Podcasts about Tramadol

We're back and talking hardcore: - Hardcore trivia- Newerish stuff: Dynamite, Tramadol, Total Con- Poison Idea - Blank Blackout Vacant LP- Best Japanese Hardcore EPs 1981-1985 - Opening Round Part 2- Interview: Vinnie Stigma (Agnostic Front)Check the website for playlists, our links, and SMASH that Patreon button:https://185milessouth.comhttps://patreon.com/185milessouthWe are on Substack (sometimes) writing about punk and hardcore:https://185milessouth.substack.comGet at me: 185milessouth@gmail.comBuy Vinnie's book here: https://revhq.com/products/vinnie-stigma-the-most-interesting-man-in-the-world-bookIntro Song: Agnostic FrontOutro Song: Lip CreamSupport the show

Folge 242: Tramadol, Diabetes durch Menopause & TikTok-Trend

Matt von Boecklin who for over a decade, traveled the world as a program evaluation specialist and chemical engineer, living in Asia, Africa, and South America.Along the way, he picked up a few bad habits, but now has quit his addictions to cigarettes, alcohol, Tramadol, and kratom. He works full time at Quit Kit, where he helps people suffering from addictions to kratom and opioids by offering a non-prescription way to relieve the severity of withdrawal symptoms.Main Business Issues:Internal struggles with people-pleasing, fear, and self-talkSelf doubt impacting Matt's business decisions Matt's Key Insights and Takeaways:Maintaining standards that align with realistic expectations is a challengeDeeper emotional work is necessary to elevate both personal growth and business performance.Connect with MattQuit Kit: https://tryquitkit.com/TikTok: https://www.tiktok.com/@the_quit_kit

Das Opioid Tramadol wird als Schmerzmittel und Partydroge benutzt. SPIEGEL-Reporterin Susanne Amann deckt auf, wie ein Pharma-Konzern und die zuständige Behörde beitragen, dass der Wirkstoff nicht stärker reguliert wird. Sagt uns, wie euch Shortcut gefällt. Hier geht's zur Umfrage. »SPIEGEL Shortcut« – Schneller mehr verstehen. Wir erklären euch jeden Tag ein wichtiges Thema – kurz und verständlich. Für alle, die informiert mitreden wollen. Neue Folgen von Shortcut gibt es von Montag bis Freitag auf Spiegel.de, YouTube und überall, wo es Podcasts gibt. Links zur Folge: SPIEGEL-Recherche: Wie deutsche Behörden in der Opioid-Kontrolle versagen Diese Mutter verlor ihren Sohn an Tramadol, jetzt will sie Gesetze ändern Opioide in Deutschland: Sucht auf Rezept ► Host: Maximilian Sepp ► Redaktion: Marco Kasang ► Redaktionelle Leitung: Jannis Schakarian ► Produktion: Fabius Leibrock ► Postproduktion: Florian Hofmann, Christian Weber ► Social Media: Philipp Kübert ► Musik: Above Zero ►►► Lob, Kritik, Themenvorschläge? Schreibt uns: hallo.shortcut@spiegel.de +++ Alle Infos zu unseren Werbepartnern finden Sie hier. Die SPIEGEL-Gruppe ist nicht für den Inhalt dieser Seite verantwortlich. +++ Den SPIEGEL-WhatsApp-Kanal finden Sie hier. Alle SPIEGEL Podcasts finden Sie hier. Mehr Hintergründe zum Thema erhalten Sie mit SPIEGEL+. Entdecken Sie die digitale Welt des SPIEGEL, unter spiegel.de/abonnieren finden Sie das passende Angebot. Informationen zu unserer Datenschutzerklärung.

Victoria Bugtrup var 14 år, da hun første gang slugte en tramadol-pille, og det blev starten på et langvarigt misbrug, hvor hverdagen gik med at finde det næste fix.Tramadol er et stærkt, receptpligtigt opioid i familie med morfin, heroin og oxycodon, men Victoria havde ingen recept. I stedet stjal hun fra butikker for at skaffe penge til at købe stofferne på det sorte marked.Victoria er en del af den voksende gruppe af danske unge, der bliver afhængige af opioider. I dag er hun 17 år, har været clean i over et år og fortæller nu med sin mor, Pia Bugtrup, om misbruget og konsekvenserne for familien i håbet om, at andre i hendes situation søger hjælp i tide. Gæster: Victoria Bugtrup og Pia Bugtrup Vært: Jacob Grosen Tilrettelæggelse og klip: Mathias Bonde Foto: Joachim LadefogedSee omnystudio.com/listener for privacy information.

For over a decade, Matt von Boecklin traveled the world as a program evaluation specialist and chemical engineer, living in Asia, Africa, and South America. Along the way, he picked up a few bad habits but has now quit his addictions to cigarettes, alcohol, Tramadol, and kratom. Now he works full time at Quit Kit, where he helps people suffering from addictions to kratom and opioids by offering a non-prescription way to combat addiction withdrawal symptoms. To make a tax-deductible donation to PAIN's Veterans In Need visit: https://gofund.me/c4b23093 For more on Matt and Quit Kit : https://tryquitkit.com/ Matt von Boecklin and PAIN Media Director Jason LaChance discuss the following and more. Intro 00:00 What was childhood like for Matt, and how did it impact her future addiction issues? 01:34 How did Matt's father's mental heath issues impact his family when he was a child? 04:19 Did Matt have a lineage of substance abuse issues in his family? 07:20 How and why did Matt stay away from alcohol until he was of legal age? 10:16 Why is a support group imperative for one's recovery? 24:02 Why did Matt finally acknowledge that he needed help with his tramadol and kratom addiction? And why does he make it known that kratom is very addictive? 31:28 What led Matt down a path of exploring a natural solution to his withdrawal symptoms, and how did it lead to the creation of Quit Kit? 36:04

Cette semaine Luka et Lebron s'aiment d'amour chez des Lakers franchement bons, les Spurs doivent-ils tanker ? Et enfin on parle des Pistons 6ème à l'Est ! Sans oublier Bobby Portis et ses pupilles Tramadol ainsi que Jayson Tatum égérie d'un parfum Nocibé, merci la NBA. Bisous les Airbalos ! InstagramYoutubeTik-tokHébergé par Ausha. Visitez ausha.co/politique-de-confidentialite pour plus d'informations.

Suspendu 25 matches sans salaire, Bobby Portis s'est trompé de médicament en confondant le Toradol et le Tramadol. Le premier étant autorisé, le second interdit. Son agent a parlé d'une « simple erreur commise en raison de la similitude des noms des médicaments et de leurs fonctions très similaires ». Il va donc falloir (quasiment) finir la saison régulière sans lui. Cette saison, Portis a une moyenne de 13,7 points par match avec les Bucks. Un coup dur pour les Bucks mais aussi une opportunité pour Kyle Kuzma, fraichement arrivé en échange de Khris Middleton et qui a là une opportunité de montrer son talent pour que Giannis Antetokounmpo et Damian Lillard leur accordent leur confiance en vue des échéances de fin de saison.Avec Jacques Monclar et Baptiste Denis.Jacques Monclar, Rémi Reverchon, Mary Patrux, Xavier Vaution, Fred Weis et Chris Singleton décryptent l'actualité de la NBA dans le Podcast NBA Extra. En complément de l'émission lancée en 2012, beIN SPORTS a créé, avec ce podcast, un nouveau format pour revenir en profondeur sur la ligue nord-américaine de basketball. Chaque semaine, les membres de l'émission débattent autour de trois thèmes majeurs, qui font l'actualité de la NBA.

Sandy Williams, the beloved guest host of Earl's Favorite, takes to the airwaves for a lively chat about Milwaukee Bucks sensation Bobby Portis, who has just been handed a hefty 25-game suspension. The NBA revealed that Portis tested positive for Tramadol, a painkiller that the league has banned, aligning with the World Anti-Doping Agency's list of prohibited substances. The conversation shifts to the weighty issue of Ukraine and its impact on American taxpayers. Earl and Sandy delve into the powers of the U.S. president, reflecting on how FDR's time in office led to the establishment of an eight-year term limit, curbing both presidential authority and duration. They discuss President Trump's aggressive stance towards Ukraine, suggesting he is pressuring the nation to relinquish its rights and potentially face conflict over territorial integrity. Despite the former president's previous support for Ukraine's resistance against Russia, the current narrative seems to echo Russian propaganda, with Trump allegedly demanding a significant portion of Ukraine's resources in a coercive maneuver. The Earl Ingram Show is a part of the Civic Media radio network and airs Monday through Friday from 8-10 am across the state. Subscribe to the podcast to be sure not to miss out on a single episode! To learn more about the show and all of the programming across the Civic Media network, head over to https://civicmedia.us/shows to see the entire broadcast line up. Follow the show on Facebook and X to keep up with Earl and the show! Guest: Sandy Williams

Your Nightly Prayer

On this Real Life Pharmacology Podcast episode, we cover medications 181-185. Proscar is the brand name for finasteride. This medication can be helpful in shrinking the size of the prostate but it does typically take a while to work (months). Sinemet is a combination of carbidopa and levodopa. Levodopa is converted in the central nervous system to dopamine to help alleviate a shortage of dopamine in the brain. Risedronate is a bisphosphonate medication that can be used in the treatment of osteoporosis. Albuterol (Ventolin) is a short-acting beta-agonist that is used to relieve symptoms of acute respiratory distress most often associated with an asthma exacerbation. Tramadol is classified as an opioid analgesic. It also has activity similar to SNRIs as it has the ability to increase serotonin and norepinephrine in the brain.

