Podcasts about symptomatic

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable slides, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at PeerView.com/BRK865. CME/MOC/NCPD/AAPA credit will be available until April 29, 2026.Exploring the Promise of Biomarkers and ATTs in Diagnosing and Treating Early Symptomatic Alzheimer's Disease: Key Takeaways From AD/PD 2025 and AAN 2025 In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation

The Robyn Engelson Podcast Ever wish you had a wellness mentor with over decades of experience whispering million dollar health tips in your ear? That's exactly what you will get each week when you tune into The Robyn Engelson Podcast. I'm your host–a sought after autoimmune and wellness expert, corporate drop-out turned serial entrepreneur, and lifestyle transformer. Each week, I'll be bringing you inspiring guests, insights, and mindset tools to empower you to be energized, compress time, and start living instead of existing.    Episode Title:  Exhausted, in pain, anxious and your labs say you're "fine"? Host: Robyn Engelson Guest:  Dr. David Clarke Episode Summary: In this powerful episode, Robyn sits down with Dr. David Clarke, a renowned expert in mind-body medicine, to explore the hidden connection between emotional trauma and chronic physical symptoms. Dr. Clarke explains how many people suffer from real, debilitating issues—such as fatigue, pain, or digestive problems, even when their medical tests come back normal. The conversation dives into how unresolved childhood stress and emotional pain can manifest physically, especially when left unacknowledged. Dr. Clarke shares stories from his practice, emphasizing the importance of listening to patients' life experiences, not just their lab results. Together, they discuss why so many women are dismissed by the healthcare system and how compassion, awareness, and emotional healing can be the missing key to true recovery. This episode offers a new lens to understand your symptoms and encourages you to trust your body's signals and your own story.   You'll learn: How unresolved emotional trauma and chronic stress can manifest as real physical symptoms The role of mind-body connection in chronic illness—and why standard medical tests often miss the root cause Why patients with normal labs still suffer, and how emotional history can reveal hidden clues How adverse childhood experiences and past life stressors can influence present-day health The importance of validating your symptoms and seeking trauma-informed care The healing power of compassionate listening—and how the right doctor-patient relationship can change your entire recovery journey   Memorable Quotes: “Healing the thyroid isn't just about labs—it's about listening to your story.” “So many patients are dismissed because their symptoms don't show up on paper. That doesn't mean they're not real.” “Compassionate care isn't optional—it's essential to true healing.” “The gut and thyroid are in constant conversation. When one's off, the other listens.” “You don't need to be your own doctor—but you do need to be your own advocate.”   Resources & Mentions: Dr. David Clarke's insights on compassionate care and thyroid healing Research on the gut-thyroid connection in autoimmune diseases Functional medicine approaches for diagnosing beyond standard lab work Clinics focusing on integrative and empathetic thyroid care   Actionable Steps for Listeners: Trust Your Instincts: If your body says something's wrong—even when labs say you're "fine"—don't ignore it. Your symptoms are valid. Prioritize Gut Health: Gut health plays a powerful role in thyroid and hormone regulation. Seek guidance from professionals familiar with both. Understand Inflammation & Genetics: Learn how these hidden factors might be draining your energy and impacting your thyroid without obvious signs. Advocate for Compassionate Care: Don't settle for being dismissed. Find a provider who listens, explains, and respects your health journey   Final Thought: When patients feel dismissed or unheard, it delays healing. That's why compassion matters just as much as science. Your symptoms aren't imaginary—they're messages. When we slow down, listen, and connect the dots between gut health, inflammation, genetics, and thyroid function, we find answers others often miss. True healing begins when you're seen, heard, and supported. You deserve that kind of care.   What listeners have to say: Dr. David brings such calm clarity to complex issues. His approach made me feel seen, heard, and finally understood. This episode gave me real hope for healing what I thought I'd have to live with forever.   Loved this episode? If you found value in this conversation, don't forget to leave a review! Scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Your feedback helps us create content that supports your journey to thriving, not just surviving.   Connect with Dr. David: LinkedIn Instagram Facebook   About Dr. David Clarke: Dr. David Clarke is the President of the Association for Treatment of Neuroplastic Symptoms (ATNS), a 501(c)(3) nonprofit dedicated to ending the chronic pain epidemic. Dr. Clarke holds an MD from the University of Connecticut School of Medicine and is Board-certified in Internal Medicine and Gastroenterology. His organization's mission is to advance the awareness, diagnosis, and treatment of stress-related, brain-generated medical conditions. Learn more at Symptomatic.Me..   Connect with Robyn: Book Robyn to speak Get Robyn's #1 best selling book, Exhausted To Energized - 90 Days To Your Best Self  Get Robyn's free video  Sign up for Robyn's personal letter  View Robyn's website Follow Robyn on LinkedIn Robyn's Facebook Watch Robyn on Instagram    

He's not an #$$hole, He's Symptomatic - Erin Maccabee & Cinnamon Reiheld   Episode Summary In this episode of the First Responder Wellness Podcast, host Conrad Weaver is joined by Erin Maccabee and Cinnamon Reiheld for a powerful conversation about the mental health challenges faced by first responders. They explore how trauma, desensitization, and high ACEs scores impact emotional well-being, and why compassion, vulnerability, and peer support are essential for healing. Erin and Cinnamon share their personal journeys, discuss the cultural stigma around mental health in emergency services, and offer actionable steps first responders can take toward recovery and resilience. Whether you're on the front lines or supporting someone who is, this episode delivers insight, hope, and a path forward. Together, they explore: The personal journeys that led Erin and Cinnamon into the field of first responder wellness The often-hidden trauma and emotional toll these professionals face daily How compassion, peer support, and vulnerability can break through the stigma and silence The evolution of mental health awareness in emergency services and the importance of grassroots movements The powerful connection between high ACEs scores (Adverse Childhood Experiences) and career choices in high-stress professions Listeners will walk away with a deeper understanding of the emotional landscape of first responders, actionable strategies for healing, and the critical role of community support and mental health training in fostering long-term wellness.

LifeBlood: We talked about the brain body connection, how over 50 million Americans are suffering from neurosplastic symptoms without realizing it, how childhood trauma manifests in physical pain and what can be done about it, and how to know if you're being afflicted by this, with Dr. David Clarke, President of the Association for Treatment of Neuroplastic Symptoms.   Listen to learn what to do if you feel you're constantly swimming against the current! You can learn more about David at Symptomatic.ME, Facebook, Instagram, YouTube, and Linkedin. Thanks, as always for listening! If you got some value and enjoyed the show, please leave us a review here: ​​https://ratethispodcast.com/lifebloodpodcast You can learn more about us at LifeBlood.Live, Twitter, LinkedIn, Instagram, YouTube and Facebook or you'd like to be a guest on the show, contact us at contact@LifeBlood.Live.  Stay up to date by getting our monthly updates. Want to say “Thanks!” You can buy us a cup of coffee. https://www.buymeacoffee.com/lifeblood Copyright LifeBlood 2025.

In this podcast, George Lawson and Hermione Lyall discuss their paper 'Polymicrogyria in infants with symptomatic congenital cytomegalovirus at birth is associated with epilepsy: A retrospective, descriptive cohort study'.   The paper is available here: https://doi.org/10.1111/dmcn.16250   Follow DMCN on Podbean for more:  https://dmcn.podbean.com/ ___ Watch DMCN Podcasts on YouTube: https://bit.ly/2ONCYiC __ DMCN Journal: Developmental Medicine & Child Neurology (DMCN) has defined the field of paediatric neurology and childhood-onset neurodisability for over 60 years. DMCN disseminates the latest clinical research results globally to enhance the care and improve the lives of disabled children and their families.   DMCN Journal - https://onlinelibrary.wiley.com/journal/14698749 ___ Find us on Twitter! @mackeithpress - https://twitter.com/mackeithpress

Miho Fukui, MD, JACC: Case Reports Associate Editor, is joined by author Ree Lu, MD, discussing this study from Cho et al presented at ACC.25 and published in JACC: Case Reports. Intravenous leiomyomatosis (IVL) is a rare benign uterine growth that extends into the venous system. This case describes a 48-year-old female who presented with 1 month of chest pain and dyspnea on exertion. She was found to have a right atrial mass that transiently crossed into the right ventricle with associated moderate tricuspid regurgitation. Computed tomography revealed a uterine mass with contiguous intravascular extension through the inferior vena cava terminating in the right atrium. This case of symptomatic tricuspid valve obstruction due to IVL illustrates the importance of maintaining preload. Chest and abdominal imaging may be necessary to identify the source of the mass and ensure appropriate surgical planning.

