Podcasts about Spontaneous

Welcome to Season 2 of the Orthobullets Podcast.In this episode, we review the high-yield topic of ⁠⁠Spontaneous Osteonecrosis of the Knee (SONK) from the Knee & Sports section.Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Orthobullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on Social Media:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Twitter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠YouTube

The Break Room (THURSDAY 7/17/25) 7am Hour 1) Spontaneous intimacy with your partner isn't always as sexy as you picture it 2) Tug boat life 3) The highest paid player in the NFL

Dana In The Morning Highlights 7/17TSA rules on taking off shoes and liquids in small containers could be changing soonHouston Livestock Show & Rodeo recently awarded $10.5 million to students heading to collegeExperts say your happiness can increase the more spontaneous you are

Watch on YouTubeIn this episode of The Worship Keys, Carson Bruce chats with Evan Fernald from The Belonging Co. about all things tracks in worship. Whether you're new to using tracks or looking to level up your setup, this conversation dives into the heart behind it all—how to keep worship spontaneous and structured. Evan breaks down his process for running tracks with flexibility, training your team, setting up gear, and navigating live worship without missing a beat. Plus, get a behind-the-scenes look at his Ableton Live session layout and real-world tips for integrating tracks into your service with confidence.Evan FernaldAbleton Session Templates & Touch OSC FilesThanks for listening! Subscribe here to the podcast, as well as on YouTube and other social media platforms. If you have any questions or suggestions for who you want as a featured guest in the future or a topic you want to hear, email carson@theworshipkeys.com. New episodes release every Wednesday!

Spontaneous combustion; Swimmer's Itch; Red Trees; Helm Creek Campground Closure due to Cougars; and lots more! Happy Tuesday! ^_^

It can be hard for couples to find good times to connect sexually. Busy lives or different sleep schedules are just some contributing factors that make finding time for sex especially challenging. Add to that an expectation that sex is "supposed to be spontaneous" and we have a recipe for frustration. Join me for an exploration of where the whole "thing" around spontaneity comes from, why you might like to de-bunk the myth that spontaneous = passionate, and how you can find more time and better times to get it on. Get my free email newsletter with helpful tips, plus a free guide to Finding Your Deepest Turn-Ons, and learn how to work with me at https://laurajurgens.com.

This episode of Kiwi Birth Tales is proudly brought to you by In this episode of Kiwi Birth Tales, I speak to Emily. Some of the topics we cover:Diagnosed with PCOS after coming off the pill Worked with a Women's Health Naturopth to reverse PCOS and symptoms Smooth preganancy COVID pos at 26 weeks, issues with Thyroid post that Changed midwives around 28 weeks Your Birth Project course Felt positive as had been surrounded by lots of "natural births" in her life Found out sex in first pregnancyPulled groin muscle while swimming at 38 weeks Almost 41 weeks went into spontaneous labourMidwife had to pull cervix forward Birth in hospital with Epidural Baby born with hand up by her face2nd degree tear Felt rushed to get up and shower post birth, felt alonePostpartum depression 2nd pregnancy wanted a homebirth Searched for positive homebirth stories where their first birth may have been challenging Found comfort and learning in these stories Changed midwives in pregnancy again Spontaneous waters breaking at home Bloom BirthpoolHeatpacks were helpful for pain management Walking up and down stairs and sitting on toilet to help progress at the end of labour Involuntary pushing Birth in the birthpool at home 1st degree tear not requiring stitches Calming, supportive midwife made a huge difference in birth and recovery Prolapse post birth Completely different mental health experience this time, very positive Your Birth Project Online Hypnobirthing Coursehttps://www.fertilityassociates.co.nz/book-a-free-nurse-consultPlease seek support for any mental health concerns, some helpful links are below:Mental Health in PregnancyPerinatal Depression and Anxiety Aotearoa Plunket - Dads Mental HealthLittle Shadow - Private Counselling NZFind me @kiwibirthtales and @yourbirthproject Hosted on Acast. See acast.com/privacy for more information.