TW : tentative de S, anorexie, boulimie.

Doggie Drive-Thru Amanda Brown opened a drive-thru fast food restaurant for dogs ONLY. Your dog can get the popular Bow Wow Bowl with their choice of protein, vegetables, or grains in an edible bowl. Bane and Vader's opened their flagship store in Easton, Pennsylvania. Amanda plans to franchise this idea, which came to her when she saw research showing that humans often ordered food for their dogs when going through a fast food drive-thru. Listen Now Microchips and Misconceptions While microchips are an essential part of pet identification, they will not help you find your missing pet unless it's picked up and scanned by a veterinarian or shelter. That's why Dr. Debbie recommends a visible tag and perhaps a GPS collar. Only a GPS collar will allow you to track your pet's location using your smart device or computer. Listen Now Shop Cats Do you know of a business that has a token cat? You'll certainly appreciate the "Shop Cats" in Tamar Arslanian's new book. She features the most notable shop cats in New York stores in pictures and written words. For instance, the wine store cat with his own chiropractor, the cat that is a mascot at a dog boutique, or the occult shop cat that totes a magic wand in her mouth. Listen Now Will There Be an Animal in the Whitehouse? A philanthropist wants to do something to make the Trump White House more like those in the past: She wants Donald Trump to have a presidential pet. The very wealthy Lois Pope, who is also the widow of National Enquirer founder Generoso Pope, announced that she was giving a ten-week-old golden retriever/poodle mix puppy to the Trumps. Listen Now Clothes Wearing Alligator Gets Pardoned Following months of negotiations with Florida state officials, Mary Thorn has been given a permit that will allow her to keep her pet alligator, Rambo, who she says is fully trained and not a "normal" gator. Mary dresses Rambo in human clothing to protect his sensitive skin. Listen Now Stealing Your Pet's Pain Killers Stealing from a sick animal may seem a low way to get a drug fix, but it happens frequently. Opioid abuse is rampant, and a survey from Baylor College of Medicine reveals a surprising number of pet owners steal their pets' medications, especially painkillers, namely the drug Tramadol. Listen Now App Replaces Trump Pictures with Kittens If you love animals, you should find this pretty amusing. Google now offers an extension for its Chrome browser called Make America Kittens Again. It replaces pictures of President-elect Donald Trump with adorable kittens. Listen Now Read more about this week's show.

En tidig morgon i januari 2024 rullar en lastbil av i Trelleborgs hamn den visar sig innehålla 740 000 narkotikaklassade tabletter. Det är tullens största enskilda beslag hittills av gängdrogen Tramadol. Lyssna på alla avsnitt i Sveriges Radio Play. ”När jag ser det här, så känner jag ju att pulsen går upp, hjärtat börjar slå lite extra”, det säger tullinspektören Victoria Malmström som var med när beslaget gjordes. Tramadol är ett narkotikaklassat läkemedel som tillhör gruppen opioider. Det togs fram av ett tyskt företag på 60-talet och kom sen ut på marknaden 1977. Tjugo år senare introducerades det på den svenska marknaden. Från början var Tramadol ett efterlängtat läkemedel, för patienter som behövde smärtstillande som var starkare än vanliga värktabletter men inte så starkt som exempelvis morfin. Men det visade sig vara långt ifrån problemfritt, flera år senare började läkare märka hur dödsfallen började öka och hur en del fick allvarliga biverkningar. ”Det är ett läkemedel som har två ansikten”, säger Kai Knudsen, överläkare och förgiftningsexpert vid Sahlgrenska universitetssjukhuset i Göteborg och förklarar att det både har en aktiverande och avslappnande effekt. På senare år har Tramadol också blivit känd som ”gängdrogen” – i flera av de mest uppmärksammade våldsdåden i de senaste årens gängkonflikter har utförarna varit påverkade av tramadol.”Om du tar den här tramadolen så kommer du må bra. Du kommer inte komma ihåg om du skjuter den här personen”, säger 22-årige ”Isak”, som använt Tramadol i flera år. Programledare: Petra Berggren och Linus LindahlProducent: Jenny HellströmReporter: David OhlssonLjudtekniker: Johan Hörnqvist Kontakt: p3krim@sverigesradio.seTipstelefon: 0734-61 29 15 (samma på Signal)

I den här veckans avsnitt ska vi berätta om ett fall som involverar en utpekad dödspatrull från Växjö - och ett mordförsök, som sker bara några meter från en tingsrätt. Senare i avsnittet går vi igenom veckans utveckling i Fallet Molly - den 14-åriga flickan från från Falun som dog förra året efter en festkväll där hon blandat Tramadol och alkohol. Nu har den 18-årige man som tros ha sålt drogerna till henne, flytt utomlands - och rättegången som skulle börjat i onsdags, har ställts in. Reporter: Marcus Ulvsand Tips & kontakt: marcus.ulvsand@aftonbladet.se

Tonåren är viktiga år då hjärnan utvecklas på flera plan och konsekvenstänket kan svikta. Samtidigt är det ofta då som de flesta testar droger för första gången. Hur påverkas den unga hjärnan av detta? Lyssna på alla avsnitt i Sveriges Radio Play. Finns det ett gap mellan vuxenvärldens förmanande hållning till droger och ungdomars lust att prova? - Det finns en fördom om att det bara är folk som mår dåligt som tar droger och att det sker i dåliga sammanhang. Men det kan pågå i roliga sammanhang också. Det är skillnad på att testa och att missbruka, föräldrar är ofta väldigt rädda för droger men borde prata mer avdramatiserat om riskerna. Då skulle man lättare våga säga att man testat, berättar en tjej som går på gymnasiet.- Att hamnar där är verkligen jätteenkelt, det kan hända vem som helst var som helst. Men att sluta kan vara så himla svårt. Det berättar Vilda som hamnade i blandmissbruk i ung ålder.I Danmark har man de senaste åren implementerat en ny metod som kallas MOVE i behandlingen av unga med missbruk. Den går ut på en kombination av bland annat KBT och Motiverande samtal. För att få ungdomarna att ta sig till de viktiga behandlande samtalen får de ett presentkort vid vartannat tillfälle.Medverkande: Hanna Brännlund från Maria ungdom, Joar Gutestam från KI och Sheila Jones, högskolan i Dalarna.Programledare: Ulrika Hjalmarson NeidemanProducent: Clara Lowden

Der er gennem længere tid set en stigende tendens til at unge mennesker er begyndt at bruge Tramadol som 'go-to' præparat, for at opnå en rus. Det er mange gange tabletter der er stammer fra udlandet og dosis pr. tablet der ligger væsentlig højere, end den anbefalede dosis mod smerter som vi har i Danmark. Problemet med Tramadol er at det er yderst vanedannende, og at det ved højere dosis som der indtages af brugere som ønsker at bruge det som rusmiddel er risiko for at brugerne får det man kalder serotonin-syndrom hvor de kan ende med at krampe, og i værste fald får maglin hyperthermi som i den sidste ende kan være fatalt. Hør med her hvor Hjalte forklarer om netop dette. Hjalte er Paramediciner og Instruktør i Akutberedskabet i Region Hovedstaden, og holdte et oplæg om netop dette, på en af vores instruktørsamlinger, for os andre instruktører og vores Ledende overlæge. God fornøjelse! FOAMmedic Podcast · Tramadol og kramper | ep. 85 Abonner eller hent via iTunes for iOS og for android via Podbean. Kan også høre via TUNE IN, STITCHER, Podimo og Soundcloud Referencer: Bivirkningsindberetning Tramadol. Lægemiddelsstyrelsen Undersøgelse af kramper hos 15-30 årige udløst af Tramadol Seretonin Syndrom Øget refleks og clonus ved Seretonin syndrom

🇨🇴 NAIRO QUINTANA renovó con MOVISTAR TEAM una temporada más. ¿Te parece merecida la renovación? Repasamos cómo fue su fichaje por el equipo español tras su positivo por Tramadol y lo que puede dar en 2025. ⚠️ ¿Quieres ayudarnos? Puedes contribuir y convertirte en mecenas de La Bicicleta Podcast en Patreon. Desde 1,50€ al mes puedes ayudar a que sigamos aquí contigo cada día. https://patreon.com/LaBicicletaPodcast?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink 🚀 Únete al canal de Telegram: https://t.me/boost/LaBicicletaPodcast Nos escuchas también en el Podcast Oficial de La Vuelta: https://www.ivoox.com/podcast-vuelta-podcast-oficial_sq_f11080118_1.html

En la última década, los diagnósticos de enfermedad renal crónica (ERC) se multiplicaron por cinco y convirtieron a esta enfermedad en la de más rápido crecimiento del país. El problema es nacional, pero especialmente agudo en la costa sur. Un audioreportaje de No Ficción. Locución: Elsa Amanda Chiquitó. Investigación y texto: Asier Andrés.

