Podcasts about pvcs

Cardiologist and electrophysiologist Dr. Gregory Marcus, chair of the American Heart Association scientific statement writing group, reveals evidence on coffee/caffeine and cardiovascular health. He discusses how earlier assumptions that caffeine triggers arrhythmias are complicated by genetics, individual risk factors, and mostly observational research. Marcus reviews randomized and observational findings: the CRAVE trial showed no increase in premature atrial contractions but more premature ventricular contractions on coffee days; a trial in post-cardioversion patients found less atrial fibrillation with daily coffee. Observational data suggest lower risks of type 2 diabetes, heart attack, stroke, and AFib among coffee drinkers, while heart failure risk may be lower at low intake but higher around 4–5 drinks/day. He cautions against extrapolating benefits to energy drinks, discusses additives like sugar, touches on alcohol, cannabis, Mediterranean/DASH diets, pollution, and evolving AFib treatments, wearables, and pacing/ablation technologies.

« Allô maman, j’ai eu un accident » : Comment les escrocs clonent votre voix Par Régis BAUDOUIN Un appel en plein après-midi. Le numéro qui s'affiche est bien celui de votre enfant. Au bout du fil, sa voix, haletante, brisée par les sanglots : « Maman, j’ai eu un accident de voiture, j’ai renversé quelqu’un, je suis au commissariat… Le policier va te parler, s’il te plaît, aide-moi. » Un homme prend le relais, exige une caution immédiate de 5 000 € par virement instantané pour lui éviter la détention. Prise de panique, vous payez. Quelques heures plus tard, votre enfant rentre du travail, indemne, n’ayant jamais passé le moindre coup de fil. Vous venez de basculer dans le pire cauchemar cybercriminel de cette année 2026 : l’arnaque aux proches par clonage vocal IA (ou Voice Cloning Scam). Quand la fiction dépasse la réalité Ce scénario n’a plus rien d’une théorie de l’évolution de la cybercriminalité ; il fait des ravages partout dans le monde et frappe désormais de plein fouet l’Europe et la France. L’affaire Jennifer DeStefano (États-Unis) : Ce cas d’école a marqué les esprits. Cette mère de famille a reçu l’appel de sa “fille” de 15 ans, prétendument enlevée, hurlant de terreur à l’autre bout du fil. Les ravisseurs réclamaient une rançon. La voix était si parfaitement identique que la mère n’a décelé aucune anomalie. Sa fille était en réalité tranquillement dans son lit lors d’un voyage scolaire. Le pillage des PME par “Deepfake Audio” : Plusieurs directeurs financiers ont viré des millions d’euros après avoir reçu un appel de leur “PDG” leur ordonnant une acquisition secrète. La texture de la voix, les tics de langage, les pauses de respiration : tout était synthétisé à la perfection en temps réel. Technique des faux colis vous recevez un message SMS et vocal d’un livreur qui vous demande des informations personnelles et financières pour disposer d’un colis. En France, l’alerte est devenue officielle au cours des derniers mois. Les autorités et les médias nationaux tirent la sonnette d’alarme face à l’importation de cette méthode appelée chez nous « l’arnaque aux grands-parents » ou « l’arnaque à l’urgence familiale ». La mise en garde officielle des autorité de cyber sécurité Le mode opératoire constaté en France : Les escrocs ciblent les lignes fixes des personnes âgées. Ils utilisent des clones de la voix de leurs petits-enfants. En France, la variante la plus courante est celle du faux accident de voiture ou de la fausse garde à vue après un contrôle de police, des situations qui bloquent psychologiquement la victime et l’empêchent de réfléchir. Le témoignage sur France Télévisions (Le cas lyonnais) Un reportage diffusé au journal télévisé a mis en lumière le calvaire d’une septuagénaire habitant la région lyonnaise. Les faits : Elle reçoit l’appel de son “petit-fils” en pleurs, affirmant avoir brisé l’écran du smartphone d’un tiers et être menacé physiquement s’il ne remboursait pas immédiatement la victime par un ticket Transcash ou un virement instantané. La voix, le ton de panique et même les expressions familières utilisées d’ordinaire par l’adolescent étaient parfaits. La victime a versé 1 800 € avant de se rendre compte de la supercherie en contactant les parents de l’enfant. Les vagues de “Spoofing” et de Voice Cloning selon Cybermalveillance.gouv.fr La plateforme gouvernementale Cybermalveillance.gouv.fr a mis à jour ses fiches réflexes face à l’émergence des deepfakes audio. Les cybercriminels français combinent désormais le clonage vocal avec le spoofing (l’usurpation de numéro). Non seulement la voix est celle d’un proche ou d’un conseiller bancaire, mais le numéro qui s’affiche sur le mobile de la victime est le véritable numéro de la personne usurpée, rendant l’arnaque indétectable sans contre-appel. Face au spoofing, les règles ont évolué. L'Arcep (Autorité de régulation des communications électroniques, des postes et de la distribution de la presse) indique que de nombreux appels frauduleux utilisant des numéros de téléphone usurpés sont émis depuis l'étranger. Depuis le 1er janvier 2026, les opérateurs français de téléphonie doivent automatiquement afficher « numéro masqué » pour les appels émis depuis l'étranger avec un numéro mobile français n'ayant pas pu être authentifié. Ainsi, lorsque vous voyez s'afficher « numéro masqué » sur votre téléphone portable, cela signifie, au choix : que la personne qui vous appelle a souhaité masquer son numéro ; que le numéro d'appel n'a pas pu être authentifié pour des raisons techniques (sans préjuger de la nature légitime ou non de l'appel). Cela vous permet donc d'identifier qu'il s'agit potentiellement d'une tentative d'arnaque, et doit susciter votre vigilance. Source Service public.fr En France : L’alerte est maximale La criminalité francophone a rapidement adopté ces outils. La plateforme Cybermalveillance.gouv.fr et la Gendarmerie Nationale multiplient les alertes en ce mois de juin 2026. En zone gendarmerie, les plaintes pour des escroqueries “au faux petit-fils” utilisant des voix de synthèse explosent. Le scénario est bien rodé : un appel sur le téléphone fixe d’une personne âgée, la voix clonée d’un adolescent de la famille simulant un accident ou une garde à vue, et l’exigence d’un virement instantané immédiat. La barrière de la langue a sauté : les IA parlent désormais un français parfait, sans accent et avec nos expressions locales. Comment les escrocs volent votre voix Pour réussir un tel coup de maître, les cybercriminels n’ont plus besoin d’équipements de studio hollywoodien. En 2026, la démocratisation des modèles d’IA générative audio grand public a rendu la manipulation d’une simplicité enfantine. Étape 1 : La collecte du “matériau brut” Les escrocs écument les réseaux sociaux (TikTok, Instagram, LinkedIn, YouTube). Il leur suffit de trouver une vidéo où vous parlez pendant seulement 3 à 5 secondes (une story de vacances, une présentation professionnelle). Ils peuvent aussi générer un faux appel de démarchage commercial (“Bonjour, vous m’entendez ?“) uniquement pour enregistrer votre réponse. A la date de publication de cette article cette information est fausse. en réalité il faut un échantillon plus important pour bien imiter une voix. Des simulations ont été faites : avec seulement quelques mots volés sur tik tok, voire l’annonce d’accueil d’un répondeur, la voix générée, comme les intonations, reste encore loin de ressembler fidèlement à celle de la cible ElevenLabs, une société de génération de voix par IA indique sur son site qu’il faut 3 à 6 heures pour obtenir un bon résultat. “Since the custom models require fine-tuning and training, it takes more time to train PVCs compared to IVCs. Generally fine-tuning takes 3-6 hours to complete, but it can sometimes take a bit longer, depending on the number of other PVCs queued for fine-tuning.” Les autorités françaises chargées de la lutte contre la cybercriminalité ne rapportent, à ce jour, aucun faits de clonage vocal ayant conduit à ce type d’escroquerie. En fait actuellement se sont surtout des imitations faites par un humain auprès de personnes qui sous la pression sont moins attentives. Les informations colportées par les réseaux sociaux sur ce type d’arnaques sont des légendes urbaines, à ce jour. surtout celle qui dit que si vous répondez Allo à un appel il vont cloner votre voix. Même le site Bitdefender a publié une alerte sur ce sujet. On est à la limite du marketing éthique. Pour vendre ses solution une marque publie des information déformées pour créer un sentiment de vulnérabilité. Cette information est maintenant considérée comme fausse. Techniquement c’est tout a fait possible, mais les moyens à déployer sont importants. Qualité et durée de la source de l’enregistrement, capacité de l’IA à tenir une conversation avec un proche. Étape 2 : Le clonage algorithmique Le fichier audio est injecté dans un logiciel d’IA de synthèse vocale (Text-to-Speech de nouvelle génération). L’algorithme analyse l’empreinte vocale : la fréquence fondamentale, le timbre, l’accentuation et les résonances nasales. Le clone sera d’autant plus crédible que l’échantillon est important. avec juste un mot ou une phrase c’est impossible de créer un clone. Étape 3 : L’injection en temps réel (Speech-to-Speech) C’est la grande rupture technique de 2026. L’escroc parle dans son propre micro, et l’IA convertit sa voix en temps réel pour y appliquer votre voix clonée, tout en y simulant des bruits de fond réalistes (pleurs, sirènes de police, brouhaha d’un commissariat). Pour masquer le numéro de téléphone, ils utilisent le spoofing (usurpation d’identifiant d’appelant) pour faire apparaître votre nom sur l’écran de la victime. [ Escroc parle au micro ] ──> [ IA de conversion temps réel ] ──> [ Voix de votre enfant ] │ [ Victime piégée (Maman) ]

This week, it's just the ladies, and they kick things off with a quick recap of their week, then share an important reminder for everyone to sort out their PVCs. Between consumer exploitation, misuse of power and the current cost of living, it's clear we need change, and this is the first step.They also talk about business owners and people in prominent spaces being more conscious of their public messaging, the impact of their words, and being fair to workers, especially when it comes to benefits.The dilemmas were delivered as always, with some cases where we really couldn't support these women's wrongs. They wrap up with a cute game where they answer a lot of questions, from their warning labels and dealbreakers to why people need Yelp reviews. It's fun, hilarious and amazing as always. Enjoy this special episode brought to you by Busha!Nigerians, we have a really important election next year. Make sure you are registered to vote - https://cvr.inecnigeria.org/Don't forget to use #ISWIS or #ISWISPodcast to share your thoughts while listening to the podcast! We love reading your posts on X! Rate the show 5 stars on whatever app you listen to, leave a review, share it with everyone you know, and if you also watch on YouTube, please subscribe, like, and leave a comment!Make sure to follow us onTwitter: @ISWISPodcastInstagram: @isaidwhatisaidpodYouTube: @isaidwhatisaidpodHosted on Acast. See acast.com/privacy for more information. Hosted on Acast. See acast.com/privacy for more information.

Send us Fan MailVisit my websiteBold claims make great headlines; clear evidence makes better habits. We take a hard look at the widely shared study suggesting two to three cups of coffee cut dementia risk by 20 percent and unpack what those numbers really mean for your brain and your daily routine.First, we break down the Harvard JAMA research: massive cohorts of nurses and physicians, decades of follow-up, and self-reported diet data that carry real strengths and built-in limits. We explore why observational studies can't prove causation, how confounders like sleep, exercise, and income can bend results, and why tea showing similar benefits while decaf shows none points to caffeine yet refuses a tidy explanation. Then we translate relative risk into absolute terms to show how a big percentage drop can still be a small difference in real life, and we discuss the publication bias that comes from testing many hypotheses and promoting only the eye-catching hits.Next, we turn to trials where the science gets sharper. The CRAVE study randomized coffee days in healthy adults with continuous heart monitoring and found no rise in atrial abnormalities that lead to atrial fibrillation, though there was a bump in benign PVCs. For those with a history of AF, the DCAF trial offers a surprise: participants who kept drinking coffee had almost half the recurrence rate compared with those who quit, suggesting caffeine didn't worsen outcomes and might even help. The message for most people is reassuring—coffee isn't the arrhythmia trigger it's often made out to be.Our bottom line is practical and personal. If coffee fits your life and doesn't wreck your sleep, enjoy one or two cups without expecting miracles. Protect your rest first, because sleep debt is a far clearer risk to cognition than a second espresso is a remedy. Stay curious, ask how a study was designed, and look for consistent results across methods before changing routines. If you learned something helpful, tap follow, share this episode with a friend who loves their morning brew, and leave a quick review to help others find the show.

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Robin Bouleau from Stockholm, Sweden. They discuss his study that aimed to test whether having PVCs but a normal heart was a risk for future AF and stroke. If you enjoy the show, please leave us a positive review wherever you get your podcasts. It helps us to reach more people - thanks! Link to published paper: https://heart.bmj.com/content/112/1/21.long

"They are changing venture capital from a 30% tax to 0% tax. If Robinhood succeeds, it makes Sequoia and Andreessen's business model untenable." — Keith TeareThe Silicon Gods must have their blood. And they've finally come for the funders of disruption, the venture capitalists, who are now being disrupted by something called Public Venture Capital (PVC). That, at least, is the view of That Was The Week publisher Keith Teare, who leads his newsletter this week with Robinhood's new venture fund. This new stock-trading app for millennials is going after Sequoia and Andreessen Horowitz—not by competing on deal flow, but by charging 0% carry instead of 20-30%. Robinhood promises it blows the doors off traditional venture capital.But Keith urges caution over PVCs. Robinhood is packaging late-stage private assets—companies like Databricks that would have IPO'd years ago but are staying private longer. By the time retail investors get access, employees are already cashing out through tender offers because they think the peak is near. The poster child: Figma, which did secondaries at $12 billion after Adobe's $20 billion acquisition failed. A lot of (dumb) people bought at the top and are now slightly less stupid.Fortunately, this week's tech roundup isn't just about get-rich-quick investment schemes. We also discuss Yasha Mounk's sobering experiment: he asked AI to write a political philosophy paper and found it "depressingly good"—publishable in an academic journal. Keith reframes this supposed "death of the humanities" as automation, not democratization. The humans aren't being leveled up; they're masquerading as producers while AI does the work. But craft still matters. When technology relieves humans of the mundane, he hopes, it elevates the special.Lastly but not least, we get to the abundance debate. Peter Diamandis and Singularity University have promised something called "exponential abundance" by 2035. Keith is sympathetic. I am not. The only thing I'm willing to guarantee is that we'll still be talking abundantly about abundance in 2035. And that the Silicon Valley Gods will have their blood. Five Takeaways●      Robinhood Is Charging 0% Carry: Sequoia and Andreessen take 20-30% of profits. Robinhood takes nothing. If they scale, the traditional VC model becomes untenable.●      But You're Buying at the Top: These are late-stage assets. Employees are selling through tender offers because they think peak valuation is near. Ask the people who bought Figma at $12 billion.●      AI Is Automating the Humanities: Yasha Mounk found AI could write "depressingly good" political philosophy. This isn't democratization—it's humans masquerading as producers.●      Craft Still Retains Its Power: Technology relieves humans of the mundane—and elevates the special. Creativity that breaks through will always command attention.●      The Abundance Debate Continues: Diamandis says abundance by 2035. Keith agrees land is already abundant. Andrew calls this "such a stupid thing to say." About the GuestKeith Teare is the publisher of That Was The Week and Executive Chairman of SignalRank. He is a serial entrepreneur and longtime observer of Silicon Valley. Keith joins Keen On America every Saturday for The Week That Was.ReferencesCompanies mentioned:●      Robinhood is launching a publicly listed venture fund, raising up to $1 billion at $25/share with 0% carry. They already have $340 million in assets including Databricks.●      Figma is cited as a cautionary tale: after Adobe's failed $20 billion acquisition, it did secondaries at $12 billion—many bought at the top.●      Polymarket is a prediction market platform that Robinhood has responded to by adding prediction markets to its offerings.People mentioned:●      Yasha Mounk wrote about AI writing "depressingly good" political philosophy papers that could be published in academic journals.●      Peter Diamandis and Dr. Alexander Wisner-Gross of Singularity University argue that exponential abundance is coming by 2035.●      Packy McCormick wrote about power in the age of intelligence.About Keen On AmericaNobody asks more awkward questions than the Anglo-American writer and filmmaker Andrew Keen. In Keen On America, Andrew brings his pointed Transatlantic wit to making sense of the United States—hosting daily interviews about the history and future of this now venerable Republic. With nearly 2,800 episodes since the show launched on TechCrunch in 2010, Keen On America is the most prolific intellectual interview show in the history of podcasting.WebsiteSubstackYouTubeApple PodcastsSpotify Chapters:(00:00) - Introduction: If it's Saturday, it must be revolution (02:11) - Robinhood's venture fund announcement (03:17) - What is Robinhood's day job? (07:43) - Secondary markets and tender offers (10:33) - Democratization or late-stage risk? (14:09) - Is Robinhood just gambling? (16:08) - Private vs. public market returns (19:02) - Is finance merging with betting? (24:23) - Blowing the doors off Sequoia and Andreessen (26:27) - Yasha Mounk: AI automating the humanities (28:47) - Where does power go in the age of AI? (30:42) - Craft retains its power (31:33) - The abundance debate (34:00) - Is land abundant? Andrew loses patience (00:00) - Chapter 15 (00:00) - Chapter 16 (00:00) - Introduction: If it's Saturday, it must be revolution (02:11) - Robinhood's venture fund announcement (03:17) - What is Robinhood's day job? (07:43) - Secondary markets and tender offers (10:33) - Democratization or late-stage risk? (14:09) - Is Robinhood just gambling? (16:08) - Private vs. public market returns (19:02) - Is finance merging with betting? (24:23) - Blowing the doors off Sequoia and Andreessen (26:27) - Yasha Mounk: AI automating the humanities

