiera Dent (04:22.508) All right, let's talk about hygiene. How do we get hygienists? How can we hire? How can we attract? What are maybe some out of the box thinking today? And also doing on both sides of the coin because I do know we have hygienists that do listen to the podcast as well. So shout out to you listening in and educating yourself and understanding kind of the predicament the doctors are in because it's this constant, like I do feel over the last four years since COVID, the hygiene pay range has like just like escalated up this ladder, which is making it hard for practices to stay profitable, which then leads to if   The practices can't maintain profitability. I do actually wonder and this is kind of just my thoughts and I'm sure Britt you've thought of it. Will there come a point where hygienists are actually asking for too much that dentists say it's not worth it for hygienists? I'm just going to hire a dentist. So I'm just like just so we know and I want hygienists. So it's going to be kind of like a really open conversation. My goal today is that none of what we bring ever should be weaponized against people. So there might be some ideas discussed hygienists if we're talking about certain things to me. This is not always on where you can go in.   take this to your doctor and demand certain things and doctors if that happens, like it sounds like that's a great opportunity to coach that hygienist out and bring someone else in and vice versa. Hygienists and doctors, like doctors not weaponizing and saying, hygienists we're so high, I can't afford to do this or things like that. I think really understanding the dynamics of where we're at, I think is gonna be a good conversation. So Britt, you, hi, Janice Britt, welcome to the scene, hello.   Britt (05:45.454) Thank you. I'll put that hat on. And it's all in fairness, right? I think that's what it comes down to in any working relationship. And even when it comes down to talking about things like compensation, like it should be a conversation for both sides, right? And sometimes there's things that can be done. Sometimes there's things that can't be done. And sometimes performance-wise, it doesn't warrant being done. So I think that's just the mindset to go into it with always when it comes to those conversations is it is a conversation. It should be a conversation.   demands back and forth and finding the best fair solution.   Kiera Dent (06:20.502) Yeah, absolutely. And Britt, I'm so glad that you're open to this. And Britt, the reason I love her in operations next to me, like I feel like her and I are really good yin and yang. think Britt and I truly, we have very different personalities. We have very different mindsets. We have very different pieces. And I think when you can bring those two perspectives to the table, I'm very strong entrepreneur. I'm very strong business. very, like Britt will tell you, I come in very strong on those and Britt will come in very strong on team.   Britt (06:32.876) you   Kiera Dent (06:45.282) I think that to have someone like that in your corner to me is invaluable because it allows Britt and I to really, like we say hash, like we really do go back and forth knowing that our ultimate goal is to land on what's fair and best for the business, what's fair and best for the patients, what's fair and best for our team, what's fair and best for every player in the scene and the arena. And I believe when you can have these conversations, you can get there. So Britt, I wanna just kick off.   It's something that's come up and I'm just curious from your perspective as a hygienist, because you are a senior hygienist. You've been in the ranks. You haven't been there as a brand new grad. And there are some hygienists who are feeling like these new grads are coming out asking for quite a lot. I've actually been told that a lot of the hygiene teachers are actually telling them to ask for higher amounts. And I'm really curious, like, do you feel that there should be ranges where if you've been out of school for say zero to five years, it's kind of like this is your range.   if you've been out of school from five to 10 years or 10 years plus, because some of those senior hygienists do feel like, hey, I've been in here, I've been running the ranks. And then I'll give you the flip side that I also think of, but sometimes my senior hygienist might not be as up to date as my brand new grads out of school. So there's this like, there is an experience piece of you've been with the patients longer, but sometimes like, I know certain hygienists don't do as much perio, whereas new grads do more perio sometimes. So.   Again, I'm not here to judge the hygiene world. I'm just curious, Britt, from your perspective, being a hygienist who's been in the realm for a while, what's your take on like, should there be ranges based on experience or is it on performance? Like, what's kind of some metrics that you see that would be beneficial when we're looking at compensation to be fair across the board?   Britt (08:22.414) I mean, you know fairness is a big thing to me, right? So I and this will be a probably to some maybe not the most popular opinion But I do think it's the fairest and I no matter the role right whether it's a hygienist whether it's an assistant whether it's a front desk whether it's an associate coming in I'm big on it comes down to skill set and what are they able to do? Right? What what's their skill set in the position? How are they able to perform? What things can they be?   responsible for and own and make sure that they get done. Now with a new grad, would I probably be a little bit conservative on what they start them out with and say, hey, here's your path forward, right? Once you show me XYZ, you're running on time, you're making sure your diagnostics are quality, all those things, this is your path forward as far as compensation goes. But I do think it should be a skill set based compensation, not just like tenure based compensation. I'm not a big fan of tenure overall, no matter like   Kiera Dent (09:21.517) Mm-hmm.   Britt (09:22.176) like where it is. The thing that I will say along with that though is to make sure that our owners, right, whoever's making those decisions on compensation, that we keep it all fair. So I think sometimes some of those more senior ones, maybe they've stayed at a rate for a really long time and maybe haven't been increased according to inflation or what they're paying other people now. And so like that piece needs to be fair as well. So make sure, I'm a big fan of tears, what's   the skills and make sure that it stays within those tiers. And yeah, if you've been with me for a long time and you've got a full set of skills for hygiene and you do really well, you should be at the top end of that top tier. And if not, then we need to have a conversation and talk about it and see how we can get you there. Because that's ultimately my goal for any of my team members is how do we get you performing to the top of your skill set, your ability or your license. And with that should come like fair compensation that comes along with it.   Kiera Dent (10:22.392) So, okay, I really like that. I've got two follow-ups on that. One is what are like set skillsets that could be ranging someone up? Are we just talking perio? Are we talking laser? Are we talking like, what is it that is specifically for hygiene, the skillset? And I do love, I hope you guys all asked like that, like every person should be performing at the top of their license. So that's follow up question number one. Second is gonna be about a compensation question. So what are those skills that you feel will range them up exponentially?   Britt (10:50.252) Yep, so for me, like basic skills, running on time. If you have an anesthesia license, you're doing your anesthesia, if that's allowed within your state. Chart audits are good. You're getting everything that needs to be done, that your charting is complete. You're getting all your diagnostics done. You're coming prepared to huddle. You're being a team player. All of those things are kind of like my basic level stuff.   Kiera Dent (11:16.846) Should they like interjecting real quick on that? Should they be hitting a certain production amount or is it more just those? It's like, what is the production amount that they should be hitting in like basic skill level before they even move on?   Britt (11:29.038) Yep. I think whatever your basic goal is, I'm usually depending on the area, depending on your PPO fee for service, right? There's going to be a little bit of a difference, but I'm usually like a 12 to 1500 is usually around kind of like my base, depending on if you're PPO or if you're fee for service kind of on that upper range. And then as you as you one, I think get more confident with perio, have those conversations, perio percentage rate, that's case acceptance for peri   percentage rate would be a next level to look at. So not only are you having the conversations, right, you can do it, but how effective are you educating patients in advocating form to get the treatment done that's needed? So this is where a few more specific metrics are gonna come into play. So per year percentage is gonna start to come into play looking at jumping to that next level. I'm also gonna start looking at how well are you setting up doctor and teeing up doctor for treatment.   That's going to be my mid range that they need to be able to have those conversations. TFDoctor, be a partner in that conversation. So that's kind of like my mid range ones and my high range ones I'm going to tie in. Yeah.   what's your case acceptance coming out of your room? How well are you supporting the doctor and advocating for those patients? Having conversations because at some point with hygiene, right, there's clinical skills and with those, right, doctors should be checking, sure, check my perio from time to time on my charting to make sure we're aligned. Yes, if I'm missing stuff that I shouldn't be missing, then like absolutely those should be things that are talked about and would keep me in that like basic pay range if I'm not doing well at my job.   But to get up into that advanced pay range, it comes to a lot of the soft skills. Are you adding in that scan? Are you on board? Are you advocating for the practice and getting things done? Are you talking about treatment? Do you have good case acceptance coming out of your room? It's a lot of those soft skills and showing initiative instead of like, no, that's too much. I'm not going to do that. It's almost like a difference in personality and an initiative once you get to those higher range and you know them, you see those hygienists that are just rock stars and they're like, yep, they will   Britt (13:34.33) help out, they are a team player. Yep, I can get that done. I've got time to do it. They are having the conversations, they're supporting the doctor really well. That's my top tier. That's what I ultimately want everyone to be.   Kiera Dent (13:47.918) And I think that actually really helped in like that 1500 that 1200 range like there has been a model out there of like three times their pay and I'm just curious Britt. Is that even a realistic number from your perspective now of three times a hygienist pay? I do say for fee for service usually at a four or four point five times their pay but with PPO schedules and with the new rate of hygienist coming out, do you still feel like three times their pay is fair?   Britt (14:14.242) I think it is a great starting point, right? There's across the country, and this is where like you can pull the economics of it into it, right? Depending on the area, depending on how many hygienists there are.   Like that's something that we, I think, have seen across the board that impacts higher ranges or lower ranges, right? That's the way a free economy works. Welcome to it. So, right, depending on the area, I would say yes, that is, everyone should be shooting to hit that. And some of our areas where   you know, it's a little bit more competitive or depending on, you know, well, we'll throw it out there. State laws, different things that have to be offered, right? That impacts the price and how expensive it can be to pay a hygienist. And I'll say to my hygienist, you guys are worth it, right? Especially you're that top tier hygienist. Like you guys are worth it. But from a business standpoint, there's like we got to we got to stay profitable at the end of the day. And so I do think that three times fee for service   us up to like four times pay is a great place to start. And if we are not there, then we need to start looking at other factors. Is it reasonable? Most of time, yes, 100 % it is. Some cases, depending on the area where there's like those shortage, those higher ranges, like it's a little bit more of a struggle. And that's where it comes to the conversation of, all right.   hygiene or associate. And we've definitely had those practices where it's like, for what I'm paying this hygienist, I can have an associate who can not only do hygiene, but can also do treatment. Which direction should I go?   Kiera Dent (15:38.862) Mm-hmm.   Kiera Dent (15:48.96) I agree. I think, I think the hygiene world, like making sure that it's cognitive of that too, because I think it could be a dangerous zone where without trying hygienists actually like work themselves out of the marketplace. I agree. think hygienists is such a valuable player on the team. And so just making sure that like we're cognitive of that. And I love that, Britt, you bring that from a hygiene perspective. I will also say though, I don't just think it's fully on the hygienist. And Britt, I know you agree with this completely that   Britt (16:15.555) Mm-hmm.   Kiera Dent (16:16.334) looking for that three times and instead of saying like we can't get there, let's look to see how could we get there. So it has the office actually looked at their fees and are we making sure that our fees are competitive, that we're negotiating with the insurances. This doesn't mean you have to drop in and drop your insurance plans, but it does mean we need to be very effective with it. Looking to see can we add in laser? Can we add in PRP or PRF? Can we add in some of those adjunct services? Are we adding fluoride? Are we getting all of our x-rays on the right series?   Are we billing out the correct comp exams for it? Are we looking for those additional pieces and looking for like, what are all the codes that we can bill out within hygiene? Of course, not over diagnosing things out or billing things out. But I think like, let's also look at medicine. They bill for the gauze, they bill for the cotton, they bill for all these things. And I'm not here to say like nickel and dime your patients, but I am here to say.   I think they're starting to become a world where we've got to start being more proactive on what we do, bill out to insurances to hit the rates that the hygienists need to be producing as opposed to just doing what we've always done. So I think like as an office collectively working in conjunction with a hygienist, let's not just throw our hands in the air and say like, they're too expensive. There's no way they'll hit it. No, that's not true. There's actually a lot of hygienists who are being paid those higher ranges and they are producing three, four times their pay. I have hygienists in...   less affluent areas able to hit that. And so it's kind of like the four minute mile. People thought it couldn't happen, couldn't happen, couldn't happen. Well, I think sometimes it's telling us it can't be done. We actually find ways to make that true rather than saying, hey, other offices are doing that. Let's get creative and let's let's let's work together and figure out what we can do. So I want to maybe have some commentary. Please do.   