Podcasts about recurrent

Dr. Asif Doja explores the diagnostic possibilities of behavioral arrests and loss of postural reflexes in a young boy, and details the diagnostic approach to such cases. View the case videos: KCNMA1-Related Episodes of Behavioral Arrest and Loss of Postural Reflexes Cataplexy in Patients Harboring the KCNMA1 p.N999S Mutation

In light of electric vehicle maker VinFast launching a certified pre-owned program in the U.S., Auto Remarketing senior editor Joe Overby connects with leaders from the EV space to discuss why the segment is a natural fit for CPO and the impact to EV accessibility, remarketing and battery health. Joining the conversation are Elena Ciccotelli of the EVs for Everyone Podcast, Jimmy Douglas of Plug and Scott Case of Recurrent.

Intracerebral hemorrhage carries high morbidity and mortality, but growing evidence highlights meaningful opportunities for prevention, risk reduction, and long-term recovery. This episode covers key strategies, including blood pressure management, interpretation of neuroimaging markers, and individualized decisions around antithrombotic therapy. It also emphasizes the prolonged recovery timeline and the importance of a holistic, patient-centered approach to improving outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Wendy C. Ziai, MD, and Vishank A. Shah, MD, coauthors of the article "Intracerebral Hemorrhage" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Ziai is a professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Shah is an assistant professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Intracerebral Hemorrhage Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Guest: @VishankShah3 Full episode transcript available here Dr Albin: A patient has suffered an intracerebral hemorrhage. They're taken to the neuro ICU, and they fortunately survive. But the journey does not end there. In fact, in some ways, the journey has just begun. Join us today as we unpack holistic care for ICH patients.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Albin: Hello to our audience. This is Dr. Casey Albin. Today, I'm interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I am so delighted that both of you are joining. To begin, let's just do a brief introduction of who you are and, and a little bit of how you got interested in the topic.  Dr Ziai: Hi, I'm Wendy Ziai. Thank you for having me on this podcast. I am a professor of neurology at Johns Hopkins. I am a neurointensivist, and I think I got primarily interested in this topic through clinical trials that I have been a part of since my fellowship days.  Dr Shah: Hi, everyone. I'm, uh, Vishank Shah. I am also, uh, very thankful for being invited to be a part of this podcast. I'm also a neurointensivist at Hopkins and the fellowship program director here for neurocritical care, and I'm interested in recovery after ICH, and that's why I'm a part of this work.  Dr Albin: Welcome to you both. It is such a treat for me to get to interview fellow neurointensivist, particularly those who have such a wealth of experience. So, I am delighted to dive into this. All right. So, to set the stage for our audience, intracerebral hemorrhage has long been approached with pessimism. But your article really highlights that there are meaningful advantages in prevention and risk stratification and long-term recovery for these patients. Though you both are neurointensivist, this article really emphasizes primary prevention and the holistic long-term care for the survivors. And so, to begin, Dr. Shah, can you just lay out a little bit for our listeners the scope of intracerebral hemorrhage and its community impact?  Dr Shah: Yeah. So, you know, ICH is the second most common type of stroke. There are more than three million new cases of ICH globally each year, and it accounts for thirty percent of all stroke types, but it is the one that has the highest mortality, with more than forty to fifty percent of the patients dying in the first thirty days, and then continued long-term impact on both functional as well as outcomes, as well as survivorship after the early period. And it also disproportionately impacts lower socioeconomic, and then minority races like Blacks, Asians, as well as Hispanic ethnicity. And so, there's a lot of work that needs to be done to reduce the burden of this disease.  Dr Albin: Absolutely. I mean, these can really be devastating for families, and I really am appreciative of your highlighting that there's a lot of disparities, and there's a lot of work to be done to really increase equity to these patients. I think a lot of this goes into really the AAN's focus on brain health and trying to improve some of what we're doing to maintain brain health. And I really wanted to kind of drill down on this because for ICH, there's a lot that can be done upfront as we think about how do we counsel patients who may walk into the office about strategies to prevent ever becoming an intracerebral hemorrhage patient. So, Dr. Shah, can you walk us through a little bit about what neurologists in the community need to be doing to make sure that no one ends up with us in the neurointensive care unit?  Dr Shah: Yeah, sure. So, I think, you know, one of the most important risk factors is, of course, hypertension and long-standing uncontrolled hypertension. And so really recognizing the need for early onset screening with regular blood pressure monitoring at a very early age, particularly in the races that I discussed earlier. And then I think another big part, obesity, metabolic syndrome, and type two diabetes. And I think there's a lot of interesting new work that with the GLP-1 agonist, you know, in a large multicenter cohort studies showing that patients receiving these had a significantly lower reduction risk of ICH. And so, this might be a really important part that, you know, clinicians need to start increasingly recognizing and using in their practice. And then, of course, other risk factors that are common include smoking, diet high in sodium, exposure to air pollution, both indoor as well as outdoor. And so, mitigating all of these risk factors can also reduce the burden of ICH.  Dr Albin: Absolutely. And I really want to highlight that hypertension plays such an important role and that we as neurointensivist, as community neurologists, really need to be creative about ways that we can help people meet those blood pressure target and meeting people in the community where they are, making sure that they're not suffering from side effects from their medication that would prevent them from sticking with it long term. Dr. Ziai, anything else to add about what we can do in the community?  Dr Ziai: So, we really want to emphasize, even in the acute phase, that patients moving forward need to have targeted interventions to reduce blood pressure, smoking, enhance their physical activity, have a diet that is high in fruits and vegetables and low in alcohol and salt, and then promoting weight loss, of course.  Dr Albin: And Dr. Ziai, I'm gonna ask you a little bit about one of the things that maybe not all of our listeners have heard about is this APOE2, APOE4 genetic risk for intracerebral hemorrhage. What's going on there and, and should clinicians be testing for that? Dr Ziai: That's a great question, and it is not one that we currently test people for at least acute ICH presentation. APOE2 and A4- E4 alleles, these give patients a two to three times higher risk of ICH by increasing cerebral amyloid deposition. And if you happen to have APOE2 carrier ship status, then along with other risk factors like white matter disease and vascular risk factors, these predict the onset of new microbleeds even during very short follow-up periods of about two years. And as we know, having cerebral microbleeds are associated with an increased risk of all strokes, ischemic and ICH, but they are one of many MRI markers of small vessel disease, which along with cortical superficial siderosis, does significantly increase future ICH risk. And so even in people who've never had an ICH, if they happen to have an MRI, it may be reasonable to look at the MRI and incorporate this burden of small vessel disease, and especially these hemorrhagic markers into, uh, decision-making about interventions.  Dr Albin: That's a really excellent point. And so, I think that your article did a really beautiful job of thinking holistically about the patient, incorporating clinical markers of their risk for having ICH, but also those radiographic markers. I'm just gonna ask you to summarize those again one more time because not everyone will be familiar with these. So, when you're looking at an MRI, what are the things that you're particularly clued in on that would increase the patient's risk of future ICH?  Dr Ziai: In the past, what we're looking for really is markers of cerebral amyloid angiopathy, which significantly increase a person's risk for lobar hemorrhage in particular. And so, we have a set of criteria called the Boston Criteria, and there's a new version of these, version 2.0. And these, um, incorporate a number of imaging markers that provide a very high sensitivity and specificity to diagnose CAA after an ICH. But even if someone's never had an ICH, and they evaluate that risk-benefit ratio for different cardiovascular prevention strategies. And so, the markers that we're specifically interested in are, of course, microbleeds. But not just having microbleeds, but are they lobar or are they deep? Lobar having a higher risk for lobar ICH. How many microbleeds are there? Is it greater than five, or is it just one or two? Also, cortical superficial siderosis is a marker, a hemorrhagic marker, that does portend a significant increased risk of recurrent ICH, along with having a lobar ICH. And now we have these new markers, which are the white matter hyperintensity multi spot pattern, which requires these hyperintensities on flare imaging in the subcortical area, having greater than at least ten of these multi spots, and also having enlarged perivascular spaces in the centrum semiovale, and having at least twenty of those. And finally, white matter hyperintensities, which can be measured with the physica score or just by visualizing them. We can look at white matter hyperintensities as well as being a measure of small vessel disease.  Dr Albin: Got it. And so just to summarize, we're looking for small vessel disease markers because that puts our patients at higher risk of ongoing future bleeds. And then we're also looking for markers of particularly small vessel disease that's caused by cerebral amyloid angiopathy, which again, because it's having that protein deposition, that puts the patient at risk of those leptomeningeal very small vessels, putting the patient at risk of lobar ICH. Just confirming I've summarized this all correctly.  Dr Ziai: Yes. That was perfect.  Dr Albin: Amazing. Dr. Shah, I'm gonna go back to you. Let's say we have a patient. Let's say this is a sixty-five-year-old man who comes in and they want follow-up and they're... And you're trying to think about they've had an ICH in the past, and they are also at risk for ischemic disease. Let's say they, they have hypertension, they've had a smoking history. They have some risk for ischemic events. And you're trying to think about how do you balance those. Let's say the patient needs to be on aspirin but does have some of those high-risk features on their MRI. Is there any guidance on how we think through preventing them from having a recurrent bleed if they're a high-risk patient, also preventing them from having an ischemic event, which they might be at high risk for as well?  Dr Shah: Yes. So, I think, you know, the first step is of course trying to understand what was the type of bleed. I think that has a very important role, like you mentioned. If it's a lobar hemorrhage versus a deep hemorrhage, the risk of recurrent ICH and ischemic events is very variable. So lobar hemorrhages, there's obviously a higher risk of recurrent hemorrhage events, whereas deep hemorrhage is actually at or behaves sort of like small vessel ischemic strokes and have a higher risk of recurrent arterial ischemic events. So that distinction in itself can help you gauge which patients would be safe and would benefit from these therapies. To begin, and of course, looking for some of these markers on MRI that were mentioned by Dr. Ziai for recurrence of hemorrhage risk. In terms of antiplatelet, the, there is a lot more data now to guide treatment, and we have the RESTART as well as the ESTART trial that showed that starting an, a single antiplatelet after intracerebral hemorrhage did not increase the risk of hemorrhage recurrence. They were very variable in the timing when aspirin was started, and so that remains still a question about what is the safest time point to start aspirin. For example, in the ESTART trial, they started them very early, within the first three days, whereas in  the RESTART it was all the way up to two months after the hemorrhage. And so... But in general, the risk of recurrent ICH was very low with a single antiplatelet agent. And so, if it's needed for ischemic prevention, it's relatively safe broadly across all types of hemorrhages.  Dr Ziai: Yeah. I would just mention that there was also a subgroup analysis of the RESTART trial using MRI. And so, this more than likely included patients with CAA, since 40% of the hemorrhages were lobar in that study, and therefore seeing that there was no increased risk of recurrent ICH in RESTART, it is thought that putting patients back on their antiplatelet therapy is safe.  