Podcasts about subq

Dr Scott joins the party and shares some interesting studies about HGH Blood Sweat & Gear 301 Coaches Skip Hill, Andrew Berry, Scott McNally 0:00 teaser - Subq vs IM GH Study 1:00 Intro and Welcome Dr Scott Stevenson to the show 2:00 GH IM vs SubQ 5:20 What is GH and what does it do? 8:30 GH Isoforms and Why GH may work better for some than others 11:18 Endogenous vs exogenous GH 15:00 IM vs SubQ HGH 24:30 Estrogen and HGH 26:45 GH is prescribed Subq 30:00 IGF release from HGH 35:00 IGF levels and bodybuilding progress 42:00 Locally produced IGF vs circulating blood levels 46:00 local growth from site specific insulin 52:20 GH and Insulin Timing ? 1:00:00 increlex vs IGFLR3 1:03:00 Skip getting trolled 1:10:30 Pros that never used IGF 1:14:30 Bonus topic : Painful fatty deposits ✅ Signed Copy of Be Your Own Bodybuilding Coach (15% goes to ASPCA) https://www.ebay.com/itm/205121965946

On this week's episode, Sam Fazeli, John Maraganore, Nina Kjellson and Matt Gline dig into an in-depth discussion on the Trump Administration's recent executive order aimed at lowering drug prices as part of a broader “Most Favored Nation.” The group discusses the 30-day ultimatum, the 180- days for negotiations and concerns that biotechs may not be adequately represented at the table. The conversation shifts to PBMs, noting that there's growing support for banning spread pricing and requiring more reporting from PBMs. The group also touches on orphan drugs, sharing that there's bipartisan support to exempt orphan drugs from IRA negotiations. Pharma's talk of investment in AI is also overviewed. Next, the group discusses Recursion Pharmaceuticals' Q1 pipeline reorganization and Galapagos reversing its decision to split in two. CMS guidance on IRA Part B negatively impacted Halozyme Therapeutics and J&J, raising questions about the classifications of subQ formulations as different drugs despite sharing the same active ingredient. The episode ends with a discussion on CytomX Therapeutics' resurrection, including its stock price jump. *This episode aired on May 16, 2025.

Show notes at pharmacyjoe.com/episode1020. In this episode, I'll discuss how to predict failure of insulin transition in critically ill patients with diabetic ketoacidosis. The post 1020: How to Predict Which Critically Ill DKA Patients Will Fail the Transition from IV to SubQ Insulin appeared first on Pharmacy Joe.

DNS Podcast with Dave Crosland & Scott McNally - TIME STAMPS BELOW 0:00 Teaser - Winstrol Vs Anavar 0:40 Intro and advertisers 1:30 Rest In Peace to Matt Minerod 4:30 Top Best to Worst Steroids 5:45 Last Place Primobolan 6:45 8th & 7th - The Limitations of Oral Steroids 7:20 6th and 5th Place Masteron vs Anadrol 8:00 4th Place : Dianabol 8:30 Tolerance vs Effectiveness : Deca vs Tren 11:30 1st Place : Testosterone 13:45 Transformation Contest 15:30 IM vs SubQ shots on cycle ? 21:10 Test Cyp to Test E for a Cycle or does it matter? 22:05 Dealing with Arthritis 25:20 Mildronate For Bodybuilding 28:30 Timing on doses for Clen, Yohimbine, Winstrol, T3 34:35 Dusty's Debate : What condiments for a hot dog 36:45 M1T ( Methyl 1 Testosterone ) 39:00 pancreatitis and gear 40:50 Arimidex vs Aromasin 41:45 Tendon Injuries : GH vs BPC157 & TB500 OR All 3? 45:40 Rotator Cuff Recovery 46:50 HCG on Cycle? 49:20 Looking for trust worthy places for your supply 53:45 Lifetime Natty watching “the podcast” ? 56:00 MT2 Melanotan 2 changing hair color? 59:10 Uncle Dave's Wisdom

Get My Book On Amazon: https://a.co/d/avbaV48Download The Peptide Cheat Sheet: https://peptidecheatsheet.carrd.co/

Pink Sheet reporter and editors discuss an emerging pharma strategy to avoid Medicare price negotiations (:25), legal wrangling related to compounding GLP-1 drugs for obesity and diabetes (14:20), and the varying opinions of FDA officials on the acceptability of artificial intelligence models that are not fully explainable (29:08) #pharma #business More On These Topics From The Pink Sheet Keytruda, Opdivo SubQ Conversions Cloud Near-Term Medicare Negotiation Savings Forecasts: https://insights.citeline.com/pink-sheet/keytruda-opdivo-subq-conversions-cloud-near-term-medicare-negotiation-savings-forecasts-BJNQCECWVNESHGCKNPJSKVIH4I/ GLP-1s: Compounders Get Temporary Reprieve But US FDA May Be Building Stronger Case: https://insights.citeline.com/pink-sheet/legalandip/litigation/glp-1s-compounders-get-temporary-reprieve-but-us-fda-may-be-building-stronger-case-2SJVLIMS5FDERNWA7UQV3IM7JM/ US FDA Opinions Vary On AI's Black Box Issues. Will Uncertainty Follow?: https://insights.citeline.com/pink-sheet/advanced-technologies/ai/us-fda-opinions-vary-on-ais-black-box-issues-will-uncertainty-follow-PPMN3R3FJ5BTZOXWDFHPHZVLNQ/

CME credits: 1.00 Valid until: 25-07-2025 Claim your CME credit at https://reachmd.com/programs/cme/comparative-efficacy-subq-vs-intravenous-dmts-in-alzheimers-disease/26347/ This series of micro-episodes will provide important information on slowing progression in mild cognitive impairment and early Alzheimer's disease. Drs. Marwan Sabbagh and John Hardy discuss best practices for recognizing early symptoms, diagnosis, and treatment of mild cognitive impairment and early Alzheimer's disease.

AST, ALT, CPK, BUN, what do all of these mean and what should you expect as a bodybuilder? PLUS NPP in a cut? Testing GH with Lab work TIME STAMPS BELOW Muscle Minds - Dr Scott Stevenson & Scott McNally ✅ Get Private Lab Work Done Here : https://www.privatemdlabs.com/?refid=ddh4nap7 ✅ Amino Asylum code THINK for 20% off research chems, peptides, l-carnitine and more https://aminoasylum.shop/ref/122/ 0:00 intro 1:30 Lab work as a bodybuilder 3:00 AST & ALT 8:40 CPK 11:30 BUN 12:35 Creatinine 17:00 Cystatin C 18:50 High Protein diet & Kidneys 26:00 What causes kidney problems in bodybuilding? 36:30 NPP in a Cut? 44:30 Using blood work to check GH quality 53:00 SubQ shots for cycles 1:03:40 Not growing on current diet

Bodyfat Levels and gear effectiveness, Deca & Tren Together, Turkesterone VS Var? SubQ vs IM? TIME STAMPS BELOW - Dave Crosland & Scott McNally

Watch Here : https://www.youtube.com/watch?v=V0ss7ET8-5k Website: https://vigoroussteve.com/ Consultations: https://vigoroussteve.com/consultations/ eBooks: https://vigoroussteve.com/shop/ YouTube Channel: http://www.youtube.com/user/VigorousSteve/ Workout Clips Channel: https://www.youtube.com/channel/UCWi2zZJwmQ6Mqg92FW2JbiA Instagram: https://instagram.com/vigoroussteve/ TikTok: https://www.tiktok.com/@vigoroussteve Reddit: https://www.reddit.com/r/VigorousSteve/ PodBean: https://vigoroussteve.podbean.com/ Spotify: https://open.spotify.com/show/2wR0XWY00qLq9K7tlvJ000 Patreon: https://www.patreon.com/vigoroussteve

Oral Only & Adding Orals to TRT DNS 186 Dave Crosland & Scott McNally TIME STAMPS BELOW

On this podcast episode, I discuss the pharmacology, adverse effects, and drug interactions of semaglutide. Semaglutide has two primary uses: Type 2 diabetes and Weight Management - the dosing varies depending upon the indication. When using semaglutide, pay attention to GI adverse effects. Nausea, diarrhea, and vomiting are the most common ADRs and are dose-dependent. Pay attention to corticosteroid bursts. They can cause substantial hyperglycemia and counteract the effects of diabetes medications like semaglutide.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2022.10.26.513928v1?rss=1 Authors: chattopadhyay, c., Bhattacharya, R., Roszik, J., Khan, F., Wells, G. A., Villanueva, H., Qin, Y., Bhattacharya, R., Patel, S., Grimm, E. A. Abstract: Uveal melanoma (UM) originating in the eye and metastasizing to the liver is associated with poor prognosis. Here, we investigated whether the IGF-1/IGF-1R signaling axis is involved in UM growth and metastasis. TCGA dataset analysis reveals that UM has high IRS-1 expression, which is the first substrate of IGF-1R. Furthermore, IRS-1 is over-expressed in all UM cell lines tested (relative to non -cancer/normal cells) and in matched eye and liver UM tumors. Therefore, we targeted IRS-1/2 in UM cells as well as UM tumors developed on a chicken egg chorioallantoic membrane (CAM) model, and subcutaneous (subQ) UM tumors grown in mice using NT157, a small molecule inhibitor of IRS-1/2. NT157 treatment in UM cells resulted in reduced cell survival and cell migration, and increased apoptosis. NT157 treatment also significantly inhibited UM tumor growth in the in vivo chicken egg CAM and subQ mouse models, validating the in vitro effect. Moreover, NT157 appears more effective than a monoclonal antibody-based approach to block IGF-1R signaling. Mechanistically, through reverse phase protein array (RPPA) analysis, we identified significant proteomic changes in the PI3K/AKT pathway with NT157 treatment. Together, these results suggest that NT157 inhibits cell survival, migration in vitro and tumor growth in vivo via inhibiting IGF-1 signaling in UM cells. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

