Podcasts about rma

On this episode of The Wholesome Fertility Podcast, I am joined by Dr. Nirali Jain (eggspert_md), a board-certified OB/GYN and reproductive endocrinologist at Reproductive Medical Associates (RMA). Dr. Jain shares her expert insights on fertility preservation for individuals undergoing cancer treatment, a crucial yet often overlooked aspect of reproductive care. We explore what options are available for fertility preservation, including egg and sperm freezing, and why it's so important to initiate these discussions before starting chemotherapy or radiation. Dr. Jain also explains the difference between Letrozole and Clomid, the impact of estrogen-sensitive cancers on IVF treatments, and innovative approaches like random-start cycles and DuoStim protocols. Whether you're facing a cancer diagnosis or simply thinking proactively about your reproductive future, this conversation is filled with knowledge and reassurance. Key Takeaways: Why it's essential to discuss fertility before starting cancer treatment. The role of Letrozole in estrogen-sensitive cancers and fertility preservation. Differences between Letrozole and Clomid, and why Letrozole is often preferred. How new protocols like DuoStim and random-start cycles are improving outcomes. Why fertility preservation is important even for those without a cancer diagnosis. Guest Bio: Dr. Nirali Jain (@eggspert_md) is a board-certified OB/GYN and fertility specialist at Reproductive Medicine Associates (RMA) in Basking Ridge, New Jersey. She earned both her undergraduate degree in neurobiology (with a minor in dance!) and her medical degree from Northwestern University, before completing her residency at Weill Cornell/NYP, where she served as co-Chief Resident, and her fellowship in reproductive endocrinology and infertility at NYU Langone. Deeply passionate about women's health and fertility preservation, Dr. Jain blends the latest research and cutting-edge treatments with compassionate, patient-centered care. Her interests include third-party reproduction and oncofertility, and she is especially passionate about supporting patients navigating fertility preservation through a cancer diagnosis. Outside of the clinic, Dr. Jain is a trained dancer, a dedicated global traveler, and an adventurer working toward hiking all seven continents with her husband. Her diverse experiences, from international medical rotations to personal connections with friends and family navigating infertility, have shaped her into a warm, resourceful, and determined advocate for her patients. Links and Resources: Visit RMA websiteFollow Dr. Nirali Jain on Instagram For more information about Michelle, visit www.michelleoravitz.com To learn more about ancient wisdom and fertility, you can get Michelle's book at: https://www.michelleoravitz.com/thewayoffertility The Wholesome Fertility facebook group is where you can find free resources and support: https://www.facebook.com/groups/2149554308396504/ Instagram: @thewholesomelotusfertility Facebook: https://www.facebook.com/thewholesomelotus/ Disclaimer: The information shared on this podcast is for educational and informational purposes only and is not intended as medical advice. Please consult with your healthcare provider before making any changes to your health or fertility care. --  Transcript:   # TWF-Jain-Nirali (Video) ​[00:00:00]  **Michelle Oravitz:** Welcome to the podcast Jain.  **Dr. Nirali Jain:** Thanks so much for having me **Michelle Oravitz:** Yeah, so. **Michelle Oravitz:** I'm very excited to talk about this topic, which, um, actually you don't really hear a lot of people talking about, which is how to preserve your fertility if you're going through a cancer diagnosis and if you have to go through treatments. 'cause obviously that can impact a lot on fertility. **Michelle Oravitz:** I have, um, seen actually like a colleague of mine go through. And she also preserved her fertility and, and now she has a baby boy. so it's really nice. **Michelle Oravitz:** to **riverside_nirali_jain_raw-video-cfr_michelle_oravitz's _0181:** so nice. **Michelle Oravitz:** So I'd love for you first to introduce yourself and kind Of give us a background on how you got into this work. **Dr. Nirali Jain:** Of course. Um, so I am Dr. Narly Jane. I am, um, an OB GYN by training, and then I did an additional, after completing four years of residency in OB GYN and getting board certified in that, I did an additional training in reproductive endocrinology and [00:01:00] infertility or otherwise known as REI. So now I'm a fertility specialist. **Dr. Nirali Jain:** Um, I trained at Northwestern in Chicago, so I went to undergrad and medical school there. And then, um, home has always been New Jersey for me, so I moved back out east to New Jersey. Um, I did all my training actually in New York City at Cornell for residency and NYU for fellowship. Um, and then moved to the suburbs. **Dr. Nirali Jain:** Um, and now I'm a fertility specialist in, in Basking Ridge at Reproductive Medical Associates.  **Michelle Oravitz:** Very impressive background. That's awesome.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** I'd love to hear just really. About what your process is. If a person has been diagnosed with cancer, like what is the process? What are some of the things that you address if they are trying to preserve fertility, and what are some of the concerns going  **Dr. Nirali Jain:** yeah, yeah. All great questions. So, you know, there's a lot of us, uh, the Reis. Are a very small, [00:02:00] there's a very small number of us. So in terms of specializing in fertility preservation, technically we all are certified to treat patients with cancer and kind of move them through fertility preservation before starting chemotherapy. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, luckily we've been working closely with oncologists in the past several years just to establish some type of streamlined system because having a diagnosis of cancer and hearing all that information. Especially when you're young is so hard. So I think that's, that's where my interest started in terms of being able to speak to and counsel cancer patients. **Dr. Nirali Jain:** I think it is a very specific niche that you really have to be comfortable with in our field. Um, I. So I'll kind of walk you through, you know, what it, what does it look like, right? Um, you go into your oncologist's office suspecting that you have this, this lump. I'll take breast cancer, for example. It could really be any kind of cancer. **Dr. Nirali Jain:** Um, but breast cancer in a reproductive age patient or someone that's in those years where you're starting [00:03:00] to think about building a family, planning a family, um, or if you have kids at home, that's usually the type of patient that we see come in with a breast cancer diagnosis. So. Kinda just taking that, for example, um, the minute that you're diagnosed, it's really your oncologist's responsibility to counsel you on what treatment options are going to be offered to you. **Dr. Nirali Jain:** And then based off of the treatment options, it's important to know how that affects your reproduction. So how does it affect your ovaries in the short term, in the long term, um, in any way possible. So. Once a patient is initially referred from their oncologist to myself or any other fertility specialist, they come into my office and we just have a 30 minute conversation really talking about family planning goals. **Dr. Nirali Jain:** Any kids that they've had in the past either naturally conceived or through um, IVF, and then we talk about where they're at in their relationship. Are they married, are they not? Are they with a partner, [00:04:00] a male partner, a female partner, whatever it might be. It's important to know the social standpoint, um, especially in this sensitive phase of life. **Dr. Nirali Jain:** So patient patients usually spend anywhere from 30 minutes to an hour. Um, just kind of talking through where they're at, how they're feeling, what their ultimate childbearing goals are. And then from there we do an ultrasound and that's when I'm really able to see, you know, the, the reproductive status. **Dr. Nirali Jain:** So what do the ovaries look like? What does the uterus look like? Is there something that I need to be concerned about from a baseline GYN standpoint? Um, and all of those conversations are happening in real time. So. I think one of the things is patients come in and they're like, I'm already so overwhelmed with all this information from my oncologist, and now my fertility specialist is throwing all this information at me. **Dr. Nirali Jain:** Luckily, the way I like to frame it is you come in and you just let go. Like you let us do the work because in the background we're the ones talking to your oncologist. We're the [00:05:00] ones giving that feedback and creating a timeline with your oncologist. Um, and really I think just getting in the door is the hardest part. **Dr. Nirali Jain:** So once patients are here to see us, we go through the whole workup. We do anything that we would do for a normal patient that came in for fertility preservation. And then based off of where they're at in their journey, we talk about what makes sense for them, whether that means freezing embryos, freezing eggs, they're very similar in terms of the, the few weeks leading up to the egg retrievals. **Dr. Nirali Jain:** So I have that whole conversation just at the initial visit. And then from there we talk about the timeline behind the scenes and make sure that it works with their lives before moving forward. **Michelle Oravitz:** So for people listening to this, why, and this might be an obvious question, but to some it might not be,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** why would somebody want to preserve. eggs or sperm. 'cause I've had actually some couples  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** come to me where the husband preserved the sperm and they had to go through IVF just because he was going [00:06:00] through cancer treatments. So he had to preserve the sperm ahead of time.  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** people need to consider doing that before doing cancer treatments?  **Dr. Nirali Jain:** So there are certain cancer treatments that do affect the ovaries and the sperm health, and you know, for men and women, it affects your reproductive organs. In a similar way, um, depending on the type of chemotherapeutic agent, there are some that are more dangerous in terms of, um, being toxic to your ovaries or toxic to your sperm. **Dr. Nirali Jain:** And those are the instances where we are really thinking about what's the long-term impact because there's medications that oncologists do give patients, and our oncologists are amazing, the ones that we work with, Memorial Sloan Kettering from Reproductive Medical Associates through RMA, um, and. **Dr. Nirali Jain:** They're just so good at what they do and are so well-trained, so they know in the back of their mind, is this going to impact your ovaries or your sperm health or not? Um, and I [00:07:00] think that any chemotherapy, you know, your ovaries are these, these small organs that are constantly turning over follicles every month. **Dr. Nirali Jain:** So every month we're losing those eggs, and if they don't become. If an egg isn't ovulated, it doesn't become a baby, it's just gonna die off. So I counsel even patients that don't have cancer, I counsel them on fertility preservation as young as possible. You know, between the ages of 28 and 35, that's like the best time to preserve your fertility. **Dr. Nirali Jain:** So in cancer patients, there's an extra level added to that where even if they are a little bit younger, a little bit older. Your eggs are not gonna be the same quality. There's gonna be higher level of chromosomal errors, more DNA breakage, um, and, and bigger issues that lead to issues with conceiving naturally afterwards. **Dr. Nirali Jain:** So I think that it's important to consider how that chemotherapy is going to affect them or how surgery would affect them if it was, for example, a GYN cancer where [00:08:00] we're removing a whole ovary, you know, what, what do we have to do to preserve your fertility in that case? And those are important conversations to have. **Michelle Oravitz:** Yeah. for sure. I know that a lot of people are also concerned, you know, with going through the IVF process, you're taking in a lot of estrogen, a lot of hormones, and many cancers are actually estrogen sensitive. So I wanted to talk to you about that. 'cause I know that the data shows that it's. It's been fine, which some people might find surprising, but I wanted you to address that and just kind of **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** from your perspective.  **Dr. Nirali Jain:** That's so interesting that you asked that question because I actually, my whole I I graduated fellowship last year and my entire, like passion project in fellowship was looking at one of the drugs that we use to suppress the estrogen levels specifically in cancer patients. Um, and I had presented this at a few of our reproductive meetings. **Dr. Nirali Jain:** Um, A SRM is one of our annual meetings where all of the reiss get together. A lot of male fertility [00:09:00] specialists come and we kinda just talk about. Specific things and fertility preservation for cancer patients is, has been an ongoing topic of interest for all of us. Um, and it's important to know that there are different medications that we can offer. **Dr. Nirali Jain:** Letrozole is the one that I, um, have a particular love for and I, uh, you know, I use all the time for my patients, um, for different reasons, but it suppresses the exposure that your body has to estrogen. And there's mixed data, um, out there in terms of, you know, does Letrozole suppression actually impact, you know, does it help or. **Dr. Nirali Jain:** Or does it have no impact on your future risk of cancer after treatment? Um, and that honestly is still up for debate. But what we do know is that there's no increased risk of cancer recurrence in patients that have undergone fertility preservation with or without Letrozole. Um, Letrozole is one of those things that we can give, and the way it works is basically. **Dr. Nirali Jain:** It masks that [00:10:00] conversion. It, it doesn't allow for conversion from those androgens in the male hormones over to estrogen. Um, and so your body doesn't really see that estrogen exposure. It stays nice and low throughout your cycle, and it does help with actually ovarian maturation and getting mature eggs harvested and, um, helps a little bit with, with quality too. **Dr. Nirali Jain:** So I think that it's really nice in terms of having that available to us, but know that. It's not, it's not essential that you have it, really, the data showing plus minus. Um, but there are certain things that we can do to protect the ovaries, protect your exposure to estrogen. Um, and so that shouldn't be top of mind of concern when we're going through fertility preservation, even with an estrogen sensitive cancer. **Michelle Oravitz:** Actually, so, uh, on a different topic, kind of going back to that, so Letrozole versus Clomid, I, it's like a, the questions I personally feel just based on what I've heard and like my own research that Letrozole would be kind of like the more. [00:11:00] Um, the, it's, it's a little better, but I know that it really depends on the person as well.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** they might do better with Clom, but I'd love to hear your perspective and kind of pick your brain on this.  **Dr. Nirali Jain:** totally. You're choosing all the, all the right questions because these are all of my, my specific interests and niches. So  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** Letrozole is basically, you know, we use Letrozole and Clomid in. Patients that don't have cancer and patients that come in for an intrauterine insemination, that's kind of the most common scenario where we're thinking about, you know, which medication is better? **Dr. Nirali Jain:** Letrozole or Clomid and Clomid used to be the, the most common medication that we use, we dose patients, you know, have 50 milligrams of Clomid, give them five days of the medication. It's an oral pill. Feels really easy and. The way it works is really, it recruits more than one follicle, so it really helps with the release of, um, more than one follicle growing more than one follicle in the ovary. **Dr. Nirali Jain:** Um, but it has a little bit [00:12:00] higher of a risk of twins because that's exactly what it's good at. Um, Clomid, not so much in the cancer. In the cancer front, it's not really used there because it's considered, from a scientific perspective, it's considered like a selective estrogen receptor modulator. So it doesn't necessarily suppress your estrogen levels in the same way that Letrozole does versus. **Dr. Nirali Jain:** Letrozole is an aromatase inhibitor, so it really blocks the chemical conversion of one drug or one hormone to the other hormone. Um, the reason we love Letrozole so much, and I don't mean to like gush over Letrozole, but um, it's a mono follicular agent, so it works really well at recruiting one follicle  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** you know, every OB-GYN's nightmare in a way is having multiples when you didn't intend on having multiples at all. **Michelle Oravitz:** so  **Dr. Nirali Jain:** Um. **Michelle Oravitz:** were saying that, um, there's more of a chance of twins, it's Clomid, not letrozole.  **Dr. Nirali Jain:** Yes, there's a higher chance with Clomid versus Letrozole. And I mean, don't get me wrong, there's a chance of twins with [00:13:00] any type of assisted reproductive technology. Even when we're doing single embryo transfers, there's a chance that it's gonna split. So, um, the chance is always there just like it is in the natural world. **Dr. Nirali Jain:** But we know for a fact that. CLO is really good at recruiting many follicles. It's good for certain patients that don't respond well to Letrozole. Um, but Letrozole is kind of our, our go-to drug these days just because of all the benefits that we've seen.  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** These are all fun things to ask because I, I love talking to our eis 'cause there's so much information that I'm always  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** learn a lot from my patients in my own research, but it's really cool. Picking your guys' brains. So another question I have, and I have actually talked to Dr. Andrea Elli, he's been on,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** and he does a lot of endometriosis and, and immune related work as well,  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** so. I'd love to know just from your perspective. One thing that I do know from, based on what I've heard is that the, [00:14:00] guess like you were just saying, that breast cancer or estrogen sensitive breast cancer doesn't seem to be affected by IVF cycles, however, and endometriosis lesions do get affected.  **Dr. Nirali Jain:** Yeah. **Dr. Nirali Jain:** that's a great question. So, you know, every, there are so many complex G mind diagnoses that the, that our patients come in with. Um, and endometriosis is a big one because there is clear data that endometriosis is linked to infertility. So we think about, you know, when a patient comes in with endometriosis, we really do think about the different treatment options and what are the short-term and long-term impacts of the hormones that we're giving 'em. **Dr. Nirali Jain:** Um, these days, again, kind of going back to Letrozole, we, letrozole is something that I give all of my endometriosis patients because it helps suppress their estrogen because we know.  **Michelle Oravitz:** interesting.  **Dr. Nirali Jain:** is very responsive to estrogen and leads to this dysfunctional regulation of all the endometrial tissue that can really flare in a, [00:15:00] in a cycle, or shortly after a cycle. **Dr. Nirali Jain:** I. So we really, for endometriosis patients, the, the best treatment is being on birth control because we don't see that hormonal fluctuation. The up and down of the estrogen and the progesterone, that's what leads to those flares. Um, so I really, I watch patients closely after their cycles too, because you definitely can have an endometriosis flare and we say the best treatment for endometriosis is pregnancy, right? **Dr. Nirali Jain:** That's when you're suppressed, that's when you're at your lowest. Um, and patients, my endo patients feel so good in pregnancy because they have. Hormones that are nice in that baseline, they're not getting periods of course. Um, and that's truly, truly the best treatment.  **Michelle Oravitz:** That's interesting.  **Dr. Nirali Jain:** But it is important to consider when you're going through infertility treatments. **Dr. Nirali Jain:** How does my endometriosis affect the short and long-term effects of the fertility medications? And really not to, not to say that they're bad in any way. I think a lot of endometriosis patients go through IVF and have success and do really, really well, and that's kind of the push that they need. [00:16:00] Um, but it's important to be mindful of the bigger picture here. **Dr. Nirali Jain:** It's not just, you're not just a number of. A patient with endo coming in, getting the same protocol. It's really individualized to the extent of your lesions, what symptoms you're having, what grade of endometriosis, where your lesions are. So we're the RAs are thinking about everything before we actually start your protocol. **Michelle Oravitz:** It's crazy how in depth it is, and it's, it, there's just so, it's so multifaceted,  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** when it's females  **Dr. Nirali Jain:** totally. **Michelle Oravitz:** are a little, I mean, they can, you know, there, there's definitely a number of things, but it's not as complicated and interconnected  **Dr. Nirali Jain:** Exactly. Exactly. That's so true. **Michelle Oravitz:** And so one question I actually have, this is kind of really off topic, but something that I was curious about. **Michelle Oravitz:** 'cause I heard about a while  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** a, a type of cancer treatment that was used. I'm not sure exactly what it was, but for some reason it actually caused follicles to grow, [00:17:00] or to multiply. And they were **Dr. Nirali Jain:** Interesting. **Michelle Oravitz:** this definitely. Puts, um, the whole idea of like a woman being born with all the follicles she'll ever have on its head, I thought that was really Interesting. **Michelle Oravitz:** Now I learned a little bit about it. I don't think it really went further than that,  **Dr. Nirali Jain:** Mm-hmm. **Michelle Oravitz:** one of those things that they're like, Hmm, this is interesting. I don't know, it was kind of a random side effect of this chemo drug. I dunno if it was a chemo drug or a cancer drug.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** ever heard of that. **Michelle Oravitz:** So I was just **Dr. Nirali Jain:** I haven't, I mean, that's interesting. I feel like I'd have to look into that because that would be definitely a point of interest for a lot of Reis. But it kind of does go back to the point of, you know, women are really born with all the eggs we're ever gonna have. So it's about a million, and then it just goes down from there. **Dr. Nirali Jain:** And the, by the time you start having periods, I like to kind of show my patients a chart, but you have a couple hundred thousand eggs and you ovulate one egg a month. That's, you know. Able to [00:18:00] progress into a fertilized egg and then into a, an embryo into a baby, um, if that's your goal. But otherwise, patients that are having periods and not trying to actually get pregnant, we're losing hundreds of eggs a month. **Dr. Nirali Jain:** So.  **Michelle Oravitz:** Mm.  **Dr. Nirali Jain:** It's important to kind of think about that decline, and it's important to know that that rate can be faster in patients with cancer, patients with low ovarian reserve. And sometimes when you have the two compounded, that's when a fertility specialist is definitely, you know, in the queue to, to have a discussion with you in terms of what that means and how you can reach your family building goals despite being faced with that, with that challenge. **Michelle Oravitz:** Yeah. **Michelle Oravitz:** I mean, 'cause we know oxidative stress is one of the things that can cause, uh,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** quality eggs, but it's also can cause cancer. **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** um, similar, you know, like things that really deplete the body could definitely impact. Um, and then what are your thoughts? I know I'm asking you all kinds of random questions, **Dr. Nirali Jain:** I love it. **Michelle Oravitz:** are your thoughts about doing low simulation in certain [00:19:00] circumstances versus high stem? **Michelle Oravitz:** Sometimes people don't respond as well to higher stems.  **Dr. Nirali Jain:** Yeah, that's a great point. I think that it kind of all goes back to creating an individualized protocol. If. A patient's going to a practice and basically just getting a protocol saying, this is our standard. We start with our standard of, you know, I, I think about the standard, which is 300 of the FSH or that pen that you dial up, and then 150 units of that powder vial. **Dr. Nirali Jain:** And we have patients mixing powders all the time, and that's kind of our blanket protocol that we give patients. But that's not really what's happening behind the scenes. And if you're given a protocol that's, and being told, you know, this is kind of what we give to everyone, it's probably not the right fit for you. **Michelle Oravitz:** Yeah, I  **Dr. Nirali Jain:** Um, there are certain patients that respond to a much lower dose and do really, really well, and then some patients that need a much higher dose. Um, and I think it's, that's kind of like the fun part of being an REI of being able to individualize the [00:20:00] protocol to the patient. Um, and I know for a fact there are so many, luckily, you know, we have so many leaders in REI that have been. **Dr. Nirali Jain:** Have dedicated their entire careers to researching these different protocols and how they can help different patients. Um, patients with lower a MH, you know, might benefit from a duo stim protocol, for example. That's kind of the first one that comes to mind, but a protocol where we're using those follicles from the second half of a cycle. **Dr. Nirali Jain:** I would've never thought that those were the follicles that  **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** would be better than the first half of the cycle,  **Michelle Oravitz:** Wait,  **Dr. Nirali Jain:** but, **Michelle Oravitz:** that. Explain that. Um, because I think that that's kind of a unique  **Dr. Nirali Jain:** mm-hmm.  **Michelle Oravitz:** that I haven't heard of.  **Dr. Nirali Jain:** Yeah, so there's this new day. It's still kind of developing, but um, kind of going back to, you know, what's an individualized protocol? Duo STEM is one of the newer protocols that we've started using. I, I've used it once or twice in patients. Um, but it goes back to the research that shows that you might actually have two different periods of time in a menstrual cycle where you could potentially recruit [00:21:00] follicles. **Dr. Nirali Jain:** You could have a follicular phase where there's a certain cohort of follicles recruited, and then you have a follicle that forms creates a corpus glut.  **Michelle Oravitz:** um, protocols  **Dr. Nirali Jain:** Yep. And then you basically go through the follicular protocol and then a few days after a retrieval, instead of waiting for a new follicular cohort or follicular recruitment from the first half of your menstrual cycle, you actually use the luteal phase and you recruit those follicles that would've actually died off or have been prematurely recruited in a prior cycle. **Dr. Nirali Jain:** So **Michelle Oravitz:** that's So  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** you just do a similar, I guess, um, medicine,  **Dr. Nirali Jain:** go right back into it.  **Michelle Oravitz:** do the same exact thing, but right after ovulation.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** Fascinating. That's really interesting.  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** has been your experience with that?  **Dr. Nirali Jain:** I think it's, honestly, it's mixed. Um, so far, you know, our data from fertility and sterility and A SRM, it, it shows support for these DUO STEM [00:22:00] protocols, saying that if patients don't have that great quality of eggs or if they have a very low number, maybe they'd benefit from starting the meds earlier and recruiting follicles. **Dr. Nirali Jain:** A little bit earlier. Um, so we've seen positive results so far. A lot of work to be done in terms of really understanding it. Um, and of course, as a new attending, I have a lot more experience to kind of build on. Um, but I, I have seen success from it. **Michelle Oravitz:** That's fascinating. Are there any other new technologies, like new add-ons, um, that you've seen, that you've found to be really cool or interesting?  **Dr. Nirali Jain:** I think the biggest thing, actually, kind of going back to our whole topic for today is fertility preservation cancer patients. One of the biggest things that I've learned recently is that we used to start fertility, um, patients. You know, only in the beginning of the cycle days, two or three is technically like when most. **Dr. Nirali Jain:** Most clinics, um, start patients, but for our cancer patients, sometimes you don't have that time. You don't wanna wait a full month to [00:23:00] restart, um, your, you know, your menstrual cycle and then do the fertility preservation and then delay chemotherapy a full month. So we started doing what we call random starts. **Dr. Nirali Jain:** So you basically start a patient whenever they come in. You know, it could be the day after your consultation, the day of your consultation. I've kind of seen all of the above. Um, and we've seen really good success with random starts, per se. Um, and we've been doing a lot more of that, where it's not as dependent on where you're at in your cycle. **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** Um, obviously there's a difference in outcomes. You might not be a great candidate for it, so definitely it's worth talking to your doctor about it. But it kind of gives relief to our cancer patients where if you have a new cancer diagnosis and you're like, oh, I just finished my period, like, I can't even start a cycle until next month. **Dr. Nirali Jain:** That's not always true. Um, so it's always worth it to go into see a fertility specialist and just get, you know, get the data that you need right away, and then you can make a decision later on. **Michelle Oravitz:** For sure. Um, Yeah. **Michelle Oravitz:** and I wanted to kind of cover a lot of different topics 'cause I know that [00:24:00] some people are gonna wanna hear what you have to say that don't necessarily, or, uh, have cancer. But it is important. I, I think that, you know, if you get to thirties and you haven't gotten married or you don't have a partner, I think it's really important to preserve your fertility in general.  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** important thing. And then if you were going through a cancer diagnosis and you decided to preserve your fertility, um, guess more for women because they're eventually going to be thinking about transfers after they go through treatment. So what are some of the things that they would need to consider as far as that goes? **Michelle Oravitz:** Like after the  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** then they go through the cancer treatments. Um, and then what, how long should they  **Dr. Nirali Jain:** yeah. Like what does it look like? So I've had patients that come back, you know, in my fellowship training I did a, a couple research projects on patients that came back to pursue an embryo transfer, um, after chemotherapy agent. And basically compared them to how they did, um, [00:25:00] compared to patients that didn't have cancer and just froze their embryos or froze their eggs and then came back to pursue a transfer and. **Dr. Nirali Jain:** I think the, the most reassuring thing from the preliminary data that we have is saying that there's no difference in pregnancy rates and no difference in life birth,  **Michelle Oravitz:** Awesome.  **Dr. Nirali Jain:** of whether they had chemotherapy or not. After freezing those eggs and going through fertility preservation.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Um, in terms of where your body needs to be, I think the oncologist, we, we wait for their green light. **Dr. Nirali Jain:** We wait for their signal to say, you know, she's safe to carry a pregnancy.  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** And then once we do that, we basically treat you like any other patient. So if you're coming in for a cycle, if you're having periods, then it's reasonable to try a natural cycle protocol, wait for your body to naturally ovulate an egg. **Dr. Nirali Jain:** And instead of obviously hoping that egg will fertilize, we, um, use a corpus luteum. We use the progesterone from the corpus luteum to really support this embryo being implanted into the uterus. Um. Yeah. [00:26:00] And then there's also another side. I mean, some patients don't get their periods back and they always ask like, what if I never get my period back? **Dr. Nirali Jain:** What if I'm just like in menopause because of the chemotherapy agents? And for that, we can start you on a synthetic protocol or basically an estrogen dependent protocol where you take an estrogen pill for a certain number of days. We monitor your lining, then we start progesterone, um, to support your hormones from that perspective instead of relying on your ovaries to release the progesterone that they need, um, and then doing the embryo transfer a few, few days after progesterone starts. **Dr. Nirali Jain:** So there's definitely different protocols depending on where your menstrual health is at after the chemotherapy or after the cancer treatment. Um, but it's important to kind of just know that. That there's options. It doesn't mean that it's the end of the road if you all of a sudden stop getting your period. **Michelle Oravitz:** Yeah, for sure. I mean, 'cause you, technically speaking, you can really control a lot of that. More so for transfers  **Dr. Nirali Jain:** Yep. **Michelle Oravitz:** Retrievals really is kind of like what [00:27:00] eggs you have, what the quality is. But people can be in complete menopause and you guys can still control their cycles for transfer, which is kind of. A huge difference  **Dr. Nirali Jain:** Yeah,  **Michelle Oravitz:** in the  **Dr. Nirali Jain:** exactly. That's exactly right. Yeah. **Michelle Oravitz:** interesting. Any other, um, new, new things that you're, you guys are excited about? I always like to hear about like the new and upcoming things  **Dr. Nirali Jain:** Of course.  **Michelle Oravitz:** actually before, which I thought was fascinating. Yeah.  **Dr. Nirali Jain:** I feel like there's always like updates and, and new data and things like that coming out, but just know, I think it's important for patients to know, like we're constantly, we're, the reason I chose to even pursue this field was because it's new. Right. There's something that we are discovering every day, every year, and that's what makes our, our conferences so important to attend, um, to really just stay up to date. **Dr. Nirali Jain:** Um, but we are, uh, constantly updating our embryology standards, the way we thaw our eggs, and the success rate associated with a thaw and [00:28:00] how we treat our embryos and the media that we use, right? Like, so we're really thinking about the basic science perspective every single day, and that's what makes this field so unique. **Michelle Oravitz:** It is really awesome. And so do you guys specialize specifically on, um. Egg freezing and, and I mean specific fertility preservation in patients that do that have cancer that are going through treatments, do you guys specialize specifically in that? I mean, I know you do range  **Dr. Nirali Jain:** Yeah. Yeah, because it's such a small community, we all have our own niches and we all kind of have our own interests and  **Michelle Oravitz:** Yeah.  **Dr. Nirali Jain:** no like specific training. There are a couple courses that you take that I took in in training as well, just to kind of understand what it sounds like to, I. Council of fertility preservation, patient with and without cancer. **Dr. Nirali Jain:** Um, and then, you know, you kind of just learn by experience and you form a niche for something that you're passionate about. 'cause that's what makes you, you know, really thorough in, in your treatment. [00:29:00] So that's one of my interests. Um, and, but I would say,  **Michelle Oravitz:** training for that. It's just like  **Dr. Nirali Jain:** yeah, **Michelle Oravitz:** just know how to treat that in  **Dr. Nirali Jain:** exactly.  **Michelle Oravitz:** especially if you're interested in doing that.  **Dr. Nirali Jain:** Exactly. That's exactly right. It's kind of, it just comes with the experience comes with your mentors and who you're surrounded by, and everyone kind of helps each other get to that point. But there are several specialists in our practice at RMA that specialize specifically in fertility preservation in cancer patients. **Dr. Nirali Jain:** So we have a close communication with our oncologist and they know who to refer to within the practice because everyone has their own little interests.  **Michelle Oravitz:** Amazing.  **Dr. Nirali Jain:** Yeah. **Michelle Oravitz:** Um, definitely. I, like I said, I really enjoy picking your brain because it's a lot of fun for me. I, I do  **Dr. Nirali Jain:** Totally.  **Michelle Oravitz:** acupuncture, so  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** and I, I think that it's just so crazy that our fields don't work together. I mean, we kind of do, but I think, I just feel like it would be so great  **Dr. Nirali Jain:** exactly.[00:30:00]  **Michelle Oravitz:** the expertise because you guys have immense. Benefits like in, in, uh, technology and incredible innovations and, and then the natural aspect of really understanding the, the body. And I, I just think that it would work so amazing together if it was more of like a thing. 'cause it, I know in China they actually combine the two  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** eastern.  **Dr. Nirali Jain:** Yeah, I mean I think that that's so important and there is data that shows, you know, there's actually a recent study that came out just a few weeks ago on the benefits of acupuncture for fertility patients. And we know that, I mean, I recommend it to all of my patients, specifically the day of the embryo transfer. **Dr. Nirali Jain:** We, luckily, we offer it on site at RMA and we have acupuncturists that come in and, and do a session before and after the embryo transfer, and I think. A lot of that is targeted towards stress relief. But I also think that holistically it's important to feel at your best when we're doing something that's so crucial to your, to your health. **Dr. Nirali Jain:** So to really focus on the diet, focus on stress relief, [00:31:00] focus on meditation, yoga, whatever it takes to get to your best wellbeing when you're going through fertility treatments, um, is so important. So I appreciate  **Michelle Oravitz:** Mm-hmm.  **Dr. Nirali Jain:** like you that really specialize in the other side of. Of this, because I do consider it still part of the holistic medicine that we need to really maximize success for our patients. **Michelle Oravitz:** Awesome. Well,  **Dr. Nirali Jain:** Yeah, **Michelle Oravitz:** Jane, this is such a pleasure Of talking to you. You've given us some, so much great information and we've definitely dived into a, do a topic that I don't typically, I haven't yet spoken about. But, um, that being said, it's such an important topic to talk about. And thank you so much for coming on today. **Michelle Oravitz:** Oh,  **Dr. Nirali Jain:** course. **Michelle Oravitz:** I get off, how can people find you?  **Dr. Nirali Jain:** That's a great question. So I have, um, a social media page. I, it's called Expert nc. So like EGG,  **Michelle Oravitz:** I  **Dr. Nirali Jain:** um, expert nc. Try, tried to make it a little bit humorous. Um, but I'm all over social [00:32:00] media and would love to hear from anyone that is listening. I, you know, every, every day I get different, um, dms and I'm happy to respond. **Dr. Nirali Jain:** I love hearing about everyone else's. Stories and things like that. Um, so that is kind of my main, main social media platform. Um, and then through like RMA and Reproductive Medical Associates, we also have a YouTube channel. We have an Instagram page, um, of our office available, um, as well that is public. **Dr. Nirali Jain:** So you can find us pretty easily if you just kind of hit Google. But um, yeah, I'm kind of developing my social media platform as the expert and I hope it grows.  **Michelle Oravitz:** Love it. Great.  **Dr. Nirali Jain:** Yeah.  **Michelle Oravitz:** was such a pleasure talking to you. Thank you. so much **Dr. Nirali Jain:** Thank you. **Michelle Oravitz:** today.  **Dr. Nirali Jain:** Of course. Thank you so much for having me.  [00:33:00]   

