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It's an All Calls Weekend with Dean Sharp! Dean answers your home questions—from interlocking driveways with pavers to sealing tips. He helps a caller with a broken foundation and another dealing with shingles falling from their roof.
With all this rain, it has been a good week to have leaf guard gutters. It is okay to install gutters piece by piece. More insurance issues. Explaining a class 4 shingle and the variety of shingles that could be installed on your roof. Rust removal tips. The process of gutter installation. How to maintain your roof without causing damage? Solving screen door issues. Contact Andy at lindusconstruction.com or you can call 844-9lindus.
In the "Medicare Advantage Minute" we enjoy an article entitled: Should you ditch your MA plan? Most people do! If you are tempted to ditch your MA plan, you are not alone! Reported problems include difficulty accessing care, receiving quality care and accessing quality care from specialists. In the "Your Medicare Benefits 2025" segment we learn under what circumstances and to what extent Medicare will cover lung cancer screenings. Even more details are to be had as we review an article entitled "Does Medicare cover the Shingles vaccine"? Turns out the answer is "Yes"! Finally, we tear into a list of thirteen of the most painful medical conditions humans can endure! After that each of us tries to disgust the other with a couple of additions to the list. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to help future readers. Official website: https://www.MedicareForTheLazyMan.com.
Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call Brooklyn 718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.
Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call Brooklyn 718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.
SHOW NOTES: Coming up this hour, we've got some incredible discussions to help you tackle those summer projects! We're also taking your calls, hearing from listeners just like you about their home improvement dilemmas! Stayed tuned to learn about: - Pool Safety: If you've got a pool, you know safety is paramount, and we'll be breaking down the unique requirements for pool fencing to keep everyone safe this summer. - Roof Rejuvenation: We're joined by Mike Feazel from Roof Maxx to talk about an affordable and environmentally friendly alternative to costly roof replacements that can extend the life of your shingles. - Drywall Repairs: Those pesky wall cracks, nail pops, and splitting seams? We've got tips to make sure your drywall fixes are "one and done." - Pet-Friendly Decorating: Leslie's Last Word will help you design a beautiful, pet-friendly home that stands up to your well-meaning furry friends. Q & A: - Martha from Ohio is dealing with a leaky window due to improper installation and a saturated flower bed. - Terry from Kansas seeks advice on the proper time and method to paint a stucco exterior after a previous peeling issue. - Katherine from Arizona is struggling with failed sod and exposed mesh netting on her lawn in a cold mountain climate. - Kim from Tennessee is looking for solutions to get rid of moles causing damage in her yard. - Albert from Massachusetts inquires about upgrading the minimal insulation in his 50-year-old home's attic. - Tim from New York wonders if he needs to put anything on the wall before installing a glass tile backsplash in his kitchen. ASK A QUESTION: Need help with your own home improvement or décor question? We'd love to help! Call the show 24/7 at 888-MONEY-PIT (888-666-3974) or post your question here: https://www.moneypit.com/ask. Learn more about your ad choices. Visit podcastchoices.com/adchoices
Send us a textA fading podcast struggles to gain new listeners but when a sinister, grinning figure emerges from the cornfields to cleanse the hosts of their burdens, they must put generations of trauma behind them for a chance at survival. On Episode 672 of Trick or Treat Radio we discuss Clown in a Cornfield from director Eli Craig! We also discuss the less than stellar results from revisiting franchise films years later, the power of cleaning products, and how different generations perceive each other. So grab your favorite scented soap, wear your creepy clown mask, and strap on for the world's most dangerous podcast!Stuff we talk about: Friday the 13th, Jaws, Stephen Spielberg, Rosemary's