Fluent Fiction - Dutch: Spontaneous Summers: Markets, Mishaps, and Memories Find the full episode transcript, vocabulary words, and more:fluentfiction.com/nl/episode/2025-07-13-22-34-02-nl Story Transcript:Nl: De zomerse zon straalde helder boven de bruisende straten van Amsterdam.En: The summery sun shone brightly over the bustling streets of Amsterdam.Nl: Het was een perfecte dag voor een avontuur in De Pijp Market.En: It was a perfect day for an adventure at De Pijp Market.Nl: Tussen de drukke kraampjes dwaalden twee vrienden, Jeroen en Annelies.En: Amidst the busy stalls wandered two friends, Jeroen and Annelies.Nl: Jeroen had een missie; hij wilde een heerlijke picknick plannen in het park, speciaal voor Annelies, zijn jeugdvriendin.En: Jeroen had a mission; he wanted to plan a delightful picnic in the park, especially for Annelies, his childhood friend.Nl: De markt was een wirwar van geuren en kleuren.En: The market was a maze of scents and colors.Nl: Verse groenten en fruit vulden de lucht met een zoete geur.En: Fresh vegetables and fruits filled the air with a sweet aroma.Nl: Lokale delicatessen lonkten aan elke kant.En: Local delicacies beckoned from every side.Nl: Maar net toen Jeroen zich van de ene kraam naar de andere haastte, realiseerde hij zich dat de markt drukker was dan hij had gedacht.En: But just as Jeroen was hurrying from one stall to the next, he realized that the market was busier than he had thought.Nl: Mensen verdrongen zich om koopjes te scoren, en het was een uitdaging om zich een weg te banen.En: People jostled to score bargains, and it was a challenge to make his way through.Nl: "Dit is gekkenwerk," zei Jeroen met een zucht, terwijl hij naar Annelies keek, die precies hetzelfde leek te denken, maar toch straalde van enthousiasme.En: "This is madness," said Jeroen with a sigh, as he looked at Annelies, who seemed to be thinking the same thing but was still beaming with enthusiasm.Nl: "Wat als we opsplitsen?"En: "What if we split up?"Nl: stelde Jeroen voor, met een lichte twijfel in zijn stem.En: Jeroen suggested, with slight hesitation in his voice.Nl: "We kunnen sneller alles vinden wat we nodig hebben."En: "We can find everything we need faster."Nl: Annelies knikte verrukt.En: Annelies nodded excitedly.Nl: "Goed idee!En: "Good idea!Nl: Laten we het doen!"En: Let's do it!"Nl: En zo gingen ze, elk hun eigen kant op.En: And so they went, each their own way.Nl: Jeroen dook tussen de kramen vol kazen en broodjes.En: Jeroen dove into the stalls filled with cheeses and sandwiches.Nl: De kraampjes leken eindeloos en de keuzes overweldigend.En: The stalls seemed endless, and the choices overwhelming.Nl: Maar hij hield vast aan zijn plan.En: But he stuck to his plan.Nl: Plots realiseerde Jeroen zich iets vreselijks: hij had zijn telefoon in zijn rugzak laten zitten.En: Suddenly, Jeroen realized something terrible: he had left his phone in his backpack.Nl: Hij had geen manier om Annelies te bellen als ze elkaar kwijtraakten.En: He had no way to call Annelies if they got separated.Nl: Zijn hart sloeg even over van bezorgdheid.En: His heart skipped a beat with worry.Nl: Met vastberadenheid begon hij zijn zoektocht naar Annelies middenin de gezellige chaos van de markt.En: With determination, he began his search for Annelies amid the lively chaos of the market.Nl: De drukte leek ondraaglijk, maar Jeroen liet zich niet ontmoedigen.En: The crowd seemed unbearable, but Jeroen was not discouraged.Nl: Hij glimlachte naar de vriendelijke markthandelaren en vroeg hen voorzichtig of ze een jonge vrouw hadden gezien die verbaasd en blij om zich heen keek.En: He smiled at the friendly market vendors and carefully asked if they had seen a young woman who looked surprised and happy.Nl: Na een tijdje, dat aanvoelde als een eeuwigheid, zag hij haar.En: After a while, which felt like an eternity, he saw her.Nl: Daar stond ze, vrolijk lachend bij een fruitkraam, met een mand vol sappige aardbeien en perziken.En: There she stood, cheerfully laughing at a fruit stall, with a basket full of juicy strawberries and peaches.Nl: Jeroen voelde een golf van opluchting en vreugde.En: Jeroen felt a wave of relief and joy.Nl: "Ik heb je gevonden!"En: "I found you!"Nl: riep hij, zijn zorgen volledig omgezet in opluchting.En: he shouted, his worries fully transformed into relief.Nl: Annelies lachte luid en ging hem tegemoet.En: Annelies laughed loudly and came up to him.Nl: "Ik kon het niet laten," zei ze speels, wijzend naar haar buit.En: "I couldn't resist," she said playfully, pointing to her haul.Nl: "En kijk eens wat ik heb gevonden!"En: "And look what I've found!"Nl: Samen, met hun manden vol lekkernijen, wandelden ze naar het park.En: Together, with their baskets full of goodies, they walked to the park.Nl: Ze spreidden hun kleed uit onder een oude boom.En: They spread their blanket under an old tree.Nl: Terwijl ze genoten van hun geïmproviseerde maaltijd, besefte Jeroen dat het niet de perfectie was die de dag speciaal maakte, maar het gezelschap van zijn oude vriendin.En: As they enjoyed their impromptu meal, Jeroen realized that it wasn't perfection that made the day special, but the company of his old friend.Nl: Jeroen leerde die dag dat soms, spontaniteit juist de mooiste herinneringen creëert.En: Jeroen learned that day that sometimes, spontaneity creates the most beautiful memories.Nl: En daar, onder de warme Amsterdamse zon, zaten ze.En: And there, under the warm Amsterdam sun, they sat.Nl: Tevreden en lachend, deelden ze momenten die veel meer betekenden dan een perfect geplande picknick.En: Content and laughing, they shared moments that meant much more than a perfectly planned picnic. Vocabulary Words:summery: zomersebustling: bruisendeadventure: avontuurdelightful: heerlijkepicnic: picknickmaze: wirwararoma: geurdelicacies: delicatessenbeckoned: lonktenjostled: verdrongenmadness: gekkenwerksigh: zuchthesitation: twijfeloverwhelming: overweldigenddetermination: vastberadenheidlivelihood: gezelligheidvendors: markthandelareneternity: eeuwigheidrelief: opluchtinghaul: buitgoodies: lekkernijenimpromptu: geïmproviseerdespontaneity: spontaniteitcontent: tevredentransformed: omgezetscore: scorenbargains: koopjesunbearable: ondraaglijkvendors: markthandelarencheerfully: vrolijk

spontaneous selections...audio / playlisthttp://feeds.feedburner.com/RadioTroubleArchives

In this episode of Relationship Advice, Cayla and Lauren are joined by sex therapist Bryttney Huseas to explore where couples commonly get stuck when it comes to sex. They dive deep into how differing arousal types—spontaneous vs. responsive—create misunderstandings, pressure, and disconnect, often fueled by cultural myths about what sex “should” look like. Offering practical tools for fostering empathy, building an “erotic team” mentality, and taking personal responsibility for sexual connection and communication. They talk about:  - Spontaneous vs. Responsive Desire - Cultural Norms & Misinformation - Personal Responsibility for Sexual Connection - Judgment & Safety in Communication - and more! Where to get connected with Bryttney Huseas LMFT, Sex & Relationship Therapist Bryttney@scottsdalesextherapy.com ⁠https://www.scottsdalesextherapy.com/meet-bryttney⁠ Give Me Discounts! Skylight - Visit skylightcal.com/IDO for $30 off your 15 inch calendar.  Function - 160+ Lab Tests for $365 to anyone who signs up between July 7th and July 11th. Learn more & get started at www.functionhealth.com/IDO Prolon - Visit ProlonLife.com/IDO to claim your 15% discount and your bonus gift. PXG - Visit PXGApparel.com/IDO or use promo code: PODAPP-IDO to save 10% off your Spring/Summer 2025 Collection order. Amazfit - Visit www.amazfit.com/IDO to get 10% off Spark My Relationship Course: Get $100 off our online course. Visit SparkMyRelationship.com/Unlock for our special offer just for our I Do Podcast listeners! If you love this episode (and our podcast!), would you mind giving us a review in iTunes? It would mean the world to us and we promise it only takes a minute. Many thanks in advance! – Colter, Cayla, & Lauren Learn more about your ad choices. Visit megaphone.fm/adchoices

Jeff and Alex are back solving your sex problems this week. Providing their interesting, insightful and entertaining perspective. So much so that they'll likely be moving to the entertainment and comedy category, to lift the spirits of listeners looking to have a good old laugh.1:14 - The Body. A discussion. Did you know?14:00 - Question 1 - Spontaneous or Planned Sex? Making things work.20:20 - Question 2 - How do I tell my partner it smells? Just say something!39:09 - Jeff! You can do something about your taste too!41:08 - The secret to having bigger "loads".43:12 - Question 3 - Slutty past, now i'm a professional. How do I handle this?49:40 - I haven't seen my new dudes D**K.Leave your comments! Subscribe! Share the podcast!!!!Got a question for Jeff and Alex? Record Your Question for Problem Solved: https://www.therapyjeff.com/podcastKeep up with Alex at https://alexandramoskovichpsychotherapy.comJeff's TikTok: https://www.tiktok.com/@therapyjeffJeff's Instagram: https://www.instagram.com/therapyjeffListen to more podcasts like this: https://wavepodcastnetwork.comDISCLAIMER: The insights shared in this podcast are for educational and entertainment purposes only, and should not be seen as a substitute for professional therapy. The guidance is general in nature, and does not equate to the personalized care provided by a licensed therapist. The callers are not therapy clients.

