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Welcome or welcome back to Authentically ADHD, the podcast where we embrace the chaos and magic of the ADHD brain. Im carmen and today we're diving into a topic that's as complex as my filing system (which is to say, very): ADHD and its common co-occurring mood and learning disorders. Fasten your seatbelts (and if you're like me, try not to get distracted by the shiny window view) – we're talking anxiety, depression, OCD, dyslexia, dyscalculia, and bipolar disorder, all hanging out with ADHD.Why cover this? Because ADHD rarely rides solo. In fact, research compiled by Dr. Russell Barkley finds that over 80% of children and adults with ADHD have at least one other psychiatric disorder, and more than half have two or more coexisting conditions. Two-thirds of folks with ADHD have at least one coexisting condition, and often the classic ADHD symptoms (you know, fidgeting, daydreaming, “Did I leave the stove on?” moments) can overshadow those other disorders. It's like ADHD is the friend who talks so loud at the party that you don't notice the quieter buddies (like anxiety or dyslexia) tagging along in the background.But we're going to notice them today. With a blend of humor, sass, and solid neuroscience (yes, we can be funny and scientific – ask me how I know!), we'll explore how each of these conditions shows up alongside ADHD. We'll talk about how they can be misdiagnosed or missed entirely, and—most importantly—we'll dish out strategies to tell them apart and tackle both. Knowledge is power and self-awareness is the key, especially when it comes to untangling ADHD's web of quirks and comrades in chaos. So, let's get into it!ADHD and Anxiety: Double Trouble in OverdriveLet's start with anxiety, ADHD's frequent (and frantic) companion. Ever had your brain ping-pong between “I can't focus on this work” and “I'm so worried I'll mess it up”? That's ADHD and anxiety playing tango in your head. It's a double whammy: ADHD makes it hard to concentrate, and anxiety cranks up the worry about consequences. As one study notes, about 2 in 5 children with ADHD have significant problems with anxiety, and over half of adults with ADHD do as well. In other words, if you have ADHD and feel like a nervous wreck half the time, you're not alone – you're in very good (and jittery) company.ADHD and anxiety can look a lot alike on the surface. Both can make you restless, unfocused, and irritable. I mean, is it ADHD distractibility or am I just too busy worrying about everything to pay attention? (Hint: it can be both.) Especially for women, ADHD is often overlooked and mislabeled as anxiety. Picture a girl who can't concentrate in class: if she's constantly daydreaming and fidgety, one teacher calls it ADHD. Another sees a quiet, overwhelmed student and calls it anxiety. Same behavior, different labels. Women in particular have had their ADHD misdiagnosed as anxiety or mood issues for years, partly because anxious females tend to internalize symptoms (less hyperactive, more “worrier”), and that masks the ADHD beneath.So how do we tell ADHD and anxiety apart? One clue is where the distraction comes from. ADHD is like having 100 TV channels in your brain and someone else is holding the remote – your attention just flips on its own. Anxiety, on the other hand, is like one channel stuck on a horror movie; you can't focus on other things because a worry (or ten) is running on repeat. An adult with ADHD might forget a work deadline because, well, ADHD. An adult with anxiety might miss the deadline because they were paralyzed worrying about being perfect. Both end up missing the deadline (relatable – ask me how I know), but for different reasons.Neuroscience is starting to unravel this knot. There's evidence of a genetic link between ADHD and anxiety – the two often run in the family together. In brain studies, both conditions involve irregularities in the prefrontal cortex (the brain's command center for focus and planning) and the limbic system (emotion center). Essentially, if your brain were a car, ADHD means the brakes (inhibition) are a bit loose, and anxiety means the alarm system is hyper-sensitive. Combine loose brakes with a blaring alarm and you get… well, us. Fun times, right?Here's an interesting tidbit: Females with ADHD are more likely to report anxiety than males. Some experts think this is partly due to underdiagnosed ADHD – many girls grew up being told they were just “worrywarts” when in fact ADHD was lurking underneath, making everyday life more overwhelming and thus feeding anxiety. As Dr. Thomas Brown (a top ADHD expert) points out, emotional regulation difficulties (like chronic stress or worry) are characteristic of ADHD, even though they're not in the official DSM checklist. Our ADHD brains can amplify emotions – so a normal worry for someone else becomes a five-alarm fire for us.Now, action time: How do we manage this dynamic duo? The first step is getting the right diagnosis. A clinician should untangle whether symptoms like trouble concentrating are from anxiety, ADHD, or both. They might ask: Have you always had concentration issues (pointing to ADHD), or did they start when your anxiety kicked into high gear? Also, consider context – ADHD symptoms occur in most settings (school, work, home), while pure anxiety might spike in specific situations (say, social anxiety in crowds, or panic attacks only under stress).Treatment has to tackle both. Therapy – especially Cognitive Behavioral Therapy (CBT) – is a rockstar here. CBT can teach you skills to manage worry (hello, deep breathing and logical rebuttals to “what if” thoughts) and also help with ADHD organization hacks (like breaking tasks down, creating routines). Many find that medication is needed for one or both conditions. Stimulant meds (like methylphenidate or amphetamines) treat ADHD, but in someone with severe anxiety, a stimulant alone can sometimes ramp up the jitters. In fact, children (and adults) with ADHD + anxiety often don't respond as well to ADHD meds unless the anxiety is also addressed. Doctors might add an SSRI or other anti-anxiety medication to the mix, or choose a non-stimulant ADHD med if stimulants prove too anxiety-provoking.Let me share a quick personal strategy (with a dash of humor): I have ADHD and anxiety, so my brain is basically an internet browser with 50 tabs open – and 10 of them are frozen on a spinning “wheel of doom” (those are the anxieties). One practical tip that helps me distinguish the two is to write down my racing thoughts. If I see worries like “I'll probably get fired for sending that email typo” dominating the page, I know anxiety is flaring. If the page is blank because I got distracted after one sentence... well, hello ADHD! This silly little exercise helps me decide: do I need to do some calming techniques, or do I need to buckle down and use an ADHD strategy like the Pomodoro method? Try it out: Knowledge is power, and self-awareness is the key.Quick Tips – ADHD vs Anxiety: When in doubt, ask what's driving the chaos.* Content of Thoughts: Racing mind full of specific worries (anxiety) vs. racing mind full of everything except what you want to focus on (ADHD).* Physical Symptoms: Anxiety often brings friends like sweaty palms, racing heart, and tummy trouble. ADHD's restlessness isn't usually accompanied by fear, just boredom or impulsivity.* Treatment Approaches: For co-occurring cases, consider therapy and possibly a combo of medications. Experts often treat the most impairing symptom first – if panic attacks keep you homebound, address that alongside ADHD. Conversely, untreated ADHD can actually fuel anxiety (ever notice how missing deadlines and forgetfulness make you more anxious? Ask me how I know!). A balanced plan might be, say, stimulant medication + talk therapy for anxiety, or an SSRI combined with ADHD coaching. Work closely with a professional to fine-tune this.Alright, take a breath (seriously, if you've been holding it – breathing is good!). We've tackled anxiety; now let's talk about the dark cloud that can sometimes follow ADHD: depression.ADHD and Depression: When the Chaos Brings a CloudADHD is often associated with being energetic, spontaneous, even optimistic (“Sure, I can start a new project at 2 AM!”). So why do so many of us also struggle with depression? The reality is, living with unmanaged ADHD can be tough. Imagine years of what Dr. Russell Barkley calls “developmental delay” in executive function – always feeling one step behind in managing life, despite trying so hard. It's no surprise that about 1 in 5 kids with ADHD also has a diagnosable depression, and studies show anywhere from 8% to 55% of adults with ADHD have experienced a depressive disorder in their lifetime. (Yes, that range is huge – it depends how you define “depression” – but even on the low end it's a lot.) Dr. Barkley himself notes that roughly 25% of people with ADHD will develop significant depression by adulthood. In short, ADHD can come with a case of the blues (not the fun rhythm-and-blues kind, unfortunately).So what does ADHD + depression look like? Picture this: You've got a pile of unfinished projects, bills, laundry – the ADHD “trail of crumbs.” Initially, you shrug it off or maybe crack a joke (“organizational skills, who's she?”). But over time, the failures and frustrations can chip away at your self-esteem. You start feeling helpless or hopeless: “Why bother trying if I'm just going to screw it up or forget again?” That right there is the voice of depression sneaking in. ADHD's impulsivity might also lead to regrettable decisions or conflicts that you later brood over, another pathway to depressed mood.In fact, the Attention Deficit Disorder Association points out that ADHD's impact on our lives – trouble with self-esteem, work or school difficulties, and strained relationships – can contribute to depression. It's like a one-two punch: ADHD creates problems; those problems make you sad or defeated, which then makes it even harder to deal with ADHD. Fun cycle, huh?Now, depression itself can mask as ADHD in some cases, especially in adults. Poor concentration, low motivation, fatigue, social withdrawal – these can appear in major depression and look a lot like ADHD symptoms. If an adult walks into a doctor's office saying “I can't focus and I'm procrastinating a ton,” a cursory eval might yield an ADHD diagnosis. But if that focus problem started only after they, say, lost a loved one or fell into a deep funk, and they also feel worthless or have big sleep/appetite changes, depression may be the primary culprit. On the flip side, a person with lifelong ADHD might be misdiagnosed as just depressed, because they seem down or overwhelmed. As always, timeline is key: ADHD usually starts early (childhood), whereas depression often has a more defined onset. Also, ask: Is the inability to focus present even when life's going okay? If yes, ADHD is likely in the mix. If the focus issues wax and wane with mood, depression might be the driver.There's also a nuance: ADHD mood issues vs. clinical depression. People with ADHD can have intense emotions and feel demoralized after a bad day, but often these feelings can lift if something positive happens (say, an exciting new interest appears – suddenly we have energy!). Clinical depression is more persistent – even good news might not cheer you up much. As Dr. Thomas Brown emphasizes, ADHD includes difficulty regulating emotion; an ADHD-er might feel sudden anger or sadness that's intense but then dissipates . By contrast, depression is a consistent low mood or loss of pleasure in things over weeks or months. Knowing this difference can be huge in sorting out what's going on.Now, how do we deal with this combo? The good news: many treatments for depression also help ADHD and vice versa. Therapy is a prime example. Cognitive Behavioral Therapy and related approaches can address negative thought patterns (“I'm just a failure”) and also help with practical skills for ADHD (like scheduling, or as I call it, tricking my brain into doing stuff on time). There are even specialized therapies for adults with ADHD that blend mood and attention strategies. On the medication front, sometimes a single med can pull double duty. One interesting option is bupropion (Wellbutrin) – an antidepressant that affects dopamine and norepinephrine, which can improve both depression and ADHD symptoms in some people. There's also evidence that stimulant medications plus an antidepressant can be a powerful combo: stimulants to improve concentration and energy, antidepressant to lift mood. Psychiatrists will tailor this to the individual – for instance, if someone is severely depressed (can't get out of bed), treating depression first may be priority. If the depression seems secondary to ADHD struggles, improving the ADHD could automatically boost mood. Often, it's a balancing act of treating both concurrently – maybe starting an antidepressant and an ADHD med around the same time, or ensuring therapy covers both bases.Let's not forget lifestyle: exercise, sleep, nutrition – these affect both ADHD and mood. Regular exercise, for example, can increase BDNF (a brain growth factor) and neurotransmitters that help both attention and mood. Personally, I found that when I (finally) started a simple exercise routine, my mood swings evened out a bit and my brain felt a tad less foggy. (Of course, starting that routine required overcoming my ADHD inertia – ask me how I know that took a few tries... or twenty.)Quick Tips – ADHD vs Depression:* Check Your Joy Meter: With ADHD alone, you can still feel happy/excited when something engaging happens (ADHD folks light up for interesting tasks!). With depression, even things you normally love barely register. If your favorite hobbies no longer spark any joy, that's a red flag for depression.* All in Your Head? ADHD negative thoughts sound like “Ugh, I forgot again, I need a better system.” Depression thoughts sound like “I forgot again because I'm useless and nothing will ever change.” Listen to that self-talk; depression is a sneaky bully.* Professional Help: A thorough evaluation can include psychological tests or questionnaires to measure attention and mood separately. For treatment, consider a combined approach: therapy (like CBT or coaching) plus meds as needed. According to research, a mix of stimulant medication and therapy (especially CBT) can help treat both conditions. And remember, addressing one can often relieve the other: improve your ADHD coping skills, and you might start seeing hope instead of disappointment (boosting mood); treat your depression, and suddenly you have the energy to tackle that ADHD to-do list.Before we move on, one more important note: if you ever have thoughts of self-harm or suicide, please reach out to a professional immediately. Depression is serious, and when compounded with ADHD impulsivity, it can be dangerous. There is help, and you're not alone – so many of us have been in that dark place, and it can get better with the right support. Knowledge is power and self-awareness is the key, yes, but sometimes you also need a good therapist, maybe a support group, and possibly medication to truly turn things around. There's no shame in that game.Alright, deep breath. It's getting a bit heavy in here, so let's pivot to something different: a condition that seems like the opposite of ADHD in some ways, yet can co-occur – OCD. And don't worry, we'll crank the sass back up a notch.ADHD and OCD: The Odd Couple of AttentionWhen you think of Obsessive-Compulsive Disorder (OCD), you might picture someone extremely organized, checking the stove 10 times, everything neat and controlled. When you think ADHD… well, “organized” isn't the first word that comes to mind, right?

Jacoby Landry, the new owner of Lafayette's oldest indoor shopping center, Northgate Mall, shares his vision to bring hope, commerce, and fresh energy to North Lafayette. Jacoby's energy and can-do attitude is a beacon of light for a community waiting to see how he will transform the mall into "The Hub." Jacoby, owner of JL Construction and Pont Breaux Plaza in Breaux Bridge, is the first local owner of Northgate Mall in years. Originally developed by Isan Fontenot, Dr. Daniel Voorheis and Joseph Angelle who opened it in August 1969, Jacoby paid $2.8 million for the property. His journey started under the wing of his grandfather, a framer, and his father, who ran dirt construction, trucking businesses, and in the oil field industry. “My entrepreneurial skills came from my dad. He's always been a business owner.” After studying engineering at UL Lafayette, Jacoby discovered his love for business and numbers, opening a tax office in his early twenties. Real estate soon became his passion, with his first major commercial property purchased from cousin Dominick Williams (formerly Dominick Davis of LSU and the Houston Texans). “There's nothing that I didn't try,” Jacoby shared, reflecting on his entrepreneurial spirit. In 2016, Jacoby earned his residential contractor's license, followed by obtaining his commercial license a year later. “I went from building custom homes to developing my own lots and building spec homes and selling them.” His interest in North Lafayette grew when he purchased seven acres on Louisiana Avenue at Butcher Switch Road in 2020 with plans for a med spa and gym. Facing zoning challenges, Jacoby joined LEDA's Elevate North Lafayette program, where he connected with Monte Anderson, a Dallas-based developer. Monte's advice led Jacoby to consider revitalizing existing properties, prompting Jacoby to set his sights on Northgate Mall. "I was always infatuated with the I-10 and I-49 crossing. I just always had it in my mind that it (development) was going to come to the North one day." “Before I started the program, I had goals of doing something bigger, but they really pushed me to actually go do it. They gave me the courage and knowledge to do it.” Once Jacoby walked the property, he couldn't sleep at night thinking about its potential. “Ever since the day I walked on the property, I couldn't sleep at night, thinking about it. I think I want to do it.” Despite initial nerves, Jacoby embraced the risk, saying, “I'm a risk taker. I could do this.” Jacoby Landry at the Northgate Mall in June 2025. Photo by Brad Kemp, Acadiana Advocate. Jacoby is rebranding Northgate Mall as “The Hub,” inspired by Lafayette's nickname, Hub City, and the I-10/I-49 cloverleaf, which will be reflected in its new logo. The redevelopment will focus on mixed-use commerce, green spaces, and lighting to ensure safety and create a welcoming atmosphere. “I want to change the whole theme of the mall. I want to have trees, green space, make it nice, have a lot of lighting and make it feel safe.” Contrary to negative perceptions, Jacoby says, “Statistically, there's no crime at the mall. There's more crime in other places. The mall's been dead for so long, there's nothing to steal.” Jacoby's vision includes a grocery store, children's entertainment options, and a health club and spa in the former Planet Fitness space in partnership with his sister, Rachel McCorvey of BeLuxxe Health and Wellness Center. “Our whole motto is to add ten years to your life.” The facility will feature a nutritionist, weight management services, Botox, IV drips, sauna, hot tub, salt room, cold plunge, a health bar, and two indoor pickleball courts. Pilates and boxing fitness will also be offered, bringing Red's Health Club-like amenities to North Lafayette on a smaller, community-focused scale. Jacoby emphasized his commitment to supporting current tenants, saying, “They've been a blessing… I came to introduce myself to ...

12 core reasons why you can trust that the Bible is God'sWord to us. Do you know these 12? Memorize these because you can use them toshare the gospel with unbelievers and doubters. Reason #6 of 12.here are bullet points on why the fulfillment of over 300 prophecies by Jesus is so powerful:Statistically impossible: The odds of one person fulfilling even a handful of specific ancient prophecies is astronomical, let alone 300+.Written centuries before: These prophecies were recorded hundreds of years before Jesus was born, proving they weren't staged after the fact.Details impossible to control: Many prophecies (like His birthplace, manner of death, betrayal price) were beyond Jesus's human control.Confirms divine plan: Shows God's sovereignty in orchestrating history to point to the Messiah.Strengthens faith: Fulfilling so many specific predictions validates that Jesus is truly the promised Savior.

Attention: The first clinical trial testing creatine for Alzheimer's just dropped, and the results are absolutely mind-blowing. In this episode, I've sat down with Max Lugavere at The White House to discuss the new research on creatine. This pilot study gave 20 Alzheimer's patients 20 grams of creatine daily for 8 weeks. The results? Statistically significant improvements across nearly every cognitive measurement.  Join the Ultimate Human VIP community and gain exclusive access to Gary Brecka's proven wellness protocols today!: https://bit.ly/4ai0Xwg Get Max Lugavere book, “Genius Foods”: https://theultimatehuman.com/book-recs Want to dive deeper into brain health? Watch Max's documentary "Little Empty Boxes" here: https://bit.ly/47Qf8Y9 Listen to Max Lugavere's "The Genius Life" podcast weekly on all your favorite platforms: https://bit.ly/47MyoWK Connect with Max Lugavere: Website: https://bit.ly/3XLOGdN YouTube: https://bit.ly/4eJc6r7 Instagram: https://bit.ly/3BsEf7y Facebook: https://bit.ly/3Y4QkZr TikTok: https://bit.ly/3Y8ov2w X.com: https://bit.ly/3ZMQgPk LinkedIn: https://bit.ly/4eGVrEw Thank you to our partners: H2TABS - USE CODE “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg BODYHEALTH - USE CODE “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV BAJA GOLD - USE CODE "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa EIGHT SLEEP - SAVE $350 ON THE POD 4 ULTRA WITH CODE “GARY”: https://bit.ly/3WkLd6E COLD LIFE - THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp WHOOP - GET 1 FREE MONTH WHEN YOU JOIN!: https://bit.ly/3VQ0nzW MASA CHIPS - GET 20% OFF YOUR FIRST ORDER: https://bit.ly/40LVY4y VANDY - USE CODE “ULTIMATE20” FOR 20% OFF: https://bit.ly/49Qr7WE AION - USE CODE “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD HAPBEE - FEEL BETTER & PERFORM AT YOUR BEST: https://bit.ly/4a6glfo CARAWAY - USE CODE “ULTIMATE” FOR 10% OFF: https://bit.ly/3Q1VmkC HEALF - GET 10% OFF YOUR ORDER: https://bit.ly/41HJg6S BIOPTIMIZERS - USE CODE “ULTIMATE” FOR 10% OFF: https://bit.ly/4inFfd7 RHO NUTRITION - USE CODE “ULTIMATE15” FOR 15% OFF: https://bit.ly/44fFza0 GENETIC TEST: ⁠https://bit.ly/3Yg1Uk9 Watch  the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka: Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8fo X.com: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps: 00:00 Intro 01:30 Getting Back to the Basics 02:17 Clinical Trial on Creatine  05:57 Impact of Creatine on Health 11:26 Spreading Awareness on Positive Healthcare Choices The Ultimate Human with Gary Brecka Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The Content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions. Learn more about your ad choices. Visit megaphone.fm/adchoices

We've got plenty to catch up on this week — from the Pan American Championships and Asian Championships to college gymnastics news. It's been a while, and we're long overdue for a sit-down. But before we dive into all that, we've got another interview lined up! We're excited to continue our Recruit Reflection series with UNC standout JoJo Valahovic, who just wrapped up her freshman season with the Tar Heels as the ACC Newcomer of the Year. In many ways, JoJo was a breakout star this season. Statistically, she was the team MVP on vault and beam in total points contributed — and she was only a freshman! JoJo joins us to talk about her recruiting journey and what led her to UNC! Thank you to our monthly Patreon supporters: Lee B, Cookiemaster, Christa, Happy Girl, Erica S, Semflam, Amy C, Maria L, Becca S, Cathleen R, Faith, Kerry M, M, Derek H, Martin, Sharon B, Randee B, MSU, Kimberly G, Robert H, Lela M, Mara L, Jenna A, Alex M, Mama T, Kelsey, Lidia, Maria P, Alicia O, Cristina K, Bethany J, Diane J, Kentiemac, Marni S, Betny T, Emily C, Cathy D, Lisa T, Libby C, Thiago, Taryn M, Dana B, Jamie S, Chuck C, Je_GL, Kaitlin, Susan P, Katertot, Mallory D, LFC_Hokie, Ella, Debbie, Megan F, Kay, Diane J, Julie B,, Austin K, Jane, Sarah, Amy, Stephen S, Johanna T, Alison S, Kristina T, Abigail W, Becky, Ola S, Jennifer K, Kate M, Naomi S, Claudia, Siona, Erin L, Sarah A, Kennedy B, Thomas B, Lauren D, Kihika N, Beth C, Amy, Renee PM, Ryan V, Brandon H, Tyler, Hayley B, Ben S, Kate & Landon, Danielle, ALittleUnderRotated, Dana C, Amy C, Grace, Pat G , Lexi G, Laura N, Kathy, Katie A, Ruby B, Katie E, Róisín, Becca, Megan J, Emily D, Britton, Ry Shep, Reyna G, Catherine, William A, MB, MJ L, Jackson G, Brittany A, Stella, Ulo F, Noah C, Melissa H, Alexis, William M, Trish, Susie, Leslie G, Catherine B, Karlin, Laura L, Katy S, J'nia G, Kathy M, Kathy S, Okcaro, Caroline P, JD B, Cookiecutter, Ailish D, Wil D & BC

0:00 - With the Panthers winning the Stanley Cup last night, Canada's cup drought continues. They haven't brought Lord Stanley north of the border since 1993. That's WILD. Statistically, that seems pretty improbable.14:08 - Every year after the Stanley Cup Finals wrap up, players on both teams rattle off a laundry list of injuries they've been playing with. It's always way more guys than you'd expect playing through worse injuries than you'd expect. Matthew Tkachuk wins the Grit award this year.33:03 - Broncos chose to bolster their defense this offseason more so than their offense. But there's a method to Sean Payton's madness.