Baby, Bird With the Crystal Plumage, Raiders of the Lost Ark, Jurassic Park, Clash of the Titans, Predator, The Witches of Eastwick, Witchcraft 8: Salem's Ghost, Battle Royale, Doghouse, Demonic, Kendra Wilkinson, Jason Mewes, Scream 3, Feast, Hellraiser 3: Hell on Earth, Sawtooth, Tales from the Crypt: Demon Knight, Scream Blacula Scream, American International Pictures, Amityville Horror, The Visitor, Q, The Abominable Dr Phibes, Spaceballs 2, Shingles, nostalgia factor, Coming 2 America, Monica Bellucci, Beetlejuice 2, Bill and Ted Face the Music, Kristen Schaal, William Sadler, “The Anthony's”, Tony Shalhoub, Samara Weaving, Sarah Michelle Gellar, kids smoking, soapscription, the smell of powerglide, Tim Curry, Clown in a Cornfield, Eli Craig, Hot Fuzz, “it's always nice to see pain and suffering”, generational horror, Urban Legend, The Faculty, viral videos, Fred Savage, The Wonder Years, how different generations were raised, Roman Anthony, Wes Craven, Scream, RIP Joe Vaz, RIP Brian Wilson, Best Wishes To All, Yuta Shimotsu, power to the pilot, scurred of the scourge, and the smoky scent of secondhand smoke.Support us on Patreon: https://www.patreon.com/trickortreatradioJoin our Discord Community: discord.trickortreatradio.comSend Email/Voicemail: mailto:podcast@trickortreatradio.comVisit our website: http://trickortreatradio.comStart your own podcast: https://www.buzzsprout.com/?referrer_id=386Use our Amazon link: http://amzn.to/2CTdZzKFB Group: http://www.facebook.com/groups/trickortreatradioTwitter: http://twitter.com/TrickTreatRadioFacebook: http://facebook.com/TrickOrTreatRadioYouTube: http://youtube.com/TrickOrTreatRadioInstagram: http://instagram.com/TrickorTreatRadioSupport the show
To have your question featured in a future video, please email: questions@morses.tv Please include at least: Age, Weight and as much history as possible.
This episode, Dean tackles real-life home challenges—from replacing flooring damaged by mold build-up to the right way to lay down a new layer of shingles on your roof. A caller dealing with critters in the attic gets expert advice, and Dean walks through the process of replacing waterlines into a garage. Plus, what's going on when a toilet flushes and debris comes back up? Dean breaks it all down with clarity, humor, and the practical know-how every homeowner needs.
Galva Mayor Rich Volkert joined Wake Up Tri-Counties to recap the June 2, 2025, Galva City Council Meeting. The water department expects a new truck by July, improving local service. Chief Townsend issued a reminder: burn days remain Tuesday, Thursday, and Saturday, with only yard waste permitted. Large item pickup can be arranged through City Hall or Eagle Enterprises. Hydrant flushing has wrapped up for the season, and two faulty hydrants have been repaired. A grassy lot between Market Street's former vet office and the dentist will soon be offered for sale, with a minimum bid set at $775. Mayor Volkert said, "It would make a good parking space for a business." June 13th marks the next car cruise-in event, starting at 5 PM, with free food available while supplies last. Galva residents are encouraged to participate in the upcoming clean-up week, running from June 16th to June 21st. It's crucial to bring proof of residency when dropping off most items at the city's maintenance yard, located between Preferred Home Health Care and Mary's Family Dining and Lounge. Please note that hazardous waste and yard waste are not accepted, and fees apply for tires and electronics. Elderly and handicapped residents unable to transport items should call City Hall to schedule a single curbside pickup. All items should be on the curb by 7 AM on June 16th for pickup, but please don't place items on the curb more than two days before. Staff will not retrieve items from backyards or inside structures. Contact Galva City Hall at 309-932-2555 for details. Shingles, antifreeze, LP tanks, yard waste, paint, or any hazardous material will not be accepted. Televisions and electronic components will be accepted for a fee at Eagle Enterprises during their normal business hours. Call Eagle Enterprises at 932-2936 if you have any questions. The maintenance yard will have extended hours from June 16th to 19th, from 7 AM to 5 PM, to allow for better convenience for residents. On June 20th, the yard will be open until 3 PM, and on June 21st, the yard will be open from 7 AM to noon.