Dr Albin: That's a really huge takeaway pearl for our listeners, that regardless of whether it's a lobar bleed or a deep bleed, if there is a strong indication, you know, this is not just, oh, because someone gave them aspirin 81, but truly that there is a reason that they need to be on a single antiplatelet agent, it probably benefits them to be on that agent, and there's good data that there's not a huge increase in risk. Summarizing all of that?  Dr Ziai: Great.  Dr Albin: Now, things are gonna get a little bit tricky here, because what if the patient, what if they need to be on dual antiplatelet therapy? Or what if they need to be on anticoagulation? Dr. Ziai, I'll, I'll throw that to you. How do you tackle that patient population?  Dr Ziai: Yeah, the safety of dual antiplatelet therapy hasn't really been studied in patients who've had a prior ICH. Although, in people who've had previous strokes, putting them on dual antiplatelets doesn't seem to increase the risk of ICH, but it does increase extracranial hemorrhage. And so there may be other reasons not to put patients on dual antiplatelet agents. Patients who have cancer and also cardiovascular or cerebrovascular disease, putting them on dual antiplatelet therapy does seem to increase the risk for intracranial hemorrhage. So, I think there is enough of a bias against DAPT therapy in patients who have had an ICH that we would not recommend DAPT for patients with a prior ICH.  Dr Albin: Absolutely. And, and then what about, let's say they have atrial fibrillation, and you know that they have a high CHA2DS2-VASc score, and they are at very high risk of ischemic events, but they've also had a prior intracerebral hemorrhage. Walk us through a little bit, how should we approach that patient? Dr. Ziai, I'm gonna start with you again.  Dr Ziai: Sure. So again, looking at the MRI, which all patients with ICH should have nowadays. If patients do have these hemorrhagic findings, a lobar ICH, evidence of CSS, cortical superficial siderosis, especially if it's disseminated, and also lobar microbleeds, especially if there are greater than five, if they're multiple, then anticoagulation should really be avoided in those patients.  Dr Albin: Absolutely. So, I'm really hearing that when we have a patient with ICH, it is just critically important that we understand is this a hypertensive bleed or is this a lobar bleed that is probably related to cerebral amyloid angiopathy? And getting to that distinction is going to play a major role in our deciding whether or not the patient can be on DAPT or can be on anticoagulation. And then what are some of the strategies for patients that you're referring them to if they really cannot tolerate being on anticoagulation, but they have atrial fibrillation, and they do need some sort of ischemic stroke prevention?  Dr Shah: There's still a lot of controversy, even in non-lobar hemorrhages, about resuming anticoagulation and when that would be safe. HAF trial, there was a reduction in ischemic stroke recurrence, uh, but a significantly higher increase in hemorrhage recurrences. I think that trial included both deep and lobar hemorrhages. So, we still need more data, and I think the ASPIRE trial and maybe a meta-analysis would answer that eventually. But in the meantime, if a, specifically for lobar hemorrhages, which are, uh, thought to be CAA related, if they, uh, and the patient has AFib, you know, where anticoagulation would be contraindicated, a watchman device or, you know, AFib ablation may be some of the other strategies that can be looked into for those patients specifically.  Dr Albin: Right. I think that's a really important point to emphasize, that we don't just don't give up and say, "Oh, you're not a candidate for anticoagulation," but we really reach out to our cardiovascular friends and say, "Hey, what other procedures can you offer that will minimize the risk of recurrence?" You know, we don't want them to have an ischemic event, but we also know long-term that there would be a real risk of anticoagulation. Just reminder to our listeners that there are new procedures, and our cardiology colleagues are always doing new trials and new devices, and so we should really leverage their expertise here. I am in the final minutes gonna just switch gears a little bit from talking about sort of the nitty-gritty of secondary ischemic prevention and secondary hemorrhagic stroke prevention and thinking about there has been this degree of pessimism around ICH patients, and that, you know, they have a much more severe outcome than our patients with ischemic strokes. I think that that is probably a myth that we need to do some debunking around, and I think maybe we need to reframe in terms of thinking about just the trajectory. So, Dr. Shah, walk us through a little bit about what we can expect about the recovery trajectory in ICH compared to those patients who have an ischemic stroke. Dr Shah: Yes. From some newer data and studies, it is becoming clear that recovery after ICH is much slower than we expect. In general, for ischemic stroke, recovery is measured within the first few weeks to up to 90 days. But in ICH, we now know that patients can keep recovering all the way up to six months and even beyond. In general, from just a, a study of heart recovery that occurs after ischemic stroke, there's a steep recovery in the first seven days, and then sort of after that, patients still continue to recover, but it, it starts plateauing where up to 90 days. Whereas with ICH, there is not much recovery in the first 7 to 30 days, but after that, there is a recovery that occurs significantly between day 30 and day 180, and then some patients continue to recover all the way up to one year. The more severe the hemorrhage, the slower the recovery, but there's still some evidence to suggest that even severe hemorrhage patients can recover all the way up to one year out and beyond. This is, of course, in terms of functional recovery.  Dr Albin: I think that's a really important point for our audience. Many of the listeners are residents, they're fellows, they're seeing these patients in the hospital, and they may not see a whole lot of improvement over even 30 days. But to keep in mind that just because the patient has not had a dramatic recovery within that first month that they may be in the ICU and then on the floor does not mean that that patient will never have recovery, and that we reset our expectations that recovery is possible, it's just gonna be slower. And I think that that's not only important for the healthcare team to take in mind, but also for patients and their families to know there is hope here. It's just gonna be slower. Dr. Ziai, looking ahead, what developments in this are you most excited about that you think will move the needle for care for the long-term outcomes and the prevention for these patients? What's ahead in, in ICH?  Dr Ziai: Yeah, I think the research that's going on is very exciting at the moment. We just saw the presentation at the World Stroke Organization conference in the fall of the TRIDENT trial, Triple therapy prevention of Recurrent intracerebral Disease events, meaning strokes. And these investigators found that a single pill, a fixed dose of three blood pressure-lowering agents actually was successful in significantly reducing the risk of recurrent stroke in patients who have had a history of ICH and have just normal or low-grade hypertension. So rather than having patients on multiple antihypertensive agents, it may be possible to have them on a single pill, and may dramatically reduce their stroke risk. So that's exciting. There is also a trial ongoing, ASPIRING, testing whether antiplatelet monotherapy after 24 hours only can reduce the risk of all serious vascular events in ICH survivors. So very early antiplatelets. The SATURN trial, we didn't talk about statins yet, but it is comparing continuation versus discontinuation of statin therapy in ICH patients. And then we have ongoing epidemiological studies that are really needed to understand this interaction between the cardiovascular prevention strategies, the antithrombotic use, the blood pressure targets, and these high-risk neuroimaging markers for ICH. And I think that's gonna be key, personalizing the interventions for these patients.  Dr Albin: So, I love that. And what I'm hearing is that it's really important to think about the personalized approach as well as how do we simplify things. We know that blood pressure control is critically important to the primary and secondary prevention of ICH, but we have to make it easy for patients to do so. Dr. Shah, I want to end with kind of understanding, you know, this was an unusual topic for neurointensivists to talk about. This was really about prevention. It was about long-term survivorship. It was about not what's happening in the neuro ICU. How did you guys get interested in sort of that aspect of care?  Dr Shah: Yeah, so that's a great question. Dr. Ziai has been my mentor since I was in fellowship, so now about eight years that I've been working with her, and this was a project that I started in fellowship with under her mentorship, looking at long-term recovery in ICH patients, and specifically severe patients. Happy that work has received a lot of recognition. It was published in JAMA Neurology. We looked at patients with severe intracerebral and intraventricular hemorrhage, those that survived with an mRS of four and five at day 30, and what happened to them over the course of the year. There was really not much data on recovery after ICH. And we were very surprised to see that up to 40% of patients that were an mRS of four and five, so really, really severely disabled at day 30, recovered to an mRS of zero to three by one year. About one-third of that group that recovered actually achieved functional independence with an mRS of zero to two, which was very surprising, really breaking the myths around the pessimism with ICH. We found that a lot of the baseline comorbidities like diabetes, white matter disease, as well as what happens to them during the acute hospitalization, were adding all of that information to the severity of the hemorrhage significantly improved our ability to predict long-term recovery after ICH. And so that's kind of how we got interested in this work, looking at how factors in the care that we provide in the ICU, as well as what the patients come in with, how all of that could be modified to promote recovery in these patients that are often been forgotten.  Dr Albin: I think that there's one takeaway to our listeners is that this is really a place where there's a lot of hope for recovery, and that the nihilism that has really surrounded ICH is a thing of the past, and we have to move forward with thinking about how do we proactively impact the recovery and counsel the patients and give them hope. Because just as your research shows, there really is the ability that they can attain that functional independence, which is absolutely astounding. It's really amazing. Again, today I've been interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Please be sure to check out Continuum Audio episodes from this and other issues. Please go and check out. They have a wonderful article with lots of tables and figures, so much data. And again, thank you to our listeners for joining us today. Thank you, Dr. Ziai and Dr. Shah.  Dr Ziai: Thanks very much.  Dr Shah: Thank you.   Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Episode 397 of the Football Fitness Federation Podcast is with Recurrent, High Grade & Post Op Lower Limb Specialist Fearghal Kerin We discussed: ▫️Hamstring Rehab in Football ▫️How much rehabs can differ ▫️The original Sin ▫️How strong do we need the hamstrings to be & much more! You can connect with Fearghal on Instagram @kerinperformance Keep up to date with the amazing work our sponsors are doing here:⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Good Prep - thegoodprep.com⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Discover the power of nutrition at WWW.THEGOODPREP.COM and use code FFF15 for 15% off your first order⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Hytro - hytro.com⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Maximise your athletic potential with Hytro BFR. Easier, safer and more practical BFR for squads to prepare for and recover from exercise than ever before.⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ Click the link [[ bit.ly/3ILVsbU ]]⁣⁣ ⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Join our online community & get access to the very best Football Fitness content as well as the ability to connect with Sport Scientists and Strength & Conditioning coaches from around the world.⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ To get FULL access to all of these & even more like this, sign up to a FREE month on our online community at the link below.⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ www.footballfitfed.com/forum/index.a…⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ Keep up to date with everything that is going on at Football Fitness Federation at the following links:⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣⁣⁣⁣ ⁣ ⁣⁣ X - @FootballFitFed⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ Instagram - @FootballFitFed⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣⁣ ⁣⁣⁣⁣ Website - www.footballfitfed.com