Britt (17:51.118) Yeah, I want to make a quick plug on this because I know I threw out there like there does come a point where like sometimes we sit there and we contemplate of like associate or not the hygienist and me do I want doctors doing hygiene? No, I don't. don't. No. Do doctors want to be doing hygiene? No.   Kiera Dent (18:04.27) No, I don't either and I'm not even a hygienist.   Now.   Britt (18:11.072) No, they don't want to, right? So like it's not an ideal solution, but when it comes to a business being able to survive and stay profitable and keep running to take care of patients and provide livelihoods for everybody, like some that's the that's the business side of my brain that it's like sometimes those are things that we have to contemplate and see what's the best decision moving forward.   Kiera Dent (18:30.296) for sure. And I'm glad you put that because the ultimate goal is to not replace hygienists. The ultimate goal is no. But I think it's like, look at other businesses. Do you think other businesses wanted to convert to AI? The answer is probably not. But due to necessity of profitability, like to me, that becomes a survival skill. Like is this business going to live or die? They're going to find ways to live. That's a natural human tendency. And so I think it's like, let's partner together. Let's find the solutions. I even have some practices who have elected to go   Britt (18:35.598) I don't want that.   Kiera Dent (18:59.064) hygiene, like no hygiene in their practices. so knowing that, like, but again, this is just getting scrappy. This is doctors just like, we have to find a way to survive. think it's   Britt (19:01.71) Mm-hmm.   Britt (19:08.14) And out of necessity, if they can't find one, right? Like sometimes that's kind of been the state that some of them have been in, so.   Kiera Dent (19:15.342) for sure. So Britt on that we did talk about like baseline pay and we talked about longevity of it. What happens when you have a seasoned team that has been there? And we've got hygienists, they love the practice, they love the things they're doing. recruiters are pretty impressive these days. Like I do feel everybody's being bombarded with other offers constantly. And it's like you might be very happy. But hey, like sometimes dollars do count. What do you do for a practice?   when like these new grads are coming out and let's say they're asking because like right now I have a practice and the new grads like literally looking on indeed all practices hiring right now are like $5 an hour more than what they're currently paying like their highest hygienist. Like what do you do in that realm because like if you've got three or four hygienists now I've got to increase everybody $5 an hour just to be able to bring one new hygienist in. I think this is where it's like this wave of constantly like chasing a number but it's not just one person I'm chasing it's multiples.   what do you recommend for businesses and new grads? Because I'm like, if I tell this new grad, like, well, this is where we'll start to, I've got seven other offices willing to offer this hygienist that they only need one hygienist. They can do it because the finances make sense for them. What do we do in those scenarios to help these practices out?   Britt (20:27.724) Yeah, I think having a community near you to know kind of what people are really getting paid, right? There will always be, especially in your more like city, right, areas, there's always going to be someone out there who can pay more.   There's gonna be an offer on the table somewhere. I always say question that. Know what you're getting into on those ones that are like real high from everybody else. But I think it's a real question of what are you ultimately looking for? One, with that higher rate you better believe you're still, you're gonna have to make your way, right? To make it worth paying you that amount. So that's gonna be there.   Also, you know, what do you value in the people you work with and the type of things that are being done and the care that's being provided in practice not taking a hit at anybody but I'm like that's an overall it's not just a dollar like sure you can go out and you just want to pick a job based on dollar Go for it. If you want it's risky in my opinion Look at the whole picture and see kind of what you're gonna be living because we spend a lot of time at work, right? It's a it's a big part of our life and we spend a lot of time and I don't know I take a lot of pride in where I work. So I care about when   the people and what we do. And I hope that's the same for our providers out there, for our hygienists out there. But I think take a look overall.   And then I think when it comes to those rates, so have a community know what like the actual rates are not just the jobs that are out there and what people are getting paid. Make sure you're competitive like 100 % the rates need to be competitive and if you fall in behind some unlike yeah we might need to see what we can do and see if we can start to get back within the range of the market to stay competitive. And then   Britt (22:16.45) that also I think brings confidence in knowing you're offering something fair, right? So if I'm like, if I know, hey, it's competitive, it's fair.   We're a great place to work. I always want to get people in to come meet us, experience us, because again, it's more than just a dollar. If they're making a decision just off of a dollar, they're probably not the right person for me anyways. So I want to get them in, let them see the whole picture. And then, you know, when it comes down to it, at the end of the day, I can offer what I can offer and offer a path of like, hey, this is where it starts. And here's what you can do moving forward in the potential. But we're getting to know each other. And   I'll say this recently, especially for assistants as well, because I think it's the same, similar scenario in assistant world, is some of the doctors that know their affair, they come in, they're confident.   have people who like them and they're like, okay, you know, not to say it always happens, right? It won't always, but it's more likely to happen instead of just chasing a dollar amount and trying to like outbid someone. So I think still be confident in your moves. Don't jump too fast. Make sure you're competitive. Make sure you're allowing people to see the whole picture of you. I'll add to that. Make sure you're actually a good place to work along with that so that you attract people.   Kiera Dent (23:12.878) Right.   Kiera Dent (23:32.398) Agreed.   Britt (23:34.382) because I think trends and you'll see articles and research out there, money matters and there's always going to be those people where money is their top priority, but life I think these days matters to people a little bit more.   Kiera Dent (23:46.22) I would agree. think that that's something that the shift of the, think money used to be the currency that people were going after. And I think now it's time and lifestyle that is the new currency. so realizing that and recognizing that, Britt, let's say an office, the going rate is higher than what you are really like able to afford in your practice. What's your take on offering like a lower base, but commission from a hygienist? Like does this, I don't know how it lands for hygienist. Is it like, well, I want the guarantee of like knowing that I can   let's say it's $5 different between offices, but this office is really struggling, but they can offer you the commission base. How attractive is that to a hygienist? I have my opinions, but I'm not a hygienist. So I'm just curious from your state, what you hear from colleagues in the industry. Cause I know you see very connected to the hygiene world. What are you kind of hearing around?   Britt (24:33.42) Yeah, I think it's a super fair model. I know when I was managing, that's the model we were off. I want you to know that you can count on something that's reliable, right? So that's where I do like having a base that's very reasonable, that's very fair, that is an amount that easily hygienists should be able to produce and make that and cover themselves.   But for those who do like hustle, right? They're not gonna be like, well, I've got an opening, I'll just go home. Or like, I'll just like chill. Like they want to work. They wanna keep people on their schedule. They want to be supportive of the team. They should make more. And so it's even just a fair from a multiple hygienist in an office. I'm like, yeah, yeah.   working hard I should make a little bit more than the person that's kind of slacking off a little bit. And so I like that model to where one you know what you can count on because there's that base there. And then yeah commission is going to be ultimately whatever you want it to be right? Like that's where you've got some control and if it's a commission based on production or adjusted production or collections whatever route the doctor ends up going   fees rise in the practice, right? That's you naturally kind of build in that increase over the years as office fees change.   Kiera Dent (25:56.782) Fair, that's a good point. And Britt, I have so many more questions I wanna ask. I think for today, keeping it here, I really also think one thing to plug on the commission that I think Britt, you and I have done a really good job. Like, mad kudos to you within our company, because we do offer our consultants based in commission. So I think like we can actually speak to this model pretty well. But something I really pride ourselves on is we actually go and look at real numbers. I don't want to be going for my best hygienist and offering off of my best hygienist.   We want to find an average between like our lowest producing hygienist and our highest producing because I would rather set a clear expectation with that hygienist coming in of like, if you do basically like bare minimum, this is what you'll be making. And then if you choose to like go more, which there are opportunities, this is the range you could do. And literally when we do offers, we literally show a hygienist or like in our instance, it's a consultant. Here's what it is. Here's what the averages are.   And for me, I think that actually makes me way more confident going in because I'm not offering the highest end. We have we have consultants that produce a lot more than other consultants. But I don't want because that just sets an expectation for that hygienist coming in. This is what I think I'm going to be paid. And then when I'm not, they get angry with you versus it being like, this is where I think it's very fair. This is very realistic. This is the time frame. Realistically, I think you can hit it. This is an average day. Here's our actual numbers. This is an actual hygiene schedule.   So that way I really do think that that will make you more confident when offering. If you can't offer say that $5 more or you want to bring people in and maybe you're a little bit less than that. You don't want to raise your entire hygiene team. And again, hygienist, it's not because I don't want to raise you. Like I just want to make that super clear as a business owner. I want to pay my entire team exponentially well. Like truly this is like my heart of hearts. Like Britt knows this. I'm constantly looking like how can we raise people? How can we do it?   Britt (27:38.413) Thank   Kiera Dent (27:40.918) I also know as a business owner, my job is to make sure I keep the business profitable because if I don't, I've actually heard every person that we serve in the community of patients. I've heard our entire team of being able to afford it. And also I don't want to be stressed as a business owner, like fully. would, I like, I love you and I want to pay you. I also want to be able to sleep at night and not constantly stressing of do I need to take a second mortgage out on my home? So like just understanding it's, it's a business, it's a person, it's a human, but I think be fair with your numbers that you offer.   And Britt, I do want to do another episode. I'll just tee it up of what do hygienists feel about assisted hygiene? Cause it is a model that's starting to come as popularity of not being able to find hygienists. Is it something of we like it, we don't. Also, I know there's conversations around, we shorten hygiene appointments to be able to see more patients as insurances aren't reimbursing as much. So I definitely want to like tee it up of having a few more hygiene conversations. But Britt on this, thank you for giving you the perspective of like the ranges of how to pay and what you feel about base plus commission.   Britt (28:13.528) Thank   Kiera Dent (28:38.874) Hopefully we were able to give you guys some tips on how can we attract these people. think like you said, Britt, having a great place and a great reputation within the community, having longevity of team members, it's been shocking. Britt and I have been doing interviews and I don't know if you picked up on it, Britt, but the last, I think two or three interviews we've done, one of the questions they've asked is how long is your longest team member and can we ask why they've stayed? It's been shocking to me that that's a question that has come through. It's been consistent.   Britt (29:02.156) Consistent. 100%.   Kiera Dent (29:05.132) And I'm thinking it's because people really want to work in places long-term and there's so much jostling that I think they're also wondering, are employers keeping team members too? So just note, that's been a very random comment that's come through on our last very, and we're talking like yesterday. We just had an interview yesterday, that question was asked, so it's very real. But Brittany, any last thoughts you've got you want to wrap up today? I appreciate your Brittany hygiene today, coming to the table for the perspectives.   Britt (29:29.102) No, I just, I think it's a good conversation and agreed on running numbers and especially if you're wanting to maybe like transition within your practice, right? Hygiene wanting to propose it or doctors wanting to like switch over so that it's a much more sustainable model for you. Run the numbers and see what it looks like, right? That's reality and I'm with you on like low and high end when it comes to hiring. Worst thing you can do is set expectations you're not gonna meet.   Kiera Dent (29:54.094) Agreed Well, Britt, thanks for being on the pod. You guys, appreciate you. We will definitely come back. I know there's lots of questions. I know this is hot right now. So, Britt and will definitely podcast again about assisted hygiene, what we do for shrinking hours. Is that even doable from a hygienist perspective? Or is that like, no, there's other solutions because I know everybody right now is just trying to find solutions for the pickle that we're in wanting to maintain and...   really pay these hygienists what we believe that they deserve. So Britt, thanks for being on it. And for all of you, if we can help you and your hygiene team, if these are issues you're struggling with, if you're like, am just like hitting my head against a wall. I don't really know what to do. Reach out. That's what we do. Hello@TheDentalATeam.com And as always, thanks for listening and we'll catch you next time on The Dental A Team Podcast.  