Did you know that spending a little more on a roof initially can save you a ton of money in the long run? It's all about longevity, efficiency, and of course, repair costs. Here's what you need to know, to start saving. Visit https://apexroofingusa.com Apex Restoration & Roofing City: Centennial Address: 7076 S Alton Way, Centennial, Website: https://apexroofingusa.com/
Stan Shingles has been serving as interim vice president of student affairs at Central Michigan University over the past year, but he has been part of the university community since 1989. In an interview with Central Michigan Life, Shingles reflects on his 36 years at the university and what he hopes for its future.
In today's episode, Angie shares the story of a gal who had a very severe case of shingles and found quick relief via an antiviral medication. There are some times when taking a drug makes the most sense. How to know? Tune in!
In this Roofing Road Trips® episode, Heidi J. Ellsworth sits down with James White of CertainTeed to dive into the world of impact-resistant roofing shingles. They'll discuss why these shingles are a game-changer for contractors in the residential roofing industry, exploring their benefits, how they stack up against traditional roofing options and why they are often an important option for homeowners. Whether you're installing a new roof or upgrading an existing one, this podcast will give you all the insights you need to help your customers choose the best material for their project. Learn more at RoofersCoffeeShop.com! https://www.rooferscoffeeshop.com/ Are you a contractor looking for resources? Become an R-Club Member today! https://www.rooferscoffeeshop.com/rcs-club-sign-up Sign up for the Week in Roofing! https://www.rooferscoffeeshop.com/sign-up Follow Us! https://www.facebook.com/rooferscoffeeshop/ https://www.linkedin.com/company/rooferscoffeeshop-com https://x.com/RoofCoffeeShop https://www.instagram.com/rooferscoffeeshop/ https://www.youtube.com/channel/UCAQTC5U3FL9M-_wcRiEEyvw https://www.pinterest.com/rcscom/ https://www.tiktok.com/@rooferscoffeeshop https://www.rooferscoffeeshop.com/rss #CustomerHastag #RoofersCoffeeShop #MetalCoffeeShop #AskARoofer #CoatingsCoffeeShop #RoofingProfessionals #RoofingContractors #RoofingIndustry #CertainTeedRoofing
5:05- News Whip: MIssing woman found after 62 years, Panda Express Karaoke and Start home in City of Orange for $499K 5:20-7 Leaks in Conway's house. Retractable hoses. Mark's plumbing issues 5:35- Shingles vaccine helps with heart disease #Shingles #Vaccine #HeartDisease #Chickenpox Mark does the buddy system for all his doctor's appointments #CatScan #Screening 5:50- More on the Shingles shot
Dr. Aileen Marty, Infectious Disease Specialist and Professor at Florida International University, joins Bob Sirott to talk about the latest health news. Dr. Marty shares details about the shingles shots and how Robert F. Kennedy Jr. wants new vaccines to be tested.
Two wide open cases from the latest issue of the journal. Starting with a case from Italy (1:18), of a 63-yo man having a history of behavioural and cognitive problems since retiring. His many changes included low mood, significant weight loss, and problems with sleep and temperature regulation. He had a background of type 2 diabetes. Initial treatment was on a suspicion of Alzheimer's, but there was no clinical improvement. https://pn.bmj.com/content/25/2/159 A case from the United States is next (17:36), featuring a 66-yo lady experiencing 10 days of generalised weakness, with episodes of forgetfulness and a series of falls. She had previously been treated for left-sided ophthalmic herpes zoster. Neurological examination showed mild right arm and leg weakness. https://pn.bmj.com/content/25/2/164 The case reports discussion is hosted by Prof. Martin Turner¹, who is joined by Dr. Ruth Wood² and Dr. Babak Soleimani³ for a group examination of the features of each presentation, followed by a step-by-step walkthrough of how the diagnosis was made. These case reports and many others can be found in the February 2025 issue of the journal. (1) Professor of Clinical Neurology and Neuroscience at the Nuffield Department of Clinical Neurosciences, University of Oxford, and Consultant Neurologist at John Radcliffe Hospital. (2) Neurology Registrar, University Hospitals Sussex. (3) Clinical Research Fellow, Oxford Laboratory for Neuroimmunology and Immunopsychiatry, Nuffield Department of Medicine, University of Oxford Please subscribe to the Practical Neurology podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/3vVPClm) or Spotify (https://spoti.fi/4baxjsQ). We'd love to hear your feedback on social media - @PracticalNeurol. Production and editing by Brian O'Toole. Thank you for listening.