Austin shares how you can statistically guarantee that you get a job offer with the “Funnel Technique”!Time Stamped Show Notes:[0:20] - A guaranteed job offer?[2:11] - Map out your job search process & track it[3:20] - Assign success rates & reverse engineer your funnel[5:36] - Gather data & OptimizeWant To Level Up Your Job Search?Click here to learn more about 1:1 career coaching to help you land your dream job without applying online.Check out Austin's courses and, as a thank you for listening to the show, use the code PODCAST to get 5% off any digital course:The Interview Preparation System - Austin's proven, all-in-one process for turning your next job interview into a job offer.Value Validation Project Starter Kit - Everything you need to create a job-winning VVP that will blow hiring managers away and set you apart from the competition.No Experience, No Problem - Austin's proven framework for building the skills and experience you need to break into a new industry (even if you have *zero* experience right now).Try Austin's Job Search ToolsResyBuild.io - Build a beautiful, job-winning resume in minutes.ResyMatch.io - Score your resume vs. your target job description and get feedback.ResyBullet.io - Learn how to write attention grabbing resume bullets.Mailscoop.io - Find anyone's professional email in seconds.Connect with Austin for daily job search content:Cultivated CultureLinkedInTwitterThanks for listening!

Trevor, Hunter, and Konner keep you up to date on everything going on in disc golf! Subscribe ► https://youtube.com/@GripLocked?sub_confirmation=1 Check out the Store: http://foundationdiscs.com Patreon: http://patreon.com/foundationdiscgolf Foundation Disc Golf: http://youtube.com/foundationdiscgolf 0:00 - Intro 3:30 - Preserve Recap 34:41 - Trevor's Trivia 44:05 - Manufacturer's Cup 46:40 - Pick Em vs Tour Life 52:50 - Top 10 57:06 - Silas Selects

My conversation with Matthew Walker, PhD on faculty at UC Berkeley where he is a professor of neuroscience and psychology, the founder and director of the Center for Human Sleep Science, and has a long history of seminal contributions on sleep science and health. Audio File (also downloadable at Apple Podcast and Spotify)“Sleep is a non-negotiablebiological state required for the maintenance of human life . . . our needsfor sleep parallel those for air, food, and water.”—Grandner and FernandezEric Topol (00:07):Hello, it's Eric Topol with Ground Truths, and I am really delighted to welcome Matt Walker, who I believe has had more impact on sleep health than anyone I know. It's reflected by the fact that he is a Professor at UC Berkeley, heads up the center that he originated for Human Sleep Science. He wrote a remarkable book back in 2017, Why We Sleep, and also we'll link to that as well as the TED Talk of 2019. Sleep is Your Superpower with 24 million views. That's a lot of views here.Matt Walker:Striking, isn't it?Eric Topol:Wow. I think does reflect the kind of impact, you were onto the sleep story sooner, earlier than anyone I know. And what I wanted to do today was get to the updates because you taught us a lot back then and a lot of things have been happening in these years since. You're on it, of course, I think you have a podcast Sleep Diplomat, and you're obviously continued working on the science of sleep. But maybe the first thing I'd ask you about is in the last few years, what do you think has been, are there been any real changes or breakthroughs in the field?What Is New?Matt Walker (01:27):Yeah, I think there has been changes, and maybe we'll speak about one of them, which is the emergence of this brain cleansing system called the glymphatic system, but spreading that aside for potential future discussion. I would say that there are maybe at least two fascinating areas. The first is the broader impact of sleep on much more complex human social interactions. We think of sleep at maybe the level of the cell or systems or whole scale biology or even the entire organism. We forget that a lack of sleep, or at least the evidence suggests a lack of sleep will dislocate each other, one from the other. And there's been some great work by Dr. Eti Ben Simon for example, demonstrating that when you are sleep deprived, you become more asocial. So you basically become socially repellent. You want to withdraw, you become lonely. And what's also fascinating is that other people, even they don't know that you sleep deprived, they rate you as being less socially sort of attractive to engage with.Matt Walker (02:35):And after interacting with you, the sleep deprived individual, even though they don't know you're sleep deprived, they themselves walk away feeling more lonely themselves. So there is a social loneliness contagion that happens that a sleep deprived lonely individual can have almost a viral knock on effect that causes loneliness in another well-rested individual. And then that work spanned out and it started to demonstrate that another impact of a lack of sleep socially is that we stop wanting to help other people. And you think, well, helping behavior that's not really very impactful. Try to tell me of any major civilization that has not risen up through human cooperation and helping. There just isn't one. Human cooperative behavior is one of our innate traits as homo sapiens. And what they discovered is that when you are insufficiently slept, firstly, you don't wish to help other people. And you can see that at the individual level.Matt Walker (03:41):You can see it in groups. And then there was a great study again by Dr. Eti Ben Simon that demonstrated this at a national level because what she did was she looked at this wonderful manipulation of one hour of sleep that happens twice a year to 1.6 billion people. It's called daylight savings time at spring. Yeah, when you lose one hour of sleep opportunity. She looked at donations across the nation and sure enough, there was this big dent in donation giving in the sleepy Monday and Tuesday after the clock change. Because of that sleep, we become less willing to empathetically and selflessly help other individuals. And so, to me I think it's just a fascinating area. And then the other area I think is great, and I'm sorry I'm racing forward because I get so excited. But this work now looking at what we call genetic short sleepers and sort of idiots like me have been out there touting the importance of somewhere between seven to nine hours of sleep.Matt Walker (04:48):And once you get less than that, and we'll perhaps speak about that, you can see biological changes. But there is a subset of individuals who, and we've identified at least two different genes. One of them is what we call the DEC2 gene. And it seems to allow individuals to sleep about five hours, maybe even a little bit less and show no impairment whatsoever. Now we haven't tracked these individuals across the lifespan to truly understand does it lead to a higher mortality risk. But so far, they don't implode like you perhaps or I would do when you are limited to this anemic diet of five hours of sleep. They hang in there just fine. And I think philosophically what that tells me, and by the way, for people who are listening thinking, gosh, I think I'm probably one of those people. Statistically, I think you are more likely to be struck by lightning in your lifetime than you are to have the DEC2 gene. Think about what tells us, Eric. It tells us that there is a moment in biology in the evolution of this thing called the sleep physiological need that has changed such that mother nature has found a genetic way to ZIP file sleep.Matt Walker (06:14):You can essentially compress sleep from seven to nine hour need, down to five to six hour need. To me, that is absolutely fascinating. So now the race is on, what are the mechanisms that control this? How do we understand them? I'm sure much to my chagrin, society would like to then say, okay, is there a pill that I can take to basically ZIP file my own sleep and then it becomes an arms race in my mind, which is then all of a sudden six hours becomes the new eight hours and then everyone is saying, well, six hours is my need. Well I'll go to four hours and then it's this arms race of de-escalation of sleep. Anyway, I'm going on and on, does that help give you a sense of two of the what I feel the more fascinating areas?Eric Topol (07:01):Absolutely. When I saw the other recent report on the short sleep gene variant and thought about what the potential of that would be with respect to potential drug development or could you imagine genome editing early in life that you don't need any sleep? I mean crazy stuff.Matt Walker (07:19):It was amazing.Glymphatics and Deep Sleepfor more, see previous Ground Truths on this topic Eric Topol (07:22):No, the mechanism of course we have to work out and also what you mentioned regarding the social and the behavior engagement, all that sort of thing, it was just fascinating stuff. Now we touched on one thing early on to come back to the glymphatics these channels to get rid of the waste metabolites from the brain each night that might be considered toxic metabolites. We've learned a lot about those and of course there's some controversy about it. What are your thoughts?Matt Walker (07:55):Yeah, I think there's really quite comprehensive evidence suggesting that the brain has this cleansing system like the body has one the lymphatic system, the brain has one the glymphatic system named after these glial cells that make it up. And I think there's been evidence from multiple groups across multiple different species types, from mouse models all the way up to human models suggesting that there is a state dependent control of the brain cleansing system, which is a fancy way of saying if you are awake in light NREM, deep NREM or perhaps you're just quiet and you are resting in your wakefulness, the glymphatic system is not switched on at the same rate across all of those different brain states. And I think the overwhelming evidence so far using different techniques in different species from different groups is that sleep is a preferential time. It's not an exclusive time, it's a preferential time when that brain cleansing system kicks into gear because as some people have, I think argued, and you could say it's hyperbolic, but wakefulness is low level from a biochemicals perspective, it's low level brain damage and sleep is therefore your sanitary salvation that combat that biochemical cascade.Matt Walker (09:15):So in other words, a better way of putting it would be, sleep is the price that you pay for wakefulness in some ways. And I think there was a recent controversial study that came out in 2022 or 2023, and they actually suggested quite the opposite. They said using their specific imaging methods, they found that the sort of clearance, the amount of cerebral spinal fluid, which is what washes through the brain to cleanse the toxins, the rate of that flow of cerebral spinal fluid was highest during wakefulness and lowest during deep NREM sleep, the exact opposite of what others have found. Now, I think the defendants of the glymphatic sleep dependent hypothesis pushed back and said, well, if you look at the imaging methods. Firstly, they're nonstandard. Secondly, they were measuring the cerebral spinal flow in an artificial way because they were actually perfusing solutions through the brain rather than naturally letting it flow and therefore the artificial forcing of fluid changed the prototypical result you would get.Matt Walker (10:27):And they also argued that the essentially kind of the sampling rate, so how quickly are you taking snapshots of the cerebral spinal fluid flow. Those were different and they were probably missing some of the sleep dependent slow oscillations that seemed to sort of drive that pulsatile flow. Honestly, I think that paper was still very well done, and I still think there is right now, I would still cleave to the majority of overwhelming evidence considering it's not just from one group in one species, but across multiple species, multiple groups. And I think it's nevertheless a weight of burden that has pushed back. And my sense right now, I used to think and cleaves to the notion that it was a sleep expressly selective process. Now I don't think that that's the case anymore. I think that the glymphatic system is a dynamic system, but it's always looking for the opportunity to go into cleansing mode. And you can kind of go into almost like a low battery mode when you are awake, but in quiet rest. And I think that can drive some already early clearance from the brain and then when you go into sleep, it's like powering your phone off entirely. It truly gets the chance to cleanse and reboot the biochemical system. But I think it's really interesting. I think there's a lot of work still yet to be done. It's not quite as case closed as we used to think.Eric Topol (12:03):Yeah, I mean first of all, it's great that you straighten out the controversy because that's exactly what I was referring to. And secondly, as you also pointed out, the weight of the evidence is that it's a sleep dependent phenomena, particularly during flow wave deep sleep is at least what I've seen.Matt Walker (12:21):Yes.Eric Topol (12:22):What's also interesting, your point about it being dynamic, which fascinating, there was a paper in my field of cardiology, people with atrial fibrillation had less active glymphatic, less clearance which was really interesting. And then the other finding that's also noteworthy was that Ambien made things worse. What do you think about that?We Are An Embodied OrganismMatt Walker (12:45):I think it's really interesting, and just to come back to your point about the AFib paper, what we know is that this cleansing system in the brain does seem to track the big slow brainwaves of deep slow wave sleep, but it's not only tracking the big slow brainwaves. If anything, there's something to do with the cardiorespiratory cycle, the respiration rate and the cardiac signal that may actually sink with the brainwaves. And it's essentially a cardiorespiratory neurophysiological coupling, which is a lot of ways, which is to say heart, lungs and brain coupled together. And it's the coupling of the cardiorespiratory slow oscillations that drive these pulsatile fluid mechanical, it's literally a hydro mechanical, hydro meaning cerebral spinal fluid push and pull in and out of the system drawing those metabolites out. So ago, if you have a disrupted either cardiac or respiratory or neurophysiological signal, no wonder the glymphatic system isn't going to work as efficiently.Matt Walker (14:00):I think that's a beautiful demonstration of the hemineglect that people like me who study sleep largely from the neck upwards would miss. But if you think about sleep is not just for the brain, it's for the body and it's not just for the body, it's for the brain. And we're an embodied organism. We study the organism in silos, neurology, psychiatry, cardiology, respiratory, but they all interact. And so, I think what's lovely about your example is the reminder that if you don't study the body in this study of the glymphatic system, you could miss out a profound explanation that possibly accounts for the head scratching, I don't know why we're getting this result. So that's a long way to come back to it. But the same group that was the pioneer in the discovery of the glymphatic system led by Maiken Nedergaard at the University of Rochester.In SUPER AGERS, p. 57. SRI-sleep regulatory indexSleep MedicationsMatt Walker (15:01):She has gone on to then look to say, well, if this is a sleep dependent process of brain cleansing during deep sleep, what about sleeping pills because so many people are either taking or are addicted to sleeping pills. And we've gone through, we're in the era of web 3.0 with sleeping pills, we started off web 1.0 which were the benzos, the kind of temazepam, diazepam, lorazepam. Then we went to web 2.0, which was sort of the Ambien (zolpidem), Lunesta, Sonata. And what was common about those two classes of drugs is that they both went after something called the GABA receptor in the brain, which is this major inhibitory receptor in the brain. And essentially, they were called sedative hypnotics because they sedated your cortex. And when you take an Ambien and not going to argue you're awake. You're clearly not awake, but to argue you're a naturalistic sleep, if you look at this, physiology is an equal fallacy.Matt Walker (16:01):They made this interesting experimental hypothesis that when you take Ambien, you sleep longer and based on how you score deep sleep, it would seem as though Ambien increases the amount of minutes that you spend in deep sleep. But if you look at the electrical signature during that “increased deep sleep” it's not the same. Ambien takes a big bite. There's a big dent out of the very slowest of the slow brainwaves, and it's the slowest of the slow brainwaves that drive the glymphatic system. So what they found was that when you take Ambien or you give mice Ambien. Yes, they sleep longer, they seem to have more deep sleep, but the brain cleansing mechanism seem to be reduced by anywhere between 30-40%, which is counterintuitive. If you are sleeping more and you're getting more deep sleep and the glymphatic system is active during deep sleep, you should get greater cleansing of the brain.Matt Walker (17:05):Here they found, yes, the drug increased sleep, particularly deep sleep, but it empowered the cleansing of the brain system. Now, have we got evidence of that in humans yet? No, we don't. I don't think it's far away though, because there was a counter study that brings us onto web 3.0. There's a new class of sleep medications. It's the first class of medications that have actually been publicly advocating for, they're called the DORAs drugs, and they are a class of drugs and there's three of them that are FDA approved right now. DORA stands for dual orexin receptor antagonists, which means that these drugs go in there and they block the action of a chemical called orexin. What is orexin? Orexin is the volume button for wakefulness. It dials at wakefulness, but these drugs come into your system and unlike the sedative sort of baseball bat to the cortex, which is Ambien, these drugs are much more elegant.Matt Walker (18:11):They go down towards the brainstem and they just dial down the volume on wakefulness and then they step back, and they allow the antithesis of wakefulness to come in its place, which is this thing called naturalistic sleep. And people sleep longer. So as a scientist, you and I perhaps skeptics would then say, well, so you increase sleep, and I have four words for you. Yes, and so what. Just because you increase sleep, it doesn't mean that it's functional sleep. It could just be like the old notion of junk DNA, that it's epiphenomenal sleep. It's not functional sleep. There was a study out of WashU and they took 85-year olds and above and they gave them one of these DORAs drugs. It's a drug called Belsomra, it's a play on good sleep or beautiful sleep, chemical named suvorexant and randomized placebo control. What they found is that when they took the drug, yes, these older adults slept longer, they had more deep sleep, but then what they did was clever. Before and after the night of sleep, they drew blood because we can now measure markers of β-amyloid and tau protein circulating in the bloodstream, which are these two markers of Alzheimer's disease.Matt Walker (19:28):Why is that relevant to the glymphatic system? It's relevant because two of the pieces of metabolic detritus that the cleansing system washes away at night, β-amyloid and tau. I'm sure enough of what they found was that not only did the adults sleep longer with these sleeping medications, they also had a greater clearance of β-amyloid and tau within the bloodstream. So this was the exact opposite of the Ambien study, which was where they were seeing an impairment in the glymphatic activity. Here in humans was a study with the web 3.0 sleep medications. Suvorexant, not only did it increase sleep, but it seemed to increase. Well, the assumption was that it was increasing glymphatic clearance because at least as the end outcome product, there was greater clearance of β-amyloid and tau protein in the blood. It wasn't just junk sleep, it was functional sleep. So for the first time I'd seen a sleeping medication that increased sleep more naturalistically, but that increased sleep made you the organism function better the next day as a consequence. Does that make any sense?Eric Topol (20:38):Absolutely. And it's interesting that we may have a sleep medicine finally or a class that actually is doing what is desired. This is one of the other things I was going to ask you about is that as you pointed out, this is an interaction throughout the organism, throughout the human being, and we've seen studies about how sleep disrupts metabolism and through that of course, and even separately, can take down our immune system or disrupt that as well. And so, one of the questions I guess is your thoughts about these other effects because you mentioned of course the potential of looking at things like p-Tau217 markers or other markers that would denote the status of your ultimate risk for moving on to Alzheimer's disease. But there's these other factors that also play a role with lack of adequate sleep and perhaps particularly sleep quality. I wonder if you could just comment about this because there's so many different systems of the body that are integrated here, and so the sanitary effect that you just described with the ability to potentially see less, at least biomarkers for what would be considered risks to ultimately develop Alzheimer's, there's also these other very important effects when we talk about high quality sleep, I guess, right? And maybe you could comment about that.Matt Walker (22:21):Yeah, I think quantity is what we've been talking about in some ways, but quality has also come onto the radar as absolutely essential. And what we find is that the quality of your sleep is as if not more predictive of both all-cause mortality, cardiovascular mortality, metabolic mortality, and in some regards, cancer mortality as well. And when I say quality of sleep, what we're really referring to here is at least one of two things. One is the continuity of your sleep. So you could be sleeping for eight and a half hours according to your sleep tracker, but maybe you are getting eight and a half hours by spending ten hours of time in bed because you are awake so much throughout the night and your sleep is very sort of punctured and littered with all of these awakenings across the night. That's sufficient quantity of sleep eight and a half hours, but it's poor quality of sleep because you are spending too much time awake.Matt Walker (23:30):And so, our measure of quality of sleep typically is what we call sleep efficiency. Of the time that you are in bed, what percent of that time are you asleep? And we like to see some measure of at least 85% or above because once you get less than 85% in terms of your sleep quality or your sleep efficiency, then you start to see many of these unfolding system-wide impairments. You seem to have high risk of diabetes, high risk obesity, high risk, as we said, cardiovascular disease. Also, hormonal changes both in men and in women. We see upstairs in the brain with poor quality of sleep, much more so than quantity of sleep. Poor quality of sleep is a more powerful predictor of mood disturbances and psychiatric conditions. And in fact, I think if you look at the data, at least in my center in the past 23 years, we've not been able to discover a single psychiatric condition in which sleep is normal, which to me is a stunning revelation. And what that tells us is that in many of those conditions they do seem to be getting not too bad of quantity of sleep. What is the marker of psychiatric sleep disturbance is not short quantity, it's poor quality of sleep. So I think it's a wonderful important point that I don't think we pay enough attention to, which is the quality.Eric Topol (25:05):Yes. And the other thing that you've emphasized, and I just want to reiterate to people listening or watching that is the regularity story, just like you said with quality. The data and I'll put the figure in that shows the link between regularity and cardiovascular, neurodegenerative, cancer, that regularity thing. A lot of people don't understand how important that is as well.Matt Walker (25:30):Stunning study from data from the UK Biobank, and this is across thousands and thousands of individuals and they tracked quantity and they tracked regularity and they split people up into the quartiles, those who were most regular and those who were least regular. And as you'll see in those sort of the figure that you flash up, those people who were in the upper quartile of regularity, de-risk all-cause mortality, cancer mortality, cardiovascular mortality, it was stunning. And then they did a cute little experiment of a statistical test where they took quantity because they had it in these individuals and regularity and they kind of put them in the same statistical bucket and did a sort of a Coke Pepsi challenge to see which one won out. And what it seemed to be was that regularity almost beat out quantity in terms of predicting all-cause mortality. Now that's not to say that you can get away with saying, well, I sleep four hours a night, but I sleep very regularly, consistently four hours a night. No, you need both, but regularity. I was someone who based on my remarkably vanilla and pedestrian personality, I've always been quite regular in my regard. But goodness me, even when I read that paper, I thought I'm doubling down on regularity. It's so important. That tells us, I think something that is in some ways a story not about sleep. It's a story about your circadian rhythm.Matt Walker (27:02):We speak a lot, or I speak a lot about sleep, and I think I've probably done a mis service to the other aspect of the sleep wake rhythmicity, which is called your 24 hours circadian rhythm. Now your sleep pressure, the drive to sleep is independent of your circadian rhythm, but they often work beautifully in harmony with each other, and you fall asleep, and you stay asleep. But I think the circadian system is critical because, excuse me, and what the circadian rhythm also regulates, sneezing right at the inopportune moment when you are recording a podcast. But nevertheless, what that tells me is that when you feed your brain signals of wake sleep consistency, which is to say wake, sleep, timing, regularity, there is something about feeding the brain signals of regularity that anchor your 24-hour circadian rhythm and as a consequence, it improves the quantity and the quality of your sleep. They're intertwined.What About Sleep Trackers?Eric Topol (28:09):That's a terrific explanation for what I think a lot of people don't appreciate it's importance. Now, last topic about tracking. Now we understand how important sleep is. It is the superpower I am with you on that really brought that to light in so many ways. But of course, now we can track it with rings with smart watches and we get these readouts things like efficiency as part of the Oura score and other rings and deep sleep or NREM, REM, the works, you can see your awake times that you didn't know you're awake and the whole bit. Do you recommend for people that aren't getting great sleep quality beyond that they should try to establish a regular schedule that they should track to try to improve it and of course how would they improve it? Or are these things like having a cold mattress temperature that is controlled? What are the tricks that you would suggest for trying to improve your sleep through tracking? Or do you think tracking shouldn't be done?Matt Walker (29:16):Oh gosh, it's such a wonderful question and as with wonderful questions, the answer is usually it's complicated and I have to be careful because for someone who's currently wearing three different sleep trackers, it's going to be hard for me to answer this question completely in the negative. And there are three different sleep trackers. But I would say that for the most part, I like the idea of sleep tracking if you are sleeping well, meaning if as long as you're not suffering from insomnia. The reason is because sleep unlike those two other critical of health, which is diet and exercise, is very difficult to subjectively estimate. So if I were to ask you, Eric, how many times have you worked out in the past week, you'd be able to tell me how cleanly or how poorly have you been eating in the past week. You could tell me.Matt Walker (30:09):But if I was to say to you, Eric, how much deep sleep did you get last Tuesday? And if you don't have a sleep tracker, you'd say, I don't know. And so, there's something useful about tracking, especially a non-conscious process that I think is meaningful to many. And often medicine we say what gets measured gets managed, and there is that trite sort of statement. I do think that that's still true for sleep. So many people I've spoken to have, for example, markedly reduced the amount of alcohol consumption because they've been seeing the huge impact that the alcohol consumption in the evening has on their ring smart ring data as a consequence. So overall, I think they're pretty good. When people ask me what's the best sleep tracker, I usually say it's the one that you wear most frequently because if I come up with a band, headband, chest straps, all sorts of different things and it's a hundred percent accurate, but after three uses of it, you stop using it, that's a useless sleep tracker. So I like to think about sleep trackers that are low friction and no friction. When we go to sleep, we take things off, we don't put things on. That's why I liked things like the ring. For example, I think that's a non-intrusive way. I think the mattress may be as if not better because it's a completely friction less device. You don't have to remember to charge it. You don't have to put it on, you just fall into bed, and it tracks your sleep.Matt Walker (31:40):One form factor, I like to think about sleep trackers is the form factor itself. But then the other is accuracy. And I think right now if you look at the data, probably Oura is winning the ring kind of wars. If you look at all wristband wars, I think it's probably the most accurate relative to something like Fitbit or Apple Watch or the Whoop Band. But they're all pretty close. I think Oura is probably the leader in class right now at least. Keep in mind that I used to be an advisor for Oura. I want to make that very clear. So take what I say with a grain of salt in that regard. I think to your question, well, I'll come back to mattresses in just one second.Matt Walker (32:34):For people who are struggling with sleep, I think you've got to be very, very careful with sleep trackers because they can have the counterproductive effect where I gave you the example of alcohol or eating too late. And these sleep trackers help you modify your behaviors to improve your sleep. Well, there are places where these trackers can actually do you a disservice. When you get so hyper focused on your data and your data not looking good each and every day, it becomes a self-fulfilling prophecy of a negative spiral. And we now have a condition in sleep medicine called orthosomnia. So ortho in medicine typically means straightened. So you've heard of orthodontic straightening teeth, orthopedic straightening bones, orthosomnia is about getting so obsessed with getting your sleep perfect and your sleep straight that it causes an insomnia like syndrome. Now, I don't know, I think the press has made more of this than there is.Matt Walker (33:30):It probably is about 5-7% of the population. I would say at that moment in time, do one of two things. Either take the ring off entirely and just say, I'm going to get my sea legs back underneath me, get some cognitive behavioral therapy for insomnia. And when I'm confident I'll put the ring back on. Or don't throw the baby out with the bath water, keep wearing the ring. Try to say to yourself only on let's say a Sunday afternoon, will I open up the app and look historically what's been happening during the past week so that you keep getting your data, but you don't get the angiogenic daily sort of repetition of reinforcement of I'm not sleeping well. I should also note by the way that I think sleep trackers are not a substitute for either a sleep recording laboratory, but also, they're not a substitute for ultimately telling you entirely how good your sleep is.Matt Walker (34:24):Don't forget, you should always keep in mind how do I feel the next day? Because I think a lot of people will see their readiness score as 92 and they feel miserable. They just feel rough. And then another day, my readiness score was 62 and I just went out and I just ran my fastest five mile that I've done in the past six months. So don't forget that subjective sense of sleep is just as important as objective measures of sleep. The final thing I would say to your point about the mattresses, I actually do think that they are a really great vehicle for sleep augmentation because these smart mattresses, they're filled with sensors, things like Eight Sleep, and they will assess your physiology, they will track your sleep just like a sleep tracking ring. But what's also good is that because they can manipulate temperature and your sleep is so thermoregulatory sensitive that they create this kind, it's almost like this bent arc of thermal story throughout the night because you have to warm up at the surface to cool down at the core to fall asleep, then you have to stay cool to stay asleep, then you have to warm up to wake up and they take you through that natural change.Matt Walker (35:41):But they do it intelligently because they're measuring your sleep minute to minute. And then they're saying, I'm tweaking temperature a little bit. Has sleep improved? Has it become worse? Oh, it's become better. Let's lean into that. Let's get them even colder. Oh, wait a second, it's getting worse. Let's warm it back up a little bit. It's like a staircase method, like a Richter shock. And gradually they find your sweet spot and I think that is a really elegant system. And now they're measuring snoring. Snoring perturbations, and they can augment the bed and raise the angle of the bed up just a little bit so that the gravity doesn't have as much of a hold on your airway because when you're lying on your back, the airway wants to collapse down to gravity, and when you raise back up again, it will change that. And so, I think that there's lots of new advantages in, I think mattress technology that we'll see coming out into the future. I think it's a great vehicle for sleep augmentation.Eric Topol (36:37):That's terrific. Well, this has been for me, very educational, as I would've predicted, if anybody's up on everything in this area, it would be you. So thank you, Matt. It's a really brilliant discussion, really enlightening. We could talk some more hours, but I think we've encapsulated some of the big things. And before we finish up, is there anything else you wanted to say?Matt Walker (37:05):No, I think just to thank you for both your work in general in terms of science communication, your offer here specifically to allow me to try to be a very poorly communicated voice of sleep, and also just what you've done in general for I think the accuracy of science communication out into the public. Please never stop, continue to be a shining light for all of us. You are remarkable. Thank you, Eric.Eric Topol (37:31):Oh, you're very kind. And I look forward to the next chance we get to visit in person. It's been too long, Matt. And all the best to you. Thanks for joining today.************************************************A quick pollI cover much about sleep and healthy aging in SUPER AGERS, which has been on the NYT Bestseller list for 3 weeks. I'm very grateful to many of you for being one of the book's readers.And thanks for reading and subscribing to Ground Truths.If you found this interesting please share it!That makes the work involved in putting these together especially worthwhile.All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years Get full access to Ground Truths at erictopol.substack.com/subscribe

