Podcasts about prp

Are fat grafts leaving you lumpy? Wondering if PRP can really refresh tired under eyes? Or concerned about the safety of your breast implants?If these questions sound familiar, you're not alone — and this episode of Plastic Surgery Uncensored is for YOU. Join Dr. Rady Rahban and former producer Maria as they dive into real concerns from women just like you. From the hidden risks of fat grafting (think: bumps, irregular texture, and why technique matters) to the truth about under-eye rejuvenation with PRP — Dr. Rahban pulls back the curtain on what's hype and what's helpful. Plus, they unpack the latest on Breast Implant Illness and what every woman should know about textured implants. This is a must-listen if you're considering a procedure, recovering from one, or simply trying to stay informed in a sea of misinformation. 

Dr. Madan is the immediate Past President for BC Doctors of Optometry and the Chair of the Government and Professional Affairs Committee. She completed a residency in ocular disease at the Eye Center of Texas in Houston and is a fellow of the American Academy of Optometry. In addition to all of this, Dr. Madan currently practices in an MD/OD setting, where she provides advanced services such as treating glaucoma and offering PRP eye drops to dry eye patients. All of this makes her the perfect guest to continue our series on scope optimization.In the first episode in this series of short interviews, we spoke with Dr. Cedrick Mah to understand how his experience with advanced procedures in Oklahoma can help us understand why scope advancement is important in Canada.In this episode we continue our conversation on scope with Dr. Madan by asking what the future of optometry looks like. What should primary care optometrist expect their job to look like? Why should we be asking for scope modernization?Keep the conversation about scope optimization going by sharing these interviews with our colleagues. Send in your thoughts and comments to help us improve these discussions so we can continue to elevate our profession.Love the show? Subscribe, rate, review & share! http://www.aboutmyeyes.com/podcast/

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.

Is your skin suddenly drier, duller, or more crepey than it used to be? You're not imagining it—and hormones may be at the root. In this episode, Dr. Carolyn Moyers is joined by Dr. Emily Johnson, triple board-certified facial plastic surgeon and founder of 817 Surgical Arts, for a deep dive into how menopause impacts your skin—and what you can do about it.From the science behind estrogen receptors in your skin to the latest in medical-grade skincare, lasers, and surgical options like facelifts, Dr. Johnson shares what works, what's hype, and how to age on your own terms.This is an empowering conversation about confidence, options, and redefining beauty in midlife.What We Cover:How estrogen decline impacts collagen, hydration, elasticity, and skin healingWhat skin changes are common during perimenopause and menopauseHow to choose the right skincare products and active ingredients (retinoids, peptides, HA, etc.)In-office rejuvenation options: microneedling, lasers, PRP, and moreWhen to consider a facelift and how modern facelifts have evolvedThe power of combining hormone support + skin strategy + self-confidenceWhy aging well is personal—not prescriptiveLearn more about Dr. Emily Johnson and her work at 817SurgicalArts.com

Today, I've got something special for you: a solo episode where I look back at the past six months and handpick the five episodes and ideas that truly changed the game for me—and, based on your feedback, for many of you too.   Episodes from this podcast: #300: Breast Cancer Overdiagnosis, Mammogram Myths, The REAL Risks For Women And Bold NEW Alternatives With Dr. Jenn Simmons #302: If You Have Creeky or Painful Joints and BIG Dreams of Staying Active, These Nonsurgical Solutions Are The NEW Way Forward - With Dr. Jeff Gross #309: Cordycepin and Methylene Blue: Two Game-Changers For Better Energy, Focus, Sleep, and So Much More With Dr. Scott Sherr #312: Age-Defying Bone Health: Preventing Osteoporosis with Science-Backed Interventions and Reversal Techniques You Can Try TODAY With Doug Lucas #318: Lies He Taught In Medical School: The METABOLIC Secret To Reversing Chronic Disease with Dr. Robert Lufkin   What I discuss: Exosomes for regeneration: cartilage, bone, and joint repair ... 00:02:19 Exosomes vs. PRP and stem cells—key differences ... 00:05:20 Managing inflammation before regenerative treatments ... 00:06:09 Exosomes in neurology & anti-aging ... 00:07:01 Regulation, safety, and advances in exosome therapy ... 00:08:33 Mammogram controversy: risks, overdiagnosis, and dense breasts ... 00:10:00 Alternatives: QT scan benefits and radiation-free screening ... 00:15:21 Optimizing mitochondrial health—importance & methylene blue ... 00:18:28 Widespread mitochondrial dysfunction & modern disruptors ... 00:21:03 How methylene blue supports energy & cautions ... 00:23:17 Bone health: density vs. quality, collagen, and vibration plates ... 00:31:17 Mechanical input & gaps in traditional osteoporosis care ... 00:34:22 Lifestyle reversal of chronic disease ... 00:37:15 Medical system limitations & patient health agency ... 00:39:25 Fasting and metabolic health—power & nuance ... 00:48:06   Our Amazing Sponsors: Ultimate GI Repair by LVLUP Health - Whether you're struggling with digestive discomfort or want to strengthen your gut health, Ultimate GI Repair provides the comprehensive support your body needs to restore balance. The ingredients are unmatched! Visit https://lvluphealth.com/ and use code NAT at checkout for 20 % off.   More from Nat:  YouTube Channel Join My Membership Community Sign up for My Newsletter  Instagram  Facebook Group

Explore the future of regenerative aesthetics with host Lori, co-host Gideon, and expert Dr. Laura Ellis as they dive into the latest advancements in skin science and healing. Get the essential insights on secretomes, exosomes, and why your regenerative products need to keep up with cutting-edge research. • Key differences between PRP, exosomes, and the new frontier: secretomes • The importance of sourcing and cell purity for regenerative products • Real evidence and clinical results behind secretome-based skincare • Safety considerations and checks and balances in growth factor products • Upcoming innovations, including post-procedure and hair-specific secretome therapies Stay informed and ahead in aesthetic medicine—watch now!