How does one treat shingles with no medical insurance, you ask? Lemme tell ya...
If your roof is leaking, don't wait, call Apex Restoration & Roofing (303-691-5035). If it's not leaking yet, then learn how to do a full roof inspection, safely from the ground, and when you need to call a professional. Learn more at https://apexroofingusa.com/douglas-county/larkspur/ Apex Restoration & Roofing City: Centennial Address: 7076 S Alton Way, Centennial, Website: https://apexroofingusa.com/
Can you believe it? EPISODE 700!!! Congrats to us but THANK YOU to our loyal listeners (and new ones too). It's very rare for a podcast to cross this milestone and we couldn't have done it without you and the love of doing the show each and every week. Enjoy #700 with Jamie and Mr. Ug.
Editor's Summary by Preeti Malani, MD, MS, and Chris Muth, MD, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from April 19-25, 2025.
Dean gives listeners small, easy tips to do a little 'makeover magic' in their homes. Dean answers listener questions about whether it's better to tent or spot treat when subterranean termites are only in certain areas of the home, how to properly install a wood burning stove in a home in the high desert, and the right self-sealing underlayment for roof shingles.
Surprise, the world's evil! "Judges" against Trump. Great calls: Was Karmelo's case self-defense? Chad O. Jackson calls-in and shares some wisdom! (P.S. Does Hake have white guilt?)The Hake Report, Thursday, April 17, 2025 ADCLIP: Was Karmelo self-defense gone wrong? (28-min) YouTube | Rumble TIMESTAMPS* (0:00:00) Start* (0:03:17) Evil in the world* (0:06:56) Hey, guys! Hake La la la tee* (0:11:35) Shingles vaxx* (0:18:31) Harvard not respectable* (0:22:17) Plenty of money… Trump truth…* (0:28:44) MARK, L.A. the race issue's gotten worse, Hake censorship* (0:37:23) MARK: Chicago the worst; Immigration; Judges* (0:48:27) DENZEL, NM, 1st: Karmelo Anthony, Austin Metcalf* (1:02:58) CHAD O JACKSON, Dallas, 1st: Soft-on-crime; Social justice mindset* (1:18:35) Coffee: white Meme* (1:27:23) Coffees… Humpty Dumpty, Bigotry, Christian Love …* (1:33:12) JEFF, LA: Dallas school shooting, Karmelo merch, speak English "hate"* (1:40:19) WILLIAM III, CA: White guilt? Letitia James. "Black Republican" Judge?* (1:48:44) RICK, CA: Metcalf* (1:53:14) Bright Lights - "Come Out" - 2014, Summer FireLINKSBLOG https://www.thehakereport.com/blog/2025/4/17/the-hake-report-thu-4-17-25PODCAST / Substack HAKE NEWS from JLP https://www.thehakereport.com/jlp-news/2025/4/17/jlp-thu-4-17-25Hake is live M-F 9-11a PT (11-1CT/12-2ET) Call-in 1-888-775-3773 https://www.thehakereport.com/showVIDEO YouTube - Rumble* - Facebook - X - BitChute (Live) - Odysee* PODCAST Substack - Apple - Spotify - Castbox - Podcast Addict *SUPER CHAT on platforms* above or BuyMeACoffee, etc.SHOP - Printify (new!) - Spring (old!) - Cameo | All My LinksJLP Network: JLP - Church - TFS - Nick - Joel - Punchie Get full access to HAKE at thehakereport.substack.com/subscribe
A new roof shouldn't cost you an arm and a leg - and it doesn't have to. Whether you're looking for new shingles, or metal sheeting, Apex Restoration & Roofing (303-691-5035) does that. They can also save you a bundle on repairs, check out https://apexroofingusa.com/douglas-county/larkspur/ Apex Restoration & Roofing City: Centennial Address: 7076 S Alton Way, Centennial, Website: https://apexroofingusa.com/
In the News podcast: the first baby is born in the UK to a woman with a transplanted uterus, and we speak to the surgeons responsible. Also, the best evidence yet the shingles vaccine can help reduce the risk of developing dementia; a drug that could make human blood deadly to mosquitoes. Then, we travel back in time 8,500 years to hear about the sea voyage of hunter gatherers to the Mediterranean island of Malta... Like this podcast? Please help us by supporting the Naked Scientists
How many measles cases in 2025? Is there a blood test for Alzheimer's? Is the shingles vaccine safe? Does the shingles vaccine prevent dementia? AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, covers measles outbreak news, a new blood test for Alzheimer's disease, the latest trends in childhood vaccination rates, and how the shingles vaccine helps prevent dementia. American Medical Association CXO Todd Unger hosts.