The numbers tell the story. Statistically, it's nearly impossible to scale massively within our industry which is why so few do so. Keith Benjamin is the exception. With over 15 locations under his belt, Keith has broken the mold by systematizing that “it factor” we're all looking to achieve. In today's conversation, we discuss how to build with intention, the tools to create massive awareness, and the essential elements of a cool concept.  For more information on his restaurant group, visit https://uptownhospitality.com/____________________________________________________________Full Comp is brought to you by Yelp for Restaurants: In July 2020, a few hundred employees formed Yelp for Restaurants. Our goal is to build tools that help restaurateurs do more with limited time.We have a lot more content coming your way! Be sure to check out our other content:Yelp for Restaurants PodcastsRestaurant expert videos & webinars

"If you don't impact your environment, your environment's going to impact you." That's how Glenn Wilson, President and CEO of Communities First Inc., sets the tone in this powerful Detroit is Different episode. What started as a casual connection in New Orleans blossoms into a deeply honest conversation about housing, healing, and hope. Glenn shares the raw journey from surviving a childhood house fire in Flint to leading a multi-state nonprofit developing thousands of affordable housing units. From reflections on faith—"Statistically, I shouldn't be here"—to breaking down what “capital stack” really means in community development, this interview is a must-listen. With tales of hot plates on broken stoves, bird nests in rooftops, and turning trauma into mission, Glenn reminds us: “The very things we take for granted are the very things people pray for.” This is about more than real estate—this is about legacy, trust, and doing the work. "It's not about being a gatekeeper. It's about being a gate opener.” Detroit is Different is a podcast hosted by Khary Frazier covering people adding to the culture of an American Classic city. Visit www.detroitisdifferent.com to hear, see and experience more of what makes Detroit different. Follow, like, share, and subscribe to the Podcast on iTunes, Google Play, and Sticher. Comment, suggest and connect with the podcast by emailing info@detroitisdifferent.com

In this episode, we confront a truth many couples avoid: one partner will likely outlive the other. Statistically, especially in heterosexual relationships, it's often the woman. That fact shapes the financial, emotional, and logistical choices couples need to make as they plan for retirement. We talk about why it's essential to create a shared plan—one that not only protects assets, but gives peace of mind to both people involved.We open by acknowledging that in many relationships, one person traditionally handles the finances. If that person passes first, the surviving partner can be left not only grieving, but scrambling to understand the financial puzzle. Amy shares how often she hears from women who feel anxious and uncertain when they're suddenly in charge. These women aren't incapable—they just haven't been part of the process.The heart of our conversation is about empowering both partners to be part of financial planning. Amy outlines the three big areas where questions tend to show up: understanding the financial picture, handling the emotional baggage around trust and confidence, and building knowledge to make informed decisions. It's not about control—it's about shared responsibility and kindness. We highlight how reframing conversations away from aging and death toward security and love can help bring both partners to the table more comfortably.We also touch on how crucial it is for the financially involved partner—often men in older generations—to help build a bridge of understanding and trust. Amy uses the metaphor of setting up a tent: it takes both people holding up their corner to make the structure stand. We talk practical next steps, including setting up regular financial check-ins, building a “what-if” folder with key documents and passwords, and ensuring both partners feel respected and heard in these discussions.Ultimately, we conclude that it's never too late to get involved, and one of the most powerful legacies anyone can leave behind is a partner who feels confident to navigate life after loss. This isn't just about money—it's about care, connection, and preparing for a future that's secure for both people in the relationship. To get in touch with Amy and her team at Thimbleberry Financial, call 503-610-6510 or visit thimbleberryfinancial.com.

Sam received a message from a friend recently. His question was simple: How many people typically give in a church? Statistically, about 75% of people will give in a typical church. In his case, only 50% of the church was giving regularly. Josh and Sam discuss some ways to teach church members about the importance of tithing. The 10% mark can be controversial, but committing to give regularly should not be. The post Five Key Tips to Teach Your Church to Tithe appeared first on Church Answers.

To watch a video version of this podcast, click here: https://youtu.be/Skx7vjdsdo8In this episode, Reuben Saltzman and Tessa Murry discuss the dynamics of home inspection attendance, exploring who should be present during inspections, the roles of buyers and agents, and the impact of these interactions on the inspection process. They share personal experiences and insights on how attendance can affect the quality of inspections and the overall experience for clients. The conversation also touches on the importance of education in the real estate industry and the various types of agents that may be present during inspections. They also discuss the dynamics of home inspections, focusing on the various roles of buyers, agents, and sellers. They explore the unique needs of first-time home buyers, the importance of agent presence during inspections, and the complications that arise when sellers are present. The discussion also highlights the significance of setting boundaries and the impact of unique situations that can occur during inspections. The episode concludes with a call for listeners to share their own experiences.Here's the link to check Inspector Empire Builder: https://events.iebcoaching.com/eventsTakeawaysThe weather in Florida can be quite challenging due to humidity.Health issues can impact professional life significantly.Home inspection attendance has evolved, especially post-COVID.Buyers should ideally attend inspections to understand their future home better.Having agents present can help clarify communication and reduce misunderstandings.Different types of agents can influence the inspection process positively or negatively.Education is crucial for both home inspectors and real estate agents.The presence of children during inspections can lead to distractions and potential issues.Home inspectors appreciate agents who are supportive and engaged during inspections.The inspection process is becoming more complex, requiring more time and attention.  First-time home buyers often feel overwhelmed and need support.Statistically, more single women are buying homes than single men.Agents play a crucial role in providing moral support during inspections.The presence of sellers during inspections can complicate the process.It's generally advised that sellers should not attend their home inspections.Buyers should ideally be present for the last hour of the inspection.Setting boundaries is essential for home inspectors.Unique situations can arise with various attendees during inspections.The role of the seller's agent can vary depending on the situation.Sharing stories from inspections can provide valuable insights. Chapters00:00 Welcome and Weather Check02:58 Health Updates and Professional Endeavors05:54 Home Inspection Attendance: Who Should Be There?12:01 The Role of Buyers and Agents in Inspections17:59 Types of Agents at Home Inspections23:59 The Importance of Education in Home Inspections24:19 Navigating First-Time Home Buyers' Needs29:45 The Role of Agents During Inspections30:10 The Seller's Presence at Inspections37:51 The Impact of Seller's Agents40:32 Unique Situations with Attendees48:32 Final Thoughts on Inspection Attendance

Let's run the numbers so far as we're deep right in pre-season.Current leagues are Pinoyliga and Filoil as of June.Order your Maroon Talk merch here!tinyurl.com/MaroonTalkMerch

Series: N/AService: Sun AMType: SermonSpeaker: Caleb Smithson

Dr. John Sweetenham shares highlights from Day 2 of the 2025 ASCO Annual Meeting, including new data on the treatment of ER+/HER2-negative breast cancer and potentially practice-changing results for patients with cutaneous squamous cell carcinoma at high risk of recurrence.  Transcript Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, your host of the ASCO Daily News Podcast, welcoming you to our special coverage of the 2025 ASCO Annual Meeting. Today, I'll be bringing you my takeaways on selected abstracts from Day 2 of the Meeting. My disclosures are available in the transcript of this episode.  Today's selection features important, new data on the treatment of ER-positive, HER2-negative breast cancer, the use of tumor treating fields in combination with chemotherapy for locally advanced pancreatic cancer, and potentially practice-changing results for patients with cutaneous squamous cell carcinoma at high-risk of recurrence.  Our first selected abstract is LBA1000. This important phase 3 study was presented by Dr. Erika Hamilton from the Sarah Cannon Research Institute in Nashville and evaluated the use of a novel agent, vepdegestrant, in patients with ER-positive/HER2-negative breast cancer, which had progressed after first-line endocrine therapy. Vepdegestrant is a selective oral PROTAC estrogen receptor degrader, which targets wild-type and mutant estrogen receptor through a novel mechanism of action which directly harnesses the ubiquitin-proteasome system to degrade ER. It has potential advantages over fulvestrant, a selective ER degrader which has to be administered intramuscularly and has limited benefit in patients who progress after endocrine therapy plus a CDK4/6 inhibitor.  Building on the encouraging results from the initial phase 1/2 study of vepdegestrant, Dr. Hamilton reported results from the VERITAC-2 global phase 3 trial, comparing this agent with fulvestrant. The patients in the study had already received treatment with hormone therapy and a CDK inhibitor and were randomly assigned to receive treatment with either vepdegestrant (313 patients) or fulvestrant (311 patients). The vepdegestrant was taken orally each day, while the fulvestrant was given intramuscularly on days 1 and 15 of the first cycle of treatment and day 1 of each subsequent treatment cycle. Patients were stratified by the presence of wild-type ER or ESR1 mutation. A total of 43.3% of patients had ESR1 mutations; 136 of those were in the vepdegestrant group and 134 in the fulvestrant group.   For patients with ESR1 mutations, vepdegestrant significantly increased progression-free survival compared with fulvestrant. For patients who received vepdegestrant, the median PFS was 5 months versus 2.1 months for those who received fulvestrant. The clinical benefit rate was 42.1% in the vepdegestrant group vs. 20.2% in the fulvestrant group. The overall response rate was 18.6% in the vepdegestrant group compared with only 4% in the fulvestrant group.  The PFS and response benefits of vepdegestrant were largely restricted to the population with ESR1 mutations. Overall survival data are currently immature. The safety profile was favorable, with fewer than 5% of patients having dose reductions or discontinuation due to toxicity. The most frequent toxicities were fatigue, nausea, and elevated transaminases.  The authors concluded that oral vepdegestrant demonstrates statistically significant and clinically meaningful improvement in progression-free survival compared with fulvestrant in this group of patients with ESR1-mutated ER+/HER2- advanced breast cancer who have progressed after endocrine therapy and a CDK inhibitor. Patients with recurrent disease in this context are now routinely tested for ESR1 mutations, and this agent is for sure a potential treatment option for them.  The next study on today's episode, LBA4005, reports on the use of tumor treatment fields for patients with locally advanced pancreatic cancer. Tumor treatment fields are electric fields which disrupt cell division and may also induce an enhanced immune response, using a non-invasive portable device attached to the skin, and are already approved for the treatment of some cancers, including GBM and non-small cell lung cancer. A previous phase 2 trial, PANOVA-2, confirmed the feasibility and safety of using this approach in combination with gemcitabine plus or minus nabpaclitaxel in pancreatic cancer. In today's presentation, Dr. Vincent Picozzi from the Virginia Mason Medical Center in Seattle presented the results of the PANOVA-3 trial, a phase 3 study comparing gemcitabine and nabpaclitaxel with the same chemotherapy plus tumor treatment fields in patients with locally advanced pancreatic adenocarcinoma.  Five hundred and seventy-one eligible patients were enrolled in the study with a total of 405 (198 in the treatment field group and 207 in the standard arm) comprising the modified intent- to-treat population. The duration of chemotherapy treatment was comparable in both study arms, and patients receiving treatment fields had a median exposure of almost 27 weeks.  Statistically significant improvements were observed for several study endpoints, including overall survival (a median of 16.2 versus 14.2 months), distant PFS (at 13.9 versus 11.5 months) and pain-free survival (at 15.2 versus 9.1 months), all in favor of the treatment fields arm. Although quality of life data were not reported in detail, the authors noted a significant improvement in global health status in the treatment fields arm. Safety data showed a higher level of skin adverse events in the treatment fields arm but were otherwise as expected for the GnP combination.  These are quite remarkable results which add to the growing evidence base for tumor treatment fields and are particularly compelling in this patient group given the substantial improvement in pain-free survival. It will be especially interesting to see the mature analysis of the quality-of-life endpoints in a subsequent report.  The final selection today is Abstract 6001, which describes the C-POST trial, a phase 3 trial of adjuvant cemiplimab versus placebo in patients with high-risk cutaneous squamous cell carcinoma of the skin. This study was presented by Dr. Danny Rischin from the Peter MacCallum Cancer Centre in Melbourne, Australia.   Although surgical resection with or without adjuvant radiation is curative in 90% of patients with cutaneous squamous cell carcinoma, high-risk features, including nodal disease, skin and subcutaneous metastases, perineural invasion and bone involvement, predict for an inferior prognosis.  Cemiplimab, a PD-1 targeting antibody is standard therapy for patients with locally advanced or metastatic disease who are not candidates for curative surgical resection or radiation therapy, with an overall response rate of almost 50%.  The C-POST study evaluated the use of cemiplimab as adjuvant therapy following surgery and radiation in high-risk patients, compared with placebo. Treatment was administered at 3-week intervals for 12 weeks, and then 6-week intervals for a further 36 weeks, with a primary endpoint of disease-free survival. Four hundred and fifteen patients were randomized in the study, 209 to cemiplimab and 206 to placebo. With median follow-up at 24 months, Dr. Rischin reported a highly significant improvement in disease-free survival for the cemiplimab arm, 49.4 months for placebo versus not reached for cemiplimab, with improvements also observed in the rates of locoregional recurrence and distant recurrence at 80% and 60% reductions, respectively. No new safety signals were observed.  This study is potentially practice-changing and provides strong evidence that cemiplimab should be considered the new standard of care in this clinical context.  Thanks for listening today and join me again tomorrow to hear more top takeaways from ASCO25. If you value the insights that you hear on the ASCO Daily News Podcast, please remember to rate, review, and subscribe wherever you get your podcasts.  Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speaker:   Dr. John Sweetenham   Follow ASCO on social media:    @ASCO on Twitter   @ASCO on Bluesky   ASCO on Facebook   ASCO on LinkedIn    Disclosures:   Dr. John Sweetenham:   No relationships to disclose  

A peak at Mishram, and some closure on Szeth's family flashbacks -- FN Episode 252

In April, we asked VOM Radio listeners to to Christians living in restricted nations and hostile areas. This week, Ty Scott, VOM's Regional Leader for East and Southern Africa, tells us about the work and effort involved in actually placing Bibles into the hands of Christians living in cities and villages in Sudan, Tanzania, or the Democratic Republic of the Congo. Statistically, Kenya, Uganda, Ethiopia, and Tanzania are majority-Christian nations. Yet each has communities where almost every person is a Muslim. How is the gospel spreading in such places? And how are new followers of Christ treated by their families and the wider Islamic community? Ty will share about family persecution in Comoros, a country we've never discussed on VOM Radio, where Christians comprise only tenths of a percent of the population. Listen as Ty and VOM Radio Host, Todd Nettleton, discuss places where ethnic identity and Islam are completely intertwined. As gospel workers share the hope of Christ in those places, they don't ask people to leave their ethnicity but to fulfill what God would have them be. Hear the amazing testimony of a young man who brought his father, an imam (Islamic prayer leader), to faith in Christ, and how the gospel brought many into Christ's kingdom through his father's witness. Ty will also share specific ways you can pray for Christians in eastern and southern Africa.

In April, we asked VOM Radio listeners to sponsor Bible delivery to Christians living in restricted nations and hostile areas. This week, Ty Scott, VOM's Regional Leader for East and Southern Africa, tells us about the work and effort involved in actually placing Bibles into the hands of Christians living in cities and villages in Sudan, Tanzania, or the Democratic Republic of the Congo. Statistically, Kenya, Uganda, Ethiopia, and Tanzania are majority-Christian nations. Yet each has communities where almost every person is a Muslim. How is the gospel spreading in such places? And how are new followers of Christ treated by their families and the wider Islamic community? Ty will share about family persecution in Comoros, a country we've never discussed on VOM Radio, where Christians comprise only tenths of a percent of the population. Listen as Ty and VOM Radio Host, Todd Nettleton, discuss places where ethnic identity and Islam are completely intertwined. As gospel workers share the hope of Christ in those places, they don't ask people to leave their ethnicity but to fulfill what God would have them be. Hear the amazing testimony of a young man who brought his father, an imam (Islamic prayer leader), to faith in Christ, and how the gospel brought many into Christ's kingdom through his father's witness. Ty will also share specific ways you can pray for Christians in eastern and southern Africa. The VOM App for your smartphone or tablet will help you pray daily for persecuted Christians throughout the year, as well as providing free access to e-books, audiobooks, video content and feature films. Download the VOM App for your iOS or Android device today.