TRT community Glucose Monitor - take the free quiz by clicking "get started" Find a Doctor We'll today I'm in studio with Miguel and we'll be chatting with Ken, founder of Matrix hormones. For those of you behind the curve, Matrix is the number one favorite clinic of the TRT Community facebook group. Topics covered: Miguel - what's your treatment status? You said you looked in to Matrix, are you treating with them yet? So I mentioned NUTRISENSE - they were kind enough to send us one of their Constant Glucose Montiros. I'm terrified of needles so I've got Kayla using it for the past two weeks and we're going to do a full episode on them soon, but I have to say the data and support she's getting from NUTRISENSE is spot on. I encourage everyone to use the link in the show notes to take their quiz. There's no obligation in doing so, just click let's get started and walk through the questions to find out how it could help you. Hi guys. For those that do frequent SubQ: can I just keep pinning the belly? Or do I have to worry about rotating to other spots? I've heard that pinning the same area over a long time may cause scarring/lumping, but I'd like to know what you think. Does T help with immune system support?  Popped a positive Covid test today and am wondering if I will recover quicker now that I'm on T. When on TRT, we will adjust dose smaller when getting older, right? To be align with natural decline. What if we keep same dose in next 10 years, is it good or bad for overall health? If we have T level of 40 years old man in body of 70 years old? My 10ml vial of testosterone cypionate expires says to discard after 28 days, however it's supposed to last me 12+ weeks, is this the norm? Does it actually expire become less effective or what? Scared to start TRT. I am 27 and have a prescription at a pharmacy ready for me to go pick up. Im just very afraid of dying from a blood clot or pulmonary embolism. My father died of a pulmonary embolism caused by untreated polycythemia vera. I am pretty healthy and workout but i'm scared TRT wil cause a blood clot. I seen it can through a couple of studies. I was just prescribed Deca .25mg twice a week. For those that are on it for joint pain, how long does it take to start working. I just did my 2nd injection.  Does TRT englarge the heart? Why does some test cyp say for intramuscular use only

Learn how to use holistic principles like clicker training to help your kitty learn that normal procedures such as nail trims and pilling can be positive experiences instead of a perpetual fight (which cats always win). Learn how to read your cat's coat and check for hydration as well as how to clicker train for success with SubQ fluid administration, nail trims, blood draws, anal gland expression and pilling. If you think about it, why should cats trust us? How can we teach them that trusting us will help them live longer and happier lives and keep your veterinarian safer and healthier too. #veterinarian #feline #cats #pillingcats #clickertraining #clickertrainingcats #DrDonna #Naturopathicpetdoc #traincats #caringforcats #wellness --- Support this podcast: https://anchor.fm/donna943/support

