Podcasts about referred

Episode 194: Acute low back pain.  Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain.  Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

Michael worked an ok program, went back and tried some more drinking and is now back doing this AA thing at 110% — and with that effort he has found peace, gratitude and the sigh he was seeking in a drink. Sobriety Date: 1/28/2024Quotes“It's a really great program that works one day at a time.”“Alcohol is not a solution, it was at a point in time, but now today, Alcoholics Anonymous is my solution and it's outlined in the first 164 pages of the Big Book.”Referred by: Sara A. (Episode #211)InstagramFacebook

Police in Hyogo Prefecture on Friday sent papers on Hyogo Governor Motohiko Saito and former Vice Governor Yasutaka Katayama to prosecutors for an alleged breach of trust related to a victory parade for local professional baseball teams, according to investigative sources.

Chris always felt like an outsider wanting to crawl out of his skin, which made his first drink the obvious answer to life. When it stopped working, at only 17 yrs., Chris attempted suicide which brought him to the rooms. He found strength through prayer and the steps, leading him to a life filled with peace, purpose, and joy.Sobriety Date: 5/18/2013Quotes“Recovery is possible even if you think you cannot be helped.”“I say that I'm recovered because I no longer suffer from the obsession to drink."Referred by: Keep Coming Back listener  InstagramFacebook

Liberal MP Moira Deeming has been referred to Victoria's anti-corruption watchdog after a controversial proposal regarding former Opposition Leader John Pesutto's bankruptcy proceedings.See omnystudio.com/listener for privacy information.

Corbin begin drinking for the release, the entertainment and the peace of mind, but eventually found himself trapped, lonely and miserable – drinking even when he didn't want to. With the Program, the Steps and taking Action, Corbin lives a life of freedom, joy and peace of mind, body and spirit. Sobriety Date: 12/10/2019Quotes“I have not been let down by alcoholics anonymous yet.” “I came in here broken and you people just put me back together like a puzzle.”Referred by: Erin M. (Episode #105)InstagramFacebook

Paul Cunningham, Political Correspondent, discusses news that the unpublished Children's Health Ireland report into concerns at one of its hospitals is to be referred to Gardai.

Martin Wall, Public Policy Correspondent with The Irish Times, joined Newstalk Breakfast to detail a report into waiting list issues and a toxic workplace culture at CHI, now referred to Gardaí.Listen here.

Martin Wall, Public Policy Correspondent with The Irish Times, joined Newstalk Breakfast to detail a report into waiting list issues and a toxic workplace culture at CHI, now referred to Gardaí.Listen here.

Click here to read the episode highlights.   The "Living with Heart" Podcast is brought to you by Chip Dodd Resources (www.chipdodd.com) and The Voice of the Heart Center (vothcenter.com). Contact Bryan Barley for coaching at bryan@vothcenter.com.  God has created “woman” with extraordinary gifts. These gifts that need to be encouraged and  expanded. Women have for centuries been minimized and diminished, sometimes mistakenly using God as the “reason” and “right” to do so.   A man has a responsibility to honor his spouse with encouragement, and with the security that  supports the expansion of her gifts.   Conclusive Main Points of “Understanding a Woman's Heart,” Episodes #63-#69 before sharing the importance of the Hebrew word Ezer, which is used to refer to  women in the Bible  The Need to Listen:  A great sadness in many marriages is that the man actually doesn't truly listen. So often, he is so  “busy” attempting to “prove” himself, “earn” love through performance, and mistakenly  equating being respected with actually being controlling, that he ends up being responsible FOR her rather than response-able TO her.  Episodes #32 and Episode #43.    The man often believes that:  If she has feelings, he has to fix them, rather than listen to them.  If she is in a “mood” or thinking “negatively,” he has to change it, rather than be curious  about her.  If she is behaving in ways that he doesn't understand, he has to stop it, rather than  question her to find out more.  If he is going to be emotionally connected to her and get his own needs met, he must  “read her mind,” which discounts actually listening to what she is saying, rather than  simply being humble enough to believe what she is saying.  Suppression of Expression = Depressing the Heart  If the man doesn't learn the “art” of listening to the woman (Episode #68 and Episode #69) he will be participating in suppressing the person that God created to be fully alive. The “fruit” produced by a woman who is fully alive, will be diminished.  “You are on earth. There is no cure for that.” Samuel Beckett:  Regardless of the mistakes that all humans make in relationship, we are inevitably and  inextricably created for relationship and its benefits. Mistakes and pain in relationship are  always going to be part and parcel of marriage. Each person must be able to relate to suffering and what it is like to be a human being on this earth. Each person must develop great tolerance  for being imperfect. This side of heaven, there is no perfect.   Click here to continue reading the episode highlights.

Allah Ta'ala is referred to as “The First Beloved” - meaning love for Him comes first. What is the reason for this? Why is love for Allah stronger than love for anyone else? And why is it the first love?What has the Imam explained regarding this in the Ikhwan us Safa? What makes love for Allah truly right and valid? What is the pinnacle of sincerity in love?Syedna Taher Fakhruddin TUS answers these questions in this Majlis, the 82nd in the Majalis al Hikma series.Watch in English: https://youtu.be/5sRoxsV5vy4Watch in Dawat ni Zabaan: https://youtu.be/NK_zw-IaWecWatch in Arabic: https://youtu.be/fuCExZigYE8Questions can be asked by email to info@fatemidawat.com

Hannah, a retread, has built a strong program, shaped by the hard-earned wisdom gained through the pain of picking up a drink after the freedom of sobriety. With vulnerable honesty, she shares her journey in a way that draws you in and has you rooting for her. Today, she does this deal on the daily.Sobriety Date: 9/26/2022 Quotes“I fell in love with the freedom that AA gives me.”“Just pray and ask just for the willingness to try something new.”Referred by: Sara A. (Episode #211)InstagramFacebook

If so most likely you're a part of a relationship trend taking over TikTok at the moment

Have you ever found yourself standing in front of the pantry during a stressful moment, reaching for something sweet, salty, or crunchy—just to take the edge off? If so, you're not alone. In this episode of the Better Than Before Breast Cancer podcast, I open up about my own experience with emotional eating during cancer recovery and share gentle, compassionate strategies to help you understand and shift this pattern—without guilt or shame. We'll explore: -How cortisol (your stress hormone) drives cravings -What emotional triggers might be signaling -How to respond to your body's needs with love and presence You'll learn mindful, doable ways to support yourself when stress eating feels like the only option, plus calming alternatives that nourish both body and soul. Whether you're fresh out of treatment or navigating long-term survivorship, this episode is a supportive space for reflection, kindness, and taking small steps toward healing.  