Exploring the intricate relationship between happiness and religiosity, this video delves into how religious beliefs can influence one's sense of well-being. Research consistently shows that religious individuals often report higher levels of happiness and life satisfaction compared to their non-religious counterparts. This phenomenon is attributed to various factors, including community support, a sense of purpose, and spiritual fulfillment. The video also examines contrasting views from individuals who have left religious communities, highlighting personal anecdotes of increased happiness post-departure. By analyzing both statistical data and personal stories, the video provides a comprehensive look at how religion can impact mental health and happiness.⏱️⏱️VIDEO CHAPTERS⏱️⏱️:00:00:00 - Exploring Relationship Between Happiness and Religiosity00:01:27 - Do Religious People Report Higher Happiness Levels?00:03:05 - Historical Perspectives on Religion and Mental Health00:04:43 - Does Money or Faith Contribute More to Happiness?00:06:21 - Personal Experiences: Leaving the Church for Happiness00:08:01 - The Impact of Predestination Beliefs on Anxiety00:09:36 - Belief in Hell and Its Psychological Effects00:11:11 - Analyzing Anecdotal Stories of Church Harm00:12:50 - Measuring Happiness Among Different Religious Groups00:14:27 - Social Media Narratives: Happiness After Leaving Church00:15:48 - Memory and Confabulation in Faith-Based Contexts00:17:14 - Critiques and Discussions on Religious Happiness StudiesTo Order Jonah's Book, "The Key to the Keystone" visit the following link and use coupon Code: WARDRADIO https://tinyurl.com/Key-to-the-KeystoneFor 10% off Plain and Precious Publishing Books, visit plainandpreciouspublishing.com and use Coupon Code: WARDRADIOFor a copy of Brad's "Dragon Theif" Book, visit: https://a.co/d/7QzqsZN⚡For free trial of Scripture Notes please visit the following link!: https://scripturenotes.com/?via=wardradioJoin this channel to get access to perks:https://www.youtube.com/channel/UCnmsAFGrFuGe0obW6tkEY6w/joinVisit us for this and more at: WardRadio.com#christian #mormon #exmormon #latter-daysaints #latterdaysaints #latterdays #bible #bookofmormon #archaeology #BYU #midnightmormons #jesus #jesuschrist #scriptures #sundayschool #biblestudy #christiancomedy #cardonellis #kwakuel #bradwitbeckTo support the channel:Venmo @WardRadio or visit: https://account.venmo.com/u/MidnightMormonsPaypal: paypal.me/@midnightmedia Amazon Wish List: https://www.amazon.com/hz/wishlist/ls/1AQLMTSMBM4DC?ref_=wl_shareCashApp: $WardRadioFollow us at:Instagram: @cardonellis @kwakuel @braderico @boho.birdyFacebook: @WardRadioWorldwideTwitter: WardRadioShowTikTok: WardRadioWorldwide

On Monday, President Donald Trump signed an executive order telling drugmakers to slash the prices of their medicines. Once again, the president showed an amazing nose for interesting questions. Statistically, the U.S. accounts for 4 percent of the world's population but nearly 50 percent of global pharmaceutical spending. Americans spend three to five times more on new branded drugs than people in Europe. Why? And what's the matter with fixing this problem by just telling pharmaceutical companies that their prices are too damn high? Today's guest is Jason Abaluck, a health economist at Yale University. We talk about why Americans pay so much for new drugs but, ironically, pay so little for old drugs. We unpack trade-offs between low prices and innovation. And finally, we consider several ways we can have our cake and eat it too: more miracle drugs and more affordability. Because, after all, what is this whole conversation about besides the obvious: How do we design a world in which imperfect people working at imperfect companies nonetheless collaborate to build therapies that save and extend our lives with products we can actually afford? If you have questions, observations, or ideas for future episodes, email us at PlainEnglish@Spotify.com. Host: Derek Thompson Guest: Jason Abaluck Producer: Devon Baroldi Learn more about your ad choices. Visit podcastchoices.com/adchoices

On this episode of the Exhaust Notes Podcast, Todd, Rohit, and Nick get into a humorous yet insightful discussion about the recent Miami Grand Prix, the upcoming Monaco race, and the evolving dynamics within Formula One. They analyze the performances of drivers like Oscar Piastri and Lando Norris, exploring the implications of their standings in the championship. The conversation also touches on the challenges faced by Nico Hulkenberg and the controversial figure of Flavio Briatore, all while maintaining a light-hearted tone that reflects the hosts' camaraderie. In this episode, the hosts discuss the recent leadership changes at Alpine, including the resignation of team principal Ollie Oakes and the controversial return of Flavio Briatore. They analyze Alpine's current performance in the F1 standings and the implications of the ruthless driver market in Formula One. The conversation shifts to the future of F1 broadcasting, highlighting the potential for streaming services like Apple and Netflix to take over. Finally, they brainstorm innovative ideas for a comprehensive motorsport streaming app.Support The ShowWatch Full Episodes on Patreon

Hi everyone, Carl Gould here with your #70secondCEO. Just a little over a one minute investment every day for a lifetime of results.   Go on 10 appointments per month, for six months. What they've learned in this organization called the Institute for Independent Business, they had business mentors in 50 countries, so there are about almost 7,000 of them. What they learned was, if you go on 10 appointments per month, a lot of things happen. You get really good at your pitch, you really understand your ideal client, you understand what works and doesn't, you figure out how to close, you overcome the objections, you really hone your presentation. And so here's what he said, what's that?  Trial by fire.  Trial by fire. And here's what he learned. Statistically, your chances of getting your client on the first 10 appointments is actually very low, very low. It's like under ten percent. Now doesn't mean that has to be your experience. You might walk out like I don't know what happened to them, I got 8 out of 10. Good on you. Your probability of getting a client with your next 10 appointments on something that's new or something you change are actually very low. Your chances of not having a client- not having a client after 60 appointments is almost impossible. Meaning the probability of you having clients after 60 appointments is ridiculously high. The probability is ridiculously high one and a way. It's a count explore. Pardon me? It's a count explore. It's a count explore, but you could I could, we could have a count explore 60 times and you could lose every time because why?  You figured it out basically. Yeah. Because you guys are too talented not to get it. Like and follow this podcast so you can learn more. My name is Carl Gould and this has been your #70secondCEO.  

Description: Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Dr. Melanie Ruffner, an Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Dr. Ruffner describes her work in clinic and the paper she co-authored about pediatric and adult eosinophilic esophagitis (EoE). She covers the questions they considered in the paper and the conclusions they reached. Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:49] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:17] Holly introduces today's topic, pediatric and adult eosinophilic esophagitis (EoE), and introduces today's guest, Dr. Melanie Ruffner.   [1:23] Dr. Melanie Ruffner is an attending physician with the Division of Allergy and Immunology in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia. Holly welcomes Dr. Ruffner to Real Talk.   [1:50] As an attending physician in the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia, Dr. Ruffner sees patients who have eosinophilic esophagitis and other eosinophilic disorders, including eosinophilic GI tract disorders.   [2:09] Dr. Ruffner also leads a research group that studies how the immune system causes inflammation in response to certain foods, leading to EoE.   [2:20] Inflammation in the esophagus is tied to other diseases like epithelial barrier dysfunction and fibrosis.   [2:28] Our bodies use many different proteins that allow cells to communicate with one another. One type of signaling protein that causes inflammation is called cytokines.   [2:41] Dr. Ruffner's group is interested in how these signaling proteins called cytokines interact with epithelial cells and how that impacts the oral function of the esophagus in patients with EoE.   [3:02] In training, Dr. Ruffner became interested in eosinophilic esophagitis and other non-IgE-mediated food allergies because we don't have a lot of clear treatments or clear mechanisms that cause them.   [3:21] Dr. Ruffner felt there was a lot of work to be done in that area. It was rewarding to be in clinical encounters with those patients. Often, patients had spent a long time trying to find out what was happening and to find a treatment plan that worked for them.   [4:31] Dr. Ruffner's group sees some patients who have eosinophilic gastroenteritis and patients who are referred for hypereosinophilia with impacts of inflammation in other organ systems.   [5:06] Dr. Ruffner co-authored a paper about pediatric and adult EoE published in the Journal of Allergy and Clinical Immunology. It explored if EoE in pediatric patients and adult patients is a spectrum or distinct diseases.   [5:29] EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to foods and causes inflammation in the esophagus.   [5:47] Eosinophils are a type of white blood cell. Eosinophils infiltrate the tissue in the esophagus of people with EoE. Doctors look for eosinophils in the tissue of the esophagus as a sign that inflammation in the esophagus is EoE.   [6:04] The symptoms of EoE can vary in children and adults. That was one of the things the doctors were interested in when they were thinking about this paper. There are no blood or allergy tests that make it easy to diagnose EoE, which requires an endoscopy.   [6:31] An endoscopy is performed by a gastroenterologist. The gastroenterologists look at the appearance of the esophagus and take biopsies.   [6:49] A pathologist counts the eosinophils in the tissue to determine if there are eosinophils present. If there are more than 15 eosinophils in the high-powered field of the microscope and symptoms and clinical conditions are present, EoE is diagnosed.   [7:25] One of the variables Dr. Ruffner considers is that symptoms can be different in children versus adults. In older adolescents and adults, the classic symptom is difficulty swallowing or dysphagia. That is often caused by fibrosis in the esophagus.   [7:54] In younger children this is often not how EoE presents. They may vomit or refuse food. They may experience more weight loss. Symptoms vary over the lifespan. Pediatric EoE symptoms of nausea and abdominal pain can also show up in adults.   [9:54] Atopy refers to allergic conditions. In the paper, a history of atopy means a history of allergic conditions, like atopic dermatitis, IgE-mediated food allergy, allergic rhinitis, or asthma.   [10:37] These disorders tend to cluster together, over time, because they share many common genetic risks. They cluster in families because some of the genetic risks are the same. Not every family member will have the same atopic or allergic conditions.   [11:07] In families, perhaps one person will have atopic dermatitis and allergic rhinitis while another will have atopic dermatitis, allergic rhinitis, asthma, and EoE. They may have inherited different genetics or had different environmental exposures.   [11:50] Ryan says that describes his family. They each have different atopic conditions. Ryan got them all! Dr. Ruffner says it describes her family, as well.   [12:26] Dr. Ruffner says it's understandable for families to stress about atopic conditions. Unfortunately, right now, there's no way to predict who will develop which atopic conditions. It's on the minds of the medical and research communities.   [13:10] IgE is an antibody that binds to food allergens and mediates anaphylaxis, usually within 30 minutes, with hives, vomiting, and difficulty breathing. Not everyone with a diagnosed food allergy will be given an epinephrine auto-injector.   [13:44] IgE-mediated food allergies are influenced by type 2 cytokines. Cytokines are immune system signaling proteins that have been labeled as groups. The group that is involved in allergy most heavily is under the label type 2.   [14:15] These type 2 cytokines are responsible for influencing B cells to make IgE. In the tissue in EoE, we find that there is a large amount of these type 2 cytokines present.   [14:37] This is quite relevant because dupilumab, the monoclonal antibody that has been approved to treat EoE, targets type 2 inflammation by blocking type 2 cytokines.   [16:04] Dr. Ruffner says one of the biggest challenges in the field of EoE is we don't have a way to stratify who should get which treatment for EoE. Patients have to choose between diet and pharmacologic therapy.   [16:48] We don't know enough about the inflammatory profiles to give any patient the specific guided information that one therapy would be better than another.   [17:11] Pediatric and adult patients are given the same treatment options. Some dosing, such as proton pump inhibitors and dupilumab, is weight-based so different doses are needed.   [17:36] Over time, people's needs change. From early school age to when people leave home, they may have very different needs. They may do well on diet therapy when their diet is controlled by parents, but, on their own, that may not be the best option for them.   [18:20] Therapy may change over time to support each patient's individual goals. It can be challenging because therapies are imperfect. Each therapy has a percentage probability of success. Not every therapy is guaranteed to work for every individual.   [19:01] There is some flexibility and possibility of switching between therapies to support people. Ryan shares one of his experiences in changing treatments.   [20:03] Some patients are stable on a therapy for a time but then see symptoms creep back up. Dr. Ruffner strongly suggests they talk to their care team for an endoscopy and biopsy to see if they need to switch therapy and if their diet has changed.   [21:31] In young children, Dr. Ruffner sees a much higher incidence of feeding refusal. The child may have a preferred food or a preferred texture like puree, long past when that would be appropriate for the age.   [22:41] It can be very difficult to move past this learned behavior even if remission is achieved through therapy. The child may need feeding therapy to help with that. [22:59] Feeding behaviors in older individuals may be much more subtle. Talk about them with your care team. Needing water to eat, cutting food very small, and fearing to eat around people are common eating behaviors to discuss in older patients.   [23:53] These eating behaviors affect people's well-being deeply because they affect how social they feel when they are around people. Ideally, you want to be around people and share in social times.   [24:16] Holly has used these eating behaviors herself and notices them in other people. When adults come to her for therapy, she asks how many times they refill their water when they eat, and if food ever gets stuck. They are surprised that those are symptoms.   [26:01] Dr. Ruffner says it's important to recognize the difference in symptoms in diagnosing EoE. The main risk factor of EoE is fibrosis, over time. The thought is that early in EoE there is an inflammatory phenotype, but later, there is a fibrotic phenotype.   [26:51] The phenotype refers to the presentation or characteristic of disease. What is the appearance at endoscopy? What do we see in the biopsied tissue? Is there fibrosis or not?   [27:15] This is the crux of the paper: Is this on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to this fibrosis over time.   [27:40] One thing that is missing is following a group of patients from the start and having that evidence. There is mechanistic evidence from studies to show that inflammation can contribute to fibrosis. That was one of the discussions in the paper.   [28:29] In endoscopies, something that can be seen with fibrosis or fibrostenotic features is more of an appearance of rings and narrowing of the esophagus. A proportion of patients with strictures or narrowing need to have them dilated.   [29:11] For patients who have dilation, it can help with symptoms significantly. When pathologists look at the tissue with fibrosis, they can see changes in the protein structure. There is more collagen and other changes in the tissue, causing fibrosis.   [30:03] Some patients use adaptive eating behaviors to adapt to significant changes in their esophagus and go for many years without being diagnosed until they present with an impaction when food becomes stuck in their esophagus.   [30:46] This makes EoE a challenging disorder for many because it can be very difficult to diagnose. The journey to a diagnosis is very individual. As a group, adults are much more likely to have fibrosis, leading to dysphagia, strictures, or impaction.   [31:25] Statistically, across all patients, you see fibrosis more in adults than in children.   [32:42] In the paper, Th1 cells are mentioned. Th1 is an immune system term referring to a cell that produces interferon-gamma. Studies show there may be differences in interferon signaling in different age groups but it needs to be studied further.   [33:57] Dr. Ruffner's team had looked at a small group and saw that interferon signaling seemed to be relatively similar between children and adults. Both CD4 and CD8 T cells (types of immune system cells) are potentially producing interferon in the esophagus.   [34:32] More study needs to be done around those immune system cells and their potential significance in EoE, if any.   [35:33] The paper suggests that EoE in children and adults is essentially a spectrum of the same disorder rather than distinct diseases.   [35:42] Aspects of immunology, responses to different treatments across children and adults, the similar responses to diet and different medications, and over time in the same individuals, indicate these are changes and complications over time.   [36:41] Dr. Ruffner suggests that medical researchers need to understand which patients are at the highest risk of complications and work to identify the best treatments to prevent those.   [37:14] Dr. Ruffner is thinking about the response to proton pump inhibitor therapy. One of the things she is looking at is whether or not proton pump inhibitors affect how eosinophils migrate into the tissue.   [37:33] They are finding that it seems that PPIs can decrease the degree of migration of eosinophils into the tissue. They are very interested in looking at that. Ryan says when Dr. Ruffner gets that paper published, she'll have to come back on the show!   [38:06] Ryan thanks Dr. Ruffner. For our listeners who would like to learn more about eosinophilic disorders, including EoE, please visit APFED.org and check out the links in the show notes.   [38:15] If you're looking to find a specialist who treats eosinophilic disorders, we encourage you to use APFED's Specialist Finder at APFED.org/specialist.   [38:24] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at APFED.org/connections.   [38:33] Ryan thanks Dr. Ruffner for participating in the podcast episode. Holly also thanks APFED's Education Partners Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Dr. Melanie Ruffner, MD, PhD, Attending Physician with the Division of Allergy and Immunology and the Center for Pediatric Eosinophilic Disorders at Children's Hospital of Philadelphia “Pediatric and adult EoE: A spectrum or distinct diseases?” by Stanislaw J. Gabryszewski, Melanie A. Ruffner, and Jonathan M. Spergel   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of Bristol Myers Squibb, GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   “EoE is a chronic allergic condition that affects the esophagus. The esophagus carries food from the mouth to the stomach. In people with EoE, the immune system overreacts to food allergens and causes inflammation in the esophagus.” — Dr. Melanie Ruffner   “In EoE, there are no blood or allergy tests that make it easy to diagnose EoE without an endoscopy.” — Dr. Melanie Ruffner   “Is EoE on a spectrum, that the inflammation is driving the fibrosis, or are these two different things altogether? There is some evidence to suggest that the inflammation contributes to fibrosis over time.” — Dr. Melanie Ruffner   “When pathologists look at the tissue with fibrosis, they can see the changes in the protein structure.” — Dr. Melanie Ruffner   “There are some folks who have adapted their eating behavior quite significantly and may have quite a number of chronic changes in their esophagus that they have adapted around, and they go for many years without being diagnosed.” — Dr. Melanie Ruffner

This episode is sponsored by Tide. Visit tide.co/savings, and use the bonus code "tennisunfiltered" to support the podcast and get a great deal Calvin Betton is stranded! The power cut in Spain means we are unable to contact our resident coach, so James Gray and George Bellshaw are taking up the mantle (or trying) in his absence. They discussed... Novak Djokovic was beaten in the second round of the Madrid Open 6-3, 6-4 by world No 44 Matteo Arnaldi, continuing a pattern that's becoming hard to ignore. Statistically, his win percentage this year has dipped below what Rafael Nadal managed in his injury-plagued, farewell-tour year. Patrick Mouratoglou says Djokovic arrived on tour with an "average game". "Even today, at the end of his career, when you look at Rafa's game, Roger's game, Novak's game, it's incredible that Novak is the strongest of the three, the one who broke all the records. It shows that the most important thing is not in the tennis, in the racket." Are Damir Dzumhur and Mattia Bellucci the greatest s**thouses of all-time Emma Raducanu says she's happy with an “informal” arrangement with Mark Petchey, who was coaching her at the Madrid Open. And what IS a good record against top 20 players? Save more, earn more—up to 4.48% AER (variable). Interest rates are tiered, with the top rate for balances over £1M. Each tiered rate applies to the portion within that range. New Tide members get these rates free for 6 months; after that, your Tide plan's rates apply. For full offer T&Cs visit tide.co/savings. Learn more about your ad choices. Visit podcastchoices.com/adchoices

This episode is sponsored by Tide. Visit tide.co/savings, and use the bonus code "tennisunfiltered" to support the podcast and get a great deal Calvin Betton is stranded! The power cut in Spain means we are unable to contact our resident coach, so James Gray and George Bellshaw are taking up the mantle (or trying) in his absence. They discussed... Novak Djokovic was beaten in the second round of the Madrid Open 6-3, 6-4 by world No 44 Matteo Arnaldi, continuing a pattern that's becoming hard to ignore. Statistically, his win percentage this year has dipped below what Rafael Nadal managed in his injury-plagued, farewell-tour year. Patrick Mouratoglou says Djokovic arrived on tour with an "average game". "Even today, at the end of his career, when you look at Rafa's game, Roger's game, Novak's game, it's incredible that Novak is the strongest of the three, the one who broke all the records. It shows that the most important thing is not in the tennis, in the racket." Are Damir Dzumhur and Mattia Bellucci the greatest s**thouses of all-time Emma Raducanu says she's happy with an “informal” arrangement with Mark Petchey, who was coaching her at the Madrid Open. And what IS a good record against top 20 players? Save more, earn more—up to 4.48% AER (variable). Interest rates are tiered, with the top rate for balances over £1M. Each tiered rate applies to the portion within that range. New Tide members get these rates free for 6 months; after that, your Tide plan's rates apply. For full offer T&Cs visit tide.co/savings. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Statistically speaking, Belichick could kick the bucket at any moment. When you consider how bad Brian needs a house, he'd be a fool not to! Chicago’s best morning radio show now has a podcast! Don’t forget to rate, review, and subscribe wherever you listen to podcasts and remember that the conversation always lives on the Q101 Facebook page. Brian & Kenzie are live every morning from 6a-10a on Q101. Subscribe to our channel HERE: https://www.youtube.com/@Q101 Like Q101 on Facebook HERE: https://www.facebook.com/q101chicago Follow Q101 on Twitter HERE: https://twitter.com/Q101Chicago Follow Q101 on Instagram HERE: https://www.instagram.com/q101chicago/?hl=en Follow Q101 on TikTok HERE: https://www.tiktok.com/@q101chicago?lang=enSee omnystudio.com/listener for privacy information.

Latest Stat Me Up Pod brings you Dave Davis & Dr Phil Bart's analysis on the current Liverpool LB, with all talk on who data-wise is the better player to keep at the club next season! Learn more about your ad choices. Visit podcastchoices.com/adchoices

Will Passover see a definite move toward the final global government?  What factors are lining up that cause such a question? Are world leaders representing their populace or maneuvering their populace into global subservience? Please join Steve and Bonnie for a look at what is brewing as YHWH will begin his push to oust the imposter. "I have said all these things to you so that in me you may have peace. In the world you have trouble: but take heart! I have overcome the world." Jn 16:33   PUSH FOR TRANSHUMANS Enemy desperate to read our minds:  https://thewinepress.substack.com/p/scientists-develop-cybernetic-injectable What could possibly go wrong?: https://truthmafia.com/greg-reese/air-traffic-control-replaced-with-artificial-intelligence/ Evil goal – no more begetting: https://www.dailymail.co.uk/health/article-14434057/Fertility-half-women-ages-30-35-suffering-symptoms-menopause-study.html Push to alter our food: https://winepressnews.com/2021/07/31/nations-join-together-pledging-to-change-the-world-food-systems-led-by-the-vatican-furthering-bible-prophecy/ 8 Pharmaceutical Companies developing Bird Flu vaxxes: https://60secondsreleased.com/bird-flu-vaccine-stocks-8-companies-developing-h5n1-vaccines/ Statistically, all vaxxes unsafe: https://www.2ndsmartestguyintheworld.com/p/if-all-vaccines-are-unsafe-and-ineffective “Long Covid” = vaxx injury: https://makismd.substack.com/p/news-ex-cdc-director-long-covid-is mRNA vaxx adverse reactions keep manifesting: https://revolver.news/2025/03/doctor-for-the-first-time-in-my-career-ive-seen-an-8-9-and-10-year-olds-with-colon-cancer/   DIGITAL Digital ID coming in EU: https://www.zerohedge.com/geopolitical/coming-soon-european-digital-identity-wallet Digital ID coming in Australia: https://winepressnews.com/2023/03/07/new-south-wales-australia-set-to-launch-all-in-one-digital-id-to-fully-replace-physical-documents-and-requires-facial-recognition/ Creepy Neuralink?: https://www.perplexity.ai/page/neuralink-files-telepathy-and-LHjgvYQrTuqKZ7fgeIau9Q Australia going cashless: https://winepressnews.com/2023/09/28/australian-media-says-country-will-be-functionally-cashless-by-2025-as-nation-continues-to-push-digital-ids-and-implantables-to-pay/ US next to go cashless?: https://thewinepress.substack.com/p/trump-quietly-signs-executive-order Spain limits cash while transitioning to digital: https://inspain.news/what-happens-if-you-make-cash-payments-over-e1000-in-spain/ EU Central Bank to bring in digital currency this year: https://slaynews.com/news/eu-central-bank-chief-confirms-digital-euro-launches-this-year/ 1st day of Trump presidency: https://www.emergingtechbrew.com/stories/2025/01/22/what-to-know-about-trump-early-ai-moves   CON CON Beware of calls for a Con-Con: https://www.encouragingangels.org/new-blog/2025/3/12/a-proposed-balanced-budget-amendment-carries-with-it-the-possibility-to-erase-the-constitution-of-the-united-states-as-we-know-it   TRAITORS IN CHARGE US/Global leaders bought and paid for?: https://winepressnews.com/2024/06/30/bought-paid-for-joe-biden-is-bankrolled-by-blackrock-and-donald-trump-is-bankrolled-by-blackstone/ Blasphemous vid re Trump by Trump?: https://winepressnews.com/2024/01/06/trump-shares-blasphemous-video-called-god-made-trump-calling-him-a-shepherd-to-mankind-who-will-never-leave-nor-forsake-them/ Buddies – Trump and Schwab?: https://winepressnews.com/2023/11/24/remember-when-trump-spoke-at-the-world-economic-forum-with-his-good-friend-klaus-schwab/ Chuck Baldwin on Trump betrayals: https://chuckbaldwinlive.com/Articles/tabid/109/ID/4738/Trumps-Three-Greatest-Betrayals-So-Far.aspx 50 euro note portrays … Satan?!: https://halturnerradioshow.com/index.php/news-selections/world-news/european-central-bank-prints-satan-on-50-euro-notes   OCT 7 Netanyahu fires Shin Bet chief over Oct. 7 truth: https://www.ynetnews.com/article/bypkkkvhje

[School of Movies 2025] A cult favourite hangout movie about working in a CD shop in the mid-90s. This one was directed by Allan Moyle, who previously helmed another music-centric, coming-of-age teen drama that should have been way more of a hit; Pump Up the Volume (1990). Statistically almost none of you have seen this, as it's the kind of movie you need a good friend to sit you down with after hearing that you've never seen it, and immediately declared "We're watching this!" Well, we are that friend today, and we are going to detail why this one is worthy of love. It's painfully white, extremely straight and concerns itself with the now-antiquated dichotomy of MTV marketability versus independent spirit, but considering Spotify Killed the Video Star, the themes are still relevant, and the ragtag cast of teens are quirky enough to make this a breezy, endlessly-quotable rewatch. Damn The Man, save The Empire.

