Podcasts about Surgery

This week we're talking with Wiley “Chip” Souba, MD, on the Faculty Factory Podcast. Dr. Souba joins us for a discussion about the inward journey of leadership. As Dr. Souba puts it: leading yourself is the prerequisite to being an effective leader of others. “It's a journey because it's a lifelong endeavor, a mountain with no top. And it's about leadership because it's about leading yourself.” Dr. Souba is a Professor of Surgery with the Geisel School of Medicine at Dartmouth College in Hanover, NH. He has also held other prestigious positions with Dartmouth College, including: Former Dean of the Geisel School of Medicine Former Vice President for Health Affairs Learn more: https://facultyfactory.org/chip-souba 

Dr. Jessica Drummond is the CEO of The Integrative Women's Health Institute and author of Outsmart Endometriosis. She holds licenses in physical therapy and clinical nutrition and is a board certified health coach. She has 20 years of experience working with women with chronic pelvic pain, facilitates educational programs for women's health professionals in more than 60 countries globally, and leads virtual wellness programs for people with endometriosis. Dr. Drummond lives and works with her husband and daughters between Houston, Texas, and Fairfield, Connecticut. In today's episode we delve into endometriosis. What it is, what causes it, and how you can treat it naturally. Discover why period pain, though common, is not considered “normal” — and what you can do to reduce and/or eliminate your pain! Today's episode is sponsored by the Fertility Awareness Mastery Online Self-Study Course.  The most in-depth and comprehensive online fertility awareness self-study program available. Click here to join now! Topics discussed in today's episode: What lead Jessica to study and delve into Women's Health and period pain What is endometriosis and the difference between paradigms Period Pain is not always endometriosis Challenges with surgery in response to endometriosis Surgery is not always a requirement for endometriosis Other options for those who are experiencing fertility issues or period pain who don't want to go straight to surgery Risks of birth control and using it as the cure for period pain What causes endometriosis Connect with Jessica Drummond: You can connect with Jessica Drummond on his Website, Facebook, Twitter, and Youtube. Resources mentioned: Conceiving with Fertility Awareness Program The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility (Book) | Lisa Hendrickson-Jack Fertility Awareness Mastery Charting Workbook Fertility Awareness Mastery Online Self-Study Program Related podcasts & blog posts: [On-Air Client Session] FFP 318 | Overcoming Period Pain + Natural Birth Control | Lisa & Lauren [On-Air Client Session] FFP 304 | Overcoming Period Pain and an Infertility Diagnosis | Lisa & Angie FFP 283 | Overcoming Period Pain | Lisa | Fertility Friday [On-Air Client Session] FFP 220 | Managing Intense Period Pain | Maria & Lisa Join the community! Follow Fertility Friday on Instagram! Subscribe to the Fertility Friday Podcast in Apple Podcasts!   Music Credit: Intro/Outro music Produced by J-Gantic A Special Thank You to Our Show Sponsors: Fertility Friday | Fertility Awareness Programs This episode is sponsored by my Fertility Awareness Programs! Master Fertility Awareness and take a deep dive into your cycles and how they relate to your overall health! Click here to apply now! Fertility Awareness Mastery Mentorship Program (FAMM) This episode is sponsored by FAMM! Are you a women's health practitioner looking for a solid way to incorporate comprehensive fertility awareness chart analysis into your practice? If yes, FAMM is the program you've been waiting for. Click here to apply now!

In this episode Scott Becker shares some thoughts on spine & surgery centers.

Dr. Jesse Morse digs deep into Antonio Brown's ankle injury. __________________________________________________________________________ Thank you to DonJoy Performance for sponsoring this video! Get 20% Off football products with Promo Code TFD20 at www.donjoyperformance.com/football#DJO #PoweringMotion #sportsmedicine #sportsinjury __________________________________________________________________________ Get your TFD Hoodies, T-shirts, and other apparel here - https://the-fantasy-doctors.creator-spring.com/ TFD APP info: - What it is? All the best sports follows on Twitter in one easy place plus injury reports, and videos for the 4 main sports - Promo video: https://youtu.be/FsLqXEynz1o - More info here: https://thefantasydoctorsapp.com/ - How to use tutorial video: https://youtu.be/kvVvNlTKcd0 - Notifications only are for new injuries. - Available on the Apple and Google Play App Stores. __________________________________________________________________________ NFL Injury Reports - Bookmark them and check daily https://thefantasydoctors.com/nfl-injury-tracker/ - Also available on TFD App (white medical button, middle bottom) - Detailed/Advanced version available on: https://tfdinjurydraftguide.com/ __________________________________________________________________________ Follow us on Social Media - Twitter / IG / TikTok / Facebook - @TheFantasyDRS @TFDNBA, @TFDNFL, @TFDMLB, @TFDNHL - @DrJesseMorse @seleneparekhMD @amarpatelMD @Harjas_Grewal 00:00 Intro 00:45 Buffalo vs New England 01:00 Cincinnati vs Las Vegas 01:15 Tampa Bay vs Philadelphia 02:22 Dallas vs San Francisco 03:16 Kansas City vs Pittsburgh 05:29 Bengals 06:18 Titans 07:51 49ers 10:00 Packers 11:30 Buccaneers 13:11 Rams 15:06 Bills 15:27 Chiefs ___________________________________________________________________________ If you're interested in advertising with us, send us an email at: TheFantasyDRS@gmail.com Dr. Jesse Morse reacts to breaking news of Fernando Tatis Jr. broken wrist. __________________________________________________________________________ Thank you to DonJoy Performance for sponsoring this video! Get 20% Off football products with Promo Code TFD20 at www.donjoyperformance.com/football#DJO #PoweringMotion #sportsmedicine #sportsinjury __________________________________________________________________________ Get your TFD Hoodies, T-shirts, and other apparel here - https://the-fantasy-doctors.creator-spring.com/ TFD APP info: - What it is? All the best sports follows on Twitter in one easy place plus injury reports, and videos for the 4 main sports - Promo video: https://youtu.be/FsLqXEynz1o - More info here: https://thefantasydoctorsapp.com/ - How to use tutorial video: https://youtu.be/kvVvNlTKcd0 - Notifications only are for new injuries. - Available on the Apple and Google Play App Stores. __________________________________________________________________________ NFL Injury Reports - Bookmark them and check daily https://thefantasydoctors.com/nfl-injury-tracker/ - Also available on TFD App (white medical button, middle bottom) - Detailed/Advanced version available on: https://tfdinjurydraftguide.com/ __________________________________________________________________________ Follow us on Social Media - Twitter / IG / TikTok / Facebook - @TheFantasyDRS @TFDNBA, @TFDNFL, @TFDMLB, @TFDNHL - @DrJesseMorse @seleneparekhMD @amarpatelMD @Harjas_Grewal 00:00 Intro 00:45 Buffalo vs New England 01:00 Cincinnati vs Las Vegas 01:15 Tampa Bay vs Philadelphia 02:22 Dallas vs San Francisco 03:16 Kansas City vs Pittsburgh 05:29 Bengals 06:18 Titans 07:51 49ers 10:00 Packers 11:30 Buccaneers 13:11 Rams 15:06 Bills 15:27 Chiefs ___________________________________________________________________________ If you're interested in advertising with us, send us an email at: TheFantasyDRS@gmail.com

Dr. Cynthia Toth joins to discuss her career including examining submacular surgery and macular translocation, positioning for retinal detachment surgery, novel imaging breakthroughs, and more.Relevant Financial Disclosures: Dr. Sridhar is a consultant for Alcon and DORC. Dr. Toth is an equity owner and consultant for Theia Imaging, LLC, and receives royalties via her institution from Alcon.You can now claim CME credits via the AAO website. Visit https://www.aao.org/browse-multimedia?filter=Audi

Even though most of you reading this probably don't think of your goats as food animals, that is how they are categorized in the veterinary world. Since very few food animals don't have the opportunity to live out their natural lives, there is little research on dealing with health challenges in individual animals. The focus tends to be on herd health, contagious diseases, and production. It can become even more challenging to care for them in old age because there is even less research on the health issues faced by senior animals. So, what's a goat owner to do when our favorite goats get old? In this episode, I'm talking to Dr. Michael Pesato, assistant clinical professor of Food Animal Medicine and Surgery at Mississippi State University College of Veterinary Medicine and a diplomat of the American Board of Veterinary Practitioners for Food Animal Practice. In a previous article on senior goats, I discussed what to expect in terms of reproduction as your goats get older, as well life expectancy, and parasites in older goats.In this episode, we are discussing some of the most common challenges faced by senior goats, including how to deal with age-related arthritis, dental issues, and extremes of hot and cold temperatures, which are especially challenging for older goats. See full show notes here >>  https://thriftyhomesteader.com/older-goats/To see the most recent episodes, visit  ForTheLoveOfGoats.comWant to support the content you love?Head over to -- https://thrifty-homesteader.ck.page/products/love-goats-tip-jar

    How do we motivate ourselves to take action?  Ramp yourself up and tell yourself what to do with Verbal Surgery -951- “Direct Suggestion!”   Take control of your mental process and feel good, NOW!  Don't miss this one!  Best of class!