Join hosts John and Jackie Melfi in this fun and revealing episode where they play "This or That: Lifestyle Edition"! The couple behind colette Swingers Clubs and the award-winning openlove101.com blog share their preferences on various aspects of open relationships and swinging.   In this candid discussion, John and Jackie answer questions about full swap vs soft swap, playing together vs separately, and much more. With over 13 years of experience in consensual non-monogamy, they offer valuable insights on jealousy, vulnerability, and how their preferences have evolved over time.   Whether you're curious about the lifestyle or looking to deepen your understanding of open relationships, this episode provides an entertaining and educational perspective from two experts in the field.   Key Topics Discussed: 0:00 - Introduction to Open Love 101 podcast 1:01 - Game explanation: "This or That" lifestyle edition 1:45 - Full swap vs soft swap preferences 2:00 - Playing together vs separately 3:20 - Spontaneous vs scheduled play 3:46 - How vulnerability affects relationships 4:44 - Meeting couples online vs at events 5:34 - Club vs resort preferences 7:07 - Same room vs separate rooms 8:03 - Processing feelings in the moment vs afterward 8:40 - Clear rules vs going with the flow 11:04 - Regular play partners vs one-timers 12:44 - Jealousy as a red flag vs growth opportunity 15:26 - Slow and sensual vs fast and wild 17:16 - Compersion as a must vs work in progress 21:01 - Home vs elsewhere preferences 22:02 - Playing with people they know vs strangers   Join the Conversation!   Like what you heard? Subscribe to our channel, hit the notification bell, and visit openlove101.com to sign up for our email list. You'll be notified of upcoming videos, articles, and events!   Don't forget to leave a comment below with your own "This or That" preferences or questions for John and Jackie. We'd love to hear your thoughts on the topics discussed!   #OpenLove101 #Swinging #NonMonogamy #ThisOrThat #RelationshipAdvice #ConsentualNonMonogamy #OpenRelationships

Dr. Feldman on NEGATIVITY BIAS -Curettage alone for NMSC - with Dr. Nathan Jensen! -Dupilumab for chronic spontaneous urticaria -ILK for KAs -Learn more about the U of U Dermatology ECHO model!https://physicians.utah.edu/echo/dermatology-primarycareWant to donate to the cause? Do so here!
Donate to the podcast: ⁠uofuhealth.org/dermasphere⁠
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- ⁠Kikoxp.com ⁠(a social platform for doctors to share knowledge)
- ⁠⁠www.levelex.com/games/top-derm⁠⁠ (A free dermatology game to learn
more dermatology!

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

So apparently there are eight different kinds of sex every married couple should be having on rotation… and obviously, we had to weigh in. Spontaneous? Scheduled? Morning? Hotel? Quickie? We're breaking them all down—what works and what doesn't, and which ones you should be doing. Enjoy this repeat episode!Want our podcasts sent straight to your phone? Text us the word "Podcast" to +1 (917) 540-8715 and we'll text you the new episodes when they're released!Tune in for new Cat & Nat Unfiltered episodes every Monday, Tuesday, Thursday and Friday!Follow @catandnatunfiltered on Instagram: https://instagram.com/catandnatunfilteredOur new book "Mom Secrets" is now available! Head to www.catandnat.ca/book to grab your autographed copy! Come see us LIVE on tour!! To see a full list of cities and dates, go to https://catandnattour.com.Are you a parent that is struggling understanding the online world, setting healthy screen-time limits, or navigating harmful online content? Purchase screen sense for $49.99 & unlock Cat & Nat's ultimate guide to parenting in the digital age. Go to https://www.thecommonparent.com/guideFollow our parenting platform - The Common Parent - over on Instagram: https://instagram.com/thecommonparentMake sure you subscribe to our YouTube channel: https://bitly.com/catnatyoutubeCheck out our Amazon Lives here: https://bitly.com/catnatamazonliveOrder TAYLIVI here: https://taylivi.comGet personalized videos from us on Cameo: https://cameo.com/catandnatCome hang with us over on https://instagram.com/catandnat all day long.And follow us on https://tiktok.com/@catandnatofficial! Hosted on Acast. See acast.com/privacy for more information.

July 1st brought Illinois some new laws. Joe and Travis bring back an old game to determine their opinions of the laws..... rules still unclear. Next week.... corrupt politicians As always, this episode was brought to you by: Carter Comics - CarterComics.Com - Use the Promo Code "FreakNet" at Check Out to save 10% on your order. & Audible.com - Audibletrial.com/freaknet  - Get a 30 Day Free Trial of Audible!!!   We Have Merchandise!!!! Check out our merch at www.TeePublic.com by searching "TFS"   This Freakin Show is now part of Freak Net Studios!! Discord: Freak Net Studios Facebook: Freak Net Studios Instagram: @freaknetstudios YouTube: Freak Net Studios Follow the Podcast on Social Media: Twitter: @thisfreakinshow Facebook: This Freakin' Show Instagram: @thisfreakinshow Email us: thisfreakinshow@yahoo.com Website: ThisFreakinShow.com   Music Provided By: MeTOMicA - Host of S.o.S & Jedi Talk

Does it ever feel like you and your partner are just never on the same page when it comes to sex? One of you wants it more often. One of you needs things to be just right. One of you initiates. One of you never does. It can feel frustrating, confusing, and even a little bit lonely. But there's a good chance the issue isn't actually about how much you want sex… it's about how you want sex. In today's episode, we're breaking down one of the most important tools we've ever shared: the two sex drive types. If you've ever felt like your desire is broken—or that your partner just doesn't “get” you—this conversation is about to change everything.

Spontaneous coronary artery dissection (SCAD) and its impact in younger women Psychological and emotional impact of heart attacks in women - Depression, anxiety and PTSD Factors that reduce optimal outcomes for women after a heart attack How best to support women following a heart attack Host: Dr Terri Foran | Total Time:31 mins Experts: Prof Robert M Graham, Cardiologist and Dr Barbara Murphy, Associate Director of Australian Centre for Heart Health Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Send a message to the pod!Join us as we break down the realities of making a living as content creators, answering listener questions about everything from revenue streams to work-life balance while sharing personal insights from our own experiences.• Brand collaborations - involving contracted content creation with companies• Platform payments from YouTube, TikTok, and other platforms offer another revenue stream based on views• Commissionable linking / purchases through creator affiliate links• Subscription models through Patreon or platform features as reliable monthly income• Individual businesses or product lines representing additional revenue opportunities• Filming with kids and clear boundaries and communication about work time versus family time• Simple vs. Easy - explaining the time and skill to produce quality videos• Video editing time and variance• Spontaneous vs planned content breakdown• The pros and cons of social for us personallySupport the showIf you've got a voicemail or want our (likely unqualified) advice on something, hit us up at the Speakpipe link below!http://www.speakpipe.com/oversharingwiththeoverbysIf you'd like to email us you can reach the pod at oversharing@jojohnsonoverby.com!And if you want to support the podcast and gain access to all episodes, check out https://www.patreon.com/oversharing!CONNECT:TikTok: @jojohnsonoverby / @matt.overbyInstagram: @jojohnsonoverby / @matt.overbyWebsite: https://jojohnsonoverby.com/Watch the Podcast: https://www.youtube.com/playlist?list=PL29Si0ylWz2qj5t6hYHSCxYkvZCDGejGq

I did a quick trip to Los Angeles, Pasadena to be exact. And I thought it would be a good way to talk about planning somewhat spontaneous trips and how best to experience a trip with minimal planning. 