Join hosts Dr. Abby Eblen from Nashville Fertility Center, Dr. Susan Hudson from Texas Fertility Center, and Dr. Carrie Bedient from the Fertility Center of Las Vegas as they dive into the role of three key hormones in pregnancy: thyroid hormone, prolactin, and insulin. In this episode, we discuss the thyroid's function and why it's problematic if it works too fast or slow. We explore common thyroid tests, how thyroid issues can impact pregnancy, and their connection to prolactin levels. We also break down prolactin's role, what affects its levels. We discuss the difference between a micro- and macro-adenoma and treatment for both. Additionally, we touch on galactorrhea, a condition causing unexpected breast discharge, and the importance of discussing it with your doctor. We then shift to insulin and its link to diabetes. We explain type 1 diabetes (an autoimmune condition) and type 2 diabetes (where insulin doesn't work effectively), along with the importance of hemoglobin A1C testing. Maintaining proper blood sugar levels before pregnancy is crucial, as poorly controlled diabetes can lead to birth defects, pregnancy complications, and delivery risks. Tune in for expert insights on optimizing hormonal health for pregnancy.This episode was brought to you from ReceptivaDx and RMA of New York.

After years of being a Tanta looking for love, Jen decided she was ready to be a mom: with or without a partner. In this episode of Oversharing, Jen walks us through the IVF process of using a donor and how she felt about shopping for sperm. We dive into the sacrifices and worries that come with pregnancy and Jen shares the ways that motherhood has changed her, including how she approaches being a first grade teacher.Find us on Instagram: @keepoversharing If you live in PA, leave more about RMA here:https://rmanetwork.com/our-locations/rma-philadelphia/philadelphia-pa/

Here on the Fertility Forward podcast, we often say that knowledge is power — and that you are your own best advocate! Joining Rena and Dara on the show today are two passionate guests who are dedicated to educating women about infertility, fertility benefits, healthcare coverage, and women's health. We're thrilled to welcome Dr. Taraneh Nazem, a double board-certified Reproductive Endocrinologist, Infertility Specialist, and Obstetrician-Gynecologist at RMA of New York's Westside office, along with Carissa Simek, one of Dr. Nazem's patients. In today's episode, Carissa opens up about how her desire for better fertility coverage led her to change jobs — and the incredible fertility journey she's walked with Dr. Nazem. They discuss the panel discussions they've led, the catalyst behind Carissa's decision to preserve her fertility, and how advocating for fertility education has empowered Carissa in her own life. We also explore the conversation around freezing eggs versus embryos, the biggest challenges Dr. Nazem faces in her field, and how infertility treatments can impact daily life. For all this and much more, don't miss this insightful conversation! 

Order my new book: Finally F**kn Fertile Using Yoga Meditation & Breathwork to Conceive! https://www.lisapinedayoga.com/store/p1/FINALLY_F%2ACKING_FERTILE_Using_Yoga%2C_Meditation_%26_Breathwork_to_Conceive.htmlDID YOU KNOW PCOS can be managed by some medications and even improve egg quality? In the latest episode of The Dismantling You Podcast I interview Dr. Cary Dicken  Topics we discussed:*PCOS*Endometriosis*Egg Freezingand so much moreCary L. Dicken, MD, joined RMA of New York – Long Island in the fall of 2020. She comes to us from the Sher Institute for Reproductive Medicine in New York City, where she served as Associate Medical Director for over six years. Dr. Dicken is board certified in both Obstetrics & Gynecology and Reproductive Endocrinology & Infertility. She has been recognized by her peers and patients as an outstanding and compassionate physician. Dr. Dicken is a caring and warmhearted fertility specialist while still being honest and upfront with her patients. She is proud to be a reproductive endocrinologist and loves spending her days helping individuals/couples create the families they want.Contact Dr. Cary DickenWebsite: https://www.rmalongislandivf.com/physicians/cary-l-dicken-mdInstagram: @dr.cary.dicken

In this episode, we discuss whether the government's RMA reforms could be the policy that kills the housing crisis — or creates a whole new one.You'll learn:What the new RMA changes actually mean for the property marketWhether this could lead to a housing oversupply in some parts of the countryAnd when these changes are expected to kick in and how they'll impact house prices in NZIf you're a property investor or developer, this is one policy shift you can't afford to ignore.For more from Opes Partners:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Sign up for the weekly Private Property newsletter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠TikTok⁠⁠⁠⁠⁠

In this insightful and informative episode of the pregnantish podcast, first airing in honor of National Infertility Awareness Week '25, we're joined by Dr. Karen Tang, a board-certified gynecologist and minimally invasive gynecologic surgeon and the author of "It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told)" From media stories to medical discussions, fertility and infertility is full of misconceptions! This episode delves into how and why we should shift the conversation from fear-based, negative messaging about reproductive health to one that's positive, empowering, and focused on achieving the reproductive goals people desire. This episode's Midroll features Dr. Lucky Sekhon, Board Certified OBGYN & Fertility Doctor who practices at RMA of NY, the episode sponsor, to tackle some of the more common myths and why sexual and reproductive health education needs a major overhaul. Both doctors in this conversation have used their platforms, including on social networks like Instagram and TikTok, to educate audiences and tackle misinformation. After all, in a recent pregnantish survey of over 800 people, we learned that social media is the #1 way people today access fertility information and education. With 1 in 6 facing infertility and 1 in 4 navigating pregnancy loss today, there's nothing niche about this topic. This episode is a celebration of breaking down barriers, busting myths and encouraging people to take control of their fertility so they can best advocate for their health. Thank you to episode sponsor RMA of New York, a global leader in reproductive medicine who is partnered with US Fertility and its network of premier reproductive medicine practices. Get the facts about your reproductive health at rmany.com. Hosted on Acast. See acast.com/privacy for more information.

My fun fact of the week, not that it's that fun or even new, given it's been around if you could be bothered looking. In Hawke's Bay there are 56 mayors, chairs and councillors spread across five councils. Just for Hawke's Bay. Not Mexico City, or London, or New York. Hawke's Bay, in little old regional New Zealand. This is contained in an excellent piece well worth reading over the long weekend to be found on the Newsroom website. Broadly it looks into amalgamation of councils. The good news is amalgamation is coming. In my view it cannot come fast enough. This small land is festooned with councils and boards and groups who do little other than add to inflation with cost, plus accounting. The trick, and part of it is the Government's Water Done Well programme, is once they spin those duties out to new entities you won't need as many councils and councils won't have a ratepayer base to be able to afford stuff anyway. But here is where it might go wrong: 1) Fiefdoms. Too many still argue they are more important than they are. 2) The Government says they won't enforce this change. They will act on the communities' will. Big, big mistake. On the upside there is talk of as few as 13 unitary authorities. That would mean 11 regional councils gone. Good, do it as quick as you like. We are grossly over-councilled in this country, with 67 currently. We have authorities for handfuls of thousands of people. It's absurd and that's before you get to the quality, or lack of it. The savings are huge, with $5 billion on the RMA side alone. By the time you read the article you are left uplifted by the possibility that one of your more boring topics, local body representation, might, just might, be heading somewhere good. My hope is if it does head somewhere good, we may at last start to pay attention to it, be invested in it and it becomes a virtuous circle of success, productivity and positivity. And if that doesn't fizz you up for a good Easter, nothing does. See omnystudio.com/listener for privacy information.

The previously announced 60 square metre granny flats that property owners will be able to build without building or resource consent - will now be 70sqm. Recent changes to the RMA will also help make it easier for these flats to be built as well as more affordable. LISTEN ABOVESee omnystudio.com/listener for privacy information.

How can data enable doctors to best support their patients? Reproductive endocrinologist and associate research director Dr. Phillip Romanski joins us in conversation to discuss the annual Pacific Coast Reproductive Society Conference (PCRS), everything he learned, and what he spoke about. Tune in to hear Dr. Romanski's perspective on mosaic embryo transfers before we dive into the complex world of segmental mosaic embryos and fully segmental aneuploid embryos. We discuss Preimplantation Genetic Testing, how to personalize care on an ongoing basis, and how in vitro maturation and in vitro gametogenesis will shape the future of fertility. Join us today to hear all about the topics covered at this year's conference, the developments RMA doctors are focused on today, and more. Thanks for listening.  

Te Pāti Māori Co-Leader Debbie Ngarewa-Packer reacts to the RMA reforms, and reporter Ruwani Perera meets the American singer-songwriter Maya Piata, whose rich heritage includes whakapapa Māori.   “Made with the support of Te Māngai Pāho and New Zealand On Air”

Gareth Hughes and Tim Hurdle discuss supermarkets, ferries and RMA reform 

This week on the Monday Wire: For our weekly catch up with Te Pāti Māori's Takutai Kemp, News and Editorial Director and Monday Wire Host, Joel, speaks to her about Finance Minister, Nicola Willis' plans to combat Aotearoa's supermarket duopoly, Green MP, Tamatha Paul's comments about police, and Te Pāti Māori's recent calls for mandatory police body cameras. For our weekly catch up with The ACT Party's Simon Court, Joel speaks to him about the Resource Management Act, or RMA reforms and concerns about the country's health and police system, following an 11-year old being misidentified as a 20-year old by police, and administered antipsychotic drugs. On Friday, they spoke to the spokesperson for People Against Prisons Aotearoa and Criminology Lecturer at the University of Auckland, Dr Emmy Rākete, about Tamatha Paul's comments about police practices in the country, the reaction they have received, and whether the reaction has been justified. They speak to the Chief Executive Officer of Consumer NZ, Jon Duffy, about Nicola Willis' plans to combat the supermarket duopoly and how the organisation are feeling about these developments. On Friday, they also spoke to a Senior Politics and International Relations Lecturer at the University of Auckland, Tim Fadgen, about US President Donald Trump's ‘overreach' in American universities, and if we should expect similar occurrences at New Zealand universities. And Global Innovator, Matt Hart, joins Joel in studio to continue our discussion around the Netflix series ‘Adolescence,'  fandoms, and exploring the role of soft power. Whakarongo mai

Last week, the government announced its plans for reforming the Resource Management Act, or the RMA, introducing two acts to replace the current RMA. The plan is to bring the two acts before the select committee next year, passing them just before the next election.  For our weekly catch up News and Editorial Director and Monday Wire Host, Joel, spoke to the ACT Party's Simon Court about this reform, working with the opposition, and the lack of a Treaty clause. We also talked about concerns that the health and police system in Aotearoa are failing, following an 11-year old being misidentified as a 20-year old by police and being administered antipsychotic drugs. But first, we touched on the RMA reform.

Gareth Hughes and Tim Hurdle discuss supermarkets, ferries and RMA reform Go to this episode on rnz.co.nz for more details

This week on the Monday Wire: For our weekly catch up with Te Pāti Māori's Takutai Kemp, News and Editorial Director and Monday Wire Host, Joel, speaks to her about Finance Minister, Nicola Willis' plans to combat Aotearoa's supermarket duopoly, Green MP, Tamatha Paul's comments about police, and Te Pāti Māori's recent calls for mandatory police body cameras. For our weekly catch up with The ACT Party's Simon Court, Joel speaks to him about the Resource Management Act, or RMA reforms and concerns about the country's health and police system, following an 11-year old being misidentified as a 20-year old by police, and administered antipsychotic drugs. On Friday, they spoke to the spokesperson for People Against Prisons Aotearoa and Criminology Lecturer at the University of Auckland, Dr Emmy Rākete, about Tamatha Paul's comments about police practices in the country, the reaction they have received, and whether the reaction has been justified. They speak to the Chief Executive Officer of Consumer NZ, Jon Duffy, about Nicola Willis' plans to combat the supermarket duopoly and how the organisation are feeling about these developments. On Friday, they also spoke to a Senior Politics and International Relations Lecturer at the University of Auckland, Tim Fadgen, about US President Donald Trump's ‘overreach' in American universities, and if we should expect similar occurrences at New Zealand universities. And Global Innovator, Matt Hart, joins Joel in studio to continue our discussion around the Netflix series ‘Adolescence,'  fandoms, and exploring the role of soft power. Whakarongo mai

Why This Episode Is a Must-Watch Planning for retirement can feel overwhelming with its complexities and uncertainties. This episode of "Inspired Money" tackles the essential question: How do you turn your savings into reliable income that will last throughout retirement? We bring together a panel of four esteemed experts to share proven strategies, actionable insights, and industry wisdom to help you craft a solid retirement income plan. Whether you are just beginning to think about retirement or looking to refine your strategy, this episode offers valuable advice on diversifying your income, managing taxes, and inflation-proofing your financial future. Meet the Expert Panelists Wade Pfau, PhD, CFA, RICP®, is one of the foremost thought leaders in retirement income planning. He's a professor at The American College of Financial Services, a partner at McLean Asset Management, and the author of the widely acclaimed "Retirement Planning Guidebook." Holding a PhD in Economics from Princeton University, Wade's research has shaped how retirees and financial professionals approach sustainable income strategies. Mary Beth Franklin, CFP®, is a leading authority on Social Security and Medicare. A veteran financial journalist, she's spent over 40 years educating both consumers and financial advisors. She's also the author of "Maximizing Your Social Security Retirement Benefits." If you want to get every dollar you're entitled to, Mary Beth's insights are invaluable. William Bengen revolutionized the way we think about retirement withdrawals and is author of "A Richer Retirement". Best known for creating the "4% Rule," his research has guided countless retirees toward sustainable spending strategies. With an Massachusetts Institute of Technology background in aerospace engineering and a second career in financial planning, Bill brings both precision and practicality to the table. Dana Anspach, CFP®, RMA®, CFP®, RMA®, is the founder and CEO of Sensible Money, LLC. She's dedicated her career to helping people create sustainable retirement income plans. She's the author of "Control Your Retirement Destiny" and "Social Security Sense." Dana's hands-on experience makes her a wealth of practical knowledge. Key Highlights: The Importance of a Diversified Income Portfolio Bill Bengen reveals insights into maintaining a balanced portfolio with an optimal stock allocation to protect against market volatility. He notes, "You need to keep a healthy allocation to stocks to ensure your portfolio generates enough return." Tax Efficient Withdrawal Strategies Wade Pfau discusses maximizing the longevity of retirement funds through strategic tax withdrawal strategies, emphasizing, "Managing an effective marginal tax rate in a strategic manner can have a huge impact on the sustainability of funds in retirement." Social Security as a Foundational Income Source Mary Beth Franklin underscores the critical role of Social Security, providing guidance on maximizing benefits while addressing public concerns about its future reliability. Inflation Risks The episode highlights the threat of inflation and offers strategies to protect retirement income, with Bill Bengen noting that "Inflation is the greatest risk to retirees. Call-to-Action This week, take a closer look at your retirement income plan. Start crafting or refining your strategy to ensure that you have a diversified mix of income sources, consider the impact of inflation, and explore avenues for making your withdrawals more tax-efficient. Planning and flexibility are your keys to a secure financial future. Find the Inspired Money channel on YouTube or listen to Inspired Money in your favorite podcast player. Andy Wang, Host/Producer of Inspired Money

The Government's made several housing announcements today - including allocating $100 million to be lent to developers for housing infrastructure on the outskirts of cities. Minister Chris Bishop also confirms the Government will cut RMA red tape limiting development on new land. He says the housing crisis is holding us back economically and socially. RMA lawyer Johanna King says these changes could work out for farmers - who can build extra spaces on their land without restrictions getting in the way. LISTEN ABOVESee omnystudio.com/listener for privacy information.

Questions to Ministers RYAN HAMILTON to the Minister of Finance: What recent reports has she seen on the economy? Rt Hon CHRIS HIPKINS to the Prime Minister: Does he stand by all his Government's statements and actions? DEBBIE NGAREWA-PACKER to the Minister responsible for RMA Reform: What is his reaction, if any, to the Kaiwhakahaere for Ngati Ruanui's statement regarding proposed changes to the RMA that "This move breaches both our settlement and the Government's obligations under the Treaty of Waitangi"? CATHERINE WEDD to the Minister of Justice: How is the Government progressing with its plan to restore stronger consequences for crime? Hon BARBARA EDMONDS to the Minister of Finance: Does she agree that the Treasury is the Government's lead economic and financial adviser; if so, does she have confidence in advice from the Treasury? CHLÖE SWARBRICK to the Prime Minister: E tautoko ana ia i nga korero me nga mahi katoa a tona Kawanatanga? Does he stand by all of his Government's statements and actions? Hon WILLIE JACKSON to the Minister for Maori Development: Is he across everything in his portfolio; if not, why not? SAM UFFINDELL to the Minister for Social Development and Employment: What recent announcement has she made about the Annual General Adjustment? Hon WILLOW-JEAN PRIME to the Minister for Children: Does she stand by all her statements and actions? Dr CARLOS CHEUNG to the Minister of Police: What recent reports has he seen on the effectiveness of the community beat teams? Hon GINNY ANDERSEN to the Minister of Police: Does he stand by his statement regarding record levels of methamphetamine in waste-water testing, "Well, I don't know whether that's dealers dumping methamphetamine"; if not, why not? SCOTT WILLIS to the Minister of Health: Does he stand by his statement that "Our Government is focused on delivering timely, quality healthcare for all New Zealanders"; if so, has he contracted the build of the inpatient building for the Dunedin Hospital yet? Question to Member Hon Dr DUNCAN WEBB to the Chairperson of the Justice Committee: Will he report the Principles of the Treaty of Waitangi Bill to the House before all submissions have been processed and considered by members?

The Prime Minister accidentally ponders Winston's health and diet, an Indian FTA, the Investment Summit, changes to RMA, a lift in GDP, Winston wanting us out of the Paris Climate Agreement and whether the latter's war of words with Chris Hipkins will win the Nats the 2026 election by default.See omnystudio.com/listener for privacy information.

Just two days ago, the government announced a complete overhaul of the Resource Management Act.  The RMA as it is would be dismantled and then split into two acts; a planning act regulating the use and development of land, and a Natural Environment Act focusing on the use and protection of land, air, water and other natural resources. Minister Responsible for RMA Reform Chris Bishop and Under-Secretary Simon Court said that the reforms were intended to streamline development more efficiently while also protecting the environment. The week before, the Greens issued a call for the compassionate release of 77-year old inmate Dean Wickliffe, who is currently on a hunger strike at the Spring Hill Corrections Facility after being arrested for being made houseless in violation of his probation conditions. And Green Party Co-Leader Chloe Swarbrick made a renewed call to the government calling on them to support a members bill of hers that would sanction Israel for their occupation of the Palestinian territories. For their weekly catchup, Oto spoke to the Green Party's Ricardo Menendez March for the party's take on all of these issues.

On today's episode, the government wants bipartisan support to repeal and replace the RMA, we cross to the US to get the latest on yesterday's bombshell that senior Trump administration officials discussed plans to bomb Yemen in a group messaging app, investigations are underway into how the police mistook an 11-year-old for a 20-year-old, and Auckland Council are set to decide on which stadium proposal to support in the city.

On the Mike Hosking Breakfast Full Show Podcast for Wednesday the 26th of March, the national stadium debate is continuing to drag on - and Rugby World Cup CEO Martin Snedden is calling for some action. The government has written to Labour and the Greens asking for cross party support for its RMA reform - Mike asks Chris Hipkins whether Labour will get on board. And Mike loves the idea of people needing a qualification to be able to become a local councillor or Mayor. Get the Mike Hosking Breakfast Full Show Podcast every weekday morning on iHeartRadio, or wherever you get your podcasts. LISTEN ABOVE See omnystudio.com/listener for privacy information.