Stick it in me bum bum. Surgery. Kidney stones. Wisdom teeth. Results of the Mungenast DFS Showdown. Iggy claims protest because of someone watering a green. The Offer. Worst mob movies. Favorite mob movies. Casino. Joe Pesci. Hollywood squares. We really go do down a rabbit hole. Steve Harvey.

Contributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment options include increasing fluid and fiber intake to soften stools as well as using padding/taping to reinforce the perineum Surgery is an option to repair the prolapse so long as the patient is a good surgical candidate Medical sugar can be used as a desiccant to dry out and shrink the prolapse thus allowing for easier manual replacement References Coburn WM, 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. 1997;30(3):347-349. 2Gachabayov M, Bendl R, Flusberg M, et al. Rectal prolapse and pelvic descent. Curr Probl Surg. 2021;58(9):100952. Segal J, McKeown DG, Tavarez MM. Rectal Prolapse. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC.; 202   Summarized by Mark O'Brien, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Out of all the letters in the LGBTQIA+ acronym, the “I” is the least known. We're gonna find out what it means to be intersex, and how a new draft law to protect the rights of intersex people in the ACT could change history in Australia – if it's passed. For questions or topic suggestions email thehookup@abc.net.au or dm us @triplejthehookup https://www.instagram.com/triplejthehookup

If rehab helps patients recover after a surgery, prehab helps patients get ready for that recovery beforehand. Learn how prehabilitation works in this episode of BrainStuff, based on this article: https://health.howstuffworks.com/medicine/surgeries-procedures/prehab-before-surgery.htm See omnystudio.com/listener for privacy information.

In this episode Dr. Eric discusses four reasons why people with hyperthyroidism should avoid thyroid surgery.  If you have a different type of thyroid condition and/or have very large thyroid nodules and are considering surgery you'll probably also find the information to be valuable.  

In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule.               Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health. Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.  Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department  Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research  Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.  Important Papers  Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., ... & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028. Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., ... & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332. Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Can the appearances of Jesus be explained away as hallucinations? Two leading doctors offer a medical critique. Dr. Harold Koenig is one of the world's experts in the intersection of science, theology, and spirituality. He has written 575 peer-reviewed scientific journals and 55 books. Craig Fowler, M.D., is Professor & Chair of Surgery at the Campbell University School of Osteopathic Medicine. He has received both Best Doctor in America and US Top Ophthalmology awards.Debunking the Hallucination Hypothesis: Leading Doctors Speak on Jesushttps://www.youtube.com/watch?v=iT12FnjJLKIJoin this channel to get access to perks:https://www.youtube.com/channel/UCIS4cWaXgWpznjwovFYQBJQ/joinSupport Paulogia athttp://www.patreon.com/paulogiahttp://www.paypal.me/paulogiahttps://www.amazon.ca/hz/wishlist/ls/YTALNY19IBC8?ref_=wl_sharehttps://teespring.com/stores/paulogiaPaulogia Audio-Only-Version Podcasthttps://paulogia.buzzsprout.comFollow Paulogia athttp://www.twitter.com/paulogia0http://www.facebook.com/paulogia0https://discord.gg/BXbv7DSSupport the show

On May 4, 2001, Bonny Lee Bakley was found fatally shot in a car on a dark North Hollywood street. The prime suspect was her husband, famed actor Robert Blake. But Bonny, a longtime con artist, had plenty of enemies. She left behind a trail of men she'd scammed, and she had a volatile relationship with Christian Brando, the troubled son of movie star Marlon Brando. Not since the O.J. Simpson case had the eyes of the nation been so fixated on a homicide. The search for Bonny's killer took detectives on an eleven-month odyssey across the country and through Hollywood's underbelly of hustlers, drug addicts, and would-be hitmen. It would be the most expensive murder investigation in LAPD history to date. This is the story of Robert and Bonny's toxic relationship, her shocking murder, and his chaotic trial. Did actor Robert Blake kill his wife? Or was the murder someone else's vendetta?From Wondery, and the team behind the hit series Hollywood & Crime (The Dating Game Killer, The Wonderland Murders, Death of Starlet) comes a six-part series about love, obsession and fame gone wrong. Co-hosted by Tracy Pattin and Josh Lucas.Listen to The Execution of Bonny Lee Bakley: wondery.fm/DD_TEOBLBSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Radiation and hormone therapy come with side effects, and while many people are willing to go through whatever it takes to make sure breast cancer is well and truly gone, a new study has shown there may be an easier way.

In the Sixties, Japan was the unhealthiest country in the G7 but quickly turned around. Is it time for us to do the same? Helen Heneghan, a Consultant Bariatric Surgeon and Professor of Surgery at St Vincent's Hospital, spoke to Newstalk Breakfast this morning.

Dr. Jaime Ranieri leads a in depth discussion on breast surgery.

Sometimes you just have to laugh, and that's what we're gonna do... it's time for Spies Like Us! Not much to analyze, break down, and get into character studies on this one... but man we do laugh! One of the 1980s films we cut our teeth on becomes one of the movies we laugh and have fun with on the show. As a leadup to the movie, we also break down our Top 5 spy movies of all time! So get your test cheat sheets ready, get your decoder wheel out of your Lucky Charms, and put on those Reagan musicals... it's time for Spies Like Us! Click here to listen and connect anywhere: https://linktr.ee/moviedefenders 00:00:00 Intro and Announcements 00:18:31 Top 5 Spy Movies 00:49:39 Spies Like Us Discussion Begins 01:09:05 Meet the Guys 01:31:33 Training 01:50:27 Doctor, Doctor 02:01:52 The Surgery 02:14:36 Emmett is Interrogated 02:21:37 The ICBM Site 02:39:46 You Have a Tent? 02:50:52 Trivial Pursuit Decides Negotiations Special thanks to all of our amazing Patreon supporters! Brett Bowen Barrett Young Brev Tanner Kevin Athey Marcin Miduch Joshua Loy Josh Evans Mark Martin Megan Bush Richard Cree Alexis Borchardt Mark Nattress Bart German Alex Kirby Michael Puckett Ena Haynes Daryl Ewry Sean Masters Randal Silver Attack of the Killer Podcast

Today we cover a variety of surgery related mishaps as well as explore our own bizarre stories! We won't have an episode next week because yours truly will be in recovery from her own surgery!

Welcome to the Sterile Technique Podcast! It's the podcast about Surgical Technology. Whether you are a CST or CSFA, this podcast helps you earn CE credits and improve your surgery skills in the OR. This episode discusses the cover article of the June 2022 issue of The Surgical Technologist, which is the official journal of the Association of Surgical Technologists (AST). The article is titled, "Anatomical Engineering and 3D Printing for Surgery and Medical Devices". "Scrub in" at steriletpodcast.com and on Twitter, @SterileTPodcast (twitter.com/SterileTPodcast). This podcast is a Dybas Media production. Sound effects adapted from GarageBand and sindhu.tms at https://freesound.org/people/sindhu.tms/sounds/169065/ and licensed courtesy of https://creativecommons.org/licenses/by-nc/3.0/.

    Examine the walls around you and break through with Verbal Surgery -950- “Under-Distanced” And feel good, NOW!  

Dr. Sophia Roberts is a resident training to become a cardiothoracic surgeon — a rarity for females in the U.S. As if that wasn't unique enough, she's following in her dad's footsteps. Dr. Harold Roberts is himself a cardiothoracic surgeon for more than 30 years. In honor of Father's Day, the duo discussed their relationship and what it's like to work at Barnes-Jewish Hospital together.