Diane Wattrelos, 34 ans, souffre d'une maladie neurologique rare et extrêmement douloureuse, une algie vasculaire de la face, depuis qu'elle a 14 ans. Pour calmer la douleur, les médecins lui prescrivent dès les premières crises du tramadol, un médicament de la famille des opioïdes, qui expose à un risque de dépendance. Au fil des années,aucun de ses médecins ne la prévient du risque d'addiction, et sans s'en rendre compte, Diane Wattrelos devient dépendante de ce médicament qui la soulage. Un jour, elle réalise grâce à un reportage à la télévision qu'elle est devenu addict au tramadol. Elle entame alors un combat pour se sevrer et s'engage pour lever le tabou de l'addiction aux médicaments.Diane Wattrelos a raconté son parcours dans un livre, « Addict sur ordonnance. Ça n'arrive pas qu'aux autres : le cri d'alerte d'une maman sur les opioïdes légaux », sorti en juin 2024 aux éditions Leduc. Elle témoigne dans Code source au micro de Barbara Gouy.Si vous avez besoin d'aide, l'Agence nationale de santé publique a mis en place un numéro d'écoute gratuit et disponible 7j/7 de 8h à 2h du matin : 0 800 23 13 13.Écoutez Code source sur toutes les plates-formes audio : Apple Podcast (iPhone, iPad), Amazon Music, Podcast Addict ou Castbox, Deezer, Spotify.Crédits. Direction de la rédaction : Pierre Chausse - Rédacteur en chef : Jules Lavie - Reporter : Barbara Gouy - Production : Clara Garnier-Amouroux et Clara Grouzis - Réalisation et mixage : Marec Panchot. - Musiques : François Clos, Audio Network. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

#34. La crise des morphiniques en France.

In this podcast recorded in early August, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the September issue of DTB. They discuss the editorial (https://dtb.bmj.com/content/62/9/130) that highlights some of the challenges associated with NHS England's national medicines optimisation measures for Integrated Care Boards. They talk about the MHRA's recent safety alert on the risk of an interaction between tramadol and warfarin (https://dtb.bmj.com/content/62/9/131), which was prompted by a coroner's prevention of future deaths report (summarised in a DTB article in March https://dtb.bmj.com/content/62/3/36). The main article reviews the evidence for icosapent ethyl for cardiovascular risk reduction (https://dtb.bmj.com/content/62/9/135).   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

Michael “Morgs” Morgan is a 30-year veteran of law enforcement who honorably served the citizens of Atlanta, Georgia, and Suffolk County, New York. In this riveting episode Morgs shares some of the heartbreaking trauma he experienced, starting with his first night as a trainee. As a warrior and law enforcement officer he was forced to compartmentalize and press forward, with each incident adding a layer of pain and trauma. The drowning of a 2-year-old child he ‘helped save' caused unbelievable grief. Later in his career he is taken off the streets because of a back injury. He got hooked on the pain reliever Tramadol and ended up in rehab. A couple years ago he saw tier one operators on podcasts sharing their healing journeys with psychedelic assisted therapy and felt the call of the medicine. He sat with Ayahuasca in Florida, and it completely saved and changed his life. He was given a new mission to put the ladder down to help save and change the lives of other first responder heroes and their families. Follow Morg on Instagram team_morgs_inc

Läkaren Johan är på ett apotek. Han ska hämta ut narkotikaklassade läkemedel. Ett recept han har skrivit ut till sig själv. Och det här är långt ifrån första gången han gör det. Lyssna på alla avsnitt i Sveriges Radio Play. Ett recept på det narkotikaklassade läkemedlet Tramadol mot huvudvärk blir början på ett långvarigt missbruk för läkaren Johan. Medicinerna hjälper mot den oro och stress han känner i livet säger han.”Det blir ett verktyg för att orka arbeta mer. Men samtidigt underhåller beroendet ångesten, oron och stressen. Det blir en ond spiral”När missbruket är som värst har Johan under en månads tid hämtat ut nästan 450 narkotikaklassade tabletter på apoteket till sig själv.Bristfälligt kontrollsystemI Sverige har man som läkare rätt att egenförskriva recept. Det innebär att man får skriva ut läkemedel till sig själv. Antalet läkare som blir av med sin legitimation eller får prövotid, alltså att man under en tid är under uppsikt, på grund av missbruk har ökat de senaste åren. I flera fall har läkarna skrivit ut narkotikaklassade läkemedel till sig själva.Och kontrollsystemet som ska fånga upp läkare som överförskriver narkotika har brister. Nu höjs röster för att läkares rätt att skriva ut mediciner för eget bruk behöver regleras. Vårdpersonalen och missbruket är en serie av Magdalena Brander från 2024. Johan heter egentligen någonting annat. Producent: Anna FreySlutmix: Staffan Schöier