Doug Reynolds welcomes listeners back to the LowCarbUSA® Podcast with a guest who works in one of the most specialized—and most misunderstood—corners of cardiovascular medicine: the heart's electrical system.  Dr. David Nabert is an electrophysiologist ("EP" doctor), focused on heart rhythm disorders, and he's one of the featured speakers at the Boca Symposium for Metabolic Health (January 23–25)—including the event's full day-plus dedicated to cardiovascular conditions. What gives this episode its pull is the combination of clinical depth and lived experience. David isn't just talking about rhythm problems from a textbook perspective—he's explaining how his own curiosity about metabolic health evolved, what shifted when he started questioning conventional assumptions, and why those questions matter for real patients in the real world. David describes how his entry point into metabolic health didn't begin in a clinic—it began with a random Google search. In 2021, while looking up a cardiology formula, he accidentally landed on a Nina Teicholz talk at the Cato Institute. "I started to watch it, and all of a sudden, an hour and a half passed," he says—one of those moments where interest turns into momentum. He listened to Teicholz's book, The Big Fat Surprise, then began searching for more voices in the low-carb space and quickly reconnected with familiar names, including Dr. Robert Cywes and Dr. Eric Westman (both will also be presenting in Boca), whom he calls mentors. That exploration ultimately led him to the Society of Metabolic Health Practitioners (The SMHP) and, importantly, a willingness to test ideas on himself. David is candid about his own weight journey. He describes a time when a body mass index under 25 felt "skinny" to him, and he's open about losing weight, regaining some after a series of hip surgeries, and continuing to work on it. What ultimately shifted, though, wasn't just the number on the scale—it was how he began to rethink what "doing everything right" actually means. For years, he approached weight loss the way many clinicians were trained to: low-fat, high willpower, endure the hunger. He describes his old strategy bluntly: "The only way I had lost weight… was by doing protein sparing modified fast… I was just eating almost no fat." Predictably, it wasn't sustainable. When he later shifted to a lower-carb, higher-fat approach—"bacon, eggs, hamburger"—he was "amazed at how quickly I started to lose weight," and he began seeing changes in markers that traditional cardiology often de-emphasizes. After stopping long-term statin therapy (which he had been on for 25 years), he saw his LDL return to roughly where it had been earlier in life, but other changes caught his attention: triglycerides dropped to the lowest he'd ever seen, HDL improved, and fasting insulin improved as well. Just as meaningful were the changes he felt: "Every 10 or 20 pounds I lost, my hips got better," he says, attributing it not only to less load, but "also part of it was less inflammation." From there, the episode moves into the heart of why David is speaking during the cardiovascular-focused programming in Boca: rhythm, electricity, and the surprising overlap between conditions that seem unrelated—like seizures and arrhythmias. David explains that early ketogenic diet research in the 1920s focused on refractory seizures, and he argues the connection matters because many antiarrhythmic drugs and antiseizure drugs overlap mechanistically. In his view, these aren't separate worlds. "Treating seizures or treating cardiac arrhythmias is basically two faces of the same coin," he says—and that opens a practical question: if ketosis can help reduce seizures, might it also influence certain rhythm symptoms? He shares a striking clinical example that stuck with him: a former submariner with PTSD and episodes of fast heart rates who said, "I know when I'm… ketogenic… when I fall off the wagon… then I start having palpitations and fast heart rates." David later learned the patient was experiencing atrial fibrillation, and while he's careful not to overpromise, he describes a pattern he's observed: in earlier stages of rhythm problems, being in a ketogenic state may reduce symptoms and potentially slow progression for some people. "It doesn't cure atrial fibrillation," he emphasizes, but he's seen ketosis "improves symptoms," not only in AFib, but in other rhythm issues like SVT and PVCs—especially early on. From there, David widens the frame to what he's seeing in younger patients—particularly young women—showing up with palpitations, rapid heart rate, anxiety, and signs of metabolic dysfunction even when they don't "look" unhealthy by BMI alone. "Only 90% of them are metabolically unhealthy," he says, describing a familiar cluster: A1C not quite normal, resting heart rates high, daytime heart rates that shouldn't be running 100–120, and a nervous system dialed up in what he calls a "hyper adrenergic state." The mainstream response is often medication—beta blockers, for example—but David argues metabolic context matters, and he's exploring how nutritional strategies (including ketosis, sometimes even supplemental ketones) may reduce symptom burden in certain cases. He also discusses POTS (Postural Orthostatic Tachycardia Syndrome), noting it can be associated with viral infections and has become more common since "the bad virus we had five years ago." Again, he's measured in his claims: ketosis isn't a cure, but he's seen it help reduce symptoms in select patients who have tried many other standard approaches first. The second half of the conversation touches on medications and the tension between "lower the number" cardiology and whole-person outcomes. David brings up PCSK9 inhibitors and recalls being troubled by early data patterns: "You were less likely to die from that, but you're more likely to die from cancer or infection… And… the overall mortality was the same." That line of thinking captures what pushed him toward metabolic health: a concern that focusing on a single marker can obscure the bigger picture of risk, resilience, and long-term outcomes. He also discusses SGLT2 inhibitors (like Jardiance and Farxiga) as potentially useful tools—especially in heart failure and diabetes—while stressing the importance of monitoring and hydration. In a moment that captures both his clinical caution and his enthusiasm for empowered patients, he tells people who go low carb on these meds to "get a Keto Mojo to check your ketone levels," because the goal is to use tools intelligently, not blindly. As the episode closes, Doug returns to the bigger mission behind the upcoming Boca program: helping attendees develop a confident, educated response to the most common fear tactic people face when they change their diet—LDL, heart attacks, and the assumption that low carb automatically means danger. Doug notes there are still "so few that really do get it and support it and talk about it," which is exactly why the cardiovascular-focused day-plus at the Boca Symposium for Metabolic Health (January 23–25) matters. David, for his part, is grateful to be part of it—and to be healthy enough to show up differently than last time. He reminds Doug that at previous events he was "either walking with one or two canes," but now, "I'm actually not going to run up on the stage, but I'll be moving pretty quickly." That moment captures the heart of the episode: metabolic health isn't theoretical. It's lived. And in Boca, that lived experience meets serious clinical discussion—especially for anyone trying to better understand cardiovascular risk, rhythm disorders, and the metabolic foundations that too often go unaddressed. If this conversation sparks your curiosity, the next step is obvious: join the community in Boca January 23–25 and immerse yourself in a day and a half of cardiovascular-focused talks designed to help you think more clearly, speak more confidently, and act more effectively—whether you're a clinician, a patient, or someone trying to help the people you love. Learn more about the Boca Symposium and register here.

Tooltips (Tüddelkrams) für Container, Kubernetes und Lets Encrypt/ACME mit Felix, Moritz und Volkmar vom FOCUS ON: DevOps Podcast.Im Engineering-Kiosk-Adventskalender 2025 sprechen befreundete Podcaster⋅innen und wir selbst, Andy und Wolfi, jeden Tag kurz & knackig innerhalb weniger Minuten über ein interessantes Tech-Thema.Unsere aktuellen Werbepartner findest du auf https://engineeringkiosk.dev/partnersDas schnelle Feedback zur Episode:

Thanks to our Partner, NAPA Autotech Training and Pico TechnologyWatch Full Video EpisodeIn this episode, Matt shares a personal Thanksgiving story that turned into a real medical emergency. A long-time family friend suddenly becomes unresponsive at the dinner table, and Matt walks through the moment he had to decide whether to act, despite not being “formally” current on CPR.He talks candidly about what it felt like to drag her to the floor, check for breathing, make the call to start chest compressions, hear ribs crack—and then watch her come back. From there, he connects the experience to life in an automotive shop: CPR and first-aid readiness, AEDs, fire extinguishers, panic, freezing, and why “somebody will know what to do” is not a plan.It's a conversation about preparedness, stress, and how our greatest weapon really is the thought we choose when everything suddenly goes sideways.Episode HighlightsOpening with the quote: “Our greatest weapon against stress is our ability to choose one thought over another.”Matt fighting a cold and joking about his “Nat King Cole” voice.Thanksgiving at his parents' house: Family and close friends gathered, including a 75-year-old family friend (“Jane”) who's been part of the family's holidays for years.Jane says she's really dizzy; Matt gets up to escort her to the living room.Her chin suddenly drops to her chest, she becomes unresponsive, cold, and clammy.The decision point:Matt checks for airway, tries to feel for a pulse, listens for breathing—only hears gurgling.Admits he doesn't fully trust his own ability to feel a pulse with his heart pounding.The mental calculus: If you can't be sure, what else is there to do but chest compressions?Starting chest compressions:Dragging her to the floor and focusing completely on her while the rest of the room “disappears.”Locking his elbows, using the beat of “Stayin' Alive” as a guide.First compression: feeling and hearing the sternum/ribs crack—and taking that as feedback that he's at the right depth.Before the second compression, her eyes fly open and she lets out a sound.The immediate emotional whiplash:First feeling isn't relief, but anger and self-doubt: “Did I just overreact?” “Did I crack her ribs for nothing?” “Was this some dramatic hero move I didn't need to make?”Reorienting to the reality that she was unresponsive and now is awake, talking, and oriented.EMS arrives:Very low blood pressure at the house (around 70/40).Hooked up to a 4-lead, showing atrial fibrillation with PVCs.Matt nerds out on the waveforms and explains AFib and PVCs in plain terms.EMTs jokingly ask if he's a doctor because of how well he reads the traces.Later imaging reveals:A cracked or stress-fractured sternum from compressions.Multiple blood clots in her lungs.The doctor tells her that sternum fractures are common with CPR and adds:Don't be mad at him — he saved your life.For Matt, the key relief is not the “hero” label, but confirmation that he did the right thing by acting.Connecting it back to shops and real life:Afterward, Matt starts calling around trying to set up CPR and first-aid training.Hard question: if he drops at the shop, who's going to act?Extending the concern beyond employees: what about customers?Preparedness checklist for shops:Is there an AED on-site, and does anyone actually know how to use it?Has anyone at the shop had recent CPR and first-aid training?Do...

Presentation, Evaluation, and Management of Premature Ventricular Contractions   Guest: Alan M. Sugrue, M.B., B.Ch., B.A.O. Host: Anthony H. Kashou, M.D.   In this episode, Dr. Anthony Kashou and Dr. Alan Sugrue cover a practical, evidence-based approach to premature ventricular contractions (PVCs), from incidental findings to high-burden, high-risk presentations. Listeners will gain tools to differentiate benign from pathologic PVCs, understand when to monitor versus refer, and recognize the role of catheter ablation in improving outcomes.   Topics Discussed: PVCs show up on Holters and ECGs all the time — how do you decide when they matter? How often do PVCs cause cardiomyopathy, and when should we act? When should we consider ablation even if the patient is asymptomatic? What's the biggest misconception about PVC ablation today? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Join host and Digital Education Committee Member Sandeep A Saha, MD, MS, FHRS for this lively discussion with his colleagues Charles A. Henrikson, MD, MPH, FHRS and Arun R. Mahankali Sridhar, MBBS, MPH, FACC. About this Article: In patients with symptomatic premature ventricular complexes (PVCs) refractory to medical therapy, non-invasive low-level tragus stimulation of the auricular branch of the vagus nerve significantly reduced median PVC burden compared to sham stimulation (median reduction ~13.4% vs ~8.6%; P = 0.021). The findings suggest that autonomic neuromodulation via transcutaneous vagal stimulation may offer a novel adjunctive therapy for frequent PVCs, although further larger trials are needed to evaluate long-term outcomes. Learning Objectives Describe the rationale and mechanism by which transcutaneous vagus nerve stimulation (tVNS) may modulate autonomic tone and reduce premature ventricular contractions. Summarize the design, methods, and key outcomes of the NoVa-PVC randomized crossover trial evaluating tVNS for symptomatic PVC reduction. Evaluate the clinical implications, limitations, and potential future applications of noninvasive neuromodulation as a therapeutic approach for ventricular arrhythmias. Article Authors Stefanos Zafeiropoulos MD, MBA, Kristie Coleman MPH, RN, Jonathan Kogan,Dimitrios Varrias MD, Jonas Leavitt BS, Alexandra Bekiaridou MD, Theodoros Zanos PhD, Stavros Zanos PhD, MD, Stavros Stavrakis PhD, MD, Stavros Mountantonakis MD, MBA  Podcast Contributors Sandeep A Saha, MD, MS, FHRS Charles A. Henrikson, MD, MPH, FHRS Arun R. Mahankali Sridhar, MBBS, MPH, FACC  All relevant financial relationships have been mitigated. Host Disclosure(s): S. Saha •Speaking/Teaching/Consulting: Medtronic   ​Contributor Disclosure(s):    C. Henrikson •Honoraria/Speaking/Teaching/Consulting: American College of Cardiology A. Sridhar •Nothing to disclose.   Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner): S. Sailor: No relevant financial relationships with ineligible companies to disclose.

Contributor: Travis Barlock, MD Educational Pearls: Quick Statistics on Electrical Burns: Electrical burns compose roughly 2 to 9% of all burns that come into emergency departments. The majority of patients who receive electrical burns are male, typically aged 20's to 30's, accounting for 80 to 90% of all electrical burn victims. The majority of burns are linked to occupational exposure. The upper extremities are more commonly impacted by electrical burns, accounting for 70 to 90% of entry points into the body during an exposure. What are some of the key considerations in electrical burns? Unlike chemical or fire/heat related burns, electrical burns have the potential to cause significant internal damage that may not be physically appreciated externally. This damage can include, but is not limited to: Cardiac dysthymias (PVCs, SVT, AV block, to more serious ventricular dysrhythmias such as ventricular fibrillation or ventricular tachycardia). Deep tissue injury resulting in rhabdomyolysis from the initial surge of electricity Rare cases of compartment syndrome What are the treatment considerations for patients who suffer electrical burns? Remembering that cutaneous findings associated with burns may underestimate the severity of the injury, with deeper structures being more likely to be involved as the voltage of the burn injury is directly correlated to severity. Manage the patient's airway, breathing, and circulation as always, and conduct further workup into potential cardiac involvement with EKGs, as well as analysis of the extremities where entry occurred for muscle breakdown and compartment syndrome. Clinical Pearl on Voltage and Current: Voltage can be thought of being equivalent to pressure in a fluid/liquid system. Higher voltages are equivalent to higher pressures, but the ultimate damage delivered to the system is from the rate of delivery/speed of the electrical energy surging (current) through the body. Current is dependent on the tissue it is travelling through, with different tissues having differing electrical resistances. Tissues like the stratum corneum of the skin and the human bone confer the most resistance (thus lower current) whereas skeletal muscle confers lower electrical resistance (thus higher current) due to water and electrolyte content, which is why injuries like rhabdomyolysis are possible and increase with increasing voltage. References Khor D, AlQasas T, Galet C, et al. Electrical injuries and outcomes: A retrospective review. Burns. 2023;49(7):1739-1744. doi:10.1016/j.burns.2023.03.015 Durdu T, Ozensoy HS, Erturk N, Yılmaz YB. Impact of Voltage Level on Hospitalization and Mortality in Electrical Injury Cases: A Retrospective Analysis from a Turkish Emergency Department. Med Sci Monit. 2025;31:e947675. doi:10.12659/MSM.947675 Karray R, Chakroun-Walha O, Mechri F, et al. Outcomes of electrical injuries in the emergency department: epidemiology, severity predictors, and chronic sequelae. Eur J Trauma Emerg Surg. 2025;51(1):85. doi:10.1007/s00068-025-02766-1 Faes TJ, van der Meij HA, de Munck JC, Heethaar RM. The electric resistivity of human tissues (100 Hz-10 MHz): a meta-analysis of review studies. Physiol Meas. 1999;20(4):R1-10. doi:10.1088/0967-3334/20/4/201 Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan and Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate

Let's start your week strong with a quick tip you can incorporate right away. In this Mo's Monday Minute shortie episode, I'm talking about  what to do when your patient is having premature ventricular contractions (PVCs). We'll talk about key assessments, when to get worried, and important nursing interventions. ___________________ FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! 20 Secrets of Successful Nursing Students – Learn key strategies that will help you be a successful nursing student with this FREE guide! All Straight A Nursing Resources - Check out everything Straight A Nursing has to offer, including free resources and online courses to help you succeed!