Thank you for joining us for Christian Faith Center's Sermon of the week. This message is from our Nampa Location. Pastor Jordan continues his series message "Bounce Back"2 Kings 5:1-5;9-15Naaman was called a mighty man of valor! Naaman was used by God! Scripture said, it was God that gave victory! But Naaman had a secret. A struggle. A sickness. Naaman was mighty in public and struggled in private. Not everything we need to bounce back from is immediately obvious to everyone else! Not everything that's private is secret..... sometimes the battle is private. Anxiety. Depression. Hopelessness. Statistically most people today are in the same place! Although you might be mighty in public you struggle in secret.

Dr. Pamela A. Popper provides valuable insights on how to effectively navigate the healthcare system. Learn practical tips to become a more informed and empowered healthcare consumer. #HealthcareGuide #PatientEmpowerment #HealthNavigation

Statistically, the vast majority of us are fearful about messing up God's plans for our lives. Brian McCormack uses a look at the life of Paul to build a list of principles to inform our understanding of God's plan, and provide a process for making big decisions as a follower of Jesus. For more information about Breakaway, check out www.breakaway.org and follow us on social media @breakawaymin. If Breakaway has impacted your life and you want to generously give back, visit www.breakaway.org/give

David and Isabelle go into greater depth about neuropsychological assessments--both back in the day and now-for kids, and for adults--and Isabelle's AHA moment about self-disclosing her AuDHD self. From the odd history of the intersection of Autism Spectrum Disorder (ASD) and ADHD (did you know you couldn't be diagnosed with both for a long long time?) to realizing how literally she takes the world and how much it helps to finally have a turn signal on the car that is her, David and Isabelle dive deep into unmasking and the mistrust we have for the world when we are so misunderstood.---Isabelle likes having her new neuropsychological results because someone who is not her got to tell her that she has autism, and David has a different experience. His story was like three different hours of testing done at school, and it spit out that he was Oppositional Defiant, and then only in college did it notice he had differences in spelling and then ADHD. His experience is watching clients have their kids be flagged by a pediatrician or teacher to be tested and then they want to retest themselves. But David is so scared he'd go in now and learn…he doesn't have ADHD? And that Isabelle actually understands this, because there was a big gap (of several months) between the interview and the tests. Isabelle goes into further details around how she took her test in a little cubicle. And how for kids, it looks more like play, it involves an IQ test and way more details about processing speed, working memory, visual spatial reasoning, reading, symbols, numbers, etc. to help with understanding learning differences and accommodations. So Isabelle had to sit in a cubicle and stare at a computer and click on a mouse for fifteen minutes and it was awful. When he was a kid, David was pulled from class, he had no idea how long it was going to take, there was a person sitting there who was reading from a book and asking him questions. For kids, a level of buy-in becomes very important, it's hard to get data when you're a willing participant. For David, his first neuropsych showed how unwilling he was to participate, because it was something he was forced to do because there was “something wrong” and they were looking for what was wrong. This is not don't like this anymore. It's important to talk to someone who has been assessed to see how they liked their assessment. You can get a second opinion. There are people who specialize in different areas of neuropsychological testing. And someone who is great at diagnosing ADHD may not be great at diagnosing autism or vice versa. And up until 7 years ago or so, it was impossible to have both autism and ADHD be a primary diagnosis; which connected to insurance company lobbying when the DSM was being updated, ensuring that the rates of certain conditions wouldn't skyrocket because that would impact insurance coverage and ability to cover/deny and all kinds of political and social isms. The history of diagnoses and what makes the cutoffs incorporates layers of ableism, racism, sexism, homophobia…all kinds of oppression. David names how important it was an opening when you could have a combined AuDHD diagnosis because it started to mean that these diagnoses of deficiency, and all the stereotypes around all autistics being nonspeakers or having high support needs, started to get busted and it became more encompassing, maybe even of strengths? It's possible for us to be complex beings, being perceived as having ADHD or autism in another context. We are the keepers of the stigma, it was the ‘last thing we wanted to be.' The other day, Isabelle's kid went to the doctor, and she always felt the doctor was annoyed with her for being so literal and asking so many detail-oriented questions. Her kid answered the doctor's question of “does your throat hurt?” By checking in and saying “No.” And she had a lightbulb flash and realized he was taking the doctor literally. So she tells her kid “You and me, we both take things really literally and answer questions extremely honestly. I think the doctor means when she asks if your throat hurts, she means across the last week or so and not necessarily all the time or right now.” And he answers, “YES!” And she saw the doctor warm up to her kid and to her and she felt the difference, and maybe it was the vulnerability or the disclosure. For David's friend, there was a significant amount of distrust in the world, there was a pattern of miscommunication and people asking you things that they don't mean, when they learned they were autistic, their last instinct was to tell someone. But when they came back from the dentist, they talked about how much the light was bothering them, they gave me some glasses and made it so much better. David can't make us all believe we are safe, we can feel cared for when we tell people what we need and they respond. Statistically, some of the time, your need won't be missed and until recently, Isabelle didn't know she really needed, she would've said words like “anxious” and “please give me more time" 

The Reality of the Numbers and What We Can Do About It   The stats on amputees is staggering. In the US 1 in 200 people have undergone amputation! Over 2.1 million people live with an amputated limb. Worldwide, 1 million ampuatations happen annually, that's 1 amputation every 30 seconds!!!   1 EVERY 30 SECONDS! Amputee Coalition's diagram of statistics taken from Promedeast.com 2023   Even more alarming is the projection of the 2.1 million in the US doubling by the year 2050! (

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In the first half, Will and Adam discuss the rapid deterioration in consumer sentiment and how it is cutting across both economic and political divides, albeit to differing degrees. Some sentiment indicators, especially concerns over job loss, are at levels normally seen during a recession, in part due to the uncertainty over tariffs with large trading partners like Canada. Another concern is spending cuts. We look past the headlines to see that cuts have not yet taken hold, though with 85% of job growth in 2024 attributable to government spending, we could be in for a volatile transition period as a result of the “detox” the administration is seeking.   In the second half, we look at the recent (albeit brief) market correction, and put it in historical context: Since 1980, the average yearly decline for the S&P 500 has been 14%. There have been about 117 10% corrections since 1928, so around one per year.   Statistically, a 10% correction turns into a bear market around 25% of the time, and that normally occurs when the economy dips into a recession. The rest of the time, the market recovers in about eight months, on average. Although modest, the 10% correction is equivalent to 12% of GDP. That type of hit to wealth has contributed to a recession in about half of the prior 12 occurrences. With the Magnificent Seven, on balance, lagging this year, we look at the prospect of a broader market showing the benefits of diversification, not to mention the strong start to the year for non-U.S. stocks, which have been buoyed by the shift in spending priorities in both developed and emerging markets. Learn more about Formidable Asset Management, Will Brown, and Adam Eagleston by visiting www.formidableam.com.

In this episode of the IC-DISC Show, I sit down with Brian Schwam to discuss how Interest Charge Domestic International Sales Corporations (IC-DISCs) can help businesses save on taxes. With over 35 years of experience, Brian shares how IC-DISC has evolved since 1972 and why it remains a valuable tool for U.S. exporters. He explains how businesses, particularly in the aerospace industry's Maintenance, Repair, and Overhaul (MRO) sector, can take advantage of this incentive to improve their financial position. We walk through a hypothetical example to illustrate how an exporting business could benefit from IC-DISC. Brian explains how companies involved in manufacturing, repairing, or trading parts can qualify and why many eligible businesses overlook this opportunity. We also discuss the annual MRO conference in Atlanta, where industry professionals gather to share insights and best practices. This event highlights the ongoing impact of IC-DISC within the aerospace sector and beyond. Despite the clear benefits, many businesses hesitate to implement IC-DISC due to a lack of awareness or expertise. Brian talks about how our firm partners with CPA firms to integrate IC-DISCs into existing tax processes, making it easier for businesses to take advantage of these savings. He also highlights the underutilization of IC-DISC and why more companies should consider it as part of their tax strategy. We wrap up by discussing the upcoming MRO America's Conference in Atlanta, where exporting aviation maintenance companies can connect and learn more about IC-DISC applications. Whether you're new to IC-DISC or looking to refine your approach, this conversation provides useful insights for businesses considering this tax-saving opportunity.     SHOW HIGHLIGHTS In this episode, I discuss the intricacies and benefits of Interest Charge Domestic International Sales Corporations (IC-DISC) with tax attorney Brian Schwam, who has over 35 years of experience in the field. We explore the historical context of IC-DISC, including its origins in 1972 and the significant changes it underwent following international scrutiny and U.S. tax reforms, such as the 2003 Bush tax cuts and the 2017 Tax Cuts and Jobs Act. Brian provides insights into how IC-DISC can serve as a valuable tax incentive for U.S. exporters, particularly those in the aerospace industry's Maintenance, Repair, and Overhaul (MRO) sector. Through a detailed hypothetical example, we illustrate how companies can leverage IC-DISC to maximize export profits, highlighting specific benefits for pass-through entities and closely held C corporations. We address common apprehensions businesses face regarding IC-DISC implementation and discuss how collaboration with CPA firms can facilitate a seamless integration into existing tax processes. Despite the clear benefits, IC-DISC remains underutilized, and we emphasize the potential missed opportunities for businesses not taking advantage of this tax-saving strategy. The episode also covers upcoming industry events, such as the annual MRO conference in Atlanta and the ICDISC Alliance Conference, which offer valuable networking and professional growth opportunities.   Contact Details LinkedIn - Brian Schwam (https://www.linkedin.com/in/brian-schwam-b6026a3/) LINKSShow Notes Be a Guest About IC-DISC Alliance About WTP Advisors GUEST Brian SchwamAbout Brian TRANSCRIPT (AI transcript provided as supporting material and may contain errors) Dave: Hey, brian, welcome to the podcast. Brian: Thanks, dave, good to be here. Dave: So where on planet Earth are you calling in from today? It's hard to tell by looking at your background. Brian: Outer space. I am in the sunny South Florida. Dave: Okay. Brian: Breezy, south Florida, okay. Dave: Now are you a native of Florida. Brian: I am not a native of Florida. I spent 50 years of my life in the upper Midwest in Wisconsin. Okay, I had to move to Sunbelt. Dave: Okay, Now were you educated in the Midwest then too. Brian: I was. I'm a proud alum of the University of Wisconsin, both for an undergraduate degree in accounting and also my JD from the law school Okay. Dave: So you've and I take it and I've known you a while, so I think that's been several decades ago that your career was started. Is that about right? Brian: Several would be a good good approximation. Yes, I've been at this for 38 years. I know it doesn't look like it, right, okay? Dave: And so, and how long have you been involved in ICDISC? Then Most of that time 38 years, oh, 38 years in ICDISC. Then most of that time, 38 years, oh, 38 years in the disc, wow, yeah. So how does that do you know? Do you have any way to quantify that? Like how many you know ICDISC returns you've, you know, signed or reviewed or prepared, or Boy, it's a big number, dave. Brian: It's probably five figures. Okay, probably, so you know, somewhere north of 10,000 for sure. Okay, over that time period. Dave: Well, and that is why I'm glad that you are one of the founding members of the IC Disc Alliance with me that when I had a chance to partner up with you and some of your team when we created the IC Disc Alliance, I was really excited because in my book I pretty much knew all the players in the IC Disc space and once the famous Neil Block retired after 50 years to me you were without peer in the IC Disc space. Brian: So I really enjoyed collaborating with you through the years here in the ICDISC space, so I really enjoyed collaborating with you through the years. Dave: Thank, you for that, Dave. I hope to be able to follow Neil into that 50-year stratosphere. Yeah, that's big shoes to follow. So let's just talk a bit about the ICDISC. What the heck is it? Why does everyone use that silly acronym? Brian: Because what it really stands for is a mouthful. Dave: Okay. Brian: Discharged Domestic International Sales Corporation and that is what the ICDISC stands for, short right ICDISC. And I don't know if we'll get into. I'll get into what the IC stands for and everything. But basically this is an export incentive that's been in the Internal Revenue Code since 1972. Okay, in various forms. Initially it was an export incentive that just about any company could use, that was exporting goods that were manufactured, produced, grown or extracted in the US. It came under some fire from our trading partners and in 1984, it was transformed into the ICDISC. It started out just as the DISC in 1972 for the Boston International Sales Corporation and it, like I said, came under scrutiny. Our trading partners said hey, you're a, you can't have an exemption from income because you're not. You know you tax things differently in your country. This flies in the face of the other incentives you give your taxpayers. So they changed it into the ICDIS, which made it into, instead of a permanent tax savings, at least on its face, into a temporary savings where, to the extent a taxpayer saved tax and deferred income from tax, they were required to pay an interest charge to the IRS on that deferred tax. Hence the IC. Dave: Okay, okay. Brian: That rate changes every year. It's based on the one-year average TBLO rate as of September 30th annually. And at the same time they instituted something called the Foreign Sales Corporation, which was widely used by thousands of companies, and that came under attack and eventually became the extraterritorial income exclusion which was immediately attacked and eventually, a couple of years later, it just went away. In the meantime, the disk floundered for quite a number of years. In fact, in the year 2000 there were only 787 disks in existence. Dave: Wow, it seems like a shockingly small number. Brian: Well, the tax laws weren't real conducive to benefiting from the disk at that time. Then, in 2003, the Bush tax cuts brought in the concept of qualified dividend income and it took the disk off of life support and really put it on robust territory for pass-through entities, because they could now, to the extent that they could qualify and we'll get into that, to the extent they could qualify and to the extent that they could benefit it provided a 20% rate benefit between ordinary income and qualified dividend income, so it was a significant savings. Now that's been whittled away over time, where it's been reduced here and there. Various tax law changes and probably the largest or the next biggest reduction came in in 2017 with the Trump tax bill, the Tax Cuts and Jobs Act, which reduced the rate on qualified income on non-qualified income. So it reduced the rate on S-corp income partnership income in an individual's tax return to a 29.6% level, and so now the spread between the qualified dividend rate and the ordinary rate just isn't as great as it used to be. It's approaching 6%. So where it used to be 20, then it went to 15, and now it's 6. But it's still a permanent savings for these past three entities and it's not something that they should ignore, because it can save significant taxes, depending upon the level of export activity. Dave: Okay, and now to be clear, depending on a company-specific fact pattern, that spread could be greater. Right For a pass-through. It could be as high as what like? Brian: 13% or so For a pass-through it could be as high as what like, 13% or so For a pass-through business. Dave: It could be as high as 13.2%, okay, but in general we see that it and it could even be somewhere between that, depending on. Brian: Anywhere in between 5.8 and 13.2. Dave: And our experience has been that most companies tend to gravitate more toward the lower end of the savings than the higher end. Brian: Yes. Dave: Yes, okay. Now what about for a C-Corp? Brian: C-Corp is a different animal. Okay, a C-Corp can't use an disc to pay deductible dividends to its owners if it's a closely held C corp. This is not something that a public company can benefit from. But if a closely held business C corp is paying dividends to its shareholders and would like to be able to deduct those payments, rather than not being able to deduct those payments, using an ICDIS can transform the dividend into a deductible dividend. Now, it doesn't save the shareholders any tax, because they're paying tax on the dividend regardless of where it comes from, but it would eliminate the corporate level tax on the C corporation, so that benefit could be as high as 21%. Dave: Okay. Brian: Okay, another manner in which certain C corporations use the disc is to fund bonuses for shareholders and key employees, and then that saves the shareholders 17% tax the difference between a tax on a wage and a tax on a dividend, qualified dividend. So that's a 17% savings for the shareholder. In that case the C-Corp doesn't save any tax. They're getting a deduction either way wages or commission to the disk. And now that I've mentioned the word commission, that's probably a good segue into how does a disk earn income? Yeah, and what is its income? So most discs are what we call commission discs. They earn a commission when a operating business that's related to that disc makes an export sale of qualified export property. So let's dig down into that first. What's qualified export property? Well, that's property that has been manufactured, produced, grown or extracted in the US. So if I'm manufacturing in Mexico or Canada or China and I'm simply selling what I've made in those other countries, you know the disc is not something that's going to benefit that type of a business. Dave: Okay. Brian: It is there to spur US manufacturing, create US jobs, right in line with the America First proposition that's headlining Washington in 2025. Dave: Okay. Brian: So it should be on safe ground, everything that's going on there. So if a company has property that's been manufactured, produced, grown or extracted in the US and they sell it for export outside the United States and not to a US possession, then that sale can potentially generate an ICDIS commission that would be paid to the ICDIS. And keep in mind this ICDISC is not an entity that the outside world sees or understands or knows about. It's simply an entity that does business, if you will, internally with the operating company, so customers don't know about it. It's really transparent to the world. It's just there to help US exporters save tax. Dave: Okay, it's just there to help US exporters save tax. Okay, and the logistics of it. Like say a company has just for simple math, let's say they have $10 million of export, of qualified export revenue, and the ICDIS commission that's calculated to say 10% of that. Brian: Okay. Dave: So 10% of that would be a million dollars, and so walk me through kind of the that's correct and it accrues the deduction, assuming it's not a cash basis taxpayer. Brian: It accrues that deduction at the end of the year, the DISC accrues the income at the end of the year and then by statute the DISC does not pay income tax. So now we've gotten a deduction on one side, we have non-taxable income on the other side and then when the disc pays a dividend to its owners, that becomes a qualified dividend and is taxed at a lower rate. Dave: Okay, so then, effectively, that million dollars gets reclassified from being taxed at ordinary dividend rates to qualified dividend rates. Brian: From ordinary income rates to qualified dividend rates. Dave: yes, Yep, thank you for that. And where that shows up for a pass-through is going to be on the individual shareholders, k-1, right. That box up near the top that shows ordinary taxable income would basically go down. Let's say there was one shareholder, that number goes down by a million dollars. And then there's a box further down on the K-1 for qualified dividend income and that's where the number's being shifted to right. Brian: Right. Assuming the disc is owned by the operating company, which most of the time it is in the pass-through business context, then the ordinary income gets reduced on the K-1 and the dividend income will increase on the K-1, not necessarily in the same year, but that will be the result over time. Dave: And then that tax savings then will show up on the individual shareholders. 1040, right, because their ordinary income line is a million dollars less. The qualified dividend income line is a million dollars more, and that's where that arbitrage. Brian: They pay less tax if they're getting a distribution from the company to cover their taxes, which is often the case, the company doesn't have to distribute as much cash, therefore increasing the working capital of the business. Dave: Okay, well, thank you. Thank you for that. Now, what I want to drill down into a little more today is looking at the aerospace industry, specifically what's called the MRO space in aerospace. Do you know what MRO stands for? Brian: I believe, I do, I believe maintenance, repair and overhaul. Dave: That's my understanding as well. Brian: That's a significant area in the aviation space. Dave: yes, Okay, and I believe that there's a big conference in Atlanta in April with like something like 17,000 expected attendees. Brian: Yeah, just a small gathering. Dave: A small gathering. Brian: For sure. Yes, that's my understanding as well. In fact, I'll be there. Dave: Yeah, I believe we'll both be there, yeah we'll both be there A few of our colleagues. Brian: Yeah, so it's a one a year significant gathering of companies that operate in this MRO space, supporting airlines and other aviation companies, and basically MRO is important because it keeps planes able to fly. Yeah, and we actually have a booth there. Dave: Yeah, and we actually have a booth there. 1818 BC and it makes it sound like it's a date from a long time ago. But yeah, we'll be there and this will be our first year in attendance or exhibiting. And this has come from, in recent years, I'd say, a big ramp up in the number of MRO companies who we are helping with their IC disk. Is that right? Brian: Yeah, absolutely. In fact, one of the sponsors of the conference was a company I was doing some work with and I asked them if he thought it would be a good idea for us to attend, and it was a resounding absolutely that he thought that we could meet a lot of companies that could benefit from this ICDISC similar to his company. Dave: Okay. What are the elements in the MRO space or the characteristics of the companies that make them a good fit for the ICDISC, because my understanding is it's probably only one out of a hundred of like all the registered corporations in the US are really a fit for the disc. Brian: Yeah, so it takes a specific fact pattern to really benefit. So the companies in the service side of the business so let's say they're carpet cleaners or something to that nature they're not going to be able to benefit from the disk. But let's say it's a repair center and airlines will ship in parts to the repair center because they've worn out and they need it. They need a replacement part so that they can fly this plane. So what happens is maybe the repair center takes their part and repairs it, but they previously repaired another part that's identical and then to the customer and that plane gets back in the air right away. So in that scenario, even though it's a different part that's going back out versus what was coming in, that type of activity qualifies as long as what they're doing qualifies as manufacturing and that repair is occurring in the US. Dave: Okay. Brian: Then that type of a company could definitely benefit Other companies. I don't want to use this term, but it's kind of like horse trading. Sometimes companies will buy a surplus of parts, knowing that eventually they're going to be used by somebody and they hang on to these parts, or they find them from somebody who says I don't want these parts anymore, I haven't been able to sell them. So they take a flyer, they take a risk and they buy these parts and they hang on to them and maybe they sell them at a significant profit and maybe they don't. But there's that space as well that can benefit from the disc, and there's some misconception out there that some of the companies that are similar to what I just described can't benefit from a disc, and so, for example, if parts are obtained outside the US, they stay outside the US. They stay outside the US and they're repaired, recertified and resold. Those aren't going to qualify for the ICBITS. But sometimes parts are acquired outside the US and they're brought into the US, they're repaired, put it back into inventory in the US and then sold for export, and that activity does qualify for the ICs, and so it's very important to know where this refurbishment or remanufacturing is taking place. Dave: Okay and yeah, and there's a US content piece to it, right, like if they buy a part from China and all they do is they just put a little lubricant on it and throw it in a box. Brian: that may not qualify and then they export it. The test is what's the customer's value when that part comes into the US. So if it's a burned out hot engine part, for example, yeah there's no value or very little value and it comes into the US, its customers value is close to zero. It gets repaired, it's going to easily meet the content test and it's easily going to be considered manufactured in the US. It's rare, I think, that we'll find that somebody will buy a new part from outside the US just to inventory it here for export. Dave: Okay, yeah, because there's that it's a 50% US content test, right which? Is also, I think confusing on the surface if you don't really dive down into the rules, right, I mean, the layperson may find it. Brian: How do you know what's 50% US content? Well, the cost of good, I mean. Think of it the other way. The foreign content can't be more than 50%. And the foreign content is the cost, the customs value when it was imported. So if I'm selling something for $100, I imported it for as much as $49.99. That's going to qualify as long as I did something, you know, remanufactured it once it got to the US and once it got to the plus, more often than not, I think the value of those things coming in because they're used and worn and damaged parts, they're going to have a low customs valuation where there'll be no problem meeting that content. Dave: Okay, I can see that. Well, I find and my listeners tell me they really like kind of case studies, little mini of case studies, little mini, you know, client case studies On an anonymous basis. Do you have an example or two of some of the types of companies we've worked with, just to give people a flavor of them and, again, you know, being anonymous to you know? What company it is, but just a sense of like the sense of the size of the company, what the benefit might have been. Brian: The size is sort of across the board, right. So some of them are someone on the smaller side. They might have export sales between $5 and $10 million, and then some of them might have export sales of $100 million. It all depends on the size of their business and the benefits are kind of all over the map. Because we don't just do a simple calculation of the benefits. And the reason we don't is because in this industry what we find is there's a lot of margin variability in the companies that are exporting, and then a transaction-by-transaction analysis of the disk commission is what makes the most sense. That allows us to benefit from the margin variability, allows them to benefit from a higher disk commission and obviously then they're going to save more tax. And in some cases the commission grows by 10x by using the T by T. Sometimes it's two or three x, sometimes it's. You know, I've seen you know where it would have been zero because there was an overall loss in the company, but we were able to get a significant discommission with a T by T approach. So it's hard to pinpoint an exact number, but generally speaking it's 15 to 20, you know the commission ends up being 15 to 20% of sales. And if you look at the statutes, one of the statutes says oh, the commission can be 4% of sales, and another implies that it could be anywhere from 4% to 10%, but we generally see in this industry at least 15% on average. It's significantly higher. Dave: Yeah, and I'd like to drill down into that because I tell, and based on my understanding, we may manage more IC disks than any other organization of the country. I mean we I think our number is somewhere north of 500 companies now that we're helping out, and when I'm having these conversations, you know. So I'm, as you know, I'm more focused on the sales side. You know, and you and your team are more focused kind of on the technical aspect of producing these returns, and what I tell people is that our real value isn't being able to produce an IC disk return. Our value is the incremental benefit that the transaction by transaction calculation yields. That the transaction by transaction calculation yields. Because you know just about any any cpa firm you know most of them their software includes the ic disk return. You know, if they just go do a four percent calculation, it's a, you know, reasonably straightforward calculation. But we find that you know they're capturing only a fraction of the total benefit. Brian: That's true, and while I've seen a good number of interesting looking disc returns, I tend to agree that if you follow the directions, anybody can probably prepare a disc return. We do that as well. That's not where we add the most value. Where we add the most value, adding the value comes in unlocking the highest commission possible so that the tax savings are as great as possible. Yeah, and a lot of businesses that are high margin I'm sorry, low margin high volume businesses. When you look at the disc, on its face it looks like oh, there's not much benefit here, we're only making 2% or 3% of sales on our bottom line. So our disc commission would be 2% or 3% of sales. But, like I said, with the transactional approach, if the commission approach is 15%, well now we've taken the company into a tax loss which could potentially save additional taxes for the owners over and above that 5.8%, because now we're offsetting that loss against other income wages, interest, et cetera and being taxed just on the qualified dividend income of the disc. And so you can't just look at the overall margin or overall profitability of the company and project what that, what it's going to look like, Because they vary all over the place. Dave: Based on this transactional approach, yeah, and I would like to talk a bit about. Oftentimes, when I'm talking to a company that's considering a disk, oftentimes they've never even heard of it. Their CPA firm may not have even mentioned the idea. And they'll say, and they'll ask me hey, does this mean my CPA, you know, screwed up by not telling me about it. In my response, you know I try to be generous and I explain it that, look, you know, in our experience only about one out of 100 companies are a candidate. And so let's just say you have a large local CPA firm and they have 100, you know midsize corporate clients. Statistically we find that only one of them, you know, would be a fit for the disk. And your experience may be a little different, you know, feel free to correct me. And so when you think about it from the CPA's perspective, if there's a special part of the tax code and they only have one client that benefits, it's a difficult economic dynamic for the CPA firm to invest in a whole team and expertise to serve one client, right? Isn't that like part of the challenge that the and I know you've worked at a number of large CPA firms Is my understanding correct? That's part of the problem is just their clientele. There aren't enough of them. That makes it worth doing yeah. Brian: Yeah, I think that's a fair characterization. I might phrase it a little bit differently. I mean, there are thousands of CPA firms and they're all excellent generalists. This is not an area where you can be a generalist. Cpa firms often outsource R&D, tax credit work, cost segregation work. This, to me, falls right in that same category. You don't want to dabble in this, and if you're not sure what you're doing, you can get you and your client in trouble. Have good intentions, but if you don't execute it properly, it can be more of a headache than it's worth. And so, like most people, I think people gravitate towards what they know and understand, and things that they don't know and understand can look and sound scary. Dave: Yeah. Brian: So it's like, oh my God, an IC disc. I've never heard of that. I'm not sure I can bring that to my client because I don't really know what I'm doing. Well, I wish I knew somebody I could call to him. He's not a competitor right who could help me through this and help my client through this, and so that's really one of the reasons why we exist, because, as you stated, you don't want it to be a competitor that you call, and so, because we are so hyper focused on what we do and we don't do the things that I'll call the cpa's generalists, that the generalists do, we're an excellent partner because we're not looking to take away anybody's tax return or any of the other type of work that the CPA might be doing for that client. We just want to play in our space. Dave: Yeah, sometimes I'm sorry. Sometimes you know clients or potential clients will say, yeah, but you know our CPA firm does. You know all of our work. It's a one-stop shop thing and I'm afraid having you do the disc return and then doing the corporate return yeah, but our CPA firm does all of our work, it's a one-stop shop thing and I'm afraid having you do the disc return and then doing the corporate return it's just going to be a nightmare for you all to coordinate your efforts. It just sounds like too much trouble. What would your response be to that? Brian: My response is I work with over 500 companies. Generally we do the disk work for those companies. The regular mainstream CPA does everything else. We coordinate our work with that CPA and it's never a problem. We say, look, we're going to need X number of days to turn this around, so please have a draft of the operating company return by a particular date, and then they work towards that date. They give us the return, we get data from the company and we turn the number around so they can finish their tax return and then we go ahead and finish the disc return and I would say 99.9% of the time it works like we're all part of the same thing. Dave: Yeah, because really the CPA they prepare that final draft corporate return. They then pull two numbers from the disk return that goes into the corporate return and then they're done, basically right. Brian: And they're done and they can go ahead and finish up their disk return, I mean their operating company return and their state returns and everything. And then we just have to get the disc return done. And sometimes you know they file their tax return in april and you know the disc returns aren't due till september. So one might say, oh, you could just sit on them until september. But you know, we try to get them done at the same time. Sure sure Everybody can rest easy. But I mean we think of ourselves as a bolt-on resource to that CPA firm while we're working with that and we work with probably 50 to 75 CPA firms around the country in that role- yeah. It works well. I mean, you can talk to any one of them about what it's like to work with us, and I'm sure you'd get a glowing recommendation for how we work with them and for their clients. Dave: Yeah, no, I'm with you. So, as we're nearing the end here, the other thing that people find interesting you'd mentioned in 2003, there were 700 IC disks under 1,000. Yeah, 787. And then, according, if my recollection is correct, the most recent IRS stats that updated that were published, I think, in 2010. And I believe in 2010, there were like 2000 disks. Brian: Yeah, something like 1926. Okay, To be exact, and that number I'm sure has grown dramatically since then. I would guess there's somewhere between eight and 10,000 disks out there now. Okay, yeah. Dave: Yeah, now what's interesting? This is what people find interesting. I believe there's about 50 million business organization, you know business entities in the country, and so let's just assume that's the number, 50 million. Brian: I mean it's tens of millions. Dave: I'm certain of that. For some reason, I think it's 50 million. Does that sound reasonable? Brian: It does so let's think it's 50 million, does that? Dave: sound reasonable. It does. So let's say it's 50 million and on your average, you know we find around one out of a hundred. You know, maybe one out of 200 companies are fit for the disc. So if we run through the math, you know one percent of 50 million, I believe, is 500, 000. You know approximate companies that we think would benefit from a disc. Yet most recent stats, there's only 2000, you know, and maybe it's 4,000, 6,000, you know. Even, let's say it's 10,000 that exists now. So if you divide 10,000 by 500,000, what is that? Like 2%, I think, of the projected eligible company actually have a disc yeah, and people can't. They always are surprised by that and I usually tell them it might. And tell me if your numbers are consistent. I say about 100. One out of 100 benefit or could benefit. The ones who could benefit 90 percent of them have never heard of the disc, maybe 95%, and the 5% of the 1% who have heard of it, even once they hear about it, they usually haven't implemented it. Brian: Right. Then there's a percent that have implemented it. They're not getting out of it what they can. Dave: Right right. Brian: So it's so. There's a lot of missed opportunities by taxpayers and everyone's always trying to save some taxes. It helps fun, you know. It might help hire another employee might help, you know, if the savings are moderate and it's 50, 6070, 1000 of tax savings that still could pay for an employee to come work at the company. Why do? Dave: you think that utilization is so low? I mean because it'd be shocking if only 2% of the companies who did research and development took advantage of the RMD tax credit. Brian: I think it's just not well known. I mean it's very esoteric, it's been in the tax code for ages and ages and it just doesn't you. You know, there were so many years where it just wasn't relevant when you think that it's not something people think about. And then if you know, if you're a small exporter and you're exporting a half a million dollars a year a million dollars a year unfortunately it probably doesn't benefit you to have a disc and so maybe someone will look at it whether that size and they're like, oh yeah, it doesn't benefit you to have a disk and so maybe someone will look at it whether that size and they're like, oh yeah, it doesn't work. And then they grow and they forget that it might work once they've grown. So once a company hits about three million of export sales really should look at it again, because that's where it starts to have economic relevance that's where it starts to have economic relevance. Dave: Do you think some of it could be that? I mean, in general, public companies don't use disks, right? Brian: They just simply don't. Dave: Okay, and so I've found that oftentimes small to mid-sized privately held companies receive a lot of their sophisticated business knowledge from their Fortune 500 suppliers or clients. You know they'll hear from them about something and you know, like the payroll protection program during COVID, you know I suspect some of those might have heard about that from you know some of their large customers. Maybe that's not a good example, but you know that could be another reason. Right, there's just a dearth of knowledge that the CPAs aren't focused on it because the economics don't make sense. The large sophisticated public suppliers and clients don't use it, so they don't hear about it from them. Right, it's not really in the news, it's just. It just kind of flies below the radar screen, doesn't it? Brian: It definitely does, and that's certainly a reason why it's not as utilized as it probably could be. Dave: Yeah, and it seems like you know most of our, you know virtually all of our clients come as a referral from either an existing client or an advisor who we've worked with other clients you know, like a CPA or attorney or banker. So yeah, it's just a yeah, even though you know the podcast is called the Icy Disc Show. I don't get the sense that I'm ever going to. You know, reach Joe Rogan's audience size. It just seems to kind of fly below the radar screen. Brian: Yeah, and the potential audience is probably a little smaller than Joe's. Dave: Probably Well. So the last thing, the other thing people tell me they're surprised about the first year of the disk return. When they set up a disk is to get everything done. And we tell them the disk return's ready and they say, super good, and e-file it for me, like the CPA does the corporate and personal returns. And what is our response when they tell us to go e-file it for them? Brian: The response is unfortunately, the IRS doesn't provide for e-filing of disk returns and we'll need to send you a paper return. You're going to need to sign it and file it with the IRS and the unfortunate thing there is gosh, I don't know what percent of the time, but it's a growing percentage of the time the IRS loses the return Right and then sends a notice saying, hey, we never filed or whatever. And some of these disk returns are quite large. The fact that they because when you do the transaction by transaction analysis, there's a lot of paper that gets produced and filed and it's shocking to me that the IRS would lose those what they do. Dave: So it's interesting what they do. So it's interesting. I like to say that not only does the ICDISC fly under the radar screen of most everything, it even, in some ways, it's almost like it flies under the radar screen of the IRS itself. Brian: Yeah, and they put some things in place with regard to the ICDISC in 1984 and have never changed it. For example, if you're in the situation where you have to pay interest on deferred tax, which often occurs. First of all, a lot of times taxpayers don't realize it and they don't do it. Secondly, if they do it. It's so antiquated that the instructions to the form where you calculate the interest it says please staple a check to this form and mail it in. I mean, who does that in 2020, right? Nobody. People, businesses prefer to do things electronically to avoid checks being stolen, fraudulent activity, so on and so forth. But here the IRS is saying staple a check to this form and mail it to Kansas City, missouri. Dave: Yeah, and I guess it kind of makes sense that you know if there's only a few thousand of these disks in existence. In the same way, you can't expect the CPA firms to make it a heavy focus, I suppose even the IRS. You know there's a hundred other tax incentives or a thousand other tax incentives that are more highly utilized that you know they maybe are spending their time on. Brian: Yeah, as I like to say, the people at the IRS that understood the disc were working there in the 70s and 80s, OK, and they're long retired. Yeah, and they're long retired. There's really not a lot of bodies at the IRS that understand the DISC and certainly when you're doing a transaction by transaction study and calculating the commission on each individual transaction, there's nobody there that understands that. Dave: Nobody Well, and it's kind of the same thing outside the IRS, right? Nobody Well, and it's kind of the same thing outside the IRS, right? I mean I have this joke that nobody makes partner at a big four firm being the IC disk expert. Oh, that's true, so it even especially nowadays. Yeah, and so it seems like like the average age of IC disks experts is about the same as the average age of the average Fortran computer language programmer. It just seems like you know new people are not coming into the disk and there's just a dearth of knowledge all around. Brian: Right, right. And I myself learned COBOL, which is a choice between Fortran and COBOL, when I was in business school, both equally non-usable. Dave: Is it part of that? Because since the disk came on in 1972, it seems like since 1973, people have been talking about the IC disk going away. So is that maybe part of it? People think, well, why should I learn something if it's going away? Brian: Maybe part of it. People think, well, why should I learn something if it's going away? There's always been a fear that it's either going to go away or that there's a technical correction coming that the disk dividend is not a qualified dividend. But the bottom line is politically, I just don't see that happening. Dave: It stands for too many things that are positive for the US Job creation export sales for too many things that are positive for the US Job creation, export sales, us companies being more competitive in the global market. Brian: So it doesn't really lend itself to be repealed. What can be repealed are some of the tax rates. Some of the tax rates can change and that can change the benefits of the disc. The concept of the disc itself and what it stands for really is very consistent with our country. Dave: Yeah, wow, I can't believe how the time has flown by, brian. Is there anything else that you want to mention about the IC disc or the MRO industry? Brian: No, I can't think of anything specifically other than I'm looking forward to being there and meeting many of the attendees and other exhibitors that are there and spending some time with you and our colleagues in Atlanta. Dave: Yeah, it will be fun. So it's the ICDISC Alliance. If you want to look us up on the website for the conference or stop by 1818BC. We also have a LinkedIn page for the ICDISC Alliance, and so I'd love to meet with any of you who are going to be at the conference. Awesome, well, thank you very much for your time, Brian. This has been really useful. Brian: You're welcome. You're very welcome. Special Guest: Brian Schwam.