In this engaging conversation, Matthew Lilley and David Vallier explore the profound themes of worship and creativity. David shares his personal journey from Louisiana to becoming a worship leader, emphasizing the importance of unique expressions of worship and the role of spontaneity. They discuss the significance of creating safe environments for worship, the value of diverse musical styles, and the necessity of discipleship in worship leadership. The conversation highlights the importance of being genuine in worship, embracing emotions, and living a life directed towards God.

“One time, that wicked king of the Daityas saw his son of lotus-like face and beautiful eyes, surrounded by women, having returned from the home of the guru. In his hand, that boy was holding a slate which had the mark of a chakra at the top and the name of Krishna written with great adoration.” (Narasimha Purana, 41.35-36)

Send us a textIf you're posting just to post—this one's for you. In today's episode, Sydney is breaking down what a real social media strategy looks like (hint: it's not just batching a few posts on Canva). If your content feels like a guessing game, you're not alone—and you're not stuck.Whether you're a founder, creative, or small business owner with an existing social media presence, this episode will walk you through our signature Renaissance Roadmap framework so you can finally stop throwing spaghetti at the wall and start showing up with purpose.Hear Sydney's honest experience with taking maternity leave as a founder and how NexusPoint helped her stay supported and sane through it all. If you've been thinking about getting a Virtual Executive Assistant, this ad alone might be the nudge you need.Book your free NexusPoint consult: go.nexuspt.io/rmgSupport the showAbout The Host:Sydney Dozier, the visionary behind Renaissance Marketing Group, has been at the forefront of social media excellence since the agency's inception in 2014. Over the past 10 years, Sydney has cultivated a full-fledged team of social media aficionados and creative minds, elevating Renaissance to its current status as one of Nashville's premier agencies. With an extensive and diverse clientele, they've consistently delivered exceptional results. From coast to coast, Renaissance offers a comprehensive suite of services, spanning social media management, strategic guidance, content creation, paid digital advertising, email marketing, influencer partnerships, graphic design, branding, in-house professional photography and videography, and beyond. Their mission is simple: to drive optimal revenue and online growth while consistently surpassing client expectations. Beyond her role as a business maven, Sydney wears multiple hats. She hosts The Renaissance Podcast, an enlightening resource for entrepreneurs seeking to spark a modern-day Renaissance in their lives and businesses. Her passion for championing women in business gave rise to The Mona Lisa Foundation, a nonprofit organization committed to supporting and accelerating women entrepreneurs in Nashville through mentorship, grants, education, and a vibrant community. Sydney is also the driving force behind The Renaissance Women's Summit, an annual...

00:00 intro 01:22 monday 04:25 tuesday 09:18 wednesday 12:50 thursday 14:16 friday 25:40 saturday 25:59 sunday 31:10 next week

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/answers-in-chronic-spontaneous-urticaria-10190SummaryIn this short CE/CME activity, moderator Dr. Brad Glick works with dermatology expert Dr. Gil Yosipovitch to answer your top questions regarding chronic spontaneous urticaria, as gathered from the 2025 NACE Conversations in Dermatology symposium. Questions cover diagnosis, treatment individualization, and more!Learning ObjectivesAt the conclusion of this activity, participants should be better able to:Assess the disease burden and impact on QoL in patients with CSUEvaluate current and emerging therapies for CSUThis activity is accredited for CME/CE CreditThe National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The National Association for Continuing Education designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.The National Association for Continuing Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 121222. This activity is approved for 0.25 contact hours (which includes 0.25 hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis activity is supported by an independent educational grant from Sanofi and Regeneron Pharmaceuticals.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Hour 1 of A&G features... Pete Hegseth press conference on Iran & FDR Katie Green's Headlines! Gender Bending Madness! Mailbag! See omnystudio.com/listener for privacy information.

In the first hour of the Chase & Big Joe Show, the guys shared their question of the day. Have you been on a spontaneous road trip? If so, when and where? Let us know. Later in the hour, Chase & Big Joe listed off some of the odd sports you can win a national championship in college. Listen to hear more.

Hour 1 of A&G features... Pete Hegseth press conference on Iran & FDR Katie Green's Headlines! Gender Bending Madness! Mailbag! See omnystudio.com/listener for privacy information.

We've long admired Schrodinger's cat here on ride, but today we're talking about two new scientific concepts - the Pavlovian dog and spontaneous generation. Mary Beth opens up about her time working in the service industry and Benny revisits Powell's candy shoppe (sp?).Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.Sponsors:Head to crapeyewear.com to shop and use code RIDE at checkout for 20% off full priced items. Get 15% off your first order of $100 or more at hillhousehome.com with code RIDE15Article is offering our listeners $50 off your first purchase of $100 or more. To claim, visit ARTICLE.COM/RIDE and the discount will be automatically applied at checkout. Go to cokeurl.com/SimplyPOP to find out where you can try Simply Pop! Start paying rent through Bilt and take advantage of your Neighborhood Benefits by going to joinbilt.com/ride. Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/QPE865. CME/MOC/AAPA credit will be available until June 20, 2026.Advancing Care for Chronic Spontaneous Urticaria: Navigating an Evolving Treatment Landscape for Optimal Patient Outcomes In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

Dr. Tony Capra and Dr. Marina Sirota, scientists from the March of Dimes Prematurity Research Center (PRC) at the University of California, San Francisco (UCSF), discuss their foundational finding that spontaneous, or unplanned, preterm birth is fundamentally different from indicated preterm birth.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA information, and to apply for credit, please visit us at PeerView.com/QPE865. CME/MOC/AAPA credit will be available until June 20, 2026.Advancing Care for Chronic Spontaneous Urticaria: Navigating an Evolving Treatment Landscape for Optimal Patient Outcomes In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent medical education grant from Sanofi and Regeneron Pharmaceuticals.Disclosure information is available at the beginning of the video presentation.

Michael answers a note from 'Frustrated'.Homesite: michaelformanwriting.com

Enjoy!