A large trial in cardiac pacing finally published, PVCs and cardiomyopathy, cannabis, CV risk and the danger of observational studies, and the tale of two disparate statin trials are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I BioPace Trial Trial manuscript https://doi.org/10.1093/europace/euaf029 II Another Belief Challenged in EP this week—PVCs and CM ‘ UC Paper https://doi.org/10.1016/j.jacep.2025.01.004 JACC Review https://doi.org/10.1016/j.jacc.2024.03.416 Lee et al https://heart.bmj.com/content/105/18/1408 III Cannabis and CV Risk Cannabis and MACE in JACC Advances: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101698 Zeraatkar –Grilling the data https://doi.org/10.1016/j.jclinepi.2024.111278 PLOS-1 10.1371/journal.pone.0199705 IV Cardio-oncology Jacc Onc Substdy https://www.jacc.org/doi/10.1016/j.jaccao.2024.11.008 Editorial https://www.jacc.org/doi/10.1016/j.jaccao.2025.01.006 STOP CA JAMA 2023 https://jamanetwork.com/journals/jama/fullarticle/2807988 PREVENT https://evidence.nejm.org/doi/10.1056/EVIDoa2200097 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In today's episode, we explore a tragic but educational case involving a 15-year-old girl who suffered severe inhalation injury following a house fire. While heroically rescuing her brother and his friend, she endured prolonged cardiac arrest and severe multi-organ dysfunction. We'll focus on the pathophysiology, investigation, and management of inhalation injuries, including the critical role of recognizing carbon monoxide and cyanide poisoning in these complex cases.Key Learning Points:Exposure to house fire and prolonged cardiac arrestSigns of inhalation injury and airway compromisePathophysiology of inhalation injuries and their impact on multiple organ systemsManagement strategies for inhalation injury, including airway protection and ventilationDifferentiating carbon monoxide and cyanide poisoning in pediatric fire victimsCase PresentationA 15-year-old previously healthy girl is brought to the Pediatric Intensive Care Unit (PICU) after experiencing cardiac arrest during a house fire. She was found unconscious by firefighters after a heroic rescue attempt where she saved her brother and his friend. Upon arrival at the hospital, she was unresponsive, intubated, and in severe cardiovascular distress with signs of multi-organ dysfunction.Key findings include:Soot deposits and superficial burns on extremitiesProlonged resuscitation (45 minutes of field CPR and 47 minutes of in-hospital CPR)Cardiovascular compromise with PVCs, cool extremities, and delayed capillary refillMetabolic acidosis, AKI, coagulopathy, transaminitisSevere hypoxic-ischemic encephalopathy on EEGThese findings raise immediate concern for inhalation injury, which is the primary focus of today's discussion.Pathophysiology of Inhalation InjuryWhen a patient is exposed to smoke and hot gases during a fire, inhalation injury results in significant damage to the respiratory system. Inhalation injury has three main components:Upper airway involvement – Thermal injury can cause swelling and obstruction.Chemical pneumonitis – Noxious chemicals like carbon monoxide and cyanide trigger inflammation in the lungs.

William H. Sauer, MD, FHRS, CCDS, Brigham and Women's Hospital is joined by Edward P. Gerstenfeld, MD, MS, FHRS, University of California, San Francisco, and Yasser Rodriguez, MBA, MD, Cleveland Clinic Florida to discuss; Background: Premature ventricular complexes (PVCs) are common and associated with worse outcomes in patients with heart failure. Class 1C antiarrhythmic drugs (AADs) effectively suppress PVCs, but guidelines currently restrict their use in structural heart disease. Conclusions: Class 1C AADs effectively suppressed PVCs in patients with NICM and ICDs, leading to increases in LVEF and biventricular pacing percentage. In this limited sample, their use was safe. Larger studies are needed to confirm the safety of this approach.   https://www.hrsonline.org/education/TheLead https://doi.org/10.1016/j.jacep.2024.01.021 Host Disclosure(s): W. Sauer: Honoraria/Speaking/Consulting: Biotronik, Biosense Webster, Inc., Abbott, Boston Scientific, Research: Medtronic    Contributor Disclosure(s): E. Gerstenfeld: Honoraria/Speaking/Teaching: Abbott, Biosense Webster, Inc., Boston Scientific, Medtronic, Membership on Committees/Advisory Boards: Boston Scientific, Farapulse, Honoraria/Speaking/Consulting: Boston Scientific, Abbott Medical, Medtronic, Adagio Medical, Research: Boston Scientific Y. Rodriguez: Nothing to disclose.   This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365     https://www.heartrhythm365.org/URL/TheLeadEpisode66

Preventricular Contractions (PVCs) by Albuquerque Fire Rescue

Deep-Learning Models for the Prognostication and Localization of Premature Ventricular Contractions Using a 12-Lead Electrocardiogram Guest: Guru G. Kowlgi, M.B.B.S. Host: Anthony H. Kashou, M.D.    In this episode, learners will understand what premature ventricular contractions are. They will learn to differentiate benign rom malignant PVCs, and understand which patients are at risk for PVC-cardiomyopathy. Furthermore, they will gain knowledge about the traditional and novel tools for risk-stratifying patients with PVCs, and how we manage these patients.   Topics Discussed What are PVCs and what are their clinical implications? When should we be concerned about a patient with PVCs? What are some of the tools we have to detect and localize high risk PVCs? How does AI help in this regard? What are the available treatment modalities for managing PVCs? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

This episode of "Heart to Heart with Anna" features a very special heart mom. Kelsi Rogers talks about the surprising circumstances around her son's heart condition. Born with an electrical problem in his heart, Jett has already faced life-and-death situations several times in his short life. Not even three years old yet, he has undergone an ablation and an open-heart surgery.Tune in to find out what kind of heart defect Jett has, why the ablation was so extensive, and what kind of surgery eventually saved his life.Following the interview with Kelsi Rogers, co-editors Megan Tones and Anna Jaworski read the last half of Chapter Seven: Facing My Mortality from their new book The Heart of a Heart Warrior Volume Two: Endurance.Links mentioned in this podcast:HeartFelt: https://www.facebook.com/heartfeltscreeningTiny Tickers Trot: https://runsignup.com/Race/Events/CA/Chico/TinyTickersTrotBaby Hearts Press: https://www.babyheartspress.com (for more information on the book The Heart of a Heart Warrior and more!)To sign up for a Baby Hearts Press Book Study, visit our website here: https://www.babyheartspress.com/volume-2Become a Supporter of the Podcast: https://www.buzzsprout.com/62761/supporters/newSupport the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

In this episode of Heart to Heart with Anna we welcome Frank Jaworski back to the program. Frank shares information about anesthesia when patients go to the electrophysiology lab (EP lab), especially when they need to undergo an ablation.Frank is a certified, registered nurse anesthetist (CRNA) and he has been delivering anesthesia for over 23 years. One of his favorite departments to work with is the EP lab. In this episode, Frank shares some tips to help those in the congenital heart defect community reduce their concerns when visiting the EP lab, he offers some helpful questions patients can ask their anesthesia providers, and even shares some tips for how to reduce anxiety during their EP visits.The 2nd and 3rd Segments involve Anna reading from The Heart of a Heart Warrior Volume Two: Endurance.  This is one of the newest books from Baby Hearts Press. This is the second in a 3-book series of essays and works of art by adults with congenital heart defects.In this podcast episode, Anna will read from the front matter of the book, including the Foreword, Preface, and Introduction.Baby Hearts Press is hosting a Book Study for those interested in meeting some of the contributors to ask questions, as well as an opportunity to share their own experiences related to the topics discussed in the book. The Book Study for Volume Two begins on Thursday, March 24th from 5-6 PM Central Daylight Savings Time and runs for 4 consecutive Thursdays. To get a ticket to attend for only $10 per session, visit https://www.babyheartspress.com.Support the showAnna's Buzzsprout Affiliate LinkBaby Blue Sound CollectiveSocial Media Pages:Apple PodcastsFacebookInstagramMeWeTwitterYouTubeWebsite

NEJM 1991;324:781-788Background A hallmark of post-myocardial infarction (MI) care in the 1980's was the monitoring and suppression of premature ventricular contractions (PVCs) via use of antiarrhythmic drugs. The practice was based on pathophysiologic rationale that PVC burden is a strong risk factor for sudden and non-sudden cardiac death following MI and thus, suppression must reduce death. PVC reduction was a seductive surrogate endpoint that was easy to measure and declare victory on, but it had never been tested in a proper RCT. The Cardiac Arrhythmia Suppression Trial (CAST) was sponsored by the National Heart, Lung and Blood Institute (NHLBI) and sought to test the hypothesis that suppression of asymptomatic or mildly symptomatic PVCs with antiarrhythmic therapy with encainide, flecainide, or moricizine after MI would reduce death due to arrhythmia.Patients Patients were eligible for enrollment 6 days to 2 years post MI with an average of ≥6 PVCs per hour on ambulatory monitoring of at least 18 hours duration, and no runs of VT of ≥15 beats at a rate of ≥120 bpm. An ejection fraction (EF) of ≤55% was required within 90 days of MI or ≤40% if recruited after 90 days. There was a run-in phase. Patients were only enrolled in the main trial if they had at least 80% suppression of PVCs and at least 90% suppression of runs of VT during an initial, open-label titration period. Initial open-label drug assignment was based, in part, on the EF. Flecainide was not given to patients with an EF of ≤30%. Moricizine was only used as a second line drug in patients with an EF of ≥30%.Baseline characteristics Baseline characteristics of the patients enrolled in the trial are not provided in the main manuscript and cannot be inferred from the results, tables or figures presented.Procedures Patients in whom arrhythmias were suppressed were randomly assigned to receive either the effective drug or its matching placebo. A detailed description of study procedures is not presented in the main manuscript. Compliance with the study drug was assessed in follow-up visits and based on pill counts of tablets returned but the schedule of these visits is not provided. Concomitant drug therapy was assessed at the time of the last visit, according to a standardized checklist.During the trial, patients could be instructed to discontinue the study drug based on the occurrence of the following events: ventricular tachycardia, significant increase in arrhythmia burden, disqualifying ECG changes including significant QT prolongation or bradycardia, new or worsened congestive heart failure, the need for treatment with an antiarrhythmic agent outside the entry criteria for the study, or any number of other adverse medical events divided into cardiovascular or non-cardiovascular events.Endpoints The primary endpoint of the study was death or cardiac arrest with resuscitation due to arrhythmia. The site PI was responsible for classifying each death without knowledge of the patient's assigned treatment. Secondary endpoints included cardiovascular and non-cardiovascular causes of death, disqualifying ventricular tachycardia without arrest, syncope, pacemaker implantation, recurrent MI, congestive heart failure, angina pectoris or coronary artery revascularization.Results Observation began on the day of randomization to blinded therapy and was censored on April 18, 1989, the date when the use of encainide and flecainide was discontinued by the Data and Safety Monitoring Board because the data indicated it was unlikely that benefit could be demonstrated, and it was likely that the drugs were harmful. The original CAST trial manuscript reports data on patients assigned to the encainide and flecainide groups. Moricizine use was continued and would be reported separately in the revised CAST II trial.1498 participants were randomized to receive either encainide, flecainide or their matching placebo and followed for an average of 10 months. Compliance with the assigned treatments was estimated to be >90% in 70% of all patients and was similar in the active-drug and placebo groups. Antiarrhythmic therapy significantly increased the relative risk of the primary endpoint of death or cardiac arrest due to arrhythmia (RR 2.64; 5.7% vs 2.2%; p=0.0004) and was associated with a number needed to harm (NNH) of approximately 29. It also increased the risk of all deaths and cardiac arrests (RR 2.38; 8.3% vs 3.5%; p=0.0001; NNH = 20); even those not associated with arrhythmia (2.3% vs 0.7%; p=0.01).Conclusions The CAST trial unexpectedly demonstrated that treatment of asymptomatic or mildly symptomatic PVCs in post-MI patients, with encainide and flecainide, increased death and cardiac arrests. From a chronological standpoint, it is the first major trial in cardiovascular medicine (perhaps all of medicine) that “reversed” a standard medical practice. In this case, one that was instituted and broadly adopted on the basis of pathophysiologic reasoning and one that targeted a surrogate endpoint. Thus, more than anything it highlights the importance of testing interventions in properly conducted RCTs prior to adoption and basing the analysis on hard outcomes that are meaningful to patients and society. How many practices in modern medicine are supported by high quality RCTs? It may be as low as 30-40%. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Listen in this episode of DC Power Hour as our battery Blarney duo of George and Allen field questions from Doug on our sales team. They discuss topics ranging from seismic racking to spill containment and neutralization to chargers.Episode Highlights:1:57 – What are the seismic and UBC zones and how have they changed over time?7:40 – If you put the spacers in, you've just got rid of half the airflow that's necessary to keep the battery cool.9:46 – What are the pros and cons of Stevrofoam sheets vs corrugated PVCs in regards to airflow for the racks?14:10 – Spill containment, is it recommended for VRLA purviews?19:35 – Does the spill containment count as a neutralization kit?

Jason T. Jacobson, MD, FHRS, of Westchester Med Center-New York Med College discusses A Novel ECG-Based Deep Learning Algorithm to Predict Cardiomyopathy in Patients With Premature Ventricular Complexes with Daniel Frenkel, MD, FHRS, of Westchester Medical Center, and Jagmeet P. Singh, MD, PhD, FHRS, of Massachusetts General Hospital. This study utilized a machine learning algoritihm to predict the devlopment of cardiomyopathy in patients with PVCs based on the baseline ECG.   https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.05.025   Host Disclosure(s): J. Jacobson: Honoraria/Speaking/Consulting Fee: American College of Cardiology, Zoll Medical Corporation; Research (Contracted Grants for PIs Named Investigators Only): Abbott, Phillips; Stocks (Privately Held): Atlas 5D   Contributor Disclosure(s): D. Frenkel: Ownership/Partnership/Principal: Summit Health J. Singh: Honoraria/Speaking/Consulting Fee: Medtronic, EBR Systems, Boston Scientific, Biotronik, Abbot, MicroPort Scientific Corporation, Cardiologs, Sanofi, CVRx Inc., Impulse Dynamics, USA, Implicity, Orchestra Biomed, Rhythm Management Group Corp, Medscape, Biosense Webster Inc., Notal Vision, iRhythm Technologies, Philips

Light Round Volume 5: Approach to a patient with frequent PVCs

Cardiologist explains PVCs and PACs and when you need to start worrying. https://dralo.net/links

FDA says Popular Decongestant is Ineffective and the Impact of Coffee on Arrhythmia Guest: Dr. Kavita Chawla, Chair - EBM Education Committee, Internal Medicine, Virginia Mason Franciscan HealthArticles referenced: https://www.nejm.org/doi/full/10.1056/NEJMoa2204737In this 5-minute check in, Dr. McGinn and guest Dr. Kavita Chawla review two health care topics making headlines: An F.D.A. panel says a common decongestant found in many over-the-counter cold medicines is ineffective. Dr. McGinn and Dr. Chawla discuss the findings and what this means for patients. The “CRAVE” trial (Coffee and Real-time Atrial and Ventricular Ectopy) published in the NEJM studies the short term impact of caffeine on palpitations in relatively healthy people. Dr. McGinn and Dr. Chawla review the impact of coffee on PACs, PVCs as well as on step counts and sleep.