Hair thinning and shedding in midlife isn't just frustrating — it can be deeply emotional and isolating. But you're not alone, and you're not imagining it. In this powerful episode, Dr. Carolyn Moyers sits down with Dr. Emily Johnson, triple board-certified facial plastic surgeon and founder of 817 Surgical Arts, to unpack the causes of hair loss in women during the perimenopause and menopause transition.From hormonal shifts and genetics to nutrient deficiencies and inflammation, they explore why it happens, how to assess it properly, and what treatment options are available — from topical and oral therapies to in-office regenerative procedures.If your hair feels like it's betraying you, this episode is a must-listen.What We Cover:The real reasons women lose hair during perimenopause and menopauseThe role of estrogen, androgens, and thyroid healthFemale pattern hair loss vs. telogen effluviumThe emotional impact of hair loss and the importance of validationDr. Johnson's approach to diagnosis, lab work, and biopsiesTreatment options: minoxidil, PRP, supplements, and moreHair transplant basics and when to consider surgical optionsAt-home tips to support healthy hair growth

In this episode, I'm joined by Dr. Maribelle Verdiales, a pioneer in regenerative and integrative fertility medicine. We dive into groundbreaking therapies like intraovarian stem cell infusions, exosomes, and ovarian PRP, and how they can support fertility, especially for women over 40. Dr. Verdiales shares her personal journey from being a traditional OB/GYN to becoming a holistic healer, and she explains the science, safety, and logistics behind these emerging treatments. We also talk about the inspiration behind her work, what's possible in fertility care today, and why she's so passionate about empowering women to take charge of their reproductive health. In this episode, we cover: What stem cells, exosomes, and PRP are, and how they might support fertility Why some regenerative treatments are offered in Mexico and what patients should know Real-life stories of hope from Dr. Verdiales' patients How regenerative therapies are helping women over 40 reclaim fertility What's next in the future of holistic and regenerative fertility care ResourcesRead the full show notes on my website, including a transcript. Dr. Maribelle Verdiales website, and her book, The Healing Circle: A Story of Health, Science, and Love Do you have questions about IVF, and what to expect? Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, July 14, 2025 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom.   Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org. Other ways to connect: Subscribe to my YouTube channel for more fertility tips Join Egg Whisperer School Subscribe to the newsletter to get updates

In this episode of the Longevity Optimization Podcast, Dr. Aimee Eyvazzadeh shares her journey into OB-GYN and her passion for helping people conceive. The conversation delves into innovative treatments for fertility, including ovarian PRP, hyperbaric oxygen therapy, and the potential of stem cells. Dr. Dr. Aimee Eyvazzadeh discusses the importance of supplements, lifestyle changes, and comprehensive fertility workups, including the TUSHY method. The episode also highlights the significance of addressing PCOS and the future of fertility medicine, emphasizing education and access to treatments.About Dr. Aimee Eyvazzadeh Dr. Aimee Eyvazzadeh—affectionately known as “The Egg Whisperer”—is a San Francisco Bay Area–based reproductive endocrinologist and fertility expert. She's the founder of her own practice where she specializes in IVF and helping women, especially those over 35, realize their dreams of becoming mothers.Her Credentials: M.D. from UCLA School of MedicineResidency in Obstetrics and Gynecology at Harvard Medical SchoolFellowship in Reproductive Endocrinology and InfertilityMaster's in Public Health (MPH) in Management and Policy from the University of MichiganBoard Certified in Obstetrics and GynecologyFellow of the American College of Obstetrics and Gynecology (FACOG)Follow her on IG Visit Her WebsiteChapters00:00 Introduction to Fertility and OB-GYN01:00 The Journey into Fertility Medicine01:48 Innovative Treatments: Ovarian PRP06:35 Understanding Ovarian PRP and Its Mechanism07:37 Hyperbaric Oxygen Therapy in Fertility09:38 The Role of Genetic Screening in Embryo Health11:32 Emerging Therapies: Stem Cells and HGH13:33 Rapamycin: A Breakthrough in Fertility Medicine19:13 The TUSHY Method: Comprehensive Fertility Testing24:10 Lifestyle Factors Affecting Fertility28:42 Supplements for Egg Health33:27 Environmental Toxins and Fertility38:25 Future of Fertility Treatments and Technologies* 10 billion platelets in PRP is what we want for clarity!

Dr. Jarred Mait is a functional medicine specialist who takes a deeply personal approach to modern healthcare. With roots in anesthesiology, he made the switch to functional and concierge care to better understand the full picture of a patient's health, not just their symptoms.Through house calls and extended visits, Dr. Mait identifies lifestyle and environmental factors that impact well-being. From sleep and hydration to air quality and daily habits, he believes health starts with the details others often overlook.His concierge practice offers advanced treatments like stem cells and PRP for pain and tissue repair, along with a dedicated IV therapy suite. Custom infusions, including NAD, support immune health, energy, and even recovery from depression or addiction.Helping both men and women manage age-related changes, Dr. Mait also specializes in hormone optimization. From boosting energy and mood to improving libido and skin, his approach targets the root causes of imbalance.To learn more about Miami Beach functional medicine specialist Dr. Jarred Mait and his concierge practiceLearn more about Stems Health Regenerative MedicineFollow Dr. Mait on Instagram @docmaitFollow Stems Health Instagram @stemshealthABOUT MEET THE DOCTOR The purpose of the Meet the Doctor podcast is simple.  We want you to get to know your doctor before meeting them in person because you're making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you're interested in. There's no substitute for an in-person appointment, but we hope this comes close.Meet The Doctor is a production of The Axis. Made with love in Austin, Texas.Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast?  Book a free 30 minute recording session at meetthedoctorpodcast.com.Host: Eva Sheie Assistant Producers: Mary Ellen Clarkson & Hannah BurkhartEngineering: Ian PowellTheme music: A Grace Sufficient by JOYSPRING

On this special episode of the Architect of Resilience Podcast, host Chris Duffin welcomes back Dr. Rahul Desai, a regenerative musculoskeletal radiologist and expert in innovative therapies for joint and spine health. Originally recorded during a private member community session, this conversation dives deep into the cutting-edge world of red and near-infrared light therapy—otherwise known as photobiomodulation. Dr. Desai shares his extensive experience using platelet-rich plasma (PRP), bone marrow, and fat-derived treatments to help patients heal without surgery, and he unpacks the science and safety of red light therapy for tissue regeneration, pain relief, and overall wellness. The discussion is packed with direct audience questions, revealing practical insights on treatment timing, optimal dosing, systemic versus local effects, and the latest research on using light therapy for everything from injury recovery to anti-aging and sleep.   This episode of the ARCHITECT of RESILIENCE podcast is available on Apple, Spotify & YouTube, and is sponsored by  @marekhealth : Performance. Longevity. Optimization.

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.

Send us a textMaking your services more accessible for hearing impaired clients Jo Haywood is a hairstylist in Kensington, London for Luke Ormsby salon.She trained with Vidal Sassoon and has enjoyed learning and growing as a hairstylist.She has a long commute to work every day, and felt like she could be using the travel time in a productive way, and decided she would like to learn sign language.Jo now holds a level 2 in BSL, which she studied with her Dad. Initially, this was just a way to continue her personal development, and a great way to connect with him, but her manager encouraged her to advertise this skill to clients. Although she was not confident at first, she received a great response.We discuss tips on how to make a hearing impaired client's salon visit easier and more enjoyable, and how sign language has enabled her to build a connection with her clients and to give them the best salon experience.Connect with Jo:InstagramBSL Dictionary Hair & Scalp Salon Specialist course Support the showConnect with Hair therapy: Facebook Instagram Twitter Clubhouse- @Hair.Therapy Donate towards the podcast Start your own podcastHair & Scalp Salon Specialist Course ~ Book now to become an expert!