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/QSQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2027.Innovation Takes the Stage in HNSCC: Immunotherapy and Novel Therapeutics in Locally Advanced and Recurrent/Metastatic Disease In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Head and Neck Cancer Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through independent educational grants from AstraZeneca, AVEO Pharmaceuticals, Inc., Johnson & Johnson, and Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/QSQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2027.Innovation Takes the Stage in HNSCC: Immunotherapy and Novel Therapeutics in Locally Advanced and Recurrent/Metastatic Disease In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Head and Neck Cancer Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through independent educational grants from AstraZeneca, AVEO Pharmaceuticals, Inc., Johnson & Johnson, and Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/QSQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2027.Innovation Takes the Stage in HNSCC: Immunotherapy and Novel Therapeutics in Locally Advanced and Recurrent/Metastatic Disease In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Head and Neck Cancer Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through independent educational grants from AstraZeneca, AVEO Pharmaceuticals, Inc., Johnson & Johnson, and Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/QSQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2027.Innovation Takes the Stage in HNSCC: Immunotherapy and Novel Therapeutics in Locally Advanced and Recurrent/Metastatic Disease In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Head and Neck Cancer Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported through independent educational grants from AstraZeneca, AVEO Pharmaceuticals, Inc., Johnson & Johnson, and Merck & Co., Inc., Rahway, NJ, USA.Disclosure information is available at the beginning of the video presentation.

Are you dealing with chronic gout attacks? Discover the underlying cause of gout, the foods that cause gout, and the best remedy for gout to help keep it from coming back.0:00 Recurrent gout symptoms0:11 Foods that cause gout0:42 Underlying causes of gout1:43 Fructose and gout flares3:15 Hidden glucose and insulin3:49 Gut health and gout6:04 Gout attack on keto7:02 How to lower uric acid7:21 How to prevent gout