Get in your hyperbaric oxygen chamber or swallow a cursed potion because today we're letting death become us- or rather we're taking a broader look at those who want to live forever- the fictional, the factual & the futuristic paths to eternal life. Why do people want to live forever? Can we? Would you? In this episode we take a look at immortality- Death Becomes Her, people who think they're vampires, my vampire facials, Bryan Johnson and his quest to live forever and teenagers starting anti aging routines. We also have Dr. Marcea Wiggins of Sante Aesthetics in Portland, Oregon to discuss PRP, PRF, BBLs & many other letter combinations! Sources: People Who Sought Immortality [And Failed] Chat History Why We Fear Aging? The Take Death Becomes Her (1992) trailer Breaking down the 'Sephora kids' trend CBC News Why 'Death Becomes Her' is "Perfect Cinema" Mashable

Live from the 2024 AAID Annual Conference in Atlanta! Drs. Justin Moody and Danny Domingue chat with Richard J. Miron, DMD, MMSc, PhD about the application of exosomes in regenerative dentistry and the potential for increasing revenue in dental practices by using platelet-rich fibrin therapy for facial esthetics. The views expressed in this episode are those of the individual participants and not necessarily that of the AAID. Links from this Episode:  To learn more about Dr. Richard Miron visit: https://www.prfedu.com/  To learn more about the AAID visit: www.aaid.com

I'm at the point with IBD and CIRS, where I feel I can start testing my limits of what I can handle. In this ep, I discuss breast and whole-body thermography and why it may be a good option in your IBD CIRS and overall health journey. I also reveal my reasons and experience of getting PRF fillers for under-eye cosmetic reasons. Please consider donating to Shelly's fistula journey. She's a warrior who has helped us so much!  