Kelly Hurd has been pitching us to producers for Discovery so I sent him footage and story lines.     Some things that are always true of our surgery and vet visits:   Unless you have been involved in these very tense situations, it is hard to explain how stressed out everyone is and our coping mechanism is to joke around and talk about things that have nothing to do with the work at hand as a way of being able to deal with these life and death situations.   In most cases we go to the vet not knowing if we will have to make the awful decision to euthanize one of our family members, because loading a cat up and taking them offsite to a vet clinic is the last ditch option to save their lives.  After 22 years of doing this, we know that there will almost never be a clear choice to make and we will almost always be burdened with making a decision that could result in lingering misery for the cat and then still having to put them out of their misery days, weeks or months later after trying every thing we can to give them a good quality of life.   A lot of the editing will require you to use common sense about what is appropriate or not.  Often in these videos you will hear people talking about other vet situations or clients, and unless it is about one of our other cats, that audio can't be included.  The ultimate goal of these vet videos is to show the details of the surgery for vet students and make our vets look great; because they are.   Some clowning around is OK to show, but it should be narrated as to why we act this way in the face of such serious business.  Sometimes, while a cat is waking up, we let volunteers touch the cats, as they are never allowed to touch cats otherwise.  I would not include this in your finished products though, because we do not want to encourage people to pay to touch big cats.   You will see us often taking a lot of photos and videos because these kinds of surgeries are rare and documentation even more so.  That is why these surgery videos could be so helpful to other cats if done well.   In the videos I have sent you, this is the sequence of events, so you know what is going on.  If you watch them in this same order, I won't have to duplicate such detail on latter videos, because you will know what is happening.   Task List   1 Four minute or less video of the surgery or vet visit with no graphic imagery.   1 Twenty minute video with the graphic imagery; suitable for both a vet student and the public, who is fully prepared for what they will see.   WARNING SLIDES:  Be sure to warn viewers before showing something like surgery both in a warning slide and in the early part of the accompanying text.   Vet Joseph Lion. http://bigcatrescue.org/joseph/   Joseph stopped eating and stopped taking his pain meds, so we sedated him for diagnostics.  Due to his age (16) we didn't want to risk a long trip to the University of Florida, if we could assess him here, so we invited Dr. Fay Hererro, DVM, from the Odessa Equine Clinic, to bring a portable X-ray machine.  Dr. Justin Boorstein invited Dr. Tim Jones to help w/ anesthesia.  They drew blood, gave fluids, administered antibiotics and did the X-rays they could, but the portable X-ray machine was just not good enough for abdominal X-rays.   Joseph did not respond to the antibiotics and fluids and continued to refuse food and water, so we asked the Humane Society of Tampa Bay if we could use their X-ray and Sonogram machines, after hours, and took him in for more X-rays, blood work, fluids, a longer lasting antibiotic and a sonogram.   Nothing of note was found in all of these diagnostics, except a possibility of neoplasia, which are masses in the abdomen.  We had hoped that the antibiotics, fluids and appetite stimulants would help get him up and eating again, but they didn't.   We discussed euthanasia, with both vets, and Dr. Wynn suggested a last ditch effort of injecting him with a steroid.  It had been 8 days since he had eaten anything and 3 days since he drank water on his own, so we gave that a shot.  He drank for the first time, a few hours later, but still wouldn't eat.  10/31/14   On 11/1/14 Sue got him to eat just a few bites of food with his meds in them, so we held off on euthanasia, to see if he is rounding the bend.   Vet Little Feather.   This is the most recent vet issue.  Little Feather is 21 years old.  http://bigcatrescue.org/little-feather/ as was on the observation chart on Oct 10th for having a puffy chin, but we didn't see an obvious swelling and she has a rather pronounced chin anyway.   Oct. 15th we could see there was an abscess and made an appointment for her to go in to the vet the next day.  Her dental X-rays showed that almost all of her teeth were rotten and the jaw bones were decaying as well.  Dr. Justin had to pull the teeth very gently, so as not to break her jaw.  He pulled 8 teeth; her last remaining canine tooth and 7 others and was about done.  There was one more tooth, that didn't look bad on the surface, or in the X-ray, but he debated as to if he should leave it or take it, given the decay in the jaw.   He decided to pull it and found that it had been the cause of the abscess and was in very bad shape.  Had he not pulled it, we would have had to bring her right back in a few days or weeks.  Good instincts!   Little Feather was put on pain meds and kept in the Cat Hospital at BCR for a few days until she was eating well and ready to go back to her cage.  When we opened the door of the transport cage she had been sleeping in, to let her out into her outdoor enclosure, she dragged her back foot.   It looked like some neurological issue, so we crated her back up and took her in to the Ehrlich Animal Hospital where Dr. Farid Saleh, who is not our regular vet, gave her an exam and said that he believed she had thrown a blood clot that was causing neurological damage to her foot.  She had no feeling in her foot.  He treated her with laser therapy and sent her home with instructions for daily massages and controlled walking to help her work out the clot and regain use of the foot.   10/31/14 Little Feather is continuing to get physical therapy, such as laser therapy, and massage therapy and harness walking to keep her foot alive and hopefully dissolve the clot that is keeping her from having the ability to use her foot properly.  We do not condone people having wild cats as pets and are hesitant to even show a cat in a harness, or being touched by people, but she is declawed and now has no teeth due to her old age, so we are able to give her the help she needs without risk.   Vet Natasha Siberian Lynx. http://bigcatrescue.org/natasha/   Natasha is 21 years old.  She has been healthy for most of her life, except a bout of seizures and dizziness in her early years that turned out to be one of the first confirmed cases of heart worms in cats.  As a result we began using ivermectin monthly in all of our cats as a preventative, back in the 90's.   Her recent observations by keepers were that she was breathing heavily and not hungry, so we took her in to see Dr. Wynn on Oct 30, 2014.  For a 21 year old cat, her kidneys look surprisingly good, but her lungs are congested and we can see, by looking down her throat (great video of this) that half of her throat is paralyzed, so all of her breathing and eating is happening on the side that is still functioning.   We did a biopsy, to see if there is a tumor that is causing the one side to be forced shut (from the pressure), but we can't see a tumor.  There isn't any surgery to fix this.   She is getting antibiotics to clear up the infection in her throat and lungs and that should help a lot.  Getting those meds into her will be the challenge.  If she will eat, that is easy to do, but if she won't then she will have to stay in the Cat Hospital for injections.  She is taking her meds and eating well, so we moved her back outside 11/1/2014   Vet Simba Leopard. http://bigcatrescue.org/simba-2/   On this page is another video. In that video is a clip of Simba going to the vet.:http://bigcatrescue.org/now-big-cat-rescue-jan-11-2014/  Appx date:  Jan 11, 2014   Cast, you don't have to name them.  Just named here in case you want to or have title slides.  Vet's should always be named or have title slides: Trapping Simba: Willow Hecht, Green Shirt Keeper, Red Hair Reddish shirt, Carole Baskin, CEO Navy shirt, Master Keeper, Jamie Veronica, President Navy shirt, Master Keeper, Gale Ingham (thin) Operation Mgr Green Shirt Keeper, Chris Poole   Lifting Simba add:   Green Shirt Keeper, blonde, Chelsea Feeney   The long golf cart we use is named Gertie   On site hospital is the: West Boensch (bench) Cat Hospital for weight so vet can sedate.   Van is a 1998 Dodge Ram van that leaks, rattles and really needs to be replaced.  Lifted into van to drive to vet who works in a practice about a mile away called the Ehrlich (ur-lick) Animal Hospital.   Vet techs help offload Simba.  Vet is Dr. Liz Wynn, who has been our vet for over a decade.  She comes twice a week at no charge to do house calls.  We do have to pay for X-rays, blood work, drugs, etc.  Simba is sedated and then gently touched around his eyes to see if he has a blink reflex.  Cats can fool you by being very still and then attacking, but they can't control an involuntary blink reflex, so we always check to be sure they are really asleep before reaching in for them.   We double check his weight and wrap him in a blanket (burrito style) because it is safer, if he wakes suddenly and carrying a sleeping big cat is like trying to carry 100 plus pounds of liver.  We draw blood every time a cat is sedated.  It gives us a benchmark to use in their record and we check for infections diseases, kidney function (failure) because our cats are all so old and in varying stages of renal failure.   Vet manipulates joints and listens and feels for “crunching” that indicate calcium build up of arthritis.  All of our old, gimpy cats are on supplements for their joints and some are on stronger meds.  Palpitates for masses as cancer is the second most common cat killer (after old age destroys their kidneys).  Even though Simba is sedated, Jamie, Gale or Carole usually hangs onto the scruff during most of the procedures, just in case he wakes up suddenly.   Leopards are the biggest cats that a typical dog / cat clinic can Xray.  The most dangerous moments at the vet are during the Xray because none of the BCR staff can be in the room.   At appx 34 min. Dr Wynn expresses frustration that the X-rays aren't showing us why Simba is so wobbly. He had been falling over and acting disoriented.  She's worried that he will hurt himself if he falls off or tries to jump down and suggests longer ramps.   Part of his problem is that he has gained 50 lbs since being prescribed medication, so they aren't as effective.  It's really hard to tell the weight of a cat, because they are so muscular and have such loose skin.   You can see and hear dogs and I hate this part of going to the vet.  Cats should never have to tolerate that and even asleep, I think they can hear us, and the dogs, and that is stressful.  It is one more reason we need a full service vet clinic on site; so we never have to expose our cats to dogs barking.   Dr Wynn is getting better about speaking up for the camera, but on these old ones you will probably really have to bump up the volume, while killing background noises, to hear her.   We drive Simba back to our on site hospital to let him recover and as soon as he can safely be returned to  his Cat-a-Tat he is delivered by Green Shirt Matt, Green Shirt Nanci, Gale and Jamie.  How long in the Cat Hospital is usually dependent on making sure they are eating well, taking their meds and are stable.   Vet Nik Tiger Eye Surgery. http://bigcatrescue.org/nikita-tiger/   Sedated, but vomited.  We try to fast them before sedation, but sometimes they still have food from the night before in their stomachs, or from morning meds.  Sedation makes them nauseous and they almost always will have dry heaves or vomit and doing so in their sleep can choke them to death.  The options aren't good if a 700 lb cat is choking because there isn't much we can do about it without someone getting killed if he isn't asleep fully.   Tests blink reflex w/ stick.   Load onto Gertie   Cast: Dr. Justin Boorstein (boor-steen) Dr. Liz Wynn Master Keeper, Jamie Veronica, President Master Keeper, Gale Ingham (thin) Operation Mgr Green Shirt Keeper, Chris Poole Yellow Shirt Keeper Sharon Yellow Shirt (maybe red) Keeper Darren Yellow Shirt (maybe red) Keeper Jen Navy Shirt, Master Keeper Regina Yellow Shirt (maybe green) Keeper Lynda   9-10 people to carry Nik on a specially made stretcher   Our scales only go to 500 so we have to distribute Nik over two of them as he is 700 lbs.   Dr. Tammy Miller is the eye specialist and she brought her own vet techs to the sanctuary to do this procedure in the West Boensch (bench) Cat Hospital.   Because this was such delicate surgery, Nik was restrained with ropes.  Sometimes cats can have seizures under anesthesia, so we didn't want him to kick the vet's hand while she is cutting on his eye.   Nik's eye trouble started the same way most big cats' eye troubles start.  They are pulled from their mothers when just days or hours old; put on an insufficient diet of puppy or kitten milk replacer and then have flashes go off in their sensitive eyes for the first 4 months of their lives, until they are too big to use.  Then they are discarded or warehoused and usually fed a deficient diet and denied vet care until they die.   Nutritional cataracts are  very common in cubs who were used as pay to play props.  Sometimes the lens breaks loose and can be very painful, so surgery is needed to repair the eye.   Make sure there are warning slides before graphic images.   We give fluids to help the cats eliminate the drugs we used to sedate them. These are given SubQ (under the skin) rather than IV (intravenously)  Sometimes you will see us squeezing the bag to give the fluids as quickly as we can, other times, like this one, there is a compression cuff (white) that squeezes the bag as we use the hand pump.  The reason we are in such a hurry is because anything can go wrong at any time and we may have to wake the cat up suddenly if they start to arrest, so we want to get the fluids on board fast.   We draw blood every time a cat is sedated.  It gives us a benchmark to use in their record and we check for infections diseases, kidney function (failure) because our cats are all so old and in varying stages of renal failure.   Vet manipulates joints and listens and feels for “crunching” that indicate calcium build up of arthritis.  All of our old, gimpy cats are on supplements for their joints and some are on stronger meds.   Palpitates for masses as cancer is the second most common cat killer (after old age destroys their kidneys).  Even though Simba is sedated, Jamie, Gale or Carole usually hangs onto the scruff during most of the procedures, just in case he wakes up suddenly.   Dr Wynn mentions “reversing” Nik.  This is an injection to reverse the drugs we gave him to sedate him and it is good to do that as soon as he is safely on gas (either a mask or tube down his throat) because having all those drugs at work and the anesthesia gas can kill them.   Nik will need drops in his eyes and Gale has become expert at tricking the cats into looking up at a treat and dropping the medication into their eyes. It stings and they don't like it, so it is amazing that she can get them to do it over and over and over; usually 2-3 times a day for 10 days.   Nik had been declawed and defanged by his former owner who used him as a petting prop, even as a full grown adult.  She had tight collars on him and the other 5 cats rescued from there, and would chain them to the ground with chains so short they couldn't turn their heads to bite the people who would sit on their backs for photo ops.  That was illegal, and she lost her USDA license, but continued to do it for years because no one took any action against her.   Nik will wake up in the transport wagon.  We can't leave any bedding in there, or he will eat it.  Whenever our cats are asleep we micro chip them, if they haven't had one before.  While the cat is sleeping, Big Cat Rescuers take the opportunity to mow, landscape and do other cage enhancements to the cat's enclosure.   There is a separate video called Vet Nik Tiger Wheezing.  You may want to add this to the end of the video and say that his eye has healed well and Nik has been doing fine, except that he has begun wheezing when he gets excited.  He needs to be X-rayed, but the only machine big enough is two hours away and he is too old and had too much trouble breathing to make the trip.  Thanks to some wonderful donors we have a new X-ray machine but need a building big enough to put it in.     There is another video file called Vet Dr Liz Wynn.  You may want to include this from it:   Dr. Wynn is a volunteer vet and has been with us for over a decade.   She shows how we put drops in Nik Tiger's eye and she describes the coloration and procedure a bit.   Vet Arthur Tiger Dental. http://bigcatrescue.org/arthur/  Date of dental:  12/9/12   Arthur was rescued in 2011 but was in no shape for the prolonged surgery necessary for a root canal.  By Dec. 2012 we asked Dr. Peak to come to Big Cat Rescue to help Arthur and his brother Andre, who had suffered broken teeth since 2003.   Cast: Dr. Michael Peak http://www.thepetdentist.com/meet-the-doctors.php Dr. Justin Boorstein (boor-steen) Dr. Liz Wynn Master Keeper, Jamie Veronica, President Master Keeper, Gale Ingham (thin) Operation Mgr Green Shirt Keeper, Chris Poole Green Shirt Keeper, Angie Green Shirt Partner Jeff (who usually stands by with a gun and dart gun in case of emergency)   You may find some video of trying to get Arthur into his feeding lock out later, out of sequence.  It was a little confusing, but they finally gave up on him going in the transport and managed to get him into his feeding area where Jamie sedated him.  Jamie is our best person on the “jab stick” which is needle on the end of a pole that injects the drugs on impact.  It makes a loud noise and the cats usually spin and lash out at the person doing it, but Jamie has nerves of steel and manages to retract the pole without the cat biting it.   It's better than a dart, because darts have to stick in the cat and stay there until the drugs dispense.  If the cat eats the dart, that is very bad.  Board is held across cat because they can raise up very unexpectedly and bite.  Protecting the vet is our main objective.   Backstory:  Arthur and Andre broke their canine teeth off during transport in 2003 from NJ to TX the first time they were rescued.  The sanctuary that took them in didn't give them dental care for 10 years and went bankrupt in 2011.  That is when we rescued Arthur, Andre and their sister Amanda, but they were in bad shape and not capable of undergoing extensive surgery.   Not in this video, but for reference; as soon as they were strong enough after their arrival, Andre (not Arthur) was sedated due to the fact that his untreated, broken teeth (since 2003) were obviously causing pain and he couldn't eat.  He died on the table during the dental surgery, but there were 5 vets there and they said, “No one is going to the light with five vets in the room!”  They brought him around, but decided to wait on doing the other two canines until he was stronger.  I don't know if there ever was any video of that.  I can't find it.   Arthur had a seizure after being sedated.  This happens maybe 5 percent of the time and can be life threatening.  We use a cocktail of drugs to be as easy on the cat as possible, but every cat is different and reacts differently.  