A few things on the agenda today. First, RFK Jr. and the MAHA crew want medical schools to dedicate around 40 hours, roughly 20% of preclinical training, to nutrition education. I have some thoughts. We already have dietitians, med school is already a fire hydrant, and the Krebs cycle had it coming, but this isn't the way. Then a Mark Cuban appreciation segment, because he's out there on X dragging the entire healthcare system toward transparency. His latest pitch: someone buy a hospital, charge Medicare rates for every single thing, expose every dollar in and out, and prove whether Medicare for All can actually work. In theory, I'm in. In practice, you can't slash physician pay without first addressing the $500,000 in debt that gets people into the door. The Australian model, a real public safety net coexisting with a private system, makes more sense to me, but only if we fix the training pipeline first. After the break, ophthalmology. A young man got a bamboo shoot to the eye six months ago. Healed up fine. Now he's waking up at 2 AM in excruciating pain, no trauma involved. That's a recurrent corneal erosion. I walk through why it happens, why CPAP can make it worse, and the whole treatment ladder, ointment, bandage contact lenses, superficial keratectomy, corneal micropuncture. Also: don't let your cornea melt. That's the headline. Takeaways: RFK Jr. and MAHA are pushing medical schools to dedicate around 40 hours, or 20%, of preclinical training to nutrition, a shift that ignores the existence of dietitians and would crowd out essential physiology and disease education Mark Cuban has floated a real-world test case for Medicare for All: buy a hospital, charge only Medicare rates, and operate with complete financial transparency to show whether the model is sustainable Any serious move toward Medicare for All or an Australian-style public-private hybrid will require addressing the roughly $500K in training debt physicians carry; otherwise the math doesn't work and recruitment collapses Recurrent corneal erosion happens when an old abrasion never fully reattaches to the underlying stroma, patients typically wake up in severe pain because the eyelid scrapes loose epithelium across a dry cornea overnight, and CPAP without a good seal makes it worse Treatment escalates from aggressive nighttime lubrication (erythromycin ointment, Genteal gel) to a bandage contact lens, and in stubborn cases to a superficial keratectomy or corneal micropuncture to create a smoother, more firmly attached corneal surface To Get Tickets to Wife & Death: You can visit Glaucomflecken.com/live  We want to hear YOUR stories (and medical puns)! Shoot us an email and say hi! knockknockhi@human-content.com Can't get enough of us? Shucks. You can support the show on Patreon for early episode access, exclusive bonus shows, livestream hangouts, and much more! –⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ http://www.patreon.com/glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Also, be sure to check out the newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://glaucomflecken.com/glauc-to-me/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you are interested in buying a book from one of our guests, check them all out here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.amazon.com/shop/dr.glaucomflecken⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ If you want more information on models I use: Anatomy Warehouse provides for the best, crafting custom anatomical products, medical simulation kits and presentation models that create a lasting educational impact.  For more information go to Anatomy Warehouse DOT com. Link: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://anatomywarehouse.com/?aff=14⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Plus for 15% off use code: Glaucomflecken15 -- A friendly reminder from the G's and Tarsus: If you want to learn more about Demodex Blepharitis, making an appointment with your eye doctor for an eyelid exam can help you know for sure. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.EyelidCheck.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for more information.  Produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Human Content⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

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This podcast features two of the investigators from the international, randomized, Phase III EMBARK trial (NCT02319837) in conversation. EMBARK evaluated the efficacy and safety of enzalutamide plus androgen deprivation therapy and enzalutamide monotherapy, as compared with androgen deprivation therapy alone, in patients with nonmetastatic castration-sensitive prostate cancer and biochemical recurrence at high risk for metastasis. In this podcast, the second in the EMBARK series, the speakers discuss the key efficacy and safety findings from the trial, consider some of the patient-reported outcomes and their implications for quality of life, and review some of the implications for clinical practice.

Podcast Host and Interviewee: Host: John Fortunato Interviewee: Sofia Rael, Ugur Sener    Podcast Description: Dr. John Fortunato interviews Dr. Sofia Rael and Dr. Ugur Sener on their recent manuscript, titled "Ivosidenib in predominantly recurrent IDH1-mutant glioma: A single institution experience."

In this episode of The Egg Whisperer Show, Dr. Jenna Turocy is joining me to talk about new treatment options for recurrent implantation failure. Recurrent implantation failure (RIF) is determined when embryos of good quality fail to implant following several in vitro fertilization (IVF) treatment cycles. The good news is that there is treatment for this, and Dr. Turocy has been researching it. The types of treatments that Dr. Jenna has studied include:

Urinary tract infections are one of the most common health issues women experience, yet there's still so much confusion about what they are, why they happen, and how they're different from yeast infections and other vaginal conditions. In this episode of Ask Dr. A, Dr. Aliabadi breaks down the anatomy behind UTIs, explains the difference between bladder infections and kidney infections, and shares the symptoms every woman should know.Dr. Aliabadi also dives into why some women seem to get recurrent UTIs while others never experience them, covering the roles of hydration, sex, genetics, hormones, menopause, and the vaginal microbiome. She explains how bacteria causes infection, why urine cultures are essential for an accurate diagnosis, and the common mistakes that can lead to repeated infections.Plus, you'll learn evidence-based prevention strategies, including the truth about cranberry supplements, D-mannose, vaginal estrogen, probiotics, and whether peeing after sex actually helps. If you've ever wondered why UTIs keep coming back, or how to lower your risk, this episode is packed with practical information every woman should know.Subscribe to SHE MD Podcast for expert tips on PMOS, endometriosis, fertility, hormonal balance, mental health, and more. Share with friends and visit SHE MD website and Ovii for research-backed resources, holistic health strategies, and expert guidance on women's health and well-being.SponsorsMidi: Ready to feel your best and write your second act script? Visit JoinMidi.com today to book your personalized, insurance-covered virtual visit. Peloton: Let yourself run, lift, sculpt, push and GO. Explore the new Peloton Cross Training Tread+ at onepeloton.comMyriad: List GetMyRisk.com to learn more about hereditary cancer testing and how you can use Myriad's virtual care option for fast, at-home testing - no office visit required. Talkiatry: Head to Talkiatry.com/shemd and complete the short assessment to get matched with an in-network psychiatrist in just a few minutes.Transcendental Meditation: Curious about Transcendental Meditation? Find a certified teacher near you and begin your journey today. Go to TM.org/SheMDWhat You'll LearnThe difference between UTIs, bladder infections, kidney infections, and yeast infectionsHow bacteria enters the urinary tract and causes infectionCommon UTI symptoms and warning signs you shouldn't ignoreWhy some women are more prone to recurring infectionsThe role of hydration, sex, and vaginal health in UTI preventionHow menopause and declining estrogen affect urinary tract healthWhen a urine culture is necessary and why it mattersThe truth about cranberry supplements, D-mannose, and other prevention strategiesWhy recurrent UTIs may require a deeper investigationKey Timestamps00:00 Welcome to She MD Podcast00:46 UTI, Yeast infection, Bladder infection, and Kidney infection07:12 E.coli and how you get them in the urethra13:09 How is the test called?19:45 What can a woman do for these infections?29:13 What kind of treatment will help with the infection?37:15 Vaginal Estrogen Treatment 45:18 How do you address the bacteria?50:20 How much is too much?51:40 Let's address some myths 53:33 Final WordsKey TakeawaysUTIs and yeast infections are completely different conditions that affect different parts of the body.Most UTIs begin as bladder infections caused by bacteria entering the urethra.Early diagnosis and treatment can help prevent serious kidney infections.Hydration, urinating after sex, and avoiding prolonged urine retention can reduce risk.Vaginal microbiome health plays a major role in preventing recurrent UTIs.Menopause-related estrogen loss can increase susceptibility to urinary tract infections.A urine culture is the best way to confirm whether symptoms are truly caused by a UTI.Cranberry extract and D-mannose may help prevent recurrent infections but are not treatments for active UTIs.Recurrent infections should prompt an evaluation of underlying causes rather than repeated rounds of antibiotics.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Contributor: Aaron Lessen, MD Educational Pearls:   UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment.  UTI signs and symptoms Burning sensation when urinating Strong urge to urinate Urinating often and passing small amounts of urine.  Pelvic pain    There are currently more guidelines and studies on treatments to prevent these recurrent UTIs in women that we can start in the Emergency Department. Vaginal estrogen has been shown to significantly reduce this issue of recurrence. Very simple prescriptions can be prescribed in the ED It has little systemic absorption and is generally very safe and effective.   References Wells BA, De EJB, Visingardi J, Feustel PJ. IP15-36 IMPACT OF VAGINAL ESTROGEN ON SERIOUS ADVERSE OUTCOMES IN POSTMENOPAUSAL WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: A RETROSPECTIVE STUDY. Journal of Urology [Internet]. 2025 May 1;213(5S):e778. Available from: https://doi.org/10.1097/01.JU.0001109984.67114.74.36 Ackerman AL, Bradley M, D'Anci KE, Hickling D, Kim SK, Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). J Urol. 0(0). doi: 10.1097/JU.0000000000004723 Kaufman MR, Ackerman LA, Amin KA, et al. The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. J Urol. 0(0). doi:10.1097/JU.0000000000004589 Meister MR, Wang C, Lowder JL, Mysorekar IU. Vaginal Estrogen Therapy Is Associated With Decreased Inflammatory Response in Postmenopausal Women With Recurrent Urinary Tract Infections. Female Pelvic Med Reconstr Surg. 2021 Jan 1;27(1):e39-e44. doi: 10.1097/SPV.0000000000000790. PMID: 31725016; PMCID: PMC7737516. Nazarko L. Recurrent lower urinary tract infection in older women [Internet]. Urology & Continence Care Today. Available from: https://www.ucc-today.com/journals/issue/launch-edition/article/recurrent-lower-urinary-tract-infection-in-older-women-ucct   Summarized by Aaryn David & Ahmed Abdel-Hafiz | Edited by Aaryn David & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