Exploring Neuroplastic Pain: Insights from Dr. David ClarkeIn this episode, host Deborah interviews Dr. David Clarke, President of the Association for Treatment of Neuroplastic Symptoms (ATNS). They discuss the chronic pain epidemic, neuroplasticity, and its link to stress-related and brain-generated medical conditions. Dr. Clarke highlights various conditions such as fibromyalgia, migraines, and chronic fatigue as examples of neuroplastic pain. He emphasizes the importance of understanding one's life stressors and adverse childhood experiences (ACEs) in diagnosing and treating these conditions. Deborah and Dr. Clarke also delve into the effectiveness of pain relief psychotherapy compared to traditional CBT. They underscore the essential role of self-esteem and the accurate understanding of personal experiences in relieving chronic pain and stress symptoms. The conversation sheds light on the necessity for modern healthcare to incorporate these insights for better patient outcomes.00:00 Introduction to Dr. David Clarke and ATNS00:58 Understanding Neuroplasticity03:04 Chronic Pain and Stress Connection05:52 Adverse Childhood Experiences (ACEs) and Chronic Illness12:56 Pain Relief Psychotherapy and Its Effectiveness18:31 Differences Between CBT and Pain Relief Psychology24:54 The Language of Physical Symptoms28:28 Protective Programs and Boundary Setting29:01 Impact of Adverse Childhood Experiences (ACEs)29:42 Rebuilding Self-Esteem30:51 Therapeutic Techniques and Exercises31:56 The Role of Affirmations33:42 Understanding False Belief Systems34:10 Brain and Body Connection35:49 Journey into Gastroenterology and Neuroplasticity43:52 Challenges in Modern Healthcare45:26 The Importance of Collaboration in Healthcare46:05 Subtle Forms of Toxicity47:17 Patient Resistance and Acceptance49:27 The Power of Placebo and Effective Treatments51:20 Success Stories and TransformationsTo learn more visit: Symptomatic.Me

Dr Tap discusses the significance of the FDA approval of vimseltinib for symptomatic TGCT, in which surgical resection may worsen functional limitation or cause severe morbidity. He also discussed key efficacy and safety data from the pivotal phase 3 MOTION trial and the increasingly important role that multidisciplinary collaboration will play as this targeted therapy is further integrated into clinical practice. 

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: Acute mountain sickness (AMS) is the term given to what is otherwise colloquially known as altitude sickness High altitude cerebral edema (HACE) is a severe form of AMS marked by encephalopathic changes Symptoms begin at elevations as low as 6500 feet above sea level for people who ascend rapidly May develop more severe symptoms at higher altitudes The pathophysiology involves cerebral vasodilation Occurs in everyone ascending to high altitudes but is more pronounces in those that develop symptoms The reduced partial pressure of oxygen induces hypoxic vasodilation in the brain, which results in edema and, ultimately, HACE in some patients Symptomatic presentation Headache, nausea, and sleeping difficulties occur within 2-24 hours of arrival at altitude HACE may occur between 12-72 hours after AMS and presents with ataxia, confusion, irritability, and ultimately results in coma if left untreated Clinical presentation may be mistaken for simple exhaustion, so clinicians should maintain a high index of suspicion Notably, if symptoms occur more than 2 days after arrival at altitude, clinicians should seek an alternative diagnosis but maintain AMS/HACE on the differential Treatment and management AMS Adjunctive oxygen and descent to lower altitude Acetazolamide is used as a preventive measure but is not helpful in acute treatment +/- dexamethasone HACE Patients with HACE should receive dexamethasone to help reduce cerebral edema Immediate descent to a lower altitude References Burtscher M, Wille M, Menz V, Faulhaber M, Gatterer H. Symptom progression in acute mountain sickness during a 12-hour exposure to normobaric hypoxia equivalent to 4500 m. High Alt Med Biol. 2014;15(4):446-451. doi:10.1089/ham.2014.1039 Levine BD, Yoshimura K, Kobayashi T, Fukushima M, Shibamoto T, Ueda G. Dexamethasone in the treatment of acute mountain sickness. N Engl J Med. 1989;321(25):1707-1713. doi:10.1056/NEJM198912213212504 Luks AM, Beidleman BA, Freer L, et al. Wilderness Medical Society Clinical Practice Guidelines for the Prevention, Diagnosis, and Treatment of Acute Altitude Illness: 2024 Update. Wilderness Environ Med. 2024;35(1_suppl):2S-19S. doi:10.1016/j.wem.2023.05.013 Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Malachi and the moment. Return to me. (3.6-8) Symptomatic sin. “Will a man rob God? Yet you are robbing me.” (3.8-9) Tangible turning. Tithes and Offerings. (10a) And I will return to you. (10b-12)

Introducing Case #25: Trent (Pt. 1) from Symptomatic: A Medical Mystery Podcast.Follow the show: Symptomatic: A Medical Mystery PodcastTrent was a vibrant and successful insurance assessor when his life took an unexpected turn. While working under a car, he sensed something was off. It wasn’t until later that day -- when his legs stopped responding while driving -- that the severity of the situation hit him. What followed was a baffling health crisis that turned his world upside down. With two newborn twins at home, Trent's sudden immobility brought his worst fears to life.See omnystudio.com/listener for privacy information.DISCLAIMER: Please note, this is an independent podcast episode not affiliated with, endorsed by, or produced in conjunction with the host podcast feed or any of its media entities. The views and opinions expressed in this episode are solely those of the creators and guests. For any concerns, please reach out to team@podroll.fm.

"'Hopefully this will also gain some more confidence from other IR folks that, you know, if you have an appropriate candidate, and you feel comfortable performing this procedure, that you can now say, 'Hey, this potentially can last you for years.'"—Lucas R. Cusumano, MD, MPHIn this Journal of Vascular and Interventional Radiology (JVIR) audio episode, lead author Lucas R. Cusumano, MD, MPH, speaks with journal Managing Editor Ana Lewis about his December 2024 paper, "Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis: 2-Year Outcomes from a Prospective IDE Trial."Related resources:Read the original article, "Genicular Artery Embolization for Treatment of Symptomatic Knee Osteoarthritis: 2-Year Outcomes from a Prospective IDE Trial," by Lucas R. Cusumano, MD, MPH, Hiro D. Sparks, MD, Kara E. Masterson, MSN, NP, Scott J. Genshaft, MD, Adam N. Plotnik, MD, and Siddharth A. Padia, MDSIR thanks BD for its generous support of the Kinked Wire.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

In this episode, Dr. Valentin Fuster delves into the latest research surrounding the use of the mitral clip for patients with severe functional mitral regurgitation, comparing the results of three major trials: the French MITRA-FR trial, the American COAPT trial, and the Reshape HF 2 trial. While the COAPT and Reshape HF 2 trials show positive outcomes, especially in reducing hospitalizations and improving heart failure symptoms, the French trial saw no benefit, prompting debate over the influence of left ventricular volume and disease severity on treatment success, with expert opinions calling for further studies and individualized meta-analyses.

Dr. Halley Alexander and Dr. Vineet Punia discuss factors influencing the decision to continue or discontinue anti-seizure medications at discharge for patients hospitalized with acute symptomatic seizures. Show reference: https://jamanetwork.com/journals/jamaneurology/article-abstract/2824063 

Dr. Halley Alexander talks with Dr. Vineet Punia about factors influencing the decision to continue or discontinue anti-seizure medications at discharge for patients hospitalized with acute symptomatic seizures.  Read the related article in JAMA.   Disclosures can be found at Neurology.org.