Labour leader Chris Hipkins says compromises will need to be made in reforming the Resource Management Act. The Government's replacing the Act with a new planning framework, including rules around land development and environment protections. It's seeking cross-party support. Hipkins told Mike Hosking the country's administration can't keep putting infrastructure projects on hold. He says that if there are projects underway, even if they're not the administration's first choice, they'll keep doing them. Labour also wants clarity around the Treaty of Waitangi's role in the reform. Cabinet's decided on ruling out incorporating a Treaty clause in the legislation, despite the Expert Advisory Group recommending the current clause be carried over. Hipkins told Mike Hosking they want to make sure Treaty settlements are respected. He says saying you want to respect the Treaty but then saying you don't want to put it into law is contradictory. LISTEN ABOVE See omnystudio.com/listener for privacy information.

It's the law that governs almost everything about New Zealand's land, air, and water management - the government's finally revealed its plans to replace the behemoth that is the Resource Management Act. Political reporter Giles Dexter joins Lisa Owen.

On today's episode, Prime Minister Christopher Luxon joins us to discuss changes to the RMA, there are concerns from hospital specialists over plans to outsource procedures to the private sector, an 11-year-old was mistaken for a 20-year-old and admitted to a mental health facility, the All Whites have qualified for the 2026 World Cup, and an early painting by Goldie has sold for nearly $90,000.

Christopher Luxon says the country needs to get faster at building things. The Government's announced it is replacing the Resource Management Act with a new planning framework, including new Acts around development of land and on protection of the natural environment. It comes after the Government also announced plans to allow trusted builders to approve their own work and look at whether consenting authorities are fit-for-purpose. The Prime Minister told Mike Hosking too many things are standing in the way of getting things done. He says it currently takes 19 months to build a standard three or four-bedroom house here and is 50% more expensive than in Australia. LISTEN ABOVE See omnystudio.com/listener for privacy information.

There are hopes reforms to the Resource Management Act have walked the line between development and environment. The Government's new framework for planning includes new acts around development of land and on protection of the natural environment. Each act includes a set of national policy direction for simplifying and streamlining local government plans and decision-making. RMA Expert Advisory Group chair Janette Campbell told Mike Hosking they're confident it's hit a balance. She says they had a clear direction to protect the environment bottom line, and they've done that with the Environment Act. LISTEN ABOVE See omnystudio.com/listener for privacy information.

On the Mike Hosking Breakfast Full Show Podcast for Tuesday 25th of March, the Government is adjusting the RMA again – will this change be the end of it all? The Prime Minister is back from India and talking Kainga Ora, councils stopping the clock, and our national debt. Australian singer Pete Murray is coming back to New Zealand after 17 years to play some shows, so he came on for a chat. Get the Mike Hosking Breakfast Full Show Podcast every weekday morning on iHeartRadio, or wherever you get your podcasts. LISTEN ABOVE See omnystudio.com/listener for privacy information.

There's potential for some bi-partisanship as the Government reveals key features of a replacement Resource Management Act system. Two replacement acts will include clearer environmental boundaries and prioritise property rights. RMA Reform Minister Chris Bishop says it also has common sense ideas - like standardised zoning countrywide. He says he'll reach out to Labour and the Greens to look for areas where they can work together. Newstalk ZB senior political correspondent Barry Soper explains further. LISTEN ABOVESee omnystudio.com/listener for privacy information.

Land owners will have more control of their property under the Government's new Resource Management Act system. It's scrapping the RMA to replace it with two acts focused on land use and environmental protections. Cabinet is hoping to pass it before the next election - to be in place before councils start 2027 long-term plans. RMA Reform Minister Chris Bishop says building and expanding will become much smoother. "So as long as you meet the standards and you're using your own property - you can go off and do it. So fewer plans, fewer resource consents, much more standardisation - a much simpler system." LISTEN ABOVESee omnystudio.com/listener for privacy information.

On the Heather du Plessis-Allan Drive Full Show Podcast for Monday, 24 March 2025, Children's Minister Karen Chhour says she's shocked by revelations of Oranga Tamariki's grievous privacy breaches, including informing a woman's former partner of her address - leading to her physical abuse. RMA Reform Minister Chris Bishop tells Ryan Bridge he's ready to rip up the RMA - but what's it going to be replaced with? Ryan has a bouquet for a Rotorua councilor .... and Local Government NZ argues councils never spend money on stupid vanity projects. Plus, former All White Ben Sigmund remembers the last time New Zealand qualified for the FIFA World Cup - and the party that followed. Get the Heather du Plessis-Allan Drive Full Show Podcast every weekday evening on iHeartRadio, or wherever you get your podcasts. LISTEN ABOVESee omnystudio.com/listener for privacy information.

When is the right time to have children? What if you put having a family on the back burner and then something tragic happens that prevents you from conceiving? Today, we are joined by cancer survivor and RMA client Alexandria Touris and her doctor, our very own Matthew Lederman, to discuss navigating fertility with cancer. Tuning in, you'll hear all about how Alexandria's life was turned upside down when she received her cancer diagnosis, her egg retrieval process, the kind of support system she had, and her personal opinion (and words of wisdom) about freezing your eggs if having a family may ever be on the cards for you. Dr. Lederman also explains that cancer is affecting younger women before sharing some of the difficult questions he asks his patients to individualize their care. Finally, we discuss what we are grateful for today. To hear all this and even be reminded to be kind and pay it forward, be sure to press play now!

Today's Topics:1. Sound Signature Review 6.180 – the Centurion Arms Maximus-L on the 5.56 standard untuned MK18. Oh, my goodness gracious. Yet another hybrid design on the market?! The humanity! Dedicated 5.56 model, Inconel, light weight…. Does it bring the performance? This is the introductory discussion for the report published today with this episode. (00:06:37)2. The Walther PPK-SD chambered in .32ACP. We got it back from RMA! What was fixed? Apparently, a common issue. No more light strikes! A quick update on this potential future test host and the slow progress of its proving ground. (00:28:57)Sponsored by - Silencer Shop, Top Gun Range Houston, Legion Athletics, Capitol Armory, and the PEW Science Laboratory!Legion Athletics: use code pewscience for 20% off your first order and double points!Magpul: Use code PSTEN to receive $10 off your order of $100 or more at Magpul

Episode 143: Recovery in the News In this episode of Recovery in the Middle Ages, we run down the latest news from the world of recovery, giving our take on the headlines that matter to those on the sober path. We discuss the tragic passing of Melissa Trachtenberg, which may have been related to alcoholic liver disease. Then, we discuss The New York Times' long-overdue admission that red wine is not, in fact, the health elixir it was once hyped up to be—turns out, the “glass of wine a day” myth doesn't hold up under scrutiny. Finally, we highlight a success story worth celebrating: Blac Chyna marks two years of sobriety, proving that transformation is possible and that the journey to recovery is as much about growth and self-discovery as it is about abstaining from booze.  Recovery in the News: Has Red Wine lost its Health Halo?  Michelle Trachtenberg, known for her roles in "Buffy the Vampire Slayer" and "Harriet the Spy," passed away at the age of 39.  Angela White, formerly known as Blac Chyna, recently marked two years of sobriety. She has been open about her struggles with alcohol and the positive changes sobriety has brought to her life The Week in Weird: Assemblyman Chris Rogers (D-Santa Rosa) puts forth bill number 666, in hopes of making Bigfoot the state cryptid of California. *This podcast does not provide medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment.* Please remember to SUBSCRIBE to the podcast on your favorite platform to get the latest episode delivered right to your devices as soon as it's released. LINKS: www.soberliningsplaybook.com We are a listener-supported podcast. If you like what we're doing here at RMA and want to support the show, JOIN THE RECOVERY IN THE MIDDLE AGES PATREON  Our sole mission is to help other people achieve sobriety and become their best, most authentic selves. As little as $3 a month makes a big difference and helps us keep the lights on.  https://www.patreon.com/RecoveryintheMiddleAges As always, we thank you for your support.  RMA ON YOUTUBE FOLLOW US ON TWITTER  Facebook Page We also have a Facebook Group! Request to join the group. It's a private space for continuing the discussion of what Nat and Mike talk about on the podcast. Hope to see you there. PLEASE leave us a 5 star review on I-Tunes if you're enjoying the show and SUBSCRIBE to get the latest episodes.  Email: MikeR@middleagesrecovery.com Natx@middleagesrecovery.com We all have a story. Tell us yours and we'll share it on the show! E-Mail your story to miker@middleagesrecovery.com If you're in trouble with substance abuse and need help, reach out. There are thousands of people who have put problems with addiction in their rear-view mirrors and you can be one of them. While we neither endorse nor condemn any particular program, the sheer number of available AA and NA meetings suggest that reaching out to those organizations would be a good first step, (but maybe not the last step), on your road to recovery.   https://www.aa.org/ https://www.na.org/meetingsearch/ Marijuana Anonymous (just in case): This Naked Mind   ONE IN THE GOOSE TWO IN THE POOSE!

Fertility treatment is constantly evolving, with new advancements offering patients more options and greater success rates. In this episode, I'm joined by Dr. Catha Fischer, a board-certified reproductive endocrinologist at RMA of New York, to discuss what's on the horizon in reproductive medicine. Dr. Fischer shares insights into the latest breakthroughs in fertility treatments, from advancements in IVF technology to the potential of artificial intelligence in embryo selection. We also talk about how egg freezing has evolved, the role of lifestyle and nutrition in fertility, and what patients should consider when looking at emerging treatments. If you're curious about the future of fertility care, this episode is for you! In this episode, we cover: The biggest advancements in fertility care today How artificial intelligence is shaping embryo selection The evolution of egg freezing and its growing success rates The impact of lifestyle and nutrition on fertility What patients should know about new and emerging fertility treatments The future of personalized fertility care Read the full show notes on my website. Visit Dr. Catha Fischer's website at Spring Fertility. IVF Class: Do you have questions about IVF? Click here to join me for The IVF Class. The next live class call is on Monday, March 10, 2025, at 4pm PST, where I'll explain IVF and Egg Freezing, and there will be time to ask your questions live on Zoom. Other ways to reach me: Visit my YouTube channel for more fertility tips! Subscribe to the newsletter to get updates. Join Egg Whisperer School. Request a Consultation with me. Dr. Aimee Eyvazzadeh is one of America's most well-known fertility doctors. Her success rate at baby-making gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.

Paul Kanning is a farmer in Montana who grows mostly red lentils and yellow peas as well as wheat and canola. He also serves as the chairman of the USA Dry Pea and Lentil Council. Lewi Crow is a Risk Management Specialist with the USDA Risk Management Agency that services Wyoming, Montana and the Dakotas. Lewi and Paul talk about the importance of RMA and crop insurance, but also the process behind developing crop insurance programs for pulse crops. “ As an individual farmer, I have to provide them data and the way I do that is by making transactions, right? And so selling pulses in the fall helps establish the harvest price for the fall. That's the only way that they can come up with the data is by farmers putting product out in the stream… That makes the whole wheel turn.” - Paul Kanning ”...some of the things that I do with that is reviewing plant dates, basically just kind of pulling apart crop programs and reviewing all aspects of it that goes on with rates and t-yields for individual counties, rotation requirements, various things that farmers tend to encounter when choosing crop insurance.” - Lewi CrowThis Week on Growing Pulse Crops:Meet Paul Kanning, a pulse crop farmer in Montana and the chairman of the USA Dry Pea and Lentil Council, and Lewi Crow, a Risk Management Specialist with the USDA Risk Management Agency Understand what the RMA provides for producers and the insight they can offer when making production decisionsMake a note of these important dates:January 15th is when the harvest price is released Beginning of March is when projected prices for this 2025 crop year are releasedMarch 15th is the sales closing date for most of the spring seeded crops so Lewi recommends reviewing your crop insurance prior to that date Growing Pulse Crops is produced by Dr. Audrey Kalil and hosted by Tim Hammerich of the Future of Agriculture Podcast.

We're being told the potential for New Zealand's 'blue economy' to take off will depend on the Resource Management Act. A new Westpac report says the marine economy could grow to $14 billion in 10 years by switching to more sustainable practices. Aquaculture New Zealand Chief Executive Gary Hooper told Mike Hosking aquaculture was recognised for the part it could play, but has yet to flourish due to RMA restrictions. He hopes the fast-track approval processes shortened time frames, certainties, and more nuanced approach could be the circuit breaker to unleash new opportunities. LISTEN ABOVE See omnystudio.com/listener for privacy information.

On this episode of Talking Away The Taboo, Natalie Richeimer, MS, CGC, Genetic Counselor, Education and Outreach Manager at Jscreen, Bat-Sheva L. Maslow MD, REI, RMA, and Rena Fox, RNC-OB, BSN, join Aimee Baron, MD to talk about genetics and Infertility. The introductory episode of our 5-part IWSTHAB x JSCREEN Podcast series dives into the genetic aspect of fertility and recurrent pregnancy loss (RPL) workups, setting the stage for an engaging and informative series that blends expert knowledge with deeply personal stories. Moderated by Dr. Aimee Baron of IWSTHAB, in this epsiode, we speak to Natalie, a reproductive genetic counselor, will explain what a genetic counselor does and how genetics factor into infertility evaluations. Dr. Batsheva Maslow (REI) will provide a medical perspective on infertility evaluations and how certain diagnoses and/or findings can help direct treatment. And finally,  Rena Fox will share her personal journey as part of a carrier couple who chose IVF for genetic reasons, shedding light on the real-life implications of genetic fertility challenges.  More about Natalie:  Natalie Richeimer, MS, CGC, is a board certified genetic counselor at jscreen with clinical experience in adult, pediatric, and reproductive genetic counseling. She holds a master's degree in human genetics and genetic counseling from the Keck Graduate Institute. Natalie is a native Torontonian, who lives in Los Angeles with her husband and two boys. She has published research in the Journal of Genetic Counseling on the impact of orthodox Jewish clergy's role in prenatal genetic counseling. Prior to her work as a genetic counselor, Natalie worked as a high school STEM teacher for 7 years in Los Angeles. She is passionate about reproductive health education and community engagement. Natalie has a special interest in outreach, with the goal of increasing awareness of and access to genetic counseling. Natalie has partnered with local organizations and high schools to provide community education. More about Dr. Maslow: Dr. Bat-Sheva Lerner Maslow is double board-certified in OB/GYN and Reproductive Endocrinologist and Infertility and is the lead physician at the Reproductive Medical Associates of New Jersey - Jersey City office. Dr. Maslow has a special interest in education, research, and the clinical care of single women considering proactive fertility preservation.  Outside of the office, Dr. Maslow lectures and writes on the intersection of halakha and reproduction. She serves as the Director of Medical Education for the North American Yoatzot Halacha Program and is a board member of several organizations related to Jewish women and health. She maintains an active educational presence on social media discussing issues related to reproduction in the Jewish community.  Dr. Maslow attended Barnard College and the Albert Einstein College of Medicine. She completed residency in Obstetrics & Gynecology at the University of Pennsylvania and fellowship in Reproductive Endocrinology & Infertility at the University of Connecticut, where she also completed a master's degree in clinical and translational research More about Rena:  Rena is an experienced nurse with 6 years in labor and delivery and 2 years in reproductive endocrinology and infertility (REI). Having personally gone through IVF, she combines professional expertise with personal insight to provide compassionate care and support to those navigating fertility challenges. Connect with us: -Check out our Website - Follow us on Instagram and send us a message -Watch our TikToks -Follow us on Facebook -Watch us on YouTube

Episode 142: RMA, RFK and the San Patrignano Experiment In this episode of Recovery in the Middle Ages, we take a look at Robert F. Kennedy Jr.'s plan to address addiction in America, which leans heavily on his personal recovery experience and the model of Italy's San Patrignano rehab center. Kennedy's proposal centers around creating “wellness farms” across rural America, where people struggling with addiction can live and work in therapeutic communities, focusing on organic farming and communal living as an alternative to incarceration. This approach is inspired by San Patrignano's long-term, work-based rehab program, which has seen success for those who stick with it. But there's a lot of pushback, as critics point out the lack of medically assisted treatment and the potential for coercive practices, which have plagued San Patrignano in the past. Kennedy's skepticism toward pharmaceutical treatments like methadone and his promotion of alternative therapies like cannabis and psychedelics are also raising eyebrows, with many worried that his approach could undermine evidence-based practices that have proven effective in addiction treatment. Recovery in the News: A study on fruit flies has identified that acetylcholine, a brain signal integral to memory and motivation, plays a crucial role in alcohol-induced sleep disturbances.  A recent survey indicates that nearly half of Americans, particularly younger generations, plan to reduce their alcohol consumption in 2025, driven by health concerns and the rising popularity of non-alcoholic alternatives.  *This podcast does not provide medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment.* Please remember to SUBSCRIBE to the podcast on your favorite platform to get the latest episode delivered right to your devices as soon as it's released. LINKS: www.soberliningsplaybook.com We are a listener-supported podcast. If you like what we're doing here at RMA and want to support the show, JOIN THE RECOVERY IN THE MIDDLE AGES PATREON  Our sole mission is to help other people achieve sobriety and become their best, most authentic selves. As little as $3 a month makes a big difference and helps us keep the lights on.  https://www.patreon.com/RecoveryintheMiddleAges As always, we thank you for your support.  RMA ON YOUTUBE FOLLOW US ON TWITTER  Facebook Page We also have a Facebook Group! Request to join the group. It's a private space for continuing the discussion of what Nat and Mike talk about on the podcast. Hope to see you there. PLEASE leave us a 5 star review on I-Tunes if you're enjoying the show and SUBSCRIBE to get the latest episodes.  Email: MikeR@middleagesrecovery.com Natx@middleagesrecovery.com We all have a story. Tell us yours and we'll share it on the show! E-Mail your story to miker@middleagesrecovery.com If you're in trouble with substance abuse and need help, reach out. There are thousands of people who have put problems with addiction in their rear-view mirrors and you can be one of them. While we neither endorse nor condemn any particular program, the sheer number of available AA and NA meetings suggest that reaching out to those organizations would be a good first step, (but maybe not the last step), on your road to recovery.   https://www.aa.org/ https://www.na.org/meetingsearch/ Marijuana Anonymous (just in case): This Naked Mind  