Today on the podcast I am sharing a story that will speak straight to your soul.And a story that will remind you just how strong women can be.My guest today went through years of TTC and multiple losses. And just over a year ago, when she finally finally got the 2 pink lines she'd been waiting for again, she sadly lost her baby a few weeks later.  But the grief of this loss could not have prepared her for what came next.This is a conversation about miracles, resilience and navigating the depths of grief while you're still trying to bring your baby home.Thanks for being here on Your Journey to Fertility! When you finish listening, I'd love to hear your biggest takeaway from today's episode. Take a screenshot of you listening on your device, share it to your Instagram stories and tag me @jen.elementpilatesyoga If you're trying to conceive, I have lots of resources to support you:To grab a copy of my Free Fertility Yoga Guide, click here:To learn more about In Your Element - The Fertility Yoga Experience click here and start using so many of the practices I speak about for yourself.This program is a guided way to: Sync with your cycle & synchronize your hormonesIncrease success rates through proven, scientific methodsRegulate your nervous system & make every part of this journey feel easier

Trisha Wise-Draper, MD, PhD - Beyond the Virus: New Strategies to Improve Outcomes of Non-HPV-Associated Recurrent/Metastatic Head and Neck Cancer

Trisha Wise-Draper, MD, PhD - Beyond the Virus: New Strategies to Improve Outcomes of Non-HPV-Associated Recurrent/Metastatic Head and Neck Cancer

Trisha Wise-Draper, MD, PhD - Beyond the Virus: New Strategies to Improve Outcomes of Non-HPV-Associated Recurrent/Metastatic Head and Neck Cancer

Trisha Wise-Draper, MD, PhD - Beyond the Virus: New Strategies to Improve Outcomes of Non-HPV-Associated Recurrent/Metastatic Head and Neck Cancer

In this episode of Accelerated Health with Sara Banta, I'm joined by Dr. Fenwa Milhouse and Heather Florio to talk about why so many women are repeatedly diagnosed with UTIs when the root cause may be something entirely different.Millions of women suffer from chronic urinary symptoms like burning, urgency, frequency, pelvic pain, and discomfort — only to be prescribed endless rounds of antibiotics that never fully solve the problem. Dr. Milhouse and Heather explain why many of these cases are often misdiagnosed and how underlying issues such as pelvic floor dysfunction, hormonal imbalances, inflammation, vaginal health changes, and other hidden factors may actually be driving the symptoms.We also discuss the dangers of overusing antibiotics, why traditional testing can miss the full picture, and what women need to know to finally get answers and proper support.If you've been struggling with chronic urinary symptoms, recurring infections, pelvic discomfort, or unresolved women's health issues, this episode is a must-listen.Follow our guests:• Dr. Fenwa Milhouse Instagram: https://www.instagram.com/drmilhouse • Heather Florio Instagram: https://www.instagram.com/hmflorio Supplements Featured In This Episode:• Acceleradine® Iodine https://www.acceleratedhealthproducts.com/products/acceleradine-iodine-supplement • Accelerated Methylene Blue® https://www.acceleratedhealthproducts.com/products/accelerated-methylene-blue-supplement Not sure what food to eat and avoid? This guide is for you.⬇️

Recurrent miscarriage is one of the hardest and most sensitive topics in women's health, and in this episode, Lauren Allen opens up a practical, research-informed conversation about why miscarriages happen, when to look deeper, and what testing may help reduce future risk.Listen in to hear Lauren share:What miscarriage is, how common it isThe difference between a random miscarriage and recurrent pregnancy lossRoot cause of miscarriage, including thyroid dysfunction, PCOS, nutrient deficiencies, gut health, clotting disorders, lifestyle factors, and inflammationWhat tests to do after repeated losses+So much moreConnect with Lauren:Get my FREE PCOS Guide hereJoin the Empowered Path to Pregnancy hereInstagramWork With MeThank you so much for listening to the About Health and Hormones Podcast! If you loved today's episode, I would love to know! Please leave a rating and review so I can make this podcast even better for you all. I would love to connect with you.I'm so glad you were here today, and I wish you all health and happiness!This episode was edited and produced by Intent Media.This podcast uses the following third-party services for analysis: Podcorn - https://podcorn.com/privacy

Dr. Centor discusses interventions to prevent kidney stones with Dr. Gary Asher.

Enzalutamide in biochemically recurrent prostate cancer: design and rationale of the EMBARK study by Taylor & Francis Group

Dr. Aimee Baron is a pediatrician and the founder of I Was Supposed to Have a Baby, a nonprofit supporting people through infertility, miscarriage, pregnancy loss, and related struggles in the Jewish community. After walking through secondary infertility, miscarriage, multiple unexplained losses, and eventually a surprise twin pregnancy, Dr. Baron turned her personal pain into a mission to help others feel less alone. Through shared stories, support groups, education, and her podcast, she works to reduce isolation and create more sensitive communal spaces.Listen in to hear Dr. Baron share:Her personal fertility journey, including secondary infertility, miscarriage, and repeated pregnancy lossWhy she founded I Was Supposed to Have a Baby and how storytelling helps break the silence around infertilityPractical ways communities can be more sensitive, from changing the way we ask about family to being mindful at Shabbos tables and simchasHow to support a friend who is struggling while sharing your own pregnancy news with careHoliday survival strategies for people facing infertility or loss, including setting boundaries, opting out when needed, and creating private spaceWhy all forms of infertility-related grief deserve validation, including circumstantial infertility for singles+So much moreConnect with Lauren:Get my FREE PCOS Guide hereJoin the Empowered Path to Pregnancy hereInstagramWork With MeThank you so much for listening to the About Health and Hormones Podcast! If you loved today's episode, I would love to know! Please leave a rating and review so I can make this podcast even better for you all. I would love to connect with you.I'm so glad you were here today, and I wish you all health and happiness!This episode was edited and produced by Intent Media.This podcast uses the following third-party services for analysis: Podcorn - https://podcorn.com/privacy

Listen to Andrew Duckworth, Colin Forde and David Keene discuss the paper 'Supervised versus self-managed rehabilitation for patients with an acute first-time or recurrent patellar dislocation: the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) external pilot randomized controlled trial and embedded qualitative study' published in the March 2026 issue of The Bone & Joint Journal.Click here to read the paper.If you'd like to get involved with the main trial if it is funded, please contact prepped@ndorms.ox.ac.uk.To find out more about the 2026 Annual Scientific Meeting of ISHA, visit www.ishasoc.net.Find out as soon as the next episode is live by following us on X (Twitter), Instagram, LinkedIn, Tik Tok or Facebook!

In this episode, Megan shares her journey through recurrent pregnancy loss, chronic illness, medical trauma, and a life-threatening birth experience that led to her son's premature arrival. Her story sheds light on the complexities of pregnancy after loss, the realities of navigating the healthcare system with chronic conditions, and the lasting impact of birth trauma and a NICU stay.