Summer might mean slower class counts and more beach days—but your Google visibility should still be working hard for you.In this quick, actionable episode, I'm sharing 5 simple ways to give your Google Business Profile and website a refresh that builds trust, improves SEO, and keeps new clients walking through your doors (even if your current ones are pausing for the season).Inside the episode:✅ The one photo mistake that could be costing you clicks ✅ Why your business name might be confusing Google—and how to fix it✅ What to do right now if a client says they're taking a break ✅ The review tip that boosts both SEO and conversions ✅ How to audit your website pages for maximum trust-building powerIf you want your studio to be the only option in town—this episode is your summer checklist.

With 25 yrs of sobriety Lorrie lives and breathes the AA way. She's all about taking action, practicing the principles, and guiding others with grace and love. With strong values and a heart for sponsorship, she's proof that recovery isn't just about staying sober—it's about thriving and lifting others up along the way.Sobriety Date: 11/28/1999Quotes “I have a selfish disease that demands a selfless cure. That means we work an altruistic plane, that means we get closer to god when we're serving others.”“Prayer and mediation are not optional, that's how you're going to stay centered and emotionally sober.”Referred by: Sara A. (Episode #211)InstagramFacebook

Follow along and subscribe/rate/review at https://www.briancovey.com/podcast/Struggling to get referrals? Wondering why your network isn't converting into real opportunities? Asking yourself why you're not top of mind when people need someone with your expertise?In this solo episode of The Competitive Edge, Brian Covey unpacks a powerful shift in mindset: success today isn't just about who you know—it's about who knows you, trusts you, and is willing to refer you when you're not in the room.Brian shares real stories and practical strategies on how to build a personal brand that stands out, demonstrate value with results, and grow your influence through intentional, trust-based networking. If you're ready to elevate your business and become the go-to in your space, this episode will show you how.

We recently covered the topic of "all killer, no filler" albums, but what about the perfect single side of a record? If the physical time and space limitations of a vinyl LP or a cassette must exist, why not do something compelling? Is it all poppycock...or cockypop?!? You make the call! Our Third Lad for this exploration is frontman/saxophonist/multi-instrumentalist Dan Voznick, aka Alec Tension from underground '80s post-punk band Afterimage. Referred to in the Los Angeles Times as "LA's Joy Division" back in the day, Afterimage created a sound that was hypnotic, skittery and chilly, but is also adventurous, playful and complex. The original lineup of the band (Alec Tension, A Produce, Rich Evac and Holland DeNuzzio) only stayed together for a couple of years and released a scant discography of one single ("Strange Confession"/"The Long Walk") and an EP (Fade In), both in 1981. Those original recordings, plus a generous helping of unreleased demos and live tracks, are now available from Independent Project Records on the new retrospective compilation Faces to Hide. Out now on double LP (available in both black and opaque white), special edition CD and digital formats, Faces to Hide proves as scathing, urgent, taut, angular and gripping as Afterimage's scarce but unforgettable output must have sounded more than forty years ago. Packaged with extensive, career-spanning liner notes by noted journalist Richie Unterberger and previously unseen band photos, Faces to Hide also features Independent Project Records' signature hand letterpress-printed custom design for the vinyl and CD packaging.  Thanks to Josh Mills from It's Alive Media for the introduction and coordination! Proud members of the Pantheon Podcasts network. Learn more about your ad choices. Visit megaphone.fm/adchoices

Michael grew up with a strong “never surrender” mindset, shaped by generations of warriors before him. But it was through a surrender that he achieved victory over alcoholism and addiction. Today, Michael lives a life with tools, purpose and peace. Sobriety Date: 1/20/2023Quotes “There's no cure for this disease, but there's a solution.”“This program is full of paradoxes . . . when I surrendered, I achieved victory; the more I give, the more I get back; my greatest weakness is my greatest strength.” Referred by: Ryan D. (Episode #220)InstagramFacebook

This week, I'm inviting you behind the curtain for a very real, very personal episode.As we officially wrap our 16th season at the studio, I'm sharing the 16 most powerful lessons I've learned from running a brick-and-mortar business—from the early hustle days to the now. The mistakes, the mindset shifts, the marketing wins, and the moments that changed everything.Inside this episode: ✨ Why hiring before you're ready might be the smartest move you make ✨ The onboarding experience your clients are craving (and how to create it) ✨ What happens when you stop trying to do it all yourself ✨ How to build trust in a world that's short on it ✨ And why your success line might not be what you thought it wasIf you're a studio owner who's ever felt the highs and lows of this business, this one's for you. Whether you're on year 1 or year 21, I hope you walk away feeling seen, inspired, and fired up for what's next.