In this episode: Justin goes to a birthday party, drives a Tesla, and configures your BIOS. The compliments department is, as always, available at podcast@searls.co. Have some URLs: This is the combination air fryer / grill I bought Microsoft dropped support for non-SecureBoot PC updates last month Aaron's puns, ranked Nobody Cares Things we learned about LLMs in 2024 Judge ends man's 11-year quest to dig up landfill and recover $765M in bitcoin The Consensus on Havana Syndrome Is Cracking (News+) Meta kills diversity programs, claiming DEI has become “too charged” Google kills JavaScript-free searches Sonos still seems kinda fucked 5090s seem kind of like a scam The official Elder Scrolls: Oblivion remake leaked Switch 2 was unveiled Guy with 200bpm heart rate complains his watch isn't working (before admitting his heart isn't working) The Diplomat Conclave Severance Season 2 is out Marvel Rivals is a hit (with the Thirstlords) Indiana Jones and the Great Circle P.T. A Short Hike Transcript: [00:00:29] Well, good morning, everyone. If it's evening, where you are, well, it's not here. So that's just what you get. You get a good morning. You can save it for later, put it in your pocket, and then the next time the sun comes up, you can just remember, ah, yes, someone did wish me a good morning today. [00:00:48] You are currently, your ears are residing inside of Breaking Change, which is an audio production. Not to be confused with Breaking Bad, certainly not Breaking Good, just broken. [00:01:03] You know, now that officially, officially or unofficially, TikTok is down. It's unreachable in the U.S. Aaron has reported, our Seattle correspondent, for the broadcast, that even over his VPN, he can't get to TikTok. [00:01:24] His arms are itchy. He's scratching. He, ah, I hope, wherever you are, I hope that you and your loved ones and your teenagers are okay. [00:01:33] But yeah, anyway, now the TikTok is down. Maybe some of you are here, because you've got nothing else to do, and you need something to fill that void. So thank you for joining. [00:01:45] Something that I've been meaning to do at the beginning of this, of the show, for the last, well, seven versions, has been to kindly ask that you go into your podcast player of choice, and you rate and review the show. [00:02:02] I would prefer five stars on a five-star scale, but if it was a ten-star scale, you know, ten stars would be better. [00:02:10] Thumbs up, or whatever. Write a little review explaining why the fuck somebody would want to listen to an explicit language, you know, tech-adjacent programmer-ish gaming movie, whatever the fuck this is. [00:02:23] Dialogue, uh, because, uh, I have found that breaking change is a really hard pitch, you know, when, when, when, when explaining to people, it's like, oh, this is me talking, just like drive-time AM radio used to be, except instead of talking about a bunch of politically charged propaganda, uh, we're just hanging out, uh, and instead of having a commute, you know, you're walking a dog, or you're doing the dishes. [00:02:50] Although, I guess, you know, maybe you listen on a commute. [00:02:53] I, I, I've heard, I've heard from, from listeners on road trips, listening to entire episodes all in one stretch, and that's something else. [00:03:03] Uh, I have not heard from a lot of commuters, so if you listen to this while you're commuting, shout out at podcast at searles.co, uh, you know, if you're driving, don't, don't try to rate and review, you know, in a distracted fashion. [00:03:16] But, but next time you think of it, you know, you, you, you slam that five-star button. [00:03:20] You know what, it's, it's, I got a lot of subversive elements, you know, in my cadre of people, because I am a total piece of shit, and I attract, I attract the good and the bad, everyone in between. [00:03:32] But some of us, you know, we, we, we appreciate a good troll. [00:03:35] There is no better way to stick it to the man and, and confuse the hell out of people than for all of you to go and give this five stars in, in, in iTunes and, in your podcast player. [00:03:46] And then have a whole bunch of people, you know, have it surface in the algorithm for others. [00:03:51] And then they listen to this, and then they're like, what, what, what the fuck is going on to my ears right now? [00:03:55] Uh, I am very confused. [00:03:57] And if that's you, hell, you know what? [00:03:59] Oh, shoot. [00:03:59] But I'm, I'm speaking from the past. [00:04:01] Maybe this is the, the future where this is a lot of five-star reviews and some, some, some rando outside of Argentina is, is, is getting this put into their feed for them. [00:04:11] And now they're like, four minutes have passed. [00:04:14] What am I doing with my life? [00:04:15] Well, hello. [00:04:16] You are also welcome. [00:04:17] Good morning to you as well. [00:04:18] Uh, by the time you're listening to this, you know, I'm recording Sunday morning. [00:04:24] First thing, uh, I know from experience that it can be hard to pretend to work during a Trump inauguration. [00:04:33] So, uh, I figured that instead of pretending to work, you could be here with me instead if you're listening on Monday. [00:04:41] And if you're, if you're fortunate enough to have Monday off, um, you know, I guess one difference between the, uh, uh, the previous Trump inauguration. [00:04:51] And this one is that the, you know, inclusivity backlash against the Trump admin, you know, that has now recently receded. [00:05:02] If you're to believe the Bezos and billionaire class, uh, uh, has resulted in way, way more people who don't work at post offices getting MLK junior day off. [00:05:13] So I suppose many of us are not working on Monday, but regardless, this is a version 29 of the program titled super switch. [00:05:24] Which, you know, depending on the audience, I think a lot of, you know, probably what I mean by that. [00:05:29] We'll, we'll talk about it later. [00:05:30] Uh, in life news, it feels like it's been a way more than two weeks since I talked to y'all. [00:05:37] Uh, uh, uh, when you live in a theme park, there's just a lot going on. [00:05:42] People coming and going stuff to do, uh, uh, stimulation overload. [00:05:49] That's why I sound so just, you know, demure downbeat chill here is because I am exhausted permanently all the time. [00:06:02] Cause every time I leave the house, I am, I am just overstimulated. [00:06:05] Uh, last night we went to a birthday party of a friend, uh, in the, uh, Orlando proper part of Orlando, [00:06:12] whereas we live in theme park, Orlando. [00:06:14] So we had to, uh, drive over the, uh, the treacherous terrain known as I four, the deadliest stretch of highway in the United States in terms of, uh, only in terms of the number of people who die on it. [00:06:26] And the party was, uh, it was funny cause our, our friends, uh, they're building a house on this beautiful lake, huge property. [00:06:34] It's, it's absolutely gorgeous. [00:06:36] It's going to, the house is a custom build. [00:06:39] And a couple of years ago, uh, the one who's, whose birthday ended up being said, you know, we're going to have my 45th birthday party here at the house. [00:06:47] After it opens the water slide, you're going to DJs. [00:06:50] We're going to have, it's going to be a big blowout fest. [00:06:52] It's going to be awesome. [00:06:53] And then his husband was like, you know, it's, it's not going to be ready yet. [00:06:57] Don't get your hopes up. [00:06:58] And, uh, uh, sure enough, uh, both things came to pass. [00:07:04] The house is nowhere near ready. [00:07:05] It is an active construction site. [00:07:07] And they trolled us hard. [00:07:08] They said, Hey, come to this hotel. [00:07:09] We're going to have, you know, uh, uh, free valet or whatever. [00:07:12] And then like, like we go into like a normal kind of like typical ballroom thing and you get a cocktail. [00:07:19] And then these construction workers show up and they, they, they, they heard us into buses. [00:07:24] Uh, and so people are in their cocktail attire, you know, Becky wore, uh, I don't know if you'd call them heels, [00:07:32] but elevated shoes for, for first time in a while, more of a flats person, which I respect. [00:07:39] Cause I'm also a flats person and, uh, we all get into the bus and everyone's dressed up. [00:07:44] And then, uh, they, they, they drive us to, uh, the active construction site. [00:07:47] That is our friend's house. [00:07:49] And, uh, they had, uh, the events planners and everyone like, like actually just decorate the shit out of, you know, what, what is a lot of concrete block first floor of most homes around here is concrete. [00:08:01] And so the bones of the house are up and they just decorated it with kind of construction paraphernalia, orange cones. [00:08:07] All of the staff had, uh, you know, orange vests on, uh, we were all given hard hats. [00:08:11] Uh, the theming was truly on point. [00:08:15] Weather was perfect. [00:08:16] Uh, and, uh, you know, it was a big raucous affair, raucous raucous, you know what I mean? [00:08:23] So that was great. [00:08:24] Uh, we didn't even stay out that late, but I feel like I got hit by a truck, uh, this morning. [00:08:29] Uh, I, I kept it to a two drink maximum, which is my new go-to rule of thumb. [00:08:34] Uh, uh, cause I always end up barely regretting the third from a, from a, an ability to sleep perspective. [00:08:43] Afterwards, uh, other life stuff, you know, like the logistics following the death of my father. [00:08:48] First of all, thank you very much for many of you wrote in to express sympathies, uh, probably don't, don't need to put them all in the mailbag. [00:08:55] Cause that after a certain point, it started reads like, you know, reading birthday cards on air, uh, in terms of they all, you know, not to diminish anyone's, uh, extension of grief, uh, or, or, or sharing their own stories. [00:09:08] But there's a certain, you know, beginning, middle and end format to, to, to, to, to, no one knows what the fuck to say. [00:09:15] I don't know what to thank you. [00:09:18] Um, but yeah, like I know just sort of like finances and, and forensics front of trying to figure out how to tease out all the complexities of his life that he never really told anyone about and didn't certainly didn't document, uh, that the work continues still trying to help my mom consolidate her situation. [00:09:36] It's been, you know, just a lot of very procedural. [00:09:42] All right, find all the stuff, organize the stuff, come up with a to-do list, figure out how to like approach this, make all the phone calls that you need to make to all these institutions to, to, to, to, to iron it out and to, to continue fact finding or to, to, to give, you know, furnish whatever documentation they need. [00:09:57] And, and, and because it's been so, uh, I guess transactional wrote, like not to say it's colored my perception of dad or anything, you know, one way or another. [00:10:11] Uh, but it's definitely, when I look back on this era of my life, of course, his passing is going to stand out in sharp relief, but like, that was like a week of stuff. [00:10:21] And then the rest of it is going to be like three months of stuff. [00:10:25] Uh, and so I wonder how that's going to affect how I, how I, how I look back on it. [00:10:28] But one of the things I noticed is a lot of different service providers, uh, like banks, for example, that have, uh, uh, you know, bills coming up, you know, you got a credit card bill and let's say it's due. [00:10:45] Uh, I, I don't know why I'm blanking, but January 25th and then January 18th comes around and it says, Hey, you have a statement due January 25th. [00:10:54] Or you got an upcoming bill or you, your bill is ready to be paid. [00:10:58] And when I get an email like that, so I just got one from dad or, you know, for dad's account from us bank. [00:11:05] And I was like, shit. [00:11:07] Cause I know he didn't have auto pay set up in a lot of places. [00:11:09] Uh, and like, do I have that login? [00:11:12] Like, you know, do I have to coordinate with mom to get the SMS thing? [00:11:15] Like I get into it. [00:11:16] And then sure enough, like, cause I thought I'd set up auto pay. [00:11:19] I even had a to-do list that said, set up auto pay for this. [00:11:21] And, uh, auto pay was set up. [00:11:23] It was just emailing me unnecessarily anyway. [00:11:25] You know, if you're going to have a recurring payment or an auto payment set up, it, you know, it's, it's okay to notify the customer that there's another bill coming, but it would be really sweet. [00:11:36] If like auto pay is enabled, just so you know, you're going to, you're set to auto pay this on X and X date, uh, because if you got, you know, as many cards as some people have, uh, it can get kind of exhausting to, to just worry about, uh, well, I hope that's, that's all set up. [00:11:53] So it's, uh, things like that are just like random nonsense stressors and the amount of context switching, because you're constantly getting emails and calls from different, from all corners. [00:12:03] I normally screen my calls really aggressively, but you know, this month I've got a pretty much [00:12:08] answer it no matter who's calling, which is not my favorite. [00:12:10] And I've, I've found myself falling into something that I never thought I would do. [00:12:17] Uh, maybe it's cause I turned 40 this week, but I'm, uh, I've always associated this with like [00:12:24] an old, a generational thing. [00:12:26] When somebody asks me a yes, no question, I've started saying yes or no. [00:12:31] Like the literal word, yes. [00:12:33] And that might sound mundane to you, but in my family growing up, the word, yes, always felt [00:12:41] violent because everyone always had more to say, or they had a compulsion to soften it, you know, [00:12:49] like, yeah, sounds a lot, um, neutral, accepting, open, soft. [00:12:58] Then yes, there's a certain like hardness to yes. [00:13:01] You ask a yes, no question. [00:13:02] The person says, yes, it feels like there's a period at the end of that. [00:13:05] And when you say, yeah, or okay, or all right, or, you know, you give some sort of like, you know, [00:13:11] like an invitation to either continue with a follow-up question or, you know, be, be open to maybe a retort or something. [00:13:20] And so I had a colleague once who is, you know, the previous generation who is my superior. [00:13:25] And, uh, his name was Daryl. [00:13:28] Daryl's a lovely person. [00:13:29] But every time I asked Daryl a question and I was asking him a lot of questions because I didn't know shit about fuck. [00:13:34] And he knew a lot of things about everything he would, he would answer every yes, no question with just the word yes or the word no. [00:13:43] And it felt so stifling and cruel and like, you know, like, why is he shutting me down like this? [00:13:51] Even though he's literally answering in the affirmative, there's something about the word yes. [00:13:55] When unadorned with any sort of softeners or explanation or exposition or, or, or, or, or justification or, or invitation to, to, to follow up that feel there's the finality of it feels just rude, even though it is very literally fine. [00:14:12] So I caught myself doing that and I guess I've become a yes man. [00:14:16] Other life stuff. [00:14:22] Our ninja, we have a, uh, we seem to have like every ninja kitchen appliance, um, just in some sort of rotation around, uh, you know, our, our kitchen and it feels to me like every modern home that every year, the, there's like a, a counter surface inflation where the counters keep getting bigger. [00:14:44] The kitchen islands keep getting bigger. [00:14:46] And then the, almost a, um, sort of like how a, a gas will expand to fill its container. [00:14:54] Like ninja appliances will continue getting invented to fill all available counter space in every home. [00:14:59] Uh, and the reason that ninjas been so successful is that unlike Hamilton beach and Cuisinart and stuff like their, their products are actually pretty good and do what they say on the tin. [00:15:09] But we had a, uh, one of the air fryer units that can also, you know, pretend to be a grill, even though like all that's really happening is a hairdryer is blowing downward onto your food and any sort of heating element underneath is indirect. [00:15:20] Uh, we had one of those and, you know, it just kind of got grody and gross from lots of oil and, and repeat washings and, you know, food stuck to the basket. [00:15:31] And it was, it was, it was no longer, you know, how sometimes you use one of these appliances, you don't clean it as intentionally or as frequently as maybe the instruction manual tells you to. [00:15:42] And eventually your food starts tasting like, you know, the bottom of the, uh, the, the, the, the, the deep fryer at, at McDonald's, like, just like that oil tarry kind of like, you know, afterglow. [00:15:55] Which makes, it takes, it really takes the shine off of, uh, whatever the omega threes that you're trying to get out of your fishes. [00:16:00] Uh, so, so we, we bought a new one and what I really wanted out of a new one was one with like multiple heating elements. [00:16:08] Like where, where there was an actual grill that could sear stuff and cook from the bottom up, but also a convection oven that could crisp it up and, and, and, and sort of dehumidify. [00:16:18] And amazingly, Ninja does sell this product. [00:16:22] Uh, it was called, uh, see if I can link to it. [00:16:25] The Ninja convection plus grill. [00:16:27] Oh no, that wasn't it. [00:16:28] It's, it's got a name. [00:16:29] Uh, something, something, grid IG 651. [00:16:35] Okay. [00:16:35] There you go. [00:16:35] I'll put a link in the show notes. [00:16:37] Uh, so the IG 651, whatever, it's got like a barbecue griddle on it. [00:16:41] It seems, it seems nice. [00:16:43] Uh, and it does exactly that. [00:16:46] It's got like a big wide surface element. [00:16:48] You can, you, you plug it in. [00:16:49] It's a very complicated, unnecessarily. [00:16:51] So a complicated thing where it's, it looks like you kind of take a George Foreman style griddle. [00:16:55] It's angled forward, meaning like it's got, you know, uh, I said griddle at just like the slabby kind of, of, of metal slats, slats, you know, where you, you put the burger on it. [00:17:07] And then it's like, you know, remember the George Foreman marketing? [00:17:10] I'm sure you do like, you know, like it's like at the, like, like the, the squeezing iconography to, to indicate like the fat is coming out and then that will make this healthier, even though the fat is often the best part. [00:17:20] Uh, so it's, it's got that it plugs into some like electrical, you know, electrode input thing with two little donguses. [00:17:28] I don't know why I'm even trying to explain this. [00:17:30] It's fine. [00:17:30] And you plug that in, you can wash it separately, but you can put a griddle on top that kind of maps to it. [00:17:36] So it'll pick up that heat. [00:17:37] And that is a flat surface, which can be nice. [00:17:40] If you're, if you're maybe, you know, toasting a sandwich or something. [00:17:46] And yeah, the thing about it, the thing about that search was that trying to answer the question of what heating elements are in this smart cooking appliance proved to be extremely difficult. [00:18:00] You go to the Amazon listing, you go to the product page. [00:18:03] I read up on every single Ninja product that does this. [00:18:06] I started looking at other products that do this. [00:18:09] I started looking at things that ran themselves as smart ovens that, you know, advertise having, uh, multiple heating elements, you know, like the June oven did this. [00:18:16] I think that's out of business now. [00:18:18] Tovala did this. [00:18:18] I think that's going out of business now where they would have, you know, like, um, maybe a microwave element plus a steam cooking element, or maybe they'd have a convection fan inside and also, um, an induction plate underneath. [00:18:31] And none of them have really taken off in the U S unfortunately, uh, such that. [00:18:39] It is a product category that the consumers are educated about, like what they're getting into in Japan. [00:18:45] There's a product called health. [00:18:46] You know, like literally like health EO, but THs are hard and it's got like the basic models have four or five different ways to heat your food. [00:18:56] And then like, it's really smart in that you, you punch in a code, like a recipe code, and it'll just do everything cradle to grave for you with the advanced sensors that it has. [00:19:04] And kind of move between whatever combination at whatever point in the cooking process, all of those heating elements need to be arranged. [00:19:11] And so things come out almost better than a human could do them because they never have to be removed from this hermetically sealed environment, you know, for people's hands to come in and, and, and adjust how the thing is being heated. [00:19:26] Because in Japan, that product has been so successful that the two or three different tiers of that product, not only are they all good, but like, no one needs to be explained what's there. [00:19:36] Like the, the, the, the, it could just be like the higher level of literacy and, and, and education generally in Japan. [00:19:42] But in general, like, it's just, it's really straightforward. [00:19:46] And here, it seems to be that like people just want a device that they can throw food in. [00:19:52] And then as long as they're picking off a menu and it has words like grill, they will feel good about it. [00:19:58] And no one's going to ask, where's the heat coming from? [00:20:01] How is this getting cooked? [00:20:02] Which now that I say it, of course, like Americans don't give a fuck how the thing gets accomplished or without it gets accomplished well, typically, uh, just that, uh, you know, they know what box to put the food in and then the button to hit, which is, you know, a little bit condescending, but, you know, y'all have earned it in my opinion. [00:20:20] Uh, so yeah, we got it. [00:20:22] It works. [00:20:22] Uh, uh, as far as I know, I turned it on the preheating started. [00:20:26] We have not yet, you know, broken the seal and actually cooked with it yet, but I'm glad, I'm glad to have that because I think, I think, I think. [00:20:32] Shit will turn out better, especially salmon, which is increasingly the number one thing that we were using our air fryer for, which was an inefficient, uh, use case. [00:20:40] Speaking of the parks being really busy, uh, and, and life here being overstimulating on Friday, I found myself really testing the fences on this new being 40 year old thing. [00:20:55] I, uh, got up at 5am with Becky. [00:20:59] We had a special event at Disney's Hollywood studios that started at six. [00:21:03] We got there. [00:21:04] There were other people there. [00:21:05] We went to bed early, you know, to, to, to, to be able to, to do this and not be super groggy and miserable, had a great time. [00:21:13] And then we had some friends coming into the park just about an hour after that, that, that event wrapped. [00:21:18] And so we went and visited with them for a little bit. [00:21:20] Then we came home and tried to recover some sort of a productive day by then it was noon. [00:21:25] Uh, and then that evening, cause the same friends that they had their big day, I wanted to debrief with, uh, uh, my buddy before he, uh, John, his name is John. [00:21:35] He is a listener of the program. [00:21:38] So hi, John. [00:21:38] Hello. [00:21:40] Uh, when to do debrief with him. [00:21:43] So we went over to a bar called trader Sam's, which is a grog grotto. [00:21:47] It's in the Polynesian resort hotel. [00:21:49] And it's one of my favorite bars because it's got like a lot of like little imagineering knickknacks and stage elements that, that have since become very common at Tiki bars. [00:21:58] But we got in there, we spent a couple hours and then pretty soon I realized, Oh fuck, it's midnight. [00:22:03] And I've literally been Disney it up to some extent, uh, since 6am. [00:22:10] And so, you know, I actually, I got a second wind in there, but I ultimately didn't get, get to bed until like two. [00:22:16] Uh, so that was a, it was a big day. [00:22:19] I feel like I did all right. [00:22:20] Uh, from an energy level perspective, I think I, I was the person that I needed to be in all of the interactions I had that day. [00:22:28] And that's probably the most I can say. [00:22:29] Uh, I'm simultaneously finding that my body is falling apart. [00:22:33] My, my, uh, left hip is pretty grumpy. [00:22:38] Uh, it's just some sort of like a constant dull discomfort, uh, feels like a dislocated shoulder, but no matter how much PT I do, [00:22:46] I, I, I seem to never fully, fully beat it. [00:22:49] Um, I need a smart, the smart oven equivalent for, for, uh, you know, muscle therapies that people do. [00:23:00] It's like, Oh, you can get some of the, it'll, it'll apply the icy hot and also, you know, drill you with a Theragun and also massage you and also use the, you know, resistant bands exercises to strengthen it. [00:23:09] Uh, just all simultaneously. [00:23:10] Cause it's like this round robin of, of attempts I've had to, to restore this fucking hip. [00:23:17] Uh, it has been great. [00:23:19] So that's been a constant thing. [00:23:21] New things are like my right knee now hurts like hell. [00:23:23] My left, my left heel, just the skin started cracking from how dry it's been here. [00:23:28] And of course it's still way more humid here than the rest of the nation, but apparently my skin is so used to the humidity, uh, that I just woke up one morning and it hurt to walk because all my skin was exposed because all my skin and my foot had cracked. [00:23:40] You know, like what the hell's going on? [00:23:42] So, uh, if you're, uh, approaching 40 and you're worried about it, good. [00:23:48] I don't know that I recommend it so far, uh, but I'm still here, still kicking. [00:23:53] Uh, uh, well, I, so far I almost didn't make it to be honest. [00:23:59] Uh, you know, well, I, if I'm going to talk about this next topic, uh, it's something that's come up in the show before. [00:24:09] And so I think that technically makes it follow up. [00:24:11] So let me hit this button right here. [00:24:13] Yeah. [00:24:20] So speaking of dying right before you turn 40, I, I'd mentioned that I four interstate four that runs east, west in, uh, through bisecting Orlando. [00:24:37] It's, uh, known to be, and I fact checked this against GPT cause I knew I'd probably end up talking about it. [00:24:45] Deadliest stretch of highway in the U S and you know, I'm a, I'm an experienced driver insofar as I've been driving for 24 years. [00:24:54] I don't like love it. [00:24:56] I'm not a car guy. [00:24:57] Uh, I, I feel like I drive fine, relatively safely, probably more on the conservative side. [00:25:05] Overall. [00:25:06] I do speed from time to time, but you know, as long as if you're in America and you're speeding, as long as you use the phrase flow of traffic, uh, you can do whatever you want. [00:25:17] And the problem is that when you live in theme park Orlando and you need literally anything that is not entertainment and hospitality related, uh, like for example, you know, I, I, and this is what puts this into the followup bucket of content. [00:25:35] Uh, I've been talking on and off about having, uh, struggling with snoring. [00:25:38] You know, I've been, uh, uh, doing that thing that a lot of middle-aged husbands start doing and deciding to interrupt their spouse's sleep by, by, by suddenly picking up this cool new habit. [00:25:49] That is just making wheezing sounds all night long. [00:25:53] And mine's really inconsistent. [00:25:56] It's clearly triggered by something. [00:25:57] Couldn't really tell what, you know, is it diet or whatever. [00:26:00] It's like clearly like none of the symptoms of apnea. [00:26:03] So that's probably not it. [00:26:04] Given that I feel fully rested after like four hours and I've never feeling short of breath. [00:26:08] Uh, you know, the new Apple watch has an apnea detection and it seems to not be detecting any apnea. [00:26:16] So I finally got a sleep study ordered and the doctor who is a very nice lady, she, you know, she's just like the reality of insurance right now is, uh, I will put in a request for an in, in a let in lab sleep study. [00:26:33] So we can watch you because the alternative is an at home sleep study. [00:26:36] And based on everything you're saying, there is a 0.0% chance that that at home sleep study is going to find anything. [00:26:44] Uh, and then I was like, well, then let's just do the in lab. [00:26:46] Like you're saying, well, she's like, oh, the insurance will surely deny based on what you're saying, uh, an in lab sleep study. [00:26:53] Uh, you have to do, you have to go through the motions of this at home sleep study first, and then it has to show nothing. [00:27:00] And then I can put in a script again for the in lab. [00:27:04] Uh, and, and then the prior authorization will go through and then you'll be able to do that. [00:27:09] And so I have to kind of do this performative nothing operation, just nothing like procedure, operation procedure. [00:27:18] It's over, you know, like diagnostic, you know, just to check some boxes and money is changing hands invisibly to me at every step. [00:27:27] Of course, for the most part, thanks, thanks to having health insurance. [00:27:30] So I, I, I schedule this and it's an at home sleep study. [00:27:36] Like there are services that mail these units, you know, they could ship it. [00:27:40] I could, I don't know, find a courier or something, but nope, this one, I have to drive to the other fucking side of Orlando, which is, you know, it's 20 miles, but it's like a 45 minute hour long adventure. [00:27:49] And I have to calling them the rules of the game were that I had to, uh, drive there Sunday night to pick it up, come back Tuesday night to drop it off. [00:28:00] And they, because of sleep study locations, this is like an actual, you know, testing center. [00:28:07] Uh, they literally open at 6 30 PM in the evening. [00:28:10] Uh, you know, so that's when their shift starts. [00:28:13] So I had to get there at 6 30. [00:28:15] So that means like, I'm basically fighting through rush hour into town and then pick it up and now I'm coming back home and now it's like eight. [00:28:22] So I guess I'll just eat dinner by myself or whatever. [00:28:25] Uh, and it's not like in a part of town where it's like, Hey, we can go downtown and like make a date, make a night date night out of it and go to like a fun restaurant. [00:28:33] It's like, this is a, I don't know what I, I have many times in this program suggested you should move to Orlando. [00:28:41] Orlando's great. [00:28:41] I love life in Orlando, but like whenever I leave the bubble of like theme park party time, Orlando, where everything's just really, really nice and customer service is incredible. [00:28:50] And the food's really great. [00:28:52] And, and it's just a party. [00:28:53] Uh, and I go to like real Florida. [00:28:56] I'm like, Oh yeah, I need to stop recommending people move to Orlando. [00:28:59] Cause this is like the median experience. [00:29:01] And I wouldn't, I would not, I can't do this for an hour. [00:29:05] I don't know how I would possibly live here. [00:29:07] No offense to Orlando, but I, uh, I went and I picked it up. [00:29:12] I drove my car there on Sunday night and traffic was pretty bad, but it's always pretty bad. [00:29:18] I had numerous cases of people jumping in front of the car on the way onto the highway. [00:29:23] Once I was on the highway, I get into the new express lanes, which do make things easier. [00:29:27] You pay a toll and you get, uh, you know, expedited traffic. [00:29:30] Um, and somebody had pulled over into the shoulder. [00:29:34] And as soon as he pulls over, he just whips open his, his driver's side door off of the shoulder. [00:29:41] And now the door is in my lane. [00:29:43] And there's of course, somebody on my left causing me to, uh, flip out and have to slam the brakes to, to the point of like, you know, bad enough that smoke is happening. [00:29:53] Right. [00:29:53] Like you can smell the burnt tire because this