Do you ever feel like there's too much happening in dentistry to keep your head on straight? Kiera talks about 4 ways you can stay up to date without being overwhelmed: Listen to podcasts Attend conferences Join a consulting group Find what you're passionate about Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: Kiera Dent (00:00.554) Hello, Dental A Team listeners. This is Kiera and welcome to the podcast. I hope today is just a magical day for you. I hope that you're having just a great time and I hope that you just remember that we're in the greatest space possible. We get to be in dentistry. We get to help people. We get to literally help people have greater smiles and greater happiness in life. And I think that that is one of the most incredible things that we get to be a part of. So thank you for being a part of our family. Thank you for being on the podcast with us.   Thank you for listening in, get ready. We're gonna actually start to have a lot of you join us on the podcast. I have a new idea that's ready to trickle out and I hope you are excited for it. I wanna get to know more of you. I want to hear from more of you. So get ready, it's coming for you. Today is going to be kind of a funny topic. I thought it was funny. I have our team, they're super kind, our marketing team, shout out to them. They actually go and they read Facebook groups and they read.   different areas, they read a lot of dental information and they're constantly watching things and they listen for what you guys are emailing in on, which you could always email me a podcast topic. Hello@TheDentalATeam.com. I love to hear from you. love pen pals. and so our team, they go out and they scope and I read this one and I said, I don't want to podcast on that. and then I read through, they have a nice list for me of about seven pages of topics for me, which is super nice. And this topic was on there like,   It was here. And then I looked on the list and it was here again. And I thought, okay, fine. I will talk about a topic. And I hope that this is helpful for you. And the question is like how to stay updated on all the new dental technology and how to keep my team educated and up to date with the latest techniques and technology. And to me, this feels like a no brainer, but I realized this is obviously a question that you guys have. So let's answer it. All right. So welcome to the Dental A Team Podcast. I'm going to teach you how to do this, how we do it, how we help other offices do it.   And again, something that I thought was so just everyday knowledge isn't. So here we go. That's why we had the podcast. That's why we share. And if you love our podcast, please do me a solid favor, go like, review and share with somebody today. Okay, so ways that we were able to do this. Number one, you're doing a great job. You're listening to a podcast. So high five there. I try really hard to bring people to the industry that I've met, that I talk to, but it is tricky. And it's like, how do we know that these people are the best? So find somebody who's a trusted source.   Kiera Dent (02:19.774) within the industry that you can trust. I have prided myself for years that I started Dental A Team because of Midwestern students. Shout out to all my Midwestern students out there. I noticed that in dental school, they were gonna get freaking eaten alive coming out into the world of dentistry. And it's like, how do you trust different reps? Because people are so good at selling you on the latest technology and the latest this and the latest that, that it's kind of scary.   And so that was something that I wanted to do is to be a resource, to be a beacon, to help you know, these are people I've vetted. Just so you know, any sponsor I bring on, they have to work with us. They have to do different pieces. They have to let me beta test on them of other practices before I will even introduce them. So I have quite a few people in the back burner at all times that I'm testing, that I'm vetting, that I wanna make sure that they're getting results before I bring them onto the podcast. I got burned a little bit early on. And also if you listen to past podcasts,   that company might not stay the top of the list. I'm constantly looking for it and I tell offices like you might not get to be or sponsors. I will always be looking and if someone comes in better than you, they will get promoted from me. So I think that that's one zone. Like I've told Zeke at Swell, if anybody comes onto the market that's better doing Google reviews than him, I will definitely promote them. As of today,   Zeke is still the number one way that I get Google reviews for clients. They tell me all the time, Kiera, but we have it in this software, this software. I say, guess what? Zeke does it for, think like 149 or 199 a month. And I have offices who I literally beta tested on who got over 50 reviews in one month from using Swell. They have grown their practice from having like three new patients a month, I'm not joking, to having over 45 new patients a month by using Swell. People ask, how did you do it, Kiera? And I'm like, honestly, it was Google reviews and time. That's it.   And so for that, I will promote them. And so when you're curious about how do we find this up to date of new technologies, I think listening to podcasts and listening to trusted sources out there, like AI and different pieces, I also think going to conferences. So the way I actually meet a ton of our sponsors and speakers and different people are through conferences. I go to these conventions and I go meet people and then I go test their products and then I work with them and I figure out and I have a lot of our clients are beta testers for me and they'll try them out and I get free trials for them.   Kiera Dent (04:35.566) but going to your conferences in your areas, not only is great for a CE, but go meet people. And I know it can be annoying to be sold all the time, but it can be helpful. And so for example, like right now, the greatest AI on the market is between Overjet and Pearl. Those are the top two for adding AI onto your X-rays to help you co-diagnose, to helping you with that. They're the best on the market. I love Pearl. That's the one we've selected to go with. We have an affiliate relationship with them where I get the most preferred pricing for all of our clients.   So if you're interested in that, be sure to reach out. We can help you connect with them and get that discounted rate. But this is how we do it. Also, I think online, like watching reels as silly as that sounds, but there's a lot on Instagram and TikTok and things like that. But then questioning it as well of is this really real and what really is needed for my practice? So right now AI is hot. So let's be looking at AI and what things could we implement into our practice. And it's one of those things I don't like to be the earliest adopter, but I also don't want to be the person who never adopted and I actually got left behind.   So when we're looking for this new technology, we're looking for these new things, attending those pieces, watching it, and then doing our own individual research. Like you can email me anytime, hey Kiera, have you heard about this company? I love it when people do that. Cause one, you expose me to other companies and two, I'm able to then go research them, vet them, and then bring it to the podcast and share. Because my goal is within our community, within consulting, I love it. We bring our offices together. And this is actually how I also learn about a lot of things. And that would be my third point of like, join a consulting group.   I know I'm a consultant, so hopefully you want to choose the Dental A Team, but join a consulting group that brings people together, that shares. We bring our doctors together every single month, and then we meet in person actually twice a year. And it's because I want you to mastermind and I want you to talk to each other, and I want you to figure out what are the best ideas, what are the best resources, who are you using for this, who are you using for that? Because just hearing and talking with other people, it's like, my gosh, I didn't even know that. In our company, we call it Tip Tuesday.   And every Tuesday, our team member brings pieces to the tables. Like today, Shelby brought like a window cleaner. And it seems so silly, but I think back to community, right? Think back to back in the day when we didn't have technology and we weren't all connected virtually, we were connected in person. And when you're in person, you chat. And when you chat, you share your secrets and you share the best things that work for you. And so like Shelby sharing a glass cleaner that's $2.89 on Amazon, life-changing.   Kiera Dent (06:59.234) But without community and without chatting, that's something that I would have just gone on my merry way continuing to buy Windex that is the strongest being promoted product out there. And it sounds so silly, but it's tips like that. What are the little things you're doing in your practice? What are the elite practices doing? What are other offices doing? And let's all share. And it's not just the elite practices. It's a lot of startups. Startups are scrappy. They've got other resources. But like I talked to my gym trainer and we used to virtually coach. And then I went in person with her.   And instantly I'm connected to people for the podcast and people for social media and different people for whatever it is because I'm with her. And so getting together with a consulting group that meets in person or meets virtually that shares ideas, our community goes wild and it's incredible to see them all sharing, hey, what cosmetic group do you want to go to? Or, hey, what's a great resource for this? Or what's a great thing for that? But being a part of a group of community of trusted colleagues, I also think is a great way to stay on top of it. Now, how do we get our team educated on it?   I think that there's other ways like you can take them to courses. So look to see, I usually try to do things within our team that I want to learn. So let's say we wanna learn marketing. We're gonna take our team to marketing events. We're going to find coaches for marketing. We're gonna find events around it. If you wanna do cosmetic, let's do cosmetic. Let's bring it to the office. Again, that's why I love consulting is because we literally fly to the office and we show you guys what you can implement within your practice that can help with it. So finding those things, but...   Also on your leadership team, get them fired up. Hygenist will go and look for research and information and see E that's going to make them so excited and so fun that they're excited about with laser and PRF and PRP and what can we do for snoring and different pieces like that. But find what you're passionate about. And that's also another way, because I think sometimes we get so inundated with technology that we miss what we're actually passionate about. And so really helping you realize this can be fun. You don't have to be.   over the top and like, my gosh, I'm missing out on all of this. I would say in a simple form of number one, plan to go to at least one dental convention every single year. I don't care what it is. I don't care where you go. I don't care if wanna travel out of state, but that's gonna be your best way to bring those people in because those conferences are constantly looking for sponsors and people and a lot of the newer companies, a lot of the OG companies.   Kiera Dent (09:13.528) they tend to attend these conferences. If you're not in a big area where maybe a lot of people won't come to it, go to some of the bigger ones like RMDC in Colorado, Chicago Midwinter, Dicama. Some of these are really big ones that will bring more people in for you. And you don't have to even go for the CE. Just go walk the vendor halls, go see who this is there, and then go do some research on it. Next would be, would say, listen to podcasts and attend free webinars. Our company puts on the third Thursday of every single month, we do a free CE webinar.   And I do that intentionally to bring great people to the audience, to share with you other people that are out there, to get all these different pieces of technology and sponsors and vendors and different things that will make your office easier, attend those. So I would pick once a year, go to a conference every month, find some sort of CE, whether it's a book, whether it's a webinar or something that's going to get you educated. And then the third thing I would say is to join a group, a consulting group, because honestly, that's where it's the networking, it's the community, it's sharing.   that you're going to learn all these different pieces. It's too hard to do it on your own. And so find someone. And of course, I would love Dental A Team to be your preferred consultant. I'd love us to help take you to the next level. I'd love to expose you and your team. We have virtual, we have in-person and we have in-person events and we have in-office visits as well where we come to your practice and we also meet together as a community, as a collective group. We do it on Friday and Saturday. It's really fun. It's really exciting. And it's a really great time to just connect to   to share and I think that you doing those items, you will stay up to date. There's no way you can't stay up to date as long as the consultant is innovative. And of course, I'm going to like toot my own horn. We're one of the youngest consulting companies out there. I'm nervous for us to become an older one, but I've tried really hard to keep myself young. Being a millennial, I'm very tech savvy. I'm very aggressive on research and knowledge and innovating and implementing ideas because I know that if we don't, be dated very quickly. And so,   also finding someone who is maybe a little bit younger on that. Like I look for social people that are in their twenties because they're going to innovate even better than I will. And so those would be some of my suggestions of how you can stay up to date, how you can stay current, how you can make sure that you're gathering all these research, these resources, and then realize I'm not going to catch them all, but I'm going to focus on the ones that turn my practice to ease efficiency in the areas I want. And that's what I'm going to do. And I guarantee you, if you do that, you will be so happy. So   Kiera Dent (11:36.386) Hopefully those gave you some ideas. Like I said, this was a topic that I thought everybody already knew, but in digging into it, I realized this can feel daunting and it can feel like I'm always behind, but I think breaking it down to your annual, your monthly, and then also joining a group. Again, like I said, I'd love you to be a part of it. I think those three things will keep you current and will keep your team current as well. And as always, if we can help you reach out, Hello@TheDentalATeam.com You guys are incredible. We're doing an incredible work. There's amazing things coming into dentistry. And I would say do not get left behind.   but stay current. And then I guess my fourth final tip for you would be commit to implementing at least one item of new technology every single year. And I think if you do those items, you will always stay up to date. I'm happy to share a ton of our resources. So reach out, Hello@TheDentalATeam.com And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.