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DNY865. CME credit will be available until June 11, 2026.From Wheals to Wellness: Transforming Chronic Spontaneous Urticaria Care With Emerging SolutionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.This activity is developed in collaboration with our educational partner, PVI, PeerView Institute for Medical Education.SupportThis activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DNY865. CME credit will be available until June 11, 2026.From Wheals to Wellness: Transforming Chronic Spontaneous Urticaria Care With Emerging SolutionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.This activity is developed in collaboration with our educational partner, PVI, PeerView Institute for Medical Education.SupportThis activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DNY865. CME credit will be available until June 11, 2026.From Wheals to Wellness: Transforming Chronic Spontaneous Urticaria Care With Emerging SolutionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.This activity is developed in collaboration with our educational partner, PVI, PeerView Institute for Medical Education.SupportThis activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DNY865. CME credit will be available until June 11, 2026.From Wheals to Wellness: Transforming Chronic Spontaneous Urticaria Care With Emerging SolutionsThe University of Cincinnati is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.This activity is developed in collaboration with our educational partner, PVI, PeerView Institute for Medical Education.SupportThis activity is supported by an educational grant from Novartis Pharmaceuticals Corporation.Disclosure information is available at the beginning of the video presentation.

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Fluent Fiction - Dutch: A Spontaneous Summer Stroll Through Amsterdam's Dam Square Find the full episode transcript, vocabulary words, and more:fluentfiction.com/nl/episode/2025-06-15-22-34-02-nl Story Transcript:Nl: Dam Square gonst van de mensen.En: Dam Square buzzes with people.Nl: Het is een prachtige zomerdag.En: It is a beautiful summer day.Nl: De zon straalt fel en er loopt een briesje over het plein.En: The sun shines brightly and a breeze wafts over the square.Nl: Gedreven door de drukte en kleur van de markt, slentert Bram langs de kraampjes.En: Driven by the hustle and color of the market, Bram strolls past the stalls.Nl: Sanne loopt naast hem, met de tas stevig in haar hand en een lijst in haar hoofd.En: Sanne walks beside him, with her bag firmly in hand and a list in her head.Nl: "Bram, vergeet niet dat we een budget hebben," waarschuwt Sanne.En: "Bram, don't forget that we have a budget," warns Sanne.Nl: Ze kijkt sceptisch naar de portemonnee in zijn achterzak.En: She looks skeptically at the wallet in his back pocket.Nl: Ze moeten een cadeau voor Brams moeder vinden en hebben niet veel tijd.En: They need to find a gift for Bram's mother and don't have much time.Nl: Bram knikt afwezig.En: Bram nods absentmindedly.Nl: Zijn ogen dwalen af naar een straatartiest die een groep mensen boeit met zijn acrobatiek.En: His eyes wander to a street performer captivating a group of people with his acrobatics.Nl: Bram kan het niet laten: hij voelt de drang om dichterbij te gaan kijken.En: Bram can't help himself; he feels the urge to take a closer look.Nl: "Kom op, Sanne.En: "Come on, Sanne.Nl: Laten we even kijken!"En: Let's have a look!"Nl: roept hij enthousiast.En: he calls out enthusiastically.Nl: Sanne zucht, maar ze volgt hem.En: Sanne sighs but follows him.Nl: De artiest maakt indruk met zijn luisterrijke trucjes, maar Bram's aandacht is al snel weer gefocust op een rij kleurrijke kraampjes langs de kant.En: The performer impresses with his splendid tricks, but Bram's attention is soon drawn to a row of colorful stalls on the side.Nl: Één kraam trekt zijn aandacht met sprankelende sieraden in de zon.En: One stall catches his eye with sparkling jewelry in the sun.Nl: "Misschien is dit iets," oppert Bram.En: "Maybe this is something," suggests Bram.Nl: Sanne schuifelt naar de kraam, haar interesse gewekt.En: Sanne shuffles towards the stall, her interest piqued.Nl: De juwelen lijken handgemaakt.En: The jewels look handmade.Nl: Ze zijn uniek en prachtig.En: They are unique and beautiful.Nl: Bram grijpt een glinsterende halsketting.En: Bram grabs a glittering necklace.Nl: "Dit is het!"En: "This is it!"Nl: roept hij.En: he exclaims.Nl: "Dit is perfect voor mama."En: "This is perfect for mom."Nl: Zijn ogen stralen als hij Sanne aankijkt voor goedkeuring.En: His eyes shine as he looks at Sanne for approval.Nl: Sanne kijkt even peinzend maar knikt dan goedkeurend.En: Sanne looks contemplatively for a moment but then nods approvingly.Nl: De prijs is redelijk en past binnen hun budget.En: The price is reasonable and fits within their budget.Nl: Met het cadeau in de hand verdwijnen de zorgen en haast.En: With the gift in hand, the worries and rush disappear.Nl: Ze wandelen weg van de kraam, beiden opgelucht en voldaan.En: They walk away from the stall, both relieved and satisfied.Nl: Terwijl ze de drukte van de Dam Square verlaten, glimlacht Bram.En: As they leave the bustle of Dam Square, Bram smiles.Nl: "We zijn op tijd klaar en alles onder budget," lacht Sanne, die nu ook ontspant.En: "We're done on time and everything under budget," laughs Sanne, now also relaxed.Nl: Het blijkt dat soms een beetje spontaniteit nodig is om iets bijzonders te vinden.En: It turns out that sometimes a bit of spontaneity is needed to find something special.Nl: Bram leert dat focus belangrijk is, en Sanne ontdekt de vreugde van avontuur.En: Bram learns that focus is important, and Sanne discovers the joy of adventure.Nl: Ze lopen samen, de drukte achterlatend, nog steeds in de energie van de zomermarkt op de Dam.En: They walk together, leaving the hustle and bustle behind, still filled with the energy of the summer market at the Dam. Vocabulary Words:buzzes: gonstbreeze: briesjewafts: looptstalls: kraampjesfirmly: stevigskeptically: sceptischwallet: portemonneeabsentmindedly: afwezigstreet performer: straatartiestcaptivating: boeitacrobatics: acrobatiekurge: drangenthusiastically: enthousiastsighs: zuchtsplendid: luisterrijkedrawn: gefocusdsparkling: sprankelendesuggests: oppertpiqued: gewektshuffles: schuifeltglittering: glinsterendeapproval: goedkeuringcontemplatively: peinzendreasonable: redelijkrelieved: opgeluchtrush: haastspontaneity: spontaniteitfocus: focusadventure: avontuurhustle: drukte

Spontaneous short episodes recorded Off The Cuff from the heart and life of Matt Knoll.