dude is just like, I'm on the highway. [00:29:57] I can open my door. [00:29:58] I'm a, I'm a big man. [00:29:59] I'm driving a truck. [00:30:00] So I chose not to blow his door off. [00:30:05] Uh, then on the way home, it was one of those ordeals where, uh, it's a, a sign said congestion, like eight, four miles ahead. [00:30:16] I was like, oh, four miles. [00:30:17] Okay. [00:30:17] Maybe I'll find an opportunity to take, get off the highway or I'll get onto the express lane and try to avoid it. [00:30:21] And, uh, Apple maps was saying I should turn right at the Kia center, which is like where the Orlando magic play. [00:30:27] And then take three more rights and then get back on the highway. [00:30:30] And I was like extremely convinced that this was just some sort of, you know, Apple maps fuckery. [00:30:36] Uh, and, and the nav and the computer being wrong because it often is, I was like, I'm going to stay on the highway. [00:30:42] I'm a smart guy and the instant that I passed that exit that it wanted me to take, everything became a parking lot and, and such a parking lot that it became road ragey pretty quickly with people driving and shoulders and honking and trying to edge each other out and motorcycles going between lanes. [00:30:58] And, and, and there's just a, you know, there's probably a metric that you could use for any civilization called like, uh, TTMM time to Mad Max. [00:31:10] And Florida has a very low TTMM, you know, it doesn't take long at all for every man for himself, uh, instincts to seemingly kick in. [00:31:22] So I, I did the rerouting and now, now the phone is telling me, all right, well, you know, literally it's so demoralizing. [00:31:32] You see the ETA to your home arrival move literally 40 minutes immediately because I chose not to take it's very wonky prescription of three right turns. [00:31:42] And now I realized in hindsight, the reason it wanted me to do that is there's a direct entrance onto the express lane. [00:31:47] And so not only did the ETA go up, not only do I have the regret that I didn't listen to the computer for, for telling me to do a stupid thing, but I also now am shamed by the insult on wounds here. [00:31:58] The left of me, the express lanes are wide open and there's just like five cars just having a great time going 80 miles an hour to get to where they want. [00:32:05] And everybody else is left in just this, this, this, this absolutely falling down style, uh, traffic jam, uh, or just after dark. [00:32:17] I did get home, I, I took a side street and it was one of those ordeals where you, you know, you take the side street, go up a couple of blocks, you go, you know, uh, turn left, kind of go, I don't know, maybe a half mile just past wherever, whatever accident was causing the congestion. [00:32:34] Then you get back on the highway. [00:32:34] And the problem was, of course, we all have automated navigation systems. [00:32:41] They all reroute us. [00:32:42] And so that was immediately backed up there that it was three traffic lights of people in the left lane, trying to, to turn onto that third traffic light. [00:32:52] And I, it would have been another 20 minutes just waiting for those light changes. [00:32:56] And so I just, you know, fortunately I had a brain and I was like, all right, I'm going to just blow past this and go in the right lane and drive forward three, three intersections and then do a U-turn turn right. [00:33:08] And then I, I successfully beat the rush and I got home and I, it merely only wasted 20 minutes of my time, but here, this story has already wasted five minutes of your time. [00:33:16] So it was death defying because even once off the highway, virtually none of those drivers had ever been on those side streets or in that neighborhood before. [00:33:27] And they were all driving like it and they were all driving like it and it was dark and there were not adequate streetlights. [00:33:31] So, uh, you know, it's not just that like Florida drivers are bad, but like you are surrounded by a certain number of frazzled dads who just picked up rental cards, cars from MCO, who are trying to get to their Disney hotel, who just had a flight delay, whose kids are screaming. [00:33:48] And nobody's happy like that is the default and that is the best case energy because like, you know, that's before you consider the, the, the capital F capital M Florida men and the tweakers and everyone else that just kind of contributes to this diverse fabric of society that we live in. [00:34:08] So, uh, that was a bad experience. [00:34:12] I, I did get home, you know, I am still with us, but by the time I got home, I was, I was so fried. [00:34:18] Like I, I, I, I, I didn't want to hang out. [00:34:22] I didn't want to talk to Becky. [00:34:22] Just wanted to like pour a whiskey and collapse. [00:34:25] Uh, the stress level is so high. [00:34:28] Like, and you can, I looked at my watch, right. [00:34:30] And I was looking at like the heart rate history and I was like, you know, I was white knuckling it. [00:34:34] Um, and that's, and that's partly on me, right? [00:34:36] Like I just, I don't, I don't like that kind of driving. [00:34:39] I don't like that stress. [00:34:39] Two days later, when I had to drop this device off, uh, the device itself was terrible, by the way, it was probably less sophisticated than my Apple watch and probably reading like less accurate, uh, heart rate. [00:34:57] And, and even the, the modern Apple watch like does track breathing. [00:35:00] That's how it does a sleep apnea thing, uh, uh, through the magic of gyroscopes. [00:35:05] And, uh, this device is a piece of shit and I'm sure somehow the rental fee for, for a one-time use was $1,500 to my insure. [00:35:12] Uh, and I'm sure it found nothing. [00:35:15] I can totally, like, I don't know how it would find anything. [00:35:17] Uh, it looked like it was built out of, you know, Teddy Ruxpin era, you know, technology in the mid eighties with, with the, the quality of the, the, the straps and the plastic. [00:35:29] I could just, but when I had to, when it, when time came to drop it off, I really did not want to repeat that experience on a weeknight when you, you know, traffic would be even worse. [00:35:41] And so I, I humbly asked my brother who has a Tesla, I said, Hey, uh, there's another follow-up item. [00:35:48] We, we, we, we picked it up together just in October. [00:35:51] I think, uh, I said, Hey man, like, can I swing by or you swing by drop off your Tesla? [00:35:59] He did some stuff to do at our house anyway. [00:36:01] And he's got the full self-driving like, like, uh, they keep renewing a 30 day trial for him. [00:36:09] And, uh, you know, full self-driving isn't, it is, uh, the car will drive itself. [00:36:14] You don't have to touch the wheel. [00:36:16] It, it, it, it, it's very conservative. [00:36:18] It has three modes, chill, uh, normal and hurried or hurry. [00:36:23] I've never tried hurry. [00:36:24] I don't need to try hurry. [00:36:26] I just stick on chill because at the end of the day, as long as I get to where I'm going, [00:36:29] I sort of don't care. [00:36:30] I'm not in a big rush. [00:36:32] Uh, I have the luxury of not needing to be anywhere in any particular pace. [00:36:37] As long as I leave on time, you know, I'm, and I'm going to get there by the time I promise [00:36:41] the chill is good with me and the, you have to supervise it. [00:36:48] And it was the case when the full self-driving crap and Tesla's first hit that people were, [00:36:55] you know, at first it was just like pressure testing the steering column. [00:36:58] And so people would like use like, uh, uh, weights, like, like weighted wristbands and [00:37:04] stuff to like make it trick the steering column into thinking that somebody was holding onto [00:37:08] the wheel. [00:37:08] Uh, and now they have cameras that look at you like inside the cabin and that, that camera [00:37:15] is using some amount of intelligence to determine that you're distracted or not. [00:37:19] So if you are looking a lot at the central, uh, tablet, it'll bark at you and say, Hey, pay [00:37:23] attention to the road. [00:37:25] If you're looking at your phone, it'll do the same. [00:37:26] If you're looking at a watch, you know, like I've had it even like when I'm talking to the [00:37:30] watch and looking forward, have it bark at me. [00:37:31] And as soon, as soon as it does it, it makes a beep and then it gets increasingly aggressive [00:37:36] and beeps louder. [00:37:37] You impressively. [00:37:39] I say this because like, you know, I'm sure that the reason it's like this is because Tesla [00:37:43] is trying to minimize it's like legal liability for accidents caused by its system. [00:37:47] If, if, if, if you ignore its beeps three times in a day, uh, you, you get a strike, the system [00:37:56] will disengage and you will be forced to manually drive your car like a plebeian for the rest [00:38:01] of the day. [00:38:01] At least that's how Jeremy explained it to me. [00:38:03] If you get five strikes, I want to say it is, um, you're just exited from your, you're ejected [00:38:12] from the full self-driving program. [00:38:14] And I am impressed not only that it's as aggressive as it is, like, you know, if you got to look [00:38:22] at the screen for something, you've got to adjust it. [00:38:23] You basically have seven or eight seconds to, you know, fix the mirrors or whatever it is [00:38:28] before you got to be looking at the road again. [00:38:29] I'm also like finding myself that when I'm driving his vehicle, I actually am significantly less [00:38:36] distracted than in my own Ford escape, which has car play. [00:38:39] And I typically don't touch the phone itself, but I, um, you know, I tune out a little bit [00:38:44] or, uh, you know, might look at something or might be tapping away at the, uh, you know, [00:38:49] the eye messages and, and, and, and whatnot seemingly longer in those cases than like what the Tesla [00:38:55] would let me get away with. [00:38:56] So I'm paying more attention to the road because the computer is telling me to, or forcing me [00:39:01] to, and I am also doing less of the driving. [00:39:05] So, you know, my foot's off the pedal, my foot, my hands are off the steering. [00:39:08] And when they say supervised, it's actually like the right word, like it is doing the [00:39:14] driving, but like the, it feels almost like a pilot co-pilot thing where I, your head's [00:39:22] on a swivel. [00:39:23] Like I can look to the left and I can look to the right and I have far greater situational [00:39:27] awareness as the car is driving. [00:39:28] Now, granted a lot of these like semi-autonomous and, and adaptive, you know, uh, uh, uh, assistance [00:39:35] in cars will for most people lull them into a false sense of security and result in further [00:39:44] driver inattentiveness and unsafety, right? [00:39:46] Like people will, you'll train them out of the vigilance that you need at all times when [00:39:52] you're the one driving a vehicle or being driven in a vehicle. [00:39:55] However, like the particular, and maybe it's just cause I'm kind of coming in and chapter [00:40:00] four of this particular saga of full self-driving and robo taxis will be here in six months as [00:40:05] Elon Musk. [00:40:06] And of course they're not there, but it seems like at least the way that I've experienced [00:40:13] full self-driving when I've used it, it seems to me like I feel a thousand times safer because [00:40:21] the combination of the car, mostly doing the right thing, mostly making the conservative [00:40:25] choice, absolute worst case. [00:40:27] It haunt, it blares at you and you need to take over, uh, combined with my own hypervigilance [00:40:35] of not, you know, I constitutionally do not trust computers and you know, Jeremy doesn't [00:40:41] either. [00:40:42] And so when we're driving these things, we're looking around all the time where we're, we're, [00:40:45] we're sort of, because we have a curiosity and how the technology works, like trying to think [00:40:49] about how is it thinking through this? [00:40:51] Like, like we have a lot of, for example, um, automated gated communities where like the, [00:40:56] the gates will open and closed when you're, when you're entering and exiting. [00:41:00] It's like, we, we look at the little like computer screens, like how does it, how does it, what [00:41:04] does it think is in front of it right now? [00:41:05] It sees that there's an obstruction. [00:41:07] Uh, and if it opens too slowly, is it thinking it's a permanent obstruction or is it going to [00:41:11] wait and then proceed after the thing opens automatically? [00:41:14] Like there's a lot of little moments like that, where it's actually kind of interesting [00:41:17] to see how, you know, how the car reacts and then it gets a software update and then how [00:41:22] the car reacts after that. [00:41:23] And then additionally, there's the typical ebb and flow of software updates generally where [00:41:28] there's regressions, right? [00:41:29] Like there was a version of this, uh, system that, that the ability, like it used to blow [00:41:35] past this one particular speed bump, uh, uh, near our neighborhood, uh, because it didn't [00:41:41] have sufficient paint on the road to indicate that it was a speed bump. [00:41:45] And then there was a software update and then it perfectly negotiated all four speed bumps [00:41:49] just right in a row every single time. [00:41:52] And then there was another update and now it blows past the third speed bump again. [00:41:56] And so, uh, I think that people who are technology enthusiasts who maybe follow this stuff and [00:42:05] understand how, what software is, how it works, that updates are not a pure linear, you know, [00:42:11] march of progress, I think the idea that there would be regressions in software releases or [00:42:18] even, uh, non-determinism in how the, how the computer car operates, that's totally natural [00:42:24] to me. [00:42:24] And I expect it now. [00:42:25] I, I grown at it and I think like, this is, this is probably a bad idea in aggregate and [00:42:31] at a population level. [00:42:33] I suspect that the average driver would be confused by that the same way that like the [00:42:38] average person is terrified of updating their phone or their computer because they associate [00:42:43] software updates with, uh, uh, you know, newness and unawareness and, and, and, and, and, and all [00:42:51] the things that they finally had working, no longer working. [00:42:54] And when they, but when you talk about the, the march of progress and technology, they sort [00:43:00] of have a, what it is, is whenever anything goes wrong with technology, if you're not, if [00:43:08] you're not primed to know that it's burning you is, it seems like people mostly blame themselves [00:43:13] instead of blaming the technology. [00:43:15] And if that's your, if that's the way you use your phone or your computer, uh, you [00:43:21] know, when, when the car makes a mistake, you might not realize it as a car making mistake [00:43:26] and you might not have the hypervigilance. [00:43:27] That's like, you know, a more adversarial, like, like, I feel like I'm constantly spot checking [00:43:31] it. [00:43:31] And I, and while I am surprisingly impressed with how well it's been negotiating everything [00:43:37] that we've thrown at it so far, it's made one or two mistakes and I've, I've, I've, [00:43:41] I've, I've dealt with it, but on net, like it's driving waste. [00:43:45] Way more safely than I am way. [00:43:47] And it's, it's taught me a few things. [00:43:49] It's like, Oh yeah. [00:43:49] Like whenever I do this at an intersection, like that's really dumb. [00:43:52] Like it's doing this way better. [00:43:53] Uh, I can't think of a specific example, but like, I'm pretty impressed. [00:43:58] And so I thought, well, I'll ask Jeremy to borrow the car because I've got this natural [00:44:03] experiment now, same time of day, uh, same location. [00:44:07] So I already know how to get there. [00:44:08] It's a, it's a little bit goofy, but like, because I was just there, I'm not going to feel [00:44:12] like I'm learning how to get, get there and also learning how to use this. [00:44:15] Auto driving system simultaneously. [00:44:17] And, uh, holy shit. [00:44:20] Like, yes, I had people jump out in front of the car. [00:44:23] It was even worse this time at the particular intersection before you get to the, to, to [00:44:27] I four and the car like saw them out of its blind spot while it was turning, right. [00:44:32] It saw them on the left camera and breaks perfectly. [00:44:37] Uh, and I, uh, my first reaction was like, I would not have caught that. [00:44:40] I probably would have cut it real close. [00:44:44] Uh, almost hitting these people. [00:44:45] Uh, you get onto the highway and then this is why I emphasize like I four is like the deadliest [00:44:51] highway in America because it's, it is, it is not like driving on the highway, wherever [00:44:59] the fuck you live like anywhere I was ever in Michigan or Ohio or anywhere else in the [00:45:04] U S or certainly anywhere I've driven in Japan. [00:45:06] Those are the only places I suppose I've driven or Canada. [00:45:09] Like, yes, sometimes it's a little stressful driving on the highway. [00:45:12] Like that's not what this is. [00:45:14] This is, you have to practice extreme defensive driving. [00:45:18] And if you actually want to get where you're going, you also have to practice offensive [00:45:21] driving. [00:45:21] Uh, so having, uh, you know, nine cameras and nine directions is just necessary for basic [00:45:28] like assurance of survival. [00:45:31] Like when I'm on I four, I, I feel constantly under threat. [00:45:35] Uh, and something happens every time. [00:45:39] So we get on the highway and that stuff does happen. [00:45:42] Uh, you know, the car on its own decided to take the express lanes by itself, which was [00:45:46] incredible, but like people were like, I was trying to merge into a lane. [00:45:50] And then as, as the things, well, it was trying to merge into a lane. [00:45:53] And as it was changing lanes, somebody who didn't even have a blinker on starts edging in [00:45:58] and the car knows I'm going to back off. [00:45:59] Uh, there was another case of somebody swerving into our lane, like very close to the car and [00:46:05] the car, you know, defensively, you know, switch to the right lane, which was wide open [00:46:11] to prevent the risk that like, you know, it might have to break. [00:46:14] Suddenly there wasn't enough distance between the cars. [00:46:16] And that was stuff that like, I only was actually even able to piece together. [00:46:19] What the fuck was it doing after the fact? [00:46:20] Like looking at the map and looking around me, it's just, it went great. [00:46:28] Got there, dropped the shit off, turned around, you know, the parking is wonderful too, because [00:46:34] it'll back into every parking spot. [00:46:36] You just tap the screen. [00:46:37] Like it'll see the parking spots. [00:46:38] You just tap which one you want and just, it handles it for you. [00:46:40] It parks way better than I park. [00:46:42] I don't know, man. [00:46:43] And on the ride home, not only, you know, everything around me felt like it was on fire and chaos, [00:46:50] but because I had a buddy who was doing the driving and I could just kind of be, you know, [00:46:54] patrolling and looking around, I actually got a, a low heart rate notification on my watch, [00:47:00] which I get, I get them frequently. [00:47:01] Cause I have a low resting heart rate, but like it would say, Hey, your, your heart rate's [00:47:05] been under 40 beats per minute for the last 10 minutes. [00:47:08] And, uh, which I, if that's not you, that's like, if that's not typical for you, that might [00:47:14] sound scary, but like, no, my, my resting heart rate when I'm actually like de-stressed and, [00:47:17] and just chill is like typically like 38. [00:47:20] So the fact that I could be on I4 with a heart rate under 40 feeling completely safe more than [00:47:27] anything, it's not about going fast or whatever. [00:47:29] It's like feeling like I've got a team of two that are dedicated to getting me home safely, [00:47:32] me and this computer. [00:47:34] Uh, it was a revelatory experience now that look, I realized it's a complicated situation [00:47:44] because Elon is a big old bucket of assholes and the politics of it are all fucked. [00:47:50] Uh, you know, the right time to buy a Tesla was, was when, uh, everyone agreed that, that [00:47:54] they were cool and EVs were good and the planet deserves saving. [00:47:57] Uh, but yeah, I got, I totally saw where, where my brother was coming from and all of his friends [00:48:03] who, who, who, who are similar technologists who, who have these things and who are, you [00:48:07] know, who got on board in the very recent hardware three or hardware four era of Tesla. [00:48:12] Um, particularly with like the, the, the entry level models that are higher volume and therefore [00:48:17] kind of more, uh, consistently produced, you know, the cyber truck, for example, more, most [00:48:26] expensive, but lowest volume and has the most problems. [00:48:29] The model Y at this point is pretty boring and dull, but like, you know, if, if you, if [00:48:34] you are like me and just kind of think of cars, the modern day car is just a tablet with wheels. [00:48:40] This is a, you know, and I, yes, I had, I had low expectations. [00:48:46] I had a high level of suspicion, but it went great. [00:48:48] And, uh, uh, I, I, I successfully dropped off my snoring thing. [00:48:55] I can't wait to get the results. [00:48:57] That'll tell me that, uh, you know, nothing happened. [00:48:59] Another bit of follow-up. [00:49:01] I think I'd mentioned that I, uh, I had used rocket money. [00:49:05] So, you know, it used to be called true bill and then quick and loans bought it. [00:49:08] And, uh, the, as quick and loan started branding itself as rocket and having this rocket suite [00:49:13] of products, rocket money became, it's, you know, a consumer entree into upselling it to [00:49:18] other products and rocket monies, you know, promises. [00:49:21] It's going to help you, uh, visualize all your subscriptions and even negotiate a tiny, tiny [00:49:27] sliver of those subscriptions. [00:49:28] And the one that I yielded to it was my spectrum account. [00:49:32] So my ISP had, had gradually been charging me more and more to the point where it was [00:49:36] like $145 after tax every month for the same internet program. [00:49:39] That was like a hundred dollars when I moved here. [00:49:41] And I was very skeptical when rocket money said, Hey, we just saved you $893 a year, uh, by, [00:49:48] by lowering your monthly bill to 70 bucks. [00:49:50] And they sent me a new modem as well. [00:49:53] And I was like, I don't need a new modem. [00:49:55] It's the, it's, it's the model number. [00:49:56] It looks almost identical. [00:49:57] And I, I was actually at UPS returning that modem. [00:50:01] And I just thought to myself, what if this modem is somehow better? [00:50:04] Cause I had not been super blown away by the performance of my current one. [00:50:09] And so I, I went to the trouble of unplugging the old one, plugging in the new one, setting [00:50:13] it up, calling to activate and it, my, my connection now is rock solid. [00:50:19] So, so just by doing this price hack thing, I now have a modem that works way better. [00:50:23] I was able to activate it myself without having some tech come over here. [00:50:25] So that's a, that's a win, but the statements were still showing up $140. [00:50:29] And I was really skeptical that like this would materialize, but sure enough, this week I got [00:50:35] a statement for $70. [00:50:36] Uh, and I guess that means I owe rocket money 35% of whatever it saved me. [00:50:42] And I don't know how that's, I don't know how that's paid or when that works. [00:50:45] I'll figure it out. [00:50:47] But if you're, if you're willing to, basically I would recommend rocket money to anyone who [00:50:52] is currently paying sticker price for whatever utilities, it's probably mostly ISPs and cell [00:51:00] phone bills. [00:51:01] If you're paying for like a normal plan that is still available and you're paying top dollar, [00:51:06] uh, call them, give it a try. [00:51:08] But if you're like, you know, like I am with T-Mobile grandfathered in on some 12 year old [00:51:13] plan that has been replaced five times. [00:51:15] And there's no like, like the most likely case then is it's going to put me on the latest plan [00:51:19] and sign me up for all of the new throttling and four ADP video and the shit that you don't [00:51:24] want, uh, in terms of limitations. [00:51:26] So check out rocket money. [00:51:30] I, I, I was extremely skeptical and now this is, this is a rocket money ad. [00:51:34] Uh, although it is unpaid. [00:51:36] If you want to be a sponsor of the program podcast at seerls.co, uh, another followup item. [00:51:47] I, let me tell you what it took to connect. [00:51:53] My Xbox controller to my, to my gaming PC. [00:51:58] So, uh, I have an Xbox series elite to whatever you call it. [00:52:04] A nice, the fancy Xbox controller that costs like $170. [00:52:07] And I like this controller. [00:52:09] It's got the little paddles in the back. [00:52:11] It's got, you know, a nicer grip, uh, interchangeable thumb sticks and D pad and stuff. [00:52:16] It's a very nice product, but it's, it's, you know, talk about low volume things that [00:52:21] aren't as reliable. [00:52:21] It has a lot of reliability issues and my right bumper button, like next to the right [00:52:27] shoulder, it had been like very, very, um, it would miss like 70% of the clicks. [00:52:36] And because the right bumper isn't the most important button in the world. [00:52:39] Like it just meant like, uh, I guess I'm just not the kind of guy to throw grenades or whatever [00:52:43] the right bumper is typically assigned to, I got a replacement relative, like a, a, a cheap [00:52:50] replacement through Microsoft support channel. [00:52:52] I think they charged me $70. [00:52:53] They didn't require me to ship back the old one. [00:52:55] Uh, the replacement came and I plugged it into the computer to start set up and pairing. [00:53:00] And the Xbox accessories app was like, this is too out of date to be able to configure your [00:53:06] controller, which was weird because windows update, which I checked frequently had said [00:53:10] that I was up to date, but there was a little message at the bottom saying, uh, windows is [00:53:16] up to date. [00:53:16] Important security updates have not been applied. [00:53:19] Make sure that your computer is turned on, which is weird because if I'm manually updating [00:53:22] and nothing's saying that it's like, where are these secret security updates that aren't [00:53:26] happening? [00:53:26] And when I dug into my actual windows version, it said I was on 21 H two. [00:53:32] So the naming scheme for these major windows releases seems to be the, the two digit year [00:53:39] followed by H one for first half of the year and H two for second half of the year, which [00:53:44] is, um, real dumb. [00:53:47] I'm going to say just a dumb way to name things, you know, numbers are good. [00:53:52] You know, I, I, I get it now why it's named that. [00:53:56] But 21 was, uh, if you, if you decode the version several, several numbers ago, it was [00:54:02] three, at least it was at least two H one ago. [00:54:05] And why was I on such an old version? [00:54:10] It turns out I'll share like a, an article from, from just December, the, the windows 11 [00:54:16] required computers to have secure boot enabled using the trusted platform module or TPM equivalent [00:54:22] encryption. [00:54:23] And that's to certify or to be able to attest that like the, the operating system has not [00:54:28] been tampered with and so forth. [00:54:29] And then this has all sorts of like DMCA, DR, DRM, um, uh, and, uh, HDCP, all this sort [00:54:36] of a content encryption, copyright protection, uh, ostensibly it's quote unquote security. [00:54:41] And it, and it's the, like making sure from a malware perspective that the veracity of [00:54:45] the system files are all in place and so forth. [00:54:47] But like a lot of nerds were not on board because they want to rip blue waves or whatever it is. [00:54:51] And this might make it marginally more difficult, but gaming motherboards were like the last ones [00:54:57] to the party to support secure boot. [00:54:59] And even though I built my gaming PC, well, after windows 11 launched the BIOS that it [00:55:04] shipped with did not support secure boot. [00:55:06] Um, it didn't support, uh, I don't think like booting from UEFI drives correctly either. [00:55:13] So I'd set it up just like a normal basic fucking computer and it worked for however long it [00:55:18] worked. [00:55:18] But apparently in December, Microsoft was just like, and you get no more updates at all. [00:55:22] No more security updates, no more, nothing, which is why I started getting that message. [00:55:25] Uh, if you want to be on the latest and greatest version of windows 11, you must have secure boot. [00:55:30] Problem now is like, it's been several years. [00:55:34] And so figuring out what kind of motherboard I even have, I'm too lazy to like open the case [00:55:38] up and look at it. [00:55:39] And so I, I found the particular model number in my Amazon orders. [00:55:42] So step one, you know, I figured out what was happening. [00:55:45] I guess step, step zero is I get this new controller and I immediately regret it. [00:55:49] Uh, step two, figure out what's happening. [00:55:52] Step three, check my Amazon orders, identify the motherboard. [00:55:55] Uh, step four, I went to the motherboard website. [00:55:58] I find that there, a BIOS update is available and it's, it adds the secure boot functionality [00:56:03] because apparently the encryption software hardware is on the device, which is great. [00:56:07] So I download the BIOS and then I start flashing it. [00:56:12] Uh, not, you know, not that kind of, get your head out of the gutter. [00:56:15] I, it, it requires, uh, you know, identifying there's a, there's a particular USB port on [00:56:23] the back of the, of the motherboard. [00:56:25] That is the only one that can flash the BIOS and you have to look for it. [00:56:30] This is like M dash flash on it. [00:56:31] So you put it in there, you know, you restart, you, uh, boot into the BIOS and I, uh, got [00:56:39] it to update that, that part was actually pretty easy. [00:56:41] Then you go into the, the BIOS and it, you know, I don't know what BIOS stands for. [00:56:45] So if you're not like a PC person, this might not make sense, but you, you, the, the, it's, [00:56:49] it's the little bit of software that runs before the computer really starts. [00:56:52] And you can typically get there by hitting a key like F12 or delete. [00:56:55] And it's, you know, if you weren't raised on windows, uh, it's, it's, it's a weird [00:56:59] under, underbelly that sometimes you have to go into. [00:57:02] It's got a lot of arcane settings. [00:57:04] None of them make any sense. [00:57:05] It's a lot of acronyms that aren't explained, even though modern BIOS systems typically have [00:57:09] tooltips, it'll be like, what is, you know, what is MDR? [00:57:12] And it's like this, this option determines whether you have MDR turned on and off. [00:57:16] And there's like room for two more paragraphs to just maybe spell out what the fuck MDR is. [00:57:20] Uh, I turned on the secure boot, figure that out. [00:57:25] Uh, chat GPT is wonderful for stuff like this. [00:57:27] Like it gave me step-by-step directions because like, there's probably 800 forum, forum posts, [00:57:31] like detailing the same thing. [00:57:33] Uh, after reboot, nothing worked and like the computer would not boot. [00:57:39] I turned on secure boot, which required turning on UEFI, which is like a related technology of [00:57:44] like a more modern boot system for computers. [00:57:46] And it turns out it's because that my drive partition map is master boot record MBR, which [00:57:51] is like from the DOS era. [00:57:53] And that was the default when I set it up in 21 or 2020. [00:57:56]