This episode covers recurrent infections in children.Notes: https://zerotofinals.com/paediatrics/immunology/recurrentinfections/Questions: https://members.zerotofinals.com/Books: https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

Shoot us a Text.Episode #1327: Dealers lose service share to quick lubes, EVs prove stronger range retention, and Chinese vehicles gain global credibility at the Beijing Auto Show.Dealership service lanes are losing ground as quick lube shops quietly gain share in 2025. New data shows fewer transactions and shrinking revenue for dealers, with pricing strategy emerging as the key battleground in keeping service customers loyal.The study analyzes credit and debit transactions across all service channels including dealerships, independents, quick lubes, and tire chains.Overall service transaction dollars fell 8.3 percent, but dealers declined faster at 11 percent.Dealership service transactions dropped 13 percent year over year, the steepest decline among all segments tracked.Quick lube shops gained market share while raising prices more slowly than dealerships, attracting cost-conscious customers.Even with free OEM-paid maintenance, dealers are struggling to retain customers in the critical first two years of ownership.“The quick lubes are what everybody should be worried about,” said Ducker Carlisle's Nate Chenenko.Electric vehicle range isn't fading the way many buyers fear. New data from over a billion miles of driving shows modern EVs are holding onto their range far better than expected, thanks to both improving battery tech and smarter software.Recurrent data shows EVs retain about 97% of range after three years and 95% after five years of ownership.The study is based on real-world driving data, factoring in climate, usage, and battery age, not just EPA estimates.About 68% of 2023 model-year EVs are still exceeding their original EPA range today.Automakers are offsetting degradation with OTA updates and built-in battery buffers that unlock over time.At the Beijing Auto Show, American YouTuber Ethan Robertson of Wheelsboy is giving global audiences a firsthand look at Chinese EVs, helping shift perception from “cheap copycats” to serious innovation leaders.Robertson led international visitors through the Beijing Auto Show, showcasing China's latest EVs and tech-forward designs.Perception has shifted dramatically, with Chinese brands now recognized for advances in batteries, software, and charging.Attendees highlighted futuristic interiors and features, calling the vehicles a “new generation” of driving experience.Competitive pricing remains a major disruptor, with fully loaded EVs around $30,000 undercutting U.S. options.“Our comment section is full of people saying, ‘I can't believe the government won't allow them to sell this car in my country,'” said Robertson.Join Paul J Daly and Kyle Mountsier every morning for the Automotive State of the Union podcast  as they connect the dots across car dealerships, retail trends, emerging tech like AI, and cultural shifts—bringing clarity, speed, and people-first insight to automotive leaders navigating a rapidly changing industry.Get the Daily Push Back email at https://www.asotu.com/JOIN the conversation on LinkedIn at: https://www.linkedin.com/company/asotu/

Host Jake New summarizes and offers insights into the JCO article by Licitra et al., "Pembrolizumab With or Without Lenvatinib as First-Line Therapy for Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Phase III LEAP-010 Study." LINK TO FULL TRANSCRIPT

Dr Tanyel Zubarioglu discusses the case of a young woman with years of severe abdominal pain, neurological symptoms, anxiety, and repeated hospital visits, initially thought to represent familial Mediterranean fever. In this episode, we explore how a simple urine test during an acute attack changed everything, and why some metabolic diagnoses remain hidden in plain sight. Read the paper here: https://link.springer.com/article/10.1186/s13023-026-04308-3

Dr. Patrick Micaroni is a pediatric dentist and practice owner from New York. We talk about just about every topic related to pediatric dentistry that you can think of, including:- How he bought an existing practice and kept the selling doc on as an associate- Why residency was truly "the good ol days"- Recurrent decay on teenagers- Why class IIs are terrible- Cloud-based dental software, pros and cons- Challenges of employing expensive hygienists in states where assistants can't coronal polishThis is a great casual episode where we vent about the common pitfalls that drive us crazy as pediatric dentists.

Shahad Abdulsahib discusses a phase 1 clinical trial of intracerebroventricular bivalent EGFR and IL13Rα2 CAR T cells for recurrent glioblastoma, published in Nature Medicine.

Featuring perspectives from Dr Haley Ellis, Prof Eric Van Cutsem and Dr Zev Wainberg, moderated by Dr Lionel A Kankeu Fonkoua, including the following topics: Gastroesophageal cancer (0:00) Recurrent colorectal cancer (5:43) Colorectal cancer with brain metastases (9:59) CME information and select publications

Fifty to sixty percent of women will get a urinary tract infection at least once in their lifetime — and for many, it won't stop there. So why does almost every conversation about UTIs still end with the same answer: another antibiotic? In this episode of the Your Health University Podcast, host Jamie Preston sits down with Madison Browning, Executive Director of Clinical Services in the Specialty Department at Your Health, to explore what's actually possible when we stop reacting and start preventing. Madison oversees the urology and nephrology divisions and brings the kind of front-line clinical perspective that turns confusing medical information into something anyone can act on. Together, they cover: Why repeated antibiotic use can actually make you more prone to future infections — and what antibiotic resistance really means for your body The honest truth about cranberry: there is science behind it, but probably not in the form you've been using What D-Mannose is, how it works, and why it practically fills the hooks bacteria use to grab onto your urinary tract Vaginal estrogen — the most evidence-backed, most underused prevention option for postmenopausal women, and why the word "estrogen" shouldn't automatically trigger fear The lifestyle changes that cost nothing, require no prescription, and form the foundation of any prevention plan This isn't about abandoning medical care. It's about having a better conversation with your provider — one that goes beyond treating the infection in the moment and starts asking why it keeps happening at all. www.YourHealth.Org

The week marks one month since the United States and Israel attacked Iran. We take a look at the impact the resulting war has had on the women and children of the country. Krupa Padhy is joined by BBC Chief International Correspondent Lyse Doucet and Ghoncheh Habibiazad, Senior Reporter from BBC News Persian.Recurrent miscarriage is when you experience more than two or three pregnancy losses, and it affects around one in 100 women. A device designed to offer more care and dignity during miscarriage, and that could aid greater understanding, is now being used in 28 hospitals across the UK. Engineer Laura Corcoran created a miscarriage collection cradle after she suffered the loss of her third pregnancy. She is calling for a wider roll-out of the device. Laura speaks to Krupha, along with Siobhan Quenby, Professor of Obstetrics at the University of Warwick.A new exhibition at Kensington Palace is celebrating the 150th birthday of Princess Sophia Duleep Singh – the Punjabi princess and suffragette. The Last Princesses of Punjab exhibition explores her life and five other women who shaped her. Krupha talks to the curator Polly Putnam and journalist and Radio 4 presenter Anita Anand, author of Sophia: Princess, Suffragette, Revolutionary.Another chance to hear our interview with Janet Willoner, known as the tree growing granny. Janet has grown more than 4,000 trees in her garden.  She forages for seeds, grows them, and they eventually grow in forests in her local area of North Yorkshire.  Zoom bombing involves crashing into a meeting and taking it over - more often than not showing shocking content including pornography. Businesswoman Lou Robey was holding a meeting on International Women's Day when it was zoom bombed. Lou has put out a call for action for media platforms and the wider community to act. She and Gina Neff, Professor of Responsible AI at Queen Mary, University of London join Krupha to discuss.

In this episode, Nicol shares her story of baby loss, opening up about her experiences of recurrent miscarriage and stillbirth, and the impact it's had on her life.She speaks honestly about the weight of grief and how isolating loss can feel, especially when the world around you keeps moving. Nicol reflects on how finding support through social media and connecting with others who truly understand helped her feel less alone, and gave her a sense of purpose in the midst of everything she was carrying.We talk about the importance of having spaces where grief is welcomed, not silenced, and how sharing your story, even when it feels hard, can be part of healing. Nicol also shares how therapy and self-compassion helped her begin to rebuild her confidence, and how she navigates conversations about loss with her children and the people around her.This episode is about connection, honesty, and the quiet strength that comes from being seen. A reminder that even after the most painful experiences, there can still be moments of hope.

In this episode, Prof Chapman breaks down recurrent miscarriage, including which baseline tests are truly worth doing, which findings actually change treatment, and which commonly suggested tests have weak evidence behind them. He explains the role of embryo chromosomal abnormalities, balanced translocation, uterine assessment, antiphospholipid syndrome, sperm DNA fragmentation, and when options like progesterone or IVF with genetic testing may be worth considering. Explore the 'Prof. Michael Chapman - The IVF Journey' Facebook Page, your reliable destination for cutting-edge insights and guidance within the realm of In Vitro Fertilization (IVF). Don't miss out on the IVF Journey podcast; stay informed with the latest episode updates. Tune in for expert discussions and valuable information on navigating the intricate path of IVF.