✨ Summer 2025's Trending Aesthetic Treatments – What's Worth It?In this episode, Dr. Kristen Herzog breaks down RealSelf's top trending aesthetic treatments for summer and gives her honest “yes” or “no” on each one. From “Clean Girl Aesthetics” to hair restoration, she covers it all.

Dr. Ankeet Choxi is an interventional pain management physician focused on treating the root cause of pain, not just masking it. During his anesthesiology residency, he discovered his passion for helping people heal through less invasive, regenerative techniques.Rather than relying on medications, Dr. Choxi takes a multimodal approach using targeted injections, PRP, stem cells, and exosomes to reduce inflammation and promote tissue repair. He often combines these with physical therapy, shockwave, or hyperbaric oxygen to speed recovery and improve outcomes.Patients travel from around the world to his South Florida clinic, where collaboration is at the heart of care. He works alongside Dr. Jarred Mait, who brings a background in integrative and functional medicine, to offer a truly root-cause, whole-body approach to pain management.To learn more about South Florida Pain and Regenerative Specialist Dr. Ankeet Choxi Learn more about Stems Health Regenerative MedicineFollow Dr. Choxi on Instagram @achoxiFollow Dr. Choxi's practice on Instagram @stemshealthABOUT MEET THE DOCTOR The purpose of the Meet the Doctor podcast is simple.  We want you to get to know your doctor before meeting them in person because you're making a life changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. When you head into an important appointment more informed and better educated, you are able to have a richer, more specific conversation about the procedures and treatments you're interested in. There's no substitute for an in-person appointment, but we hope this comes close.Meet The Doctor is a production of The Axis. Made with love in Austin, Texas.Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast?  Book a free 30 minute recording session at meetthedoctorpodcast.com.Host: Eva Sheie Assistant Producers: Mary Ellen Clarkson & Hannah BurkhartEngineering: Ian PowellTheme music: A Grace Sufficient by JOYSPRING

Dr. Laura Bricman est médecin rhumatologue, micronutritionniste et spécialisée en rhumatologie intégrative et métabolique.⁠https://dr-laurabricman.com/⁠⁠https://www.youtube.com/@LauraBricman-M%C3%A9tabomed⁠CHAPITRES :0:00 Introduction00:57 Métabolisme et Articulations18:37 Les Traumatismes Articulaires et leurs Conséquences32:32 Nutrition et Santé Articulaire45:34 Approche Holistique de la Santé Articulaire1:01:59 L'Inflammation Chronique et ses Effets1:03:11 Gluten et santé intestinale1:05:34 Maladies auto-immunes et perméabilité intestinale1:09:57 Génétique et maladies auto-immunes1:11:39 Environnement et maladies auto-immunes1:21:45 Acide urique et goutte1:25:52 Arthrose et facteurs de risque1:34:20 Différences homme-femme en arthrose1:35:26 Ostéoporose et santé osseuse1:46:09 Alimentation et santé articulaire1:47:22 Collagène et articulations1:55:16 Acide hyaluronique et entretien articulaire1:57:37 PRP et cellules souches2:01:22 Futur des maladies articulairesBIOMÉCANIQUE :⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Youtube⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Spotify⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Apple Podcasts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Discord⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠La Lettre Biomécanique⁠⁠⁠⁠⁠⁠⁠⁠™⁠⁠ Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode of the Stronger Bones Lifestyle Podcast, I welcome back Dr. Jeff Gross—renowned regenerative medicine specialist, former neurosurgeon, and a leading voice in cutting-edge healing strategies. Together, we explore the incredible potential of stem cells, exosomes, and regenerative medicine to reverse joint degeneration, optimize bone health, and even slow the aging process.Dr. Gross explains how chronic inflammation, lifestyle stressors, and toxin exposure accelerate aging by depleting your body's stem cell function—and how biologic therapies like exosome injections can help restore vitality, repair tissues, and potentially help you avoid surgeries like joint replacements.Whether you're struggling with knee pain, bone loss, osteoporosis, or long COVID, or you're simply interested in aging with strength and mobility, this episode is a must-listen.What You'll Learn in This Episode:What stem cells are and how they function in regenerationThe difference between PRP, stem cells, and exosomesWhy exosomes may be the future of joint repair and anti-agingHow chronic inflammation leads to stem cell exhaustion and accelerated agingThe role of bone marrow as your body's regenerative powerhouseWhy targeted exosome injections into bone (not cartilage) yield better long-term resultsInsight into natural killer (NK) cell exosomes for cancer support and immune healthWhy Dr. Gross shifted from surgery to regenerative medicineThe systemic impact of lifestyle, diet, EMFs, and toxins on healingHow regenerative therapy supports osteoporosis, osteoarthritis, autoimmune conditions, and longevityResources & Links Mentioned:

Dr. Erin Faules sits down with Dr. Mark Goodman to explore the evolving field of non-operative sports medicine. They dive into how metabolic health, inflammation, and lifestyle play critical roles in joint pain and injury recovery—far beyond what traditional orthopedic approaches consider. Dr. Goodman unpacks the promise of orthobiologics like PRP and stem cell therapies, shares insights on aging athletes, and explains why joint care must treat the whole system, not just the symptom.

Aging isn't a slow fade—it's a set of levers you can pull long before the wrinkles show up.  Dr. Julian Gershon breaks down how hormones nosedive by decade, why new moms feel aged overnight, and how stem cells, exosomes, peptides, and bioidentical hormones can reboot your body to age 25—minus the bro-science. If you're sick of being told “you're normal, just wait for menopause,” this one hands you the playbook for feeling switched-on at 30, 40, 50 and beyond. WE TALK ABOUT:  04:30 - Why a Division-1 sports doctor pivoted to anti-aging medicine 08:15 - Post-baby hormone crashes no one prepares moms for 12:40 - The single testing mistake that keeps women misdiagnosed 18:20 - “Running your life at 40%” — optimal Testosterone ranges for men and women 22:40 - Sugar is the real longevity killer (and why NAD runs out faster in women) 24:00 - Perimenopause saw-teeth: Smoothing the ride with micro-dosed hormones 28:10 - Rebuilding bone, brain & libido after menopause with true bioidenticals 31:50 - The PremPro problem: How synthetic hormones hijacked breast-cancer stats 34:40 - PRP, exosomes & stem cells for hair, skin, cartilage—and even intimacy 39:15 - Peptides decoded: BPC-157, tesamorelin, NAD injections & more 45:20 - Brittany's 600-day sobriety experiment & what her biomarkers say now SPONSORS: Swap restless nights for real recovery with Magnesium Breakthrough by BiOptimizers (code: BIOHACKINGBRITTANY) — the full-spectrum formula I trust for calmer nerves, balanced hormones, and deep, restorative sleep. RESOURCES: Trying to conceive? Join my Baby Steps Course to optimize your fertility with biohacking. Free gift: Download my hormone-balancing, fertility-boosting chocolate recipe. Explore my luxury retreats and wellness events for women. Shop my faves: Check out my Amazon storefront for wellness essentials. Aspen Institute's website Beyond the Fountain of Youth LET'S CONNECT: Instagram, TikTok, Facebook Shop my favorite health products Listen on Spotify, Apple Podcasts, YouTube Music