Episode 141: The Return of RMA-Recovery in the News Edition It's been a minute, we know — but Mike and Nat are BACK, rested, refreshed and ready to serve up a new episode packed with recovery bon mots, musings, and thought-provoking insights. This week we're diving into the latest conversations around sobriety, cultural norms, and health, giving our take on three recent articles from The New York Times that challenge the narrative that drinking is normal and safe. First up: I Quit Drinking Four Years Ago. I'm Still Confronting Drinking Culture by Charles Blow. Blow reflects on his journey to sobriety, unpacking the emotional and cultural challenges faced when stepping away from alcohol. Why does society romanticize drinking while casting suspicion on those who abstain? Next: Alcohol Carries New Risks in Middle Age by Cari Blum. There are clearly heightened health risks associated with alcohol consumption in middle age, and new research reveals just how impactful booze in any quantity is on our health as we age. Finally: When It Comes to Drinking, There Are No Good Answers by Rachael Bedard. This article takes a hard look at the conflicting messages around alcohol consumption, from moderate drinking myths to the growing body of research linking alcohol with serious health concerns, including cancer and liver disease. After a long break, we're back with sharper perspectives, plenty of laughs, and the same witty repartee that RMA is known for throughout the universe. Before I forget, this week's Week in Weird is all about Drones and Orbs, and anal probing! Nat is an expert! *This podcast does not provide medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment.* Please remember to SUBSCRIBE to the podcast on your favorite platform to get the latest episode delivered right to your devices as soon as it's released. LINKS: www.soberliningsplaybook.com We are a listener-supported podcast. If you like what we're doing here at RMA and want to support the show, JOIN THE RECOVERY IN THE MIDDLE AGES PATREON  Our sole mission is to help other people achieve sobriety and become their best, most authentic selves. As little as $3 a month makes a big difference and helps us keep the lights on.  https://www.patreon.com/RecoveryintheMiddleAges As always, we thank you for your support.  RMA ON YOUTUBE FOLLOW US ON TWITTER  Facebook Page We also have a Facebook Group! Request to join the group. It's a private space for continuing the discussion of what Nat and Mike talk about on the podcast. Hope to see you there. PLEASE leave us a 5 star review on I-Tunes if you're enjoying the show and SUBSCRIBE to get the latest episodes.  Email: MikeR@middleagesrecovery.com Natx@middleagesrecovery.com We all have a story. Tell us yours and we'll share it on the show! E-Mail your story to miker@middleagesrecovery.com If you're in trouble with substance abuse and need help, reach out. There are thousands of people who have put problems with addiction in their rear-view mirrors and you can be one of them. While we neither endorse nor condemn any particular program, the sheer number of available AA and NA meetings suggest that reaching out to those organizations would be a good first step, (but maybe not the last step), on your road to recovery.   https://www.aa.org/ https://www.na.org/meetingsearch/ Marijuana Anonymous (just in case): This Naked Mind