Dr. Holly Everett's work helps us better understand roadside memorials and other public expressions of remembrance. Her 1998 master's thesis, “Crossroads: Roadside Accident Memorials in and around Austin, Texas,” examines 35 memorials, exploring how they're constructed and the cultural meanings they convey. What is the intent of a roadside memorial? Is it meant to be temporary or permanent? Are these markers legal? Who builds them, and what does that process look like? How do roadside memorials compare to spontaneous large-scale public commemorations of grief? Dr. Everett offers insight into these everyday and deeply meaningful spaces of mourning. After learning more about them, you'll never look at them the same.

Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These techniques improve the detection of various types of CSF leaks thereby enabling targeted therapies. In this episode, Katie Grouse, MD, FAAN, speaks with Ajay A. Madhavan, MD, author of the article “Radiographic Evaluation of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Madhavan is assistant professor of radiology at the Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Radiographic Evaluation of Spontaneous Intracranial Hypotension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones:  This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse:  This is Dr Katie Grouse. Today I'm interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chazen. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Madhavan:  Hi, thanks a lot, Katie. Yeah, so I'm Ajay Madhaven. I'm a neuroradiologist at the Mayo Clinic in Rochester, Minnesota. I did all my training here, so, I've been here for a long time. And I have a lot of interest in spinal CSF leaks, and I do a lot of that work. And so I'm really excited to be talking about this article with you. Dr Grouse:  I'm really excited too. And in fact, it's such a pleasure to have you here talking today on this topic. I know a lot's changed in this field, and I'm sure many of our listeners are really interested in learning about the developments and imaging techniques to improve detection and treatment of CSF leaks, especially since maybe we've learned about this in training. I want to start by asking you what you think is the most important takeaway from your article. Dr Madhavan:  Yeah, that's a great question. I think---and you kind of already alluded to it---I think the main thing is, I hope people recognize that this field has really changed a lot in the last five to ten years, through a lot of multi-institutional collaboration and also collaboration between different specialties. We've learned a lot about different types of spinal CSF leaks, how we can recognize the disease, particularly the types of myelography that we need to be using to accurately localize and treat these leaks. Those are the things that have really evolved in the last five to ten years, and they've really helped us improve these patients' lives. Dr Grouse:  Can you remind us of the different common types of spinal leaks that can cause spontaneous intracranial hypotension? Dr Madhavan:  Yeah, so there are a number of different spinal CSF leaks, types, and I would say the three most common ones that really most people should try to be aware of and cognizant of are: first, ventral dural tears. So those are, like, just physical holes in the dura. And they're usually caused by little bone spurs that come from the vertebral columns. So, they're often patients who have some degenerative changes in their spine. And those are really very common. Another type of spinal CSF leak that we commonly see is a lateral dural tear. So that's like the same thing in a slightly different location. So instead of being in the front, it's off to the side of the dura laterally. And so, it's also just a hole in the dura. And then the third and most recently discovered type of spinal CSF leak is a CSF-venous fistula. So those are direct connections between the subarachnoid space and little paraspinal vein. And it took us a long time to even realize that this was a real pathology. But now that it's been recognized, we've found that this is actually quite common. So those three types of leaks are probably the three most common that we see. And there's certainly others out there, but I would say over 90% of them fall into one of those three categories. Dr Grouse:  That's a great review, thank you. Just as another quick review, as we talk more about this topic, can you remind us of some of the most common or typical brain imaging findings that you'll see in cases of spontaneous intracranial hypotension? Dr Madhavan:  Yeah, absolutely. So, when you do a brain MRI in a patient who has spontaneous intracranial hypotension, you will usually, though not always, see typical brain MRI abnormalities. And I kind of think of those as falling into three different categories. So, the first one I think of is dural enhancement or thickening. So that's enlargement or engorgement of the dura, the pachymeninges, and enhancement on postgadolinium imaging. So, that's kind of the first category. The second is that, when you lose spinal fluid volume, other things often expand to take up the space. So, for example, you can get distension or enlargement of the dural venous sinuses, and sometimes you can also get subdural food collections or hematomas. They can arise spontaneously. And I kind of think of those as, you know, you, you've lost the cerebrospinal fluid volume and something else is kind of filling up the space. And then the third category is called brain sagging. And that's a constellation of findings where the posterior fossa structures and the pituitary gland in the cell have become abnormal because you've lost the fluid that normally cushions those structures and causes them to float up. For example, the brain stem will sag down, the distance between the mammillary body and the ponds may become reduced. The suprasellar cistern space may be reduced such that the optic chiasm becomes very close to the pituitary gland, and the prepontine cistern may also become reduced in size. And there are various measurements that can be used to determine whether something is subtly abnormal. But just generally speaking, those are really the three categories of brain MRI abnormalities you'll see. Dr Grouse:  That was a great review. And of course, I think in many times when we are thinking about or suspecting this diagnosis, we may be lucky to find those imaging findings to reinforce a diagnosis. Because as it turns out, after reading your article, I was really surprised to find out that in as many as 19% of cases we actually see normal brain imaging, which really was a surprise to me, I have to say. And I think that this really encompasses why spontaneous intercranial hypotension is such a difficult diagnosis to make. I think a lot of us struggle with how far to take the workup when, you know, spontaneous intercranial hypotension is clinically suspected, but multiple imaging studies are normal. Do you have any guidance on how to approach these more difficult cases? Dr Madhavan:  So, that's a really good question. And you know, it's- as you can imagine, that's a topic that comes up in most meetings where people discuss this, and it's been a continued challenge. And so, like you said, about 19 or 20% of patients who have this disease can have a, a normal brain MRI. And we've tried to do some work to figure out why that is and how we can identify patients who still have the disease. And I can just provide, I guess, some tips that have helped me in my clinical practice. One thing is, if I ever see a patient with a normal brain MRI where this disease is clinically suspected---for example, maybe they have orthostatic headaches or other very typical symptoms and we don't know why, but their brain MRI is normal---the first thing I do is I try to look back at their old imaging. So many times, these patients who present to us at Mayo, who, when we do their MRI scan here, their brain MRI looks normal… if you really look back at imaging that they've had done elsewhere---maybe even two to three years prior---at the time their symptoms started, they actually had some abnormalities. So, I might see that a patient, two years ago, had dural enhancement that spontaneously resolved; but now they still have symptoms of SIH and they may still have a CSF leak that we can find and treat, but their brain MRI has, for whatever reason, normalized. So, I always start by looking back at old imaging, and I found that to be very helpful. The other thing is, if you see a patient with a normal brain MRI, it's also important to look at their spine MRI because that can provide clues that might suggest that they could still have a spinal CSF leak. And the two things I look for on the spine MRI: one, if there's any extradural CSF. So, spinal fluid outside of where it's supposed to be within the confines of the subarachnoid space. And you know, really, if you see extradural CSF, you know they probably have a spinal fluid leak somewhere. Even if their brain MRI is normal, that just gives you the information that there is a dural tear probably somewhere. And so, in those patients we'll definitely still proceed to myelography or other testing, even if they have a normal brain MRI. And then the last thing I look for is whether or not they have prominent meningeal diverticula. Patients with CSF venous fistulas almost always have one or more prominent diverticula on their spine along the nerve root sleeves. And that's probably because most of these fistulas come from nerve root sleeve diverticula. We don't completely understand the pathogenesis of CSF venous fistulas, but they're clearly associated with meningeal diverticula. So, if I see a patient who has a normal brain MRI, but I see on their spine MRI that they have many meningeal diverticula that are relatively prominent, that makes me more inclined to be a little bit more aggressive in doing myelography to find a CSF leak. And then I look at other demographic features, too. So, for example, elevated BMI and older age are associated with CSF venous fistulas. So, that can help you determine whether or not it's warranted to go on to more advanced imaging, too. So those are all just a variety of different things that we've used to help us. Dr Grouse:  Thank you for sharing that. I wanted to go on to say that, you know, reading your article, of course, as you mentioned, you alluded to the fact there's lots of new imaging modalities out there. It was very illuminating and just an excellent resource for the options that exist and when they're useful. You did a great job summarizing it. And I encourage our readers to check out your article, to refresh themselves, update themselves on what's happened in this space. And of course, we can't summarize them all today, but I was wondering if you could possibly walk us through a hypothetical case of a patient who comes in with a history very suspicious for SIH? How would you approach this patient? Say you have gotten imaging that suggested that there is a spinal fluid leak and now you have to figure out where it is. Dr Madhavan:  Yeah. So, you know, I think the most typical scenario it'll be a patient who has been seen by one of my excellent neurology colleagues and they've done a brain MRI and they've made the diagnosis through a combination of clinical information and brain MRI finding. And then the next thing we'll do always is, we'll obtain a spine MRI. So, I think of the purpose of the spine MRI as to determine what type of spinal fluid leak they have. On the spine MRI, if you see extradural CSF, those patients essentially always will have a dural tear. And it may be a ventral dural tear or a lateral dural tear. But if you see extradural