Auto recycling stands at a crossroads where education and adaptation determine who thrives in tomorrow's market. In this thought-provoking conversation with industry veteran Mike Kunkel of Profit Team Consulting, we explore how the once-stigmatized "junkyard business" has transformed into a sophisticated industry attracting major investment and mainstream acceptance.The landscape is shifting dramatically. Organizations like URG, ARA, PRP, and RCD are aligning their educational initiatives to professionalize the industry. As Kunkel notes, "If McDonald's spends $1,400 annually teaching employees to make a consistent Big Mac, we must invest similarly in our teams." This focus on education comes at a crucial time – the average age of owners has decreased significantly, bringing fresh perspectives but requiring knowledge transfer from industry veterans.What's particularly fascinating is Kunkel's revelation about profitability: most recyclers are merely "one to two parts per vehicle short" of substantially improved financial performance. This seemingly small optimization represents the difference between struggling and thriving in today's competitive environment. With artificial intelligence transforming inventory management and customer interactions, the industry must balance technological adoption with the irreplaceable human element of relationship building.We also explore how international expansion into markets like Australia, Canada, and Argentina offers valuable lessons for domestic operations. The expected impact of tariffs will likely increase the average vehicle age beyond today's record 12.6 years, potentially creating opportunities reminiscent of the 1950s-60s era when customer-pay used parts were more common.Whether you're an industry veteran or newcomer, this episode reveals why now is the time to invest in your team's development. Consider incentivizing conference attendance as Kunkel suggests for the upcoming URG/PRP Annual Conference in Denver. As he powerfully concludes, the auto recycling community offers "a shot of energy, enthusiasm, and intellect like you've never received before." Don't miss this opportunity to gain insights that could transform your operation's future.

  Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113

  Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113

In this week's episode, Dr. Fiona Lovely sits down with Kim Casaburi, co-founder of Serotonin Centers, esthetician, and passionate menopause wellness advocate, for a powerful and empowering conversation about reclaiming midlife health through hormone optimization and functional medicine. After facing years of unexplained weight gain, fatigue, and emotional struggles, Kim shares how her search for answers led her to hormone replacement therapy (HRT)—a turning point after being dismissed by traditional medical professionals. She opens up about the medical gaslighting many women face and how she found her vitality again through functional, whole-body care. Kim also dives deep into the connection between hormones and skin health, sharing why aesthetic treatments like microneedling and HydraFacials fall short when hormones are out of balance—likening it to “pouring water into a bucket with a hole.” She explains why testosterone is not just for men and how it supports women's confidence, energy, and emotional resilience. Together, Dr. Lovely and Kim explore the need to shatter outdated medical narratives around menopause, embrace personalized care, and prioritize thriving—not just surviving—in midlife and beyond. What You'll Hear: Kim's personal journey through misdiagnosis and healing The overlooked impact of hormone imbalance on skin and vitality Testosterone: the misunderstood hormone women need too How Serotonin Centers blend HRT, aesthetics, and wellness coaching The stigma around menopause in conventional medicine Why hormone health is a cornerstone of longevity A call to action for women to own their needs and advocate for themselves You can learn more about Kim Casaburi and the services offered at Serotonin Centers by visiting www.serotonincenters.com. Offerings include hormone optimization, PRP microneedling, IV therapy, HydraFacials, and more.. Final thoughts from Kim: “Stand up straight. Stop hiding your pain. And own your needs.” Dr. Fiona Lovely is a longevity, health and wellness expert with specialties in menopause medicine, functional neurology and functional medicine.  She is speaking to the topics of women's health around perimenopause and menopause. Thank you to our sponsors for this episode:

  Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113

Episode 172 features John Bianchi DO, a Primary Care Sports Medicine (PCSM) physician, who specializes in non-operative management for orthopedic conditions affecting the entire body. Dr. Bianchi's sports medicine training included management of a wide variety of musculoskeletal conditions affecting the extremities, spine, joints, muscles, ligaments, and nerves. He is experienced in diagnostic and interventional ultrasound use, trigger points injections, steroid/hyaluronic acid joint injections, platelet rich plasma (PRP) and more. He practices a “hands-on” approach to treatment and provides Osteopathic Manipulative Treatment (OMT) to patients. Join our conversation as we discuss the non-operative approach to pain, the various options and side effects patients have to mitigate pain, what to do when non-surgical methods don't help, and the importance of exercise and physical therapy for life long success. For more information about his work, visit https://www.totalorthosportsmed.com/ and for all other questions about the show visit www.bemoretoday.com.

This week on D-List Diaries, Nicole and Gina sit down with Kristin Torres—owner and principal injector at Amálie Aesthetics, one of Nashville's top med spas—for an unfiltered convo about all things aesthetics. From clearing up the biggest myths around Botox to unpacking the buzz (and science) behind GLP-1 weight loss injections, Kristin shares the truth behind what's trending and what's actually effective. We also get into why choosing the right provider matters, what to ask before getting any work done, and the newest innovations hitting the med spa world, such as Sculptra and PRP injections. Whether you're a seasoned injector girlie or just curious, this is the expert-backed insight you didn't know you needed.Have questions or comments? Reach out on Instagram!

I was shocked when my dentist connected my bleeding gums to low estrogen – the same culprit behind my achy joints and poor recovery! This revelation unlocked my understanding of what Dr. Vonda Wright calls the "Musculoskeletal Syndrome of Menopause." If you're waking up feeling stiff, experiencing joint pain, or noticing your body doesn't bounce back like it used to, you're not crazy or broken – you're experiencing a natural but manageable part of midlife. Contrary to popular advice, the answer isn't to move less or accept joint pain as inevitable. I'm sharing the science-backed strategies that helped me delay knee surgery for 25 years and recently transformed my debilitating foot pain into pain-free walking, from strength training protocols to regenerative therapies and anti-inflammatory nutrition approaches that actually work.   What you'll learn: Why joint pain often emerges during perimenopause and menopause (hint: it's about more than just aging) The truth about movement – why "protecting" your joints by moving less actually makes them worse How certain foods can dramatically increase or decrease joint inflammation The critical connection between gut health, inflammation, and joint pain Which supplements have research-backed benefits for joint health (and the specific ones I take daily) Strategies to balance muscle-building against fat gain to protect your joints How regenerative therapies like PRP, stem cells, and cutting-edge treatments can help rebuild cartilage Love the Podcast? Here's what to do: Make My Day & Share Your Thoughts! Subscribe to the podcast & leave me a review Text a screenshot to 813-565-2627 Expect a personal reply because your voice is so important to me. Join 55,000+ followers who make this podcast thrive. Want to listen to the show completely ad-free?  Go to subscribetojj.com Enjoy the VIP experience for just $4.99/month or $49.99/year (save 17%!) Click “TRY FREE” and start your ad-free journey today! Full show notes (including all links mentioned): https://jjvirgin.com/jointhealth Learn more about your ad choices. Visit megaphone.fm/adchoices