In 2023, the opioid crisis claimed over 81,000 lives -- a staggering number, yet many of these deaths could have been prevented. While prescription opioids can be essential for managing pain, they come with significant risks that are often overlooked. In this episode, we dive deep into the hidden dangers of opioid prescriptions and explore the crucial questions you should ask before accepting these medications. Ellen Eaton, MD, a leading expert in opioid treatment from the University of Alabama Birmingham, joins us to discuss the real risks of misuse, the warning signs to watch for, and the steps you can take to protect yourself and your loved ones. From understanding the potential side effects, to navigating the road to recovery, this conversation sheds light on the opioid epidemic and the urgent need for prevention and education. UAB Medicine Addiction Recovery Services Transcript Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's, Chief Physician Editor for Health and Lifestyle Medicine. Many of us have talked to our children and loved ones about how to respond if they're offered an opioid or some other unknown substance, even if it's candy at a party, fearing the dangers of opioids and overdose. But how many of us think about the risks in these situations? Our child is injured playing sports and we're given a 14-day prescription for an opioid containing medication. We're at the dentist's office and we're given a prescription for an opioid for a short course after a procedure. New data shows that there were over 81,000 opioid deaths in 2023. So, what can we do to keep our loved ones safe? Today we'll talk about the best strategies to prevent opioid misuse and abuse in the first place. Even if it starts with a prescription from our doctor's office. The journey to addiction and to recovery and what we need to know about preventing opioid deaths.   But first, let me introduce my guest, Dr Ellen Eaton. Dr Eaton is an associate professor at the Department of Medicine at the University of Alabama at Birmingham. She's the director of the office based opioid treatment clinic at the UAB 1917 clinic, and a member of the leadership team of the UAB Center for Addiction and Pain Prevention and Intervention. Welcome to the WebMD Health Discovered podcast, Dr Eaton. Ellen Eaton, MD: Thank you so much for having me. Pathak: I'd love to just start by asking you about your own personal health discovery. So, what was your aha moment that led you to the work that you're doing with opioid treatment, management, and addiction and pain prevention interventions? Eaton: Yeah, I have an interesting story as an infectious diseases physician who is primarily working on substance use treatment and prevention. I had the honor of being a fellow with the National Academy of Medicine, really a health policy fellowship. And as an infectious disease physician, I was invited to a working group around infectious consequences of the opioid epidemic. And that was in 2017. It was a tremendous opportunity to go to D.C. and work with thought leaders in the field, other physician scientists, infectious diseases doctors, and those experiences and treatment models that I was hearing about in D.C. were not happening in my home institution at UAB. There were addiction medicine physicians, but we hadn't integrated care. We were not doing syndemic care where you're treating the infection, preventing Hep C, and you're treating their substance use disorder. So that opportunity in 2017 inspired me to come home to UAB, create a clinic here that is for our patients living with HIV who have opioid use disorder, and from there, we've really expanded services broadly for substance use and infectious diseases. So really grateful for the National Academy and that opportunity. That really was a launch pad for my career. Pathak: I would love to talk about what you've seen as the entry point for a lot of people when it comes to opioids and that progression to addiction, potentially overdose. What does that look like for many of the people that you see? Eaton: Because of the care I provide, I am seeing patients who are living with substance use disorder, but I always start when I meet them with really open-ended questions like tell me about your first exposure to opioids. Tell me when you began using them for medical reasons or recreationally. And what I hear over and over again is that many of our patients are starting to experiment or use from a prescriber for a medical condition in their teens or early twenties. And that is often a trusted medical provider. It may be an urgent care physician for a musculoskeletal injury, for a teenager on the athletic field who was injured. It may be a woman who just delivered a baby, a very healthy, common touch point, where there may have been a tear or maybe some residual pain.   Another common touch point is a dentist treating you for a dental infection. And so, I hear these types of anecdotes over and over from my patients, and often it is a trusted physician, so they don't feel like this is a scary medication. They may be given a 14-day supply of opioids, not realizing that can lead to physical dependency and opioid misuse in the future. And often don't ask questions about what to look for, warning signs, and certainly as young people, I haven't ever heard that their caregiver expressed concerns. I think more often the patient has a prolonged course seeking opioids for various conditions, becomes dependent, is seeking them more and more, and often caregivers or family members don't get involved until they are pretty far down the continuum of opioid use disorder. So, those are the stories I hear when I meet patients and ask about their journey. Pathak: What are some of the questions we should ask before we even accept that prescription? Eaton: This is a really important question at that prevention touch point, that we often miss. I think asking your provider do you really need oxycodone. Could you start with something like an NSAID or a Tylenol. Asking your provider to be very explicit. When my pain hits a seven out of 10, when my pain hits an eight or nine out of 10, when do I need to take this opioid as opposed to some other opioids sparing pain modulators? And then number of days. So not just at what point today, but also tomorrow, the next day, what pain should I expect, and I think setting the expectation you will have some pain. This is a challenge that many of us that see patients in a primary care setting have to remind patients, you will have some pain. That is normal. That is healthy. That means your nerves are telling you they're giving you feedback on what's going on after your leg fracture. And I think unfortunately opioids have been normalized as safe, in many cases they can be, but in many cases they are not.   I also see amongst families where an individual will tell me, “Oh, well, I got a Tramadol from grandma, or I had some opioids leftover from that time that I had a surgery and so I took that for some other condition,” comparing them to medications like chemotherapy, which also have risks. You would never hear a patient self-medicating, sharing with friends and loved ones. But I think because opioids became so ubiquitous, in past decades, entire families, kind of normalize them. They feel comfortable sharing them, taking others. And that type of culture leads to a culture where young people feel comfortable experimenting. They take pills at parties, they take pills from friends and, they purchase them off social media, like TikTok for example, because they do not appreciate the adverse outcomes that can be associated with these types of medications. Pathak: So, tell us about this slippery slope. What is it that happens to us when we take these medications unnecessarily? Eaton: Often one of the biggest teaching points that I make with trainees in my clinic, when is someone experimenting and when does it become a use disorder? And in my clinic, it's usually pretty clear and that includes negative consequences. So, taking opioids and falling asleep, nodding out, overdosing, right? Those patients have gone from opioid misuse to use disorder. So having negative consequences, becoming physically dependent. We do see that needing to take more and more to prevent withdrawals, which with opioids, unlike some other substances, you can pretty quickly become physically dependent. And then you need to continue to opioids just to not feel sick, to not have the flu-like symptoms. So, becoming physically dependent, having to take more and more, increasing your dose to get the same desired effect. Those are the things that I see most commonly in clinic. With opioids and certainly the very potent non-medical opioids we're seeing now, heroin, fentanyl, we don't see people who just dabble here and there at a party, at a wedding.   Now the other substances that I see pretty routinely used in my clinic with or without opioid use disorder, stimulant use disorder, marijuana use disorder. Alcohol use. I do have to ask more questions and certainly there are validated screening tools out there that physicians and clinicians can use to determine very objectively. Did they just drink too much at that wedding two months ago and it was a problem because they got in a fight or had a DUI? Or is this a pattern of use that meets criteria for alcohol use disorder?   So, it is important to ask those questions and know, but I would say really the negative consequences, the physical dependency, escalating use, those are things to look for in your patients. As a caregiver or a parent, those are things to look for as well because we are really in a position to identify these before our loved ones have escalated their use. Pathak: And then what do you do? So, you notice some of these types of red flags. What is the intervention that you should make as a parent or a loved one or a caregiver? Eaton: I think starting with a primary care provider is always the best step. And most of us do use these objective screening tools. There are several you can find. My clinic uses an assist. These are validated tools that have been tested on many patients, not physicians, not PhD scientists, that have been tested on patients to make sure that they are asking the right questions to get to the true use behaviors and patterns. And I would go from there with your primary care provider.   I think if you as a parent or loved one are even asking yourself, is it time to go? It's time to go. I think too many of us wait until there are very obvious motor vehicle accidents, overdoses. And I think most parents that I encounter in a clinical setting knew there were issues much longer before they sought help.   And this gets to your question around stigma, shame that a lot of families do not want associated with their loved one or their family. And so, they wait until there are really negative consequences. Ideally, we'd be intervening much sooner. Pathak: I'd love to talk a little bit and dig into what you just said about stigma and shame and some of the words we use when we talk about having a problem, quote unquote, with opioids, or becoming addicted or physically dependent. In that recovery phase, oftentimes we'll talk about someone becoming sober or sobriety from some of these medications. Can you talk a little bit about the terms that you use and what best helps uplift your patients? Eaton: This is a really nuanced area, and it does take some retraining of us as clinicians who have been in practice for a while. When I went through medical school, you were either 100 percent abstinent or not. We weren't taught that there was this whole middle ground of harm reduction, and I think as physicians, once we get some additional education on this, we realize that our words really matter. We can be much more supportive of our patients because this is a journey and much like diabetes or hypertension, your patient may have chapters where they aren't in care. Their chronic disease, substance use to chronic disease, is unmanaged.   