Hair loss isn't just about genetics or male pattern baldness. Aging, stress, and environmental factors can also take a toll. Dr. Jason Bloom joins Dr. Bass to discuss solutions for thinning hair, hair loss, and baldness, from everyday treatments like minoxidil to advanced options like hair transplant surgery. Find out how FUE (Follicular Unit Extraction) and FUT (Follicular Unit Transplantation) hair transplant procedures work, along with the pros and cons of each. Plus, Dr. Bloom shares his personal journey with hair transplant surgery to give you a firsthand look at what to expect. Drs. Bass and Bloom cover: The importance of planning ahead before a hair transplant Why harvesting a strip of hair from the back during hair transplant surgery doesn't mean losing that hair How NeoGraft helps achieve natural-looking results The maximum number of grafts you can safely transplant at once Other transplant areas, including beards, eyebrows, and even scars Exciting advancements on the horizon for hair restoration treatments About Jason Bloom, MD Located in Bryn Mawr, Pennsylvania, Dr. Jason Bloom is a double board certified facial plastic and reconstructive surgeon.  He is an Adjunct Assistant Professor of Otorhinolaryngology – Head & Neck Surgery at the University of Pennsylvania and Clinical Assistant Professor (Adjunct) of Dermatology at the Temple University School of Medicine. Read more about Philadelphia facial plastic surgeon Jason Bloom, MD About Dr. Lawrence Bass Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond. To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass. 

DENÚUUNCIA! Fizemos um compiladão dos principais temas que cairão no ENEM de 2025 e no concurso público da PRF! Nesse episódio você poderá ouvir a grande biografia de Lyudmila Pavlichenko, da qual sentimos muita saudade nos dias de hoje. Falamos do maior caso de família da história da ciência. Tem a grande reportagem sobre o seu amiguinho favorito. E o grande manifesto contra a calvofobia! Ficha técnica deste episódioParticipação: @sirtomzeraEdição, decoupage e consultoria técnica: Randi Maldonado (@grimoriopodcast) Sonoplastia: André Ávila Quer sugerir um filme e se tornar um Aleatórier? Clique aqui e mande a sua Sessão Aleatória!Clique aqui e saiba mais sobre o Sessão Aleatória.Quer falar conosco? Mande um email para sessaoaleatoriapodcast@gmail.comInstagram: @sessaolaeatoria

In this episode, join Dr. Anthony Youn, renowned as "America's holistic plastic surgeon," as he unveils the top five cosmetic treatments set to take 2025 by storm! Get ready to dive into the future of beauty with insights on the revolutionary Motiva breast implant, the game-changing platelet-rich fibrin (PRF) for banishing under-eye hollowness, and the transformative deep plane facelift. Dr. Youn passionately emphasizes the importance of thorough research and exercising caution before embracing these cutting-edge technologies. He also underscores the critical need to select highly qualified surgeons and stay updated on the latest advancements in the field. Plus, Dr. Youn takes a moment to celebrate a listener's glowing review and warmly invites everyone to share their feedback to help spread the word about the podcast. Don't miss out on this exciting journey into the future of cosmetic surgery! Learn more about your ad choices. Visit megaphone.fm/adchoices

Book a consultation at Allure Medical.https://www.alluremedical.com/schedule-an-appointment/Get to know platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) therapy, two of the biggest breakthroughs in regenerative medicine. In today's episode, Dr. Charles Mok explains how PRP and PRF are derived from your blood through centrifugation and how they're used to promote better skin quality and joint repair. These therapies can be incorporated into anti-aging routines and maintenance procedures.  He also introduces the concept of biological fillers made from your own blood components and addresses common concerns about synthetic fillers and the appeal of using one's own tissues for a more natural approach. Tune in to Inside The Cure Podcast —  PRP vs. PRF Therapy: The Differences.————————————————————————————————Subscribe to Inside the Cure on Apple Podcasts and leave a 5-star review! https://podcasts.apple.com/us/podcast/inside-the-cure-with-dr-charles-mok/id1495870043?uo=4Read the latest research and advice from the doctors at Allure Medical:https://www.alluremedical.com/books/Dr. Charles Mok received his medical degree from Chicago College of Osteopathic Medicine, Chicago, Illinois in 1989. He completed his medical residency at Mount Clemens General Hospital, Mt. Clemens, Michigan. He has worked with laser manufacturing companies to improve their technologies; he has performed clinical research studies and has taught physicians from numerous other states. His professionalism and personal attention to detail have contributed to the success of one of the first medical spas in Michigan.LinkedIn: https://www.linkedin.com/in/charles-mok-4a0432114/Instagram: https://www.instagram.com/alluremedicals/Website: https://www.alluremedical.com/YouTube: https://www.youtube.com/@AllureMedical Amazon Store: https://www.amazon.com/stores/Dr.-Charles-Mok/author/B0791M9FZQ?ref=ap_rdr&store_ref=ap_rdr&isDramIntegrated=true&shoppingPortalEnabled=true #AntiAging #PRPTherapy #PRFTherapy #RegenerativeMedicine #Health #Wellness #SlowAging #SkinCare #SkinTightening #SkinRejuvenation #BioPRF #Fillers #BiologicalFillers #JointRepair #AestheticMedicine #HealthPodcast 

*PODCAST 13 MINUTOS | Confira o que foi destaque nesta semana* Resumo da Semana |  20 a 24 Janeiro de 2025 O presidente Lula assinou a concessão da BR-381, rodovia essencial para Minas Gerais e para o vale do aço. O Brasil terá 6,5 milhões de testes para diagnosticar a dengue em 2025. A presidenta do PT, Gleisi Hoffmann, comentou o indiciamento de 4 ex-diretores da PRF acusados de impedir eleitores de votar nas eleições de 2020. Não perca mais essa edição do 13 minutos, seu podcast semanal de notícias da rede PT, no Spotify ou no seu tocador de áudio preferido.