RESHAPE-HF2 – Percutaneous Repair of Moderate-to-Severe or Severe Functional Mitral Regurgitation in Patients with Symptomatic Heart Failure

In this episode of The Shoulder Physio podcast, I am joined by Dr John Kuhn, who is an orthopaedic surgeon and researcher from the United States. Doctor Kuhn and his colleagues, through the MOON shoulder group, have published several high impact studies investigating the management of individuals with rotator cuff tears and the results of these studies have caused some controversy (good controversy, that is). Rotator cuff tears are ubiquitous in musculoskeletal health care. They are both common and often burdensome, so it is important that shoulder surgeons and physiotherapists can agree on best practice management, for the betterment of the individual with the rotator cuff tear. So do John and I agree or not? Listen to find out. Don't miss this wonderful episode with Doctor John Kuhn. Key Papers: Kuhn et al; MOON Shoulder Group. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9. doi: 10.1016/j.jse.2013.01.026. Epub 2013 Mar 27. PMID: 23540577; PMCID: PMC3748251. Dunn WR et al; MOON Shoulder Group. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016 Aug;25(8):1303-11. doi: 10.1016/j.jse.2016.04.030. PMID: 27422460. Kuhn JE et al. The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort. J Bone Joint Surg Am. 2024 Sep 4;106(17):1563-1572. doi: 10.2106/JBJS.23.00978. Epub 2024 Jul 9. PMID: 38980920. Kuhn, 2023. Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease Check out the Shoulder Physio Online Course here - 40% off for a limited time! Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 John's Research Gate profile See our Disclaimer here: The Shoulder Physio - Disclaimer

Welcome to this exciting LIVE panel discussion, where we gathered six esteemed professionals from the pharmacy industry on November 12th at 6PM ET, to dig into the intriguing world of "Symptomatic: A Medical Mystery Podcast."  Listen in to this fascinating discussion with Pharmaceutical Industry Epidemiologist Dr. Ryan Paul, the CEO of Yaral Pharma, Stephen Beckman, Pharmacogenomics Pharmacist expert, Dr. Becky Winslow, Pharmacy Profession's 'Pain Guy' expert in pain management and Professor at WVU University School of Pharmacy, Dr. Mark Garofoli, and Nutrigenomics Pharmacist pioneer, Dr. Tamar Lawful with panel moderator & founder of the first podcast about the pharmacy profession, the RxPodfather, Todd Eury as we explore the podcast's compelling narratives through a pharmacy care lens.  Hosted by Lauren Bright Pacheco, "Symptomatic" takes listeners on a weekly journey through the complexities of medical mysteries, examining how symptoms can shape patients' lives.  From the initial signs of trouble to the challenges of chronic illnesses and elusive diagnoses, this discussion promises to shed light on the critical intersection of pharmacy and patient care.  Tune in for an engaging conversation that blends expertise with the captivating stories of real-life medical enigmas. Find all Symptomatic episodes here:  https://www.iheart.com/podcast/1119-symptomatic-a-medical-mys-102740051/ 

I believe this world and this life is at the core, truly beautiful and glorious. And, we have some very concerning trends to address. Health care is the number one GNP in America. We spend more money, not on our health, but our unhealth, than on anything else. Why? Lifestyle. Just do the research. It's not happening to it, we are doing it to ourselves. A very unpopular perspective, but in truth, isn't that the best news? You have power, otherwise you are claiming victimhood. Healthcare in America has become sick-management. And we address the symptoms. Even cancer, which my Dad just died of, is a symptom. We try to beat cancer and don't ask…what is causing cancer. We create a new drug to treat every growing problem, without asking why the problem exists and keeps growing. Let's ask. Sign up for a $1/month trial period at shopify.com/kevin Go to shipstation.com and use code KEVIN to sign up for your FREE 60-day trial Get 20% off your first probiotic membership order at pendulumlife.com/drivesyou  Kajabi is offering a free 30-day trial to start your business if you go to Kajabi.com/kevin Go to cozyearth.com/driven and use code DRIVEN for an exclusive 40% discount Join thousands of parents who trust Fabric to protect their family. Apply in minutes at meetfabric.com/WHATDRIVESYOU. If you're concerned about OCD, visit NOCD.com to schedule a free 15-minute call with their team. Learn more about your ad choices. Visit megaphone.fm/adchoices

In her mid-20s and thriving in a fast-paced communications job, Mila Clarke began experiencing symptoms reminiscent of those her mom had managed with diabetes for years. However, as time went on, it became clear that this was different. Little did she know, her life was about to take a significant turn, leading her on an unexpected journey with a chronic illness she never saw coming.Support the show: https://www.steveharveyfm.com/See omnystudio.com/listener for privacy information.

In this episode, Dr. Valentin Fuster delves into a groundbreaking study on the effects of the cardiac myosin inhibitor, Aficamten, on patients with obstructive hypertrophic cardiomyopathy. The findings reveal significant improvements in echocardiographic measures of cardiac function, despite a mild and reversible decrease in left ventricular ejection fraction, highlighting the need for long-term safety evaluations of this promising treatment.

Listener feedback on PFA and STEMI/NSTEMI paradigm, oral semaglutide, symptomatic vs asymptomatic AF, and the win-ratio are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback Oct 18, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001769 Pulsed Field Ablation https://www.hrsonline.org/guidance/safety-alerts/boston-scientific-cardiac-cryoablation-system STEMI/NSTEMI https://doi.org/10.1016/j.jacadv.2024.101314 II. Oral Semaglutide Press Release: https://www.novonordisk.com/content/nncorp/global/en/news-and-media/news-and-ir-materials/news-details.html?id=171480 Rationale Paper SOUL trial III. Symptomatic vs Asymptomatic AF Meta-analysis in EHJ   Meta-analysis of rate vs rhythm-control strategies https://doi.org/10.1016/j.jacep.2024.03.006 IV. The Win Ratio Pocock and colleagues https://doi.org/10.1093/eurheartj/ehae647 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Contributor: Travis Barlock MD Educational Pearls: Assessment of head and neck vascular injury due to blunt trauma Symptomatic patients require screening head and neck CT angiography EAST guidelines include the following criteria for a screening CT angiography in blunt head trauma: Unexplained neurological deficits Arterial nosebleed GCS < 6 Petrous bone fracture Cervical spine fracture Any size fracture through the transverse foramen LeFort fractures type II or type III EAST guidelines include a grading scale for vascular injury: Grade I: Luminal irregularity or dissection with 25% luminal narrowing, intraluminal thrombus, or raised intimal flap Grade III: Pseudoaneurysm Grade IV: Occlusion Grade V: Transection with free extravasation References Bensch FV, Varjonen EA, Pyhältö TT, Koskinen SK. Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke. Emerg Radiol. 2019;26(4):365-372. doi:10.1007/s10140-019-01677-0 Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522. doi:10.1016/s0002-9610(99)00245-7 Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. doi:10.1097/TA.0000000000002668 Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

This week we listen in on a debate from the PICS 2024 Symposium that occurred two weeks ago in San Diego. Today's debate is between master surgeon, Professor of Surgery at UCLA, Dr. Glen S. Van Arsdell taking the position of superiority of primary TOF repair and going up against Dr. Van Arsdell is noted master interventional cardiology expert, Professor of Pediatrics at Baylor College of Medicine, Dr. Athar M. Qureshi. Prepare for a spirited 'debate' between these two experts in their field. Apologies in advance for some sound deficiencies but the orators can be heard clearly enough to allow for an engaging back and forth and learning experience. Has either speaker swayed you? Take a listen!

Ronald Chen, MD, MPH, FASTRO, hosts a conversation on the background, methodology, primary recommendations, and implications of the updated External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Alongside Tracy Balboni, MD, MPH, and Sara Alcorn, MD, they discuss recent data and changes to practice patterns such as increased use of advanced treatment approaches (e.g., stereotactic radiation) and reirradiation. The guidelines address five key questions in this context, built upon a systematic review of the available literature and with assessment of evidence quality and recommendation strength.

Ronald Chen, MD, MPH, FASTRO, hosts a conversation on the background, methodology, primary recommendations, and implications of the updated External Beam Radiation Therapy for Palliation of Symptomatic Bone Metastases: An ASTRO Clinical Practice Guideline. Alongside Tracy Balboni, MD, MPH, and Sara Alcorn, MD, they discuss recent data and changes to practice patterns such as increased use of advanced treatment approaches (e.g., stereotactic radiation) and reirradiation. The guidelines address five key questions in this context, built upon a systematic review of the available literature and with assessment of evidence quality and recommendation strength.

The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort Kuhn JE, Dunn WR, Sanders R, et al. J Bone Joint Surg Am. Published Ahead of Print. doi:10.2106/JBJS.23.00978 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux

Introducing Case #18: Gary (Part 2) from Symptomatic: A Medical Mystery Podcast.Follow the show: Symptomatic: A Medical Mystery PodcastGary Gravina, a skilled carpenter and Marine, was rushed to the ER in 2016 due to severe flu-like symptoms which morphed into a brutal battle with a mysterious disease. Discover how Gary's dire condition would lead him to Dr. David Fajgenbaum and Dr. Grant Mitchell, who had become experts on his rare disease. See how their collaboration not only saved Gary's life but also significantly impacted the field of medicine.See omnystudio.com/listener for privacy information.DISCLAIMER: Please note, this is an independent podcast episode not affiliated with, endorsed by, or produced in conjunction with the host podcast feed or any of its media entities. The views and opinions expressed in this episode are solely those of the creators and guests. For any concerns, please reach out to team@podroll.fm.