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Lily's VBAC birth story episode is finally here!!! You know and love her just like we do. She not only manages the social media content here at The VBAC Link but also spends so much time connecting with you personally. She has the biggest heart for VBAC and champions all types of empowered birth.Lily walks us through her experiences with ectopic pregnancy, loss, her traumatic Cesarean, and how she persisted through a 66-hour long labor without an epidural to achieve her hospital water birth VBAC.If you followed her pregnancy journey, you saw that Lily was incredibly proactive during her pregnancy. She built the strongest team of birth and body workers. She was specific in her desires, yet remained open-minded. This served her so well in labor and made all the difference during her birth!Needed WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, everybody. You guys, today is a very exciting day. We have recently had two of our VBAC Link team members have their babies. Paige was one with the first Maternal Assisted Cesarean in Korea, and today is the second with Lily. Oh my gosh. If you guys have been on our social media, you have seen our cute Lily. She is just so amazing. She's so fun. She's in the DMs on Instagram literally every day chatting with you. I just absolutely adore her. She's so incredible. Lily is a born and raised Colorado-- I don't even know how to actually say this. Lily is a born and raised Coloradoan.I think that is how you say it.She's from Colorado, living in northern Colorado with her husband, son, and daughter. She is a kinesiologist who works in community health and a dual-certified fitness instructor passionate about movement and wellness. After an unexpected Cesarean two and a half years ago, Lily found The VBAC Link and began planning her VBAC and is excited to share her story today. I cannot wait for you to hear it. This was actually the first time that I got to hear it in its entirety. It's just amazing, and I'm excited for you to hear it. Like I mentioned, Lily is also our social media assistant at The VBAC Link and is truly honored to empower and hold space for all the Women of Strength in our community. You guys, she is absolutely amazing. We love her so, so, so, so much. We do have a review that we're going to share, and then we are going to turn the time over to our sweet Lily to share her stories. This review is by Savannah, and it says, "Started listening to The VBAC Link Podcast around 16 weeks pregnant and continued throughout my pregnancy. It was so good and encouraging for me as a mama who was preparing for a VBAC. It helped me gain confidence, and helped me know what to look for and watch out for in my providers. Hearing other stories was so encouraging and helped me gain so much knowledge. I had my hospital VBAC unmedicated with an 8-pound, 15-ounce baby and I know the knowledge I gained from this podcast played a huge role in being able to advocate for myself and get a better birth outcome." Congratulations, Savannah. We're going to talk a little bit about this today as well with Lily on the podcast how sometimes the thought of going to the hospital is scary because of stories you've heard or things you've heard. But VBAC can happen in the hospital, and it can be beautiful, and it is beautiful. I think it always dials back to me to finding the best provider for you, finding the best location that feels right for you, building your team, and doing what is best for you in the end. So I really am so excited one minute after the intro to turn the time over to Lily. Okay, Ms. Lily, I really am so excited because I was even texting you the day you were in labor. I don't really know all the details, but I've seen your incredible pictures. Oh my goodness, your pictures are so incredible, and I've heard a little bit from you so I really can't wait. So let's talk. Let's talk about these births.Lily: Okay. Yeah. So every Cesarean story is what starts us off, so I will go with that. But I'm going to try to be fast because I feel like my birth was really long. I have a lot more to say about my VBAC, but I always try to really honor our story in that before we had our beautiful, amazing rainbow baby boy, we also experienced a miscarriage and an ectopic pregnancy prior to having our son. I lost my right fallopian tube. I always like to be the encourager that you can get pregnant naturally with one fallopian tube. It turns out fallopian tubes are not fixed body parts, so when we got pregnant with our son, I ovulated from the side I didn't have a fallopian tube on, and my other tube was able to come over and grab the egg and sense the ovulation which feels so miraculous.Meagan: So incredible, so incredible. I love that message that you're dropping for our community because I think if someone was in that situation as you know, it could feel very defeating and uncertain.Lily: Yeah, it feels really scary. I remember thinking, "I'm at less than 50% fertility if I've lost one tube," but that's not true. Statistically, it's really pretty equal to people with both fallopian tubes, which is kind of neat.Meagan: Yeah.Lily: After that, I started acupuncture. My sweet friend, Montana, we had been friends for years and she's always been like, "You should come see me." She specializes in women's health and fertility and loss and all the things. I started acupuncture then, and I say that now cause it has continued. I always say I'll never not be a patient of hers ever again because she's the best. I started to do that, and then we got pregnant. we found out we were pregnant on the last day of week of prayer at our church, which was really incredible and just felt like such a tangible miracle. We chose to go with a birth center for our care. We did that because I had a lot of hospital trauma. I just didn't think that a hospital was a safe place for me to have my baby. I'm a big believer that we should birth wherever feels the safest. We went for birth center care and had a great experience at our birth center.We loved our midwives and were really excited for birth. I think I hear so many times as women tell their VBAC stories that often we feel underprepared going into our first birth, and it leads to a cascade. I think I was the birthiest nerd of all. I felt like I was really prepared going into birth. I was excited for it. I had a lot of birth education. I had been a birth podcast listener forever and ever. I just felt really empowered in birth and all the things I was doing, chiropractic care and acupuncture and all the stuff. We did get to 41 weeks, and at my 41-week appointment, my midwives gave me a 3-page-long induction protocol because in our state, we have to transfer at 42 weeks. So it was their, "This is the last-ditch effort when you are 41--", and I can't remember how many days, "we want you to do this big thing." It was a daily schedule. "You're going to wake up and you're going to go for a drive on a bumpy road, and you're going to eat this, and you're going to do this." It was really overwhelming. Meagan: Yeah.Lily: Well, the night before we were supposed to do that protocol, the doula who was on-call at the center was texting me and was like, "Hey, how are you feeling?" I was like, "I don't know. I feel really nervous to do this big long thing." She suggested that I journal out all of my fears about birth and see if that did anything. I journaled all my fears, and I burned it in our kitchen sink. As I walked up the stairs, I had my first contraction. I'm also a huge believer that our emotions play such a huge role in our labors. So I was really stoked that my labor started and all the things. That's the same doula that we had for our next birth too, which is really cool. So yeah, I labored all of that night. It was Friday that I went into labor, that evening. Saturday, I labored. My midwives came and checked in eventually. My doula did come over, did some stuff with me, hung out and helped me labor, did some homeopathy, some emotional release work, and all the good stuff. But my labor was really, really long.So by Sunday, my midwives were like, "Hey, you are super exhausted. We want you to take a Benadryl and try to take a nap." I am a girly who does not take a lot of medicine. So this Benadryl knocked me on my booty. I had six really awful contractions trying to take a nap. After I got back up from the nap, I got back on the toilet which is where I was loving to labor. I stood up because I was like, "Okay, I think maybe things are starting. I'm finally getting a pattern. Maybe I can finally go to the birth center." I stood up, and I checked the pad I was wearing. There was a copious amount of meconium. Not water, but meconium which is scary, you know? I knew right then that I was going to have to transferred. It was thick. It was poop.Meagan: Yeah, yeah.Lily: There was no water stained. It was just meconium. And so I called my midwife, and in her sweet midwife voice, I said, "Do I have to transfer?" And she goes, "It's definitely a conversation we have to have." I was like, "Okay. So, yes." She explained that because of the way the meconium came out, she now thought my son was breech because his butt was right up against my cervix, and it just came right out. Soo she came over. Actually, she wasn't even on call. She happened to live in our neighborhood. She came over and checked me and all the things, and she's like, "Yep, this feels really different than a few hours ago. He's definitely breech. We do have to transfer." And so as we're transferring, in my mind, I know that we're probably going to have a Cesarean. My midwives were really great in that they called ahead and they were like, "Hey, we called ahead. No one's willing to do a vaginal breech delivery, or at least they're not trained in it." But my midwives were also really encouraging that, "If this is something you want to do, you have a right to deny a surgery. You have that right. We will be here in support of that." They don't have hospital privileges. They were out-of-hospital midwives, so they had to transfer me. They could go with me and essentially be that emotional support, but we were still kind of in COVID times, so I had to also choose who I wanted to be in there with me. It was 2022. I just felt so defeated. I was so mad that I wasn't going to get the birth that I wanted. I started screaming through contractions. I can confirm that does make it worse. I was just pissed. And so I opted for a Cesarean. It was really tough. I remember as we were leaving my house, asking my midwives, "I can have a VBAC at the birth center, right? Like, you can do VBACs?" They were like, "Yep, but let's get this baby out first." So I transferred. I had my Cesarean. I think it went as smoothly as it could go. I remember there was this a sweet tech who-- I was just in a lot of pain, and she gave me the biggest hug as they put my spinal in and was stroking my back saying, "This is the last one. This is the last one. You can do this." And it was like, "Okay." There was some tenderness there. But post that was a lot of grief, and I think we've all experienced that and a lot of hard. I never saw the surgeon who did my surgery ever again. None of my follow-ups were with her. It was just some random OB. I was so thankful that I had been at the birth center because I got all of their postpartum care, so I had a couple of home visits and a lot of really tender care from my midwives, which was exactly what I needed. And then I found The VBAC Link. I remember finding it on a walk because I had listened to birth podcasts for years, like I said, and suddenly it was grievous to listen to this thing that I loved hurt my feelings to listen to. It was like, "Oh gosh, I don't want to listen to the first-time mom who had an amazing waterbirth, and it was pain-free." It just was grief. Meagan: Right.Lily: So when I found The VBAC Link, I was like, "This is exactly what I needed. This is stories of women that give me hope and not just that trigger jealousy," which I think is a very real and valid emotion.Meagan: Very, very real. Very real and valid.Lily: It's okay to feel that way, but I remember going for all of my postpartum walks and listening to The VBAC Link and crying through every episode and all of the things. And then, just in that postpartum time, I got back into fitness. I have a background in kinesiology and teach a lot of fitness classes. So I got back to the community and finding that, and then I also got to work here which is so fun a year ago in November which is so cool. I think it's really a cute thing that my year anniversary was in November, and that's when I had her, so how cool that I spent a year empowering other women and also getting to plan my own which was really fun. So if you've ever DM'd us on Instagram, you're probably talking to me.Meagan: Yep, yep. She's in there every day a lot of the day because we get a lot of messages. We really do.Lily: And we want to answer all of them. I want you to feel seen and known and all the things. So if you're getting an answer, you're not getting a robot.Meagan: Yeah, you're absolutely not.Lily: You're getting me or Meagan or Olga or Ashley. You're getting one of us which is really neat.Meagan: Yep. Yeah.Lily: Okay. So then we got pregnant again, eventually. So we had planned to start trying when our son was two. We got pregnant a couple months before his second birthday. And again, it was such a redemptive moment of going from having a really hard trying to conceive to me, a girly with one fallopian tube getting pregnant on accident. Are you kidding me? It's crazy. But it was so great. It was really scary at first. We did have some early pregnancy bleeding. We thought we were having another miscarriage. And at the same time, my dad had his appendix rupture, so he was in the hospital septic while I'm early pregnant bleeding. It was just a hellstorm at first and felt really scary. But I knew that I was going for my VBAC, and that was really grounding. I won't share a ton of this journey. My midwife, Paige, and I were on the podcast earlier in 2024, so if you want to listen to that podcast about finding care, but I'll just quickly cover essentially the birth center that I was supposed to be at that I always dreamed would be my redemptive birth again was the same midwives. Oh, Matilda is grabbing my ears.Meagan: Also, the episode is 342 if you want to go back and listen.Lily: Yes. For midwife stuff.Meagan: Yes.Lily: So essentially, my midwives were amazing and I love them, but the birth center just wasn't in our financial capability. They don't take insurance. This time around, it was just not something that we were able to do. I started my care at the birth center and was really grateful to be there because they really knew my story, so they held me through the worry about miscarriage. And then we ended up having to navigate transferring care, so I interviewed another birth center that was in-network with our insurance that was about an hour away. I interviewed my midwife, Paige, and her practice partner, Jess. I told my husband when we went in to interview them, I was so terrified to like these hospital midwives and that I would have a hospital birth. And I did. I fell in love with them. I think that's so important. One thing I get really frustrated with, I think, especially in the more crunchy birth community is that we are often told that hospital birth can't be beautiful and that you can't have a physiological birth in a hospital.Meagan: Yep.Lily: I'm here to tell you that that's wrong. We have to stop telling women that the place that they feel safest is less than in any way. If a hospital is where you end up, then that is incredible and amazing and that's where you should birth if that's what feels right for you and your baby.Meagan: Yeah. It's the same thing with like epidural versus non-epidural. It doesn't matter. You're not any less powerful or strong or amazing if you birth without an epidural versus an epidural or out of the hospital versus the hospital or a planned Cesarean versus not going for a VBAC or if it goes to a Cesarean.We have to start having more love for one another in our community. Even though it might be something really great for one person, and they believe that, and that's okay that they believe that, that doesn't mean it's right for that next person.Meagan: Totally, totally.Lily: Yeah. So we navigated what hospital care was going to look like. At the time, our hospital was under construction, so they were "letting"-- I put that in quotes-- letting you labor in the tub, but you couldn't deliver in the tub at the time. The tubs were home birth tubs that they were blowing up in the rooms and all these things. But by the end of my pregnancy, the low-intervention rooms were open, and they were supporting waterbirths which I think is so neat to see from a hospital. So yeah, we were really excited. This time, I did more acupuncture. I continued to see my amazing acupuncturist. She's amazing. Montana Glenn if you ever need her in northern Colorado. I did switch chiropractors. Last time, I went to just the chiropractor that I'd always gone to. She wasn't Webster-certified. This time, I did go see a Webster-certified chiropractor. Laura is amazing. That really changed a lot of my pelvic pain and things like that.I was way more active in this pregnancy. With my son, I was working at a Barre studio, and the fitness studio closed about halfway through my pregnancy. I kind of just petered off the train of staying active. But with my daughter, we were able to, I say we because she was there. I worked out until the day before I was in labor. I teach spin, strength, and yoga. It's a combo. It's called Spenga. I was there all the time. I did stop on the spin bike at 34 weeks pregnant because I learned that that's not great for baby positioning, and it can shorten some of those ligaments. I stopped doing the spin bike at that point to be really cautious of position. Speaking of that, I had a standard kind of pregnancy. I would talk with my midwife forever and ever. I came in with questions about my birth probably on day one. She was like, "Girl, you're 16 weeks pregnant. Chill, no." But I had questions, and I would come in every time. I did feel like a first-time mom in that sense because the last time, I had a lot of expectations of I knew what the birth center was going to look like, and I had no idea what a hospital labor was going to look like. How many nurses are going to be in my room? Who's going to be up in my space? What does this look like? How do I do intermittent monitoring and all the things? Paige was great about, my midwife, saying, "Hey, this is what the hospital protocol is. Hospital protocol is not a law. You get to do what you want to do, and we support you in that." She was awesome. At 32 weeks, though, Matilda was breech which was really scary as a mama who had a surprise breech baby. I did all the things. If you want to know all of those things, we have an Instagram Live that is saved on our page of literally the kibosh of things that I did for flipping her. We did flip her. I also saw a bodyworker in town and a doula who's amazing. Her name is Heather Stanley, and she's the breech lady here in northern Colorado. I did some bodywork and stuff with her and worked through emotional stuff and birth stuff. It was, I think, really what I needed. Heather said that in our session, and I kind of rolled my eyes. She's like, "I think sometimes babies go breech because we've got some stuff to process." And I think that I did. I thought I processed. I went to therapy after my Cesarean. I did all the things, but I still had some stuff. I think she was teaching me, like, "Hey, let's work through this now."Meagan: Yeah, I mean, I had the same thing with Webster. He kept flipping breech. I had never had a breech baby before, but I was like, "If I have to have a C-section because you're breech, I've done all the things." I was really frustrated. We'd get him to flip, and then he'd go back. My midwife was like, "We need to stop." And I believe that it was the same thing. I needed to work through some things. He needed to be in those positions during that time for whatever reason. We had to gain more trust in our bodies and our abilities and processing. Right?Lily: Yeah, totally. So yeah, so then she flipped, and it was great. And then I just felt so seen by Paige in all of it, because she knew like, "Hey, when you get to the hospital, we'll check with an ultrasound and double-check that she's still head down because I know that's anxiety-inducing for you." I just felt so empowered with all of our decision-making. It felt like a big partnership. One thing that I struggled with with my son was I was at home laboring for 44 hours. I never got to go to the birth center. What I loved is this time, it was my call when I got to go to the hospital. It was my decision, all of it. Paige was so great about saying, "Hey, this is your labor, and we're here to make this happen." I just think she's such a unique human. I don't think care always looks like this in a hospital for sure, but it can. What if we advocated for what we deserve, you know?Meagan: Just talking to her, I love her. I love her so much, and I one day hope to meet her in person.Lily: She's the greatest human being. I tell her all the time, I'm like, "You're changing the world, and so many women need you." Actually, their practice was at one point so full of VBAC patients that they've had to unfortunately turn a couple of people away because their practice is getting full which is really amazing, though.Meagan: Yeah.Lily: And we need that.Meagan: It's a good thing. Yeah.Lily: Yeah. So super cool. All right, I think we've got labor coming. Here we go. I never felt pressure of when am I going to go into labor or any of that. Paige was super great about, like, "Hey, if you're dilated before labor, that's great. If not, whatever. Most people dilate while they're in labor," and it was just super helpful. I knew that there was no worry about when I would go into labor. There was no worry about just any of that stuff. So it was really nice to just be at peace. That's one of the reasons that I actually loved having a hospital provider because I had a lot of anxiety about transferring from a birth center again. Actually, as I tell my story, I think I would have been a transfer again. I remember them saying that in my initial consult appointment. Jess, who practices with Paige, said, "You know, what's beautiful about hospital care is that we can induce you if you need to be induced, and we have the hospital privileges, and you can have the interventions if you need them." And I did. Spoiler alert, and it was great. I got to 40 and 1. I started contractions around 11:00 PM on Tuesday night. I was already felt like it was such a blessing because I finally had contractions that were normal. I didn't have contractions like that with my son. They started out fast and furious and they were seven minutes apart or less my whole 44 hours. With this, I felt the wave of a contraction for the first time. And I remember texting my doula like, "This is already so redemptive just that I can like breathe through a contraction. This is nuts. This is so cool." There were a couple that I had to get on all fours in my bed and sway back and forth and eventually, my husband like leaned over and he was like, "You need to go to sleep. What are you doing?" I was like, "I'm having contractions." And he's like, "Oh." So it was fun. I texted my doula and just said, "Hey, I think I'm in labor," which was weird for me to say. And again, what's so great is Jessie, my doula, had been with us in our first birth and she's also a VBAC mom. It was just like God had His hands on exactly what we needed and the people that we needed even from our first birth to carry into our second. So on Wednesday, Jesse also lives in our neighborhood now, so that's fun. She came over, and we went for a walk. We did some homeopathy, and she gave me a great foot massage, and then she said, "Okay, hey. Let's try to pick things up a little bit. I want you to take a nap with your knees open." She's like, "We don't have a peanut ball," so I grabbed the triangle pillow from my kid's nugget couch. It works really well by the way. I napped with that between my legs and was able to get things to pick up a little bit. My contractions did get pretty intense, but they were still spread out. She went home for a little bit, and then I took a nap and labored. I went downstairs. We live multi-generationally, so my parents live in our basement in a basement apartment. My niece also lives with us. They have custody of her. My parents have a way cooler shower than I do because they got to customize their basement. I went down and took a shower in their shower which has three shower heads and all the stuff. I was like, "This is like a being at a birth center." So I hung out in their shower. I took a two-hour shower. My mom's like, "Our water bill is going to be insane."Meagan: How did you have hot water long enough?Lily: We have that-- I don't know what it's called.Meagan: Reverse osmosis thing?Lily: I don't know.Meagan: I don't even know. That's not the water heater. Lily: I don't know what we have. I don't know what it's called. Anyway, we did have hot water. Meagan: That's amazing, though. Lily: I was just in there chilling and music on and lights off. When I could get into the mental space of labor, my contractions would come way closer together, and things would intensify. But if I did the advice of living life, it was like they just stayed really far apart. So I was like, "I know that some of this is prodromal labor a little bit because I'm not getting into consistency unless I'm forcing myself to be there."So amongst all of this, my husband is not feeling well. I'm looking at him like, "You seem sick." My husband never gets sick. And he's like, "I'm fine, I'm fine, I'm fine." And I was like, "No, I think that you should go get tested for something." Something in my gut was like, "You need to go in." So he went and got swabbed for the flu and all the things, and he had strep. And so I was like, "See? Good thing that we got you tested." So he started antibiotics right away. And then that night, my sweet doula came and spent the night because Jared was just not up for being a labor support and yay for having a doula because I needed someone to be there physically with me, and I needed that support, but he couldn't be there in that moment.Meagan: Wow, what an incredible doula. I love hearing that. Yeah.Lily: So she came and spent the night, and we did some like side-lying releases, which from my first labor, I knew I was going to hate it. It's just the position that, to me, is just the absolute worst when I'm in labor. It's awful. My doula was like, "Hey, so we should do some of that." And I was like, "No, we're not. I don't want to." She was like, "I think we should then."So we did some of that, and then eventually, she drifted off to sleep. My contractions again, were still staying spread out. They would get close together and then they'd fizzle. But