At age 22, Debbie Mantenopoulos was the youngest co-host of The View and Barbara Walter's protégé. We get all the details and the behind-the-scenes drama of Debbie's career in the entertainment industry. She also talks about her new Greek-inspired clean beauty skincare line, IKARIA Beauty.A Hurrdat Media Production. Hurrdat Media is a digital media and commercial video production company based in Omaha, NE. Find more podcasts on the Hurrdat Media Network and learn more about our other services today on HurrdatMedia.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Cesarean Section, Childhood Trauma & Accidents, Surgery, Stroke Recovery, Genetic Disorders. Whoa! That's a lot. Chelsea & Nate discuss their experiences with chronic pain and how they treat/live with it. Sobriety introduces a different spin on treating pain and they address this as well as a naturalistic approach to the “idea” of pain and body memory. This is all delivered with Chelsea & Nate's classic banter and a lighthearted approach to a serious topic. Join Chelsea and Nate for a candid and hilarious take on life- nothing is off limits. They tackle everything from their sobriety, the queer spectrum, where do we go in “dreamland” and so much more! Get to know Chelsea & Nate as they get to know each other! You know Chelsea Rose Fitzy from her hilarious Tiktok account with over 150k followers, portraying all of our favorite characters from the restaurant business and as the founder of The Lobster Clam Lighthouse Shanty Sea Shack. Nate is a podcast host and producer and has created and produced The Sobriety Diaries and The Influence: A Social Media Podcast. Together they bring a raw and uncensored look at their own lives, the world around them, and of course, their Unqualified Opinions. Subscribe now so you don't miss a beat! New episodes every Friday! IG @unqualifiedopinionsofficial unqualifiedopinionsofficial@gmail.com Leave us a voice message here: https://anchor.fm/nate-kelly9/message Apple Podcasts: https://podcasts.apple.com/us/podcast/unqualified-opinions-with-chelsea-nate/id1622978816 Spotify: https://open.spotify.com/show/7dTGzFJ3Wt9H3EOTbGTawy Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy85NWVjNjA5MC9wb2RjYXN0L3Jzcw?sa=X&ved=2ahUKEwjw3taatvP3AhWVmGoFHVptCaUQ9sEGegQIARAC Amazon Music: https://music.amazon.com/podcasts/3922a05e-cb41-43d7-ac87-1e1a63d81fb2/unqualified-opinions-with-chelsea-nate iHeart Radio: https://www.iheart.com/podcast/269-unqualified-opinions-with-96607841/ Audible: https://www.audible.com/pd/Unqualified-Opinions-with-Chelsea-Nate-Podcast/B09ZRBQ2L9?action_code=ASSGB149080119000H&share_location=pdp&shareTest=TestShare --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/nate-kelly9/support

7:05 - NBA Finals / Buzz Lightyear part ways w Tim Allen Lottery Sales - where does the money go for education / illegal fireworks crackdown7:20- Valley College FB - father kills son / IKEA closing in Russia / IKEA food 7:35- Ozzy Osbourne major surgery 7:50- Tech Companies layoffs and hiring freezes by / Dogecoin suing Elon Musk

A verdict has been reached in the trial of Paolo Macchiarini. What happens next?Please support us by supporting our sponsors!See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Dr. Rady Rahban is joined by the three beautiful Nash Sisters; Becky, Liz and Rikki. Listen to their journey of losing almost 100 pounds each and what it took for them, now as adults, to feel comfortable enough to purchase two-piece bikinis for the first time in their lives! We would love your feedback... If you enjoyed this episode, or if you find our podcast helpful, tell us why! Leave us a review and make sure you subscribe on your favorite podcast platform. If you have a topic you would like us to discuss in an upcoming episode, please reach out to us on: www.Instagram.com/DrRadyRahban www.Facebook.com/RadyRahbanMDwww.RadyRahban.comExecutive Producers are Maria Alvarez + Mike Morse for YEA Networks / YEA Podcasts Associate Producer is Sally ChaconIf you are interested in advertising on this podcast or having Dr. Rady Rahban as a guest on your Podcast, Radio Show, or TV Show, reach out to podcast@yeanetworks.com#podcast #listen #podcastlife #podcaster #podcastshow #podcasts #podcasting #drradyrahban #drrrahban #radyrahban #plasticsurgery #plasticsurgeon #boardcertifiedplasticsurgeon #boardcertified #cosmeticsurgery #cosmetics #truth

In this episode, BarefootFitJess discusses her recent surgery experience to update her initial (botched) surgery almost 20 years ago, and how surgery or injury impacts your health holistically.