Did you know 1 in 8 women will get breast cancer in their lifetime? Join Lauren Bright Pacheco for a special episode from the 2024 ASCO Annual Meeting in Chicago, where she dives into the best collaborative approach to breast cancer diagnoses and care. Medical oncologist, Dr. Nan Chen, and breast cancer surgeon, Dr. Sarah Shubeck share how their teamwork benefits breast cancer treatment.See omnystudio.com/listener for privacy information.

Welcome to this special episode of the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. For major FDA decisions in the field of neurology, we release short special episodes to offer a snapshot of the news, including the main takeaways for the clinical community, as well as highlights of the efficacy and safety profile of the agent in question. In this episode, we're covering the recent approval of donanemab as a new treatment for adults with early symptomatic Alzheimer disease (AD). Marketed as Kisunla, donanemab's approval marks the third antiamyloid therapy to get FDA greenlight for early-stage AD, following the controversial approval of aducanumab (Aduhelm; Biogen) in 2021 and lecanemab (Leqembi; Eisai) in 2023. Donanemab, administered as a 350 mg/20 mL once-monthly injection for intravenous infusion, had its approval supported by the phase 3 TRAILBLAZER-ALZ-2 trial (NCT04437511), a large-scale, double-blind, placebo-controlled trial that featured 1736 patients with early-stage AD. Following the approval, NeurologyLive sat down with Joel Salinas, MD, MBA, a behavioral neurologist at NYU Langone and clinical assistant professor in the department of neurology at the NYU Grossman School of Medicine. Salinas, who also serves as the chief medical officer at Isaac Health, discussed the positive impacts of the approval, the importance of patient selection for the medication, and how clinicians should discuss its benefits and harms to patients. In addition, he commented on how approvals like donanemab continue to carry momentum in the AD field going forward.  For more of NeurologyLive's coverage of donanemab's approval, head here: FDA Approves Eli Lilly's Donanemab for Early Symptomatic Alzheimer Disease Episode Breakdown: 2:10 – Positive downstream impacts of donanemab's approval 4:20 – Considerations and caution with prescribing donanemab 6:05 – Salinas on patient-clinician conversations about AD treatments 8:00 – Closing remarks and continued progress in AD field Thanks for listening to the NeurologyLive Mind Moments podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.

Andrew Yoo, Ph.D., provides insight into the ongoing research on neurodegeneration and neuronal reprogramming, highlighting the complexities and challenges in modeling and understanding these processes. Series: "Stem Cell Channel" [Health and Medicine] [Science] [Show ID: 39454]

Andrew Yoo, Ph.D., provides insight into the ongoing research on neurodegeneration and neuronal reprogramming, highlighting the complexities and challenges in modeling and understanding these processes. Series: "Stem Cell Channel" [Health and Medicine] [Science] [Show ID: 39454]

Andrew Yoo, Ph.D., provides insight into the ongoing research on neurodegeneration and neuronal reprogramming, highlighting the complexities and challenges in modeling and understanding these processes. Series: "Stem Cell Channel" [Health and Medicine] [Science] [Show ID: 39454]

Andrew Yoo, Ph.D., provides insight into the ongoing research on neurodegeneration and neuronal reprogramming, highlighting the complexities and challenges in modeling and understanding these processes. Series: "Stem Cell Channel" [Health and Medicine] [Science] [Show ID: 39454]

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressants like amitriptyline Atropine Antipsychotics like olanzapine Antispasmodics - dicyclomine Jimsonweed Muscaria mushrooms Mechanism of action involves competitive antagonism of the muscarinic receptor Symptomatic presentation is easily remembered via the mnemonic: Dry as a bone - anhidrosis due to cholinergic antagonism at sweat glands Red as a beet - cutaneous vasodilation leads to skin flushing Hot as a hare - anhidrotic hyperthermia Blind as a bat - pupillary dilation and ineffective accommodation Mad as a hatter - anxiety, agitation, dysarthria, hallucinations, and others Clinical management ABCs Benzodiazepines for supportive care, agitation, and seizures Sodium bicarbonate for TCA toxicity due to widened QRS Activated charcoal if patient present < 1 hour after ingestion Temperature monitoring Contact poison control with questions Physostigmine controversy Acetylcholinesterase inhibitor Black box warning for asystole and seizure Contraindicated in TCA overdoses Crosses blood-brain barrier, so useful for TCA overdoses Indicated only in certain anticholinergic overdose with delirium Disposition Admission criteria include: symptoms >6 hours, CNS findings, QRS prolongation, hyperthermia, and rhabdomyolysis ICU admission criteria include: delirium, dysrhythmias, seizures, coma, or requirement for physostigmine drip References 1. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080/15563650.2017.1342828 2. Nguyen TT, Armengol C, Wilhoite G, Cumpston KL, Wills BK. Adverse events from physostigmine: An observational study. Am J Emerg Med. 2018;36(1):141-142. doi:10.1016/j.ajem.2017.07.006 3. Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2006;44(3):205-223. doi:10.1080/15563650600585920 4. Shervette RE 3rd, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979;63(4):520-523. 5. Woolf AD, Erdman AR, Nelson LS, et al. Tricyclic antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233. doi:10.1080/15563650701226192 Summarized by Jorge Chalit, OMSIII | Edited by Jorge Chalit  

Folks it's time to say "Symptomatic," because we're watching SHANE! Topics include: why is this movie basically Heaven's Gate, the weird glimpse of Hollywood's narrative future it provides, and just how guilt a violent person needs to feel to experience some degree of redemtpion in the eyes of the audience. Warning: Corbin sounds a little weird  Watch Corbin's reccomendation here. Matt reccomended shirts. Next episode is about "GOOD MORNING," which you can watch here. 