TWiV notes the passing of Klaus Conzelmann, then reviews reverse-zoonoses of 2009 H1N1 pandemic influenza A viruses and evolution in United States swine, and reduction in dementia incidence in recipients of Zostavax. Hosts: Vincent Racaniello, Alan Dove, and Rich Condit Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode Support science education at MicrobeTV ASV 2025 Reverse zoonoses of 2009 H1N1 in US swine (PLoS Path) Zostavax reduces dementia (Nature) Letters read on TWiV 1207 Timestamps by Jolene Ramsey. Thanks! Weekly Picks Rich – Certain Roller Coasters May Help Small Kidney Stones Pass Alan – Analog and Asimov's science fiction magazines Vincent – Science Under Threat in the United States: How scientists and institutions should respond Listener Pick Charles – Why Techdirt Is Now A Democracy Blog (Whether We Like It Or Not)
Viruses such as herpes and vavaricella-zoster are being increasingly implicated as possible causes of dementia
Send us a textOn this week's show we dive into the hidden connections between shingles vaccines and decreased dementia risk, while exploring how humans often misinterpret their pets' emotions based on environmental context rather than actual animal behavior. Our guest, Dr. Yasmin Mohseni blows us away with the inner workings of the immune system.Some highlights:• Shingles vaccine study reveals a 20% reduction in dementia risk, particularly among women• The protective effect may be linked to how viral infections modify the immune system• Humans heavily rely on situational context rather than dogs' body language when assessing canine emotions• A study of 400 college students showed they couldn't distinguish dog emotions without environmental cues• Dr. Yasmin Mohseni explains why the immune system isn't a simple on/off switch that can be easily "boosted"• Immunotherapy approaches like CAR T-cell therapy are revolutionizing cancer treatment• Cancer cells create "fortress-like" defenses that engineered immune cells must overcome• Understanding your pet's actual body language rather than situational context can improve communicationDr. Yasmin's links:Instagram: https://www.instagram.com/doctor.yas_/Our links! Our Website! www.bunsenbernerbmd.comSign up for our Weekly Newsletter!Bunsen and Beaker on Twitter:Bunsen and Beaker on TikTokSupport the showFor Science, Empathy, and Cuteness!Being Kind is a Superpower.https://twitter.com/bunsenbernerbmd
What to know when selecting home insurance and how to work with them when it comes to home repairs. Does shingle color impact the temperature of the home? Why Leaf Guard Gutters are worth the investment. What is the benefit of roof coating? Preventing stairs from creaking over time. Tips to mouse and bat proofing your home. Contact Andy at lindusconstruction.com or you can call 844-9lindus.