On Episode 17 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the June 2022 issue of Stroke: “Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage” and “Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm: Prevalence and Practice Patterns.” She also interviews Dr. Bruce Campbell on his article “Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Is vitamin D that golden key to recovery from intracerebral hemorrhage? 2) Endovascular therapies seem to have prevailed where thrombolytics have failed. In the era of fast and furious thrombectomy, what is the role of pre-thrombectomy thrombolysis? 3) And finally, 20 years of clinical research has failed to demonstrate the superiority of anticoagulation over antiplatelet therapies for treatment of patients in sinus rhythm with low left ventricular ejection fraction, and yet, our practice patterns have not changed. Why do we remain resolute in prescribing anticoagulation despite the lack of evidence? We're back here to tackle the toughest questions with our Stroke Alert Podcast because this is the latest in Stroke. Stay with us. Dr. Negar Asdaghi:         Welcome back to another extremely motivating Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. The June 2022 issue of Stroke contains a number of interesting articles. As part of our Advances in Stroke, we have two articles, one on the topic of cost-effectiveness of stroke care to inform health policy and the second on the current state and the future of emerging stroke therapies. As part of our Original Contributions category, we have an interesting study by Dr. [Ben] Assayag and colleagues from the Department of Neurology at Tel Aviv Sourasky Medical Center, where we learned that just over 10% of patients with TIA and stroke developed post-traumatic stress disorder, or PTSD. Higher presenting stroke severity, preexisting white matter disease, and having anxious coping styles are risk factors for development of post-stroke PTSD. Dr. Negar Asdaghi:         In another Original Contribution, by Dr. Daehoon Kim and colleagues from Yonsei University College of Medicine in Seoul, South Korea, we read with interest on the topic of whether or not we should be anticoagulating frail patients with atrial fibrillation. In this large population-based cohort, which included patients with atrial fibrillation older than 65 years of age with frailty as defined by a score of equal or greater than five on Hospital Frailty Risk Score, we learned that despite their frailty, patients with atrial fibrillation still significantly benefit from oral anticoagulation therapy. In this study, those treated with anticoagulation had lower net adverse clinical events as compared to those untreated. We also learned that direct oral anticoagulants provided lower incidence of stroke, bleeding, and mortality over Coumadin. This paper really provided practical information on treatment of frail patients with atrial fibrillation. So, I encourage you to review these papers in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Bruce Campbell from University of Melbourne in Australia on an especially timely topic, that is the role of intravenous thrombolytics prior to endovascular therapy. Dr. Campbell is a leading authority on the topic, and his interview does not disappoint. But first, with these two articles. Dr. Negar Asdaghi:         In the setting of intracerebral hemorrhage, or ICH, aside from the primary brain insult that occurs at the time of hemorrhage, secondary brain injuries continue for days and sometimes to months mostly due to the pathological response of the brain to byproducts of hematoma lysis or RBC degradation products. Today, the majority of spontaneous ICH cases are not surgically evacuated, so we rely on the body's own ability to clear blood for hematoma clearance, and obviously the faster the clearance, the better the outcome. Erythrophagocytosis by monocyte-derived macrophages contributes to hematoma clearance and ultimately to the functional recovery from ICH. So, it's conceivable that therapeutic approaches to enhance the endogenous erythrophagocytosis can potentially improve ICH outcomes. Vitamin D has been known to have variety of functions within the central nervous system, and it turns out that it may also be one such therapeutic option to improve the much needed erythrophagocytosis in intracerebral hemorrhage. Dr. Negar Asdaghi:         In the current issue of the journal, in the study titled "Vitamin D Enhances Hematoma Clearance and Neurologic Recovery in Intracerebral Hemorrhage," a group of researchers led by Dr. Jiaxin Liu from the Department of Surgery at Queen Mary Hospital at the University of Hong Kong studied the effects of oral vitamin D administered two hours after the induction of hematoma in a rodent model of ICH using direct collagenase injection into the striatum of the mouse. Eighty-nine young mice and 78 middle-aged mice were included in the study and randomly divided into three groups. Group one were sham-operated mice; group two, ICH mice treated with vehicle, which was corn oil; and group three, vitamin D-treated ICH mice. In the third group, 1000 international unit per kg of vitamin D diluted in corn oil was administered orally using a pipette two hours after the induction of ICH to mice, and then daily afterwards. And here are their top three findings of this study. Dr. Negar Asdaghi:         Number one, vitamin D-treated mice did better than vehicle on two neurobehavioral tests that were completed in the study. On the cylinder test, treatment with vitamin D significantly alleviated the asymmetric usage of four limbs at day seven, and vitamin D elongated the duration that the mice could run on the accelerated rod at day 10 on the rotarod test. Dr. Negar Asdaghi:         Number two, in terms of hematoma resolution and perihematoma edema, it's an issue that we deal with, with ICH, they used MRI imaging for edema measurement on T2-weighted images, and then sacrificed the mice and used digital quantification of hematoma volume with fresh brain specimens. And they found that treatment with vitamin D significantly alleviated both the ICH-associated brain swelling on MR and resulted in significant reduction in hematoma volume on the fresh brain specimens when compared with the vehicle-treated group at day three and day five. Dr. Negar Asdaghi:         And finally, their third main finding is in terms of erythrophagocytosis. So, the pathway that is mediated by the monocyte-derived macrophages is an endogenous pathway, that is, PPAR-γ (which stands for peroxisome proliferator-activated receptor γ) and its downstream scavenger receptor CD36 mediated. This pathway is essential for directing the endogenous erythrophagocytosis. Using flow cytometry, they found that vitamin D-treated mice had more mature macrophages expressing the scavenger receptor CD36, which was not expressed by the undifferentiated monocytes. Dr. Negar Asdaghi:         Western blot analysis confirmed that vitamin D treatment increased the tissue levels of CD36 and the upstream PPAR-γ levels in the brain at day five after collagenase model. Locally, vitamin D-enriched phagocytes that were positive for PPAR-γ and CD36 in the perihematoma regions. So, in summary, vitamin D increased the number of mature macrophages rather than undifferentiated monocytes in the perihematoma region and accelerated the differentiation of reparative macrophages from bone marrow-derived monocytes. So, bottom line is that in vitamin D, we have a simple, accessible, and well-tolerated agent to improve both the ICH outcomes and enhance hematoma resolution, but this we all observed in rodents. So, we stay tuned with interest to find out whether the same success will be seen in humans treated with vitamin D after intracerebral hemorrhage. Dr. Negar Asdaghi:         Patients with depressed left ventricular ejection fraction, or low EF, are at risk of development of ischemic stroke even if they remain in sinus rhythm. The optimal antithrombotic treatment for these patients is still unknown. Over the past two decades, we have a number of randomized trials studying the efficacy of oral anticoagulation, predominantly Coumadin, over aspirin therapy in prevention of all forms of stroke, that is ischemic and hemorrhagic, and death in patients with a low EF in sinus rhythm. Dr. Negar Asdaghi:         The meta-analysis of WASH, HELAS, WATCH, and WARCEF trials showed that treatment of low ejection fraction patients in sinus rhythm with Coumadin does reduce the subsequent risk of stroke, but it comes at the cost of a higher major bleeding risk in this population. The COMMANDER HF clinical trial published in New England Journal of Medicine in October 2018 studied whether low-dose rivaroxaban at 2.5 milligram BID was superior to placebo in patients with recent worsening of chronic heart failure, reduced ejection fraction, coronary artery disease, but no atrial fibrillation, and very similar to its prior counterparts, it did not show that rivaroxaban was associated with a lower rate of combined death, myocardial infarction, or stroke as compared to placebo. But very similar to prior studies, it also showed that rivaroxaban-treated patients had a lower risk of subsequent ischemic stroke. This poses a conundrum for stroke neurologists treating patients with this condition, especially after they present with an embolic-appearing stroke. So, the question is, how often do we encounter this situation, and what do we do in routine practice? We know that when there is equipoise, there's practice variation. Dr. Negar Asdaghi: In the current issue of the journal, in the study titled "Acute Ischemic Stroke, Depressed Left Ventricular Ejection Fraction, and Sinus Rhythm," Dr. Richa Sharma from the Department of Neurology at Yale School of Medicine and colleagues examined the prevalence of heart failure with sinus rhythm among hospitalized patients with acute ischemic stroke and the physician's practice patterns with regard to the choice of antithrombotics in this population. Dr. Negar Asdaghi:         So, let's look at their study. The study was comprised of five separate study cohorts of hospitalized acute ischemic stroke patients in the Greater Cincinnati Northern Kentucky Stroke Study for the year 2005, 2010, and 2015, and then four additional academic hospital-based cohorts in the United States during different timeframes. These were the Massachusetts General Hospital from 2002 to 2016, Rhode Island Hospital from 2016 to 2018, Yale-New Haven Hospital 2015 to 2017, and Cornell Acute Stroke Academic Registry from 2011 to 2018. All of these cohorts combined contributed to the 19,155 total number of patients in this study, which included over 14,000 patients that had documented left ventricular ejection fraction. Amongst those, 1,426 had a depressed EF and were included in this study. The investigator obviously excluded those with documented atrial fibrillation and flutter. And so the sample size for this analysis was 805 patients. And here are their main results. Dr. Negar Asdaghi:         The overall prevalence of this condition, that is low ejection fraction and sinus rhythm, among hospitalized acute ischemic stroke patients was 5%. It varied slightly between the different cohorts in this study from 4 to 6%. In terms of the antithrombotic treatment patterns, this information was available in close to 500 patients in the cohort. Overall, 59% of patients were discharged on an antiplatelet treatment alone, and 41% on anticoagulation. But these percentages significantly varied between the different institutions and was as low as 22% in one of the cohorts and as high as 45% in another cohort. Dr. Negar Asdaghi:         So, what were the factors that were associated with the use of anticoagulation at discharge? They found that the absolute percentage of left ventricular ejection fraction and the presenting NIH Stroke Scales were associated with anticoagulation use. That is, the lower the percentage of EF and the higher the presenting NIH Stroke Scale, the more likely physicians were to discharge the patients on an anticoagulation in univariate analysis, but in multivariate analysis, only the study site and presenting NIH Stroke Scale over eight were independently associated with anticoagulation use. Dr. Negar Asdaghi:         Now, interestingly, 2002 to 2018, which was their overall study period, was a time during which some of the largest and neutral randomized trials on the topic of anticoagulation versus antiplatelet were published, including the WATCH and the WARCEF trial. But the authors found no temporal variation in anticoagulation practice patterns before and after the publication of the results of these trials. So, it appears that we didn't change our minds. So, overall, we have some important takeaway messages from this study. We learned that 5% of hospitalized acute ischemic stroke patients have low left ventricular ejection fraction and remain in sinus rhythm without atrial fibrillation. Today, over 40% of patients with this condition are anticoagulated at discharge despite the results of the randomized trials, but the practice is widely variable among different institutions, and a higher presenting NIH Stroke Scale is a significant predictor of anticoagulation use at discharge in this population. Dr. Negar Asdaghi:         Almost 20 years after the approval of intravenous thrombolysis for treatment of patients with acute ischemic stroke, endovascular therapy was approved for treatment of select ischemic stroke patients with a large vessel occlusion. The two treatments are, therefore, entangled, as one was the standard of care while the second one was being tested. Therefore, all endovascularly treated patients enrolled in randomized trials would've received intravenous thrombolysis if eligible. Now, with the overwhelming success of endovascular therapy in achieving reperfusion in areas where IV thrombolysis has drastically failed, there're still critical questions regarding the added value of IV thrombolysis to endovascularly treated patients. The critical question remains as to whether eligible ischemic stroke patients who have immediate access to endovascular thrombectomy should receive prior IV thrombolysis, or should we skip the thrombolysis step altogether and just move to the angio suite as fast as possible. And there are, of course, arguments for and against each approach. Dr. Negar Asdaghi:         In this issue of the journal, in an invited topical review titled "The Role of Intravenous Thrombolytics Prior to Endovascular Thrombectomy," we learn about these arguments as the authors go through a comprehensive review of the current literature on this issue. I'm joined today by the first author of this review, Dr. Bruce Campbell, to discuss this paper. Dr. Campbell absolutely needs no introduction to our Stroke listeners. He's a professor of neurology and head of neurology and stroke at Royal Melbourne Hospital, University of Melbourne, in Australia. He's a pioneer in the field of acute stroke therapies and acute neuroimaging. He has served as the lead investigator of multiple landmark randomized trials, including EXTEND-IA and EXTEND-IA TNK, and holds multiple leadership roles. He's the clinical director of the Stroke Foundation and co-chairs the Australian Stroke Guidelines Working Party and the coordinator of the National Brain School Training Program for Neurologists in Training. And, of course, last but not least, he's my friend. So, I'm delighted to welcome him to our podcast today. Top of the morning to you, Bruce, 6:00 a.m. in Melbourne. That's quite some dedication. Thank you for being here. Dr. Bruce Campbell:       It's great to be with you. Thanks for the invitation. Dr. Negar Asdaghi:         Congrats on the paper, really exciting topic. So, let's just start with this question as part of a case. We have a patient with an M1 occlusion, a large clinical syndrome presenting two hours out from their symptom onset, and we are at a hospital where the angio suite is ready. What are some of the benefits of basically spending time in giving IV thrombolytics first rather than quickly going to the angio suite? Dr. Bruce Campbell:       I think a key element of this case is that the patient has presented directly to a hospital with immediate access to thrombectomy. Thrombolytic used in drip-and-ship transfer patients really isn't controversial, and the recent randomized trials excluded them. So, the debate's all about this context of bridging thrombolytics in patients presenting directly to a comprehensive stroke center. And you mentioned spending time giving lytics, but in fact, if you do things in parallel, that shouldn't be the case. It shouldn't