Arthur reacted very badly and scared us even further because he would hold his breath for such long periods of time that we often feared he was dead.   Graphic warnings through out are needed.   Back to Arthur.  Dr. Peak performed a root canal.  They drew blood to check for feline viruses, infections and kidney levels.  This lets us know if there are underlying issues to deal with and gives us comparisons for latter life levels.  We draw blood every time a cat is sedated.  It gives us a benchmark to use in their record and we check for infections diseases, kidney function (failure) because our cats are all so old and in varying stages of renal failure.   During the root canal Dr Peak finds a shard of plastic lodged inside the tooth against the nerve.  You can just imagine how painful that must have been.  It was probably from a toy or water bucket that was not tiger proof.  While this was pretty rare, to see a shard of plastic embedded inside the tooth, it is very common for people to give big cats toys and water buckets that are too flimsy.  The cats bite off portions, which end up lodging in their stomachs and intestines, causing internal hemorrhaging and a painful death.  The reason people do that is that it is cheaper than buying items that are safe for the cats.   The gun they point at the tiger's face is an X-ray gun. Dr Peak takes X-rays in the field and even brings along a developing tank to monitor his progress as he goes.  Arthur gets IV fluids to give him an added boost and to flush the sedation drugs out of his system when he awakes.   At about minute 35 Dr Liz Wynn gives a good overview of what we are doing and why.  These are usually at the end of the videos that I give you, because we don't know what is going to happen in the beginning, but you can use parts of it earlier in the story to illustrate.   Dr. Peak packs Arthurs root canals with antibiotics to help kill any infection.   We move Arthur into the transport wagon to wake up.  As soon as surgeries are over the cats are “reversed” ( they are reversed as soon as they go on gas, if they are masked or intubated ) Cats can wake up very quickly as soon as they are reversed, and / or taken off gas.  They can easily take off a limb with a groggy bite so we are very quick to get them into a controlled area so they can wake up fully.  The next really dangerous part of any sedation, is the waking up.   Even though they can wake up quickly, they also can go back to sleep and never wake up.  We do everything we can to get them sternal (laying on their stomachs with their heads up) as soon as possible after sedation.  We call their names, tickle their ears and toes (they hate that) rock the cage, bang on the bars and totally obnoxious.  It is so tempting to just let them enjoy a good long sleep after their ordeal, but that could be the death of them, so we have to be the bad guys and wake them up.  Another thing that kills many exotic cats is hyperthermia from anesthesia.  This causes their bodies to overheat and can just cook them to death inside of a few minutes.  The whole time we are waking them up we are looking for signs of hyperthermia (opposite of hypothermia where you get too cold and die)  If they spike a temperature we are suddenly in a life or death position of deciding if the cat is groggy enough to pull them out and put them in a tub of ice water, or, in the case of a tiger, if it will be safe to open the door and start packing them in ice.  There is always this dilemma going on of doing what will save the cat without undue risk to the people trying to save the cat, because if the cat wakes up, someone is going to get hurt or die.   Cats don't understand; as much as we would like to believe they do, when you are trying to save their lives.  There have certainly been what appears to be exceptions, like removing a piece of food from a choking cat's mouth and having them not turn right around and bite me for reaching down their throat, but I think by and large I've just been lucky.   Back to Arthur.  Several hours lapse between the time of his waking and release back into his Cat-a-Tat, and I think there may even be some film out of sequence, at this point, although I am not sure how that could have happened.   Dr. Peak did the root canals on both Arthur and Andre on this day, so we would have been sedating Arthur, doing his surgery, putting him back in the transport to wake up and then sedating Andre, doing his surgery, and then putting him back in his enclosure.  The easiest way to tell these brothers apart is that Andre has a notch in his ear, courtesy of his brother.   Waking up from anesthesia can be ugly.  Arthur thrashed around a bit waking up.  What most people don't know, when they take their pets to the vet, is that they are kept away as the animals are going down and coming up from anesthesia, or they would completely freak out.  The cats bang their heads on the bars and thrash around like wild.  Unless they are very, very sick, they don't usually go under easily.   Vet Andre Tiger Dental. http://bigcatrescue.org/andre/. Date of dental:  12/9/12   Gale distracts Andre so Jamie can sedate him using the pole syringe.  We often put a blanket over the head of the sedated animal so that if they wake suddenly, they feel secure in the dark and cannot land a bite as easily.  You will often see Jeff Kremer, our Director of Donor Appreciation (tall, slim, bald, usually wearing khakis) in our surgery videos because he is our marksman and in charge of darting or killing the tiger depending on what life threatening event happens.   As noted in Arthur's dental info, this is Andre's second dental.   He died and was revived during our first attempt several months ago, so now we are trying to finish the repair to his four broken canine teeth.  We were told that in 2003, when Wild Animal Orphanage rescued him from Tigers Only in NJ, he broke off all four canines on the bars of the transport cage.  Wild Animal Orphanage took in 23 tigers during that rescue operation and was unable to fund all of the medical needs.  Andre suffered with exposed nerves in his teeth for the next 8 years.  When WAO went bankrupt we helped orchestrate the rescue of the final 7 tigers there, thanks to financial help from an amazing couple.  Four went to Carolina Tiger Rescue and Andre, Arthur and Amanda came to us.   Andre has a growth on one of his back legs, so we used the opportunity to do a biopsy.  Andre's blood pressure began dropping dramatically 107/72 so he was reversed, since he was on gas.  His temperature dropped significantly as well, so we covered him in an electric heating blanket.  He was fighting sedation so hard that we had to give him more drugs.  It is always such a fine line to balance between making sure they feel no pain and don't hurt anyone and yet not killing them with kindness.     This video shows the X-ray developing tank.  Red glass tank.  At the end the vets gave Andre straight oxygen through the mask to help him flush the anesthetic gas from his lungs.  This will help him wake more quickly.  Again we stimulate him in every way we can to get him up and sternal as quickly as possible.   King Tut and Zulu Hybrid Cats. 10/16/2012   http://bigcatrescue.org/king-tut/https://www.youtube.com/watch?v=ka3Xu1cEEq4 You can scrape video from here to use in this video if you want   http://bigcatrescue.org/hybrid-facts/   We almost never take in hybrid cats because they do not require permits to possess, so any cat lover can take them in and we need to save our cage space for cats who require permits that most domestic cat rescue groups don't have.  The hardest part of turning them away is that breeders will try to get their hands on any hybrids they can because people buy them over the Internet or at cat shows and don't know, until after they have paid thousands of dollars for them, that they spray and defecate all over everything to mark it as theirs.   King Tut and Zulu had been terrorizing a neighborhood after either escaping or being turned loose by their owner, and Animal Control trapped them.  A man from the Sierra Club heard about it and went to see the cats that had been brought in.  He wasn't sure what they were (I think he called them Jag Cats) and called us.  He brought them to us to see if we would take them.   Both were thin, but King Tut was emaciated.  His paw had been injured, so he probably couldn't hunt or travel as well as Zulu, plus he felt awful trying to fight off infection, so he was just wasting away.   Zulu turned out to be a handful and have awful house manners, but one of our long time volunteers, Sharon Dower, asked to adopt her anyway, and we were happy that she would get a home.  She was spayed first and for a while could be watched on our live web cams via UStream.tv/channel/bigcathospital   King Tut responded well to antibiotics and a good diet, but he's just too dangerous for a pet home, so he will live with us forever.  There is some later video of him (I don't know if I bound it into one file) where King Tut is released out into his Cat-a-Tat.  All he needs now is food and love.   Vet Dr Wynn. http://www.ehrlichanimalhospital.com/about-us/veterinarians/   This video can be put into other videos as needed.  I don't think there is enough here for a full 20 min segment.  Maybe a segment under 4 minutes as a stand alone piece.   Dr. Wynn is a volunteer vet and has been with us for over a decade.  She shows how we put drops in Nik Tiger's eye and she describes the coloration and procedure a bit.  http://bigcatrescue.org/nikita-tiger/   We don't give Vet Tours but our vets both come out twice a week or more and will answer questions if a tour group happens by.   Tonga the white serval had a nosectomy, to remove his nose, to get rid of all the cancer.  That's been more than two years ago and has allowed Tonga to live as long as most of our servals usually do (17 is the average for our servals.  most other places only 10-12) and he is still doing well.  This shows how quickly and how far a wild cat can reach out through the bars of the cage and why we have to be so careful around them.  http://bigcatrescue.org/tonga/   Jumanji the black leopard is being treated for his skin allergies.  Not in this video, but we are now using a new blend of fatty acids in all of the cats' diet to help them with skin and coat condition.  http://bigcatrescue.org/jumanji/   There is some previous footage on Tonga's nose.   Vet Skipper Lynx  May 2014. http://bigcatrescue.org/skipper/   Skipper is taken to the vet because Keepers notice that he isn't passing feces.   Every day, as Keepers clean the cages, they note food left over, the feces condition (runny, grassy, missing), vet issues like scratching, coughing up hairballs, and cage maintenance issues.  All of these notes are entered into a data base at the end of cleaning.  This sends an immediate email out to the Operations Manager, CEO, President, Vets and Maintenance staff and becomes a permanent part of each cat's medical record.  Not passing feces for a couple of days means trouble, so Skipper was taken to the vet for diagnostics.   That's never an easy thing to do.  Catching the cat is always stressful to the cat and dangerous for the people involved.  If there is any way to check a cat and treat them in their cage we do, but this sort of problem would require sedation and X-rays.  There is footage of us catching Skipper in this video that you can scrape for use in this video if you want.https://www.youtube.com/watch?v=XRC_pCZqza4 Dr. Wynn tries a warm water enema first, but Skipper's intestines are really blocked.   Note that Jamie Veronica is able to pull up Skipper's complete medical history on her phone for the vet, because of the google Education Apps site that we use to keep all of these records.  We have set up more than a dozen sites like ours for other sanctuaries to use in the care of their animals.   Let me know if you want screen shots of these kinds of files for the video.   When we have time to take a volunteer or intern along, we often pick someone who has been especially helpful and who happens to be in the right place as we are heading out.  This time it was Green Shirt Afton Tasler.  Afton got the job of clipping Skipper's nails while he slept.  In this raw footage are vets talking about other client's pets, so be sure none of that makes it into the final cut.   The vet does X-rays and a sonogram to make sure she has gotten to the root of the problem.  It would be foolish to assume we got it all and then be back in here two days later because the main blockage was still there.  This is a good time to talk about how dangerous it is to sedate a cat and why we don't do it any more than absolutely necessary and to talk about why we need our own, on site X-ray and sonogram.  Both have now been donated, but we are still fundraising for the building to house them, as our current, West Boensch Cat Hospital is too small.   Skipper is given fluids to help flush out the drugs used to sedate him and to help hydrate his entire system to make it easier to pass feces.  Dr. Wynn talks about how cats get so stressed going to the vet (domestics too) that their blood sugar levels spike, which can sometimes be mistaken for diabetes.   Vet Cheetaro Leopard. 2013 vet visit. http://bigcatrescue.org/cheetaro/   Even though our cages are full of trees and wooden structures for the cats to sharpen their claws, they often do not do it consistently enough to keep their nails from growing too long.  Because of the way the claws are curved, they can grow all the way around and pierce the paw pads.  Their feet are so furry and the ground in their cages so soft, that we often cannot see that there is a problem until the cat begins limping.   Given the ages of our cats who are mostly geriatric, it can be hard to tell if it is an ingrown nail or the inevitable arthritis of old age.  Some cats, like Cheetaro, we know to have chronic nail issues, so in his case we knew we would have to sedate him and clip his nails back.   You might wonder why we don't declaw cats who have these issues, but declawing takes off the entire last digit of the toe, can cause extreme pain to walk and the nails still grow back in many cases; just worse, like out of the tops or sides of their paws.   Due to Cheetaro's advanced age we only want to lightly sedate him, but he's one of our most dangerous leopards too, so we need to be sure the vet is safe while working.  You can see in this video how hard it can be to draw blood from a cat.  They have evolved to have tiny veins that roll away from the point of puncture.  This is great for avoiding a bite from another cat, but makes it hard on our vets to get a vein.  Dr. Wynn and Jamie Veronica discuss some ways to encourage Cheetaro to use his scratching items more.   Vet Jade Leopard. http://bigcatrescue.org/jade/   Jade had been vomiting.  There probably isn't enough here to do anything with.  There must have been other video taken at this time that may have already been used on BigCatTV.com or YouTube.com/DailyBigCat  Jade illustrates how hard it is to catch a leopard.  I think leopards are the smartest of the cats.   We feed them every night and their water bowls are in their Lock Outs, so they know it is a safe place.  Part of our Operant Conditioning with them is to give them treats in Lock Out and open and shut the door, so that when we do need to trap them, that isn't scary.  CEO, Jamie Veronica and her husband, Dr. Justin Boorstein talk about how they will hook up the transport inside the cage.   We lock the cat into one of the furthermost sections of their cages, which are all in 2 to 4 sections, separated by guillotine doors.  Then we can open the outside door to bring in the transport.  Once in the transport we have to slide in long metal poles so that the volunteers carrying the cats can keep their hands and arms away from the cat.  We have to go slowly so the cat doesn't strike out at the poles and risk breaking a tooth.   We weigh Jade at the West Boensch Cat Hospital before taking her in to see Dr. Wynn, so she has a recent weight on which to base her sedation drug dose.  Unfortunately there is no vet video attached, so I don't know if any of this makes sense to use.  This video was on our secondary site, and thus never got much exposure.  Jade's sister, Armani had a polyp in the back of her throat that was causing her to choke and had to be removed.https://www.youtube.com/watch?v=mjxJL-_uO4s   Vet Canyon Sandcat Claws  12/10/13  http://bigcatrescue.org/canyon/   I didn't get a chance to take notes on this one, but it's pretty clear what is happening.  According to books I've read, Sandcats don't live past 13.9 years and ours are both over 14 now.  Given the ages of our cats who are mostly geriatric, it can be hard to tell if it is an ingrown nail or the inevitable arthritis of old age.  Some cats, like Canyon, we know to have chronic nail issues, so in his case we knew we would have to sedate him and clip his nails back.   You might wonder why we don't declaw cats who have these issues, but declawing takes off the entire last digit of the toe, can cause extreme pain to walk and the nails still grow back in many cases; just worse, like out of the tops or sides of their paws.  Due to Canyon's advanced age we only want to lightly sedate him, but the littler the cat, the more fierce they are, so we need to be sure the vet is safe while working.   Enrichment  http://bigcatrescue.org/enrichment/   I didn't get to take notes while encoding the enrichment footage from tape to digital but here is what I did note:   Pinatas   Cupcakes - Jade and Armani Leopards http://bigcatrescue.org/jade/  and http://bigcatrescue.org/armani/   Dinosaur - TJ Tiger http://bigcatrescue.org/tj/   Donkey - Cameron Lion and Zabu Tiger  http://bigcatrescue.org/cameron-lion/ and http://bigcatrescue.org/zabu/   Flower - Nikita Lioness  http://bigcatrescue.org/2011/nikita-3/   Present - Jumanji Leopard  http://bigcatrescue.org/jumanji/   Toys   Barbara Frank and Chris Poole load toys.   Yellow Donut - Cameron Lion's favorite toy    http://bigcatrescue.org/cameron-lion/ and http://bigcatrescue.org/zabu/   Red & Blue Donuts - Arthur, Andre and Amanda Tigers  http://bigcatrescue.org/arthur/ and http://bigcatrescue.org/andre/  and http://bigcatrescue.org/amanda/   Meat Cakes for Birthdays   Apollo and Zeus the Siberian Lynx http://bigcatrescue.org/apollo/ and http://bigcatrescue.org/zeus/   Bengali Tiger moaning and rubbing  http://bigcatrescue.org/bengali/   Other   Castle - Little Feather Bobcat  http://bigcatrescue.org/little-feather/   Rock den - Apache Bobcat who got a card board cake  http://bigcatrescue.org/apache/     Jamie at the beach with her friend Gail.    Hi, I'm Carole Baskin and I've been writing my story since I was able to write, but when the media goes to share it, they only choose the parts that fit their idea of what will generate views.  If I'm going to share my story, it should be the whole story.  The titles are the dates things happened. If you have any interest in who I really am please start at the beginning of this playlist: http://savethecats.org/   I know there will be people who take things out of context and try to use them to validate their own misconception, but you have access to the whole story.  My hope is that others will recognize themselves in my words and have the strength to do what is right for themselves and our shared planet.     You can help feed the cats at no cost to you using Amazon Smile! Visit BigCatRescue.org/Amazon-smile   You can see photos, videos and more, updated daily at BigCatRescue.org   Check out our main channel at YouTube.com/BigCatRescue   Music (if any) from Epidemic Sound (http://www.epidemicsound.com) This video is for entertainment purposes only and is my opinion.