But unlike diabetes or hypertension, where we just counsel them and support them and bring them in maybe more frequently to check in, have them bring their spouse to help with the pill bottles and set their phone alarms so they don't forget. Unlike those medical conditions, this chronic brain disease of substance use, we treat patients unintentionally as if they have failed. They have failed our clinics. They have failed the treatment. We treat them with judgment and shame. And there are a lot of complex routes for that that I am not an expert in. But what I tell my colleagues and my trainees is that we need to know and our patients need to know that they have not failed us. They are not a failure. They are living with a chronic disease, just like diabetes or hypertension. And just like diabetes or hypertension, if they fall out of care, if they stop taking their medications, we allow them to come back when they're ready to reengage. Just like my patients with HIV, right? So, using words are often the first interaction that we have with our patients. I even say when I get to meet them, “tell me about your journey. Have you ever been in recovery before?” rather than tell me about your addiction. “Have you ever been abstinent?” Have you ever been sober? Did you fall off the wagon? These are all terms that have very negative connotations and really reinforce a lot of the stigma that our patients already feel. My patients come with a lot of stigma to clinic. I have to remind them not to use stigmatizing words to describe themselves. They'll say things like, “I've really been an addict for 20 years.” And I have to say, “you've been a survivor for 20 years. You've been a survivor.” Or, you know, I'm the black sheep of my family. And I remind them. Actually, you have a chronic disease, and didn't you tell me your uncle has the same brain disease it runs in your family? Just reminding them much like the diabetes example again, this is a chronic disease. Those are some of the strategies I use to be really person centered and inclusive. And I do use the survivor language a lot. If they're using opioids in 2024, they are a survivor because we know the substance is out there. I do try to use a lot of empowering language as well. Pathak: I come at a lot of this from the primary care lens. I'm a primary care physician and prevention is the key for what we're always trying to do before we get to treatment and management. If we're talking about red flags or the types of questions we should be asking before we even prescribe these the first time, is it asking about family history? Should our patients be thinking about that? Like, oh, you know, Uncle Jim has had a problem with opioids in the past. That's probably not a medication we want to start in our child. What are some of the other types of questions we can be asking before we even think about that very first prescription or letting your child know that this is something that you need to be thinking about if you're at a party and someone offers you something because this is our family history. What are some of the other things you ask about?   Eaton: Family history is really important. Past experience with opioids. And if you have a patient who is in recovery, many of them will say, I know I have to have my hip replaced. Please do everything you can. Give me blocks. They want to avoid opioids. So, asking about any experience with opioids, how that went.   I would also ask about social support. You know, remind me where you're living these days. Oh, you're in an apartment with your niece. Do you have a safe place to store your medications? Tell me about that. Where do you store your medications? This comes up a lot with our unhoused population, that they are frequently having to move. Their medications are often stolen. That doesn't mean that they don't meet criteria for opioids. It may just mean you need to be more thoughtful. Do you need to go to a boarding care or shelter while we get through this period where you're recovering from your injury and you need opioids to be kept in a locked box? I think those are most of them. And then just appreciating that things like a history of trauma and social determinants of health are really going to put our patients at risk. And a lot of the young people that I see are 30 and 40 year olds who started experimenting with substances in their teens and 20s were in these multi-generational households where mom had substance use. Grandma had substance use. There were always pills around.   So, if you are seeing a patient who has a lack of social structure, living with other people with substance use, without a lot of accountability boundaries, without close follow up with a physician, that may be someone you want to consider alternatives or, you know, give them a three-day supply post op and bring them back. Right? Clinics are so full. We may not have that structure or care model in place, but that's ideal. Giving a short course. Reassess. Maybe it's time to transition something else.   Pathak: Great. Can you help us understand what exactly an overdose is? What does it look like? And what are some of the strategies like naloxone that we should be aware of? Eaton: Yeah. So right now, we're seeing the vast majority of overdoses have opioids as a contributing substance. So many of our decedents who pass away and have toxicology results have multiple substances, including stimulants. But currently, fentanyl is contaminating so many types of street drugs, whether they're a counterfeit, benzodiazepine, or a counterfeit Vicodin, or cocaine.   So, the vast majority of overdoses we're seeing right now, are opioid related, and that usually involves people looking sedated, stuporous, failure to respond to verbal stimuli, tactile stimuli. And in the current setting where we're seeing so many overdoses, I think you should always think opioids first when you're seeing someone like that. It is important to approach them, call their name, shake them if they don't respond. That's when you're going to call 9-1-1 and be looking for naloxone.   I have some in my backpack. I travel on airplanes with naloxone. And my kids who are elementary age know about naloxone. I haven't gotten to the point of educating them. But because these events are more common than cardiac arrest in many, many communities, we're training our Boy Scouts how to do CPR, but we're not necessarily training our Boy Scouts how to do naloxone for overdose reversal. But we should.   These are happening in schools. If you have a young person in your home, if you have a teenager in your home, you should have naloxone, and your teenager should as well and be trained to use. It doesn't mean your teenager is using or experimenting. It just means the people in places that young person is around have a higher likelihood of overdose than a cardiac arrest in many settings. Right? I know a lot of schools. My community schools are getting naloxone because they do appreciate that children are experiencing at school. They've had some adverse outcomes in my state on school property.   I would encourage anyone who is living with young people or older people who have access to opioids, even prescription opioids, to have naloxone. And then obviously if you know your loved one has opioid use disorder, you and they and anyone who is a caregiver for them should have naloxone on their person. Truly. So that's pretty much all of us, right? And whenever I talk to the rotary, I've talked to schools, I talked to clinicians. There are very few people who don't need to know about naloxone in the current day and age. And think of compared to something like an AED or CPR. You know, we're really good about these less stigmatized acute medical events, right?   We feel very comfortable training our Boy Scouts on how to do this, and we feel very comfortable putting an AED on our walking trails and at our gyms. Because of the stigma around substance use, we do not have naloxone in many of those community spaces, and we have not trained our community to respond to overdose in the same way we have cardiac events. Pathak: What would be part of your counseling in a Boy Scout troop or Girl Scout troop or at school to share that part of the information? How do you use something like a naloxone? What are the signs that you're looking for?   Eaton: I think this is a great topic for Boy Scout and Girl Scout troops and for health education courses for middle school. By talking about it, we're normalizing it. And based on the prevalence of substance use, we should all be aware of the signs or symptoms. So that is very appropriate. There are developmentally appropriate ways to talk about this, even to elementary students. I think sharing the statistics on youth who start experimenting, the average age, the prevalence in communities, the types of places where they may be exposed to opioids that are non-medical, the signs or symptoms of overdose, which we discussed, and the fact that there is a safe, over-the-counter reversal. Naloxone that they can and should carry as a good community citizen and community helper.   I know this will be stigmatized in some areas, and some parents will not feel comfortable with that. But I think the more that we have partnerships between pediatricians, public health officers, and schools and coaches, these types of individuals should really feel comfortable talking about this. It is nothing to stigmatize or shame or your kids aren't going to come to you.   What we want is we want these kids looking out for their friends and their parents. We want this to be something we talk about, and we go to a trusted adult when we have concerns. And that's what it will take as we're speaking to prevention. It will take a village of informed adults, trusted individuals. Who our youth can go to early when someone is just starting to experiment. When your friend just brought pills to a party for the first time. Early intervention, right? So, I think the Boy Scout example is a perfect one, but thinking all the touch points for our young people, churches, the faith-based community. And we recently did a pop up with an AME church here in the deep South. Who wanted to have a pop up. It was myself and a community agency that I work with called the Addiction Prevention Coalition. They do great work. I'm delighted that they've included me, and we passed out naloxone and we talked to these church members, many of whom were elderly. They were grandparents. They're worried about their grandkids. They're worried about what they're seeing in the news. They're worried that these kids are going out partying and they know that there are substances involved. So, another great touch point, just thinking across the age continuum, all the people who are part of communities who can be on the prevention arm of substance use. Pathak: That's really helpful and really interesting. So, we've talked a little bit about prevention, overdose prevention. We've talked about substance misuse and what that can look like. What does the process of achieving and maintaining recovery look like? When someone comes to your clinic, because that's really the goal of their treatment, how do you get started? Eaton: So just thinking about the term recovery, we use to describe someone who has reached a point where they're not using any non-medical substances, but it's important that we have each patient define that for themselves. I have many patients who are in recovery from alcohol and opioids. They cannot give up cigarettes and they're not ready to, right? I would never tell them you're not there yet. But I congratulate them on every step, and I remind them you've been in recovery from opioid use for 10 years. You've been in recovery from alcohol use for five years. You don't want to talk about tobacco today. That's fine. Look how far you've come.   And that is part of just supporting them in their journey and encouraging them. There are some people who are going to return to use. I never say fall off the wagon. I never say, you know, other stigmatizing terms. Return to use. There are some of my patients, specifically with opioid use disorder, common triggers, a breakup, a job loss, housing loss, death in the family. I do see patients return to use.   It's less common when they have been on a stable medication for opioid use disorder like buprenorphine and they are engaged in medical care. They have some counseling or group that they can go to for support and accountability, but it still happens. And then once we get them back into our clinic and we initiate the treatment again, and we follow them very, very closely in that very fragile time, you're back in care. Let's start you back on buprenorphine, for example. Let's check in with you in a week. And I have a peer counselor in my clinic who has lived experience with substance use. She's the perfect person. She's been there. She sees them very frequently over that period until we can get them back into recovery. For opioid use disorder, it is pretty clear from their behaviors. It is so physically addictive. It is so disruptive to relationships that I have very few people who can dabble with opioids. Because usually once they return, they are back in active use, is the term we use.   Pathak: And as we close out our episode, I'd love to invite you to share some bite sized action items to help create change in our lives if we are caring for a loved one, a child who may be experiencing some of the symptoms that you described.   Eaton: Absolutely. I think thinking about their survival analogy can be very encouraging and not overwhelming. Just do the next step. I think many of us want to fix our loved one. We may want to fix our child, but what is the next step? The next step may just be getting your loved one to a doctor's appointment, and that's a win. They showed up, right? Then the next step may be getting them to commit to like goals. It's not accomplishing the goals. It's just having them identify what matters to them. You know, so do these baby steps make recovery seem much less overwhelming if recovery is the goal? But I think just viewing caregiving and living with substance use as survival. And being kind to yourself, being kind to your loved ones who's living with this chronic medical condition and taking things one step at a time. Pathak: Thank you so much for being with us today. Eaton: My pleasure. Thanks for having me. Pathak: We've talked with Dr Ellen Eaton today about prevention. How do you even prevent that first use of opioid if it's not necessary? And we've talked about the journey of addiction to recovery. To find out more information about Dr Eaton, we'll have information about her and her clinic in our show notes. But you can check out the Center for Addiction and Pain Prevention page. And again, we'll have that link in our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at webmdpodcast@webmd.net.   This is Dr Neha Pathak for the WebMD Health Discovered podcast. 