The following question refers to Section 4.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by Texas Tech University medical student and CardioNerds Academy Intern Dr. Adriana Mares, answered first by Rochester General Hospital cardiology fellow and Director of CardioNerds Journal Club Dr. Devesh Rai, and then by expert faculty Dr. Eldrin Lewis.Dr. Lewis is an Advanced Heart Failure and Transplant Cardiologist, Professor of Medicine and Chief of the Division of Cardiovascular Medicine at Stanford University. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #26 A 45-year-old man presents to cardiology clinic to establish care. He has had several months of progressive dyspnea on exertion while playing basketball. He also reports intermittent palpitations for the last month. Two weeks ago, he passed out while playing and attributed this to exertion and dehydration. He denies smoking and alcohol intake.   Family history is significant for sudden cardiac death in his father at the age of 50 years. Autopsy has shown a thick heart, but he is unaware of the exact diagnosis. He has two children, ages 12 and 15 years old, who are healthy.   Vitals signs are blood pressure of 124/84 mmHg, heart rate of 70 bpm, and normal respiratory rate. On auscultation, a systolic murmur is present at the left lower sternal border. A 12-lead ECG showed normal sinus rhythm with signs of LVH and associated repolarization abnormalities. Echocardiography reveals normal LV chamber volume, preserved LVEF, asymmetric septal hypertrophy with wall thickness up to 16mm, systolic anterior motion of the anterior mitral valve leaflet with 2+ eccentric posteriorly directed MR, and resting LVOT gradient of 30mmHg which increases to 60mmHg on Valsalva.   You discuss your concern for an inherited cardiomyopathy, namely hypertrophic cardiomyopathy. In addition to medical management of his symptoms and referral to electrophysiology for ICD evaluation, which of the following is appropriate at this time? A  Order blood work for genetic testing B  Referral for genetic counseling C  Cardiac MRI D  Coronary angiogram E  All of the above Answer #26 Explanation   The correct answer is B – referral for genetic counseling.  Several factors on clinical evaluation may indicate a possible underlying genetic cardiomyopathy. Clues may be found in: ·       Cardiac morphology – marked LV hypertrophy, LV noncompaction, RV thinning or fatty replacement on imaging or biopsy ·       12-lead ECG – abnormal high or low voltage or conduction, and repolarization, altered RV forces ·       Presence of arrhythmias – frequent NSVT or very frequent PVCs, sustained VT or VF, early onset AF, early onset conduction disease ·       Extracardiac features – skeletal myopathy, neuropathy, cutaneous stigmata, and other possible manifestations of specific syndromes In select patients with nonischemic cardiomyopathy, referral for genetic counseling and testing is reasonable to identify conditions that could guide treatment for patients and family members (Class 2a, LOE B-NR). In first-degree relatives of selected patients with genetic or inherited cardiomyopathies, genetic screening and counseling are recommended to ...

In this episode, I talk about Cardiophobia aka the fear of your heart-related symptoms (heart palpitations, PVCs, skipped heartbeats, heart flutters, chest tightness, etc). I explain exactly what this is and what it can look like for people who are struggling with this fear. I also share many tips and strategies on how to start responding differently to your symptoms in order to get relief from them so that you can ultimately recover from Cardiophobia. You are not alone if this is something you experience! FREE GUIDE - The Ultimate Health Anxiety Toolkit https://haley-joy.ck.page/c0e33657db MASTERCLASS - Heal Your Health Anxiety ⁠⁠⁠⁠⁠ ⁠⁠https://haley-joy.mykajabi.com/offers/CTFDkAJv⁠⁠ SCHEDULE THERAPY with me: PA, NJ, and FL residents only https://www.innergrowthcounseling.com INSTAGRAM: https://www.instagram.com/your.anxious.therapist/ TIKTOK: https://www.tiktok.com/@youranxioustherapist/ --- Send in a voice message: https://podcasters.spotify.com/pod/show/haley-ostrow/message

In this episode of Kubernetes Bytes, Ryan and Bhavin sit down with Sachin Mullick and Peter Lauterbach - the Product Management team at Red Hat focused on Red Hat OpenShift Virtualization and the open-source KubeVirt project and talk about how users can run containers and virtual machines side-by-side on the same Kubernetes cluster. They discuss the benefits of having a unified control plane for all your applications and the different features that enable users to run their applications in production. They also talk about some customers that have implemented this technology in production. Listen to learn more about how you can get started with KubeVirt and run your VMs alongside your Kubernetes pods on your Kubernetes or OpenShift clusters. 03:27 - News Segment 13:54 - KubeVirt Interview 01:06:12 - TakeawaysThe Motley Fool: Save $110 off the full list price of Stock Advisor for your first year, go to http://www.fool.com/kubernetesbytes and start your investing journey today! *$110 discount off of $199 per year list price. Membership will renew annually at the then current list pricShow Notes: 1. Kube by Example - https://kubebyexample.com/ 2. Ask An OpenShift Admin - https://youtube.com/playlist?list=PLaR6Rq6Z4IqdsG6b09q4QIv_Yq5fNL7zh 3. https://kubevirt.io/ 4. https://www.redhat.com/en/technologies/cloud-computing/openshift/virtualization Cloud-Native News: 1. New Security Startup - Stacklok - https://techcrunch.com/2023/05/17/kubernetes-and-sigstore-founders-raise-17-5m-to-launch-software-supply-chain-startup-stacklok/ 2. Traefik Lab announces Traefik Hub - Also raised $11M https://techcrunch.com/2023/05/17/traefik-labs-launches-traefik-hub-a-kubernetes-native-api-management-service/ 3. KSOC releases the KBOM standard - https://tech.einnews.com/pr_news/629861155/ksoc-releases-the-first-kubernetes-bill-of-materials-kbom-standard 4. Upbound announces managed Crossplane service - https://www.infoq.com/news/2023/05/upbound-managed-control-plane/ 5. Kubernetes 1.27 StatefulSet auto deletion for PVCs to beta https://kubernetes.io/blog/2023/05/04/kubernetes-1-27-statefulset-pvc-auto-deletion-beta/ 6. Cost reduction CAST AI company focuses on reducing compute costs running generative AI models on k8s https://siliconangle.com/2023/05/18/kubernetes-firm-cast-ai-adds-support-reducing-generative-ai-deployment-costs/ 7. Vault secret store operator https://thenewstack.io/hashicorp-vault-operator-manages-kubernetes-secrets/ 8. Managed Kafka or Run it yourself ? https://thenewstack.io/kafka-on-kubernetes-should-you-adopt-a-managed-solution/ 9. Cool usecase - edge k8s - robots picking fruit - https://thenewstack.io/fruit-picking-robots-powered-by-kubernetes-on-the-edge/ 10. Knative 1.10 release https://knative.dev/blog/releases/announcing-knative-v1-10-release/ (4-25 missed it)

Welcome to another exciting podcast episode, where we dive into the latest cardiovascular research! Join us as we discuss four fascinating studies: STUDY #1: Discover how subclinical coronary atherosclerosis detected by computed tomographic angiography (CTA) can pose a significant risk for myocardial infarction (MI) in asymptomatic middle-aged men and women in a Danish cohort. Fuchs A et al. Subclinical coronary atherosclerosis and risk for myocardial infarction in a Danish cohort: A prospective observational cohort study. Ann Intern Med 2023 Mar 28; [e-pub]. (https://doi.org/10.7326/M22-3027) STUDY #2: We'll examine the Open Payments Program (OPP) data, revealing trends in industry payments to cardiologists from 2014 to 2019, including the necessity for transparency. Zhang R et al. Trends in industry payments to cardiologists from 2014 to 2019. Circ Cardiovasc Qual Outcomes 2023 Mar 17; [e-pub]. (https://doi.org/10.1161/CIRCOUTCOMES.122.009820) STUDY #3: In this randomized case-crossover study, we'll explore whether caffeinated coffee affects premature atrial contractions (PACs) and ventricular contractions (PVCs) in healthy adults. Marcus GM et al. Acute effects of coffee consumption on health among ambulatory adults. N Engl J Med 2023 Mar 23; 388:1092. (https://doi.org/10.1056/NEJMoa2204737) STUDY #4: Lastly, we'll discuss a phase 3 trial of sotatercept, a potential new class of therapy for pulmonary arterial hypertension (PAH), focusing on its effects on 6-minute walk distance and other secondary endpoints. Hoeper MM et al. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. N Engl J Med 2023 Mar 6; [e-pub]. (https://doi.org/10.1056/NEJMoa2213558) This episode promises to be a wealth of knowledge and insights into cardiovascular health. So, get comfortable, grab your headphones, and let's dive into these captivating studies to uncover the secrets to a healthier heart. Enhance your understanding and make a difference in patients' lives. See you there! For shownotes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.  

Nigeria elections is today!

Visit Harvest Eating Now! When it comes to electrolytes I did not know very much until about 8 mos ago. You'd think with my athletic background which spanned the gamut from decades of ice hockey at a serious level, tennis, mountain biking, and even mountain bike racing that I would be familiar with electrolytes, but no. Aside from Gatorade which I hate, I really was not aware that average people, or anyone not a paid athlete, can benefit from electrolyte consumption. I followed the “health experts” who said to drink 8 glasses of water each day, more if you're sweating, but they were always demonizing salts in every form. Remember a low-sodium, low-fat, and plant-based diet is best…! We've all heard this nonsense from the FDA on sodium intake, I think it's crap. I even listened to my own doctors who pretty much caused an electrolyte deficiency by prescribing medications that cause fluid and mineral loss and then double-downed with advice to take other prescriptions to help with symptoms caused by the prior medicines, read-lunacy! A few years back during a routine checkup my by was a touch high, 125/80 and the doctor advised going on a low dose BP med basically so my wife would not worry. I also had started snoring for the first time, so the doctor and my wife were worried about potential sleep apnea and future heart problems so I agreed on the low dose of BP meds. A few years later, I started having some weird heart rhythm issues called PVCs which are common, about 20 million Americans have this. It's not life-threatening but it can be very strange and uncomfortable when your heart flops around. I was referred to a cardiologist and prescribed yet another drug. Still blindly following the advice I started that medication, but after a few weeks I hate the side effects and threw it away, and never went back to the cardiologist. The PVCs continued for years and were ok sometimes but not always. I started exercising more and realized I could not be on meds that caused excessive urination, because with additional sweating I would get dizzy, likely from dehydration and electrolyte imbalances so I had the meds changed and decided to see a functional medicine practitioner instead of the family MD who just followed his guidelines and gave the same dumb advice. During this process, the functional medicine doctor had extensive blood panels drawn, like 12 vials of blood. They tried to take blood in the office, but the physician's assistant got no blood from the left arm, she switched to the right and go no blood, that's how dehydrated I was. She had never seen this in any patient. I waited for a few days and drank a ton of water and went again, this time some blood came out, but still not flowing that freely. The results showed my electrolytes were way out of balance with potassium and sodium low, and magnesium slightly low. They suggested I take some electrolytes and after doing some research I settled on one. Within a week the constant PVCs went away, and except for a 2-day period, they have been gone which is amazing. My BP is quite a bit lower and I know am only on half the prescribed dose and working to shed the last 15 pounds I have to lose to get to my goal of 155 pounds and hopefully be off all meds! I am riding my bike a lot more and really seeing great health improvements and I credit electrolytes with much of that improvement, especially with increased energy. Important Links: Support Harvest Eating Join Food Storage Feast Brown Duck Coffee About Chef Keith Snow Some of My Fav Recipes   Resources for today's Show: https://drinklmnt.com/pages/our-story https://myoxcience.com/collections/hormone-adrenal-support  

From Chest Pain to Myocardial Bridge Diagnosis and Surgery at Stanford, Jeff Holden recounts a life-changing episode that shifted his perspective on health, empathy, and purpose. An avid cyclist, Jeff was blindsided by a severe medical emergency that defied his otherwise stellar physical condition. This episode dives into the mystery of his heart condition, the surreal experiences during his recovery, and the transformative moments that followed. Plus, discover how Jeff's journey led him to launch a new podcast aimed at helping others dealing with similar health issues. Show notes:0:00 Introduction1:40 "What gets you up in the morning?"2:05 Jeff dives into his story starting with the Death Ride in July 20213:30 By August, he was experiencing a deep burning in his chest5:00 Sees his primary physician who recommends he sees his cardiologist6:00 By that Thursday, he woke at 5:45am with all the sensations of a heart attack, 911 is called and the EMTs find a heart attack and he's wheeled out of his house to the ambulance with a pulse of 468:00 Jeff has a catherization and nothing is found9:20 He starts cardiac rehab and was experiencing PVCs which became problematic in addition to vasospasms10:10 Jeff tries multiple medications11:00 Last day of cardiac rehab September 2021 where he had "the sensation" after climbing stairs in the garage11:50 The cardiologist calls and calls Jeff to the hospital as he had just had ventricular tachycardia episode. As in RIGHT NOW. His spasm episodes were triggering the tachycardia.13:45 Electrophysiologist casually mentions Jeff has a myocardial bridge but that it is benign but Jeff pushes back14:30 Jeff asks for a bypass of the LAD that is bridged but the doctor says, "we don't do that"15:00 Jeff's cardiologist says "it's beyond us" and recommends provocative testing15:30 Stanford is recommended and he sees Dr. Tremmel16:30 Jeff learns his myocardial bridge is 40mm long and when he is experiencing vasospasms in the LAD, it is 98% blocked17:20 Jeff had unroofing surgery at Stanford January 4, 202217:50 prior to surgery, Jeff quizzes Dr. Jack Boyd on his success rate which is great coaching for listeners. Take note!18:45 Boots recommends the Myocardial Bridge Facebook group which is a treasure trove of information20:10 Jeff feels much improvement since his unroofing21:10 Jeff connects with a marathon runner who also had unroofing in August 2021 and is doing well too22:00 Jeff and Boots met through the Facebook group thankfully.22:30 Jeff revisits why he gets up in the morning23:00 how we have to be our own best advocate.23:30 Jeff shares what he did to recover in addition to prepping for surgery including having the pre-surgery to surgery which is semi-comical.25:30 Jeff felt the power of prayer27:00 recovery was a little rough. He did not "dig" ICU at all. Sleep deprivation was an issue.28:00 Jeff takes control of his recovery.28:40 Boots shares her ICU story with Jeff.29:20 Jeff is sent home and his wife promptly gets sick. He even empties the dish washer.30:00 Minor blip and Jeff has to go to the ER and then comes down with Covid!31:00 Jeff and Boots reminisce about the heart pillow31:30 Boots asks Jeff what surprised him the most about open-heart surgery32:20 Boots asks what has been most helpful?33:10 Jeff laments how his wife was impacted34:30 Grace, gratitude, appreciation for the medical community34:50 He never felt sorry for himself. He just asked a lot of questions and did what he had to do to survive.36:00 He believes there is a reason why all of this happened the way it happened.37:00 Jeff shares about an important dream.39:10 Jeff asks Boots if she had an important dream, and she shares the impact on...

In this episode, Akindare and Jemima discuss Nigeria's leading presidential candidates', elections in Nigeria and why its important for us all to engage with politics on some level. Nigerians, please get their PVCs. What are your thoughts & experiences in the run-up to Nigeria's 2023 elections? Share with us on Twitter: @theshrinepod; Instagram: @theshrine.pod, or by email at theshrinepodcast@gmail.com. Join The Shrine on Clubhouse and become a member of our community. Everyone is welcome! 