Good afternoon! Back in Western New York after a busy 72 hours in Florida. Shingles ‘n all, we got a lot accomplished down there. I cannot wait to share one feature in-particular. First up, a feature on Zac Taylor and the state of the Cincinnati Bengals live at Go Long.There's a lot of noise around this organization at the moment, from stadium squabbles to Trey Hendrickson sniping back at Katie Blackburn on McAfee. The good news? Taylor's the sort of coach that can guide a team through it all. We take the conversation to Substack Live. Here's the Orlando Brown Jr. story from ‘23 mentioned at the top, too. If you'd like to join future Live episodes, download the Substack app and flip notifications on. Thanks, all. Go Long subscribers can access every story and every podcast.Bob McGinn's 41st annual draft series is exclusive to members. Live on Friday is a close look at Travis Hunter and the cornerbacks. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.golongtd.com/subscribe
00:46 Millimetre-sized pacemaker fits inside syringeResearchers have developed a tiny, temporary pacemaker that dissolves when no longer needed, helping to overcome some of the challenges associated with current devices. Temporary pacemakers are often required after heart surgery but implanting them can require invasive procedures. This new device is injectable, requires no external power and is controlled using light shone through the skin. The tiny pacemaker has shown promise in animal and heart models, and the team think it could also be used in other situations where electrical stimulation is needed, like the brain.Research Article: Zhang et al.08:19 Research HighlightsMeasurements show that global warming is causing lakes to lose their oxygen, and a massive, 30-year analysis showing that a diet of plant-rich foods is associated with healthy ageingResearch Highlight: Life-giving oxygen is wafting out of lakes worldwideResearch Highlight: The best foods for healthy ageing ― and the worst10:21 Shingles vaccine linked to reduced dementia riskA large-scale population study suggests that getting a shingles vaccine reduces the probability of someone getting dementia by around one-fifth. By taking advantage of the way a shingles vaccine was rolled out in Wales, a team were able to compare dementia outcomes in vaccine-eligible people to those born just a few weeks earlier who were ineligible. Although more tests will be needed to confirm this finding and to understand the mechanisms behind it, the team hope that vaccination against this viral infection could represent a cost-effective way to for preventing or delaying dementia.Research article: Eyting et al.20:20 Briefing ChatData suggests that racial profiling plays a role in whether someone receives a traffic citation or fine, and studies suggest that paying researchers who review manuscripts could speed up the peer-review process, without affecting the quality of reviews.Ars Technica: Study of Lyft rideshare data confirms minorities get more ticketsNature: Publishers trial paying peer reviewers — what did they find?Subscribe to Nature Briefing, an unmissable daily round-up of science news, opinion and analysis free in your inbox every weekday. Hosted on Acast. See acast.com/privacy for more information.
Scientists say the shingles vaccine may protect against more than just the shingles. AP correspondent Donna Warder reports.
Shingles is a skin infection that results from reactivation of the virus that causes chicken pox. It can occur in areas like the eye where it may compromise vision, and is also associated with persistent and unremitting pain at the … The shingles vaccine is on the do not miss list, Elizabeth Tracey reports Read More »
If you had to take a blind guess, how much do you think someone could sell a couple severed, dog-vomit covered human toes for on the black market? Never thought that would be a question we would ask ahead of today's episode. Let's talk about that, what Joe is really thinking about when riding in the car, probably the most messed up use for AI thus far, what's ok to adjust when borrowing someone's vehicle, and more on today's episode of Can You Don't?!*** Wanna become part of The Gaggle and access all the extra content on the end of each episode PLUS tons more?! Our Patreon page is LIVE! This is the biggest way you can support the show. It would mean the world to us: http://patreon.com/canyoudontpodcast ***New Episodes every Wednesday at 12pm PSTWatch on Youtube: https://youtu.be/aeApjJ_JDNwSend in segment content: heyguys@canyoudontpodcast.comMerch: http://canyoudontpodcast.comMerch Inquires: store@canyoudontpodcast.comFB: http://facebook.com/canyoudontpodcastIG: http://instagram.com/canyoudontpodcastYouTube Channel: https://bit.ly/3wyt5rtOfficial Website: http://canyoudontpodcast.comCustom Music Beds by Zach CohenFan Mail:Can You Don't?PO Box 1062Coeur d'Alene, ID 83816Hugs and Tugs.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Send us a textOn this week's episode of WTR Small-Cap Spotlight, Marcus Laun, Co-Founder and VP Executive of Sky Quarry joined Tim Gerdeman, Vice Chair & Co-Founder and Chief Marketing Officer of Water Tower Research, and Peter Gastreich, Energy and Sustainability Analyst at Water Tower Research to discuss: 1) SKYQ's business of recycling asphalt shingle waste into oil products and other materials, and with zero waste; 2) SKYQ's innovative revenue model and offering waste shingle suppliers a lower cost alternative to landfills; 3) planned commissioning of the first 1.0 million ton per year capacity facility in Utah this year; 4) national expansion strategy; 5) expectations for decreasing regulation and streamlined permitting process; and 6) crowd funding as a source of financing.