In Episode 210, Dave starts the show with a quick rundown of Judge Pirro being tapped by Trump before passionately discussing FEMA packages meant for hurricane victims being found at the border and earmarked for illegal immigrants. He also discusses the pausing of funding for NPR and PBS. After that, Dave discusses the investigation and case against Trump hater Letitia James. From there, he dons his tinfoil hat to discuss Klaus Schwab's daughter working with prosecutors before closing the show with an article where the leftists are wishing Joe would just go away. Articles discussed/reviewed: Former Judge And Prosecutor Jeanine Pirro Of Fox News To Serve As Interim D.C. Prosecutor by Brooke Mallory from One America News Letitia James officially under federal criminal investigation for alleged fraud by Cortney Weil from Blaze Media Klaus Schwab's Daughter Confesses: ‘WEF Plans to Murder Billions of People' by Baxter Dmitry from The People's Voice Report: Dems Fume Over Biden's Return to Spotlight by Theodore Bunker from Newsmax Support Dave by visiting his new website at Two Rivers Outfitter for all of your preparedness needs and you can also visit his Etsy shop at DesignsbyDandTStore for fun clothing options. Available for Purchase - Fiction: When Rome Stumbles | Hannibal is at the Gates | By the Dawn's Early Light | Colder Weather | A Time for Reckoning (paperback versions) | Fiction Series (paperback) | Fiction Series (audio) Available for Purchase - Non-Fiction: Preparing to Prepare (electronic/paperback) | Home Remedies (electronic/paperback) | Just a Small Gathering (paperback) | Just a Small Gathering (electronic)

Suicidal-felon turned happy, joyous and free attorney—this is a story of an alcoholic who through the gift of desperation asked for help. Then it was hard work, dedication and a commitment to these principles that brought him the grace of sobriety.Sobriety Date: 4/3/2011Quotes“It's easy to help other people, but it's not always so easy to let other people help you.”“Do what we do here and you will get what we got here.”Referred by: Ryan D. (Episode #220)InstagramFacebook

Referred dental pain can be difficult for practitioners to diagnose without an understanding of the cause of dental pain and how teeth respond to different pathologies. Referred dental pain is caused by real symptoms that need to be treated, and in this episode Dr. David Alleman discusses types of referred dental pain, tips for diagnosing cracks under restorations and procedures for eliminating post-operative sensitivity through biomimetic restorative dentistry.Article referenced in this episode:Brannstrom M. The hydrodynamic theory of dentinal pain: sensation in preparations, caries, and the dentinal crack syndrome. Journal of Endodontics. 1986;12(10):453-457Send us a text2025 training programs:Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastershipIn-Person SLA Workshop Dates:August 8-9October 24-25December 12-13Learn more and register at allemancenter.com/trainingInstagram @david.alleman.dds@davey_alleman_dmd@allemancenter.comYouTube@allemancenter

Welcome back listeners! After a short break, join Jen and Lane once again, today with the hilarious "Three Men in a Boat" by Jerome K. Jerome. This tale is based on a real adventure taken by Jerome on the Thames, and includes all of the chaotic shenanigans that happen when you take a trip with your closest friends. Especially when just about everything seems to go wrong.Referred to in the episode:Jerome K Jerome Society: https://www.jeromekjerome.com/Tom Stoppard's “Three Men In a Boat” (1975) (IMDb Link)Buy the Book:⁠Three Men in a Boat (Bookshop.org paperback)⁠Three Men in a Boat (libro.fm audiobook)⁠⁠⁠⁠⁠⁠Bards Alley Bookshop Website⁠⁠Show Links:Bard's Alley Bookshop Website

Though a well-educated and confident man today, Mark was once consumed by anger and alcohol. Through the honesty in the rooms, and a bit of humility, he began to learn about himself and his place in the world. By living the 12 step principles in all his affairs, Mark discovered peace and purpose – and 35 years of sobriety. Sobriety Date: 2/5/1990 Quotes “Every day I pray, I turn my life over, I say: just let me know what I'm supposed to do and help me do it.”“I learned how to be a friend to people, I learned how to love and to be loved, I learned how to stay sober, I learned how to be a parent.”Referred by: Michael L. (Episode #248)InstagramFacebook

Send us a textStruggling to grow your fitness studio despite investing in expensive lead generation tactics? You're not alone. Many studio owners find themselves trapped in a cycle of diminishing returns from traditional marketing—paying for ads, making cold calls, and running endless promotions with little sustainable momentum to show for it.The solution isn't finding the next marketing trick; it's leveraging what you already have. Your existing clients represent an untapped growth engine waiting to be activated. In this candid episode, I share my personal journey of discovering how a structured referral system transformed my business after experiencing the frustration of inconsistent growth and client churn.At the heart of a successful referral strategy lies a systematic approach that combines review generation with incentivized referrals. By implementing a three-month checkpoint that requests reviews and encourages referrals with meaningful rewards, you create a dual-purpose system that builds your online reputation while generating high-quality leads. These tools need not be complicated—simple email and text automations can drive significant results when implemented consistently.The beauty of referrals extends beyond just acquiring new clients. Referred members arrive with pre-established trust, shortening your sales cycle dramatically. They typically match the values of your existing community, improving retention and creating a more cohesive studio culture. And perhaps most importantly, this approach concentrates your growth within your critical 3-5 mile service radius, creating neighborhood momentum that becomes increasingly difficult for competitors to disrupt. Ready to transform your existing clients into your studio's secret weapon for sustainable growth?Support the showSubscribe to our Newsletter: https://creatitive.com/fit-to-grit-cast/

AP's Lisa Dwyer reports on new efforts to collect on Student loans that are in default.

Chuck was just 17 when his parents dragged him to his first AA meeting. After years passed and he earned his 8th DUI (2 in one day) he found AA again and sat all the way down. Today, Chuck works his program like his life depends on it—because he knows, without a doubt, that it does.Sobriety Date: 9/11/1991Quotes “No one ever comes to AA by accident; I belong here, this is where I need to be.”“Come in the door and sit all the way down.”Referred by: Keep Coming Back listenerInstagramFacebook