Babak Nazer, MD directs the UW Translational Electrophysiology Laboratory, where his research focuses on the diagnosis and treatment of ventricular arrhythmias (premature ventricular complexes (PVCs) and ventricular tachycardia (VT). In collaboration with acoustic physicists and biomedical engineers, his laboratory develops new diagnostic and therapeutic ablation tools for the treatment of PVCs and VT, particularly those using ultrasound as an energy source.  As Director of the UW Multidisciplinary Ventricular Arrhythmia Program, he collaborates with psychologists to investigate the psychosocial symptoms associated with VT and defibrillator shocks, and therapies to alleviate these symptoms. bnazer@uw.edu

The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by New York Medical College medical student and CardioNerds Intern Akiva Rosenzveig, answered first by Cornell cardiology fellow and CardioNerds Ambassador Dr. Jaya Kanduri, and then by expert faculty Dr. Randall Starling.Dr. Starling is Professor of Medicine and an advanced heart failure and transplant cardiologist at the Cleveland Clinic where he was formerly the Section Head of Heart Failure, Vice Chairman of Cardiovascular Medicine, and member of the Cleveland Clinic Board of Governors. Dr. Starling is also Past President of the Heart Failure Society of America in 2018-2019. Dr. Staring was among the earliest CardioNerds faculty guests and has since been a valuable source of mentorship and inspiration. Dr. Starling's sponsorship and support was instrumental in the origins of the CardioNerds Clinical Trials Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #6 Mr. D is a 50-year-old man who presented two months ago with palpations and new onset bilateral lower extremity swelling. Review of systems was negative for prior syncope. On transthoracic echocardiogram, he had an LVEF of 40% with moderate RV dilation and dysfunction. EKG showed inverted T-waves and low-amplitude signals just after the QRS in leads V1-V3. Ambulatory monitor revealed several episodes non-sustained ventricular tachycardia with a LBBB morphology. He was initiated on GDMT and underwent genetic testing that revealed 2 desmosomal gene variants associated with arrhythmogenic right ventricular cardiomyopathy (ARVC). Is the following statement true or false? “ICD implantation is inappropriate at this time because his LVEF is >35%” True   False   Answer #6 Explanation This statement is False. ICD implantation is reasonable to decrease sudden death in patients with genetic arrhythmogenic cardiomyopathy with high-risk features of sudden death who have an LVEF ≤45% (Class 2a, LOE B-NR). While the HF guidelines do not define high-risk features of sudden death, the 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy identify major and minor risk factors for ventricular arrhythmias as follows: Major criteria: NSVT, inducibility of VT during EPS, LVEF ≤ 49%. Minor criteria: male sex, >1000 premature ventricular contractions (PVCs)/24 hours, RV dysfunction, proband status, 2 or more desmosomal variants. According to the HRS statement, high risk is defined as having either three major, two major and two minor, or one major and four minor risk factors for a class 2a recommendation for primary prevention ICD in this population (LOE B-NR). Based on these criteria, our patient has 2 major risk factors (NSVT & LVEF ≤ 49%), and 3 minor risk factors (male sex, RV dysfunction, and 2 desmosomal variants) for ventricular arrhythmias. Therefore, ICD implantation for primary prevention of sudden cardiac death is reasonable. Decisions around ICD implantation for primary prevention remain challenging and depend on estimated risk for SCD, co-morbidities, and patient preferences, and so should be guided by shared decision making weighing the possible benefits against the risks,

The captain's mind remains a beautiful enigma with its ability to connect the most random of thoughts to paint a picture what framing. Talking on a thousand ways to die, healthy cultism and Orijin Bitters to emphasize the importance of time (management), Cavey charges listeners to be always with deliberate. ps: Nigerians in Nigeria, have you picked up your PVCs? --- Send in a voice message: https://anchor.fm/naked--baked/message

It's 64 days to the 2023 general elections, and the Independent National Electoral Commission, INEC, has started distribution of the permanent voter's cards.How many Nigerians have collected theirs?In this episode of Nigeria Daily, we look at how Nigerians are headstrong in collecting their PVCs despite all odds.

A smart speaker and your Heart. “ Alexa, is my heart rhythm normal”? An Electro Cardiologist interfaces a clinical problem with a smart speaker to identify cardiac arrhythmias. Learn how innovation in biotechnology had led a cardiologist and his team to train Alexa to determine abnormal from normal heart rhythms. Still in development, this fascinating interface highlights how leading innovators take technology and smart devices forward to enhance clinical care.  Listen as we review common cardiac arrhythmias, causes, treatments and diagnosis current and future. Directions for innovation with devices and additional developments in Telehealth.   Guest:  Arun Mahankali Sridhar, M.D., M.P.H., is a cardiac electrophysiologist and a specialist in heart rhythm disorders. He is an Assistant Professor in the Division of Cardiology at the University of Washington.  Dr. Sridhar's sees patients with both rapid and slow heart rhythm disorders, as well as patients with a risk of sudden cardiac death. He has comprehensive expertise in management of both common and complicated arrhythmias. He is an expert in catheter ablations for atrial fibrillation; atrial flutters (both typical and complex), supraventricular tachycardia, WPW, ventricular tachycardia (VT) and premature ventricular complexes (PVCs); stroke prevention in atrial fibrillation, including left atrial appendage closure; In addition he is an experienced implanter of all types of cardiac device therapy, including cardiac pacemakers; implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy (CRT).  Dr. Sridhar's research focuses on improving ablation techniques and patient outcomes in atrial arrhythmias. He collaborates with the UW computer science and bio-engineering department on various innovation projects to improve the care of heart rhythm patients utilizing advanced computing and novel low-cost patient accessible technologies.     During This Episode We Discuss:  Cardiac (Heart) Arrhythmias: causes, detection and treatment options.  Innovations in the diagnosis of arrhythmias.  The benefits of a multi disciplinary team in researching a very innovative solution to a common clinical problem.  The role of adaptive, machine learning, signal processing and clinical experience in moving technology forward.  Future potential enhancements in current technology to diagnose other metabolic, cardiac and respiratory conditions.    Recommended Resources:  Nature: COMMUNICATIONS BIOLOGY| (2021) 4:319 | https://doi.org/10.1038/s42003-021-01824- https://www.nature.com/articles/s42003-021-01824-9.pdf  UW Cardiology website  Stopafib.org      Visit our website for all the podcasts, additional resources and social media links Website: theoriginalguidetomenshealth.org Facebook: https://www.facebook.com/theoriginalguidetomenshealth/ Twitter: https://twitter.com/guide2menshlth Linkedin: https://www.linkedin.com/company/the-original-guide-to-mens-health/  

Quote of The Day: "You don't need people to validate your gift; you were gifted before they met you". ~ Bishop T.D Jakes Hosts: TOLA Omoniyi, Olufunke Aderogba, Eyiyemi Olivia

In today's episode, Gina answers a listener question regarding anxiety, exercise and skipped heartbeats. Some of the physiology behind the sensation of skipped heartbeats is discussed as well as how adrenaline released during exercise can make the occurrence more likely. The safety and how to handle this experience is also covered.Link mentioned in the show for more information on PVCs and exercisehttps://www.livestrong.com/article/426515-frequent-pvcs-during-exercises/Book mentioned by Kelly McGonigalThe Joy of Movement: How exercise helps us find happiness, hope, connection, and couragehttps://amzn.to/3OPqfWGFind even more peace and calm with our Supercast premium access membership! https://anxietycoaches.supercast.com/Here's what's included for $5/month:❤ New Ad-Free episodes every Sunday and Wednesday❤ Access to the entire Ad-free back-catalog with over 600 episodes❤ Premium meditations recorded with you in mind❤ And more fun surprises along the way!All this in your favorite podcast app!To learn more go to:https://www.theanxietycoachespodcast.comJoin our Group Coaching Full or Mini Membership Program Learn more about our One-on-One CoachingWhat is anxiety?Quote:When you exercise, it increases endorphins, dopamine, adrenaline and endocannabinoid — these are all brain chemicals associated with feeling happy, feeling confident, feeling capable, feeling less anxiety and stress and even less physical pain.-Dr. Kelly McGonical Learn more about your ad choices. Visit megaphone.fm/adchoicesSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

For more information on this topic or to schedule a consultation please visit us at http://WhatIsHashimotos.com We're going to talk about Hashimoto's and heart problems. This is kind of an interesting one. And I'm going to speak to you strictly from experience on this because a lot of people are looking for, “Oh, it's causing this exact thing, that to the heart and it's creating the bundle branch to not work right,” and blah, blah, blah, and all that type of stuff. But I'm going to tell you the nuts and bolts, blue collar aspect of Hashimoto as a heart disease. So I've been doing this for a long time, seen thousands and thousands and thousands and thousands of patients. And here's what I hear. I am going to grew greatly downplay how many times I think I've heard this, but I have heard this somewhere between 500,000 times. And I think probably more, but this is how common it is. The patient comes in and maybe they don't even know that they have autoimmune disease at that time, maybe they don't even know that they got a thyroid problem at that time. And so you're sitting there are listening and digging and taking notes and trying to go, “Okay, what's going on here? Does this person fit my practice? Do they have autoimmune problems?” And then it happens. Then I ask, “Do you have heart palpitations for no reason at all? Heart palpitations or anxiety for no reason at all? Would you call that PVCs, pre ventricular contractions? Would you call that SVPs?” These are all medical pathology that cause your heart to beat out of your chest. And then I'm like, “Well, tell me more about that.” Here's the story. “I was under a lot of stress and then all of a sudden, for no reason at all, for no reason at all, my heart started to really pound. And I really started to get big time arrhythmias. And I couldn't breathe very well, and I was really getting anxiety and so on and so forth. [inaudible 00:02:05]. So I was at a hospital and then they did an EKG, they did an echogram, they did a cardiogram, they did everything. And everything was normal,” for the lucky ones. For the lucky ones. “And everything was normal. And they told me to go home and they told me to take some electrolytes and I'm probably just stressed and maybe I just need to deal with my stress and go to counseling. ‘But if it happens again, maybe you can go to cardiologist,' even though everything was normal.” The second person, who's not always quite as fortunate, they'll pick something up on some of the electrical diagnostics and they'll go, “Okay, we're going to go in and we're going to ablate the nerves that are causing your heart to do that…” And then they do that. But the patient's still sitting in front of me with heart palpitations for no reason at all, and anxiety for no reason at all, and those types of things, even though they've been ablated. So when I see questions that come in on does Hashimoto's cause heart problems, technically the answer is no. However, not technically, the answer is yes. And here's how it happens. http://powerhealthtalk.com http://drmartinrutherford.com Martin P. Rutherford, DC 1175 Harvard Way Reno, NV 89502 775 329-4402 http://powerhealthreno.com https://goo.gl/maps/P73T34mNB4xcZXXBA

In this episode, we discuss PVCs, live shows, first jobs, work experiences, tiring jobs working in Nigeria and abroad and career lessons so far. Make sure you like, share and rate us everywhere you listen to podcasts. Twitter – @Roadto30podcast, @IsaacKanye_, @Dolly.writes Instagram – @Roadto30podcast, @IsaacKanye_, @DollyAkitoye,

Trade – OsmitrolClass – Osmotic DiureticMOA – Facilitates the flow of fluid out of tissues including the brain and into interstitial fluid and blood, this causes dehydration of the brain which results in decreased swelling. Reabsorption by the kidneys is limited so increased urine output takes placeIndications – increased ICPContraindications- Active intracranial bleeding, heart failure, pulmonary edema, severe dehydration, use caution with hypovolemia and renal failure.Side effects – Pulmonary edema, headache, blurred vision, dizziness, seizures, hypovolemia, nausea/vomiting, diarrhea, electrolyte imbalance, hypotension/HTN, sinus tachycardia, PVCs, angina, phlebitis DosageAdult: 0.25-1g/kgPediatric: SAA

• 00:13 - Ukraine / Russia war brief  • 00:14 - Why our parents were/are always tired. Hectic weekend for Sanmi  • 00:22 - Ladies, would you think your man wasn't man enough if you're getting disrespected and he doesn't step in?  • 00:34 - What is the single most expensive item that is not furniture or appliance in your home? • 00:37 - What is the thing you have the most of in your home? (It can't be food)  • 00:40 - Tragic state of Ukraine

Season 2 starts explosively! Lola OJ & Mandy are joined by a special guest, outspoken Falz aka Folarin Falana, they discuss a topic that gets constant airtime here, politics. Nothing is held back in this episode, they discuss the importance of the #EndSars movement, the up and coming elections, and why we should all have our PVCs. With the right balance of seriousness and banter, it's an episode you don't want to miss! Make sure you rate, share and leave a comment wherever you listen to the podcast telling us how much you enjoyed the episode!. Always use the hashtag LegalAvenuePodcast to let us know what you think of the episode, we love hearing from you... Follow Us on Social Media Instagram @legalavenuepodcast @mandyuzoagba @lolaoj Twitter @legalavenue_pod @mandyuzoagba @lola_oj --- Send in a voice message: https://anchor.fm/legal-avenue-podcast/message

What is the significance if they occur during stress or recovery?