Bir hap düşünün ki insanın acılarını dindirsin, ulaşımı kolay olsun, hem de ucuz olsun. Afrika halkının ve hatta teröristlerin kullandığı Tramadol adeta bir kabus gibi kıtanın üzerine çökmüş durumda. Gelin bu kaçık hikayeye hep beraber dalalım! Support the Show.Bize ulaşmak için: Twitter @hkbu_podcast İnstagram @hkbu.podcast Facebook hkbupodcast.com hkbu.podcast@gmail.com Bizimle yolculuğa devam ettiğin için teşekkürler!

Längst fram i kapellet står en ljus kista fullklottrad med personliga meddelanden. I kistan, klädd i sin bästa klänning, ligger 17-åriga Emilia, död i en överdos. Lyssna på alla avsnitt i Sveriges Radio Play. När Emilia hittas livlös i en soffa är hon den andra tonårsflickan i Göteborg på bara några dagar som dör i en överdos. Emilia har vid det laget kämpat mot missbruket sedan 12-årsåldern.– Jag visste det här, jag visste att det skulle bli dödlig utgång, säger hennes mamma Linda.Precis som för många andra unga tjejer började Emilias missbruk med drogen Tramadol, en smärtstillande men också prestationshöjande opioid som kan jämföras med heroin.– Jag förstår tjusningen med att testa Tramadol: ”Jag fick ju bättre betyg här, jag klarade av skolan mycket bättre. Men vänta nu, mina pengar räcker inte, jag kan inte gå och lägga mig utan tabletter”. Börjar du med Tramadol medicinerar du dig själv till döden, säger poliskommissarie Mika Jörnelius.Användandet av Tramadol bland unga ökar. Undersökningar visar att den som tar Tramadol är mer benägen att testa andra tyngre droger. För Emilia var det till slut en överdos rökheroin som tog hennes liv.– Hon tackade mig för att jag alltid har stått vid hennes sida. Jag säger inte att hon gjorde det medvetet, att hon tog sitt liv. Men hon hade en längtan att gå vidare, för att hon inte orkade längre.Reporter: Ulrika NandraProducenter: Martin Jönsson och Sofia KottorpSlutmix: Elvira BjörnfotFrån 2020

In this episode I answer 3 questions from the hospice nurse support group on facebook.  The first question has to do with giving liquid morphine every 6 hours scheduled and PRN morphine every 3 hours PRN.The second question involves using Tramadol for pain management.The third question has to do with elevated vital signs for actively dying patients.==============================As always, don't forget to call, text or email to leave feedback! I would love to hear from you!816-834-9191James@confessionsofahospicenurse.net==============================Be sure to check out thehospicenursingcommunity.com for extra content as well as hope, help and encouragement from other hospice nurses just like you!

När 13-åriga Vilda ska köpa cannabis i Nordstan blir hon erbjuden en gratiskarta Tramadol. Sedan går allt fort utför mot ett svårt blandmissbruk som hon nu kämpar mot varje dag. Lyssna på alla avsnitt i Sveriges Radio Play. Cannabis var den först drogen Vilda började med. Då var hon 11 år. När hon sedan som 13-åring blev erbjuden en gratiskarta Tramadol gick det fort.– Det är som världens kortaste centimeter. Jag trodde aldrig att jag skulle bli beroende av droger, säger Vilda.När Vilda berättar om vilka droger hon tagit blir listan lång: cannabis, tramadol, ecstasy, tjack, kokain, LSD, lyrica, ”blå”, antipsykotiska läkemedel, någon annans ADHD-medicin. Ibland köper hon droger för sina fickpengar, ibland handlar hon på ”krita,” men hon blir också erbjuden droger. Ibland med sex som motkrav.När Vilda berättar om sin kamp mot drogerna är det en mörk bild där den rätta hjälpen från myndigheterna som socialtjänst och BUP tar lång tid med utredningar och handläggningstider, besök som Vilda inte tycker ger något.Mini-Maria är en ungdomsmottagning för unga med drogproblem och finns i Göteborg, Malmö och Stockholm. Alexander Holmstedt, psykaitrisköterska vid Mini-Maria i Malmö delar bilden Vilda ger.– Vi har tydligt sett att när unga väl går över gränsen från cannabis till Tramadol blir det en väldigt mycket större risk för att snabbt hamna i ett blandmissbruk. Det vi också har sett är att tidigare arbetssätt är otillräckliga och det krävs helt andra arbetsmetoder för den här gruppen som tar Tramadol och blandar drogerna.Tramadol, det smärstillande opiodläkemedlet har ökat explosionsartat de senaste tio åren. Under 2019 beslagtogs nära en miljon tabletter. För många unga är Tramadol vägen in i ett djupt blandmissbruk och till och med död. Under 2019 dog 126 unga mellan 15-29 år av överdoser.– Gör vi ingenting nu kommer vi har en större grupp opioid- och benso (bensodipiaziner) missbrukare än vad vi har sett tidigare, säger Alexander Holmstedt som initierade Tramadolprojektet, en kartläggning och forskningsstudie över Tramadol bland unga i Sverige.Reporter: Ulrika NandraProducenter: Sofia Kottorp och Martin Jönsson Slutmix: Elvira BjörnfotProgrammet är gjort 2020

In this week's episode, we dive deep into a groundbreaking study that shows how chiropractic care can significantly reduce tramadol prescriptions in adults with radicular low back pain. We explored how tramadol, an atypical synthetic opioid, is often prescribed and the implications of that, contrasting it with the benefits and effectiveness of chiropractic spinal manipulation. This research highlights the dire need for guideline-concordant care pathways and how chiropractors play a crucial role in providing safer, more effective alternatives to opioids.Episode Notes: Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back painThe Best Objective Assessment of the Cervical Spine- Provide reliable assessments and exercises for Neuromuscular Control, Proprioception, Range of Motion, and Sensorimotor-Integration. Learn more at NeckCare.comInterested in ShockWave technology? I built a practice using StemWave and can't recommend it enough. Learn more at- https://gostemwave.com/theevidencebasedchiropractor Patient Pilot by The Smart Chiropractor is the fastest, easiest to generate weekly patient reactivations on autopilot…without spending any money on advertising. Click here to schedule a call with our team.Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

El consumo de fármacos ha aumentado considerablemente en los últimos años. En Las Mañanas de RNE hablamos con Joan-Ramon Laporte, catedrático emérito de Farmacología y autor de ‘Crónica de una sociedad intoxicada’, quien nos explica que el consumo excesivo de medicamentos no es solo propio de España, esta tendencia también se da a nivel mundial: “Esto se debe a la presión comercial. Consumimos el doble de medicamentos que hace 15 - 20 años, sin embargo, no estamos el doble de enfermos”.Laporte alerta que hay medicamentos que han aumentado su consumo “en mil veces en 23 años” y deberían ser recetados como “último recurso”. Estos son los analgésicos derivados del opio, como el fentanilo, y sobre todo en España el Tramadol y recuerda la facilidad que existe de recetar medicamentos: “Antes el médico tenía que retirar un talonario de recetas y poner el nombre de cada paciente [...] ahora la prescripción está integrada en el sistema electrónico y solo con clicar ya se puede prescribir. La única limitación es que no se puede prescribir por más de tres meses, se renuevan de manera casi automática y no hay seguimiento ni vigilancia de sí esto está causando dependencia o no”.El farmacéutico señala al marketing comercial como uno de los factores del aumento de consumo: “Desgraciadamente, los profesionales sanitarios se informan de los medicamentos a partir de fuentes que están directa o indirectamente controladas o ya montadas y organizadas por las compañías farmacéuticas. El sistema sanitario no tiene un sistema de información independiente sobre los medicamentos”.Otro de los factores es la falta de tiempo que tienen los médicos de atención primaria y la necesidad de sentirse atendidos de los pacientes, esto deriva en “la tentación para el médico de prescribir un medicamento es grande sumado a la tentación para el paciente de pensar que quizá no ha sido atendido con el debido detalle sobre su, pero por lo menos ha pillado una receta de un medicamento” explica.Escuchar audio