Interview with Trisha M. Wise-Draper, MD, PhD author of Amivantamab for Recurrent or Metastatic Adenoid Cystic Carcinoma: A Phase 2 Nonrandomized Clinical Trial. Hosted by Paul C. Bryson, MD MBA. Related Content: Amivantamab for Recurrent or Metastatic Adenoid Cystic Carcinoma

Dr. Erik Goodwyn is a practising psychiatrist with a background in neurobiology who bridges the worlds of neuroscience, Jungian psychology, and fantasy. Erik is co-editor-in-chief of the International Journal of Jungian Studies and has written dozens of academic papers along with books on the neurobiology of the gods, dreams, and archetypes. Last year he published his first fantasy novel, King of the Forgotten Darkness, which won the Literary Titan Golden Book Award.________________In this return visit, we dive deep into who actually creates the dream – the Invisible Storyteller that isn't your conscious self. We explore the neuroscience behind this, discussing the Default Mode Network, Salience Network, and Executive Control Network, and what they reveal about dreaming, meaning-making, and the deeply non-egoic nature of consciousness. Erik shares clinical insights into Dissociative Identity Disorder as evidence of an underlying organising principle, we tangle with what it means for consciousness to be "non-egoic," and we work through his groundbreaking definition of archetypes through Cognitive Metaphor Theory. It's a conversation that challenges everything you think you know about who you are.________________

Priyanka Jain, co-founder and CEO of Evvy, shares how being dismissed by the medical system led her to help transform women's health through better vaginal microbiome data. We talk about why the vaginal microbiome matters, how dysbiosis can drive inflammation even without obvious symptoms, and why women still face outdated standards of care. We also cover recurrent UTIs, yeast infections, fertility, pregnancy, postpartum, perimenopause, probiotics, and at-home testing. This is a practical conversation for women who want to better understand their bodies, stop brushing off symptoms, and use better data to support long-term health. Join my NEW private community at thelongherlife.com for ongoing protocols, live coaching, and deeper support. WE TALK ABOUT:  12:00 - Why the vaginal microbiome is one of the most overlooked biomarkers in women's health 14:40 - Why vaginal discomfort is one of the top reasons women seek care 18:30 - Why pH shifts can allow harmful bacteria to take over 20:50 - How women normalize symptoms and miss signs of imbalance 22:45 - Why baseline testing can help women get more attuned to their bodies 26:55 - How the vaginal microbiome changes during pregnancy and postpartum 30:15 - What recurrent yeast infections and UTIs may really be telling you 34:50 - What cotton underwear, synthetic fabrics, and moisture may mean for infections 35:45 - The unanswered questions around period products and vaginal health 36:50 - What research is starting to show about IUDs and the vaginal microbiome 39:05 - How vaginal microbiome testing could one day help track menopause progression 41:00 - How community-driven research is changing the future of women's health RESOURCES: Join my NEW private community at thelongherlife.com for ongoing protocols, live coaching, and deeper support. Download the non-toxic baby registry guide to reduce toxic exposure and make confident, evidence-informed choices for your family—free. Evvy's website and Instagram LET'S CONNECT: Instagram, TikTok, Facebook Shop my favorite health products Listen on Spotify, Apple Podcasts, YouTube Music

Probiotics. They are often marketed as the end of all and be all for all our health issues. And they CAN do some real good. There is NO DOUBT a connection with overall heath and gut health…and NO ONE can deny that. But probiotics gets grey for some women's health issues. A new prospective, single-arm, non-blinded, multicenter study across 31 hospitals in Japan is making some pretty dramatic claims regarding oral probiotics and recurrent spontaneous preterm birth (ePUB). Can oral probiotics reduce spontaneous recurrent preterm birth? Listen in for details. 1. Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics: Results from a Prospective, Single-Arm, Multicenter Trial. PPP trial Collaborators et al.American Journal of Obstetrics & Gynecology, Volume 0, Issue 02. Grev J, Berg M, Soll R. Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2018 Dec 12;12(12):CD012519. doi: 10.1002/14651858.CD012519.pub2. PMID: 30548483; PMCID: PMC6516999.3. Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, McDonald SD. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):14. doi: 10.1186/s12884-017-1629-5. PMID: 29310610; PMCID: PMC5759212.4. Othman M, Neilson JP, Alfirevic Z. Probiotics for preventing preterm labour. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD005941. doi: 10.1002/14651858.CD005941.pub2. PMID: 17253567; PMCID: PMC9006117.5. Timing of Probiotic Milk Consumption During Pregnancy and Effects on the Incidence of Preeclampsia and Preterm Delivery: A Prospective Observational Cohort Study in Norway.6. Nordqvist M, Jacobsson B, Brantsæter AL, Myhre R, Nilsson S, Sengpiel V. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open. 2018 Jan 23;8(1):e018021. doi: 10.1136/bmjopen-2017-018021. PMID: 29362253; PMCID: PMC5780685.7. Gao Q, Sun Y, Qu Y, Li F, Li P. The effect of probiotic supplementation during pregnancy on pregnancy complications: An umbrella meta-analysis. Medicine (Baltimore). 2025 Dec 19;104(51):e46409. doi: 10.1097/MD.0000000000046409. PMID: 41430994; PMCID: PMC12727282.SPONSOR WEBSITE: Visit perspectivemedical.org to learn more about the Hemorrhage View C-Section Drape

In this episode of Optimal Metabolism, I sit down with Dr. Michael Biamonte, founder of the Biamonte Center for Clinical Nutrition and author of The Candida Chronicles, to unpack the surprising connection between Candida overgrowth and metabolic dysfunction. Candida is often reduced to "just a yeast infection," but Dr. Biamonte explains why chronic fungal overgrowth can disrupt insulin signaling, impair liver detoxification, drive inflammation, weaken immunity, and create the perfect storm for weight gain, fatigue, high cholesterol, and blood pressure issues. If you've ever felt like your body is working against you, this conversation may connect the dots. You may want to explore this deeper if you experience: Stubborn weight loss resistance Blood sugar swings or insulin resistance Chronic fatigue or brain fog Recurrent infections Bloating, digestive complaints, or food sensitivities Hormonal imbalances that don't improve with diet alone

Today, we're bringing you a special feed drop from ReCurrent, a podcast from the Getty that explores how art, history, and culture shape the world around us. In this episode of ReCurrent, host Jaime Roque takes us back to 1980s Los Angeles, when civil wars in El Salvador, Guatemala, and Nicaragua sent hundreds of thousands of people north and helped turn LA into “Little Central America.” With professor and longtime participant Rubén Martínez as our guide—someone who lived through this moment firsthand—we follow the Sanctuary Movement as churches quietly, and then publicly, open their doors to refugees the U.S. refused to recognize. Sanctuary meant food and a place to sleep, but it also meant music, theater, poetry, and posters that challenged U.S. policy while helping people process their grief. From there, we step inside Echo Park United Methodist Church, where artist and performer Elia Arce and a circle of Central American poets, musicians, and organizers transform the basement into a cultural home. We also sit with Rev. David Farley, pastor emeritus of Echo Park United Methodist, who was there to witness it all. Upstairs, families try to stay invisible on classroom floors; downstairs, performances inspired by banned writers, songs from back home, and handmade banners turn fear and exile into shared story. Our last stop is the Getty Research Institute, where researcher Jasmine Magaña—a Salvadoran Angeleno herself—is helping build a new, expansive record of this era.  Learn more about the episode here: https://www.getty.edu/podcasts/recurrent/central-american-art-and-resistance-in-1980s-la/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Recurrent respiratory papillomatosis (RRP) has long been managed with repeated surgical debulking, sometimes requiring dozens of procedures over a lifetime. In this episode of BackTable, Dr. Aaron Friedman and guest host Dr. Stephen Schoeff discuss a major shift in care: immune-directed therapy targeting HPV 6 and 11. --- SYNPOSIS Dr. Friedman reviews the recent FDA approval of the Precigen product PAPZIMEOS (August 2025), a therapeutic vaccine designed to stimulate HPV-specific T-cell responses. Clinical trial data show that about half of treated adults required no additional surgeries over the following year, with many responders maintaining durable benefit for years. The conversation also covers traditional management strategies, adjuvant therapies like bevacizumab, HPV vaccination, and the evolving algorithm for adult RRP care. --- TIMESTAMPS 00:00 - Introduction02:13 - RRP Patient Types and Symptoms05:06 - Adult vs Juvenile Transmission10:46 - When to Escalate Treatment15:40 - Immunotherapy 18:55 - Trial Enrollment, Results and Dosing Rules26:17 - Durable Long Term Response30:47 - Who Should Get Treated32:34 - Logistics And Public Perception37:50 - Future Research And Prevention --- Recurrent Respiratory Papillomatosis Foundation Position Statement on the Management of Adults With RRPhttps://pubmed.ncbi.nlm.nih.gov/41543033/ Dr. Stephen Schoeffhttps://healthy.kaiserpermanente.org/washington/clinicians/stephen-schoeff-6848607 Dr. Aaron Friedman https://www.uchealth.com/en/provider-profiles/friedman-aaron-d-1609057587