CSF, that is pretty much what they have. And conversely, if you don't see extradural CSF---if you just see, for example, many meningeal diverticula, but you don't see anything else particularly abnormal---most of those patients have a CSF venous fistula, just common things being common. So I use the spine MRI to determine what type of leak they have. And then the next thing I think about is, okay, I'm going to do a myelogram on this patient. How do I want to position them? Because it turns out that positioning is probably the most important factor for finding these spinal fluid leaks. You have to have the patient positioned correctly to find the leak that you're trying to localize. And so, if I suspect they have a ventral dural tear, I will always position those patients prone for their myelogram. And I might do one of many different types of myelograms. And, you know, the article talks about things like digital subtraction myelography and dynamic CT myelography. And you can find any of these leaks with any of those techniques, but you just have to have the patient positioned correctly. So, if I think I have a ventral dural tear, I'll put them prone for the myelogram. If I think they have a lateral dural tear, I'll put them in the cubitus position for the myelogram. And also, if they- if I think they have a CSF-venous fistula, I'll also put them in the decubitus position. Obviously if you're putting them in the decubitus position, you have to decide whether it's going to be left or right side down. So that may require a two-day exam. Sometimes you don't have to; in many cases, we're able to just do everything in one day. But those are all the different factors I think about when I'm trying to determine how I'm going to work those patients up further. So, I really use the spine MRI chiefly to think about what type of leak they're going to have and how I'm going to plan the myelogram. Dr Grouse:  That's really great. And it's, I think, really nice to emphasize how much the positioning matters in all this, which I think is not something we've been classically taught as far as the diagnosis of spinal leaks. Another thing I'm really interested in your opinion on is, you talked a lot about how to optimize and what can make you successful at diagnosis. I'm curious what you think one of the easiest mistakes to make or, you know, that we should hopefully avoid when treating patients with this disease. Dr Madhavan:  Yeah. And I think, you know, one other thing that's been discussed a lot in this topic… you know, we've talked about the patients with a normal brain MRI. Another barrier or challenge particularly with CSF-venous fistulas is, sometimes they can be very subtle on imaging. So, it's not always you see it very definitive CSF-venous fistula where you can say, like, there's no question, that's a fistula. There are many times where we do a good-quality myelogram and we see something that looks, like, possible for a CSF venous fistula, or probable. If I had to put a number on it, maybe there's a 50 to 70% chance of real. So, in those cases, we end up wondering, like, should we treat this suspected leak? And I think one common mistake  or one thing that needs to be looked at further is, how do we handle these patients where we don't know whether the fistula is real or not? That's usually something where I will have a discussion with the patient, and I'm usually just very upfront with him about my interpretation of the imaging. I'll just tell them, we did a good-quality myelogram. You did a great job. We got good images. I don't see anything definitive, but I see this thing that I think has maybe a 60% chance of being real. And then I'll confer with one of my neurology colleagues and we'll decide whether it's worth treating that or not. And we'll just be very upfront with a patient about whether- about the likelihood of its success and what their long-term prognosis is. And oftentimes we let them make the decision. But I think that remains to be one of the big challenges is, how do we treat these patients who have suspected leaks that are not definitive on imaging. Dr Grouse:  That sounds absolutely like an important area where there can be problems, so I appreciate that insight. I'm interested what you think in your article would come as the biggest surprise to our listeners who may not have kept up as much with all of the changes that have happened in recent years? Dr Madhavan:  One of the things that was certainly, at least, a surprise to me as I was going through my training and learning about this topic is how diverse myelography has really become. You know, when I was a radiology resident, I learned about myelography as this thing that we've been doing for 30 to 40 years. And historically we've used myelograms just to look for degenerative changes: disc bulges, you know, disc herniations and things like that. Now that MRI is more prevalent, we don't use it as much, but it has turned out that it has a very big role in patients with spinal fluid leaks. Furthermore, something that I've learned is just how diverse these different types of myelograms have become. It used to kind of be just that a myelogram is a myelogram is a myelogram, but now we have different types of positioning, different types of equipment that we use. We vary the timing between contrast injection and imaging to optimize success for finding spinal fluid leaks. So, I think many times I talk to people who may not be as familiar with this field and they're surprised at just how diverse that has become and how sophisticated some of the various myelographic techniques have become and how much that really makes a difference in being able to accurately diagnose these patients. Dr Grouse:  Well, I can say it was a surprise to me. Even as someone who does treat quite a few patients with this condition, I was surprised to see the breadth of different options that have become available. And then kind of a follow-up to that, what do you think the current area of controversy is in this area of diagnosis and treatment? Dr Madhavan:  The biggest ones are ones you've sort of already alluded to. So, one big one is, how far do we go in patients who have a normal brain MRI who still have a clinical suspicion of the disease? And sometimes it's really hard, because sometimes you will find patients who clinically have a very strong case for having spontaneous intracranial hypotension. You look at them, they have very acute-onset orthostatic headaches. There's no better explanation for their symptoms that we know of. And it's hard to know what to do with those patients, because some of them want to continue to undergo diagnostic workup, but you can only do so many myelograms and you can only do so much with this diagnostic workup that requires some radiation dose before it becomes very challenging. That's a major point of just, I guess, ongoing research as to what can we do better for that subset of patients. Fortunately, it's not all of them, it's a subset of them, but I think we could help those patients better in the future as we learn more about the disease. So that's one. And the other one is treating these equivocal findings, like I discussed.  And where should our threshold be to treat a patient, and what type of treatment should we do in patients where we don't know whether a leak is real? Should we just do a very noninvasive- relatively noninvasive blood patch? Do we do an embolization where we're leaving a foreign body there? Is it worth sending those patients to surgery? Those are all unanswered questions and things that continue to spark ongoing debate. Dr Grouse:  Do you think that there's going to be any new big breakthroughs, or even, do you know of any big developments on the horizon that we should be keeping our eyes out for? Dr Madhavan:  You know, I think for me the biggest thing is, imaging is dramatically improving. We talked a little bit about photon counting detector CT in our article, and that's one of the newest and best techniques for imaging these patients because it has very, very high resolution, it has a lower radiation dose, it has allowed us to find leaks that we were not able to find before. And there are other high-resolution modalities that are emerging and becoming more accessible to things like cone beam CT which we do in addition to digital subtraction myelography. And on top of that, we've started to use AI-based tools to make images look a lot better. So, there are various AI algorithms that have come out that allow us to remove artifacts from imaging. They help us image patients with a bigger body habitus better without running into a lot of imaging artifacts. They help us reduce noise in imaging. They can just give us better-quality images and aid us in the diagnosis. For me as a radiologist, those are some of the most exciting things. We're finding less invasive ways with less radiation to better diagnose these patients with just better-quality imaging. Dr Grouse:  Well, that is definitely something to be excited about. So, I just want to thank you so much for talking with us today. It's been such an interesting, informative discussion and a real privilege to talk with you about this important topic. Dr Madhavan:  Yeah, thanks so much. I really appreciate the time to talk with you, and I look forward to seeing the article out there and hopefully getting some interesting questions. Dr Grouse:  Again, today I've been interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chasen. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Three Ideas to Bring Your Mind to the Concept That You Have a Magic Lamp in Your Mind Imagine a magic lamp in your mind, like the Genie who grants you three wishes. These wishes can help you: Create your own economy. Chase and achieve your dreams. Bring fun back into your life and spice it up with serendipity.   Action Steps Write it down: Use a notebook, journal, or any physical writing apparatus (avoid typing on PDAs). Write out your: Dreams Ideas of fun Ways to incorporate serendipity into your life. Create visual inspiration: Make vision boards or a photo book. Collect images from: Magazines Websites Your own photos Include: Fun ideas Your dreams Spontaneous activities like baseball games, swimming holes, sailing, hiking nearby, etc. Act the part: Pretend you already have the goal. Take small steps every day to train your mind that your dream is real and on its way. Example: If your dream is to buy a house: Start visiting open houses. Talk to real estate agents about: PMI Closing costs You don't need to share your financial situation—just let them know you plan to buy in a specific neighborhood.     PROSPERITY and ABUNDANCE KRIYA KUNDALINI YOGA : FEEL YOUR ABUNDANCE. KID FRIENDLY YOGA!  Remember to use an orange https://youtu.be/jRegtSKAZDI?si=wAKsXcr8BKTqCXkJ   Fine Wine & Spirits TEQUILLA for sipping NOT margaritas Typical flavors of Tequilla for food pairing: Blanco - unaged or slightly, in neutral oak.  Pair with fish, cheese, light meals such as shrimp salad.  Reposado means rested - it is aged in barrels from a few months to two years.. pair with Mexican food..easy. Anejo- smokey and smooth- grilled meats on the barbeque.. portabello mushrooms, corn on the cob.. big flavors so barbeque flavors are the perfect match. A rare fine Tequilla is available from Zacatecas, Casa Endemica. Organic and Sustainable farmed.    FURTHER RESOURCES: Dan Ison VNS : (YOUR) VERY NEXT STEP Dan Ison financialguardiandan@gmail.com Tequila Exhibit Branigan Cultural Center exhibit: Alienate a Tequila https://lascruces.gov/arts-and-leisure/museums/branigan-cultural-center/ Collier, Robert: The MASTER CODE to ABUNDANCE and ACHIEVEMENT   CONTACT Valerie Hail valerie@allinourminds.com www.allinourminds.com                    