delay thrombectomy if you go and give thrombolysis. Dr. Bruce Campbell:       So, the general principle is that getting the artery open faster by any means is better, and IV thrombolytic certainly has the potential to open the artery before thrombectomy in a proportion of patients, perhaps not that many, but it may also facilitate the thrombectomy. So, in the randomized trials, reperfusion after the thrombectomy was significantly better when patients had had bridging thrombolytic despite a low rate of pre-endovascular reperfusion. Other reasons for giving the lytics are the potential safety net it provides if the thrombectomy procedure is unexpectedly delayed or fails to get the artery open, and there's also this potential for lytics to dissolve distal embolic fragments and perhaps improve microvascular reperfusion. Dr. Negar Asdaghi:         So, great. So, let me summarize for our listeners what you mentioned. First off, so these are arguments in favor of giving lytics. As you mentioned, we're not really wasting time. These processes occur in parallel, so it's not like we're wasting time in giving a therapy that is potentially not as efficacious as thrombectomy is. And number two, we have improved the possibility of early reperfusion, perhaps, with the lytics. And if there are some fragments or distal clots that thrombectomy wouldn't have reached, then the lytics would. And then also there is also the chance that the thrombectomy might have failed in difficult access, and so on and so forth, and at least the patient has some chance of revascularization with the lytics. So, if these are the arguments for giving lytics, what are the arguments against giving lytics in this scenario? Dr. Bruce Campbell:       The main argument is the potential to reduce both the intracerebral and systemic hemorrhagic complications. There's also potential cost saving by skipping thrombolytics. That's probably more relevant in low-resource settings, particularly when relatives may have to pay for the thrombolytic before treatment is initiated, and that can be burdensome and also potentially delay the thrombectomy. There's a theoretical concern about thrombus fragmentation with lytics and potential migration of the clot out of reach of the thrombectomy or to new territories. But final reperfusion, as I mentioned, was, on average, better with the patient having a lytic on board in the randomized trials. Dr. Negar Asdaghi:         Perfect. And I want to highlight this issue of thrombus fragmentation because I think our readers will read more and more about this idea of, as you mentioned, fragmentation will potentially make an accessible clot for thrombectomy inaccessible. But I see that later in our questions, we're going to address that as part of the findings of randomized trials as well. So, these are some of the arguments for and against. And before we go to the randomized trials, I'd like to get an overview of what we knew as part of observational studies and non-randomized studies prior to more recent randomized trials on this topic. Dr. Bruce Campbell:       There've been a couple of nice systematic reviews and meta-analyses of the observational data, and notably in most of these studies, the direct thrombectomy patients had contraindications to lytics, and that introduces confounding factors that are difficult to adjust for. For what that's worth, the functional independence, mortality outcomes were better in the bridging patients. Hemorrhage rates weren't always higher with the lytic, and one study by Jonathan Coutinho in JAMA Neurology for the SWIFT and STAR studies showed the opposite despite them having really careful adjustment for all the confounders they could think of. And the meta-analysis by Eva Mistry in Stroke did not detect a difference in symptomatic ICH between the direct and bridging strategies. One thing that should be less affected by the patient characteristics would be the technical efficacy outcomes, and it was interesting that in the observational data, the patients who'd had bridging lytic had higher mTICI 2b-3 rates and also fewer device passes. Dr. Negar Asdaghi:         Okay. And now we do have further information with all of these new randomized trials. So, why don't we start with some of the earlier studies, the three, SKIP, DEVT, and DIRECT-MT, and start with those studies first before we move to some more recent European trials. Dr. Bruce Campbell:       SKIP was performed in Japan, and it used the lower 0.6 milligram per kilogram dose of alteplase that's standard there, and DEVT and DIRECT-MT were performed in China. All three of them showed numerically similar functional outcomes with slight trends favoring direct thrombectomy. SKIP had a smaller sample size and did not meet its non-inferiority criteria, and the other two trials did meet their specified non-inferiority margin, but it could be argued those margins were overly generous. If you think about non-inferiority trials, we generally try to set a margin for non-inferiority such as lower 95% confidence interval for the trial intervention would sacrifice up to 50% of the reference treatment effect. And it's difficult to estimate the effect of alteplase in this specific population. But if you think of the Emberson meta-analysis of alteplase, overall zero to three hours alteplase versus placebo has a 10% effect size and mRS 0-1, three to four and a half hours of 5% effect size. And we regard that as clinically important. So, half of 5%, 2.5%, is a lot tighter margin than any of the direct randomized trials employed. Dr. Negar Asdaghi:         So, Bruce, let me recap what you just mentioned. Two out of the three earlier trials seem to suggest that perhaps skipping IV therapy is the way to go rather than bridging as these two trials met the non-inferiority criteria if we believe that non-inferiority margins you mentioned. And now we have a couple of more trials, more recent trials. Can you tell us about these trials please? Dr. Bruce Campbell:       MR CLEAN-NO IV in a European population did not demonstrate non-inferiority, and the point estimate slightly favored bridging. Interestingly, in that trial, the symptomatic intracerebral hemorrhage risk, which was one of the main drivers for trying this strategy, was 5.9% in the direct and 5.3 in the bridging group. So, there's no hint of benefit from dropping the lytic on that metric. SWIFT-DIRECT was more selective in only enrolling internal carotid and M1 occlusions, which had a lower chance of early recanalization with lytic. But the protocol also specified giving the full dose of lytic. In the other trials, it seems the alteplase infusion was often stopped once the patient was in the angio suite, so the full dose may not have been delivered. And despite very low pre-endovascular recanalization in that selected group in SWIFT-DIRECT, the end of procedure reperfusion was significantly better in the bridging group, which is a consistent finding across the trials and suggests that the lytic may improve the thrombectomy outcome. Dr. Bruce Campbell:       DIRECT-SAFE, the final of those trials, was interesting in that the patients were enrolled roughly 50:50 from Australia, New Zealand, versus Asia. And in contrast to the original three randomized trials in Asian patients, DIRECT-SAFE found a significant benefit of bridging lytic in Asian patients. So, it'd be very interesting to see the results of the IRIS individual patient data meta-analysis, but we may not find a difference in Asian versus Caucasian patients despite those initial trials and despite substantial differences in the prevalence of intracranial atherosclerosis, which has often been proposed as something that would increase the risk of having bridging thrombolytic on board. Dr. Bruce Campbell:       The original study level estimate of symptomatic hemorrhage had a borderline significant 1.8% absolute reduction in the direct group. Whether those data were not all core lab adjudicated and the final analysis may show a smaller difference than that. Notably, given that trend with symptomatic intracerebral hemorrhage, mortality did not differ significantly, and, in fact, the trend favored bridging patients. So, the symptomatic hemorrhage slight trend into increase did not translate into any hint of increased mortality. Dr. Negar Asdaghi:         So, Bruce, a lot of information, and I need a recap for me. So, let me try to recap some of the things you said, and please jump in. So, so far, the newer data really basically don't show us any convincing evidence that skipping is the way to go, and direct endovascular we really don't have data in favor of going directly to the angio suite. And the jury is still out regarding an increase in the symptomatic intracerebral hemorrhage rate amongst those that actually are pre-treated with IV therapy. Is that correct? Dr. Bruce Campbell:       That's correct. So, none of the three recent trials met their non-inferiority margins. And again, we had this issue of relatively generous non-inferiority margins, and the symptomatic hemorrhage, it would make sense that there's a small difference, but it's not really been borne out in the data to be statistically significant at this stage. And again, this individual patient data meta-analysis is keenly awaited to get the most accurate estimate on that. Dr. Negar Asdaghi:         So, while we wait that, I'm going to digress a little bit and ask you a question that's not addressed in the paper that you have in this issue of the journal, and that's the CHOICE trial. So, by now, we have the results of CHOICE trial. Do you mind first give us a brief overview of what CHOICE was and how you feel that the results of CHOICE would affect this field of direct versus bridging in general? Dr. Bruce Campbell:       CHOICE is a very interesting study in that it tested giving the intra-arterial lytic at the end of a thrombectomy procedure that had achieved an mTICI 2b or better, which is what we traditionally regarded as angiographic success. The idea was to improve microvascular flow, and that may be the case. The trial was terminated early due to logistic reasons and showed a very large effect size that requires replication. The subgroup analyses are interesting in that the benefits seem to mostly accrue in patients who'd not already had intravenous lytic. Dr. Bruce Campbell:       So, perhaps giving the IV lytic before thrombectomy can still benefit patients after the thrombectomy, as well as achieving early recanalization in a proportion of patients and perhaps facilitating the thrombectomy. The other issue to address with the DIRECT trials is that with the exception of a few patients in DIRECT-SAFE, the comparator was alteplase and not tenecteplase. And we have data from EXTEND-IA TNK that tenecteplase bridging is not just non-inferior, but superior to alteplase bridging. There's an ongoing Brazilian trial of exactly that, tenecteplase versus the direct approach, which will be very interesting. Dr. Negar Asdaghi:         So, great, Bruce. I just want to repeat this segment again for our listeners. So, CHOICE is a very interesting study, looked at giving intraarterial alteplase to patients after endovascular therapy was completed and after they'd already achieved the complete and successful revascularization, and the trial was terminated early because of logistic reasons. So, we have to keep in mind, this was a smaller study, early termination, but the effect size was pretty large in favor of giving lytics. Dr. Negar Asdaghi:         So, what you mentioned is interesting, and I think that it's really worth paying attention to, that the majority of the benefits seem to have occurred from intraarterial thrombolytics in patients that have not been given intravenous lytics prior to endovascular therapy. So, in other words, you need some sort of lytics either before or after the endovascular thrombectomy to achieve that ultimate improved outcome. So, moving forward now from the randomized trials that we have on bridging versus direct thrombectomy, you have mentioned in the paper some interesting subgroups that may benefit or not benefit as much from bridging versus direct thrombectomy. Do you want to elaborate a little more about those subgroup analyses? Dr. Bruce Campbell:       The idea of precision selection or individualized treatment is being talked about a lot given there didn't seem to be much overall difference between strategies in the randomized trials, but it's important to note that the randomized trial actually disadvantages the bridging group by delaying lytic until the patient was firstly confirmed eligible for thrombectomy and then consented and randomized. Putting that aside, if we could identify a subgroup who clearly benefit from skipping lytic and, importantly, identify them without delaying lytic for those who likely benefit, that's clearly attractive. Dr. Bruce Campbell:       Currently, I'd say we have not identified that kind of subgroup, and the planned IRIS individual patient data meta-analysis will be critical for that. Patients with a large ischemic core are one potential group where there's a high risk of bleeding hypothesized. To date, there is no definitive data to indicate the risk is lower with the direct approach. Patients who need stents certainly may benefit from not having a lytic on board because they often need adjuvant antithrombotics that could increase the bleeding risk. But the question there is whether we can confidently identify those patients before the procedure, and I think that's unclear at this stage. Patients with really large clot burdens and proximal occlusions have sometimes been said not to benefit from IV lytic based on the low rates of pre-endovascular reperfusion, but the randomized trials really hinted other benefits like this potential facilitative thrombectomy. So, that hypothesis may be insecure as well. Dr. Negar Asdaghi:         And how about age? Have you come across and has there been any signal towards an impact or interaction between age and benefit from pre-endovascular thrombectomy and thrombolytics? Dr. Bruce Campbell:       It's an interesting question because age has not generally been a treatment effect modifier in previous stroke studies with thrombolytics and thrombectomy, and the individual direct thrombectomy trials that have reported subgroups haven't shown any convincing heterogeneity by age. There's certainly no indication that older patients are at risk from bridging in what I've seen so far. Dr. Negar Asdaghi:         So, this question comes up in clinical practice all the time, that a person's older, perhaps more atrophy, more vascular risk factors and white matter disease, and they're more prone, so to speak, of having a symptomatic intracerebral hemorrhage. So, what you're saying is, from the data we have, there's really no signal in favor of withholding pre-thrombectomy lytics in this population. So, it's important to know this. Bruce, what should be our final takeaway message from this study? Dr. Bruce Campbell:       I tend to agree with the recent European Stroke Organization and ESMINT guideline that for now, patients should receive lytic as early as possible and in parallel with the decision to perform thrombectomy such that neither treatment delays the other. I think if we can identify a subgroup that benefits from direct thrombectomy, and that's confirmed in the individual patient data and meta-analysis, and we can identify them without disadvantaging the majority of patients, and also that the ongoing improvements in IV lytic strategies don't render the existing trial data obsolete, then we may, in future, skip lytic for some patients, but we are not there yet. Dr. Negar Asdaghi:         So, that's amazing, Bruce. We look forward to reviewing the paper and individual data meta-analysis and interviewing you, hopefully at a better hour your time, on that. Thank you very much for joining us on the podcast today. Dr. Bruce Campbell:       Thanks again for the invitation. It's been great talking to you. Dr. Negar Asdaghi:         Thank you. Dr. Negar Asdaghi:         And this concludes our podcast for the June 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including three very interesting images that are presented as part of a new article type, Stroke Images, and a special report in Comments and Opinions section on "Bias in Stroke Evaluation: Rethinking the Cookie Theft Picture." June is the month of Pride, and in spirit of equality, we hope to do our part to reduce all biases in stroke processes of care, diagnosis, and outcomes as we continue to stay alert with Stroke Alert. Dr. Negar Asdaghi:         This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