Trump faz primeira ameaça a Putin por acordo na Guerra da Ucrânia. PF indicia ex-dirigentes da PRF por ação contra eleitores de Lula em 2022.See omnystudio.com/listener for privacy information.

What's the best way to reduce post-op pain after extractions? And why should we never use the term “painkiller” with patients? What to do when you hear the dreaded *crack* of a tuberosity? In this episode we talk about all things post-operative extraction complications! And I'm joined by one of the nicest guys in dentistry - Dr. Nekky Jamal  Complications are something we ALL experience, so this episode is great for any dentist. Whether you're brushing up on dry socket prevention, mastering post-op communication, or just curious about advanced healing hacks, tune in for real-world advice to make extractions smoother - for both you and your patients https://youtu.be/BvB3hDESYDY Watch PDP210 on Youtube Protrusive Dental Pearl: The "Niche Kebab" concept encourages dentists to narrow their focus by reducing the variety of procedures they perform and prioritizing those they genuinely enjoy. By evaluating every new skill or treatment added and strategically dropping less-loved procedures, dentists can avoid overextension and the "jack of all trades, master of none" pitfall.  Learn how to Extract Impacted 3rd Molars, don't miss out on Third Molars Online and use the coupon code ‘protrusive' to get 15% off! Key Takeaways Pain management is about setting realistic expectations. Dexamethasone can be beneficial but must be used cautiously. Dry socket is often overhyped; proper care can prevent it. Effective communication can alleviate patient anxiety and prevent misunderstandings and complaints. Preoperative care can help manage pain expectations. Understanding the signs of infection is essential for diagnosis. Chlorhexidine rinses can significantly reduce dry socket risk. Patients appreciate being informed about their unique dental situations. PRF can significantly reduce the incidence of dry socket. Dentists should embrace new techniques like PRF to enhance patient care. Patient involvement in post-surgical care is crucial for healing. Dentists should not hesitate to refer complex cases to specialists. Highlights of this episode: 02:54 Protrusive Dental Pearl 04:05 Dr. Nekky Jamal  08:39 Managing Post-Extraction Pain and Swelling 21:37 Infection 25:02 Identifying Dry Socket and How to Prevent it 28:30 Case Selection and Communication 37:13 Mitigating Dry Socket with Platelet-Rich Fibrin (PRF) 39:47 The Importance of Nicheing in Dentistry 43:19 Cryotherapy and Post-Surgery Care 47:32 Handling Tuberosity Fractures 55:08 Patient Consent  57:55 Litigation and Patient Communication This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.  This episode meets GDC Outcomes A, C and D. AGD Subject Code: 310 ORAL AND MAXILLOFACIALSURGERY (Exodontia) Dentists will be able to: Identify and differentiate common postoperative complications, and recognise the  key symptoms associated Evaluate the ethical and clinical considerations of case selection for extractions Communicate effectively with patients regarding potential complications If you loved this episode, be sure to check out another epic episode with Dr. Nekky Jamal - Wisdom Teeth Extractions – SURGICAL TOP TIPS

In this episode, we dive deep into the U.S. Federal Reserve's latest rate cut announcement, bringing the fed funds rate down by 25bps for their final decision of the year. We discuss why markets reacted sharply to the news and what it means for investors. We also spotlight 10 ETFs to watch for 2025. From strategies to hedge against the "Magnificent Seven" in the S&P 500 to leveraging rate-sensitive sectors like utilities, we cover it all. Tickets of ETFs discussed: ZGLD.TO, ZLB.TO, CLU.TO, PRF, RSP, FBTC.TO, ZEO, HXE, HUTS.TO, UBIL-U.TO Check out our portfolio by going to Jointci.com Our Website Canadian Investor Podcast Network Twitter: @cdn_investing Simon’s twitter: @Fiat_Iceberg Braden’s twitter: @BradoCapital Dan’s Twitter: @stocktrades_ca Want to learn more about Real Estate Investing? Check out the Canadian Real Estate Investor Podcast! Apple Podcast - The Canadian Real Estate Investor Spotify - The Canadian Real Estate Investor Web player - The Canadian Real Estate Investor Sign up for Finchat.io for free to get easy access to global stock coverage and powerful AI investing tools. Register for EQ Bank, the seamless digital banking experience with better rates and no nonsense.See omnystudio.com/listener for privacy information.

O problema do desgaste e da desvalorização da moeda nacional é o descrédito na política econômica fiscal do governo. É o desequilíbrio fiscal e o aumento da dívida pública que arrasta o aumento de juros.

Send us a texthttps://renegadehealthboss.comIn episode 134 Heather Gray FDN-P  welcomes Dr. Sharla Aronson, an expert in biological dentistry. Together, they uncover the lesser-known impacts of dental health on overall wellness, addressing how traditional and biological dentistry differ and the profound effects dental materials and procedures can have on the body. They explore the importance of biological dentistry, the impact of low-grade infections on overall healthIn this podcast you will discover0:00 Heather introduces the episode's focus on redefining health, wellness, and the unseen factors in our environment.2:26 Dr. Sharla Aronson joins to share her journey into dentistry and her transition to biological practices.4:45 Dr. Sharla discusses how her child's health concerns led her to rethink conventional health approaches.8:05 The potential dangers of amalgam fillings and the effects of mercury exposure.10:05 Core differences in approaches to infections, dental materials, and patient care.12:33 Dr. Sharla's patient-centered exams that look beyond cavities to systemic health factors.13:51 Mouth taping and airflow can reduce cavities, reshaping perspectives on preventive care.15:39 First signs of cavitation and chronic cognitive effects, including memory issues and stuttering.18:34 Importance of specialized imaging to identify cavitations, often missed by traditional dentists.22:15 Removal of infection, use of ozone and laser treatment, and PRF therapy.26:08 Surgical vs. ozone treatments for cavitations, along with recovery expectations.29:27 Connections between gum disease, cardiovascular health, and other serious conditions.35:00 Monitoring is essential and the difference between biological and traditional approaches.38:01 The energy flow impacted by dental health and compatible materials for implants.Thank you to our amazing sponsors, without them our podcast would not be possible.  Thank you to The BioMed Center and MHP Vitamins.  Please learn more about our sponsors here. https://renegadehealthboss.com/sponsors/Thank you, and have a healthy day. Guest Bio: Dr. Sharla Aronson, a SMART-certified biological dentist, specializes in holistic, minimally invasive, biocompatible care, inspired by her journey into root-cause health after her first child's birth. Trained by IAOMT and completing the Biodentist Way in 2022, she offers personalized treatments that prioritize both oral and overall health.To learn more, visit www.alive-dental.comFrom nutrition and stress management to restorative practices, this ebook is your essential companion for a balanced and vibrant life. Perfect for anyone looking to make lasting changes to their health and well-being, this guide empowers you with the knowledge and tools needed to take control of your health naturally. Start your healing journey today FREE mini eBook [Foundations of Health]https://rhbcourses.com/products/free-mini-ebookGet the Foundation of Health Course here. Lose the brain fog, have more energy, and get your gut working right. https://rhbcourses.com/discount/ACTION this link saves you $100 on the course. #SustainableDentistry #Biodentist  #healthyteeth #toothhealth #fatigue #youarenotcrazy  #dentaltips #overcomingchronicillness#lymedisease 