they were intense, and that's what's hard is you think prodromal labor, and at least in my brain, it's like, "Oh, contractions are mild and really far apart," but that's just not how they were for me. They were really intense. Meagan: They can be. Eventually, I went upstairs and took a bath because I was like, "Okay, I'm just going to force them to shut down then." I need some rest. So I went and took a bath upstairs, and got them to slow down enough that I could sleep for the rest of the night.Meagan: Good.Lily: That was Wednesday, and like I said, my labor was long. On Thursday, we woke up. My doula was here with me. We made breakfast, and she forced me to eat protein. Yay, doulas. I had already a scheduled appointment that day for my 41-week or whatever it was. 40 weeks, I guess. We went into the clinic and my contractions were, I mean, maybe 30 minutes apart at this point. I remember we drove all the way. My clinic is 20 minutes for my house. We drove all the way there, and I didn't have a contraction in the car. I was like, "Okay." So we went. I was 4 centimeters dilated and 90% effaced. I did ask for the membrane sweep, but I asked for the cervical check. Not one time ever did I get a check that was like, "Hey, we should check you now." It was like, "Hey, I want to be checked now."Meagan: Yeah.Lily: It was so empowering. So 4 centimeters. She was like, "You know what? You're doing it. Yes, prodromal labor, sure, but also, your body's making progress. You're doing something."Meagan: But also not prodromal. It was a prodromal pattern and acting that way, but progressing. So, it was on the cusp.Lily: Yeah. It was weird but encouraging to hear that, okay. I've done a day and a half work. Yeah. But at this point, I'm like, ticking in my brain, like, "Okay, how long has this been?" Because my first labor was 44 hours, and I was 10 centimeters when we transferred to the hospital. I had told myself my whole pregnancy, "I can do anything as long as it's less than 44 hours." It was not. It was not. Spoiler alert. So we went home, and then my sweet chiropractor actually lives in our neighborhood. I texted her and was like, "Hey, I don't know if this is a positional thing. She feels really low and engaged, but can you come adjust me?" So she came and brought her table to my house and adjusted me. She did this thing called adductor stripping.Meagan: Oh.Lily: And so I had done an actual membrane sweep with my midwife, and then my chiropractor took her knuckles and went on my inner thighs and pushed all down. It hurt so bad.Meagan: I'm doing it to myself barely, and I'm like, oh.Lily: It was awful. But she was like, "This is the big hip-opener thing." So we did that. She even taught my doula how to do it. I looked at my doula and I said, "You're not doing that to me. So glad you learned you can do it to another client, not me." My doula went home again. I got back in the shower and was moving around. And at 4:00, I decided like, "Okay, I'm exhausted. I am ready for a change." I am the type of person who likes to go somewhere and do something. It's part of why I didn't ever feel like a home birth was the right option for me because I know that I get stuck in a space. I like the idea of going somewhere to have my baby. It felt like a good change. So I was ready, but I wasn't having contractions that were there. And I was like, "I also don't want to go to the hospital and be stuck there for a million years." So I decided to go upstairs and put myself into labor. I'm like, "Okay, I'm doing this." I turned off all the lights, and started to labor, and my mom came up and gave me a back massage. It was also cool to see her shift because in my first labor, she was super anxious. And then in this labor, she was really trusting of my process and was more just like, "Hey, what do you need?" So she gave me a really big back massage, and I listened to music, and I finally got my contractions to six minutes apart. I texted my midwife and I said, "If these stay this way for an hour, I want to come because I am exhausted. I'm ready for a change. I need this." And she's like, "Great, awesome. Let me know. Keep me posted." So I did have some bloody show, and I thought maybe my water broke. It had been an hour, and I was like, "Hey, we're going." My mom had just made dinner, so I'm scarfing meatloaf on my way out the door. Great last meal.Meagan: I love it.Lily: And then we head to the hospital. I got to the hospital, and I was 4.5, maybe a 5. So again, earlier that day, I had been a 4. So I had made a little bit of progress, but not a ton. But Paige was great. She's like, "Great, you're here." What I love about their practice is their direct admittance, so you don't have to go through triage and have some sort of evaluation to decide if you're supposed to be there or not. She was the one who made that call, and we made it in partnership with each other. I was like, "I feel like I need to be here." She's like, "Great, you're here."Meagan: Yeah.Lily: And so I chose no IV and to do intermittent monitoring which will come up in my story in a little bit, but that's kind of where I was. We started to fill up the tub, and I was laboring in the tub, and then I started to get nauseous and throwing up and all the things. In my head, I'm like, "I'm in transition. This is very transitiony." I'm watching as the baby nurse comes into my room and starts to set up the bassinet. I'm starting in my head to tell myself, "I'm so close. I'm in transition. This is happening." And as I talked to my doula afterward, she was like, "Yeah, we all thought you were in transition, too, dude. You were in it." I started to get frustrated and say, "I want to push." Not that I felt pushy, but I was just like, "I want, again, a change. I want to have a baby." And so I asked for another check, and I was 6.5 centimeters. I cursed so much, and I was like, "I just want to have my effing baby." I screamed that so loud. My poor, sweet doula and midwife. They dealt with my sass, and it's like my body knew, "Okay, we're defeated now." Everything shut down. My contractions spread apart to 20 minutes apart again. They had been 5 minutes. My mental space was not ready, and my body was like, "Okay, we're going to rest." Meagan: Yeah. Lily: And so I get out of the tub and dry off, and we decide that I'll do a little bit of pumping. My midwife put some clary sage all over my belly, and she does try. I asked to rupture my membranes because we thought maybe they had not ruptured when I thought they did. She was like, "They're definitely intact." She goes, "Nice protein intake girly because these are hard, and I can't rupture them." She's like, "You have a really strong bag of water." And I said, "Thanks, Needed, for all of the amazing collagen that I took."Meagan: I was going to say, collagen protein right there.Lily: I'm terrible at protein intake, so really the collagen from Needed was one of the strongest ways I got protein in during my pregnancy. So pat on my back for my protein intake and things to need.Meagan: Very, very good job. Very impressive. Well, because really, a strong bag of water, it is hard to get that protein and that good calcium in. It really is. To the point where she can't even break it, that's pretty cool. Pretty cool. Good job. Lily: Yeah. So then at this point, it's later in the evening, like 9:00 or 10:00. And so I started to just be exhausted. I started falling asleep between contractions. My doula is like, "We're going to wind down. Let's turn the music just to instrumental. I'm going to go take a nap." Our birth photographer is napping on the floor. Paige goes and takes a nap, and they tell my husband to curl up next to me.That was such a sweet moment of disc connection that I needed of, "This is my person and we're here. We're doing this together." We snuggled up on the bed and got through contractions together all night long. I did at one point ask to try the nitrous oxide because, in my head, that was the only pain relief that I could think of that was available to me in this low intervention room because the way that the hospital works is if you're not going to have a waterbirth, if you decide to get an epidural, they will transfer you out of this room because there are two of them, and at that point, you can't use the tub. So I was like, "Okay, I think nitrous might be my only option." So I tried that. It sucked.Meagan: You didn't like it.Lily: She was like, "You know, it's really not helpful for people that are coping with contractions well." And she said the same thing when I started asking about an epidural later on. She was like, "You're coping well, and you're relaxing." These types of things can be really helpful for people that are in the fetal position in between their contractions, but you're not, so it's probably not actually going to help because you're already relaxed. All it did was make me feel a little dizzy,  and then I was like, "Well, this is silly." I got in the shower again there. It was not as good as my parents' shower, so I did get right out of the shower. It was very cold. And so the next morning, now it's Friday. So reminder, labor started on Tuesday. Meagan: Tuesday, Wednesday, Thursday. Now we're here. Lily: Thursday morning. And so Paige comes in, and we had a really long talk about options. At this point, I am mad, and I'm just feeling like I can't do it. I keep having contractions and saying, "I can't do this anymore. I can't do this anymore. I can't do this anymore." In my head, I'm like, "Well, at least I'm going to get a VBAC. Hopefully, I can get an epidural," and then rest and those stories. I'm trying to be really open-handed because I think that's what you have to be in birth is really surrender to the process. Paige comes up with this idea to do some therapeutic rest to which I had never heard of before. I think I was texting you during this and I was like, "What is that?" She's like, "We can give you some morphine. You can either stay here at the hospital or you can go home, and hopefully, you'll nap for 4 or 5 hours. Typically, people wake up in active labor." I was like, "Sweet, sounds awesome. Give me that nap." My doula was like, "Why don't we go for a walk, first? Let's remind ourselves that it's daytime. Let's go on a walk. We'll talk about it together, and then we can come up and do our next steps." So we went out for a walk in the parking lot of the hospital. It was cold, and I threw up a couple of times. Yay. I was like, "I think I really need this. I can't continue to do this without any progress." She's like, "Great, I'm excited for you." So we went up, and they put an IV in cause I didn't have an IV. What was great was that the hospital staff was so accommodating. I was really nervous about nurses being like, "Hey, we don't like this," or whatever. Paige was also great about choosing my nurses to be the ones that are going to be more supportive. But they put an IV in. They gave me the morphine, and then they took it out. I didn't just then have an IV.We did that, and then we decided we would break my water and try to get things progressing. She did end up being able to break my water because I could sit still. I was way more relaxed with the morphine. It was supposed to be a 4-hour nap. I woke up 20 minutes later. We had sent my doula off to go run errands thinking that we had hours. I wake up 20 minutes later with really intense contractions that are peeking through the morphine, and they're super close together. I was like, "Well, crap. Let me call my doula back and get her to come back." And so that really picked things up again. It was kind of discouraging because I was expecting to get to rest, and then to have intense contractions again was like, "Oh gosh, okay. Here we go." But we did it. We labored the whole day doing that, but my contractions would never get closer than 5 minutes apart. They would stall out at that space. At 2:30ish, I asked about morphine again because I was like, "Can we do that again? If that was an option, can we try that again?" The nurses were like, "Hey, we actually think maybe you should just do some IV Fentanyl." My older brother is an addict, so I am someone who was super cautious. I had actually said it when I got there that my preference is no opioids. But this felt like, "Okay, maybe it's an option." When Paige came in and we talked a little bit, she was like, "Why don't we do that? And would you be open to doing a low dose of Pitocin?" And I was like, "Absolutely not," because in my brain, Pitocin means epidural. Pitocin is scary and hard. My contractions are already intense. I can't imagine Pitocin. Like, absolutely not. And so Paige said, "Hey, what's cool is you're already in active labor, so Pitocin is not likely going to make your contractions more intense. It will likely bring them closer together.Meagan: It's what you might need.Lily: "You might be able to wait it out, or this might be an option. Let's do the pain medicine so that you feel mentally like you can handle it." I was like, "Okay." So they placed another IV because I didn't have one in, and they gave me Pit. We started at 2 at 3:30, and then we upped it to a 4 at 4:00.Something that I will mention while I have the IV thought in my brain is I had said I was doing intermittent monitoring, and I ended up hating that. I was just irritated by people coming into my space. It felt like it interrupted my labor pattern. They had to reach down into the water if I was in the tub. I was moving, and I felt like I couldn't move or they wouldn't get it. They were just in my space a lot more. So when we started the Pitocin, the hospital policy was continuous monitoring, but they have the wireless monitors that are waterproof. They were like, "Do you feel okay with that?" I said, "Yeah, I think so, actually. I think I'm ready for people to stop touching me," because at one point, I looked at a nurse and I was like, "I understand why this is important and why you're here to check on my baby. Please go away." I hated it, but I also felt like I wanted some sort of monitoring.Meagan: I can see that though.Lily: Yeah, it was just disruptive. It's funny because in my brain, I thought that the continuous monitoring would feel disruptive, but it was great because they just put these two little dots on me. I had a belly band that went over. They were wireless. I could still move all around. It was great. Meagan: That's nice.Lily: Yeah. So at this point, I'm hooked up to Pit on the little IV pole, but I can still go wherever I want. I decided to go labor in the bathroom. This is the part of my labor that gets a little fuzzy. I was really thankful to have had a conversation with my acupuncturist prior to labor because she had a great labor experience, but she was actually a home birth hospital transfer too. She had talked about how I had said, "I don't want to do medication because I want to be really present. There's so much of my son's birth that I don't remember because of the medication." She had told me, "Hey, there is a place sometimes in labor land that your body just naturally goes fuzzy, so don't be taken aback if that's your experience." That was really helpful to know that in this transition time, things feel a little fuzzy, but I'm at peace with that versus my son's birth where it felt invasive to not have those memories.Meagan: Yeah.Lily: So we were laboring in the bathroom, and then I remember at one point yelling for Paige because my doula is in there with me. I was like, "I'm feeling pushy and ring of fiery." She's like, "Okay." We came out of the bathroom. They unhooked me from the Pitocin. They did keep the hep lock in. And again, they were really respectful and asked like, "Hey, since we've already been doing Pit, we've already put two in. Do you mind if we keep the hemlock? And we'll wrap you up. You can do whatever you want." And I was like, "That's fine. It's already there. Let's not bruise up my arm anymore." We came out, and I was laboring on all fours. I had gotten sick of the tub, and I had actually said, "I don't want to be in the tub anymore," at some point during the day, because this thing that was so great, and it is helpful, but every time I get in, I get discouraged because my contractions pick up. But then, it seems like I have to get out. My doula is looking at me, and she's like, "Hey, are you sure you don't want to get in the tub?" This was your goal. This was your goal. Are you sure?" I'm laboring on all fours, and I'm feeling pushy, and she's like, "We can fill up the tub so fast. Do you want us to just fill it up? This was your goal. Are you sure?" I was like, "Okay, yeah. Fill up the tub." The one other thing that I think was funny is that I was wearing a really ugly bra because I had had two black bras that I really wanted to wear, and they had gotten wet over two days of being at the hospital. I looked at her, and I was like, "I'm wearing my ugly bra." She was like, "Change." So my birth photographer ran over and grabbed my black bra that I wanted to have on, and I changed really fast which was really funny, and then hopped in the tub and started to just labor there. My doula and midwife coached me to wait for the fetal ejection reflex. So they were like, "If you can just breathe through these contractions, let's wait and see if your body just starts to push." I was like, "Okay, I guess we'll be here." I was in this really deep, low squat. I have 20 years of dance in my history. I teach Barre. I'm on one tippy toe. Paige told me after, "I have never almost broken a mirror trying to get so low to see what was going on because you were in such a low squat." I did deliver my daughter on my tippy toes. It was like, if I put my heel down, it hurt more. I don't know why, but my tippy toes felt great. Meagan: Interesting. Like pointe in ballet?Lily: Standing on my tippy toes.Meagan: Yeah. Yeah. Oh my goshLily: Yeah. I was in a lunge with one leg up on a tippy toe.Meagan: With bent toes, yep.Lily: I was laboring there, and these contractions felt different, which again, is so cool to have gotten to experience. At this point, Fentanyl wears off after 30 minutes, and so I really feel like it was perfect because I got it for the hard Pitocin part, which actually wasn't bad at all, by the way. It was exactly what Paige said. It just got them closer together. They didn't hurt anymore.Meagan: Increase, yeah.Lily: Yeah, it was awesome. So I highly recommend if you need it at the end to know that it probably won't increase intensity. It just can help. I was fully unmedicated at this point. I would feel the beginning of my contraction. I could breathe through. And then when that fetal ejection reflex hits, man, it is crazy. I had heard someone describe it as the feeling of when you have to throw up and you just can't stop. That is exactly what it feels like. Now I'm pushing.My body just did it by itself, and I didn't have to worry about, "Okay, how do I breathe? How do I do?" There was no counting. I pushed for 52 minutes on my tippy toes. It was so cool. My husband really wanted to catch her, and so he was right there. He'll joke forever that I bruised his hand in labor because I was death-gripping it.I remember feeling the ring of fire and all of the things. And then she just came out and her whole body came out with her head, and it just felt like the biggest relief in the world of, whoo. And then I grabbed her. So Jared's like, "You kind of stole my thunder." I was just so excited, so both of us had our hands on her and got to bring her up to my chest. What we realized is I had a really short chord. The theory is that so much of my labor was probably held back because she didn't have a lot of bungee room to descend. It kind of explained a couple of things. Yeah. She was on my chest in the tub and hanging out. And then we got off and got to the bed, and she was hanging out on my chest. And then as the cord stopped pulsing, she forgot to breathe.Meagan: Oh.Lily: And so they had to cut the cord really quickly, take her off my chest, and take her over to the warmer, and she was fine. They called in the neonatalist and all of the things, and she did eventually just come back to me after I had delivered the placenta, but that was the only scary moment. The theory is that she was still relying on the cord, and then it stopped pulsing, and she was like, "Oh shoot, I need to breathe now. Got it. Okay."Meagan: Yeah.Lily: It was great. I got to see my placenta, and I did have a marginal cord which we knew, which is when your cord is kind of off to the side of your placenta. Again, we knew that my whole pregnancy, and it was never like, "This is going to prevent you from having a VBAC" conversation. But yeah, we got to do the thing and catch a baby, and it was just the coolest thing ever. I can look back and say gosh, yeah. I probably would've been a transfer because of how long my labor was. I'm so thankful that I took the interventions when I needed them and that I had a provider who I trusted was in my corner. Never once did I think, "Oh, she's recommending this so that it goes faster," or "Ohh, she's" bothered or anything. And Paige actually had specialed me in that she wasn't on call that night, but she came in for me which was really special. I don't know. I never expected that I would have a hospital birth. I never expected that I would have Pitocin or pain medication or any of the things and yet feel so at peace with how it played out. It was absolutely beautiful and absolutely physiological in all of the ways that it needed to be.So that was her birth.Oh my goodness. I'm so happy for you. I'm so happy. I can just close my eyes, and I can see your picture. So many feels and such a long journey. Such a long journey for you to keep shifting gears. But going back into your team and all the relationships that you established working up to these days and this moment, you had all of those people come into your labor too, at some point whether it was mentally thinking about something that they had said or they physically came down the street and we're able to serve you and touch you and adjust you and work with you that way. There were so many things along the way that it's like, wow. You should be so proud of yourself for building that team, for getting the education, for having this big different experience, and for trusting your instincts. I do think in the VBAC world, in all birth world, but for the VBAC world, we do sometimes get into this, "Oh, Pitocin can be bad. Epidurals can be bad. Hospitals can be bad. This can be bad," You know, all of these things, and a lot of the times it's based on negative experiences that one has had.Lily: Or stories that you hear.Meagan: Or stories that we hear, yes. Because, I mean, how many stories have we heard about the cascade? Lily: Absolutely.Meagan: We've heard so many. But like you said, these things needed to come into your labor at the points that they did, and they served you well. When you said that you didn't expect to have these experiences, and then find them healing and positive, but I truly believe when we are making the decisions in our birth experience, when we have our birth team that we trust and know are there for us, for us, and in our corner, like Paige is and was, it's very different.Lily: It makes a world of difference.Meagan: It's very different. I mean, I have had clients where I've had providers actually say with their words, "I like to manage my labors. I like to manage my labors." So if we hear that, and then we hear the experience, you guys don't do those things because they led down a negative path. But those are so different, and so we need to remind ourselves as we're listening to stories about Pitocin and epidurals or hospitals, have a soft part in your heart for them because you never know. They may be something that you need or want in your labor. Lily: Totally.Meagan: And if we can have the education about those things and then make the choice that feels right for us in our labor, I mean, here you are saying these things. You're saying these words. "I had these experiences. I experienced Pitocin. I experienced Fentanyl that I didn't know I wanted. I had all these things, and it was great."Lily: It was beautiful. Yeah. And Paige was like, "I've never seen someone dilate to a seven with such an irregular contraction pattern."Meagan: Yes. Yeah.Lily: What I love is that a couple of days before I went into labor, someone had posted this quote. We posted it just recently to our page, but it was from the Matrescense podcast. And it says, "For every birth video that you watch where a woman calmly breathes her baby into the world, make sure you watch one where she begs, pleads for, swears, doubts, and works incredibly hard to meet her baby." I know I cried.Meagan: That just gave me the chills.Lily: "So that if that is your experience, you are not caught off guard by the intensity of birth." I had seen that before I went into labor. Someone posted it in The VBAC Link Community on Facebook. And that is exactly my experience. I screamed and I begged and I roared. Oh my god. There was no quiet breathing during my pushing. My throat was sore the next day so much so that I had them swab me for strep because my husband had strep and I was like, "Did I get strep?" But my throat was just raw from screaming. Not screaming. I would call it roaring because I wasn't high-pitched screaming. It was just the natural, primal thing.Meagan: Guttural roar.Lily: It doesn't make it less than. It was pretty dang cool. So, yeah, so that was all the things. And then in this postpartum experience, it's been so great. Paige is awesome. We've been chatting over the phone, and we had a two-week postpartum visit. I just have the best community. I feel a deep sense of gratitude for the community that I have this time compared to my first and sweet friends who literally right before I came on were like, "Hey, update. How are you? What's going on? How's Tilly? What do you need?" That community has made a huge difference, too. And also, I feel like I could run a marathon because I didn't have a C-section, you know? Holy cow.Meagan: Yeah, your recovery is feeling a lot better. Lily: Oh, my gosh. Yeah. Yeah. And I was super active prior to having her, so I think that helps too, you know?Meagan: Yeah.Lily: Just feeling that strength is there and resilient. So, yeah.Meagan: Oh, my gosh. I love you. I'm so happy for you. Seriously, I can't wait to even go back and re-listen to this once it airs. You're just incredible. You're such a ray of sunshine. And truly, it is an honor to have you here on our VBAC Link team and then to be part of this story. You had said before that you haven't really even shared it in this entirety, and so I feel tickled that I get to be one of the first to hear it in its entirety.Lily: Well, thank you, friend. It's an honor to be on the team to get to hold space for everyone else's stories, and I have a squeaky baby, but it is just a joy and a dream to get to be here. So thanks for holding space for all of us who have needed it for years. We love you.Meagan: Oh, I love you back, and thank you.ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