There's definitely a gap in how seriously women's sexual health is taken compared to men's. For many, these issues aren't just physical—they hit self-esteem, relationships, and emotional well-being. But when they finally do speak up, they're often brushed off or handed solutions that barely scratch the surface. It's frustrating, especially knowing that real science exists—just rarely applied with women in mind. There's a growing sense that things need to change, not just in treatment but in the way the entire conversation is handled. Dr. Charles Runels, best known for inventing the O-Shot and Vampire Facial, is transforming how we approach sexual wellness and aesthetic medicine. Today, he talks about the science behind the O-Shot—a PRP-based treatment helping women with low libido, sexual dysfunction, and other intimate health concerns. It's a non-surgical, regenerative approach that uses the body's own healing abilities. With a background in chemistry and internal medicine, Dr. Runels blends hard science with practical application. His mission is to normalize conversations around sexual health and give women real, research-backed options. Stay tuned! Resources: The O-Shot® [Orchid Shot®] can help… Health Lessons by Dr. Charles Runels, MD Follow Dr. Charles Runels on Facebook Connect with Dr. Charles Runels on LinkedIn

In S5Ep6 of the PRP, Adam goes to stoke city with electric long distance runner, heart-first honcho of hype, belief bolstering coaching phenom and the undisputed master of the mid-run monologue Chris Sadler, who has been preparing for the Bayshore Marathon on Saturday May 24th, 2025. Kendra Nylen, certified strength queen, dignified Gilmore Girls scholar and Chris's proud fiancee joins the show to offer her take on all things banana accoutrements, Spartan spirit and of course, what it takes to keep up with a household full of Sadlers.The trio wades deep into the rhythm of the long run—where love lingers, legacy builds, fingers freeze and weekend miles turn into moving pictures with dope music & motivation. Chris reflects on his coaching journey and shares insight about how this experience has added unmeasurable depth and direction to his own running story. With a mentoring ethos built on joy, character, and contagious hype, tap in to learn how Sadler's Saddles are empowering one another as teammates through athlete spotlights, cold weather grind reels and a relentless commitment to showing up for each other with authenticity and pulse you can feel through the pavement.Things get vulnerable when Sadler ruminates about the return to his marathon roots, the deeply meaningful value of having Kendra by his side, and the full-circle feels of racing Bayshore again with new goals, ALL the homies and fresh perspective. From sharing your stoke to protecting your peace, Chris reminds us that the true measure of a running journey isn't found in finish lines or stats—it's in the belief you help spark in others as they chase their own unhinged dreams in the vast world of running. Who are the OTQ boys & how is the Life in Stride Podcast dishing out so much heat?! Did Bailey the 17 year old labroador just get a bark-out?! Stewards of stoke?! John Wooden drops in from the ethosphere?? Yooo, where the photographer at? Power train control modules? Expedited bromancing??  Bouje drizzlin? Race cruxes, proposal stories and banana saddles oh my!This and so much more in this joy-forward, mentor-driven, laugh-heavy episode of the PRP.Sponsors⁠⁠⁠⁠⁠Up & Running Performance⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ann Arbor Running Company⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Recorded Tuesday May 20th @ 5:00PM EST

Makhachev vacated the title? Topuria is now facing Oliveira for Vacant Light Weight Title. Favorable match up?Coach Bryan is available for Clinics worldwide. Email: levelupgrappling@gmail.comPCI Website courtesy of www.vitaldigital.usStem Cells, PRP and more: www.rejuveantiaging.com

Y'all know there's no gatekeeping around here! Today, we're dishing about the new, undetectable era in cosmetic surgery with one of the go-to experts of our time, Dr. Catherine Chang. The board-certified, quadruple Ivy league-educated plastic surgeon is known for her attention to meticulous detail, hidden incisions and faster healing at her Prive Beverly Hills clinic. In this episode, we're getting all of her pro takes on the hallmarks of undetectable plastic surgery, what to ask for when undergoing blepharoplasty and why so many surgeons get it wrong. You'll learn about:The “Bijoux Lift,” Dr. Chang's signature mini-lift technique designed for people in their 20s (?!) and 30s, and why Dr. Chang doesn't promote thread lifts for premature signs of agingThinking about blepharoplasty? The advantages of going under the knife early for this popular surgery, according to the pro“Jellyroll Botox” – while North Americans are obliterating creases under the eyes, why the Korean market is embracing under eye contours with makeup, according to the proLasers, PRP and more – The non-surgical rejuvenation treatments that Dr. Chang uses herself to maintain a locked-in-time lookEverything to know about Dr. Chang's own line of skincare, NakedBeauty MD, that grew from cult-favourite hydrogel under eye patches (Carlene is a fan!) to her newly released growth factor eye serum Psssst - you're invited! Click here to RSVP for our live event with board-certified dermatologist, #skinfluencer and self-described skin nerd, Dr. Shereene Idriss coming up in Toronto on June 20! Get social with us and let us know what you think of the episode! Subscribe to our YouTube channel and find us on Instagram, Tiktok, Twitter. Join our private Facebook group. Or give us a call and leave us a voicemail at 1-844-227-0302. Sign up for our Substack here For any products or links mentioned in this episode, check out our website: https://breakingbeautypodcast.com/episode-recaps/ Related episodes like this: Is the “Plastic Surgery Lite” Trend As Breezy As it Seems? “Mini” Facelifts, “Liquid” Nose Jobs & More With Board-Certified Plastic Surgeon Dr. Rady RahbanThe Biggest Celeb Transformations: The $400,000 Facelift, Lie Detectors On Blast and Ozempic is Changing Everything with Dana Omari-Harrell AKA @IGFamousByDanaArielle Lorre Reveals The Holy Grail Products That Transformed Her Skin, Her Annual Tweakments Budget and Can Cosmetic Procedures Be Addictive? PROMO CODES: When you support our sponsors, you support the creation of Breaking Beauty Podcast! NutrafolThis summer, stop worrying about your hair and start making memories. For a limited time, Nutrafol is offering our listeners $10 off your first month's subscription and free shipping when you go to Nutrafol.com and enter the promo code BREAKING.BoulevardRight now, Boulevard is offering new customers 10% off your first year subscription when you go to join JOINBLVD.com/BEAUTY and book a demo.AryaThis is your chance – go to ARYA.FYI and use code BEAUTY for 15% off and find the best play style for your relationship today.Strivectin Discover the science behind great skin with Strivectin. Plump and smooth like a pro with the NEW Peptide Plump™ Collagen Cushion Cream from StriVectin. *Disclaimer: Unless otherwise stated, all products reviewed are gratis media samples submitted for editorial consideration.* Hosts: Carlene Higgins and Jill Dunn Theme song, used with permission: Cherry Bomb by Saya
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Dr. Azi and Nurse Lacie are back with an episode that gets to the root of one of the most talked-about topics in beauty: hair loss. From hormonal imbalances to genetic causes and the latest treatment options, they're breaking down the science behind why we lose hair—and what we can do about it. Together, they answer your most asked questions: How do you know if you're really losing hair? What treatments actually work? Can you support your hair growth with the right ingredients? And what's the deal with PRP, Spironolactone, and Dutasteride? Whether you're dealing with shedding, thinning, or patchy spots, this episode of More Than a Pretty Face is packed with the facts (and a few rapid-fire fun moments, too).   Timeline of what was discussed: 00:00  Introduction 02:25  Beauty & Blemish 08:05  The Most Common Type of Hair Loss 12:57  Ways to Test If You're Going Through Hair Loss 15:39  What Are Some Treatment Options? 21:23  PRP Treatment & Dutasteride Injections 23:51  Taking Spironolactone for Hair Loss 24:29  The Science Behind Hair Growth Cycles 29:48  New Hair Loss Research & Innovations 31:32  Alopecia Areata: What You Should Know 34:23  Rapid Fire Questions   ______________________________________________________________ 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.  