 Brent: Welcome to this new year today, I have ghetto Yansen and he is with Spriker and I'm very excited to talk to him ghetto. You are the global business and technology. Evangelists for Spriker and which in the blue room or the green room, we talked about that you're the Ben marks of Spriker or the Ben marks of shop where, or the benchmarks of Magento or whatever.  Brent: However you want to say that. Why don't you do a better introduction than I just did. And maybe tell us what you're doing day to day and, one of your passions in life.   Guido: Oh, I have many passions brands. One of wishes now a Spriker indeed. Yeah, my background's in the. I guess to try to compromise a bit that I have a background in psychology and what a usability part of of psychology optimizing a web shop off the debts.  Guido: The study itself at university I'm done. I don't feel that old, but at university that didn't have a lot of online things going on. In terms of examples. So that was mainly about the usability. I could think of thing machine or a way, finding an airports how that works. But I always applied this to align to e-commerce and in, started out with things like mumbo and.  Guido: Wait maybe I am old mama Joomla and a, and I switched gears to to e-commerce and Magento in 2008. That time when we were all playing around with cameras and virtual mark, and those kinds of things that Magento came around, which was this magical thing that was way ahead of its time. And we all add a great fun, I think playing around with that and did that for, 13 years.  Guido: And I think that's also like 20 10, 20 11 that I met you. I think we met at a. It was the Moscone center in San   Brent: Francisco. Could be, yeah. Yeah. The fabric comm X dot commerce.   Guido: This will all be beeped   Brent: out with the knee, right? Yeah. In fact, I was just going through all my supplies. I was going through my old video just getting stuff, getting my mat cleaned up and I found of a video of the, in the intro or the, welcome from the.  Brent: PayPal slash Magento slash whatever eBay people. Yeah. And it was us coming out of the conference center and they all, there's huge. Just all the employees lined up welcoming, everybody to the event. So it was definitely a well thought out event and it was fun how could you go wrong?  Brent: I don't know if if the outcome was what they had expected, but it was fun. And then. A fun event, 2011, definitely.   Guido: Yeah. Events were a fun ride. Remember those events were fun. Now we had a lot of fun with that with Magento organized, a lot of stuff. For Magento we had the Mimi, Japan and Netherlands kickstart this whole global movement of Magento events.  Guido: And I've been lucky enough to to attend many of those those firsts, which are the best I think, to go through like those first events in a country where. People have heard each other's names online on slack or on the forums, but never met in person. So all those awkward first meetings, or those are great to to, attend to.  Guido: And yeah, I and it's also a, the Magento ecosystem is also where I met Boris the founder of Spriker and currently co CEO of Spriker. I think we met sills. 20 11 20 12 had a Magento agency. And some six, seven years ago when you started with we kept in contact and yeah, I would have lost a year.  Guido: I was working at a Magento merchants actually. And he approached me and said, Hey, we're growing like crazy at Spriker and we need someone like you doing community stuff. Spriker we need something like that. So to support that. I don't think you actually build this, build a community.  Guido: I The community is there and does its own thing. That's what we see, which has the rights. But we need someone from Spriker to facilitate what's happening out. There are very similar indeed to what's. What bandage. And before that, around though, we're doing a Magento. So yeah, that's the,   Brent: yeah.  Brent: And I, I did I've interviewed my Miquel Turk for both Spriker and it's an interesting and fun platform and one of the. I had made early on was about the who 15 and how we're working on getting sub one second times. And he laughed at me and he said, yes, Spriker, we're working on sub 400 millisecond times or something like that.  Brent: It is an interesting platform and I'd love to dive into it a little more, but first let's I know that you have been involved with. In conversion rate optimization, I think from an e-commerce standpoint, that is one thing that is often overlooked, especially. A lot of clients will come to a technology partner and they'll say, Hey, I want to build a fantastic website.  Brent: Then they leave those either the technology partner doesn't focus on that or the client doesn't see value in that. So can we maybe just have a brief conversation around, what does it mean for conversion rate and why is that? And so why is that even more important than the platform you're on or the store build that you're doing or any of those.  Guido: I think the conversion rate optimization traditionally it's in the name. It's, a bit limiting. It's the oldest Christian in the Ciroc community. Let's first define what it is. So Euro it's about a practice of semi or semi-truck. Practice or figuring out what works for your online store which usually involves doing user research talking to users, doing surveys, translating those into a hypothesis on what could work and what's, where you expect to be a better for, your store.  Guido: And then validating that through experiments. Usually that's, an AB test. That's, very short description of of, Shiro these days. And I think one of the things that was holding back Shiro, it depends a bit on the depends a lot on the area you're in the business you're in, but for many companies it's, relatively easy to say what the ROI is for buying more ads, buying Edwards.  Guido: This is what I put in. This is what I put out. That's, very straightforward and that's something that then people try to apply to Shiro and that doesn't really work zeroes more. Often long-term strategy, trying to figure out what worked for your customer. And it's really hard to say at the end of the day, at the end of the year what came out of that?  Guido: Exactly. Which is also a bit counter-intuitive because we're doing an AB test. So we can exactly say, this is what version a is doing. This is what version B is doing, but. The course of the year, like if you do three aunts or a thousand experiments what's your contribution? I don't know. And that's that's, sometimes hard for managers to get into and also it can also mean that you're not even growing, but it can also mean that you're not going down.  Guido: So your conversion rate stays the same. Your number stays the same if you're in a declining business like a couple of last years with, if you're in a, in a. Selling holiday houses, like booking.com. It's going to be really hard to increase refresher rates or to, or avenue. But you really need a team like this to understand.  Guido: Okay, what are people still buying? What are the, changing consumer behavior to last year's? And companies that do CRO well those are the ones that can survive this. And if you just keep buying more assets, that's going to be a very difficult thing to,   Brent: to maintain that. Yeah. I think with the Google mistake or the Google ad mistake or the paid ad mistake has always been, Hey, let's just throw money at it.  Brent: And money will also always get it there. And sure. It's true. You can plow enough money into anything to make anything work, but there was a diminish diminishing return on that investment. And I think one thing we learned, I was part of the PayPal mobile optimization program for a year. And we did learn that number one, measuring and doing those tests matters.  Brent: Getting the merchant to get involved and see what's happening. And then I think what you said is you are either not propping up, but finding what works best for you. And then even doubling down on that to make sure that you're putting that investment where it's really paying off, but learning things that are counter-intuitive.  Brent: And I think one of the things that we learned in the mobile optimization. Some of the things that you would think would perform better, perform worse when you think they should perform better. And I think from a from a psychological standpoint or any, type of human behavior standpoint, for me, that's always very interesting to learn.  Brent: Why and why would something you would think performed better perform worse? And I think for the mobile one, I think was all about we're going from this desktop. People have a perception of desktop and then people have a perception of mobile. And I'll just say in the Western world, I'll generalize.  Brent: Most of the time, we're still on our desktop computer buying something it's going more mobile it's compared to the emerging markets where it's, maybe they don't even have a desktop and they're buying everything online. Yeah.   Guido: Yeah and that's counter-intuitive parts saying, okay.  Guido: We think this is going to work with. But it didn't, that's also a big part of why CRO can sometimes be a difficult conversation. Because w with management often, Ciro's also an initially used just to prove whatever management wants it to prove. And that doesn't always work. For example with, booking that I just mentioned that it's booking.com.  Guido: It's you can book hotel rooms there. It's a big company worldwide. It's based in the Netherlands originally. So that's why I use it as an example. There are the example of running experiment. But they, publicly said it. Okay. One in 10 experiments is success. So that even for that company, that's the pinnacle of AB testing and running experiments.  Guido: They're really good at this. And even they well fail nine out of 10 times fill as in doesn't go up doesn't increase your conversion rates or revenue or whatever you're optimizing. So you can imagine if, you don't have your processes in place or you're not as good as booking yet, that number is not as good as one in 10, but might be wanting 21 in 50 or whatever.  Guido: And that's, also I think Bartel for whites white can be really hard to start For companies doing this because you really need to be dedicated. It's not just running a three tests a year and then the hope for the best. That's probably not going to work for you. So that's makes it a bit harder than just buy more Google ads.  Guido: But yeah, you need to realize that. The traffic to your website, that's part one, part two is getting the people on those websites to convert to whatever you want them to buy. And it's still a very important blocking factor if that's not, good. And if you're double the amount of people converting on your websites, that's probably going to stay there.  Guido: Even if you stop optimizing today, if you double that and you're stopped today, it's not going to be we worse tomorrow. Less like things with ads. If you still buy ads today, you're not going to have any traffic any more tomorrow. So that's going to be I think Sierra is going to be in the end.  Guido: There's going to be a better investment, but yeah,   Brent: I think that looking at at what people are doing there, the op the, alternative is not doing. And then you don't even know, then you're really just sailing into a black hole without any knowledge or, thought about what you're doing. So measuring it.  Brent: And I think I've heard is that it's hypothesized, so you can come up with some experiments, you observe those, you measure them and then adjust after. So even, like you said, one in 10 or, one in 20. Those numbers mean that at least you've, found success in that little piece. And normally not normally, but let's just say in the business world if you get a one and 10 on a stock pick and that stock picked does a thousand.  Brent: The increase in your business or your, return? That one in 10 usually pays for the nine. And I think if, as we dig in to CRO and we work in on those specific things with, clients and learn what is doing better, those that one in 10 is going to give a payback. And I'm guessing booking.com does it because it gives them a payback.  Brent: And of course they know their customer.   Guido: Yeah. Yeah. And I think if you're interested, you're all, if you're, like I said you're in an agency you want to sell these things to clients. I think it helps to frame it in a totally different way. Don't, sell it as optimization senators, risk managers.  Guido: And a way to prioritize your backlog. If you run the experiments and you say indeed nine out of 10 would not have works. That may, that means that you save money on implementing those nine things that wouldn't would not have worked anyway. So you don't have to implement them. Just implement the one that does work.  Guido: And, you can also say to the strands that's maybe you think you're not experimenting, but you're changing a little things on your websites today and tomorrow under the author, you still, basically, you're still experimenting. You just don't have any idea what the outcome mess of the experiments.  Guido: The overall sum, you know what happens at the end of the month when you're looking through your books okay, this is what we solve, but you have no ID which. Which of those experiments that you're, I don't know that your content team and what your design team, whatever they or development team, whatever they deployed, you have no idea what those individual experiments contributed to the whole.  Guido: So you're not learning anything. Exactly. It's something   Brent: you can build upon. All right, so let's tie this into Spriker. We, Came on to talk more about Spriker than CRO, but how how we   Guido: can do multiple episodes of breath is found. Good.   Brent: Good good So how well let's, frame it around Spriker and, your role.  Brent: So some of your role is, going to be helping clients and some of your roles building a community.   Guido: It's a bit of a it might, feel like a bit of a career switch, so I'm not, I won't be. So for the last 10 years I've been running those experiments, running hero programs and actually building teams that do this.  Guido: So I won't be doing that. That Spriker at least not, initially. It's, more about the community part. The thing I've also been doing with. With Magento on the side for, 13 years. That's what I'm going to focus on doing doing for Spriker, but it still feels a bit it still feels a bit similar, so I'm not running AB tests anymore, but I'm still trying to.  Guido: To get the best possible feedback out of that community and use that to make Spriker better. And it can be Spriker the product can be Spriker the services that we offer. So in that sense, it's not that far from what I've been doing is Bombi. It won't result in an AB test, only commercial websites.  Guido: But I still plan on running some experiments with the community to see what's working and what isn't, and then collecting that feedback we are building or expanding, facilitating the community that we have. That's a, that's the main goal. Some of the things. That we have. So we have a couple of subgroups within that community.  Guido: We already have a partner advisory board for both the solution partners in the technology part. That's already running. I'm not involved with that. I'm currently working on seating, a customer advisory boards. So that's existing customers getting them to get our coupler, like 15 customers, getting them to get R and R on a regular basis.  Guido: And I get feedback from them on how they use system and help them communicate with Spriker in a better. So that's one thing I'm doing. The second one is regular user groups. So we already had to use a group sets Spriker before the pandemic, those are now being continued on our remote basis.  Guido: So we had our first one last month, which was really fun. Doing that and that's, more aimed necessarily at at the strategy level. There's more day-to-day users that are doing that. The, like most user groups are and a third one is that's working on I'm not sure about the name yet, but like a developer attraction and adoption group.  Guido: So there will be people from, clients, from solution partners and from Spriker itself to she. Okay. What can we do to get, to attract more developers basically to Spriker. We've seen that with, Magento that has, can be quite the bottleneck if you don't have enough developers out in the world.  Guido: So we have a great academy team. That's a surprise. We've got some great courses to onboard people, both for people working in the back ends for developers itself or for people selling selling Spriker those courses that it's something we have. So also I think learning from I'm not the only one from magenta and the spikers and the LA people with Magento background.  Guido: So Carol making sure that Spriker has really good documentation. So that's a, this has been thinking. But the academy, of course only works if people know about Spriker itself, you need to get those developers on board first. And so that's going to be part of that's that third group that I'm working on to figure out, okay, what can we do to onboard more people more developers and get them enthusiastic about the platform.  Brent: It reminds me of the tech stack on spreads. The, what is that? The platform's on, tech beach BHP. Perfect. Yes. So a Magento developer could, he could transition a Spriker or fairly, easy. Yup. Yup. And   Guido: multiple have   Brent: gone sour yeah. It seems to be. I think we've always said this with Magento.  Brent: It seemed like Magento had run the course with eBay and then mark Lavelle and the team came in and, really reinvigorated the community. It seems like red, another tipping point now did an amazing job at that. Absolutely. We're at an another tipping point. So it sounds like some of your role is to listen to what the community is saying and maybe.  Brent: Not adjust commercial aspects of it, put at least adjust communication aspects. Would that be a good realization of, part of your role of how the community is reacting, not reacting, but forming strategy and forward-looking planning in to involve the community.   Guido: Yeah. And of course that's something I experienced in the last 15 years with Magento myself being an active community member, but multiple working on the I'd never worked on the Magento site itself.  Guido: So I've seen something that Magento did really well. I've seen some things I think Magento could have done better. And that's, definitely the part. And one of the first things I said two boars, whatever I'm going to do I won't have sales targets. That's an important one. For this job to work people need to trust you, right?  Guido: That, they need to be able to come with you with open feedback, open open criticism about whatever they think is important for them to continue their journey with with the products and that shouldn't result in a call from the sales department next day, saying. Yeah.   talk-commerce-guido-2022-1-10__22-55-15: Why   Brent: did you do that?  Brent: Why did you say that? I've definitely I've unfortunately, or fortunately had those calls. It does get you. And unfortunately those calls do change a little bit of your direction as a, maybe even as an agency head or as a, or a community organizer in order to get money from. The not from the community, but from that entity and Magento was very good at saying, we're never going to give you money for anything.  Brent: So that was easier. But in in order to get people, let's just say, get people involved. There was a aspect of, we, you need to tow the line. And I agree there has to be some kind of line that has to be towed in terms of don't don't bash us on stage and at a meet Magento event, which actually happened.  Brent: And it should happen when it's something that's egregious. But there are I think there always has to be a commercial aspect to things. And again, so just help educate me. Is there a community version of spark or is it completely commercial?   Guido: It's completely commercial. It's the sources.  Guido: But it's not an open source license. So it the full code is on the, is available and get up for everyone to see and to try and as a and if you're like me too lazy to install it. So there's there are demos available for the different markets that we serve. So we have B to B, to C we have we have marketplace solutions so that's all there for people to see.  Guido: But if you want to use the product, then it becomes a commercial license and that's fully based on either the items sold order. So it depends a bit on the business model and I guess on what's our sales team agrees with   Brent: the clients. Okay. So it's negotiable somewhat.   Guido: Now yeah so, they have it's not necessarily negotiable, but there are levels that you can get to.  Guido: And then of course the better the price becomes lower. Yep.   Brent: Got it. Yeah. Marketplaces is certainly a, big topic right now. Everybody's trying to do a marketplace. I think Magento has made the way Magento is, engineered. Isn't great for marketplace applications. So tell us a little bit about how the marketplace would help a merchant.  Guido: Yeah, and I think w what makes breaker great is that it's, it really focuses on the non standards business models, protocols, the sophisticated business model. And usually with specifically, I think with, marketplace with B to C it's, usually straightforward and there are a lot of platforms supporting that.  Guido: And then you go to B2B or to marketplace usually. And like you said, with Magento You often get into the area of a lot of customizations. And then you need a platform that supports that the business models get more and more diverse, more and more when you go to B2B and marketplace and you need a platform to support that.  Guido: So I think that's one of the, strength of   Brent: biker a Spriker started in Germany. And it's branching out to the rest of the world. So what are. What are your plans now for the U S market? I'm assuming that's the next big market to tackle.   Guido: Yup. So we got our first clients in in the U S and this is definitely, yeah.  Guido: Western Europe and the U S or for many platforms to go to markets, especially if that's one of those countries, your, if you use your own country, U S is a big focus. We have already started there this year. Or 2021 last year and this year 2022 will be a big focus here and we will have we already had an exciting events.  Guido: There are last year, I think we'll have one or two excite events. There are next year for context excites is the spike of fruition of of Magento. Imagine if if that's, if that helps you with with context So that's another, we are definitely focusing on that, but for me personally like I said, the one aspect that I find important is to grow.  Guido: That's a developer base. And specifically for that, I think it's even more important to be a presence. What is feasible in countries that are not Western Europe and the U S because there are a lot of development communities in south America and Africa in Asia, Indonesia, India. And that those are typical markets where marketing or sales is not active or not active yet, or not as active in, in as in Western Europe and in the U S so that's going to be a fun challenge for, me and my team to, see outcome are we are, we can visit get visibility specifically in those markets, but in terms of sales we're growing really fast in in the U S right now, I think this Fastest growth rates.  Guido: Yeah. So it's going to be definitely a big one for 2020   Brent: type of merchant. That would be a good fit for Spriker.   Guido: Yeah. That, that will be the, customer like I said, that has a sophisticated business model and that is a tricky term, I think, because I've met a lot of, I've also worked agency side and every customer thinks they have a sufficient.  Guido: Business model. So that's, always a up for discussion but a typical I think the best suit it's like we just said with B2B and market. Those are definitely the customers that would be a better fit force. Private, I think B2C, although we do have some beets see clients that have more sophisticated mall.  Guido: Sorry if there's, if it requires more customization then then your standard shop, that's definitely a good one. Maybe, a good dimension for context that's Spriker is a password. Oh man. It was on-prem before that we had on-prem we still have some on-prem customers but we only sell the past solution right now.  Guido: So platform as a service and which means we also everything, but there's still a lot of customization that you can still do that you can either have an agency for, we have a lightness partner now. Our orders. You can do in-house if you have a development team in that.   Brent: Oh as I think that past solution and just to educate our audience, the past means that it is a single installation, but it is all, it was hosted by the vendor.  Brent: So you're hosting the platform, you're supporting the base code. But it's the single issue, but it's not shared, it's not an instance that shared like a SAS solution. It's not shared with thousands of people. How do you, then   Guido: you anchor customize it. You can build on top of that compared to with a SAS solution where you can customize some things through settings, but if it's not in the setting, Then you're done.  Guido: Yeah.   Brent: And it's a big difference there. It's the only way to customize that is to build an application that's sitting outside of the application that would con connect via an API. You can't build it directly into the software.   Guido: And a nice addition to that is that's we're going to release. I think there's going to be a Q2.  Guido: I think that was announced. I hope I think Q2, we will release our SDK and AOP. That's the. The application that the platform basically that we will have so then we're going to have our own marketplace, our own app store for things to connect with. Spriker. So then we can have a shared database of whatever you want to connect.  Guido: If you want to connect your your email, your CRM, your ERP to Spriker. You can do that. And I think that's especially interesting because a lot of things in Spriker are interchangeable. So w what the gardener calls package business capability. BBC's which basically means that everything in Spriker it's a collection of those package business capabilities.  Guido: And that's, talk to each other through an API. So if you want to, for example remove that or use your own. You can remove practice checkouts and use a third-party checkout or your own checkouts. And that's different elements in Spriker have. We have I don't know the accounts, but we have several PVCs that consists of several undoes of modules.  Guido: You can just swap them out and especially with the AOP, that will be really interesting because then you can Israel can be relatively well, even more easy to do.   Brent: So coming back to the past model one of the complaints with the Magento version of pass is that it, doesn't necessarily save the client any money on, maintenance because you basically, you're hosting it on Magento, but they'll help support your core, but they won't do anything else then.  Brent: Answer support tickets. So is Spriker taking any different approach to that? Do they, are they doing some of the core updates on the code itself?   Guido: That's a good question. And I don't really, I haven't worked with a Magental spouse version, so I don't really know how to compare it to to that. But yeah, the this Riker core is maintained and it's a it's the same for everyone.  Guido: And you can then choose to update it for you. Yes or no. For all the different models. There are hundreds, I think we're currently over a thousand modules of Spriker itself. They're all versions. You can choose to update. Those were never Whatever works for you. You can you can, of course, ideally update them all when they come out.  Guido: And then that's all on a rolling basis. I think on average, I heard someone say that on average, we have 10 releases a day. That's something I'm definitely that's, being maintained and that you can benefit   Brent: from. So the I, know that speaking to Mike McKell earlier in the year, he talked a lot about the BDB version and then the scalability and the robustness of the platform.  Brent: Maybe tell it, talk to us a little bit about the type of client that would look at B2B and skew counts and things like that.   Guido: Oh, yeah. In terms of we have those extreme examples, and last year at at the, excite conference we had one they have over 550 million sq use in their Spriker store, which I find mind boggling.  Guido: That's that's, very impressive. And yes, people order dare on a regular basis. It's not just sitting there but they they sell electronic parts it's and the case study is actually on my website. If you're interested, it's a sociability and this is the name of the. That's the platform.  Guido: And yeah, I think In terms of, and that's, why I think Spriker is very interesting to me personally. I was funded and that there's already, there's something I found with, Magento. I funded the B2B sites, that those those clients always way more interesting PTC sites because of those those tricky business models and the tricky Details that you need to get right in, B2B.  Guido: B2C can be hard with a lot of customers. Just the sheer volume of, customers. If you have a lot of shopping that those customers of customer behavior change can change fast, but with B2B also have this and the detail that you need to get, right? All those specific things for your business.  Guido: I was Working with a company that did prince and they printed basically on that. And that means that if you print on everything, it's really hard to get templates for, printing. I know, yeah. Umbrella umbrellas, that's a different cars. You can mugs pens, everything, all the merchant you can think of that they would print it.  Guido: And which, meant that it was basically almost all manual. For, the depends that some, automation but basically everything else was done manually, which is mind blowing, but then you need to keep in mind when, someone orders it they had their, our local supply was in the.  Guido: But if, you didn't need a speed delivery, so if you needed a speed delivery, they would do that in a, in the Netherlands. And then you'd have an extra fee for that. But if If you would want to deliver, like in one and a half, two weeks, they would actually ship all the stock that was in the Netherlands.  Guido: Put it on a on a truck, drove it to Poland, and then there are people would unpack everything print it, put it back in a truck, drive it back to the Netherlands and. Because it was so labor intensive, that was actually cheaper to do that than just to print it in the Netherlands, which again is mind blowing, but then you need a system, a backend that supports crazy shit like that.  Guido: And, that's what I find interesting. Those, clients of debt, those are the things that are holding. Or, things your system is holding you back on? I think that's those are great cases for Spriker.   Brent: Yeah, same example that we worked with the eyeglass company that had the same idea where they, want part of the eyeglasses would get done in a factory, in one part of the city.  Brent: And then it would get shipped across town to put the lenses in the frames or whatever. Then they get shipped to the retail store, get shipped back, and then. Then get shipped to the client directly. If that's that's the if that's the model that they had. And that was I know that for Magento, that turned out to be very complicated.  Brent: But, yeah. So I can see how that would from a standpoint of complexity and from a platform where you that's, where you, the necessity of having a platform that you can modify and make your own. Essentially,   Guido: if you want to do a. What we call unified commerce. So your terminals in your stores, your physical stores, where people can can order stuff or clients can order stuff locally.  Guido: And that's connected into your system complexity rises quickly. And also things like in the beginning with, Magento Magento was fixed right now, but in Magento in the beginning it was all already really hard to have multiple warehouses. There's also, it was also another thing.  Guido: And luckily Spriker fixed that from beginning. That's, something. We have a lot of clients that's a doer multiple millions of revenue. That's the things they want to fix and expect from from a platform to. Yeah, it's F as a default.   Brent: There's a whole bunch of buzzwords floating around in the community on monoliths and microservices and micro blah-blah-blah PWA.  Brent: Where is Spriker sitting in on that. And I guess from a technology standpoint, is it easier for a customer to get into it and not worry so much about the technology? Or are they going to have to. Not worry there's going to be a certain amount of development needed to get things running.  Guido: It's a past platform so, there will always be some some development needed to get at the Oregon. Although we do have a. We do have for there's a front end that you can use if that's what you want, but you can also add your own phone tents. It will need to be connected to, the data that you have or data that you have needs to be important.  Guido: So those are always things that, that needs. And yeah, there are a lot of buzzwords and it can be complex can get complex really fast. I'm still struggling with it myself. And honestly, the first time I heard the term monolith was with the open letter the Magento Ruthie last summer, they started complaining about how things were going and partially rightfully and that's where I I formed encountered the term monolith before, but just disregarded it and then, but that, wasn't the first point. I thought I need to look into this and then, oh, this is what they mean, but yeah for, a Spriker I think Spriker is more something that's often listed in the.  Guido: Corner of things, a mock standing for a microservices, API, firsts cloud something and a cloud native and and, the headless. So those are also for. Yeah.   Brent: Excellent.   Guido: But that's, like a, term that people use often. We, were not fully onboard with the microservices part of that that equation Spriker believes more.  Guido: And that's what I just mentioned with, the package business capabilities. Microservices first will mean that everything is a microservice. That that leads to a lot of overheads very quickly. And that's, not needed for most companies. And there are always exceptions. But it's not something that you'd benefit from.  Guido: And then on the other end of the spectrum is the, monolith like a magenta was at the. Mainly and then Spriker sits, in the middle, which we find very comfortable and most lines seem to be for most lines. It seemed to be a nice balance between the flexibility that you would get with a, with API first and microservices.  Guido: But to have those package in things that make sense for the business package business capabilities. It's not a developer term. It's, business. It's a business term. Alexa, you're you to have a package business capability for you can have a CRM or an ERP or your checkouts or your phone tense.  Guido: Those can be different, capabilities of your system. And for, clients that just makes more sense. That language makes more sense and the way at least Spriker has built a, it also prevents the overhead that, you would get with only using microservice.   Brent: Yeah. I like that term, a package business capabilities.  Brent: Yeah, it gives the I think it, the idea of behind that is. You don't there. There's going to be a lot of solutions that would apply, but you don't necessarily have to do the customization, but if you need to, you still can. So clients or merchants can feel better about. Making their solution work at a lower cost or at least a lower initial investment to get them up and running.  Brent: Yeah.   Guido: And the Spriker is also not. It's targeting the local bakery rights. That'd be fair. It's we're, targeting a larger enterprise businesses mainly and those usually. Either an agency or their own development team that, can handle this. And that's also where I think Spriker shines.  Guido: A lot of developers love working with Spriker because it's so maintainable for them, they only need to focus on those extra things that are the, exceptions basically for their business and not necessarily maintaining the system behind us. That's also not something I'm not a developer, but a.  Guido: Recurring daily tasks, not something necessarily that you're looking forward to for doing for most people, at least I'm generalizing here, but most people the new things, that those are the challenging things. That's what you want to do with most developers want to do. And that's, what we enable.  Guido: And, along those package, business capabilities, one thing I I think you need to mention that's not something that's probably grant funded or something it's a term developed by by Gardner Spriker was also they recognized Spriker as a, as efficient, airy in their magic quadrants last year.  Guido: And it's only the second year that we, that the sparkle was even listed. And the magic quadrants. And we're already we were spoken was the platform. We moved the most distance in a positive direction within that. Within the quite uncertain, there was really nice, but also if you look at this quadrant the market changed so much compared to when we started with Magento.  Guido: Like I said, with Magento, we had commerce where we had virtual mark and there was Magento And we had a couple of like Intershop or those kinds of more commercial packages. But right now the magic quadrants, the market is so different than Demetric wardens already contains like 16, 16, 17 systems.  Guido: And that's like the creme de LA creme from, what gardeners selectors are the F right now are the hundreds of solutions that you as a company can pick. That's a huge challenge, I think for both developers, both an agencies and clients to say, what on earth do I need to a, big year? A lot of we saw all of you included agencies that's select a platform, right?  Guido: And you need to stick to dads and that's what you invest in. And that's what you then hope sticks when for, long enough. But also in, in debt, I think. And of course I am definitely biased in this in-depth. Spriker is positioned really well because it's so open with the API, with those package B business capabilities there's relatively easy to adopt for you as an agency or develop our work lines that fits really well with with whatever you have, right.  Guido: With the adjacent tools for e-commerce that you need to connect with debts because it's focuses only on the, on you bringing development through the table for, everything that's specific to your business and enabling that. I think that positions us   Brent: really well.  Brent: Five 10 minutes left here. What are you excited now for 2022? What do you see coming on the e-commerce horizon on the technology horizon? Do you think? I think one thing you mentioned is that there's so many more technology players in that magic quadrant and it's, you would think that we'd be seeing some more consolidation, but it's almost as though we're splitting it between SAS pass and on-prem, and then everybody.  Brent: There's more of them. So what, do you see happening in 2022? What's exciting. More and more. Yeah,   Guido: this is very exciting. I, do think and, actually I had the same thing with magenta. I never looked at other platforms and look the oldest competition that we need to fight. Those other platforms.  Guido: Apparently. The e-commerce market is huge and we all get to play a part in that. And there's this place for almost all of us or these, a lot of us there is place for, Magento and there's place for, a shop where there are a lot of business cases, that's fifth with those, and we don't necessarily need.  Guido: Bethel each other. And in a ring and the bolt flying everywhere that this was really needed. I think we can all focus on that's the thing that we really good at. And looking at how fast Spriker is going in terms of clients and employees I'm not worried about that.  Guido: That's a very exciting thing to be at. I'm actually for the past forever, every ever since I've. The works basically. I had this dream once working for like a SAS company, like Dropbox or Evernote that those were the companies I thought 15 years ago, that will be really cool to work at. So I have a, single piece of software and you can optimize debts and both from a usability perspective, but also you have this endless nearly endless world markets and form of your, that you got, that you can conquer that there will be really exciting.  Guido: And that's, this is what I am excited about. This is my first time working on the platform sites and, doing this and Applying my, my experience with, community building for the first time in actually a professional way. I They actually paying me for this now, especially my dream job that had been doing on the side for, 13 years now.  Guido: So I'm very, excited about that. And it's a great spot to be in with, Spriker it's it's very they're, remote first. I've been working remote first for, but at least pre Corona, but four or five years. But it's, so natural to the company. It's everyone is remote first have with limited holidays.  Guido: That's always nice to have I'm working work from Netherlands. I don't have to complain and we already. Twenty-five holidays by default. So nothing to complain there, but it's still nice to have, especially we have to, to kids like I do sometimes you need, you just need some extra because they're the home again.  Guido: And And, building that community. And like I said, w what I really enjoyed with the Magento community, bringing people together, especially for the first time, I does have a lot of community first next year. And the awkward moments, the recognition. That's exciting starting point at five that you see where people first meet the immediate charter and then build businesses based on that.  Guido: I clearly remember the first meeting magenta are organized in the Netherlands. To developers came to get our metadata for the first time. And now they have this huge Magento business that they sold a couple of years ago. And, that's happened multiple times and that's really exciting to me to see that's happening and then to be at the start of that.  Brent: Yeah, I agree. So I like the idea of having an MMA. MMA cage match, but you'd call it Magento, meet Magento association, cage match, and we'd get Spriker and shop wire in there. And we'd just get some we just have a Throwdown and see who wins. That's that's one way to look at it.   Guido: That's one way to look at it.  Guido: Like I said, I don't necessarily need a cage measure. I think we're, I think we can all we're all in e-commerce. So that's, a really good choice to begin with. And I think if we play at rise, we will all win big. What would be   Brent: a buydown instead of a Throwdown? I think. So we as, we close out, I always give people an opportunity to do a shameless plug.  Brent: What w shameless plug is just, you can promote anything you'd even a local school or charity or whatever it is that you're, thinking about the.   Guido: I feel like I've been shamelessly plugging Spriker for us lost at least 20 minutes already. Yeah, but if you want me to continue with that, we have we have for looking for a lot of people.  Guido: As, everyone in the in the e-commerce sphere is, so if you're interested in in dance and now working for a great European employer have a look at the Sprocket. Hiring people work white likes. That's where we are remote first and work from anywhere. So a take your pick if you're interested, definitely take a look there.  Guido: And on a personal note, we started out with a CRO. I have my podcast on the, on CRO still. It's a weekly podcast interviewing experts in the field and that's the last hero. So I have looked there and you probably already into podcasts anyway, since you're listening to this, so might as well subscribe.  Brent: Absolutely. Yeah. We all need to share our subscribers and get people to listen more and learn more. I think that the, at first first this should be education. This should be learning about other platforms is not about Magento or whatever. The place where we can learn about what other platforms are doing.  Brent: And from my personal for 2022, I'm super interested in CRO and I have seen sodas seen the light and, why that's so important for clients. So I applaud you for what you've done over the years. And just as a plug. You did organize the first meat Magento, right way back in 2009,   Guido: January 27th, 2009.   Brent: Wow.  Brent: Yeah, that's amazing. And it's, been such a fantastic journey for both the community building, which has been the most important part for me. Because that's when I got introduced to right about that same time, that's when I got introduced to Magento. And I think that community is what has driven the Magento to where it is.  Brent: And you have to give a lot of a lot of kudos, so to speak to the community for helping move that along. And right now there's a lot of A lot of communication that isn't and is happening in the Magento community.   Guido: Yeah. Yeah, I do think community a, is a huge asset for, you as a company, whatever you're doing as a as a company community is one of those things that is the hardest to copy.  Guido: It's all of us can copy your product. They can copy your servers, your pricing model, your business model. But it's really hard to copy a, community. And I think that's also the, one of the big reasons magenta was still so big, even with all those comp the competition that's out there in, in that 14, 15 year that Magento was existing.  Guido: Something better probably has come along. And, maybe it has For that specific business model. But transitioning all those agencies away from, you or the developers to learn something new or clients to switch platforms. Clients don't switch platforms every year. There's, a time delay in that and, it gives them that gives you the opportunity to, improve your product again, because you have that community commitment from people through you in the company.  Guido: And that's Yeah, I think I mean with Adobe taking over Magento right now, they're well, they're not investing in the name Magento anymore. That's I think that's abundantly clear with removing the name from the website. The logo was and magento.com now redirecting to to the Adobe website.  Guido: But, even for, the product It's. Yeah, it's hard to see a little of investment from, Adobe. What we hoped would happen when they took over. But still everyone's using Magento. And it's really hard. You, as a business owner, you or the Magento agency, it's really hard to have everyone trained on a different, platform.  Guido: That's not necessarily something you're looking   Brent: forward to. Yeah. That's so true.   Guido: Yeah. And so communities is a huge assets for four years of community. And then for user, as a business and that's community, then in a broad sense, a sense of the word can be individuals, developers, the companies that, are attached to you and committed to   Brent: I think I get your name right there, ghetto Yonson.  Brent: Thank you so much for being here today. Ghetto is the global business and technology evangelist for Spriker. I look forward to seeing you in 2022 in person, somewhere in the world. Hopefully in the U S or in Europe maybe even at a race, we can do a race together. We did, we got through this whole episode without talking about running.  Brent: Next time we'll do more of that. I appreciate you being here today. Thank you.   Guido: Thanks for having me.   Brent: Thank you.