Regardless of the underlying cause of spinal cord disease, we have many tools at our disposal to improve symptoms and function in these patients. Even better, technology in this area is advancing rapidly. In this episode, Lyell Jones, MD, FAAN, speaks with Kathy Chuang, MD, author of the article “Symptomatic Treatment of Myelopathy,” in the Continuum February 2024 Spinal Cord Disorders issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Chuang is an instructor in neurology at Harvard Medical School and assistant in neurology co-director at Paralysis Center, Massachusetts General Hospital and Spaulding Rehabilitation Hospital in Boston, Massachusetts. Additional Resources Read the article: Symptomatic Treatment of Myelopathy Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Transcript  Full transcript available on Libsyn   Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum, who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article by visiting the link in the show notes. Subscribers also have access exclusive audio content not featured on the podcast. As an ad-free journal entirely supported by subscriptions, if you're not already a subscriber, we encourage you to become one. For more information on subscribing, please visit the link in the show notes. AAN members, stay tuned after the episode to hear how you can get CME for listening. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum Lifelong Learning in Neurology. Today, I'm interviewing Dr Kathy Chuang, who has recently authored an article on symptomatic management of myelopathy in the latest issue of Continuum, on spinal cord disorders. Dr. Chuang is a neurologist and physical medicine and rehabilitation specialist at Mass General, where she serves as Co-Director of the MGH Paralysis Program and Chief of the Neuromuscular Rehabilitation Program. Dr Chuang, welcome, and thank you for joining us today. Would you introduce yourself to our listeners? Dr Chuang: Hi, my name is Kathy Chuang. As you said, I'm a neurologist at Mass General Hospital specializing in neuromuscular medicine, also physiatry, physical medicine, and rehab. And I'm glad to be here. Dr Jones: Thank you for joining us. Basically, if we want to know more about managing spinal cord disorders, we have come to the right person, right? Dr Chuang: I try to do my best with all patients - yep. Dr Jones: For our listeners who are new to Continuum, Continuum is a journal dedicated to helping clinicians deliver the highest quality neurologic care to their patients, and we do this with high-quality and current clinical reviews. For our long-time Continuum Audio listeners, you'll notice a few different things with our latest issue and series of author interviews. For many years, Continuum Audio has been a great way to learn about our Continuum articles. Starting with our issue on spinal cord disorders (this issue), I'm happy to announce that our Continuum Audio interviews will now be available to all on your favorite open podcast platform, with some exciting new content in our interviews. Dr. Chuang, your article is absolutely full of extremely helpful and clinically relevant recommendations for the treatment of myelopathy, regardless of the cause. If there were one single most important practice-changing recommendation that you'd like our listeners to take away, what would that be? Dr Chuang: I think the most important thing to take away is that spinal cord injury of any type spans so many organ systems, it is good to get people - or multidisciplinary care - involved early on. There's eighteen model systems for spinal cord injuries scattered across the US. Those can be great avenues of resources for patients and for practitioners, for people around. Physical medicine and rehab specialists (our physiatrists or spinal cord injury specialists) can be very useful. And then, also for each individual organ system, there are specialists involved. And so, having that multidisciplinary care is probably the most important thing for a patient that's suffering from myelopathy because every patient is different and coordinating that care is so important to them. Dr Jones: So, teamwork is probably the most important thing, and I think most of our listeners who have taken care of patients with spinal cord disorders realize that that's really key. Your article - it leads off with such a great review of one of the big problems with myelopathy, which is spasticity management. From a medication perspective, I think many of us struggle with the balance between controlling the spasticity and some of the side effects of those medications, like sedation. How do you walk that fine line, Dr. Chuang? Dr Chuang: Spasticity management, like everything else, is patient directed. It depends on what the patient is most complaining of. If a patient has spasticity but they're not actually having any complaints from it, we don't need to treat, because of fear of side effects. I tend to try to use focal procedures (like botulinum toxin injections) earlier on, in order to try and spare side effects of antispasticity medications. Use of other conservative therapies, like bracing, stretching, is very essential. Another thing to consider is that dantrolene doesn't usually have side effects - cognitive side effects, at least - and actually can be monitored pretty closely for hepatotoxicity, which is its major side effect. Other possibilities are the baclofen pumps, which can be very useful in patients with spinal cord injury because their spasticity is often more in their lower limbs than in their upper limbs. By using multimodality approaches, we can definitely limit the amount of cognitive side effects of medications. Dr Jones: That's fantastic. Do you start with that multimodal at the beginning, or do you step into it with one, then the other, then the other? Dr Chuang: I usually start off with a low-dose baclofen because they usually have generalized tone - first, in order to see if they have cognitive side effects with it and if so, at what dose. Also, so that insurers have a trial of some medication before we proceed to something as expensive as botulinum toxin injection. But yes, if there's significant focal spasticity, especially, I try to bring in botulinum toxin injections as early as possible, just because of the possibility of minimizing the effect. Dr Jones: That's a great point - that you can start these from multiple angles and start them early. And great point about dantrolene - I think the hepatotoxicity makes many of us nervous. But it's a key point there - that it can spare some of the cognitive side effects. Dr Chuang: Yes, and actually, it can be monitored pretty closely. As long as a patient has access to labs, we can check liver function tests weekly or every two weeks until you're on a stable dose, and after that, only at intervals. And it can be weaned off just as quickly. Dr Jones: Fantastic. Another issue that you cover really nicely in the article, that I think is an underrecognized complication of spinal cord diseases - neuropathic pain. What's your approach to that problem, Dr. Chuang? Dr Chuang: Neuropathic pain is very, very tough to treat a lot of times. I usually give the chance of gabapentin, pregabalin, and duloxetine early, just to see if we can start managing their pain early and to try to prevent potentiation of pain. But I also tend to try to get pain management specialists on early, and also keep in mind that there can be other causes of pain other than just the actual spinal cord injury itself. Because of deafferentation and reafferentation, patients may think of neuropathic pain, and it could be something as simple as appendicitis. If there's a change in pain, there always needs to be a workup for acute causes. Again, multidisciplinary treatment, especially with pain specialists, can be really helpful. Dr Jones: Great point about thinking of other causes, including appendicitis or the musculoskeletal things that I'm sure can be pain generators in this pain population, right? Dr Chuang: Yeah, it's very common. Patients can often fracture themselves just with a simple transfer and that can cause a huge flare-up of pain. So, not all pain should be just dismissed as being neuropathic or just from the spinal cord injury itself. Dr Jones: Great point - thank you. Another topic that you cover - that I think is mystifying to many of us - is the neurogenic bladder problems that occur in patients with myelopathy. You talk about the different types - how do you tell them apart? Dr Chuang: It's hard to tell them apart from a patient perspective because a patient will just say that they have difficulty with urination. With a spastic bladder or detrusor sphincter dyssynergia, oftentimes, patients will complain of a short stream and having to force things out. And with an atonic bladder or flaccid bladder, they have difficulty initiating a stream. What can be useful are postvoid residuals - where, if a patient is in the hospital, or if you have access to an ultrasound, or if they see a urologist - after they void, you measure the amount of urine left in their bladder. You can see whether it's a smaller amount, which is suggestive of a spastic bladder, versus a large amount, or an atonic or flaccid bladder. The standard procedure that's done to measure these are also urodynamic studies that are done, oftentimes, by urologists, where they can actually measure pressure volumes and oftentimes get EMG recordings of the actual bladder - the sphincters. Dr Jones: Perfect. When you do those postvoid residuals (easiest done with ultrasound), what's the general cutoff you use to say - that's a small amount that might be suggestive of a spastic bladder? Dr Chuang: I would say, probably less than a hundred. And then, if it was flaccid, more than five hundred. If there's in between, it may fall into either category. Dr Jones: Got it. When you think about neurogenic bladder, what are the treatment options? How do they vary between the different types that patients may have? Dr Chuang: If you have an atonic or flaccid bladder, the main possibilities for patients just are, oftentimes, Credé maneuvers (or pressure on the bladder) in order to try and help with the bladder to squeeze urine out. But a lot of times they need clean intermittent catheterization or maybe placement of a suprapubic catheter long term. For patients who have a spastic bladder or detrusor sphincter dyssynergia, we can use anticholinergic medications, like bethanechol, tolterodine - those medications - in order to try to relax the sphincter a little bit and then allow the urine to pass through. You can also have BOTOX injections to these sphincters of the bladder as well, which can be useful to relax them so that they can allow the urine to pass through. But a lot of times, a mainstay of treatment is intermittent catheterization, also for patients with severe detrusor sphincter dyssynergia, so that we can maintain small bladder volumes and not develop hydronephrosis, urinary tract infections, and complications of holding urine in the bladder. Dr Jones: Thanks for that, Dr. Chuang. Another part of your article that I thought was really fascinating, and probably will cover some new ground for our readers and listeners, is the use of nerve transfers or surgical treatment of weakness, basically. Tell us about that and how it's used in patients with myelopathy. Dr Chuang: For patients with myelopathy, it's used often in the upper extremities. If a patient has voluntary control of either elbow flexion or elbow extension (usually, elbow flexion), you can oftentimes have the ability to transfer nerves into the finger flexors and allow voluntary hand closure. If there's supination or wrist extension, you can oftentimes allow transfers of branches of the nerve - for example, from the supinator, or from the branch to the extensor carpi radialis brevis, into the finger extensor - so that, over a period of nine to twelve months, we'll be able to slowly regrow the nerve back in and allow the denervated muscle to become reinnervated with a voluntary controlled muscle and then restore voluntary finger extension, which can be extremely beneficial - just being able to voluntarily open and close their hands. Dr Jones: Right. And it sounds like the goal is really that functional use of grip and use of the upper limb. Not really so much for transfers, I imagine - is that not so much the goal? Dr Chuang: If there's less than antigravity strength of elbow extension and reasonable external rotation strength, you may be able to get elbow extension strong enough antigravity, and at that point a patient may be able to transfer independently - with a lot of training. Dr Jones: Wow, that's fantastic - thank you. There's lots of therapeutic options, really, for many of these complications, which I think is an important point for our readers and our listeners to take home. When you look into the future, Dr. Chuang, what do you see on the horizon as the next generation of care for patients with spinal cord disorders? Dr Chuang: I see a huge, expanding field, both of therapeutics - there are stem cell trials all over the world; there are neurorestorative hormones that are being tried. I'm very excited about the advent of robotics, with motors being basically shrunk down to the size of millimeters, and exoskeletons becoming lighter and lighter. I suspect that, long term, we'll be able to have robotic exoskeletons to be able to help patients walk and move their limbs normally. I know there are clinical trials right now involving orthoses that are controlled with brain interfaces that will hopefully help restore function in patients who need it. Dr Jones: It sounds like science fiction, but a lot of that technology exists now, right? Dr Chuang: Yes, it does. We definitely have prototypes of multigear hands with multiple directions. Now, the problem is trying to find the way to control these motors and to control these robotic hands and legs. Dr Jones: Caring for patients with myelopathy I imagine can be challenging, but I imagine it can also be quite rewarding. Tell us, Dr. Chuang, what drew you to this work specifically, and what do you find most exciting about it? Dr Chuang: I want to help people move better. I'm a physiatrist by training, and our job as physiatrist is to try to get people back to their activities of daily living as soon as possible; to try to remove any barriers to becoming active, independent people in their society. And so, I think that spinal patients that suffer from myelopathies or other spinal cord injuries have a lot of potential in the amount of activities that they can do and the way that they can contribute. I've seen patients who have been paralyzed and unable to move their hands at all develop tenodesis scripts, initially in order to just pick up things and then later obtain voluntary control of opening and closing their fingers. And it's huge in terms of what they can do in their everyday lives. Just being able to see that is just really rewarding. And even being able to help patients navigate society around them is just a hugely rewarding experience. Dr Jones: I imagine that must be really fantastic to see folks regain those milestones. Dr Chuang: Yes. Dr Jones: It's pretty unusual for someone to have done a neurology and a physiatry residency. So, between me and you and all of our listeners, which residency was better? Dr Chuang: Wouldn't trade one without the other. Probably wouldn't have done the one without the other, either! Dr Jones: What a great, diplomatic answer. Okay, good. Dr Chuang: It's true. Dr Jones: Yeah. You avoided offending all the neurologists and physiatrists out there. And really fascinating discussion, Dr. Chuang. It's an outstanding article. I think it's a must-read for anyone who takes care of patients with spinal cord disorders. I want to thank you Dr. Wang for joining us and for such a thoughtful, fascinating discussion on symptomatic management of spinal cord disorders. Dr Chuang: Thank you, Dr. Jones for having me today. Dr Jones: Again, we've been speaking with Dr. Kathy Chuang, author of an article on symptomatic treatment of myelopathy in Continuum's most recent issue on spinal cord disease - please check it out. And thank you to our listeners for joining today. Dr. Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, please consider subscribing to the journal. There's a link in the episode notes. We'd also appreciate you following the podcast and rating or reviewing it. AAN members, go to the link in the episode notes and complete the evaluation to get CME for this episode. Thank you for listening to Continuum Audio.