Today's episode is dedicated to the differentiation and management of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) We are delighted to be joined by Dr. Eric Felner. Dr. Felner is a Professor of Pediatrics/Pediatric Endocrinology at the Emory University School of Medicine and is an Adjunct Professor of Chemical and Biomedical Engineering at Georgia Tech. Show Highlights: Our case, symptoms, and diagnosis: A 15-year-old male presents with a one-week history of increased urination. He is otherwise healthy except for a viral URI last week. He is found to be disoriented and tachycardic, with an exam notable for delayed peripheral capillary refill and cool extremities. The patient has deep, labored respirations upon examination, and labs confirm hyperglycemia with a serum glucose of 850, mild acidosis, and 2+ ketones. His CPK level is elevated, and a crystalloid fluid bolus is started.  Hyperosmolar hyperglycemic state is defined as a serum glucose greater than 600 mg/dL, serum osmolality of 330 mOsm/kg, and the absence of ketosis and acidosis. The key difference between HHS and DKA is that DKA is characterized by the presence of ketones in the blood and acidosis, but HHS means these are completely absent. Even though DKA and HHS are similar, their management strategies have their own nuances. In DKA, the lack of insulin leads to management strategies, while HHS is marked by complete dehydration and excessive urination.  Factors that point to HHS will be a very overweight child, family history, and ethnicity; Type-2 diabetes is much more common in African-American, Latin-American, and Native-American children, while Type-1 is more common in Caucasians.  Specific labs for patients with suspected DKA or HHS include a comprehensive metabolic panel (CMP), blood gas, and CPK for HHS. For both conditions, management strategies focus on insulin and fluid administration, but there are key differentiations: DKA is managed using the triple bag therapy that was pioneered by Dr. Felner. There is a risk for cerebral edema with administering fluid. The most important data relating to fluid administration with regard to neurological outcomes is what we have learned in calculating fluids with the “2x maintenance formula” to guard against mistakes that could result in cerebral edema. Key considerations regarding low-dose vs. standard-dose insulin therapy revolve around the weight and age of the pediatric patient. For HHS, the key is to manage fluids and give insulin; for Type-1 diabetics, the key is to eliminate acidosis. Key PICU management pearls in minimizing cerebral edema risks are to determine the level of sickness by the PCO2 level, high BUN, and by not giving bicarbonate. Remember that children under age 5 have a higher risk for cerebral edema. In the management of both DKA and HHS, remember that it comes down to how sick a patient is and not necessarily following the numbers.  In general pediatrics, managing a sick DKA patient means giving an IV, administer fluids, and call a specialist management team right away. Dr. Felner discusses the association between COVID-19 and Type 1 diabetes based on his experience.  As intensivists and endocrinology teams work together to transition patients to an intermittent insulin regimen, it's important to remember how to convert from IV insulin to subQ insulin.  Takeaway clinical pearls include the key diagnostic elements between DKA and HHS. In HHS, patients will have higher glucose levels, milder acidosis, mild ketosis, and increased dehydration. Both conditions will have insulin and fluid management, and HHS patients may require increased fluid resuscitation.   