Nhân tuần lễ ‘Nâng cao nhận thức về bệnh Giời Leo', tiếng Anh là Shingles, còn gọi là bệnh Zona vốn là một chứng bệnh gây ra những cơn đau nhức khủng khiếp ở người mắc phải. Đây là chứng bệnh không chừa một ai, nam cũng như nữ, trẻ cũng như cao tuổi, đặc biệt là các vị trên 50 tuổi. Bệnh nầy có những triệu chứng ra sao, có thể chữa trị hay không và việc tiêm chủng thế nào, bác sĩ Liêu Vĩnh Bình tại Sydney giải thích thêm chi tiết.
Shingles is a common condition in Australia, affecting around one in three people at some point in their lives. Its occurrence is notably higher in individuals over the age of 50, with the risk of complications increasing with age. Therefore, if you are over 50, it is recommended that you speak with your doctor or pharmacist. Dr Ali Ziabari explains shingles symptoms and the vaccines available for this condition. - Shingles (mekutok/mîrkut) li Australya gelemperî ye, di jiyanê de ji sê kesan yek bandor dibe. Ew bi gelemperî di kesên ji 50 salî mezintir e çê dibe, û xetera tevliheviyan bi temen re zêde dibe. Heke hûn ji 50 salî mezintir in, yan ciwanin, tenduristin, bi doktorê an dermansazê xwe re li ser şîngils bipeyivin. Dr Elî Zêbarî hin ronkirin û zanyariyan derbarê vê nexweşiyê dide me.
On this MADM, Laarni San Juan shares about her experience with shingles while heading to Hawaii for vacation. Listen & share. Sponsor: Bob Sykes Bar B Q BobSykes.com
On this MADM, Dr. Bayo Curry-Winchell is discussing what shingles are and those it affects. Listen & share. Sponsor: SIMRP
On this edition of TMWS, we are starting out with Dr. Bayo Curry-Winchell & Laarni San Juan as they discuss the importance of shingles awareness. After that, I have Ayesha Patel with Nothing Bundt Cakes to share about a new location opening in Athens, Alabama, and her family's journey with the business. Listen & share.
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Amino acids are the true building blocks of the human body. This episode of Vitality Radio focuses specifically on Lysine, Tyrosine, and Acetyl-L-Carnitine. Jared unpacks the unique impact of these powerful aminos and why they deserve a closer look. You'll learn about their impressive benefits as individual nutrients - immunity, brain boosting, energy, thyroid health, and more! Jared also explains how single amino acids work vs. protein as a whole, and additionally, the role of digestive enzymes in breaking down protein to ensure we absorb these vital amino acids. Products:Lysine, Tyrosine, and Acetyl-L-Carnitine Additional Information:#479: Amino Acid Spotlight: Glycine, Citrulline, and Glutamine#412: A Natural Approach to Supporting Your Body Through ShinglesVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.
Send us a textFlower Fatties, it's go time! After a couple of hectic weeks, the 2 Fat Guys Talking Flowers crew got together to share some Flower holiday stats, Man Boob stories, and, of course, more food tastings! The JF Building has officially been open for 171 hours and counting, and in that time, we've devoured over 35 lbs of Mommy Blacks candy. The crew has been working around the clock, but none more than our warehouse and shipping team! While there's no official guest this week, we're here to motivate you to push through this busy day. We're sending positive vibes to everyone in the industry, wishing you success, and to your customers – we hope they have an awesome experience with your flowers. Let's spread that contagious Flower Feeling and keep it rolling!