Find the complete show notes here:  https://watwm.podbean.com/.  In this episode of the Woman at the Well Ministries podcast, join Kim Miller and Erika Klose in a “conversation as we walk with Jesus.” In today's “conversation” we continue a series on the book of Proverbs. In today's podcast, we discuss the lessons learned in Proverbs 31. Scriptures Mentioned in this Episode Proverbs 31 – Discussed extensively throughout the podcast, describing the virtuous woman. www.biblegateway.com/passage/?search=Proverbs+31&version=KJV  Jeremiah 33:3 – Quoted: “Call unto me, and I will answer thee, and show thee great and mighty things, which thou knowest not.” www.biblegateway.com/passage/?search=Jeremiah+33%3A3&version=KJV  1 Thessalonians 5:22 – Referenced in the discussion about abstaining from all appearance of evil. www.biblegateway.com/passage/?search=1+Thessalonians+5%3A22&version=KJV  1 Peter 5:6 – Mentioned in the context of humility: “Humble yourselves therefore under the mighty hand of God, that he may exalt you in due time.” www.biblegateway.com/passage/?search=1+Peter+5%3A6&version=KJV  Matthew 14:29-30 – Referred to in the story of Peter walking on water and then sinking when he looked away from Jesus. www.biblegateway.com/passage/?search=Matthew+14%3A29-30&version=KJV  Luke 6:38 – Referenced in the conversation about giving and receiving blessings. www.biblegateway.com/passage/?search=Luke+6%3A38&version=KJV  Isaiah 64:4 / 1 Corinthians 2:9 – Referenced in: “Eye hath not seen, nor ear heard...” (the quote blends elements from both). www.biblegateway.com/passage/?search=Isaiah+64%3A4&version=KJV and www.biblegateway.com/passage/?search=1+Corinthians+2%3A9&version=KJV  Did you enjoy this podcast? Post a review and share it! If you enjoyed tuning into this podcast, then do not hesitate to write a review. You can listen to us on all major podcasting platforms like Apple Podcasts,  Spotify,  Google Podcasts,  YouTube, and Podbean. Check out Kim's latest Bible Bit book on Amazon! Do you want to bring Kim Miller to your church, upcoming retreat, or conference? Contact us! This podcast is brought to you by Woman at the Well Ministries and is supported by our faithful listeners. To support this podcast, please visit our support page.  

Cristy started drinking late but quickly went all-in and made up for lost time. After an intervention and a few good choices, she unexpectedly found herself sober. Today, she's living as her true self, discovered through sobriety.Sobriety Date: 8/22/2013Quotes “It turns out that I had no control over my drinking.”“I had no idea that it was the first drink that got me so drunk.”Referred by: Anna (Episode #89)InstagramFacebook

Elizabeth was born at Greenwich in 1533 and was the daughter of the Tudor King Henry VIII by his second wife Anne Boleyn. Elizabeth succeeded her half-sister Queen Mary to the throne in 1558. Elizabeth’s long reign was one of the most brilliant in English history. Referred to as The Golden Age, it is remembered for the defeat of the Spanish Armada in 1588, the execution of Mary, Queen of Scots the year before, and for many important voyages of exploration and discovery to North America. Known as the Virgin Queen, the colony of Virginia along the eastern coast was named after her. Check out the YouTube version of this episode at https://youtu.be/sd0_d0Aaf-U which has accompanying visuals including maps, charts, timelines, photos, illustrations, and diagrams. England History books available at https://amzn.to/4526W5n British Kings & Queens books available at https://amzn.to/430VOo0 Age of Discovery books available at https://amzn.to/3ZYOhnK Age of Exploration books available at https://amzn.to/403Wcjx ENJOY Ad-Free content, Bonus episodes, and Extra materials when joining our growing community on https://patreon.com/markvinet SUPPORT this channel by purchasing any product on Amazon using this FREE entry LINK https://amzn.to/3POlrUD (Amazon gives us credit at NO extra charge to you). Mark Vinet's HISTORICAL JESUS podcast is available at https://parthenonpodcast.com/historical-jesus Mark's TIMELINE video channel: https://youtube.com/c/TIMELINE_MarkVinet Website: https://markvinet.com/podcast Facebook: https://www.facebook.com/mark.vinet.9 Twitter: https://twitter.com/HistoricalJesu Instagram: https://www.instagram.com/denarynovels Mark's Books: https://amzn.to/3k8qrGM Song Excerpt Credit: Greensleeves by R. McAllister. Audio excerpt reproduced under the Fair Use (Fair Dealings) Legal Doctrine for purposes such as criticism, comment, teaching, education, scholarship, research and news reporting.See omnystudio.com/listener for privacy information.

It was a moment of grace that brought Kent to his first AA meeting, and it was a man reaching out his hand and asking a simple question that kept him here – that was almost 15 years ago. Today, Kent does the deal: the steps, the service and the fellowship – and his reward is peace of mind.Sobriety Date: 5/27/2010 Quotes “I have no defense over what's going to happen when I put alcohol in my body.”      “I reached a point where I realized that I needed to make this a priority consistently, and when I did I immediately saw dividends.” Referred by: Michael L. (Episode #248)InstagramFacebook

Wayne grew up in an atmosphere of drugs and alcohol, beginning his drinking at 8 and selling drugs at 11 yrs old. This led to 20 years of being on probation, parole or locked up. His is a story of hope – it was with the steps, fellowship and service of AA that brought Wayne to more than 30 years of peace and sobriety.  Sobriety Date: 12/7/1992Quotes “Alcoholics Anonymous is a beautiful way to live.”“If you go to enough meetings, you're gonna hear what you need to hear.”“The whole thing about Alcoholics Anonymous is you gotta get busy, stay busy, then you get other people busy.”Referred by: Marlys S. (Episode #253) InstagramFacebook