Alberta's only female cardiac surgeon, Dr. Teresa Kieser, has filed a human rights case alleging systemic gender-based discrimination over her 34-year career. Matt Galloway talks to Kieser about why she's trying to bring “the light of day” to her experiences; and Canadian surgeons Dr. Nancy Baxter and Dr. Marisa Louridas about what needs to change.

“My mom was like ‘Absolutely not, we are not telling a child he has 6 months left to live,' which I think played a huge role in [me] staying positive.” David is one of the longest surviving patients of glioblastoma in America, beating all the odds stacked against him since he was a child. He is joining Amber Barbach on Glioblastoma aka GBM to talk about his experience as a three-time survivor, how the support of his friends and family pushed him through, and the importance of being your own advocate. Hear us talk about: David's first diagnosis. David was a healthy child who never got sick, until he got sick. When he was 10, he started getting headaches and deja vu so bad they caused him to vomit - even touching his head induced severe pain. A CT scan that showed a brain tumor. After taking many other tests and being admitted to the hospital, David was scheduled for a surgery to remove his tumor, and it was successful - so successful that the neurosurgeon claimed it was the easiest surgery he had ever done because the tumor fell out of his skull due to its fully encapsulated nature. The pathology of the tumor revealed that it was stage four glioblastoma, and the doctor's diagnosis was that David would only have six more months to live. His mother informed him of his cancer but refused to let the doctor tell David that his days were numbered. The return of the tumor. David's headaches and deja vu episodes came back with a vengeance, and it was discovered that the tumor had returned, bigger than it was before. Surgery was performed, but his chance of survival was even lower this time. Not one to be deterred, David's mother thanked the doctors and respectfully decided to get a second opinion. He was put in a clinical trial at Duke for a new type of treatment, and the positive attitudes of everyone around him kept him grounded and stable. He gradually got better. More cancer. The year was 2019, and David started getting pain in his jaw. At first thinking it was TMJ, he went to a specialist who told him he had a severe underbite and needed total jaw realignment surgery. Knowing that underbites were either hereditary or caused by a severe contact injury, none of which applied to him, he got a second opinion, which led to an MRI. The MRI showed that there was a tumor the size of a baseball at the base of his skull. He had a biopsy done, and it revealed that it was radiation-induced osteosarcoma. Experiencing chemotherapy as an adult was a stark difference from when he was a child. There were moments where he faltered in spirit, but he quickly snapped out of the ‘why me' spiral. Being your own advocate. If a surgeon or doctor says something to you that you don't agree with, just know that there are millions of them on the planet - you are bound to find one that's willing to help you. Don't just roll over and accept whatever you're told.  Finding positivity. It is absolutely essential in the midst of any adversity to find positivity, David shares. Some people might handle it through humor, meditation, exercise - as long as you find an outlet to channel what you're feeling into something positive, you will feel more complete. “Cancer is already going to change your life as it is through your health, but it doesn't have to change who you are spiritually or mentally, emotionally.” What's Next? David Fitting is an ambassador for the Glioblastoma Research Organization, who has given hope to people all around the world. He's passionate about motivational speaking and sharing his story to inspire others. As always, the information that is discussed in Glioblastoma AKA GBM is not meant to treat or diagnose any disease. What we and our guests share are personal stories of what has worked for the individuals in question, and should not be taken as medical advice or opinion, and is not a substitute for medical advice. If you have any questions about your own situation, always consult with your medical provider and healthcare team.