Dive into the realm of advanced pain management with Dr. Mark Epstein, as he unveils the latest on Tramadol, Gabapentinoids, and more in our dedicated pain management series. Quick Summary: This episode, part of a five-episode series from a comprehensive workshop held in late 2023, focuses on Tramadol, Gabapentinoids, and their roles in veterinary pain management. Dr. Mark Epstein, a renowned expert, discusses the effectiveness, applications, and considerations of these medications in dogs and cats, offering practitioners insights to enhance patient care. Speaker: Dr. Mark Epstein, DVM, DABVP, CVPP, a leading authority in veterinary pain management, shares his expertise. Dr. Epstein is the medical director at Total Bond Veterinary Hospitals, North Carolina, and a celebrated figure in the field, having led significant pain management guideline programs. Main Talking Points: Tramadol's Efficacy: Exploration of Tramadol's varying effectiveness in dogs versus cats, highlighting its limitations and potential uses. Gabapentinoids: Discussion on Gabapentin and Pregabalin's roles in treating neuropathic pain, with specific dosing insights for both species. Emerging Therapies: Introduction to promising medications like Amantadine and Acetaminophen, outlining their contributions to multi-modal pain management strategies. Interesting Quotes: "The conversations about Tramadol... pretty much settled by now that the oral form of it in dogs is simply no strong evidence that it's effective." - Dr. Epstein "When it comes to dogs... we need more evidence to show it. So this is like going to be a therapeutic in progress of its study." - Dr. Epstein on Tapentadol "We can say with some confidence that [Gabapentinoids] can have a benefit when there's a neuropathic component to pain." - Dr. Epstein Timestamps: 0:00 - Introduction  2:05 - Tramadol's efficacy and limitations 5:40 - Gabapentinoids in pain management 10:25 - Insights into Amantadine and Acetaminophen 11:00 - Final thoughts   Visit IVDI.org to learn more about the Veterinary Dental Practitioner Program. Tune in next week for more insights into veterinary dentistry and pain management.   This episode provides a deep dive into the complexities of using Tramadol and Gabapentinoids for managing pain in veterinary patients, guided by Dr. Mark Epstein's rich experience and research. By dissecting the latest findings and practical considerations, veterinarians and technicians can glean valuable strategies for optimizing pain management in their practice. Affiliate & Sponsor Links: This series is brought to you by the International Veterinary Dentistry Institute (IVDI.org), offering comprehensive training to elevate your veterinary dentistry skills.

The best stories I read in February of 2024. Sorry it is not over an hour, I did not create as much content this month as you already know! We got air duster stories and even Tramadol this month!

In this podcast recorded in early February, James Cave (Editor-in-Chief) and David Phizackerley (Deputy Editor) talk about the March 2024 issue of DTB. They discuss the editorial highlighting the important work that the founders of The Medical Letter, Worst Pills, Best Pills and Drug and Therapeutics Bulletin did to scrutinise the safety of medicines and the need to challenge the processes by which medicines are licensed, appraised, commissioned and promoted. They review a coroner's Prevention of Future Deaths report that highlighted an interaction between tramadol and warfarin. They also talk about a study that compared the emergency contraceptive efficacy of levonorgestrel plus piroxicam with levonorgestrel plus placebo. The main article considers the effectiveness of low or very low calorie diets in achieving remission of type 2 diabetes.   Link Mathew R. Prescribing isn't a single act—getting it right requires time and effort. BMJ 2024;384:q279 (https://www.bmj.com/content/384/bmj.q279) Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page (https://podcasts.apple.com/gb/podcast/dtb-podcast/id307773309). If you want to contact us please email dtb@bmj.com. Thank you for listening.

Bobbi rants about the "other" pain medications. Host: Dr. Bobbi Conner Producer: Topher Conlan

SOCIAL MEDIA PROVOCATEUR | CARTOONIST | BLOGGER |

Le phénomène a pris tellement d'ampleur aux États-Unis qu'il est devenu l'une des priorité de Joe Biden : le Fentanyl tue une personne toutes les sept minutes dans le pays. Dans plusieurs grandes villes, on peut voir ces corps pliés en deux sous l'effet de cette drogue ultra-puissante, importée du Mexique voisin. Décryptage avec Bertrand Monnet, professeur à l'Edhec business school et spécialiste de l'économie du crime, il enquête depuis plus de dix ans sur le tristement célèbre cartel de Sinaloa, qui lui a ouvert les portes de ses « laboratoires » de fabrication de la drogue. De très nombreuses victimes ont d'abord connu la dépendance aux médicaments aux États-Unis, aux anti-douleurs opioïdes, comme Tom Wolf qui raconte être devenu addicte après une intervention chirurgicale : « J'ai commencé à aller dans la rue pour trouver des pilules, et en deux ans, mon addiction a pris tellement d'ampleur que je prenais 560 mg par jour juste pour fonctionner.Comme ces pilules coûtent très cher, j'ai fait faillite, j'ai ruiné ma famille et je suis passé à l'héroïne, parce que c'est beaucoup moins cher. J'en ai pris pendant environ un an et cette année-là j'ai perdu mon travail, j'ai été viré de ma maison, ma femme a déposé une main courante contre moi donc je ne pouvais pas retourner chez moi et j'ai terminé par vivre dans la rue, en prenant de l'héroïne tous les jours. Et au début de l'année 2018, le fentanyl a commencé à apparaître dans les rues de San Francisco et j'ai adoré. Je sentais… comment l'expliquer… comme un élan de chaleur, comme si quelqu'un m'avait recouvert d'une couverture, comme si tous mes problèmes s'étaient envolés, ce genre d'euphorie. Le problème, c'est que tu dois en prendre souvent, et tu ne sais pas à quel point la drogue est chargée, tu ne sais pas vraiment quelle dose tu prends, donc le risque d'overdose est très élevé. »Le Fentanyl est généralement 30 à 40 fois plus fort que l'héroïne, précise Bertrand Monnet. « L'addiction est immédiate, c'est sans doute la drogue la plus forte qui ait jamais été vendue dans la rue. Les témoignages que j'ai pu recueillir à New-York, ce sont des gens qui ne veulent même pas arrêter. » D'anti-douleur à drogue super-puissanteLe Fentanyl est initialement un anti-douleur, « parfaitement légal et administré dans les hôpitaux, seulement dans ces établissements et très souvent, il n'est pas administré par injection mais pas timbre cutané. C'est une sorte de super Tramadol, explique Bertrand Monnet, un médicament dont une petite partie des ventes sont détournées par les narcos, qui ne parlent d'ailleurs pas de Fentanyl considéré comme le produit de base mais de M30, et après les drogués eux-mêmes consomment très rarement du Fentanyl pur, ce qui est encore pire en termes d'addictologie. » Bertrand Monnet n'a pas observé l'import de Fentanyl mais les narcotrafiquants lui ont expliqué qu'il existait des intermédiaires chinois et indiens, « parfaitement fondés à acheter des médicaments pour le revendre après, et au sein de ces entreprises, ils corrompent certaines personnes à des fonctions clefs pour qu'elles détournent les quantités dont les cartels ont besoin. » L'importation est centralisée par l'état-major du cartel puis le produit est distribué à la centaine de clans du cartel pour la fabrication par des chimistes des pastilles de M30.Multiplication des sites de fabrication pour éviter la répression« Le cartel fonctionne comme une entreprise et donc s'adapte à ses contraintes », analyse Bertrand Monnet, en l'occurrence la répression. Pour éviter de se voir saisir trop de marchandises au même endroit, ils divisent cette production dans des dizaines de petits laboratoires. En cas de saisie, la police ou plutôt l'armée ne saisit donc qu'une petite quantité de marchandises. Les militaires sont en première ligne pour lutter contre les narcos, car de très nombreux policiers du Silanoa sont corrompus, souvent sous la menace. Les militaires sont moins soumis au phénomène car « ils ne vivent pas en ville mais dans les casernes et ils tournent souvent donc il est beaucoup plus dur pour les narcos de les approcher », précise le spécialiste ajoutant qu'il existe un autre échelon très accessible, en plus des policiers, « ce sont les élus notamment locaux ».  Le président mexicain mis en causeDes révélations de presse, une enquête de la Deutsche Welle, rapporte des informations de la DEA, l'agence américaine de lutte contre la drogue, selon lesquelles le cartel de Sinaloa aurait financé la campagne de 2006 d'Andres Manuel Lopes Obrador, à hauteur de deux à quatre millions de dollars en échange d'une protection et du droit à participer à la nomination du procureur général de la République. « Cela ne me surprend pas, commente Bertrand Monnet, si ce n'est le montant qui me semble assez peu élevé au regard des moyens dont dispose le cartel, mais il s'agit sans doute d'une estimation plancher de la DEA. » Le spécialiste de l'économie du crime ajoute que la corruption à très haut niveau fait partie de l'une des priorités de l'état-major du cartel mais précise « est-ce AMLO lui-même qui avait organisé ça ? S'agissait-il de financer une petite partie de sa campagne ? Était-il vraiment informé ? Ces questions sont très importantes car on parle de quelqu'un qui a la confiance de l'administration Biden. Si cette information continue d'être documentée, c'est potentiellement un séisme au Mexique. Nous sommes potentiellement au début d'une crise majeure. »

Addiction treatment centres across India are observing an uptick in patients grappling with abuse of opium-derived painkillers like Tramadol, specialists say.