As we are closing in on the deadline for Pasture, Range, and Forage Insurance, we had Rachel Myers join us on the show today explaining all things related to "Rainfall Insurance". The deadline for 2025 sign-ups for PRF insurance is Dec. 1st!   Contact Info for Rachel Myers (Email)  (Website)  Links to Topics Mentioned on the Show RMA PRF Decision Support Tool Podcast Sponsors Capital Farm Credit,  AgTrust Farm Credit, Texas Corn Producers, Braun & Gresham, Plains Land Bank, Plateau Land & Wildlife Management, and AgTexas      

Kiera breaks down need-to-know pieces of leadership meetings—ones that are regularly scheduled, have focused agendas, and require personal ownership from each person present. Episode resources: Reach out to Kiera Tune Into DAT's Monthly Webinar Practice Momentum Group Consulting Subscribe to The Dental A-Team podcast Become Dental A-Team Platinum! Review the podcast Transcript: Kiera Dent (00:00.798) Hello, Dental A Team listeners. This is Kiera and welcome to the Dental A Team podcast. I hope you guys are just having the best day of your life. I hope that you just remember we are truly so incredibly blessed to be able to be in dentistry. I say this often and I genuinely mean it. I think it's so incredible that we get to be a part of dentistry. We get to be part of all this evolution. We get to be a part of AI coming into our practices and being able to have all these fun things. We're able to help our patients with   PRF and now there's laser that's helping with restorative treatments have less sensitivity and we're able to add it on and have literally patients healing like within three days after a full mouth extraction by using a lot of these procedures like it is truly mind-blowing that we get to be a part of this and giving people their smile. I was in an office this last weekend one of the the team members she's new to dental and she said you know a smile is the universal hello.   And while, yes, I've heard that before, it just kind of hit me again of how beautiful of a work dentistry is where we get to help people with that universal hello of being able to smile and have the confidence and also be able to fuel and be able to eat the healthy foods that we need to eat. To my mother-in-law, she had an accident and she wasn't able to eat. Some things happened and just hearing like how hard it was for her to be able to eat and consume food and how hard it was for her body to heal. just thought...   I think we sometimes forget how important our job and our role and what we're doing in dentistry is and the life impacts we're able to make for people. just wanted to remind you of what a great work you're doing and mass kudos and celebrate your team because we really are doing a work that changes lives. I understand we're not heart surgeons, but we are smile surgeons and we're able to give people the smile and the confidence of their dreams and make that a reality for them. So just wanted to remind you.   Keep doing what you're doing because you're making an incredible impact in this world. So as always, thank you for being a part of our Dental A Team podcast family. If you've not left a review, please go leave those five star reviews. Be sure to share this podcast with someone. Just literally like send it to someone. I want you to think of one dentist or one office manager or one hygienist that you know. Just send this podcast to them because I really am here to inspire and positively impact this world of dentistry in the greatest way possible. And the only way I can do that is providing great content.   Kiera Dent (02:21.984) that you naturally want to share. So please share this with someone. And today's topic is going to be really fun for you to share. It's all about how to run effective leadership meetings. I know. Don't worry. I know how to give a good pitch and hook. How to run great effective leadership meetings. I just came in off the road. did nine leadership meetings in one week. That was my latest record. It's definitely something that I have not done before. And to say I was very tired at the end of it and   What my favorite phrase is, came from Tony Robbins and he said, bone tired, but victorious. And that's how I felt. I was literally physically exhausted. I slept in four different hotel rooms in five different days. It was just very, very like I was running. I was sleeping on all different time zones. But by the end of it, my cup was so full from being able to help so many offices achieve goals and dreams and amazing leadership teams that they never believed were possible.   And for me as a consultant, think my greatest success is watching my offices. Yes, I love numbers. I love hitting up sexy numbers. I love seeing offices who when I first started with them, like I have one office that I'm thinking of, when I first started with them, they were doing about 2 million. Incredible practice. They were doing a great job. And just over the course of a few short years, they are now producing, we're hoping that they end in the 5 to 6 million range.   And so to be able to give that ROI of sexy numbers, those are always fun for me to throw out to you of true real life examples, other offices that are producing 12 million, other practices that started out as scratch startups that are now producing 1 million, 2 million, 3 million, and having very successful profit margins on that too, because I don't care what your top line number is, I care what your profitability is, to see offices that bringing on partners are able to pull in 35 % profit.   Those to me are really fun, sexy numbers, because I think in consulting, you're looking for ROIs. And so to be able to share those success stories, but then I also have other offices that don't have as great of numbers. And I really do look to see what's the difference between them. And I think there's a few differentiators and one is execution and commitment. Offices that flourish truly do execute and commit for at least the three to six months or whatever we've committed to as a team, they commit and they stay committed to that. They don't just like, yeah, we did this. And then they let it slip off.   Kiera Dent (04:41.056) The owners are very, very strict with that. Something else is the doctor is very much, the owner is very much involved in not necessarily running the meetings or doing all the pieces, but they're there setting the vision. They are there being a part of it with the team and they very much love their teams. And then the other part is they expect their teams to rise up. They expect their teams to have the conversations. They invest in their teams. They pay for the consulting, but they have their teams come to the meetings.   I have an office and like our meetings every single month. We have our leadership meetings and it is never missed and it is never let go. It is and it is in gold and it's so important and they expect the leadership team to go and tell the doctor what they learned at that meeting versus my other offices who are missing the meetings. They're not blocking the schedules. They're not taking the time. They're not following through. And then we're looking at the numbers. We're consistently looking at the numbers to see where we at, where the lovers and we fall in love with numbers.   All of my offices that are very successful know their metrics forward and backward. If I called each of them up right now, they would know their overhead, they know their profit, they know their collection percentages, they know how much is in their AR, they would know how much their doctors are producing, every single one of them. Like literally I would call them, but that's been trained over years of this is what we need to look for and we need to make decisions off of that. And then I train leadership teams to do the same. Training leadership teams to think like owners, to look at this practice and take the ownership of like, yes, the doctor is here.   but leadership teams are now setting the vision. They're setting the goals. They're setting the objectives. The doctor has a small portion of that as the owner, but the leadership teams are ultimately taking the ownership and having an ownership mindset on the practice. The doctors that don't do as well in consulting, or I would say in general, are the ones who are making excuses that are blaming, that aren't having the uncomfortable growth conversations with their team, that aren't expecting their team to show up to meetings. It's crazy. Some teams start right on time. Like the offices that do really well.   They are always set up, prepared. Everyone has a notebook and a pen. They're there usually five to 10 minutes before the meeting starts. And that's the expectation that they have versus other offices. They're coming in. No one has notes. No one's taking notes. No one's following up on what's going on. You obviously have two different stages, two different standards, but both of them have the same opportunity if they desire. And so just giving you guys some tips on how you can run very successful leadership meetings is one.   Kiera Dent (06:59.796) always have it like set in the schedule and everybody comes and I recommend you always start five minutes like they're there five minutes before and that's on time. We always have an agenda. So there's got to be an agenda. I follow the traction model by Gina Wickman. We call them L10 or level 10 meetings. And there's a very solid structure in there where we start with our personal professional wins of the week. And then we have our expectation of what we're hoping to get out of the meeting. I do this every single time our team does it. My offices that I coach do this.   After that, we then go into reviewing last week. Did we get our action items done? Where are we at? We look at the numbers and the metrics. If anything is off track for that quarter, that goes to an issue that we're going to discuss. And then we move on to issues and issues we don't just go one by one by one. We categorize them, we put them together, and then we look at what's the one, two, and three most important things to get solved and resolved. And we come to meetings to resolve. We don't come to meetings to just talk. So we're coming there to make decisions. We're coming there with all the information people speak up.   Then we commit, we have our action items, people follow through. And a lot of times it's like dependent upon the office manager to tell everyone, no, in very successful leadership teams, you are taking notes, you are writing down your action items of what you need to get done. So you take personal ownership of it. The office manager is just expected to know everything going on. And if something's off track, they go have a conversation with that team member. But if leaders can come to the table this way, if leaders show up this way, leaders are being very involved, the bulk of the time is spent on those issues.   We're not here to debate it of a way of making people right or wrong. We're here to debate of what does the business ultimately need and why is this an issue without blaming? Sometimes it is like you got to call people out like, hey, Kiera, you're not showing up to these meetings on time. And I can either be annoyed, that's the ego, or I can say like, you know what, guys, you're right. And I need to set an alarm 10 minutes before so that way I'm here. I really have found that excuses destroy leadership teams.   