Episode 164: More Than Just A HeadacheDr. Song presents a case of a subacute headache that required an extensive workup and multiple visits to the hospital and clinic to get a diagnosis. Dr. Arreaza added comments about common causes of subacute headaches.    Written by Zheng (David) Song, MD. Editing and comments by Hector Arreaza, MD.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction to the episode: We are happy to announce the class of 2027 of the Rio Bravo / Clinica Sierra Vista Family Medicine Residency Program. Our new group will be (in alphabetical order): Ahamed El Azzih Mohamad, Basiru Omisore, Kenechukwu Nweke, Mariano Rubio, Nariman Almnini, Patrick De Luna, Sheila Toro, and Syed Hasan. We welcome all of you. We hope you can enjoy 3 enriching and fulfilling years. During this episode, you will hear a conversation between Dr. Arreaza and Dr. Song. Some elements of the case have been modified or omitted to protect the patient's confidentiality. 1. Introduction to the case: Headache. A 40-year-old male with no significant PMH presents to the ED in a local hospital due to over a month history of headaches. Per the patient, headaches usually start from the bilateral temporal side as a tingling sensation, and it goes to the frontal part of the head and then moves up to the top of the head. 8 out of 10 severities were the worst. Pt reports sometimes hypersensitivity to outdoor sunlight but not indoor light. OTC ibuprofen was helpful for the headache, but the headache always came back after a few hours. The patient states that if he gets up too quickly, he feels slightly dizzy sometimes, but it is only for a short period of time. There was only one episode of double vision lasting a few seconds about 2 weeks ago but otherwise, the patient denies any other neurological symptom. He does not know the cause of the headache and denies any similar history of headaches in the past. The patient denies any vomiting, chest pain, shortness of breath, cough, abdominal pain, or joint pain. The patient further denies any recent traveling or sick contact. He does not take any chronic medication. The patient denies any previous surgical history. He does not smoke, drink, or use illicit drugs. What are your differential diagnoses at this moment? Primary care: Tension headache, migraines, chronic sinusitis, and more.2. Continuation of the case: Fever and immigrant.Upon further inquiries, the patient endorses frequent “low-grade fever” but he did not check his temperature. He denies any significant fatigue, night sweats, or weight loss. He migrated from Bolivia to the U.S. 12 years ago and has been working as a farm worker in California for the past 10 years. He is married. His wife and daughter are at home in Bolivia. He is currently living with friends. He is not sexually active at this moment and denies having any sexual partners. Differential diagnoses at this moment?  Tension headache, migraine, infections, autoimmune disease, neurocysticercosis. 3. Continuation of the case: Antibiotics and eosinophilia. As we kept asking for more information, the patient remembered he visited a clinic about four months ago for a dry cough and was told he had bronchitis and was given antibiotics and the cough got better after that. He went to another local hospital ED one month after that because the cough came back, now with occasional phlegm and at that time he also noticed two “bumps” on his face but nothing significant. After a CXR at the ED, the patient was diagnosed with community-acquired pneumonia and sent home with cough medication and another course of antibiotics. His cough improved after the second round of antibiotics. We later found on the medical record that the CXR showed “mild coarse perihilar interstitial infiltrates of unknown acuity”. His blood works at the ED showed WBC 15.2, with lymphocyte 21.2%, monocyte 10.1%, neutrophil 61.7%, eosinophil 5.9% (normally 1-4%), normal kidney, liver functions, and electrolytes, and prescribed with benzonatate 100mg TID and doxycycline 100mg bid for 10 days. He went to the same ED one month before he saw us for headache and fever (we reviewed his EMR, and temp was 99.8F at the ED). After normal CBC, CMP and chest x-ray. The patient was diagnosed with a viral illness and discharged home with ibuprofen 400mg q8h.Due to the ongoing symptoms of headache and fever, the patient went back to the same clinic he went to four months ago for a dry cough and requested a complete physical and blood work. The patient was told he had a viral condition and was sent home with oseltamivir (Tamiflu®) for five days. However, the provider did order some blood work for him. Differential diagnoses at this moment?  Patients with subacute meningitis typically have an unrelenting headache, stiff neck, low-grade fever, and lethargy for days to several weeks before they present for evaluation. Cranial nerve abnormalities and night sweats may be present. Common causative organisms include M. tuberculosis, C. neoformans, H. capsulatum, C. immitis, and T. pallidum. At his physical exam visit, the patient actually asked the provider specifically to check him for coccidiomycosis because of his job as a farm worker and he heard from his friends that the infection rate is pretty high in the Central Valley of California. His serum cocci serology panel showed positive IGG and IGM with CF titer of 1:128. His HIV, syphilis, HCV, HBV are all negative. The patient was told by that clinic to come to ED due to his history of headache, fever, and very high serum coccidiomycosis titer.  The senior and resident intern were on the night shift that night and we were contacted by the ED provider at around 9:30 pm for this patient. When reviewing his ED record, his vitals were totally normal at the ED, the preliminary ED non-contrast head CT showed no acute intracranial abnormality. A lumbar puncture was performed by the ED provider, which showed WBCs (505 - 71%N, 20%L, 7%M), RBC (1), glucose (19), and protein (200). CSF: High Leukocytes, low glucose, and high protein.On the physical exam, the patient was pleasant and cooperative, he was A&O x 4, he had a normal examination except for two brown healing small nodules on his forehead and left cheek and slight neck stiffness. At that point, we knew the patient most likely had fungal meningitis by cocci except for the predominant WBC in his CSF fluid was neutrophil not the more typical picture of lymphocyte dominant. And because of his very benign presentation and subacute history, we were not 100% sure if we had a strong reason to admit this patient. We thought this patient could be managed as an outpatient with oral fluconazole and referred to infectious disease and neurology. 4. Continuation of case: Admission to the hospital.Looking back, one thing that was overlooked while checking this patient in the ED was the LP opening pressure. Later, the open pressure was reported as 340mm H2O (very high). The good thing was, after speaking to the ED attending and our attending, the patient was admitted to the hospital and started on oral fluconazole.  Three hours after the admission, a rapid response was called on him. While the floor nurses were doing their check-in physical examination, the patient had a 5-minute episode of seizure-like activity which included bilateral tonic arm/hand movements, eye deviation to the left, LOC unresponsive to sternal rub, and the patient desaturated to 77%. He eventually regained consciousness after the seizure and pulse oximetry increased to 100% on room air. The patient was started on Keppra and seen by a neurologist the following day. His 12-hour EEG was normal, but his head MRI showed “diffuse thickening and nodularity of the basal meninges are seen demonstrating enhancement, suggesting chronic meningitis, possibly related to cocci. Other etiologies including sarcoidosis and TB meningitis and/or infiltration by metastatic process/lymphoma are not excluded. The ventricles are slightly prominent in size”. MRI of the cervical, thoracic, and lumbar spines also showed extensive diffuse leptomeningeal thickening, extensive meningitis, and nodular dural thickening. Also, his chest x-ray showed “some heterogeneity and remodeling of the distal half of the left clavicle. Metabolic bone disease, infectious etiology and/old trauma considered”. This could also be due to disseminated cocci infection. The infectious disease doctor saw this patient and recommended continuing with fluconazole, serial LPs until opening pressure is less than 250 mmH2O and neurosurgery consultation for possible VP shunt placement. The neurologist recommended the patient continue with Keppra indefinitely in the context of structural brain damage secondary to cocci meningitis.Take home points: Suspect cocci meningitis in patients with subacute headache associated with respiratory symptoms, new skin lesions, photophobia, neck stiffness, nausea, vomiting, eosinophilia, erythema nodosum (painful nodules on the anterior aspect of legs). Other symptoms to look for include arthralgias, particularly of the ankles, knees, and wrists.____________________Brief summary of coccidiomycosis. Etiology Coccidioidomycosis, commonly known as Valley fever, is caused by dimorphic soil-dwelling fungi of the genus Coccidioides (C. immitis and C. posadasii). They are indistinguishable in clinical presentation and routine laboratory test results.1, 2, 3, 5Epidemiology In the United States, endemic areas include the southern portion of the San Joaquin Valley of California and the south-central region of Arizona. However, infection may be acquired in other areas of the southwestern United States, including the southern coastal counties in California, southern Nevada, southwestern Utah, southern New Mexico, and western Texas (including the Rio Grande Valley). There are also cases in eastern Washington state and in northeastern Utah. Outside the United States, coccidioidomycosis is endemic to northern Mexico as well as to localized regions of Central and South America.1, 2Overall, the incidence within the United States increased substantially over the 1998-2019, most of that increase occurred in south-central Arizona and in the southern San Joaquin Valley of California. From 1998 to2019, reported cases in California increased from 719 to 9004.1, 6The risk of infection is increased by direct exposure to soil harboring Coccidioides. Past outbreaks have occurred in military trainees, archaeologists, construction or agricultural workers, people exposed to earthquakes or dust storms. However, in endemic areas, many cases of Coccidioides infection occur without obvious soil or dust exposure and are not associated with outbreaks. Change in population, climate change, urbanization and construction activities, and increased awareness and reporting, are possible contributing factors.1, 2, 5 Pathology In the soil, Coccidioides organisms exist as filamentous molds. Small structures called arthroconidia from the hyphae may become airborne for extended periods. Arthroconidia are usually 3-5 μm—small enough to evade bronchial tree mucosal mechanical defenses and reach deep into the lungs.1, 3Once inhaled by a susceptible host into the lung, the arthroconidia develop into spherules (theparasitic existence in a host), which are unique to Coccidioides. Endospores from ruptured spherules can themselves develop into spherules, thus propagating infection locally.1, 3, 5Although rare cases of solid organ donor-derived or fomite transmitted infections have been reported, coccidioidomycosis does not occur in person-to-person or zoonotic contagion, and transplacental infection in humans has never been documented.2, 5Cellular immunity plays a crucial role in the host's control of coccidioidomycosis. Among individuals with decreased cellular immunity, Coccidioides may spread locally or hematogenously after an initial symptomatic or asymptomatic pulmonary infection to extrathoracic organs.1, 3, 7Clinical manifestationThe majority of infected individuals (about 60%) are completely asymptomatic. Symptomatic persons (40% of cases) have symptoms that are related principally to pulmonary infection, including cough, dyspnea, and pleuritic chest pain. Some patients may also experience fever, headache (common finding in early-stage infection and does not represent meningitis), fatigue, night sweats, rash, myalgia.1, 2, 3, 5In most patients, primary pulmonary coccidioidomycosis usually resolves in weeks without sequelae and lifelong immunity to reinfection. However, some patients may develop chronic pulmonary complications, such as nodules or pulmonary cavities, or chronic fibrocavitary pneumonia. Some individuals with intense environmental exposure or profoundly suppressed cellular immunity (e.g., in patients with AIDS) may develop a primary pneumonia with diffuse reticulonodular pulmonary process in association with dyspnea and fever.1, 3, 5Fewer than 1% of infected individuals develop extrathoracic disseminated coccidioidal infection. Common sites for dissemination include joints and bones, skin and soft tissues, and meninges. One site or multiple anatomic foci may be affected. 1, 2, 3, 7It is estimated that coccidioidal meningitis, the most lethal complication of coccidioidomycosis, affects only 0.1% of all exposed individuals. Patients with coccidioidal meningitis usually present with a persistent headache (rather than a self-limited headache in some patients with primary pulmonary infection), with nausea and vomiting, and sometimes vision change. Some may also develop altered mental status and confusion. Meningismus such as nuchal rigidity, if present, is not severe.Hydrocephalus and cerebral infarction may develop in some cases. Papilledema is more commonly observed in pediatric patients.1, 3, 4, 5, 7When meningitis develops, most patients may not have any respiratory symptoms nor radiographic manifestation of pulmonary infection. However, a large number of these individuals also present with other extrathoracic lesions.7DiagnosisAlthough early diagnosis carries obvious benefits for patients and the health care systems as a whole (e.g., decreases patient anxiety, reduces the cost of expensive and invasive tests, removes the temptation for empirical antibacterial or antiviral treatments, and allows for early detection of complications), considerable diagnostic delays up to several weeks to months are common in both endemic areas and non-endemic areas.3, 7 Most symptomatic persons with coccidioidal infection present with primarily pulmonary symptoms and are often misdiagnosed as community-acquired bacterial pneumonia and treated with antibiotics. In endemic areas like south-central Arizona, previous studies found up to 29% of community-acquired pneumonia is caused by coccidioidomycosis. Healthcare providers thus should maintain a high clinical suspicion for coccidioidomycosis when evaluating persons with pneumonia who live in or have traveled to endemic areas recently. Elevated peripheral-blood eosinophilia of over 5%, hilar or mediastinal adenopathy on chest radiography, marked fatigue, and failure to improve with antibiotic therapy should prompt suspicion and testing for infection with coccidioidomycosis in endemic areas.1, 3, 5Serological testing plays an important role in establishing a diagnosis of coccidioidomycosis. Enzyme immunoassay (EIA) to detect IgM and IgG antibodies is highly sensitive and therefore commonly used as the screening tool. Immunodiffusion is more specific but less sensitive than enzyme immunoassay. It is used to confirm the diagnosis of positive EIA test results. Complement fixing (CF) test, which indirectly detects the presence of coccidioidal antibodies by testing the consumption of serum complement, are expressed as titers. Serial measurements of titers are of not only diagnostic but also prognostic value.1, 2, 3, 5Other methods, including culture, microscopic, or polymerase chain reaction (PCR) exam on tissue or respiratory specimens, are limited by their availability, sample obtaining and handling, or lack of sufficient evaluation.1, 2, 3, 5Cerebrospinal fluid (CSF) examination in coccidioidal meningitis usually demonstrates lymphocyte dominated elevation of leukocytes, although polymorphonuclear leukocyte dominance can also be seen in the early stage of the infection. Profound hypoglycorrhachia and elevated protein levels in CSF examination are also very common in coccidioidal meningitis.1, 7Although isolating Coccidioides from CSF or other CNS specimens are diagnostic for coccidioidal meningitis, in practice, diagnoses are often made based on the combination of clinical presentation, CSF examination that suggesting fungal infection, and positive Coccidioides antibodies found in CSF.7Imaging, especially enhanced magnetic resonance imaging (MRI), can help in diagnosing coccidioidal meningitis. Basilar leptomeningeal enhancement is a more common finding even though hydrocephalus, cerebral infarction, and vertebral artery aneurysm can also be seen.7TreatmentMost patients with focal primary pulmonary coccidioidomycosis do not require antifungal therapy. According to 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline, antifungal therapy should be considered in patients with concurrent immunosuppression that adversely affect cellular immunity (e.g., organ transplant patients, AIDS in HIV-infected patients, and patients receiving anti–tumor necrosis factor therapy) and those with significantly debilitating illness, extensive pulmonary involvement, with concurrent diabetes, pregnant women, or who are otherwise frail because of age or comorbidities. Some experts would also include African or Filipino ancestry as indications for treatment. Conversely, humoral immunity comprise splenectomy, hypocomplementemia, or neutrophil dysfunction syndromes are not major risk factors for this disease.1, 2, 3, 4, 5Triazole antifungals (fluconazole or itraconazole) are currently considered as the first-line medications used to treat most cases of coccidioidomycosis. Amphotericin B is reserved for only the most severe cases of dissemination and patients with coccidioidal meningitis in whom triazole antifungal therapy has failed. It is also the choice of therapy for coccidioidomycosis in pregnant women during the first trimester because of the possible teratogenic effect of high-dose triazole therapy during this period of time.1, 3, 4, 5Treating coccidioidal meningitis (CM) poses a special challenge because untreated meningitis is nearly always fatal. Lifelong therapy is recommended for CM because the majority 80% patients with CM experience relapse when therapy is stopped despite initial response to antifungal treatment. Shunting of CSF is required in cases of meningitis complicated by hydrocephalus.1, 3, 4, 5, 7Prevention Avoidance of direct contact with contaminated soil in endemic areas (e.g., respirator use by construction workers) may reduce disease risk, although clear evidence of its benefit is lacking.1, 5Some special population groups may benefit from prophylactic use of antifungals, such as those about to undergo allogeneic solid-organ transplantation or patients with a history of active coccidioidomycosis or a positive coccidioidal serology in whom therapy with tumor necrosis factor α antagonists is being initiated. The administration of prophylactic antifungals is not recommended for HIV-1-infected patients even if they live in an endemic region.1, 5Conclusion: Now we conclude episode number 164, “More than just a headache.” Dr. Song explained that a headache with an indolent course, accompanied by subacute respiratory symptoms, nausea, vomiting, photophobia, neck stiffness, and skin lesions can be secondary to Valley Fever. The Central Valley of California, as well as other areas with dry climate, are endemic and we need to keep this disease in our differential diagnosis.This week we thank Hector Arreaza and Zheng (David) Song. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Roos KL, Tyler KL. Acute Meningitis. McGraw Hill Medical. Published 2023. Accessed August 18, 2023. https://accessmedicine.mhmedical.com/content.aspx?bookid=2129§ionid=192020493Information for Healthcare Professionals. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/health-professionals.html#printValley Fever (Coccidioidomycosis) a Training Manual for Primary Care Professionals. Accessed August 18, 2023. https://vfce.arizona.edu/sites/default/files/valleyfever_training_manual_2019_mar_final-references_different_colors.pdfAmpel NM. Coccidioidomycosis. Idsociety.org. Published July 27, 2016. Accessed August 18, 2023. https://www.idsociety.org/practice-guideline/coccidioidomycosis/Herrick KR, Trondle ME, Febles TT. Coccidioidomycosis (Valley Fever) in Primary Care. American Family Physician. 2020;101(4):221-228. Accessed August 18, 2023. https://www.aafp.org/pubs/afp/issues/2020/0215/p221.htmlValley Fever Statistics. Published 2023. Accessed August 18, 2023. https://www.cdc.gov/fungal/diseases/coccidioidomycosis/statistics.htmlUpToDate. Uptodate.com. Published 2023. Accessed August 18, 2023. https://www.uptodate.com/contents/coccidioidal-meningitis?search=7%20Coccidioidal%20meningitis&source=search_result&selectedTitle=1~10&usage_type=default&display_rank=1Royalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from  https://www.videvo.net/