Unlock the secrets to not just making money, but creating wealth. Join us on this transformative episode of The Flourishing Entrepreneur Podcast as we dive deep with Nikki Nash, a marketing genius and client enrollment expert who has mastered the art of increasing wealth. Whether you're speaking on stage or looking to elevate your financial game, Nikki's insights are invaluable. Key Takeaways: Mastering Money-Making as a Speaker: Nikki shares how moving beyond just getting paid to speak is crucial. It's about leveraging your stage presence to create ongoing revenue streams and build substantial wealth. Strategic Engagement for Financial Success: Learn how Nikki turned typical speaking engagements into opportunities for substantial income, not just through direct payments but by engaging audiences in a way that leads to long-term business relationships and growth. Preparation is Key: Discover Nikki's approach to preparing for talks that not only deliver value but also strategically set the stage for lucrative opportunities post-presentation. The Power of Connection: Nikki emphasizes the importance of genuinely connecting with your audience, understanding their needs, and aligning your message to address these needs, which significantly increases the impact and financial returns of your engagements. Insightful Moment: Nikki recounts a pivotal speaking event where she realized the importance of aligning her presentation with audience expectations and business goals. She stresses that "What you focus on grows," urging speakers to concentrate not just on the content but on the potential outcomes of their speeches.   About Nikki Nash Nikki Nash is a Hay House author, motivational speaker, podcast host, and client enrollment expert. Referred to as a “marketing genius” by clients and peers, Nikki uses her 15+ years of experience to help service based businesses attract and retain their dream clients. Nikki's methodologies and frameworks have helped clients fill group programs, triple their revenue, double their profits, and so much more. She believes that entrepreneurship can be a vehicle for generational wealth and strives to help close the gender and racial wealth gap in America.   Connect with Nikki Nash Instagram - https://www.instagram.com/nikkinashofficial/ LinkedIn - https://www.linkedin.com/in/nikkinash/ Facebook - https://www.facebook.com/NikkiNashOfficial/   About Aleya Harris Aleya Harris is the spark for your spark™. A trailblazer in purpose-driven story crafting, she is a marketing executive and ex-Google Vendor Partner who brings her dynamic experience to her role as the CEO of The Evolution Collective Inc. Aleya is an international award-winning speaker, the founder and lead trainer of Spark the Stage ™, and the host of the award-winning Flourishing Entrepreneur Podcast. She is also the author of the bestselling book Spark the Stage: Master the Art of Professional Speaking and Authentic Storytelling to Captivate, Inspire, and Transform Your Audience. Her unique approach as a Strategic Storytelling Consultant has revolutionized the way businesses communicate, transforming workplace cultures and market positioning. With her dynamic energy and proven methodologies, Aleya guides clients to unlock their potential, articulate their radically authentic stories, and achieve unparalleled success.   Watch the Free Masterclass Join Aleya's free masterclass "Build Unstoppable Confidence and Book Speaking Gigs Without Feeling Like an Impostor." Discover the proven framework to own your story, captivate audiences, and land speaking gigs—even if you've doubted your worth or have no experience on stage. Register at https://www.aleyaharris.com/masterclass    Buy the Book Aleya's bestselling book will help you become a more confident and authentic professional public speaker. Buy Spark the Stage: Master the Art of Professional Speaking and Authentic Storytelling to Captivate, Inspire & Transform Your Audience on Amazon or anywhere books are sold. Buy the Book: https://a.co/d/1T4EoJ7    Sign Up for Spark the Stage™ Spark the Stage™ is an online course and 12-month group coaching program that helps entrepreneurs and executives become radically authentic professional public speakers who can confidently deliver a compelling Radical Spark Signature Talk™ from the stage. Enroll at https://www.aleyaharris.com/spark    Work with Aleya to Craft a Better Story An unclear strategy, confusing brand, or undefined workplace culture will repel ideal clients, visibility opportunities, and career-making connections. The Evolution Collective Inc. transforms disconnected teams and overwhelmed leaders into thriving, inclusive cultures through Radically Authentic Strategic Storytelling. Schedule a call at https://www.evolutioncollective.com/    Book Aleya to Speak To book Aleya to edutain your audience at your next event as a keynote speaker, please visit www.aleyaharris.com/speaking to check out her speaking topics, reels, and why.  Click "Schedule a Call" to secure the speaker with "that something new" you've been looking for.   Connect with Aleya Harris Instagram: https://www.instagram.com/aleyaharris/  LinkedIn: https://www.linkedin.com/in/aleyaharris/  TikTok: https://www.tiktok.com/@thealeyaharris 

Referred to by Outside Magazine as "one of the world's most respected chroniclers of Everest," Alan Arnette is not only a journalist, but also a climber. At age 38, Alan discovered a passion for climbing and completed over 37 expeditions, including Mt. Everest and K2. Living in Colorado, he has summited all 58 of the 14,000-foot mountains over 225 times. In anticipation of the 2025 Mt Everest climbing season, Alan joins Sam and Adrian on episode 25 of the Duffel Shuffle Podcast! Alan talks about his life, entering the world of climbing and mountaineering as an adult. - Alan shares his path to climbing, and how he shifted his life at age 38 and became quickly embedded into the world of mountaineering. - Alan talks about some of his experiences on expeditions, including Mt Everest and K2 expeditions that were transformative in his life as a climber. - Alan highlights the importance of having a purpose in climbing, and shares his connection to Alzheimer's advocacy after watching his mom, Ida, decline. Today, he advocates for Alzheimer's patients and caregivers through his mountain climbing.You can learn more about Alan through his blog, https://www.alanarnette.com/ and his Instagram, @arnette.alan. Alan's coaching services can be followed at https://summitcoach.org/. Follow our podcast on Instagram @duffelshufflepodcast where you can learn more about us and our guests. Visit our website at www.duffelshufflepodcast.com and join our mailing list. The Duffel Shuffle Podcast is supported by Alpenglow Expeditions, an internationally renowned mountain guide service based in Lake Tahoe, California. Visit www.alpenglowexpeditions.com or follow @alpenglowexpeditions on Instagram to learn more.

Running a brick-and-mortar business means juggling all the things—marketing, sales, customer service… oh, and actually delivering your products and services like a boss. But what if you didn't have to do it all alone? Enter brand ambassadors—your secret weapon for getting your biz in front of more people without adding to your already overflowing to-do list.In this episode, we're breaking down three game-changing ways to use brand ambassadors to grow your local business (without cringing at the word "influencer"). Whether it's showcasing loyal customers, partnering with a community rockstar, or tapping into local networks like your chamber of commerce—this is a strategy you don't want to sleep on. Plus, I've got a free Brand Ambassador Checklist so you can take action right away. Ready to work smarter, not harder? Hit play!