Alex and Kyle break down all there is to talk about from the two day Chargers mandatory minicamp. Also sign up for our memberships here: https://www.youtube.com/channel/UCBnSd0Mx4BHUXlpxVegCoOg/join Patreon: https://www.patreon.com/guiltyascharged​ Go to https://www.expressvpn.com/guilty to start your free trial of a VPN network today! Use the code “GAC” for 10% off your order at https://www.backroomcollection.net/! Use the code GUILTY10 for 10% off your order at https://www.qwest360.com/! Follow us on Twitter! Podcast: @GACPodcast17 Steven: @StevenIHaglund Alex: @alexinsdorf99 Tyler: @tylerjschoon Arjun: @arjunmenon100 Maddie: @maddieschmidt15 Kyle: @TheKyleDe Learn more about your ad choices. Visit podcastchoices.com/adchoices

Riz Hattton shares the latest news on the Spine and Orthopedic industry.

https://youtu.be/BNXmA14vM4k

STRONG Life Podcast 318 This QnA was Awesome with a wide array of topics. - Nutrition & Training Tips for Overweight Teenage Athletes - Returning from Injury / Surgery - Grip Strength  - Improving Your 1 Mile Run Time Take Action with the BIG 33 Year Anniversary Sale. ALL Sale Courses and Discount Codes are Here: https://zacheven-esh.com/33-year-anniversary-sale/ Don't miss all the updates, subscribe to our BEAST of a newsletter & get your FREE Training Course! http://ZachStrength.com  

Drs. Sarah Read Choi and Jack Stringham join to discuss considerations for retinal surgery when operating in areas with varying altitude, including tamponade choice, preoperative planning with the patient, and more.Relevant Financial Disclosures: None relevant for any contributor.You can now claim CME credits via the AAO website. Visit https://www.aao.org/browse-multimedia?filter=Audi

Dodgers pitcher Walker Buehler is already on the injured list with a Grad 2 right flexor tendon strain. On Monday, he also had surgery to remove bone spurs in his right elbow, which he says won't affect his timetable for returning to the majors. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Dodgers pitcher Walker Buehler is already on the injured list with a Grad 2 right flexor tendon strain. On Monday, he also had surgery to remove bone spurs in his right elbow, which he says won't affect his timetable for returning to the majors. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Today Eric and I talk about my freak out. I am having surgery on my carpal tunnel.  What does your body do when your freaked out? My body just goes into this panic mode where everything goes fast, I can't stop my brain from racing about all the things. Do you have support when it comes to moments of freaking out? What tools might you have? Just after this recording I called an old co-worker of mine who worked at the surgery center, he's like an uncle to me. He talked to me about my surgery because he has had it done bilaterally as well. He is also a nurse like my mom and I found comfort in his words and knowledge. He talked to me straight up and gave me all of the tips that I will need to know. He walked me through the going to sleep process as I feel very fearful of that. Then he told me what I should do when I start to wake up and look around and maybe look at my hands wiggle my fingers ever so slightly. Knowing all of this stuff about pre-op and recovery helps my brain prepare for what to expect so it doesn't feel like the unknown. He also reassured me that I will manage this and he had confidence that I will be okay. He even was prepared to take care of me at the place he was staying. That made me feel so good. Even though i'm not having surgery in his town it was so sweet to know he was gonna be there for me. I constantly and truly reach out to people that I trust and feel safe with to help regulate my system in times of need. This choosing of supportive people makes a huge difference in how you are witnessed and accompanied. I hope you enjoy an episode of empathy and what it is like to accompany another when they are having a freak out and a wave of emotions. Eric does a great job of reflecting, finding needs, hearing me and holding space while witnessing my discomfort in all this. My experience going forward might be feeling a little more ease after talking with Eric. We shall see.   CONTACT INFORMATION:Email: Livingconnected.nvc@gmail.comInstagram: livingconnectednvcLiving Connected Facebook PageWebsite: https://www.buzzsprout.com/1153175Music is brought to you by: https://www.purple-planet.com/

In this episode, Jake and Dan from LAFB discuss the latest Chargers Breaking News OTAs and Minicamps. Chargers highlights include Derwin James ' possible contract extension timeline and labrum surgery James had after last season, Brandon Staley's latest news conference, Joey Bosa and Khalil Mack's time at the podium, JT Woods signing his rookie contract. Bryce Callahan, Kyle Van Noy, Asante Samuel Jr, Mike Davis, JC Jackson, Mark Webb, Kenneth Murray Jr, and much more are discussed. Hosted by Jake Hefner and Dan Wolkenstein from the LAFB Network, Chargers Unleashed is a sports-focused podcast providing Los Angeles Chargers fans, writers, and listeners with news, team and game breakdowns, unique and refreshing perspectives, as well as exclusive special guest episodes with several NFL and Chargers players, HOF announcers, writers, insiders. and NFL Draft prospects. Chargers Unleashed prides itself on providing authentic Chargers coverage as a voice for Chargers fans, and in collaboration with Chargers fans worldwide. Latest Chargers News - Derwin James Surgery & Contract Updates, Khalil Mack & Joey Bosa Speak Twitter: @LAC_Unleashed | @DanWolkenstein | @JakeTHefner Support the show: https://www.patreon.com/chargersunleashed Youtube: https://www.youtube.com/channel/UC5Gy3eD3R2AKVj8UONtv0Eg Twitter: https://www.twitter.com/LAC_Unleashed Facebook: https://www.facebook.com/ChargersUnleashed Our website: https://www.lafbnetwork.com/chargers-unleashed/ THANK YOU SPONSORS! This episode of Chargers Unleashed is sponsored and brought to you by: *** BetUS (for CA users): 125% Sign-Up Bonus: https://bit.ly/LAFB-BetUS ***Charger Bolt Family! Find them on Facebook and on Instagram for all of your Chargers memorabilia, upcoming player signings, free giveaways, raffles, tailgating experiences, and more! ***UFC Fit Temecula *** Golden Road Brewery ***Other Sports BettingPartnerships: https://linktr.ee/lafbbettingoffers - DraftKings - FanDuel - BetMGM - PickUp See omnystudio.com/listener for privacy information.

2pm - The Big Lead @ 2 // Sex reassignment surgery in prison // Slanted news coverage in Seattle // Recap of Rep. Andrew Barkis interview, whose office was "firebombed" // Awesome Audio See omnystudio.com/listener for privacy information.

Si gets a surprise call from Houston that puts him one step closer to breathing easy. Martin warns that T-shirts with pockets aren't just dumb — they're dangerous. Godwin returns from his beach trip with sage advice about what to do when someone pees in the pool. Si recalls surfing with a sea turtle in Hawaii and a close encounter with an army of one-armed crabs. John-David gets the boys to give their best wedding advice to a listener. And Si runs a hilarious cost-benefit analysis on a fan's relationship. https://truebill.com/duck — Save up to $720 a year with Truebill! https://nutrafol.com — Get $15 OFF your first month with promo code DUCK plus FREE shipping on EVERY order! https://mystore.com — Buy one, get one with ANY purchase of MyPillow sheets, towels, or pillows & get amazing deals on 100s of American-made products with code DUCK! - Learn more about your ad choices. Visit megaphone.fm/adchoices