In this spontaneous SPC episode, we dive deep into a wide-ranging conversation filled with mind-bending ideas and paranormal intrigue. These special episodes are where we unload everything we've been exploring lately—when there's too much to talk about for just one topic.We discuss Hemi-Sync meditations, the strange intersections of quantum mechanics and consciousness, and the ongoing evolution of Isaac's unique abilities, including his latest experiments with energy manipulation.From personal meditation breakthroughs to wild theories in quantum physics, this episode also features compelling stories about alien encounters, skinwalkers, and other unexplained phenomena that continue to challenge what we think we know.Whether you're here for the science, the supernatural, or the strange, Episode 8 offers a raw, unscripted look into the many realms we've been exploring.Topics Of EpisodeHere's a list of places and topics discussed in the episode:Hemi-sync meditation experiencesParanormal investigation at the parkEnergy manipulation and healing experimentsQuantum physics and multiverse theoriesSensory deprivation meditation techniquePast life regressionAlien encounter story Skin walker legend in AfghanistanSpiritual awakening experiencesBlack and white hole energy conceptParanormal conventions and dreamsSwamp and water-related visionsAlligator storiesUpcoming podcast interviewsPersonal paranormal abilities developmentLovin' the intro and outro music?"Swamp Witch”Our other intro Music: "Stacy Dahl" by MaudlinWant to hear more from Maudlin? Check them out on social media!Tik Tok: @maudlinInstagram: @maudlinListen on Spotify and YouTube!Have a paranormal experience to share? Reach out to us! Send us a message on social media, fill out our contact form, or shoot us an email (Hiddenintheshadowspodcast@gmail.com)Get ready for more spooky content coming soon! Follow us for updates. Hosted on Acast. See acast.com/privacy for more information.

Do you find yourself starting multiple projects or even businesses at the same time? Do you like and need variety in your day to day activities, do you experience ups and downs in your inspiration and ability to take action?In today's 20 min mini episode, I'm sharing more about what it means to have spontaneity vs rationality built into your nature.Understanding yourself is so key for architecting your own dream work as well as to loving and accepting yourself.If you enjoyed this episode, please share it with someone else, it really helps to support the podcast and allows more people to find it.And Happy June!Xo,Baiba