David's first drink was at 14 and a treatment center at 15. He struggled while sober in the rooms which led to relapses and suicidal thoughts. But it was this history that gave David the ability to recognize and support suffering sober AA members. David works his program every single day—it's a commitment to himself and others. Mentioned in the share: Tom B. Emotional Sobriety talkSobriety Date: 12/22/22Quotes “That's the process of AA . . . it's designed not to fail.”“I needed long-term relief, I needed to be recovered.”Referred by: Bert W. (Episode #228)InstagramFacebook

On this episode of ¡Qué Spooky! Podcast, we remind you not to put those winter clothes away just yet, 'cause winter is still holding on.Kevin takes us to Vietnam in this episode! For decades, locals, visitors, hikers, and veterans from the Vietnam war have reported very strange sightings of unidentified creatures in the Sơn Ɖoòng Cave in the Quảng Bình province of north central Vietnam. Referred to as "devil creatures," they are definitely something you don't want to stumble upon in the jungle. These unidentified creatures have been described as towering 7 to 8 feet tall with scaly skin, claws, snake-like eyes, and able to emit an eerie glow. Join us to hear more about this cryptid.Email us any personal paranormal and true crime encounters and/or suggestions at: quespookypodcast@gmail.com Follow us on Instagram, TikTok, and YouTube: @quespookypodcast

Marlys found sobriety at 25, and despite a relapse, she returned to and fell in love with Alcoholics Anonymous. Since getting sober in 2018, she has endured the loss of her son yet stayed strong in her recovery. She is a testament to the power of the fellowship.Sobriety Date: 5/6/2018 Quotes “I accepted the fact that I am an alcoholic and this is the road I'm going to travel . . . and it worked.”“This program has given me a long-term solution. Alcohol gave me a short-term solution to a long-term problem.”Referred by: KCB ListenerInstagramFacebook

Drinking and driving and taking a life at 18 years old, James had a long road to forgive himself, but he made his way there. James's gentle and honest recounting of his experience transforms into a touching story, offering profound insights and wisdom.Sobriety Date: 9/25/2018Quotes “I don't have to be right today; I just have to be sober and loving and forgiving.”“That's where you're blocking the spirit of God, when you're thinking there's nothing wrong with you.”“That's the secret to the program, accepting that you're really broken and need help.”Referred by: KCB Listener InstagramFacebook

War Room Congressional Hearing On Sanctuary Cities Pops Off After Democrat Mayors Are Referred To DOJ For Criminal Prosecution

Send us a textChange happens!  Are you ready for what may appear on your horizon in midlife and beyond?  Eileen Caroscio will present 3 key strategic ways to navigate those changes and bounce forward from the book, Midlife New Life: Living Consciously in Midlife and Beyond.Eileen's father died suddenly when she was a teenager. This made her realize that life could change unexpectedly and steered her into a fulfilling career as a registered nurse. She helped people adjust to health status changes and achieve next-level health goals. Her deep interest in supporting people's total well-being and their potential for moving forward beyond change and uncertainty expanded into helping individuals navigate the challenges and opportunities of the second half of life.Being a nurse, consultant, and coach gives Eileen a unique perspective on presenting ways to address changes and challenges that can show up anytime. The program will provide you with a new perspective on resilience and an easy plan to bounce forward.In this program, you'll discover how to:Look at resilience in a new wayIdentify and build upon the 4 main building blocks of resilienceNavigate typical transitions of midlife and beyondIncorporate resilience tips from those we interviewed for the bookCreate your own personal resilience M.A.P to bounce forward About Eileen Caroscio:Eileen Caroscio is a multi-certified coach, consultant, and a registered nurse. She is passionately dedicated to helping individuals achieve their goals and live their best life, especially those in midlife and beyond. Referred to as the "midlife muse," she engages you beyond your titles, jobs, and formalities to get to the core of what will enrich your midlife, making it more resilient, meaningful and magical.Midlife New Life: Living Consciously in Midlife and Beyond is the Amazon bestselling book she co-authored with Sandy Demarest and Paul Ward. The book supports the value of giving conscious thought to how you want to live out your second half of life. It emphasizes the importance of developing a plan for having more joy and resilience to bounce forward into an enriched future.Eileen holds a baccalaureate of science degree in nursing from Catholic University and a Master of Science degree in Nursing from Mary Mount University, totaling over 35 years of diverse experience. Eileen adds to her nursing, 19 years' experience as a consultant and coach for life transitions.In her free time, Eileen can be found in nature walking, hiking or kayaking. She has a fondness for foxes and can often be found with her camera capturing their antics and escapades.Get in touch with Eileen Caroscio:Buy Ellen's book:  https://revolutionizeretirement.com/caroscio Visit Ellen's website: https://passagewayscoaching.net/ Download Eileen's handout: https://revolutionizeretirement.com/carosciohandout Sign up for 4 Building Blocks of Resilience Focused on Well-being Mindset PDF https://passagewayscoaching.net/ What to do next: Click to grab our free guide, 10 Key Issues to Consider as You Explore Your Retirement Transition Please leave a review at Apple Podcasts. Join our Revolutionize Your Retirement group on Facebook.

Ebby T was an old drinking friend of Bill W and later his sponsor in AA. He is credited with introducing Bill to the initial principles that AA would soon develop, such as one alcoholic talking to another. If you would like to learn more about Ebby there is a very good book about him "Ebby: The Man Who Sponsored Bill W." He sparked the creation of AA but was unable to maintain long term sobriety. Bill always called Ebby his "sponsor," and even though he had returned to drinking, Bill looked after his friend's welfare for the rest of his life. Ebby struggled on and off with sobriety over the years, and ultimately died sober in 1966. This is the best quality recording I have found of Ebby and I have cleaned it up as much as I can. He is speaking in 1958 in Memphis TN. Support Sober Cast: https://sobercast.com/donate Email: sobercast@gmail.com Event List: https://scast.us/event Roundup, retreat, convention or workshop coming up? List the event on the Sober Cast website. Visit the link above and look for "Submit Your Event" in the blue box. Sober Cast has 2700+ episodes available, visit SoberCast.com to access all the episodes where you can easily find topics or specific speakers using tags or search. https://sobercast.com

Zak shares his life growing up with awesome parents, his amazing marriage, awesome kids, outdoors, hunting, wakeboarding, photography and so much more! Referred by a mutual friend, Billy Botieff….