Stephen Berkley is a Writer/Director/Producer and Filmmaker whose PBS feature film, titled LIFE WITH GHOSTS, is a Best Documentary Film Festival winner. The documentary, which was inspired when Stephen's father transitioned and his mother began reporting interactions with his father's ghost, is the culmination of a seven-year investigation into the nature of love, loss, and ghosts. Be sure to tune in to hear Irene and Stephen discuss this enlightening documentary, which features three survivor's quests for answers to questions such as “Are ghosts a real phenomenon or are they merely symptomatic of profound grief?”, Induced After-Death Communication, also known as IADC, which is a welcome alternative to traditional talk therapy and prescription drug use for the chronically bereaved, and more! IN THIS EPISODE, YOU'LL HEAR ABOUT THINGS LIKE:How automatic writing helped Stephen's mother connect with his dad.The testing of Induced-After-Death Communication (IADC) at the University of North Texas, and the jaw-dropping results.How IADC helps people suffering from prolonged grief disorder. Stephen's three reasons for putting “ghosts” in his documentary title.SOME QUESTIONS IRENE ASKS STEPHEN:How effective is IADC as a therapeutic intervention for grief compared to traditional talk therapy?Is IADC also known to work for skeptics?How is IADC like EMDR, and how is it different? What are your hopes for Life With Ghosts moving consciousness on this planet?What synchronicities have you experienced since creating Life With Ghosts? Why do you say, “Life is not an immortality project, instead it is a discovery of your true nature”?Register for the screening of LIFE WITH GHOSTS here: https://www.livingwithghostsmovie.com/regwein