Patrick and Amy catch up on some recent community news then speak with leukemia survivor and bone marrow transplant recipient Bob Falkenberg as he’s set to kick off his 10th Lifeblood cycling ride to support Be The Match.   Notes: PRESENTING SPONSOR: Takeda - bit.ly/TakedaBDsite   SUBSCRIBE to BloodStream on Apple Podcasts: bit.ly/BSPAP CHECK OUT all our stuff:  bit.ly/AllBloodStreamStuff   BloodStream LIVE May 26th - Event link: http://bit.ly/BloodStreamIsBack   Bob’s Team Lifeblood: http://bihttps://bit.ly/3yaPj2U NHF’s Community Voices in Research: http://bit.ly/CVRNHF CSL and uniQure close agreement: http://bit.ly/CSLuni Experimental SubQ Inhibitor Treatment: http://bit.ly/SubQinhib

Progeria is a rare disease that causes premature aging in childhood; the FODMAP diet is explained as a treatment for IBS; J&J vaccine restarted; Question of the month: Fever and Cough.Introduction: Low FODMAP Diet and J&J COVID Vaccine is back.  By P. Eresha Perera, MS3, and Sherika Adams, MS3.Today is May 10, 2021.Irritable Bowel Syndrome. Patients with IBS frequently have other conditions such as anxiety, depression, somatization, fibromyalgia, chronic fatigue syndrome, GERD, dyspepsia, non-cardiac chest pain, chronic pain, and other mental illness. A common triad we see in the clinic is: Anxiety + Fibromyalgia + IBS. Treating these conditions is hard, and even more so when they are combined. Let’s focus for now on IBS treatment. Recently we had a patient with IBS who had a laparoscopic cholecystectomy and of course was complaining of abdominal pain and constipation. We mentioned the low FODMAP diet as part of the treatment. The low FODMAP diet has been proven for the treatment of irritable bowel syndrome (IBS) and or small intestinal bacterial overgrowth (SIBO). It has decreased symptoms in 86% of people. FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. This diet attempts to restrict these short-chain carbs that are poorly absorbed by the small intestine, resulting in cramping, constipation, diarrhea, bloating, and gas or flatulence.You can recommend your patients to follow 3 steps: Step 1: Eliminate foods that are high on FODMAP, Step 2. Determine which foods cause symptoms by reintroducing eliminated foods slowly, and Step 3. After identification of the FODMAP foods that cause symptoms, remove them completely from the patient’s diet. Dr. Hazel Galon Veloso, John Hopkins's gastroenterologist, recommends doing step 1 for 2-6 weeks and step 2 reintroducing a high FODMAP food back into diet every 3 days. Example of HIGH FODMAP foods: Dairy-based milk, yogurt, ice cream, wheat products (cereal, bread, and crackers), beans, lentils, vegetables like artichokes, asparagus, onions, and garlic, and fruits such as apples, cherries, pears, and peaches. Example of LOW FODMAP foods: Eggs, meat, cheese such as Brie, cheddar, and feta; almond milk, rice, quinoa, oats, potatoes, tomatoes, cucumbers, zucchini, grapes, oranges, and strawberries.If available, Fodmap should be initiated with the advice of a nutritionist that can help with the transition, prevent over-restriction and nutritional replete diet. Consider this diet as an initial treatment for your patients with IBS.Vaccination with J&J COVID 19 Vaccination has been restarted.On a different note, On April 23, 2021, the CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended to restart vaccination with the Janssen/Jonson & Jonson COVID-19 vaccine after a pause on April 13, 2021[2]. After giving the J&J vaccine to almost 8 million patients, 15 cases of Thrombosis with Thrombocytopenia Syndrome (TTS) were reported and three of them died. The recommendation was given after a risk-benefit analysis that determined that the benefits of the vaccine outweigh the risks. The risk of TTS in women age 18-49 still exists, but it is considered very low when compared to all the risks carried by COVID 19 itself. Under the emergency use authorization, the Jonson & Jonson vaccine is considered highly effective and safe. In comparison, the AstraZeneca vaccine has had several more cases of TTS, Moderna has had only 3 but with normal platelets, and Pfizer has had zero cases of TTS[3].  This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.___________________________Question of the Month: Fever and CoughWritten by Hector Arreaza, MDWhat are your top 3 differential diagnosis and acute management for a 69-year-old man with new onset of fever, cough, leukocytosis and a right lower lobe consolidation? Important: Rapid COVID-19 test is negative.____________________________Progeria. With Salwa Sadiq-Ali, MS3, Veronica Phung, MS3; and Hector Arreaza, MD.   “The Curious Case of Benjamin Button” is an American movie released in 2008, directed by David Fincher, starring Brad Pitt. Let’s see how we can connect this movie to today’s topic.What is Hutchinson Gilford Syndrome better known as Progeria?V. Phung: That’s a great question! Progeria is an extremely rare disease. It’s progressive and causes children to age very quickly within the first few years of their life. The disease is not evident at birth. S. Sadiq-Ali: Exactly! Usually, kids will start developing symptoms within their first year of life with the first symptom being failure to thrive. Other common features include a disproportionately large head for their face, narrow nasal ridge and tip, small mouth, retro and micrognathia, little to no subQ fat with small outpouchings, delayed eruption of primary teeth, progressive joint contractures, and essentially all geriatric conditions like alopecia, osteoarthritis, and hearing loss. One interesting tidbit though is that their motor and mental development is normal! H. Arreaza: A child getting old quickly, that’s so interesting. What’s the pathophysiology of this condition?V. Phung: So, it’s due to a genetic mutation - a single nucleotide polymorphism - in the LMNA gene known as lamin A. This gene codes for the lamin A protein which holds the cell’s nucleus together. A mutation causes your body to make a much smaller protein called progerin. Progerin is not stable so it doesn’t hold the cell’s nucleus together properly. This instability is thought to be the cause of premature aging. S. Sadiq-Ali: That’s right Veronica! There are two common mutations – the classic form and the non-classic form. The difference between the two forms is where in the gene the mutation occurs. H. Arreaza: So, if I suspect my patient has progeria, I should do a genetic test for the LMNA gene mutation. How common is progeria?S. Sadiq-Ali: About 1 in every 4 to 8 million births is affected by progeria. Unlike many other conditions, there aren’t any predisposing factors - such as gender, location, or ethnicity. It’s completely random! Right now, about 179 children across 53 different countries have been diagnosed with progeria. 18 of those cases are here in the US. One family in India, has had 5 children with progeria. Another interesting fact is that there have been only 2 known cases of a completely healthy person carrying the mutated gene!  V. Phung: Since they’re aging so rapidly and prematurely, their life expectancy is about 14.5 years. However, the oldest believed survivor - Tiffany from Ohio – has lived up to the age of 43! H. Arreaza: And she is still alive, as far as I know. What can be done in terms of management to ensure these children and adults can live their best, most comfortable life? S. Sadiq-Ali: There’s no cure so you’d want to manage any symptoms and make sure the child is getting proper nutrition. Generally, the recommendation is to have small frequent meals, maintain good hydration, do routine PT and exercises, use shoe pads since they don’t have much body fat to provide cushioning, use plenty of sunscreen, prescribe anticoagulation as needed for geriatric conditions like CAD/CVD, and manage any fractures or dislocations that may occur. It requires a multidisciplinary care team.H. Arreaza: So, you mentioned Tiffany Wedekind, the person with progeria who has lived the longest. Now, I want to mention Sam Berns, maybe the most famous person with progeria. “Life According to Sam” is an HBO documentary directed by Sean Fine and Andrea Nix Fine. It was presented in January 2013 at the Sundance Film Festival (I love Park City, Utah). The documentary explains the impact of progeria on the lives of Sam Berns and his parents, Dr. Leslie Gordon and Dr. Scott Berns. You can also see or listen to the Ted Talk given by Sam Berns (google it or go to the link in our script).S. Sadiq-Ali: These kids are aging so quickly they have geriatric conditions; do they die from natural causes or from heart disease and stroke? V. Phung: That’s a great question. Unfortunately, yes. Death is commonly due to complications from atherosclerosis, cardiac disease, and cerebrovascular disease - like a heart attack or stroke. S. Sadiq-Ali: “The Curious Case of Benjamin Button” is usually thought to be an example of progeria, but it’s actually the opposite: A child born as an adult who dies as a baby.H. Arreaza: That was really educational. Progeria, a rare disease that you should know about, in case someone asks you. Remember, “family doctors know everything”.  Even without trying every night you go to bed being a little wiser.ConclusionBy Hector Arreaza, MDNow we conclude our episode number 51 “Progeria”, a rare disease that requires care by a multidisciplinary team. You may not encounter a patient with progeria in your life, but if you do, now you know the fundamentals of that syndrome. We started this episode talking about the FODMAP diet. Consider this diet as part of the initial treatment of IBS. Don’t forget to send your answer (one more week to do it). What are your top 3 differential diagnosis and the acute management of a 69-year-old male with new onset of fever, cough, leukocytosis, right lower lobe consolidation and negative rapid COVID 19 test. Remember, even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Sherika Adams, Eresha Perera, Salwa Sadiq-Ali, and Veronica Phung. Audio edition: Suraj Amrutia. See you next week!_____________________References:Veloso, H. G. (n.d.). FODMAP Diet: What You Need to Know. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/fodmap-diet-what-you-need-to-know.  ACIP Updates Recommendations on Johnson & Johnson Vaccine, American Association of Family Physicians, aafp.org. https://www.aafp.org//news/health-of-the-public/20210429acipjjvac.html Meara, Killian, CDC’s ACIP Votes to Reaffirm Recommendation of Johnson & Johnson COVID-19 Vaccine, April 23, 2021, ContagionLive.com. https://www.contagionlive.com/view/cdc-s-acip-votes-to-reaffirm-recommendation-of-johnson-johnson-covid-19-vaccine Progeria, National Center for Advancing Translational Sciences, National Institutes of Health, https://rarediseases.info.nih.gov/diseases/7467/progeria, accessed on May 6, 2021. Sinha JK, Ghosh S, Raghunath M. Progeria: a rare genetic premature ageing disorder. Indian J Med Res. 2014;139(5):667-674. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140030/ Gordon LB, Brown WT, Collins FS. Hutchinson-Gilford Progeria Syndrome. 2003 Dec 12 [Updated 2019 Jan 17]. In: Adam MP, Ardinger HH, Pagon RA, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1121/.  The Progeria Research Foundation, https://www.progeriaresearch.org/, accessed on May 6, 2021. Family battles with rare progeria disease, Deccan Herald, New Delhi, November 9, 2009, https://www.deccanherald.com/content/34971/family-battles-rare-progeria-disease.html Sam Berns, TEDx MidAtlantic 2013, My philosophy for a happy life. Available at: https://www.ted.com/talks/sam_berns_my_philosophy_for_a_happy_life?language=en, accessed on May 6, 2021.