With over a billion creators projected to be active in the next decade, is the traditional distinction between a brand, a publisher, and a creator in need of an updated definition? Agility requires not just reacting to new platforms, but fundamentally rethinking who creates your content and how you build an authentic community around it. It's about moving from a campaign mindset to an ecosystem mindset. Today, we're going to talk about the seismic shift in the media landscape, driven by the explosive growth of the creator economy. We'll explore how the very definition of a creator is evolving from a short-term influencer to a long-term brand builder, and what opportunities and challenges this presents for established brands that are trying to earn and keep their audience's attention. To help me discuss this topic, I'd like to welcome, Andrew Perlman, Co-Founder and CEO at Recurrent. About Andrew Perlman Andrew Perlman is the Co-Founder and Chief Executive Officer of Recurrent. Perlman co-founded the company in 2018 with the acquisition of The Drive. Over a span of three years, he oversaw the acquisition of nearly 25 noteworthy brands, including Task & Purpose, Popular Science, Dwell, and Donut, and in the process, introduced Recurrent as the new parent company for the digital media portfolio. In 2022, Perlman rejoined the organization from his role on the board as the Head of M&A and Corporate Development before he assumed the role of CEO in 2023. Previously, Andrew spent over six years as the Chief Executive Officer of XpresSpa, FORM Holdings, and its predecessor company, Vringo, where he led the overall business operations and strategy as well as capital raising. During his tenure, he also oversaw five acquisitions and the NASDAQ listing of the company. Andrew has also served as Vice President of Business Development at EMI Music, SVP of Music and Digital at Classic Media, and held roles at early mobile content companies. Andrew Perlman on LinkedIn: https://www.linkedin.com/in/adperlman/ Resources Recurrent: https://recurrent.io/ Take your personal data back with Incogni! Use code AGILE at the link below and get 60% off an annual plan: https://aglbrnd.co/r/c43e68ce5cfb321e The Agile Brand podcast is brought to you by TEKsystems. Learn more here: https://aglbrnd.co/r/2868abd8085a9703 Drive your customers to new horizons at the premier retail event of the year for Retail and Brand marketers. Learn more at CRMC 2026, June 1-3. https://aglbrnd.co/r/d15ec37a537c0d74 Enjoyed the show? Tell us more at and give us a rating so others can find the show at: https://aglbrnd.co/r/faaed112fc9887f3 Connect with Greg on LinkedIn: https://www.linkedin.com/in/gregkihlstromDon't miss a thing: get the latest episodes, sign up for our newsletter and more: https://aglbrnd.co/r/35ded3ccfb6716ba Check out The Agile Brand Guide website with articles, insights, and Martechipedia, the wiki for marketing technology: https://www.agilebrandguide.com The Agile Brand is produced by Missing Link—a Latina-owned strategy-driven, creatively fueled production co-op. From ideation to creation, they craft human connections through intelligent, engaging and informative content. https://www.missinglink.company

With over a billion creators projected to be active in the next decade, is the traditional distinction between a brand, a publisher, and a creator in need of an updated definition?Agility requires not just reacting to new platforms, but fundamentally rethinking who creates your content and how you build an authentic community around it. It's about moving from a campaign mindset to an ecosystem mindset.Today, we're going to talk about the seismic shift in the media landscape, driven by the explosive growth of the creator economy. We'll explore how the very definition of a creator is evolving from a short-term influencer to a long-term brand builder, and what opportunities and challenges this presents for established brands that are trying to earn and keep their audience's attention.To help me discuss this topic, I'd like to welcome, Andrew Perlman, Co-Founder and CEO at Recurrent. About Andrew Perlman Andrew Perlman is the Co-Founder and Chief Executive Officer of Recurrent. Perlman co-founded the company in 2018 with the acquisition of The Drive. Over a span of three years, he oversaw the acquisition of nearly 25 noteworthy brands, including Task & Purpose, Popular Science, Dwell, and Donut, and in the process, introduced Recurrent as the new parent company for the digital media portfolio. In 2022, Perlman rejoined the organization from his role on the board as the Head of M&A and Corporate Development before he assumed the role of CEO in 2023. Previously, Andrew spent over six years as the Chief Executive Officer of XpresSpa, FORM Holdings, and its predecessor company, Vringo, where he led the overall business operations and strategy as well as capital raising. During his tenure, he also oversaw five acquisitions and the NASDAQ listing of the company. Andrew has also served as Vice President of Business Development at EMI Music, SVP of Music and Digital at Classic Media, and held roles at early mobile content companies. Andrew Perlman on LinkedIn: https://www.linkedin.com/in/adperlman/ Resources Recurrent: https://recurrent.io/ Take your personal data back with Incogni! Use code AGILE at the link below and get 60% off an annual plan: https://aglbrnd.co/r/c43e68ce5cfb321e The Agile Brand podcast is brought to you by TEKsystems. Learn more here: https://aglbrnd.co/r/2868abd8085a9703 Drive your customers to new horizons at the premier retail event of the year for Retail and Brand marketers. Learn more at CRMC 2026, June 1-3. https://aglbrnd.co/r/d15ec37a537c0d74 Enjoyed the show? Tell us more at and give us a rating so others can find the show at: https://aglbrnd.co/r/faaed112fc9887f3 Connect with Greg on LinkedIn: https://www.linkedin.com/in/gregkihlstromDon't miss a thing: get the latest episodes, sign up for our newsletter and more: https://aglbrnd.co/r/35ded3ccfb6716ba Check out The Agile Brand Guide website with articles, insights, and Martechipedia, the wiki for marketing technology: https://www.agilebrandguide.com The Agile Brand is produced by Missing Link—a Latina-owned strategy-driven, creatively fueled production co-op. From ideation to creation, they craft human connections through intelligent, engaging and informative content. https://www.missinglink.company Hosted on Acast. See acast.com/privacy for more information.

343: Today I'm joined by Dr. Albert Chung, who is a certified colon and rectal surgeon specializing in hemorrhoids, colorectal cancer, Crohn's Disease, Ulcerative Colitis, Diverticulitis, Anal Fissures and more. In our interview, we hone in on the topic of hemorrhoids and discuss what they are, natural ways to treat them and prevent them, and what we've been doing wrong!  Topics Discussed: → Different types of hemorrhoids → What causes hemorrhoids → What to look for if you have one → When to see a doctor → Typical time it takes for them to go away → Home treatments and what NOT to do → Is surgery for everyone → Different types of surgery options → Surgery recovery time  → What to expect from surgery → How to prevent hemorrhoids  As always, if you have any questions for the show please email us at digestthispod@gmail.com. And if you like this show, please share it, rate it, review it and subscribe to it on your favorite podcast app.  Sponsored By:  → Fatty15 | For 15% off the starter kit go to https://fatty15.com/digest → Seven Sundays | Go to https://sevensundays.com/ and use code: lilsip for 20% off Timestamps: → 00:00:00 - Introduction  → 00:02:36 - What are hemorrhoids  → 00:07:10 - Stress & digestion  → 00:09:12 - Sitting too long on the toilet  → 00:10:46 - Office chair donuts  → 00:12:06 - Hemorrhoid treatments  → 00:16:14 - Fiber intake  → 00:20:31 - Hydration level  → 00:23:18 - Size range  → 00:24:35 - When to see a doctor  → 00:26:17 - Recovery time→ 00:29:09 - Hemorrhoid surgery & recovery  → 00:33:43 - Pain management & level → 00:36:35 - Surgery options  → 00:39:03 - Recurrent hemorrhoids  → 00:41:11 - Untreated hemorrhoids  → 00:43:12 - Hemorrhoid prevention  Check Out Dr. Chung: → YouTube: Your Friendly Proctologist | @yourfriendlyproctologist → Instagram: @YourFriendlyProctologist  | https://www.instagram.com/yourfriendlyproctologist/ → Website | https://crsurgeryoc.com  Check Out Bethany: → Bethany's Instagram: @lilsipper → YouTube → Bethany's Website → Discounts & My Favorite Products → My Digestive Support Protein Powder → Gut Reset Book  → Get my Newsletters (Friday Finds) Learn more about your ad choices. Visit megaphone.fm/adchoices