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Authors:  Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center   Resources:  Rutherford's 10th Edition Chapters: 88, 89, and 91 The North American Symptomatic Carotid Endarterectomy Asymptomatic Carotid Atherosclerosis Study Audible Bleeding's eBook chapter on cerebrovascular disease Houston Methodist CEA Dissection Video: Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w   Outline:  1. Etiology of Carotid Artery Stenosis Risk factors: advanced age, tobacco use, hypertension, diabetes. Atherosclerosis as the primary cause. Development of Atherosclerotic Disease and Plaque Formation LDL accumulation in arterial walls initiating plaque formation. Inflammatory response, macrophage transformation, smooth muscle cell proliferation. Role of turbulent blood flow at carotid bifurcation in plaque development. Clinical Features of Carotid Artery Stenosis Asymptomatic nature in many patients. Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit. Carotid bruit as a physical finding, limitations in diagnosis. Importance of Evaluating CAS Assessing stenosis severity and stroke risk. Revascularization benefits dependent on stenosis severity. Classification of Stenosis Levels Clinically significant stenosis: ≥ 50% narrowing. Moderate stenosis: 50%–69% narrowing. Severe stenosis: 70%–99% narrowing. Stroke Risk Associated with Carotid Stenosis Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis. Diagnosis and Screening No population-level screening recommendation. Screening for high-risk individuals as per SVS guidelines. Carotid Duplex Ultrasound as primary diagnostic tool. Additional tools: CT angiography, Magnetic Resonance Angiography. Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4. Revascularization Criteria Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively. Asymptomatic Patients: 70% stenosis, considering life expectancy. Surgical Indications and Contraindications Indications: symptomatic patients, life expectancy considerations. Contraindications: Stenosis

SEGMENT - Jones, Mego, and Arcand breakdown NESN's Dakota Randall's one-on-one with Trent Brown and discuss how he is a part of all the problems that he claims to have with New England and the Patriots. 

In this bonus segment, host Lauren Bright Pacheco checks in with Michele from Case #09 to share feedback from the Symptomatic community.See omnystudio.com/listener for privacy information.

After the birth of her first child, Michele was hit with the onset of sporadic tingling and numbness on alternating sides of her face. Despite enduring years of the mysterious symptoms, she had given up hope of finding the root cause. Michele eventually built up walls of shame because of the uncontrollable flare-ups. It was the concern of her family and the unwavering support of her new partner that would reignite her hunt for a proper diagnosis.See omnystudio.com/listener for privacy information.

After the birth of her first child, Michele was hit with the onset of sporadic tingling and numbness on alternating sides of her face. Despite enduring years of the mysterious symptoms, she had given up hope of finding the root cause. Michele eventually built up walls of shame because of the uncontrollable flare-ups. It was the concern of her family and the unwavering support of her new partner that would reignite her hunt for a proper diagnosis.See omnystudio.com/listener for privacy information.