Your favorite 2 Black Runners Aaron & Joshua Potts are joined with a member of the recently formed USA 10,000m World Championships Team, Sean McGorty. Sean is the 10th fastest 10,000m American of all-time in the event in his first year doing it and made the U.S. team at the 2022 Prefontaine Classic in only his second 10,000m race of his life. In this episode the Potts brothers talk about watching the U.S. Championship Final with McGorty's parents in in the Bowerman Fan Section, his family's love for UNC Basketball, legendary 8:46 solo 3200m in high school, coming back from numerous injuries, and so much more. *Thank you to World Athletics 22 for sponsoring this episode with their #NextStopOregon Segment!! Go get your tickets now for the first World Athletics Championships ever on U.S. soil at WorldChampsOregon22.com ✔ Don't forget to RATE, REVIEW, AND SUBSCRIBE to the podcast ✔Watch on YouTube and SUBSCRIBE to help us reach 10,000 SUBs: https://youtu.be/CVpemgeK-BM TIME STAMPS 00:00 Episode Preview 00:54 2BR Intro 02:14 Sean McGorty Introduction 02:51 Interview Starts 04:18 We are BIG Bowerman fans 05:24 Describing the Bowerman Fan Section in Hayward Field 06:40 Was it weird having the 10,000m Champs away from USAs Championships? 08:32 Looking back do you feel like you ran a good race at the Prefontaine Classic? 10:30 Stressing out his Mom and Elise Cranny? 11:16 Do you talk to Elise about strategies to run better races? 12:26 Gaining a better appreciation for the 10k 13:15 Have your parents always been invested in your running? 13:53 Parents running in college 14:20 Aaron's first time seeing Sean McGorty in 2013 15:26 Were your parents big basketball fans at UNC? 16:16 Any connection to University of Virginia? 17:14 When did you start running? 18:47 Starting his successful high school cross country season? 19:38 Mom inspiration 20:56 How has it been getting that support from the Bowerman track club? 24:09 His strong bond with Grant Fisher, Elise Cranny, and Vanessa Fraser as Stanford teammates to Bowerman teammates 26:32 When did the goals of being a professional athlete start? 29:23 Being part of the New Wave of Bowerman 32:05 Coming back from an achilles last summer to make the world team. 34:36 What's been the toughest thing about coming back? 36:33 From going thru the injuries do you feel like you know your body better now? 39:13 A lot of running is pain 40:06 #NextStopOregon Segment starts 40:36 What does your chance to compete at the World Championships mean to you? 41:38 Did you think it was going to be the 10k that would get you there? 42:28 Are you gonna do the 5 at USA's? 43:27 Running 8:46 by yourself in high school 46:25 Do you follow Stanford track & field right now? 47:36 Spreading rumors about Leo and Lex Young 49:11 Fav food spots in Oregon 51:08 Who should we have next on the podcast? 52:27 What mark do you want to leave on the sport of running? 53:57 If you want to hear more about Sean 55:28 Episode end ✔Website: https://www.running-report.com/ ✔Twitter: https://twitter.com/_RunningReport_ ✔Instagram: https://www.instagram.com/_runningreport_

In this episode of the PRS Global Open Keynotes Podcast, Gabriel del Corral MD and Abigail Tirrell BS discuss facial feminization surgery and patient outcomes. This episode discusses the following PRS Global Open article: “Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes” by Gabriel del Corral, Abigail Tirrell, Areeg Abu El Hawa, Jenna C. Bekeny, and Brian L. Chang. Read the article for free on PRSGlobalOpen.com: https://bit.ly/FacialFeminizationSurgery Dr. Gabriel del Corral is a board-certified plastic surgeon as Associate Professor of plastic surgery at Medstar Georgetown University Hospital and the Director of the Medstar Centre for Gender Affirmation in Washington, D.C. Abigail Tirrell is a fourth-year medical student at Georgetown University Medical School in Washington, D.C.. Your host, Dr. Damian Marucci, is a board-certified plastic surgeon and Associate Professor of Surgery at the University of Sydney in Australia. #PRSGlobalOpen #KeynotesPodcast #PlasticSurgery

Links: Today's episode is sponsored by Motif Medical. See how you can get Motif's Luna breast pump covered through insurance at motifmedical.com/birthhour. Know Your Options Online Childbirth Course Beyond the First Latch Course (comes free with KYO course) Support The Birth Hour via Patreon!

Pelvic floor muscles play an important role in our bodies, and we may not realize how important until we have incontinence, pain, and/or prolapse. A common concern is the root cause of a dysfunction might not be properly addressed causing issues down the line such as the need for surgery or repeat surgery. Kim Vopni, author of Your Pelvic Floor, is a self professed pelvic health evangelist and is known as The Vagina Coach.She is a certified fitness professional who wants to end the suffering associated with pelvic floor dysfunction. Kim speaks with Fempower Health on the following about pelvic floor health and surgery: Which are the 3 types of pelvic floor dysfunctions? What are the signs of a weak pelvic floor and how do you fix pelvic floor dysfunction? What are pelvic floor dysfunction treatment options and which pelvic floor dysfunctions might require surgery? How do you optimize pelvic floor surgery recovery time and outcomes? How successful is pelvic prolapse surgery, and what can you do post surgery to optimize results? How do you find the right pelvic floor surgeon? Which questions should you ask the pelvic floor surgeon? What if you can't afford a pelvic floor specialist or surgeon? “I do see a lot of people after the fact who say “I had surgery for this and then I still have this problem or the problem came back” or “I have another problem and then I had another surgery.” People will chase the problem with surgery or pharmaceuticals and aren't getting to a root cause.” - Kim Vopni Follow Kim Vopni on Instagram Resources: Buff Muff App Free Pelvic Surgery Webinar Spotify Playlist for other Pelvic Health related episodes Kim's Book Your Pelvic Floor Study on lower back pain and association with pelvic floor issues Below the Belt film   If you liked this episode and you're feeling generous, don't forget to leave a review on iTunes or Spotify! And be sure to: Follow Fempower Health on Instagram for updates and tips. Tell 2-3 of your friends about this episode!   **The information shared by Fempower Health is not medical advice but for information purposes to enable you to have more effective conversations with your doctor. Always talk to your doctor before making health-related decisions. Additionally, the views expressed by the Fempower Health podcast guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent.** **Contains affiliate links and I will be compensated if you make a purchase after clicking on my links** More about Kim Vopni Kim Vopni is a self professed pelvic health evangelist and is known as The Vagina Coach. She is a certified fitness professional who wants to end the suffering associated with pelvic floor dysfunction. She is a published author, a passionate speaker and women's health educator. Kim is the founder of Pelvienne Wellness Inc - a company offering pelvic health programs products and coaching for women in pregnancy, motherhood and menopause. She also co-founded, grew, and sold a company called Bellies Inc where she created the Ab System – a revolutionary birth prep and recovery system for pregnant women. Her annual event Kegels & Cocktails™ has helped hundreds gain knowledge about pelvic health and her Buff Muff app is ensuring everyone knows how to do kegels and actually does them! Kim also certifies other fitness and movement professionals to work with women with core and pelvic floor challenges through her Core Confidence Specialist Certification. You can find her on-line at www.vaginacoach.com and on social media @vaginacoach

Colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Guest: Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson.  He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases. Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context.  We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients.  We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM. Links to Papers Referenced in this Episode: Journal Article: Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966. Recommended Additional Podcasts on CRLM: The AHPBA Podcast: 1.     Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474) Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Zion Williamson wants to stay with the New Orleans Pelicans which should make fans in the Crescent City very, very happy. Jake Madison explains why the contract extension negotiations for Zion Williamson might end up being pretty easy after all. Plus, he explains why Brandon Ingram having surgery is not a big deal at all,. Plus, he goes through the first 7 picks of the Locked On Pelicans community mock draft. #nbadraft #pelicans #zionwilliamson Support Us By Supporting Our Sponsors! PrizePicks Check out PrizePicks.com and use promo code: “NBA” or go to your app store and download the app today. PrizePicks is daily fantasy made easy! Built Bar Built Bar is a protein bar that tastes like a candy bar. Go to builtbar.com and use promo code “LOCKED15,” and you'll get 15% off your next order. BetOnline BetOnline.net has you covered this season with more props, odds and lines than ever before. BetOnline – Where The Game Starts! Rock Auto Amazing selection. Reliably low prices. All the parts your car will ever need. Visit RockAuto.com and tell them Locked On sent you. TrueBill Don't fall for subscription scams. Start cancelling today at Truebill.com/LOCKEDONNBA. Arcade1up Pre-order now from arcade1up.com - that's Arcade, the number 1, Up, dot com - for an estimated early September ship date! They are giving away a NBA JAM Shaq edition to a Locked On listener! Enter for a chance to win a game console for your man-cave at arcade1up.com/lockedon. Learn more about your ad choices. Visit podcastchoices.com/adchoices

On this week's episode of The Waves, Slate science editor and writer Shannon Palus is joined by freelance science journalist Eleanor Cummins to talk about plastics. Surgery that is. And all the physical and mental concerns that come with altering your body. They start out by talking about Eleanor's recent piece on the health concerns of breast implants. Then they talk about VIP Syndrome, and how it's coming for all of us.  In Slate Plus, is breast reduction surgery feminist? Recommendations: Shannon: Perfect Bars Eleanor: Cotopaxi gear.   Podcast production by Cheyna Roth with editorial oversight by Shannon Palus and Alicia Montgomery. Send your comments and recommendations on what to cover to thewaves@slate.com Learn more about your ad choices. Visit megaphone.fm/adchoices