Drive with Dr. Peter Attia: Read the notes at at podcastnotes.org. Don't forget to subscribe for free to our newsletter, the top 10 ideas of the week, every Monday --------- View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility. We discuss: The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00]; How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00]; The built-in filter that weeds out genetically abnormal sperm [14:45]; How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30]; How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30]; Male infertility and Paul's diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30]; Viral infections that can affect the testes and potentially lead to sterility [40:30]; Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45]; Effects of medication, microplastics, stress, and exercise on fertility [57:15]; Testosterone replacement therapy (TRT) and male fertility [1:06:00]; Restoring fertility after prolonged use of exogenous testosterone [1:25:00]; Effects of heat and cold exposure on fertility and sperm quality [1:36:00]; How different levels of exercise—especially cycling—affect male fertility [1:41:45]; How alcohol, marijuana, and nicotine affect male fertility [1:46:00]; Why type 2 diabetes is a risk factor for male infertility [1:50:00]; How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15]; Genetic factors that affect fertility [1:54:00]; The impact of lifestyle and environmental exposures on fertility [1:56:30]; The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30]; Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00]; Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

In this episode of Plastic Surgery Untold, we're joined by Danielle Fette, burn nurse and regenerative medicine expert behind ReyaGel—a company bringing hospital-grade healing technology into the aesthetic world. With decades of proven results treating burns, trauma, and chronic wounds, ReyaGel's newly cleared gel-based ECM formula is now making recovery from lasers, microneedling, and surgery faster, safer, and more effective. Key Topics Discussed: What Is ReyaGel? – A next-gen blend of extracellular matrices packed with biomolecules to support accelerated skin healing and reduce downtime. From Burn Units to Beauty Clinics – How a life-saving hospital product evolved into an aesthetic recovery essential. A New Era of Healing: How combining ECMs with other regenerative tools like PRP and exosomes enhances outcomes in even the most aggressive treatments. If you're looking for the future of post-procedure recovery, ReyaGel is leading the charge with science, safety, and skin health at the forefront.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility. We discuss: The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00]; How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00]; The built-in filter that weeds out genetically abnormal sperm [14:45]; How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30]; How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30]; Male infertility and Paul's diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30]; Viral infections that can affect the testes and potentially lead to sterility [40:30]; Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45]; Effects of medication, microplastics, stress, and exercise on fertility [57:15]; Testosterone replacement therapy (TRT) and male fertility [1:06:00]; Restoring fertility after prolonged use of exogenous testosterone [1:25:00]; Effects of heat and cold exposure on fertility and sperm quality [1:36:00]; How different levels of exercise—especially cycling—affect male fertility [1:41:45]; How alcohol, marijuana, and nicotine affect male fertility [1:46:00]; Why type 2 diabetes is a risk factor for male infertility [1:50:00]; How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15]; Genetic factors that affect fertility [1:54:00]; The impact of lifestyle and environmental exposures on fertility [1:56:30]; The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30]; Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00]; Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Twin Peaks: the Return: the DECODE episode 4.SONNY JIM IS BACK IN. Full stop. June 1st, 2025 has arrived. We all knew this day would come. 2000 years ago, when the first western savior was born to a virgin in a manger beneath the Star of Bethlehem, the prophecy was set in motion: "Yay, verily, a special child would rise again when the world of shadows most needs him. This savior of the 3rd age wouldst appear impossibly from behind the door of red, in the Court of Lancelot. His name shalt be known only as "Sonny Jim." And Sonny Jim shalt be back on in. " And now it has finally come to pass....Join Post Relevant Podcast hosts Phil Ristaino and Justin Epifanio as we decode Twin Peaks: the Return episode 4. We seek to understand the adventures of Dougie Jones, aka Mr Jackpots, as he wins $425,000.00 and then pees, fails to dress himself, stares in the mirror, eats pancakes, and most importantly, amuses his angel of a son, the impossible boy known to one and all as Sonny Jim.Also: We marvel over Michael Cera as Marlin Brando. We ponder the color yellow. We remember the owls (are not what they seem. ) We talk extra low. We are exonerated in Courts of Law. We watch "A Boy and His Atom" while failing to observe electrons. And we try to fix our hearts or die.And, in the extra secret end section, we debate what might happen if we met ETs in a Dark Forest.But really, I'm just being coy, because this episode is all about the debut of the spanking new smash hit song (in Sweden) entitled "Sonny Jim (Is Back In)." It will change your life and show you how your heart can also be 'so full.'Prepare the way, young warrior! The moment of Post Relevance hath finally arrived! The End of the End of Time is Nigh! Prepare ye! Prepare ye! Just do it already....Listen to all episodes of the PRP at www.PostRelevant.comCheck out Phil's acting/art/music at www.TheseAreDreams.comGet the full 5-D PRP experience: https://www.instagram.com/philristaino/Get the PRP "Under the Silver Lake" tribute shirt at Spyrodon Apparel:https://spyrodon.store/products/phil-ristaino-artist-edition-for-the-post-relevant-podcast-under-the-silverlakeenter 'postrelevant' at checkout for 10% off.Donate to the show: https://buymeacoffee.com/postrelevantJustin's doc: www.instagram.com/heyoka.documentary/All the songs on this episode come from the Polypores albums "ECCO."Get Polypores albums  on Bandcamp: https://polypores.bandcamp.com/"Sonny Jim (Is Back In)" written by Phil Ristaino with Justin Epifanio. The musical track for this song is called "Savior Above" and was written by Ketsa. Find all Ketsa's music at https://freemusicarchive.org/music/Ketsa/PRP theme song by Agents of Venus: https://agentsofvenus.bandcamp.com/David Lynch forever...