The ultimate NAD episode with Jeanne Petrie & Tom Ingogia from the Longevity Collective. My guests today are partners in an incredible new venture with a mission to bring NAD to people everywhere including those who need it most. Their mission? To cure addiction, to optimize brain health AND to increase lifespan by 20 years. In this episode we talk about the many different ways that NAD can be used as well as where it’s precursors NR and NMN fit in. Jeanne Petrie is a Nurse, a Naturopath and a Healer who has 14 years experience as an NAD infusion nurse so when it comes to the finer points of using NAD for whatever application she is THE one to go to!! Tom Ingoglia is a businessman with a health journey that took him from being a healthy, vibrant and successful executive to the brink of despair as a mysterious illness and subsequent efforts by the medical establishment to treat him robber him of his health and rendered him a pain ridden shadow of himself dependant on pain medications to get through the day – he was able to reclaim his life through the discovery of NAD. Between the two of them they have published research, attended and organized NAD conferences and rubbed shoulders with many of the leaders in NAD research….they run a not for profit - The Center for Research and Brain Health also known as The Longevity Underground, as well as The Longevity Collective an e-store selling Transdermal NAD patches & supplements…these two are on a mission and we all stand to win from what they have set out to achieve. In the meantime, they generously sat with me and shared their knowledge, their stories and so much more…so pour yourself a hot or cold drink, grab a pen and paper and let’s dive in to the world of NAD. Here are a few time stamps to orient you through the interview: 14:34 Longevity Diagnostic Research – developing a test that can establish individuals’ innate NAD levels and best course of action to restore them 19:00 The types of NAD supplements available now at Longevitycollective.com (promo code Longevity15) 22:00 How to decide which route of administration is optimal for an individual – choosing between intranasal, sublingual, SubQ or IV 27:00 Bioavailability of different forms of administration 29:00 What NAD does at a cellular level… and why it seems to affect people differently 36:00 Tom Ingoglia’s incredible health story…. 44:00 Floxies, CFS, Lyme – all respond differently to NAD and other treatments – why low and slow is the only way to go 51:00 The questions to ask next time you are going in for an NAD infusion…the results you can expect to experience… 56:00 Turning the clock back to 1948, the first NAD IV’s in Italy to treat morphine addiction 60:00 The connection between NAD and brewer’s yeast, pellagra and…Covid? 1:02 How NAD treatment may hold one of the keys to treating veterans, addicts…. 1:07 Longevity Underground – ultimately searching for ways to fund and run clinical trials to help the homeless, veterans, elderly and COVID populations 1:09 Callout for volunteers to join the Longevity Undergound…. 1:11 Tackling the issue of using precursors to NAD, do they work? Who might they not work for? 1:16 The work that Elysium is currently doing with ALS patients & NR that is showing results 1:24 Jeanne’s take on why some people may just need to be long term users of NAD… 1:26 Possible caution around using NAD in the presence of certain types of cancer… Links: LongevityCollective.com LongevityUnderground.com (not-for- profit) Promo code: Longevity15 to get 15% off your purchase of NAD products Please note that this podcast is for information purposes only!! None of the content is intended as medical advice – before undertaking any new health initiative be it a change in diet, lifestyle or supplementation please consult with your medical practitioner!!

OverviewDo you ever get overwhelmed with all the ED analgesic options? In part 2 on ED Pain Management, Dr. Sergey Motov helps break things down, reviewing a few cases and finishing with Sergey’s 10 Commandments of ED Pain Management. Key PointsSergey's 10 Commandments of ED Pain Management Titrate opioids regardless of initial dosing regimen: weight-based, fixed, or nurse-initiated. Use alternatives (to IV) routes of analgesic administration: PO, PR, IN, SubQ, nebulized, topical. Utilize sub-dissociative dose ketamine for selected acute and chronic painful conditions. Educate patients about appropriate expectations of pain course and management. Embrace a concept of channels/enzymes/receptors targeted analgesia. Use NSAIDs based on their analgesic ceiling dose. Attempt to use non-opioid analgesics whenever possible. Promote nerve blocks for a variety of acute painful conditions (trauma, infection, inflammation). DO NOT prescribe long-acting opioids, SR/ER opioids, or fentanyl patches in the ED or at discharge. If indicated, DO prescribe a short course of immediate release opioids (preferably morphine sulfate IR) at discharge and arrange proper follow-up. Resources and References Cisewski DH, Motov SM. EMRA Pain Management Guide. EMRA. Dallas, Texas:2020. • App version available within MobilEM at iTunes and Google Play. Motov SM. PainFreeED.com.