PVC is known as Poison Plastic. It falls under the category of synthetic plastic polymer. PVCs are non-biodegradable; current disposal options include burning which releases toxic fumes that have serious implications on public health. Another option is to send them to the landfills as waste pickers do not earn anything from the discarded flexes. It is said that PVC contaminates humans and the environment throughout its lifecycle: during its production, use, and disposal & most of us are ignorant of this information. As per The Times of India, 90 % of all advertising in India in 2017 was done on PVC. On an average, around 18 tonnes of PVC flex is consumed per month. Today this industry is almost linear in nature however let's understand what a circular business model here would look like. When you are on a drive, you come across direction signs, if you are on the expressway or even in a tech park, you can identify building names written in bold that can be identified from kilometers away, when you are in a shopping mall, you notice each brand has a specific layout in their store the feel of which stays common no matter which part of the country you are...this forms a part of visual branding. Next when you are at a petrol pump you notice, so many signs or boards that talk to you silently...can you remember a few? All of these are known as visual identification and this is the exact portfolio of Vivenge, the company we are talking about today. Vivenge is a Poland based signage company that has embarked on a sustainable rebranding process. Currently the company is a one-stop-shop for durable visual identification as they provide both outdoor (outdoor signage, small architecture) and indoor visual identification (durable indoor signage, furniture, small architecture) as well as related services (e.g. installation, logistics). They have been in business since 1997 and currently its clients comprise 48 brands in 9 countries. Listen to the episode to understand how they are implementing circular business models. Source : http://r2piproject.eu/circularguidelines/wp-content/uploads/2019/10/R2pi_Vivenge_final2.0.pdf; http://r2piproject.eu/circularguidelines/wp-content/uploads/2020/04/Vivenge-Case-Study.pdf; The Better India article Keyword : What is a circular economy? Follow our page- (Circular Business Podcast | The Circular Collective) Reach out to us on LinkedIn | Facebook | Instagram | Twitter --- Send in a voice message: https://podcasters.spotify.com/pod/show/circular-business-podcast/message Support this podcast: https://podcasters.spotify.com/pod/show/circular-business-podcast/support