Heart health is one of the most misunderstood—and yet, one of the most critical—topics in modern medicine. In this episode, Dr. Anand Patel joins me to break down why traditional heart disease screening is outdated, what tests you actually need, and why cholesterol alone doesn't tell the full story. We also dive into the future of healthcare, parenting in the AI age, and what it means to take true ownership of your health in 2025 and beyond.Dr. Patel is a board-certified internal medicine physician and the founder of Elevate Health (Lv8), a cutting-edge health optimization clinic. He's also building Elevate Academy, a hands-on, AI-integrated educational space designed to prepare kids for the future. With a background in clinical medicine, tech startups, and entrepreneurship, Dr. Patel is at the forefront of rethinking health from the inside out.If you care about longevity, prevention, and staying ahead of the curve, this conversation is a must.What You'll Learn in This Episode:Why annual checkups aren't enoughThe truth about soft plaque and heart attacksWhat traditional medicine gets wrong about cholesterolAdvanced heart scans (like Cleerly) that most people have never heard ofPersonalized medicine vs. population healthHow AI will transform both education and healthcareWhy Dr. Patel is pulling his kids out of school and building a new learning modelThe future of diagnostics, wearables, and health accountability— Episode Chapter Big Ideas (timing may not be exact) —00:00 – Intro00:48 – Zion National Park and getting into hiking02:20 – Family, winter sports & Chicago winters04:30 – Growing up in an immigrant family and becoming a physician06:00 – Why he's pulling his kids out of school for a new AI-integrated education model14:20 – From hospitalist to health entrepreneur after COVID16:00 – Why he launched Elevate Health (Lv8)19:30 – The problem with annual checkups22:30 – The truth about cholesterol, LDL particles & soft plaque26:30 – Why heart health testing is broken (and what to do instead)34:30 – Cleerly Scan and advanced heart disease detection36:00 – Are statins good or bad? Dr. Patel weighs in42:00 – The danger of over-relying on influencers for health advice45:00 – Full-body scans: helpful or overkill?50:00 – Why hyperbaric chambers, PRP & stem cells are gaining traction56:00 – Health optimization isn't just for the rich—mindset matters59:20 – Time + health = your most valuable assets1:02:00 – What success means to Dr. Patel— Key Quotes from Dr. Anand Patel — “Heart disease isn't just a clogged pipe. It's soft plaque—and it's deadly.”“You have a PhD-level tutor in your pocket now. The entire purpose of education has to shift."“Medicine 3.0 is about data, personalization, and proactivity. Annual labs just aren't enough anymore.”— Connect With Dr. Anand Patel —Website: https://www.lv8.health/ Instagram: https://www.instagram.com/dranandpat84/ LinkedIn: https://www.linkedin.com/in/anand-patel1484/  — Connect with Julian and Executive Health —LinkedIn — https://www.linkedin.com/in/julianhayesii/Ready to take your health, leadership, and performance to the next level? Book a complimentary private executive health diagnostic call with Julian Hayes II. Link below. https://calendly.com/julian-exechealth/chemistryWebsite — https://www.executivehealth.io/***DISCLAIMER: The information shared is not meant to treat or diagnose any condition. This is for educational, informational, and entertainment purposes. The content here is not intended to replace your relationship with your doctor and/or medical practitioner.

You've heard the buzzwords—PRP, robotics, joint replacements—but what do they actually mean for your body (and your recovery)? In this episode, we're joined by world-renowned orthopedic surgeon Dr. Jason Snibbe, the go-to doctor for top athletes and A-list celebs alike, for a masterclass on all things joint health. From how to properly prep for surgery and what to eat for faster healing, to debunking the biggest myths around replacements and robotic-assisted procedures, Dr. Snibbe breaks it all down with warmth, humor, and next-level expertise. Whether you're dealing with chronic pain, recovering from an injury, or just want to stay active for life—this is the episode your joints will thank you for. Mentioned in the Episode: www.drjasonsnibbe.com Snibbs Shoes Bodyhealth Perfect Amino Acids Vital Proteins Collagen Peptides A Sony Music Entertainment production. Find more great podcasts from Sony Music Entertainment at sonymusic.com/podcasts and follow us at @sonypodcasts To bring your brand to life in this podcast, email podcastadsales@sonymusic.com Learn more about your ad choices. Visit podcastchoices.com/adchoices

In this special episode of The Common Sense MD, Dr. Tom Rogers brings listeners right into the exam room for a real-time demonstration of a PRP (platelet-rich plasma) knee injection. Joined by Jill Henritze, PA-C, Dr. Rogers discusses his personal journey with knee joint pain and the benefits he's experienced from PRP therapy—especially for aging, active adults. Go behind the scenes as Jill Henritze, PA-C ,who has over 20 years of orthopedic and injection experience, walks through each step of the procedure, including what to expect, potential side effects, and why PRP is a promising alternative to cortisone and other treatments for large joints. The episode also covers immediate post-injection advice, restrictions, and the realistic timeline for seeing improvement. If you're curious about regenerative medicine, how PRP compares to other joint therapies, or just want to hear the straight talk from medical professionals who use these treatments themselves, this episode is a must-listen. What did you think of this episode of the podcast? Let us know by leaving a review!Connect with Performance Medicine!Check out our new online vitamin store:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/shop/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Sign up for our weekly newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/doctors-note-sign-up/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PMedicine⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PerformancemedicineTN⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Performance Medicine

Sexual health is NOT just about what happens in the bedroom—it's a mirror of your full-body health, metabolic function, and emotional well-being. In this powerful Thrive State Podcast episode, Dr. Kien Vuu (Doctor V) sits down with pioneering regenerative medicine expert Dr. Anne Truong to talk about the root causes of erectile dysfunction, what most men are doing wrong, and the advanced therapies (including PRP, shockwave, and even Botox) that are changing lives. Plus, Dr. Truong drops gold on the real secrets behind building a thriving online medical business.

In S5Ep5 of the PRP, Adam prattles with blossoming long distance runners, local food & agriculture champions, community cultivators and proud park-hopping pals Meg Goldwyn & Laura Matney, who have been preparing for the Glass City Half Marathon on Sunday April 27th, 2025. Tap in to learn how two remarkable human beings are leveraging their passion for fresh produce & funky vibes to build a healthier, more connected Ann Arbor. Meg—Argus Café Store Manager and certified dog mom of the decade is newer to the sport but fully aboard the endorphin express. Laura, General Manager at Argus Farm Stop and lifelong endurance adventurer with a flair for fungi, brings years of grit and community organizing insight to the convo. The squad unpacks how Argus Farm Stop's unique model supports local farmers, feeds neighbors, and keeps the lights on (literally) in a way that blends business, service, and sustainability into one delicious, community-enhancing mission. But it's not just about the veggies—it's about the vision. At the heart of it all is a guiding question: “How does what we do every day serve the local food economy?”Things get vulnerable when the duo deep dives on the power of shared knowledge—how pulling back the curtain on their systems, lessons, and even missteps can spark change across the local & national food landscape. Whether it's telling tales at a farm stop conference, spreading the gospel of pawpaws, or dropping hot tips on turning smoothies into waffles (yes, that's a thing), Meg & Laura live to connect dots and people alike. From park bagging all 162 green spaces in Ann Arbor to gap-trail biking and glacial terrain escapades, this lovely duo reminds us that movement and nourishment go hand in hand—and that the spiritual symbiosis of running, food, and community might just be the perfect fuel to keep us joyful, curious, and snack-happy as we traverse through this wild ride called life.What's in tarnation is an L3C? Laminated life mantras? Sommelier say whaaa?? WTF is a wild ramp?! Volun-told you so? Old socks, banana relatives & Shaq gummies oh my!This and more in this nourishing, laughter-filled, and deeply mission-driven episode of the PRP.Sponsors⁠⁠⁠⁠Up & Running Performance⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Ann Arbor Running Company⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Recorded Friday April 25th @ 9:00AM EST