Without ever having a driver's license, Garet gathered 168 traffic tickets. He was in the revolving door of prison and had no idea how to stop using and drinking. In this story of recovery, you'll hear about the game changing hug that gave Garet just enough hope to do the necessary work.  Sobriety Date: 3/17/2013Quotes “I get to be in that one place that I never was—and that was this moment.”  “I just love participating in the AA way of life.”Referred by: KeepComingBack.net listener InstagramFacebook

Title: What Does It Take to Be the Most Referred Professional in Your Community? Host: Michael J. Maher Guest: Scott Edwards Description: What if you could create an event so powerful that it generates 815 referrals? In this episode of Referrals Podcast, Michael J. Maher sits down with Scott Edwards, a highly referred lender in Santa Clarita, CA, to uncover the strategies behind his incredible success. Scott shares the secrets to hosting impactful events, building strong relationships, and leveraging the (7L) system to become the go-to professional in his community. Whether you're a lender, real estate agent, or business owner, this episode will provide actionable insights on how to attract more referrals and create lasting connections. Plus you will also learn: - How Scott's last movie event generated 815 total referrals - The power of hosting client and community events to build relationships - Which (7L) strategies Scott consistently applies to grow his business - How to follow up effectively after an event to maximize referrals - The mindset shift needed to become the most referred professional in your community (7L) Referral Strategies and Podcast Topics: Events, Rituals Special Offer: Want to learn how to host your own referral-generating events? Join our upcoming Event Mastery class. Details are at www.EventMastery.com

Join the Behind the Knife Bariatric Surgery Team as they kick off 2025 with a crucial discussion on pediatric and adolescent bariatric surgery. Drs. Matt Martin, Adrian Dan and Katherine Cironi delve into the latest ASMBS guidelines, comparing long-term outcomes of gastric bypass and sleeve gastrectomy in adolescents versus adults. They explore key comorbidities, including type 2 diabetes, hypertension, and orthopedic issues, and emphasize the importance of early intervention. This episode also tackles the complex ethical considerations surrounding surgery in this vulnerable population, including consent, multidisciplinary care, and the evolving role of medical therapies like GLP-1 agonists. Show Hosts: - Matthew Martin - Adrian Dan - Katherine Cironi Learning Objectives:  ·  Identify the current ASMBS guidelines for pediatric and adolescent bariatric surgery, including BMI thresholds and associated comorbidities.  ·  Describe common comorbidities seen in the pediatric population eligible for bariatric surgery, such as type 2 diabetes, hypertension, and orthopedic issues.  ·  Compare and contrast long-term outcomes of bariatric surgery (gastric bypass and sleeve gastrectomy) in adolescents and adults, including remission rates of comorbidities and reoperation rates.  ·  Discuss the importance of a multidisciplinary approach, including psychological and ethical considerations, when evaluating adolescent patients for bariatric surgery.  ·  Explain the ethical framework used in evaluating adolescents for bariatric surgery, including consent/assent, parental involvement, and addressing potential coercion.  ·  Recognize the evolving role of medical management (e.g., GLP-1 agonists) in conjunction with or as an alternative to bariatric surgery in adolescents. Article #1: Inge 2019 – Five-year outcomes of gastric bypass in adolescents as compared with adults https://pubmed.ncbi.nlm.nih.gov/31461610/ - The cumulative effect of sustained severe obesity (BMI >35) from adolescence into adulthood increases the likelihood of diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitations, and venous edema in legs/feet (when compared to adults that did not report severe obesity in adolescence) - American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for adolescents who should be considered for bariatric surgery: BMI is ≥35 with a co-morbidity or if they have a BMI ≥40 (class 3 obesity, 140% of the 95th percentile) - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LAB) and LABS (adults) databases to evaluate the outcomes of adolescents vs. adults who underwent bariatric surgery Roux-en-Y gastric bypass (2006-2009) - 161 adolescents (13-19 at the time of surgery) with severe obesity (BMI>35) vs 396 adults (25-50 years old at the time of surgery) who have remained obese (BMI>30) since adolescence  - Both groups had the gastric bypass procedure as their primary bariatric operation  - Both groups had unadjusted similar demographics, however, BMI was higher in adolescence (54) when compared to adults (51)  - Results were analyzed using linear mixed and Poisson mixed models to analyze weight and coexisting conditions - After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes and hypertension - Increased likelihood of remission of diabetes due to the shorter duration of diabetes, lower baseline glycated Hgb, less use of medications, and increased baseline C-peptide levels  - Increased vascular stiffness in adults along with a longer duration of hypertension make the cessation of hypertension less responsive with surgery in adults  - No significant difference in percent weight changes between adolescents and adults 5 years after surgery  - Both adults and adolescent groups had decreased rates of hypertriglyceridemia and low HDL levels, albeit not significantly different when comparing the two groups  - Of note, the rate of abdominal reoperations was significantly higher among adolescents (20%) than among adults (16%) with cholecystectomy representing nearly half the procedures in both groups - Limitations - At baseline, adults had a high prevalence of both diabetes and hypertension - only 14% of adolescents had diabetes vs 31% of adults  - Only 30% of adolescents had hypertension vs 61% of adults  Article #2: Ryder 2024 – Ten-year outcomes after bariatric surgery in adolescents  https://pubmed.ncbi.nlm.nih.gov/39476348/ - The goal is to discuss the long-term durability of weight loss and remission of coexisting conditions in adolescents after bariatric surgery  - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LABS) database to evaluate the 10-year outcomes in adolescents who underwent gastric bypass or sleeve gastrectomy  - 260 adolescents with an average age of 17 years old at the time of surgery (ages ranged from 13-19 years old) - 161 adolescents underwent gastric bypass, 99 adolescents underwent sleeve gastrectomy  - Results were analyzed using propensity score-adjusted linear and generalized mixed models  - At 10 years, the average BMI had decreased significantly with both groups experiencing about a 20% change in BMI on average - To assess comorbidities, both groups were analyzed together -  55% of patients who had DM2 at baseline, were in remission at 10 years - 57% of patients who had HTN at baseline, were in remission at 10 years -  54% of patients who had dyslipidemia at baseline, were in remission at 10 years - Limitations  - Neither of these studies compare surgery to medical management. GLP-1s have shown promise for weight loss management but we need more data in terms of long-term outcomes in co-morbidities like diabetes, hypertension, dyslipidemia  - Highlighted Outcomes  - Metabolic bariatric surgery is quite effective in the adolescent population  - Adolescents tend to have weight loss that is similar to that of adults and improved resolution of comorbid conditions (DM2, HTN, dyslipidemia) Article #3: Moore 2020 – Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation https://pubmed.ncbi.nlm.nih.gov/33191162/ - The purpose of this paper is to describe the ethical framework that supports the use of metabolic & bariatric surgery (MBS) on the principle of justice, and how providers can conduct a thorough evaluation of patients presenting for these surgeries - Highlights adolescents with intellectual and developmental disabilities (IDD) and preadolescent children who pose more ethical questions before considering surgery  - This article utilizes the bariatric surgery center at one children's hospital and the institution's ethics consult service to develop an ethical framework to evaluate pediatric patients seeking bariatric surgery – using the national ASMBS guidelines  - This ethical framework utilized 4 central ethical questions 1.     Should any patients be automatically excluded from evaluation for MBS? 2.     How should it be determined that the benefits of MBS outweigh the risks? 3.     How do we ensure the patient fully understands and is capable of cooperating with the surgery and follow-up care? 4.     How do we make sure the decision to have surgery is truly voluntary, and not coerced by family or others? - Results: this ethical framework was discussed in depth in two case studies  - Overview of framework: an ethical question would arise from the bariatric team they would review & apply the ethical framework. The question is either resolved by the bariatric team OR ethics consult, continue pre-operative workup vs no surgery - Case 1: 17M (BMI 42) with a history of autism spectrum disorder, pre-DM, depression with behavior challenges, HTN, dyslipidemia. Testing at school demonstrates intellectual functioning at a fourth-grade level. Pt lives with mom and 11-year-old sister. Mom endorses food insecurity (on supplemental nutrition assistance benefits) and struggles with her son's large intake of food.  1.     Co-morbidities should not be exclusionary, but pt should undergo a comprehensive psychosocial evaluation with attention to family dynamics and support and the patient's decision-making capacity  2.     Discuss benefits vs risks. Benefits – decreased progression of DM2, HTN, hyperlipidemia, cardiometabolic dx. Risks – gastric leak, infection, bleeding, dumping syndrome, etc.  3.     Can assess decision-making capacity with the surgical team or if need be other teams. In this case, the pt had limited decision-making capacity  - His level of understanding remained stable during the pre-op visits, and he gave assent to surgery - The mom identified a second source of support (extended family) - The team talked to both the patient and mother alone and then, together, found that the patient developed an independent desire for surgery, and thus moved forward.  - Case 2: 8F (BMI 50) with a history of mod OSA, L slipped capital femoral epiphysis s/p surgical stabilization (6 mos prior). The patient is neurotypical & excels in school, and lives with mom & dad. Referred by mom & dad (mom with a recent history of sleeve gastrectomy).  1.     An 8-year-old should not be discriminated against based solely on age, but the patient should be offered more conservative/less invasive options before OR.  a.     In this case, the family had not yet been offered these nonsurgical approaches (structured weight management program, physical support, dietician) 2.     Discuss benefits vs risks. Benefits – preventing progression of hip disease, improvement of OSA, decreased risk of cardiometabolic dx. Risks – anatomic/infectious/nutrition risks  3.     Decision-making capacity was assessed. Found that the parents were more advocating for the surgery saying she has a poor quality of life physically and socially. When the patient was separated from her parents, she said she could lose weight if she had healthier foods at home and someone to exercise with. The patient had decision-making capacity & did not assent to surgery.  4.     When the ethics team interviewed the patient and parents, the parents had a strong preference toward surgery vs patient was scared of surgery and wanted to try other approaches first  a.      Decided that the child's dissent outweighed the medical necessity for surgery and that there were conservative treatment options still available to try  - Highlighted Outcomes  - ASMBS guidelines give us good direction on who qualifies for surgery and emphasize an interdisciplinary approach to decision-making. The decision to pursue surgery should always weigh the benefits and risks and should be made collaboratively with the patient, family, and care team ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