Transcript is below pic.  Season 1 Episode 8 Ehlers Danlos Syndrome  In this episode we interview one of our PodcastDX co-hosts, Jean Marie.  As you remember, she also discussed one of her EDS co-morbidity disorders (POTS) in a recent episode.  Today we ask Jean to share a little more detail of her Ehlers Danlos Syndrome and how that ties in to her complex medical diagnosis.  EDS is more than just being "really flexible" as you will soon learn.   TRANSCRIPT Ron: [00:00:30] Hello and welcome to another episode of podcast DMX. The show that brings you interviews with people just like you whose lives were forever changed by a medical diagnosis. [00:00:40][10.4] Lita: [00:00:41] I'm Lita. [00:00:42][0.2] Ron: [00:00:43] I'm Ron. [00:00:43][0.2] Jean: [00:00:44] And I'm the guinea pig. [00:00:45][1.0] Lita: [00:00:47] Collectively we are the hosts of podcast D X this podcast is not intended to be a substitute for a professional medical advice diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or a treatment. And before undertaking a new health care regimen and never just regard professional medical advice or delay in seeking it because of something you have heard on this podcast. [00:01:16][29.6] Jean: [00:01:18] Now on future episodes we have many interesting people to speak with about a wide variety of different medical conditions and diagnoses but in this episode we will be discussing a rare set of disorders that fall under the category of Ehlers Danlos syndrome which we will abbreviate from this point forward as E D S. [00:01:39][20.9] Ron: [00:01:41] E D S or a group of connective tissue disorders that can be inherited and are varied both in how they affect the body and in their genetic causes. They are generally characterized by joint hyper mobility that is joints that stretched further than normal, skin hyperextensibility. Again, skin that can be stretched further than normal, and tissue fragility. There are 13 subtypes, each one being diagnosed through genetic testing. The hyper mobile type does not have a genetic marker identified just yet. This type is diagnosed by a physician using something called the Beighton Scale, which includes a variety of tests to give reference to the amount of hyper mobility involved in the patient. The connective tissue of a person with EDS is not structured the way it should be. Some or all of the tissue in the EDS affected body can be pulled beyond normal limits which causes damage connective tissue can be found almost anywhere. It can be found in the skin the muscles tendons in the ligament the blood vessels the organs in the gums the eyes and so on you get the picture. [00:02:58][77.6] Lita: [00:02:59] That's right. Run. I bet you got that right off the EDS Society website. [00:03:03][4.1] Ron: [00:03:04] Was it that obvious? I wanted to make sure that we were giving the most accurate definition to the listeners out there. The link for EDS Web site along with more detailed information regarding EDS can be found on our Web site PodcastD X dot com. [00:03:21][16.9] Lita: [00:03:22] Well now that we know the definition of EDS, I guess it's time to point out the actual symptoms that a person with us experiences. The first is typically joint hyper mobility loose or unstable joints which are prone to frequent dislocations and or a subluxations, joint pain, hyper extensible joints., (they move beyond the joints normal range) and early onset of osteoarthritis. [00:03:52][30.1] Ron: [00:03:55] Lita, what's the difference between a dislocation and subluxation. [00:03:57][2.2] Lita: [00:03:59] Well a dislocation is defined as the separation of a human body's two bones from a joint or area where the two bones come together. In time, if treated incorrectly. It can lead to ligament or nerve damage, which will hinder the patient's body movements. A partial dislocation is referred to at times as a subluxation. This is the result of an incomplete separation of the bones that come together at the joints. [00:04:28][29.1] Ron: [00:04:30] Wow. Either way they both some pretty painful. [00:04:32][1.9] Lita: [00:04:32] They sure do. Pain is a huge problem with EDS. It can also turn into a chronic early onset debilitating musc, musculoskeletal pain similar to fibromyalgia. Another common issue with EDS is a skin related problems. It's very common to have fragile skin that tears or bruises easily, bruising may be severe. Severe scarring, slow and poor wound healing, even following a surgery, scars can reopen after you think they were healed. Other problems can occur within the body due to lack of collagen and or ligaments support. Things like frequent hernias, digestive problems, mitral valve prolapse, scoliosis, uterine fragility, and gum disease. [00:05:24][51.8] Ron: [00:05:26] That certainly is an incredible array of symptoms. And this disorder is not curable but it is managed with medication physical therapy and rest. So now that we have laid some of the background for our listeners at home it is time to introduce today's guest who unfortunately deals with EDS on a daily basis. Our own co-host here podcastDx, Jean Marie. Could you please explain a little bit about your journey with EDS?. [00:06:00][33.8] Jean: [00:06:01] Sure. I didn't know what it was but I've been, but I knew that I had some issues with my joints stability and such for some time. When I was little, I was always very "bendy" and my hip will go out of joint just walking and my shoulders would come out of joint several times, and I've had some other issues but I've had some severe problems with it as well, but most of my issues were later in life. [00:06:30][29.2] Ron: [00:06:32] So the first symptoms that when you were much younger you said about your hip. [00:06:37][5.3] Jean: [00:06:38] Well I would say that although I recognize that there was something going on I didn't understand what. How complex and difficult the situation was and that I had EDS until much later in life, in my 30s. [00:06:52][14.3] Lita: [00:06:53] Is it common for people with EDS to get a diagnosis of fibromyalgia. [00:06:57][3.3] Jean: [00:06:58] Sure. I mean you have joint issues and joint pain is often common in eds. So you may be diagnosed with fibromyalgia but it's actually a connective tissue issue when it comes to eds and you could also have an issue with your vascular system which is a subset of eds. [00:07:18][19.5] Lita: [00:07:18] Okay. And how do gastrointestinal problems. Irritable bowel or Gerd. How do those play a part with EDS? [00:07:27][8.2] Jean: [00:07:27] Well since your gastrointestinal system is comprised of connective tissue it can be affected by eds. So in your nerves are also surrounded by connective tissue. So since your gastrointestinal system works on a umm [00:07:43][16.0] Lita: [00:07:49] The pulsing of the muscles that move the product through the gastro system right? [00:07:55][6.0] Jean: [00:07:55] Right. That's all influenced by your nerves. And it's not something that you can control. It's an autonomic function and it's controlled by your nerve. So if your nerves are affected by your eds then your gastrointestinal symptoms are affected by that as well. And did I mention brain fog. I think brain fog is a part of eds. [00:08:13][17.7] Lita: [00:08:13] yes I know I know. [00:08:14][1.0] Ron: [00:08:16] Well I know your symptoms have changed over the years. This is based on surgery's medication changes etc. etc.. How would you say that eds affects your lifestyle right now. [00:08:27][11.6] Jean: [00:08:28] Well I have to make different modifications and accommodations for eds. Yes I have to take into account that my. For example I my hip might come out of joint and I do utilize different. Things to try to reduce the number of incidents I have. [00:08:45][16.7] Lita: [00:08:46] OK. Well since this is you know this is EDs Awareness Month as you know. Are you up for that EDs challenge that they've been talking about. [00:08:54][8.1] Jean: [00:08:55] Nope [00:08:55][0.0] Lita: [00:08:58] (laughter) Good. Let's do a lightning round. I'll ask the questions and you'll have 15 seconds to answer before I go on to the next one. [00:09:04][6.4] Jean: [00:09:05] Great. [00:09:05][0.0] Lita: [00:09:05] . Ron you'll keep time. You're ready. [00:09:07][1.9] Ron: [00:09:08] I Certainly am. whenever You're ready. [00:09:09][0.9] Lita: [00:09:10] Jean said she's not ready. [00:09:11][1.5] Ron: [00:09:12] Well you're ready Ready or not. [00:09:13][0.9] Lita: [00:09:13] That's right. OK. Question 1 What type do you have. [00:09:17][3.5] Jean: [00:09:17] Hyper mobile. [00:09:18][0.3] Lita: [00:09:19] And when were you diagnosed. [00:09:19][0.8] Jean: [00:09:20] Several years ago before my cranial cervical fusion in New York. [00:09:23][3.1] Lita: [00:09:25] OK. Do you have any comorbilities. [00:09:26][1.4] Jean: [00:09:28] Yes I have pots which we discussed on a prior episode. I get migraines. I have several hernias. I have an issue with my gastro parasen, paracentesis there say that three times fast. I have thyroid disorders tinitis in my ears cranial cervical settling and cranial cervical instability which has been repaired with a number of different titanium accessories, syncope is lipo edema, latex sensitivity I get PVCs with my heart. Now I have celiac disease and I have difficulty swallowing just to name a couple of related issues. [00:10:05][37.7] Lita: [00:10:06] Hey Ron I think we have a client here that we can use for a lot of future podcasts [00:10:10][4.1] Jean: [00:10:11] Oh no no no no. There are many other people that want to get on the show. [00:10:14][3.3] Lita: [00:10:14] OK. All right. Question number four do you have any mobility aids that you use. [00:10:20][6.0] Jean: [00:10:21] I do. There are some are unusual but it's difficult. For example for me to squeeze a bottle. So when it comes to toiletry products and things of that nature I use a pump. [00:10:31][9.7] Lita: [00:10:31] OK. [00:10:31][0.0] Jean: [00:10:32] Because that makes it my life much easier and I join up to worry about my fingers going out of joint. I also make sure that I you know I have trecking polls to assist when I'm walking and if need be I also use a wheelchair when I know when that comes. [00:10:46][14.6] Lita: [00:10:48] To much walk. [00:10:48][0.5] Jean: [00:10:49] And yet when walking becomes too much I wear very comfortable shoes that offer a great deal of support. And I just try to take it easy and rest. [00:10:58][9.5] Lita: [00:10:59] OK. What do you use for pain management. [00:11:01][2.1] Jean: [00:11:02] Anything I can. I've taken everything from fentanyl to oxycodone and I have recently submitted my application for medical marijuana for the state of Illinois. So I'm looking forward, looking forward to trying that as well. And then I also use things like distraction music. I'll read books listen you know watch movies spend time with my family spend time in the garden and I try to you know alleviate my pain through other techniques as well. [00:11:33][30.7] Lita: [00:11:34] And pet therapy. [00:11:34][0.8] Jean: [00:11:35] And pet therapy yes. [00:11:36][0.6] Lita: [00:11:36] Can't forget Buddy and Gi.Gi.. [00:11:37][1.0] Jean: [00:11:38] Nope. [00:11:38][0.0] Lita: [00:11:39] Have you had any surgeries do to eds. [00:11:41][1.8] Jean: [00:11:41] Yes yes. My , when walking my ankle. the tendons and ligaments tore off my ankle. So they had to be repaired. And I have not yet had my other ankle repaired but there is a similar situation there. And I also had a cranial cervical stabilization procedure to try to keep my neck stretched to its full full height. And it added a nice little inch to my height. [00:12:08][27.0] Lita: [00:12:09] OK. Have you had any hospital stays. [00:12:11][1.9] Jean: [00:12:11] Yep. One or two variety of reasons. [00:12:14][2.5] Lita: [00:12:14] What types of specialists do you have. [00:12:16][1.5] Jean: [00:12:17] I have a specialist for everything from my vision. So I have a neuro ophthalmologist straight down to my toes and I have an orthopedist that works specifically on ankle repairs. [00:12:31][14.1] Lita: [00:12:32] OK. What is your funniest EDS story. [00:12:34][2.8] Jean: [00:12:35] Before I knew I had eds I would entertain people by moving my hair around and it looks like it's a wig because I can move it so much because of the flexibility. So it's a little bit unusual. [00:12:46][10.4] Lita: [00:12:47] Mm hmm. Excuse me. What was your worst doctors experience. [00:12:51][4.1] Jean: [00:12:52] I had an orthopaedic surgeon told me that my shoulder blade was fine because I hadn't fractured my clavicle which I didn't realize in order to hurt your shoulder blade. You have to fracture clavicle but I don't think that's the case. And indeed I needed extensive repair to my shoulder blade and had to have two major procedures for that. [00:13:11][19.0] Lita: [00:13:11] Okay. And what was your best doctors experience. [00:13:14][2.6] Jean: [00:13:14] I have amazing GP's that juggle all of the specialists that I have and they're able to consolidate everything and handle all of my new and unusual conditions. [00:13:29][14.0] Lita: [00:13:30] OK so you say the gps would be the best. [00:13:32][1.9] Lita: [00:13:33] Yes. OK. Do you consider your she's doing pretty good on time. [00:13:36][2.8] Ron: [00:13:36] She is. [00:13:36][0.3] Lita: [00:13:37] Do you consider yourself. [00:13:37][0.6] Jean: [00:13:38] Since I forgot where I put my my notes. This must be an off the cuff. Yeah. Yeah. [00:13:43][5.0] Lita: [00:13:43] Do you see. Do you consider yourself disabled. [00:13:45][1.6] Jean: [00:13:46] No. No. I may be differently abled. [00:13:48][2.3] Lita: [00:13:49] Have you experienced ableism. [00:13:50][1.5] Jean: [00:13:52] is that like Cain and Abel ism or. I don't know what it was. [00:13:55][3.2] Lita: [00:13:55] This was one of the questions on the I'm assuming a challenge. [00:13:58][2.6] Jean: [00:14:00] I don't know. [00:14:01][1.1] Jean: [00:14:01] I do know that when I'm sitting in using my wheelchair sometimes people don't look at me or talk to me they'll talk to whoever is assisting me at the time and I find that disconcerting and that I've had issues in certain situations where I can't speak to someone and it does because it's the desk is so high and when I'm going on a tour of a museum it's difficult because you know you're trying to see everything. It's just there's challenges in that regard but nothing too horrific. [00:14:31][29.4] Lita: [00:14:33] What is something that you wish everyone understood about eds. [00:14:36][3.6] Jean: [00:14:37] oh... About Eds. [00:14:38][0.6] Lita: [00:14:38] Yes. [00:14:38][0.0] Jean: [00:14:38] Yeah. You say because you really do have to narrow it down that you can't necessarily see what's wrong. So if I am parking in utilizing a handicapped parking place it might be because my hip has popped off the day. And you might not be able to see that because you know you can't see that and you can't see other issues. But I do need assistance from now, you know every now and again and. Yeah. So just you can't always see what's going on with somebody. [00:15:04][26.1] Lita: [00:15:05] So it's an invisible illness. [00:15:06][1.0] Jean: [00:15:06] It can be. It can also be a very visible illness because I do have quite a few scars. And it takes me a very long time to heal. So in that regard you can see it. But yeah most of the time you cant tell what's going on. [00:15:18][11.3] Ron: [00:15:18] From the naked eye if people don't get you in a wheelchair they think you're fine. [00:15:21][2.9] Jean: [00:15:21] Yes. Yes and I could very well be passing out or having a syncapal episode at any moment and that's very frightening. [00:15:29][8.0] Lita: [00:15:31] True true it scares the heck out of me I know. [00:15:33][2.5] Lita: [00:15:34] Sorry Mom. Yeah. Yeah. If you could rid yourself of one EDs symptom which would it be. [00:15:40][5.9] Jean: [00:15:42] I guess the gastrointestinal complications I've been told that I should really have my colon removed and that's not something I'm jumping for joy about so certainly I'd want that corrected. And I guess any of the. [00:15:55][13.3] Lita: [00:15:56] No one one, you see how, she's that, now she's losing the trick. [00:15:59][3.5] Jean: [00:16:00] Well yeah. All right all right. Any. But yeah. OK. [00:16:02][2.6] Lita: [00:16:03] Just one. Well that wraps up today's session. If you have any questions or comments related to today's show you can contact us at podcast D X at yahoo dot com through our Web site podcast D X dot com at our Facebook page at Instagram or Twitter. [00:16:22][18.8] Ron: [00:16:23] And if you have a moment to spare please give us a five star review on I tunes podcast app. [00:16:29][5.6] Jean: [00:16:30] And thank you to all of our followers on Instagram. We really appreciate the feedback. And on Facebook I love all the feedback there as well. And the Twitter followers too, have to give you guys a shout out into all of our other podcasters out there who have given us praise and assistance and encouragement. We appreciate you guys. [00:16:49][19.5] Lita: [00:16:49] Yes we are. We're. moving... (forward) [00:16:49][0.0] [887.2]