Drugs n Stuff 71: Anadrol. Hosted by Dave Crosland and Scott McNally. Presented by: TRUE NUTRITION. Code: ADVICES https://www.truenutrition.com/ 3rd Party Tested, Discover the source that bodybuilders trust! Steroids in the News: High School coach injects student with steroids. Profile of the week: Oxymetholone. Listener Questions: houghts on Tren E instead of Ace How much does have life change when injected SubQ? Arachidonic Acid Supplements- What does it do? Any experience? When to cut injections before a contest Primo Vs EQ for strength Back Loading Insulin Pins Does Asprin Lower Hematocrit? Reach out to Dave : Croslands.org.uk Reach out to Scott : mcnallydiets@gmail.com

In this Interview, Jean-Francois Tremblay, owner of CanLab and I dig in to one of the new darlings of the peptide world - Tesamorelin and a less known but possibly just as effective other option - Setmelanotide - an offshoot of the better known Melantonan 2. We also cover AOD 9604, FRAG 17691 and CJC1295 ...and why you probably want to avoid the version with DAC (drug affinity complex)... We start with a chat about how if you're after lasting results there's really no way to avoid optimizing your diet, moving more, optimizing sleep etc... but these peptides might just help to speed things along and ease some of the bumps along the way. Please note that this content is intended for information purposes only and is not intended to substitute professional medical advice, diagnosis or treatment. Peptides are for the most part classified as research chemicals so should not be used on humans. Before changing your diet or using any new supplement make sure to consult with your health care provider. Always seek the advice of your physician or health care provider with any questions or concerns you may have regarding a medical condition before you make any changes. Show Notes: Keto Calorie Peptides Help with Fat Loss Body Recomposition Growth Hormone unregulated by Fat Loss peptides like FRAG 17691 or AOD9604 (just one amino acid difference) help to mobilize fatty acids in the fat cell – but need to be in calorie/energy deficit for it to stay out Consistency and sticking to your plan is the ultimate secret sauce…   Why Canlab combines Frag and AOD 9604 More about Frag and AOD….are they the same or different? AOD lacks one tyrosine…means that it lasts longer…whereas Frag uses more up front and gets metabolized faster….. Tesamorelin…..what it does…. The skinny on Tesamorelin….it’s not about Tesa it’s about the growth hormone release…. Re Muscle Gains attributed to Peptides….in studies re old people it’s about bringing back muscle you once had…. Hormone replacement therapy is at the foundation of reclaiming muscle mass GH good for muscle sustaining (vs growth) and tissue repair (but doesn’t hold a candle to BPC and TB4) Tesamorelin – origins – where it came from originally….very close to CJC 1295 (Mod IGRF 121 is actually CJC 1295 without dac). and other Growth Hormone Secretagogues. The difference between Tesa and CJC not really all that great….why some people may be promoting Tesa over CJC 1295 the magic is in the dose. Difference about with Dac and without Dac. With Dac too many peaks of growth hormone (similar to MK 677….increases risk of insulin resistance…..why is the Dac long lasting…binds to albumin in the blood ….which is problematic as there may have been relationship to blood cancer seen in certain studies….so better to use without DAC…just use multiple times a day if necessary  Post workout (3) is a good time…but pre bed(1), pre workout and first thing in the morning (2) are all better    Setmelanotide – another derivative of alpha MSH (Melanotan, melanotan 2, PT141) Basically prioritizes appetite suppression over tanning and sexual enhancement..they all create a tan just to varying degrees…. SM get appetite curbing (some sexual stim)…increases metabolic rate by about 6%, without increasing HR or BP…. On average can expect about 1 lb a week fat loss…. Many reports of people using it with good results – safe track record…..Clinical studies went for 12 months   Do not start at full dose of 1.5mg a day….start at .5 1-2 days then 1.0mg for a couple of days and then increase to full dose to avoid possible /nausea In studies – they changed nothing else….and saw results but it’s likely that as people lost weight they may have started to move more etc… At this point best method for most peptides is SubQ over oral….Intranasal may work but need to use higher dose (aka PT141 1 mg is SubQ and 2mg is IntraNasal)   Tesofensine – not a peptide acts on dopamine and AC receptors in the brain so needs to be used with great caution Please note that this video is intended for information purposes only and is not intended to substitute professional medical advice, diagnosis or treatment. Peptides are for the most part classified as research chemicals so should not be used on humans. Before changing your diet or using any new supplement make sure to consult with your care provider. Always seek the advice of your physician or care provider with any questions or concerns you may have regarding a medical condition.

Nassim Usman, CEO, Catalyst Biosciences discusses the problem of Hemophilia, a rare and debilitating disease in which patients have a genetic deficiency in their ability to prevent bleeding.  Currently, these patients must receive cumbersome bi-weekly IV infusions of clotting factor replacement therapy and may still bleed.  Catalyst is developing a solution to give these patients a better and more convenient treatment particularly for inhibitor patients who have developed antibodies to their replacement therapy. @catalystbio #hemophilia  #catalystbio  #subQ  #biotech Catalyst Biosciences Listen to the podcast here.

Nassim Usman, CEO, Catalyst Biosciences discusses the problem of Hemophilia, a rare disease in which patients have a genetic deficiency in their ability to prevent bleeding.  Currently, these patients must receive cumbersome bi-weekly IV infusions of clotting factor replacement therapy and may still bleed.  Catalyst is developing a solution to give these patients a better and more convenient treatment particularly for inhibitor patients who have developed antibodies to their replacement therapy. @catalystbio #hemophilia  #catalystbio  #subQ  #biotech Catalyst Biosciences Download the transcript here.

Join Brandon as he discusses subcutaneous injections versus intramuscular. The science is there, the trials are there, but is it safe? Let's find out. If you have comments or concerns, email Brandon directly at brandon@trtcommunity.com Like always, rate, subscribe and share and come see our community on Facebook!

Sam Bowker is a pulmonary hypertension patient on triple therapy from Canada. Ken Porter is her partner and caregiver. They discuss Sam’s diagnosis and creative ways they work together to manage her PH treatment regimen. Learn more about pulmonary hypertension trials a www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware #YoungwithPAH #LifeInPurple #PHUnited @PHACanada @antidote_me  

Canadian Pulmonary Hypertension Patient, Brooke Paulin discusses her road to PH Diagnosis. Learn more about pulmonary hypertension trials a www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware #YoungwithPAH @PHACanada @antidote_me

Canadian Pulmonary Hypertension Caregiver Darren Dempsey discusses the impact rare disease has had on his family and how stress impacts the entire family. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware @antidote_me @phacanada

Canadian Pulmonary Hypertension Patient, Marion Roth discusses the importance of clinical trials, fearlessly tackling her bucket list and educating the world about #phaware-ness. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware @antidote_me @phacanada

Kristen Wieneke is a long term pulmonary hypertension survivor. She was diagnosed in 2003 during open heart surgery to repair an ASD. She discusses the stigma that comes with rare disease, the importance of clinical trials and why patients must be their own advocate. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware @antidote_me

Abby Sherwood discusses navigating life with pulmonary hypertension on the 15th anniversary of her PH diagnosis. Learn more about pulmonary hypertension trials at www.phaware.global. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware #pottsshunt #YoungwithPAH

This month on BloodStream, we review major takeaways from World Federation of Hemophilia’s 2018 World Congress, Dakota Rosenfelt shares his journey of life with hemophilia, and we speak with Lisa Thibeault, the nurse coordinator from the Southeastern Ontario Regional Inherited Bleeding Disorders Program in Ontario, Canada, about the progress made in the treatment of women with bleeding disorders. All that and more on Episode 25 of The BloodStream Podcast! Exclusive Sponsor: Shire World Federation of Hemophilia 2018 World Congress World Congress Daily Recaps FDA Clears way for gene therapy BioMarin presents data on BMN 270 Bayer presents insights on HemACTIVE study Novo Nordisk presents data on Rebinyn and presents study data on NovoEight CSL Behring Supports patient advocacy groups through LEAD Program Octapharma presents data on SubQ-8 and presents data on Nuwiq UniQure presents data their AAV5 gene therapy program Bioverativ (a Sanofi company) presents preliminary data for BIVV001 Shire presents data on rVWF in the treatment of people with VWD National Hemophilia Foundation’s Dawn Rotellini elected to WFH’s Board of Directors. Genentech/Roche received Priority Review from the FDA for Hemlibra in Hem A patients without inhibitors. coreHEM publishes Core Outcome Set for Hemophilia Clinical Trials Spark and Pfizer present data on SPK-9001 and the modified process New study looks at Von Willebrand Disease, Von Willebrand Factor, and Aging   Latest Ask The Expert Podcast: Episode 15 featuring Shari Luckey.  Latest Powering Through Podcast: Episode 17 featuring Vanessa Flora, Jason Flora, and Heather Stephenson Share Segment: Dakota Rosenfelt - A Prescription for Success Interview Segment: Lisa Thibeault, RN - Let’s Talk Period, from Queen’s University + partners   BloodFeed: https://www.bloodfeed.com Connect with BloodStream: Email mailbag@bloodstreammedia.com Find all of our bleeding disorders podcasts on BloodStreamMedia.com BloodStream Facebook Page BloodStream Twitter Account Subscribe to BloodStream: iTunes: http://bit.ly/bloodstreamitunes Stitcher: http://bit.ly/bloodstreamstitcher LibSyn: http://bit.ly/bloodstreamlibsyn SoundCloud: http://bit.ly/bloodstreamSC TuneIn: http://bit.ly/bloodstreamtunein Google Play: http://bit.ly/bloodstreamPlay Spotify: http://spoti.fi/2nNPhui