First home sold in Altadena for $550K /Space X launches // SpaceX out of Vandenburg! Did you see it? High flu activity! Vaccine Fatigue / What shot are you getting? Flu? Pneumonia? RSV? Shingles? Covid? // Vax drives thru / Winter storm heading back East 150 M people impacted / Trump says the penny costs too much, orders Treasury to stop making them/ Do you round-up at the store? Don't do that! // HB Police Awards Ceremony / Plane owned by Motley Crue's Vince Neil crashes at Scottsdale Airport 1 dead, 3 injured
Natalie addresses the fires in LA and shares how she discovered she has shingles?! Plus, puppy updates and more. Pray for LA Sponsor Notes: Wildgrain is offering our listeners the 30% the first box plus free croissants. Go to wildgrain.com/hungry to start your subscription. Learn more about your ad choices. Visit megaphone.fm/adchoices
Ortho Eval Pal: Optimizing Orthopedic Evaluations and Management Skills
Send us a textIn today's episode called Common Causes of Deltoid Atrophy I talk about...1.Anatomy related to the deltoid musculature. 2. Causes of deltoid atrophy 3. Differential diagnoses and so much more! (Video) Patient with Axillary Nerve Palsy(Video) Patient with Shingles causing shoulder weakness✅Are you looking for One on one Coaching? We have it!✅ Hop onto our email list?
Today Mike, Pam and Scott are together to take a virtual vacation to the Disney Parks! On Sunday, we discussed how quickly Disney made the transition from Halloween to Christmas at Walt Disney World this year, so that got us thinking about our favorite transitions at the Disney Parks, places where you are transported to and from a different time and place in just a few steps! From lands to attractions to even restaurants, we give some great examples of transitions that we love, and sounds play a HUGE part in almost every experience! Did you favorite make the list? If not, share yours with us! Please share your thoughts over on the Discord channel at www.beourguestpodcast.com/clubhouse. We hope you enjoy today's podcast! Please visit our website at www.beourguestpodcast.com. Thank you so much for your support of our podcast! Become a Patron of the show at www.Patreon.com/BeOurGuestPodcast. Also, please follow the show on Twitter @BeOurGuestMike and on Facebook at www.facebook.com/beourguestpodcast. Thanks to our friends at The Magic For Less Travel for sponsoring today's podcast!
Some of us eat once a day, some of us eat ten times a day and some of us sit in between. Depending on the size of the meal, what the meal is made up of and depending on how healthy the meal might seem to be, the person eating could be chumming. Chumming is a method to draw out a shark from deep within the ocean, but people who are eating foods of different sorts may be chumming for something far different than an ocean shark. They might be chumming for a blood and organ pathogen. Bugs make up a large swath of sickness in this world, bugs such as EBV and Shingles. These bugs have an appetite for certain foods and these bugs can be dormant for quite some time, or out and about already wreaking havoc, and then comes the food—food that pathogens really enjoy. As we go through life, we end up chumming our bugs if we are not wise to what they eat. We strengthen our bugs and make them grow as we chum. In this episode, learn how to protect yourself and what steps to take to not chum your bugs into proliferation, allowing sickness to worsen. Learn how to thwart sickness and live healthier. Listen to this advertisement-free podcast on Apple & Spotify. In this episode… • Learn about chumming and how you might be doing it without even realizing. • Discover what Public Medical Research & Science does and doesn't know about viruses and pathogens, and what secrets Classified Medical Research & Science is keeping. • Uncover what the public has been kept in the dark about for over 100 years. • Learn about the bug assembly line and how eggs played a huge role in its development. • Discover the most common ways in which people contract new bugs and viruses. • Uncover the reason why some people go from never craving eggs or other foods, to suddenly craving these foods out of nowhere. • Learn about one of the first organic and wild food grocery stores in the U.S. All this and more, tune in and don't miss out on this important episode. You can revisit this episode anytime you need it. For more information visit www.medicalmedium.com
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