In this empowering episode, Dr. Diane Reidy-Lagunes speaks to a panel of onco-fertility experts about preserving fertility during cancer treatment. MSK oncologists Dr. Julia Brockway-Marchello and Dr. José Flores discuss the timing and options for patients who want to have biological children without delaying life-saving cancer treatments, like radiation and chemotherapy. Dr. Lucky Sekhon, reproductive endocrinologist and fertility specialist at RMA of New York, explains the safety, success rates, and evolving technologies used to freeze eggs and bank sperm. A nurse from MSK's fertility preservation program, Lauren Martino, explains what patients should know about the cost and the importance of early referrals. Emotional stories from cancer survivors, new parents, and patient advocates offer hope to anyone, man or woman, who faces cancer and wants to have a baby someday. Episode Chapters:2:26 - Timeline from diagnosis to preservation3:17 - Why fertility preservation is recommended4:27 - Preservation options for women5:58 - Egg retrieval success rates7:31 - Testing embryos for cancer-causing genes9:12 - Breast cancer patient testimonial10:23 - Embryos or eggs: Which is better to freeze?12:39 - Testicular cancer patient testimonial13:26 - Preservation options and timeline for men14:43 - Will the preservation process delay my treatment?16:14 - Will the preservation process worsen my cancer?17:25 - Preservation options during/after treatment19:25 - Pregnancy success rates for various methods22:40 - Cost of sperm banking23:16 - Cost of egg and embryo freezing24:41 - Insurance and financial grants28:23 - It takes a villageSee omnystudio.com/listener for privacy information.