excuses of why things aren't happening are what destroy and make it to where we can't move forward. And these are the things that I would recommend and encourage that you actually remove out of your leadership and call each other out of like, Hey, is that an excuse or is that a fact? And encouraging your leadership teams, like I'll throw another plug for Patrick Lanziani's, five dysfunctions of teams book, making sure that we're actually all talking about it. And we're, we're working on winning.   Kiera Dent (09:22.582) And we've got to have the healthy debate. We've got to be able to call each other out and not take the personal offense. We've got to put our egos at the door and it's okay to feel bad because you didn't meet the standards and you let your team down. But that doesn't mean we make excuses or we blame. We take personal ownership and then we commit and resolve and we don't have it happen again. And so that's how you run effective leadership meetings. And then we always rate them and we rate them honestly on a one to 10. So 10 was, was an incredible meeting. We got a lot done. There's a solid plan in place. Everybody's clear.   One is this was a complete and utter waste of time. And the more honest and truthful we are with our meetings, like I've given my team a six before I'm like, it was a six today because we just got in a spin and we resolved nothing today. And it was an absolute waste of time for all of us. So next time we come in, this is what we need to do differently. I usually don't give that low of numbers, but when it's not a good meeting, leaders need to step up and say the honest truth. Now there's the flip side where people are like, I'm never giving tens or I'm never giving this like, but if it was.   give the celebration and let's celebrate that we did an incredible job as a leadership team. and then the other piece that I always recommend. So we start on time. It's always consistent. We have an agenda. There's someone who's taking notes, but everybody should be taking their own notes of what they're expected to do. There's true follow up. No excuses. Let's have that. And then whatever we discuss in the leadership team needs to stay confidential within.   and we all need to be committed. We're not having side conversations and that's literally being all brought up within that leadership team meeting. And you can also do this within your team meetings too if you don't have a leadership team today. But really making sure we're doing these pieces, we're building the trust, we're having the conversations, we're having the healthy debate, we're fully committed. And then I recommend ending that meeting about 10 minutes before time so that way we can make sure, okay, what did we discuss today? What's the action plan?   who's doing what and what did we truly like solve today to make sure we're all on the same page. And it's almost like giving you a 10 minute time to recap it before we get to the next meeting. And I found that that really, really helped. So even on my calendar, we shrink it up by 10 minutes. That way we can recap it at the end and we can end and be done right on time. And I'm always very committed to we end on time. Now, if you're in the middle of something that's very important and if we could get this resolved, we can move it forward faster.   Kiera Dent (11:37.938) move the next meeting if appropriate, but try really hard to end on time. I understand sometimes it takes a while to get things there. So I give our leadership team permission of like, let's move our next meeting by 10 or 15 minutes. That way we can get this resolved. Let's be respectful of time. But I think a lot of those things are very helpful for running it. And something I found is I'm obsessed working with leadership teams. I'm obsessed with helping leaders learn how to run a practice and think like an owner. So we look at the numbers to make the decisions. We have the...   growth conversations with each other. fully committed when things aren't there, we figure out how to have the conversations with each other. This is the type of stuff that freaking lights my fire because if I can teach a team of leaders how to be leaders, that doctor is able to then have a practice that flourishes with a team that's bought in and committed to things that they would never imagine possible. This doctor that I was telling you that went from 2 million to about 6 million, we were chatting and he said, Kiera, I never believed that this would be possible. And I'm like, it's because   it's probably not possible with just you. But when you have a leadership team that's as passionate and fired up about it, they go and find the creative solutions. They're thinking about it as a business. And I've had to like work with this team. We're talking a year, two years, three years. We're helping them look at the numbers and learn the numbers because I don't think that that's happenstance. I don't think that this is something where we just naturally get it. And team members, myself included, we're not looking at the business like a business. We're looking at it as a team member of our   Like the awareness piece that we have is all that we know and all that we know is making paychecks and then paying our bills. We don't know what overhead is. Like it would work. Like that's how much is left over at the end of your paycheck. We don't have big tax bills because our taxes are just taken out of our paychecks for us. And so really helping teams understand how this works in a business. I think there was like a golden star moment in one of my meetings where the office manager said,   This is so incredible because you've literally taught me to think like an owner that I'm thinking like an owner and this is going to hit my PNL and what can I do so it doesn't hit my PNL and I make sure that it's fair amongst the other practices in the organization. And it was like chef's kiss, so much love for her because she literally thought like an owner. She thought this is going to hit my PNL. I don't know that I want to pay for this. What other solutions do we have? So that way it's not taking away from our profitability of our practice.   Kiera Dent (13:57.802) when you can get your leadership team thinking like that and asking those questions, but that takes time, that takes education, that takes having the conversations. And so really, hopefully, that gave you a quick structure of how to run these leadership meetings. But I think the core piece is being consistent, executing consistently, following through, having the conversations, and then staying laser focused. We're all focused on it. Really, really truly is gonna help you guys have incredible leadership meetings.   and incredible practices. So kind of take an assessment of yourself. I gave you a little checklist of like my really amazing offices and then offices who actually don't do as well. Some maybe some DNA traits of these different practices and DNA feels a little unfair to say because I don't think that they're naturally born with it. So I would say that these are more talents that they've developed throughout the years because I believe anybody can be a successful business owner. I believe that anybody can actually have a thriving practice. I believe that practices should flourish.   Somebody I heard, I overheard that they said they thought that the glory days of dentistry is over. And I almost spit like my food out because I was so taken back that we do create our own realities. And I actually would argue that we are in the most glorious days of dentistry. There are so many opportunities around, there's so many ways that we can serve more patients. There's so many amazing things that you can do. And maybe it's just because I consistently see it with the clients that we consult that.   they're living the glory days that they're having these incredible practices that cashflow is not an issue for them. The profitability is there that they can take vacations with ease. Like, of course, everybody goes through ebbs and flows of owning a business, but the glory days are here if you want to. And I think having a leadership team really can help you. So if we can help with that, this is what I think we specialize in exponentially. We definitely do the systems and the foundations. And then we move you into leadership teams and helping them think like owners and the numbers and the pieces. And if that just feels like   Gosh, like I would love that. Reach out, Hello@TheDentalATeam.com or go to our website, TheDentalATeam.com and click book a call. I promise if you're not quite ready, we'll let you know and we'll give you resources. So no matter what, your time will definitely be well worth it. Cause I will make sure that you get resources and value no matter if you work with us or you don't. Because I think sometimes we just need to have the courage to do something differently and to have the courage as an owner to say, I don't know this. I had to say this this year, like guys, I don't know this. I've never done this before.   Kiera Dent (16:14.764) We need to hire an expert who has and can teach us the way. What I'm obsessed with of what we do is we do it with the doctors and the team to make sure that doctors, you don't have to just learn it and then go try and execute it to your team. Cause I actually think as a business owner, that's the hardest part. We literally help with that integration with your team, getting them fired up, getting them excited about it, making it easy for them. And that's what I think we're experts in. There's lots of consulting companies, but definitely team does it with doctors and teams, getting our teams to think like owners, getting them to be incredible leaders.   getting goals to be hit with ease and to have a just ton of fun. Like throw the confetti, laugh a lot, have a good time and serve as many patients as you can. So reach out, I'd love to help you. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.

Today, we're in Houston getting some "skin deep" treatments from Jamie Marcelletti, M.A., who has established herself as one of the city's most respected aesthetic injectors. With 20 years of experience, she has turned her knowledge of facial and body contouring into an age-defying art form. Kristi gets the "PRF" treatment, a pioneering procedure that utilizes platelet-rich fiber injections to regenerate bones, and enhance facial appearance.Alissa gets PCDC injections, known as Kybella. They break down fat cells and encourage natural elimination, all while tightening the skin. Many of the procedures Jamie carries out also mitigate bone loss. https://joinskindeep.com/(00:00) Start(00:04) Introduction to Skin Deep in Houston(03:15) Jamie and getting started on a 20-Year Skin Business (03:50) How treatment technology has advanced(04:02) Explaining PCDC injections  (04:20) How the treatment shrinks the skin(07:10) The secrets of medical aesthetics(07:50) The difference between PRP and PRF(09:25) European Facial(10:05) Preventing bone degeneration(12:22) VIP Beauty Prep Vibe (16:33) Comparing Skin Rejuvenation Techniques (20:57) Slimming Treatment With Microneedles