In this funny and heartfelt tale, Fernando shares the horrors of addiction and the joys of sobriety. He very much disliked everything about AA when he arrived, but he stuck around and over 30 years later, he lives a life beyond his wildest dreams.Sobriety Date: 8/21/1991Quotes “King Alcohol found me, picked me up and took me away.”“I don't know what my higher power is, but I know it when I feel it.”Referred by: Sean J. (Vol. 199)InstagramFacebook

Ali successfully paid off $17,000 in debt in just five years through Money Management International's (MMI) debt management plan. Ali shared how a job loss led him to accumulate debt across nine credit cards, with the highest balance reaching $7,000. Referred to MMI by one of his credit card companies, Barclays, Ali found solace and clarity through MMI's debt counseling services. You will learn about the pivotal role of debt consolidation in Ali's journey, as he described how MMI helped him condense his debt into one manageable payment, thus simplifying his financial obligations and making real progress on his balances. We also highlight the psychological benefits of debt management, as Ali explained how having a structured plan reduced his stress and restored his financial confidence. Additionally, Ali provided valuable advice for those struggling with debt, emphasizing the importance of recognizing when professional help is needed to effectively manage and pay off debts. Key insights: (00:00) Ali's story of consolidating Credit Cards (04:29) Debt consolidation and financial relief (08:40) The liberating feeling of being Debt Free

Sara found sobriety at the age of 25, and notates her first addiction as reading. The escape she found in books she replaced at 11 yrs old with alcohol, and then drugs. With complete transparency, Sara shares the endless possibilities sobriety brings and the many lessons she continues to learn. Sobriety Date: 3/15/2016Quotes “The possibilities are truly endless to what can happen in this life as long as I stay sober.”“It's just one foot in front of the other until the fog lifts.”Referred by: Anonymous speakerInstagramFacebook