***Just discovered there was an audio synchronization problem that truncated from 1:11 to 0:50; it is now fixed.*** I take the time to discuss some of the conventional ramifications of modern warfare and book recommendations that have given me a deeper and more nuanced understanding of why wars begin and end as they do. Robotics, autonomous targeting and hyper-velocity munitions are democratizing the battle field in a way heretofore unimagined. Drones are the new "low tech" answer to the First World's exquisite military platform that are over priced and have the same provenance of battleships planet-wide in January 1942. The electronic emissions environment in future conflicts will be a two-way street that will put any active acquisition sensors and attached effectors in the hazard if they emit and remain in one place. Autonomous targeting will become more and more relevant as the speed of munitions increases and the salvo competition costs are driven down. Hyper-velocity munitions are here to stay. The US Army and all land forces in the allied nations in the first world are in for a dramatic wake-up call. The life of the light infantryman will change significantly since for the first time in human history, the cost of hunting individual soldiers and small groups of soldiers in an effective fashion has reached a cost in concert with technology. "Quantity has a quality all of its own." - Thomas A. Callaghan Jr. ** I cover these issues in detail on my Chasing Ghosts podcast in Episodes 19, 24, 33-34, 47-48 and 53-54. ** References: A Retrospective on RMA, 2000-2020. The Russian Reconnaissance Fire Complex Comes of Age Army Futures Command Concept for Fires 2028 Christian Brose The Kill Chain: Defending America in the Future of High-Tech Warfare Lester Grau & Charles K. Bartles The Russian Way of War: Force Structure, Tactics, and Modernization of the Russian Ground Forces David Glantz Soviet Operational and Tactical Combat in Manchuria, 1945 (Soviet (Russian) Study of War) David Glantz Soviet Military Operational Art: In Pursuit of Deep Battle (Soviet (Russian) Military Theory and Practice) Georgii Samoilovich Isserson G.S. Isserson and the War of the Future: Key Writings of a Soviet Military Theorist Sun Tzu The Art of War Carl von Clausewitz On War Miyamoto Musashi A Book of Five Rings: The Classic Guide to Strategy H. John Poole The Last Hundred Yards: The NCO's Contribution to Warfare Qiao Liang & Wang Xiangsui Unrestricted Warfare: China's Master Plan to Destroy America My Substack Email at cgpodcast@pm.me

When access to fertility treatments is under threat, advocates like Dr. Kimberley Thornton step up to protect the rights of patients. In this episode of Fertility Forward, Dr. Thornton, a leading reproductive endocrinologist at RMA of New York, discusses her advocacy efforts with RESOLVE, a national infertility organization dedicated to improving access to fertility care. She shares RESOLVE's work pushing for the Right to IVF Act, which aims to safeguard IVF access and expand treatment coverage for everyone, including veterans. Despite legislative setbacks, Dr. Thornton emphasizes the importance of sharing personal stories with lawmakers and the small but significant victories achieved in the ongoing fight for accessible care. Tune in to learn how you can support the cause and make a difference by advocating for greater fertility treatment access! 

The #liverbirds reflect on a great November and a big week with games against RMA & Man City. They look at our forthcoming fixtures and squad options, with our ongoing injuries. Finally they share their Christmas wish lists.... Learn more about your ad choices. Visit podcastchoices.com/adchoices

Joining Rena and Dara on the Fertility Forward podcast today is Dr. Erkan Buyuk, who is a board-certified reproductive endocrinologist, infertility specialist, and OB-GYN practicing at RMA of New York's Eastside office. He currently serves as the Director of the Reproductive Endocrinology and Infertility (REI) Fellowship Program and as an examiner for the REI Division of the American Board of Obstetrics and Gynecology. Before joining RMA of New York in 2019, Dr. Buyuk was the Director of the Fertility Preservation Program and Reproductive Tissue Bank and the Director of the REI Fellowship Program at Einstein/Montefiore Medical Center. We are very excited to have Dr. Buyuk share a fascinating abstract presented at the most recent American Society for Reproductive Medicine Conference in Denver. Join the conversation to hear from Dr. Buyuk about why their research topic is important, why they chose to do this study, how they completed it, the results, and much more. Be sure not to miss out on this very insightful episode!  

The trillions dollar fragile American military complex is in big trouble in big war. It doesn't work. Robotics and drones are the new "low tech" answer to the First World's exquisite military platforms that are over priced and have the same provenance of battleships planet-wide in January 1942. Autonomous targeting will become more and more relevant as the speed of munitions increases and the salvo competition costs are driven down. Hypervelocity munitions are here to stay. The life of the light infantryman will change significantly since for the first time in human history, the cost of hunting individual soldiers and small groups of soldiers in an effective fashion has reached a cost in concert with technology [I will treat this with more detail in a future episode on the end of the legacy infantryman]. In my next podcast, we will discuss how to recover from the current collapse. "Quantity has a quality all of its own." - Thomas A. Callaghan Jr. References: A Retrospective on RMA, 2000-2020. The Russian Reconnaissance Fire Complex Comes of Age Army Futures Command Concept for Fires 2028 Christian Brose The Kill Chain: Defending America in the Future of High-Tech Warfare Daniel Bolger Why We Lost: A General's Inside Account of the Iraq and Afghanistan Wars Craig Whitlock The Afghanistan Papers: A Secret History of the War My Substack. Email at cgpodcast@pm.me.

I'm thrilled to have Dr. Dana McQueen from RMA in San Francisco join us for this episode of our IG Live series. Dr. McQueen is a renowned reproductive endocrinologist and OB/GYN, recognized for her work in IVF research and recurrent pregnancy loss. We discussed the latest findings and treatments in this challenging area, offering hope and solutions to patients navigating this journey. We covered the common causes of recurrent pregnancy loss, the emotional support patients need, and how IVF may play a role. Dr. McQueen also shared insights from recent studies and answered audience questions about genetic factors, immune testing, and chronic endometritis. Main Highlights: Common causes of recurrent pregnancy loss: genetic, hormonal, autoimmune, and anatomic factors. Emotional support and validation for patients. The role of IVF in treating recurrent pregnancy loss. Recent studies, including NIH research on miscarriage genetics. Q&A Topics: MTHFR mutation, endometriosis diagnosis, chronic endometritis treatment, and immune testing. Read the full show notes on Dr. Aimee's website. Dr. Dana McQueen at RMA San Francisco Dr. Dana McQueeen on Instagram Do you have questions about IVF?Click here to join Dr. Aimee for The IVF Class. The next live class call is on Monday, October 21, 2024 at 4pm PST, where Dr. Aimee will explain IVF and there will be time to ask her your questions live on Zoom. Click to find The Egg Whisperer Show podcast on your favorite podcasting app.   Watch videos of Dr. Aimee answer Ask the Egg Whisperer Questions on YouTube.  Sign up for The Egg Whisperer newsletter to get updates  Dr. Aimee Eyvazzadeh is one of America's most well known fertility doctors. Her success rate at baby-making is what gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.

Today, I'm fortunate to have Dr. John Lieurance, a great friend of the show, joining us again; he's been a frequent guest, sharing his expertise over the years. John Lieurance, ND, DC, RMA, BS, DABCN (Board Eligible), is a chiropractic neurologist and naturopath who has been in private practice for 25 years. He works at Advanced Rejuvenation, a multidisciplinary clinic focused on alternative and regenerative medicine, naturopathic medicine, chiropractic functional neurology, Functional Cranial Release (FCR), Lumomed, Lyme disease, mold illness, and various other neurological conditions. He also travels internationally, teaching other doctors. In this episode, Dr. Lieurance emphasizes the benefits of melatonin, particularly its influential role in stress resilience and anti-aging. Beyond its well-known effects on sleep, melatonin is produced in every body cell, acting as a protective mechanism against oxidative stress. As we age, melatonin levels drastically decline, which impairs our ability to repair at a cellular level. Dr. Lieurance highlights that supplementing with melatonin can extend our capacity to handle stress, promote deep relaxation, and support healthy aging. Also, we explore the fascinating properties of methylene blue, a vivid blue salt with a unique affinity for the mitochondria. This compound enhances the body's ability to absorb and utilize red and near-infrared light, which is crucial for cellular energy production. Methylene blue supports the mitochondria, improving their function by approximately 30% and acting as a neuroprotective agent. Dr. Lieurance emphasizes how the body can harness energy from photons, not just food, by absorbing light into the mitochondria. Tune in until the end of this show with Dr. Lieurance as he dives into how supporting your circadian rhythm, especially through sun exposure, can profoundly impact melatonin production. He shares insights on the power of sungazing, nitric oxide's critical role, and even melatonin's surprising benefits in detoxifying the brain. Plus, Dr. Lieurance speaks about his journey in developing advanced cranial treatments and stem cell therapies that span decades, incorporating innovative techniques from around the world, including regenerative medicine with adipose-derived stem cells that offer groundbreaking potential for conditions like tinnitus, hearing loss, and orthopedic injuries. Resources from this episode:  Website: https://www.drjohnlieurance.com/ Mitozen: https://www.mitozen.club/ketokamp Advanced Rejuvenation: https://www.advancedrejuvenation.us/ X CELLS: https://xcell.us/ Melatonin: Miracle Molecule: https://www.amazon.com/Melatonin-Transform-Melatonin-resilience-longevity/dp/B09VDRSJBV/benazadi-20 SunaVae: Inner Ear Regeneration: Miracles of Science: https://www.amazon.com/SunaVae-Inner-Regeneration-Miracles-Science/dp/B0DDT8KRDK/benazadi-20 Anti-Aging Biohacking Routine with Keto Kamp: https://www.youtube.com/watch?v=3p6EmP6VFO8 The Best Bio-Hacks to Support Mitochondrial Health: https://www.youtube.com/watch?v=pZwgb7ZltDA Methylene Blue for Brain Health | Protection Against Neurodegeneration: https://www.youtube.com/watch?v=Nxoo0WZymWk