Hello dear listeners! We're back after a longer than usual holiday hiatus, and this episode you're in for a real treat. Oh, no it isn't a good game show. Statistically those don't actually exist. No, this episode we are going to rage out on the set of beloved sitcom Friends and break everything in Monica's apartment. Isn't that just such a better idea than actually trying to win this game show? We think so too. Zach met himself from the future, Jared soft launches a new segment about local goverenment, and Adam asserts that there are statistically zero good game shows. Talking Points Include: Santa's Vacation Schedule, Municipal Roundup, The Adam Experience, Gunter Took Our Jobs, Joey is The Frasier of Friends, Squatters Rights in Monica's Apartment, The Bazinga Boys

John Perkins is a storyteller. His stories tell of his work as an economic hit man, creator of a death economy that is polluting and consuming itself into extinction. He has served as advisor to the World Bank, UN, IMF, Fortune 500 corporations, and government and business leaders across the globe. “You know, my job was pretty easy, generally speaking, because I was offering the president of a country or his finance minister, whoever, a big loan. And the fact that this loan would help him and his family, his friends – they owned the businesses in most cases – they were the ones who benefited from big infrastructure” “They knew that if they didn't accept this deal, the people we call the jackals would come in and they would either overthrow or assassinate the President, whoever was responsible. And, you know, the United States has admitted to this over and over. Allende in Chile, Mossadegh in Iran, Lumumba in the Congo. My two clients. We haven't admitted to that one yet, but we have admitted to Diem in Vietnam and more recently [Manuel] Zelaya in Honduras. We've admitted to these things.” For seven out of his ten years as an economic hit man, John believed what he was taught in business school: to help a poor country pull itself out of poverty, you invest heavily in infrastructure. Statistically this can be shown to increase the country's economy – its GDP and GDP per capita. Per capita implies that everybody in the country is participating, but that's just not true. “GDP primarily measures how well the wealthy are doing and the big corporations.” John's insights are not merely theoretical; they are rooted in personal experience. In other episodes of this podcast, we've talked about cycles of debt that sink global South nations into dire poverty. In this conversation, John recounts the manipulative tactics for securing lucrative contracts for US corporations across the globe, thus creating these debt traps. To repair the damage, John urges a radical shift towards a ‘life economy'—one that focuses on sustainability, equity, and regeneration. John Perkins served as Chief Economist at a major consulting firm and was advisor to the World Bank, UN, IMF, Fortune 500 corporations, and government and business leaders in Africa, Asia, Latin America, the Middle East, and the United States. Before that, he apprenticed with shamans when he lived in the Amazon rainforest from 1968 to 1971 and has since studied with shamans from many different cultures. His eleven books on economics, shamanism, and transformation include the Confessions of an Economic Hit Man trilogy; Shapeshifting; The World Is as You Dream It; and Touching the Jaguar. They have been on the New York Times bestseller list for more than 70 weeks, sold millions of copies, and are published in at least 38 languages. https://johnperkins.org/

Statistically, it would be fair to argue that Jayden Daniels is better than Patrick Mahomes. At least, when it comes to playing against the Philadelphia Eagles. Is the Commanders star QB actually better or is this all smoke and mirrors. We discuss how Jayden Daniels stacks up against one of the leagues best.

Growing up is hard enough, but for the children of serial killers, the weight of their parents' horrific crimes is a shadow that never fades.Darkness Syndicate members get the ad-free version. https://weirddarkness.com/syndicateInfo on the next LIVE SCREAM event. https://weirddarkness.com/LiveScreamInfo on the next WEIRDO WATCH PARTY event. https://weirddarkness.com/TVIN THIS EPISODE: Many people have claimed to see ghosts near the iconic “Hollywood” sign in California – but one particular ghost is seen more often than the others – and it comes with a sad story. *** Weirdo family member Andrew Horne tells of his ghostly experience in Gettysburg. *** Why did Nellie Blye intentionally check herself into an asylum for a harrowing ten days? *** Statistically speaking, you will walk past a murderer 10.76 times in your life. But what if you didn't just walk past a murderer - what if they were a part of your family and you didn't know it?CHAPTERS & TIME STAMPS (All Times Approximate)…00:00:00.000 = Disclaimer and Show Open00:01:48.735 = The Children of Serial Killers00:31:10.541 = Hollywood Sign's Lady in White00:35:02.092 = Ghosts In Gettysburg00:39:18.622 = Nellie Bly's Living Nightmare00:43:30.805 = Show Close00:44:02.975 = Final ThoughtSOURCES AND RESOURCES FROM THE EPISODE…Episode Page at WeirdDarkness.com: https://weirddarkness.com/ChildrenOfSerialKillers“The Children of Serial Killers” by Stefanie Hammond for Ranker: https://weirddarkness.tiny.us/557775be“The Hollywood Sign's Lady In White” posted at RealParanormalExperiences.com: (link no longer valid)“Ghosts In Gettysburg” by Weirdo family member Andrew Horne – submitted directly to Weird Darkness.“Nellie Bly's Living Nightmare” by Orrin Grey for The Line Up: https://weirddarkness.tiny.us/nellie-bly=====(Over time links seen above may become invalid, disappear, or have different content. I always make sure to give authors credit for the material I use whenever possible. If I somehow overlooked doing so for a story, or if a credit is incorrect, please let me know and I will rectify it in these show notes immediately. Some links included above may benefit me financially through qualifying purchases.)= = = = ="I have come into the world as a light, so that no one who believes in me should stay in darkness." — John 12:46= = = = =WeirdDarkness® is a registered trademark. Copyright ©2025, Weird Darkness.=====Originally aired: November, 2018TRANSCRIPT: https://weirddarkness.tiny.us/37h8eewc

In our last episode, we discussed spotting before your period and what's normal and what could be a sign of low progesterone or even endo. Today I want to discuss spotting around ovulation and again, this is going to be a nice and easy to digest bite sized episode. So, ovulation occurs roughly midway in your cycle, though that's just the average. Statistically, the average ovulation day is around Day 14 but it can be a few days before or after, and maybe we can do an episode on what's a healthy time frame for ovulation and what's a sign of a problem, but until then, I actually have an episode on what's a healthy cycle, so I'll link to that in the show notes. Read more. Show notes https://www.ncbi.nlm.nih.gov/books/NBK279054/ https://www.mdpi.com/1422-0067/25/8/4499 https://www.sciencedirect.com/science/article/abs/pii/S030372071730504X https://www.hopkinsmedicine.org/health/conditions-and-diseases/uterine-fibroids https://pubmed.ncbi.nlm.nih.gov/6838950/ https://pubmed.ncbi.nlm.nih.gov/12369286 https://pmc.ncbi.nlm.nih.gov/articles/PMC9916952/ https://www.sciencedirect.com/science/article/pii/S0015028211006807 https://pmc.ncbi.nlm.nih.gov/articles/PMC3136067 Need more help or want to learn how to work with me? Free resources: This podcast!  Endometriosis Net Column Endometriosis News Column Newsletter Instagram Ways to work with me: This EndoLife, It Starts with Breakfast digital cookbook Masterclasses in endo nutrition, surgery prep and recovery and pain relief Live and Thrive with Endo: The Foundations DIY course One to one coaching info and application This episode is sponsored by BeYou Cramp Relief Patches. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches. Click here to find out more and to shop: https://beyouonline.co.uk/pages/how-it-works Produced by Chris Robson

How many Mondays do you have left? Statistically, we all get about 4,000 Mondays in our lifetime, so if you're halfway through your life, you might have roughly 2,000 Mondays to go. The good news is that you are in charge of how you spend those days, the question is will you be toiling away at a job that you hate, or will you be creating a career that you love? Will you choose to scroll mindlessly for hours a day, or will you pursue hobbies and travel that light you up? Will you be dreading the inevitable end, or will you be living your life in full in a way that allows you to meet the Grim Reaper with a smile? These are the existential ponderances in which Jodi Wellman thrives. Jodi is a speaker, author, executive coach, and facilitator of living lives worth living. She founded Four Thousand Mondays to help people make the most of the time they are lucky to be above ground. Jodi has a Master's of Applied Positive Psychology from the University of Pennsylvania, where she is also an Assistant Instructor and facilitator in the Penn Resilience Program. She is an ICF Professional Certified Coach and a Certified Professional Co-Active Coach. Jodi has been featured in The New York Times, Oprah Daily, Fast Company, CNBC, Forbes, Psychology Today, and The Los Angeles Times, to just name a few. Jodi's TEDx talk, How Death Can Bring You Back to Life, has over 1.3 million views and was the 14th most-watched TEDx talk in 2022. Her new book, You Only Die Once: How to Make It to the End with No Regrets, made Adam Grant's Summer Reading List, is a Next Big Idea Club must-read. Jodi's book, work, and life show us all how we can gain a newfound appreciation for our lives and prioritize what truly matters. Her book uses a blend of research, personal anecdotes, and practical exercises all done with a sharp sense of humor that guides us through self-assessment, habit identification, and action planning, encouraging us to break free from routine, discover our passions, and live a life in full - brimming with vitality and purpose.

Today's Sports Daily covers Mahomes vs Hurts is a lot closer statistically than you probably think, where Jalen places now with 2 Super Bowl trips in first 5 years, NBA looking at a major format change, & the Brady/Olsen broadcasting dilemma Fox has.Music written by Bill Conti & Allee Willis (Casablanca Records/Universal Music Group)Ads:BetOnline - Enter Promo Code: BLEAV for your welcome bonus on your first deposit!

Hey where's that damn dog of mine? He better not be…oh no…oh NO!!! Well, anyway. Update on our various locations: the YKS boys are off to CES, and you all are here at home, listening to the show. Or you're at your work, I guess. Whatever THAT is. Presumably some kind of sexy doctor like they have on TV. So we had better make this a good one to get you through that long slog of sexy surgery. Ah man! Don't drop some hot sweat into that open cavity! On today's program, we can finally share our dreams with you, and the dreams are, guess what. Bad. Plus we are getting down to brass tax with some good old fashioned common American sense, which is a scam of some kind, and a TV channel which is not a scam at all probably but man it sure is a bummer. Unfortunately we do end the episode on that one which is poor planning on my part, but in my defense, that is ok for me to do because I don't like to feel bad about my actions. Anyway have fun at work doc. We will be trying out fancy new dildos in the desert. Music for YKS is courtesy of Howell Dawdy, Craig Dickman, Mr. Baloney, and Mark Brendle. Additional research by Zeke Golvin. YKS is edited by Producer Dan. Social Media by Maddalena Alvarez.Executive Producer Tim Faust (@crulge)Want more YKS? Well, YKS Premium's got what you're after! Last week we previewed the Consumer Electronics Show in beautiful Las Vegas, California! This week, we're probably watching some movie called Shlump 2. Just kidding, it's another good one. Statistically speaking, some of them are stinkers, but we don't charge more when it's good so it evens out. Sign up today at Patreon.com/YourKickstartersucksFollow us on Instagram: @YKSPod, TikTok: YourKickstarterSucks and subscribe to our YouTube channel for more video stuff! This holiday season, give the gift of stupid bullshit! Gift subscriptions to YKS Premium are now available at Patreon.com/yourkickstartersucks/giftSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

We first released this episode almost two years ago. But women are still apologizing for their existence and saying sorry way too often. We are still people pleasing and putting ourselves down when we make a mistake. So we thought you should hear this again. Apologizing is a learned behavior and being able to recognize it is the first step towards improving your self confidence. If you feel the need to make other people more comfortable, listen to some things to say instead of sorry. Because you deserve to take up space. In this episode, we help you identify when and why you are unnecessarily apologetic and help you decide if it was truly worthy of an apology. Your brain is listening. So no more harmful language about yourself. Let's stop being sorry together.  (00:00:00) Welcome and the woolly mammoth  (00:07:40) What is all this apologizing doing to us?  (00:11:10) Statistically women apologize more  (00:12:00) What to say instead of sorry and the importance of recognition (00:16:40) Do you put yourself down when you make a mistake at work?  (00:20:00) What throw-away comments do to your brain (00:25:15) Apologizing to make other people feel more comfortable (00:28:00) Self proclaimed people pleasers tend to over apologize (00:32:05) Followup statements to your accomplishments  (00:36:20) A power pose to try Want to leave the TTSL Podcast a voicemail? We love your questions and adore hearing from you. https://www.speakpipe.com/TheThickThighsSaveLivesPodcast ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠The CVG Nation app, for ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠iPhone⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠The CVG Nation app, for Android⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Our ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Fitness FB Group⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thick Thighs Save Lives Workout Programs⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Constantly Varied Gear's ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Workout Leggings⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ The CVG 2025 Movement Calendar