Let's start with, What the Heck is a Hack? A hack is a small change or a shortcut designed to improve your life. Today's guest, Zora Benhamou, is the Queen of Midlife Health Hacks. She's also someone who, despite living a very active life, ended up with osteoarthritis.  She tried to avoid surgery for as long as possible. How was she able to do that? She used a few health hacks to get as much "life" out of her hips as possible. She tried PRP, physical therapy, and an anti-inflammatory diet. On the podcast, she discusses a few more hacks that you've got to hear about! Let's also talk about scars. Zora ended up with two hip replacements, and she tried a few different hacks to lessen her scarring. She used a copper peptide cream on one scar and a different product on the other. The copper peptide scar improved so much that she started using it on both wounds, and she's thrilled with the results! I just bought this copper peptide cream, Zora suggested using the link below (20% off!) https://www.vitaliskincare.com/discount/cancerwarrior?ref=cbkmpsij ____ Water Filtration: Boroux I've been looking for a water filter for two years. Okay, maybe I'm a little picky...but my research paid off. I've chosen the Boroux Filter system and am really happy with it. Are you curious about my criteria? Here's what I was looking for in a filter: Removal of heavy metals. The Boroux removes 99.36% of heavy metals. Pharmaceuticals are removed. Because people don't dispose of drugs properly, the drugs get into our water system. The Boroux removes 99.5% of pharmaceutical contaminants. Glyphosate removal (glyphosate is the active ingredient in Roundup and is a known carcinogen). A year ago, I was tested for glyphosate and was in the 95th percentile. I was shocked! Since I was already eating mainly organic, my doctor suggested getting a water filter. I had a challenging time finding one that would filter this chemical, and this was one of my main drivers for purchasing this filter. Boroux has a special offer for my community. Click the link below to research and purchase. https://boroux.sjv.io/7aM1a3 ____ Air Dr. I've been using the Air Doctor air purifier for almost a year and absolutely love it! I first heard about it from Dr. Mark Hyman, and even though it was a bit of a splurge compared to what I usually spend, I'm so glad I invested. Every time I change the filter and see all the gunk it collects, I smile, knowing it's doing a great job keeping my air clean! And I'm so happy that all that gunk isn't going into my body ;) Click here to purchase: https://airdoctorpro.com/?oid=17&affid=6165 ____ Connect with Zora Benhamou Website: https://hackmyage.com/ Instagram: https://www.instagram.com/hackmyage/ Facebook: https://www.facebook.com/HackMyAge LinkedIn: https://www.linkedin.com/in/zora-benhamou-37167017/ X: https://x.com/hackmyage ______ Connect with Deborah Deborah on Instagram: https://www.instagram.com/whydidigetcancer/ Deborah on Facebook: https://www.facebook.com/DebsHealthCoachKitchen Deborah on Twitter: https://twitter.com/ydidigetcancer Deborah on Pinterest: https://in.pinterest.com/whydidigetcancer/ Join Deb's weekly newsletter!  -https://whydidigetcancer.us14.list-manage.com/subscribe?u=1c37affeccf004c8957941069&id=a8572db3c2

In this episode, Dr. Jen Haley sits down with internationally recognized hair restoration expert Dr. Marc Avram to dive deep into the science and solutions behind common causes of hair loss in both men and women. They discuss the causes, treatments, and what to expect from professional care for conditions like androgenetic alopecia, telogen effluvium, and hormonal hair loss related to menopause and stress. Dr. Avram is a world-renowned dermatologist with expertise in hair transplantation and non-surgical hair loss treatments. He has authored key textbooks in cosmetic dermatology and frequently speaks at major medical conferences.   Topics discussed: Common causes of hair loss: genetic, hormonal, and stress-related Signs & symptoms of different types of hair loss Best treatments for male and female pattern hair loss How low-level laser therapy (LLLT) and platelet-rich plasma (PRP) work for hair regrowth Pros and cons of oral minoxidil, topical treatments, and finasteride Cutting-edge treatments and when hair transplantation makes sense The truth about supplements, nutrition, and weight loss effects on hair health How long hair regrowth treatments really take to show results   Dr. Haley personally uses and recommends the Hairmax laser band.  www.hairmax.com and use code LASER345 for 20% off   Connect with Dr. Marc Avrim: Website: https://www.dravram.com/   IG: https://www.instagram.com/drmarcavram/     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

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Dr. G dives deep into the hidden dangers of mainstream hair dyes, exposing chemicals found in brands like L'Oréal, Clairol, and Revlon that are linked to hormonal disruption, cancer, and premature graying. Blending science with real-life impact, he unpacks the emotional ties to hair color and reveals the biological drivers of graying, from oxidative stress and hydrogen peroxide buildup to the decline of melanocyte activity. Dr. G then shares a powerful five-part protocol to support natural hair color, covering internal nutrients, lifestyle shifts, topical solutions, and regenerative therapies like red light and PRP. He also reviews cleaner dye alternatives and challenges conventional beauty norms, promoting a holistic approach to hair health rooted in overall well-being. #grayhair #productreview #hairdye Timestamps: 00:00:00 - Hair Dye & Graying 05:10 - Gray Hair Science & Fear 06:27 - Graying, Stress, & Health 13:00 - Harmful Hair Dye Chemicals 16:19 - Toxic Dyes & Alternatives 19:15 - Safer Dyes & Graying Protocol 22:18 - Vitamins & Stress for Gray Hair 25:25 - Reversing Gray Hair 28:28 - Ditch Toxic Hair Products ==== Thank You To Our Sponsors! BiOptimizers Go to https://bioptimizers.com/drg and use promo code DRG10 to get 10% any order. BON CHARGE Go to https://boncharge.com/products/red-light-face-mask and use code DRG for 15% off storewide ==== Be sure to like and subscribe to #HealThySelf Hosted by Doctor Christian Gonzalez N.D. Follow Doctor G on Instagram @doctor.gonzalez https://www.instagram.com/doctor.gonzalez/ Sign up for our newsletter! https://drchristiangonzalez.com/newsletter/