Brian fights through the pain to give you the quality content you've come to expect from this podcast! For our Stories of the week, we talk about a Florida woman scorned and a woman who may have killed people with some bad mushrooms. Senator Bob Menendez is facing corruption charges (again), the Senate dress code is relaxed, and we discuss the prisoner exchange with Iran. NFTs are worthless, the Oakland A's gave Miguel Cabrera a bad gift, and we give you our NFL Locks of the Week! We also have two of our most beloved segments: But The Drag Queens Are The Problem and What Are We Watching!

Delving into the controversy surrounding Nairo Quintana's positive tests for tramadol during the 2022 Tour de France. We discuss the complex considerations surrounding the substance's classification, its potential impact on performance, and recent developments that have prompted new discussions.Plus, 750D? Another new wheel size has been revealed, this time for gravel bikes, more controversy, team finances, and the social media rounds.Watch this on Youtube: https://youtu.be/pjvUKLWDWeYWADA Twitter post: https://twitter.com/wada_ama/status/1574912951995322369Tramadol study on Outside Online: https://www.outsideonline.com/health/training-performance/New Gravel Bike Wheel Size on Instagram: https://www.instagram.com/p/CwQZImfh4Tg/?hl=enLotto-Dstny terminates Allan Davis' employment: https://www.cyclingnews.com/news/lotto-dstny-terminates-allan-davis-employment-following-inappropriate-social-media-messages/Article on swapping Giro and Vuelta dates: https://www.cyclist.co.uk/in-depth/giro-vuelta-weather-swapGroupama-FDJ finances: https://inrng.com/2023/08/groupama-fdj-finances-2021/Greg Van Avermaet Instagram post: https://www.instagram.com/p/Cvw7m9XMJCx/Sam Gaze MTB Rider Instagram post: https://www.instagram.com/p/CwSvfgKr-4F/Robert Gesink Instagram post: https://www.instagram.com/p/CwS30aGt-VT/?img_index=6

Cocaïne, Tramadol, cannabis, le trafic et l'usage de stupéfiants explosent dans tous les pays d'Afrique de l'Ouest. Comment lutter efficacement contre le trafic de drogue ? Quelles solutions sont apportées aux consommateurs ?

Stacie Czech founded Thryv Organics after years of helping her mother manage her autoimmune disease, Multiple Sclerosis. The experience taught her that there had to be a better way. After learning about and using CBD products and seeing the results, she knew she needed to help others find the relief her mother found. Thryv Organics code ASHLEY25 12:25: Why third party testing is important 12:52: Chernobyl & hemp (WHY organic matters!!!) 13:43: Hempcrete instead of dry wall 14:09: Dr Rachel Knox TED Talk 20:45: Difference among broad spectrum, full spectrum, and isolate CBD 22:45: Pregnancy, breastfeeding, and CBD 26:13: Michael Crawley 26:19: Dr Kadile | Coimbra Protocol (high dose vitamin D protocol) 31:21: Swap wine for CBD gummies 32:18: Menopause + CBD + THC 46:00: Prioritize your own wellness Instagram Facebook Tik Tok Thryv Organics Website Stacie's Mom was on Gabapentin, Diazepam, Methocarbamol, Tramadol, and Trazodone BONUS material: Dr. Terry Wahls reverses her MS

The lads are back and talk about Paddy's wild Glastonbury Festival weekend, flash Motorhomes, Gummi Bears and Alex Turner being up his own arse. Paddy's been on the Nitrous Oxide and nearly got kicked out of Glasto for having a danger wee while Ryan has developed a man crush on Fred Again. Ryan's finally watched Many Saints of Newark and is about to give Fake Festival the beans while Paddy is off on Bushbye's Stag doo and keeps getting bought kids shoes by a mystery person plus much much more happening on this weeks AiC….@ambitioniscritcal1997 on Instagram @TheAiCPodcast on Twitter

Is Gabapentin the new Tramadol? We see quite a many post on Veterinary Anesthesia Nerds discussing the use of Gabapentin for acute post surgical pain..but what does the evidence say? Here Stephen breaks down how this drug works, why acute pain may not be the best use of gabapentin and what you should reach for instead. Resources mentioned in this episode: Pypendop B, Siao K, Lkiw J. Thermal antinociceptive effect of orally administered gabapentin in healthy cats. Am J Vet Res. 2010;71(9). doi:10.2460/AJVR.71.9.1027 Reid P, Pypendop B, Ilkiw J. The effects of intravenous gabapentin administration on the minimum alveolar concentration of isoflurane in cats. Anesth Analg. 2010;111(3). doi:10.1213/ANE.0B013E3181E51245 Johnson B, Aarnes T, Wanstrath A, et al. Effect of oral administration of gabapentin on the minimum alveolar concentration of isoflurane in dogs. Am J Vet Res. 2019;80(11). doi:10.2460/AJVR.80.11.1007

När 13-åriga Vilda ska köpa cannabis blir hon erbjuden en gratiskarta Tramadol. Sedan går allt fort utför. Cannabis var den först drogen Vilda började med. Då var hon 11 år. När hon sedan som 13-åring blev erbjuden en gratiskarta Tramadol gick det fort.”Det är som världens kortaste centimeter. Jag trodde aldrig att jag skulle bli beroende av droger,” säger Vilda.När Vilda berättar om vilka droger hon tagit blir listan lång: cannabis, tramadol, ecstasy, tjack, kokain, LSD, lyrica, ”blå”, antipsykotiska läkemedel, någon annans ADHD-medicin. Ibland köper hon droger för sina fickpengar, ibland handlar hon på ”krita,” men hon blir också erbjuden droger. Ibland med sex som motkrav.Vilda upplever att den rätta hjälpen från myndigheterna, som socialtjänst och BUP, tar lång tid med utredningar och handläggningstider. Besök som Vilda inte tycker ger något.Tramadoltjejerna är en serie från P1 Dokumentär Miniserie av Ulrika Nandra, inspelad 2020.Producenter: Sofia Kottorp och Martin Jönsson Slutmix: Elvira Björnfot

Episode Summary Margaret and Agatha talk about mutual aid in Ukraine and Agatha's experience trying to go there to fight in an anti-authoritarian platoon, but ending up doing a bunch of mutual aid supply distribution work instead. They talk about he intricacies of relief work and some of the special circumstances in Ukraine. Heavy content warning on this episode. Towards the end of the episode around 46:00, Agatha starts to tell a really intense story about being in a war zone. Around 56:00 is when it begins to get graphic. Guest Info Agatha (they/them) can be found on IG @jalutkewicz You can donate to their mutual aid work on venmo @agathawilliams or on Paypal @jalutkewicz@gmail.com Host Info Margaret can be found on twitter @magpiekilljoy or instagram at @margaretkilljoy. Publisher Info This show is published by Strangers in A Tangled Wilderness. We can be found at www.tangledwilderness.org, or on Twitter @TangledWild and Instagram @Tangled_Wilderness. You can support the show on Patreon at www.patreon.com/strangersinatangledwilderness. Transcript Agatha on Ukrainian Mutual Aid Margaret 00:14 Hello and welcome to Live Like the World is Dying, your podcast for it feels like the end times. I'm your host, Margaret Killjoy. And I'm really excited about this week's interview, I am going to be talking to an old friend of mine from quite a while back who haven't talked to in a while about what's involved in anarchists mutual aid in war zones, and specifically, Ukraine, and in the things that are going on there. Yeah, I'm really excited for you all to hear this conversation. But first, I'm excited for you all to hear that we're a proud member of the Channel Zero Network of anarchists podcasts. And here's a jingle from another show on the network. Margaret 01:13 This is Margaret, from the future, coming back to say that this episode deserves a content warning near the end of the episode and there'll be some heads up. We will be talking about, "Hey, so I hear you were attacked." That part contains graphic descriptions of war and violence. And so listener discretion is advised. Margaret 02:05 Okay, we're back. So, if you could introduce yourself with your name, your pronouns, and then kind of a brief description of why you are in a good place to talk about anarchists mutual aid in places of active conflict. Agatha 02:20 So my name is Agatha. My pronouns are they/them. Yeah, I went over to Ukraine last year about this time to do mutual aid support with anti authoritarian units and anarchists units. Things got fucked up on my way over there. So, that wasn't a possibility any longer. So, I just started doing aid runs with a convoy of other solo operators who went over there to try and do something to help alleviate the suffering of folks. Yeah, I'm here to talk about that. Margaret 02:57 So one of my questions about that, is, what do these aid runs look like? I'm under the impression there are different organizations working to try to get new vehicles and armor and all of these things that, you know, to frontline units, to anti authoritarian units. And these are like, organizations from outside Ukraine that are like sending people and supplies to then deliver the supplies? Like what does this look like? Agatha 03:25 Yeah, so me and a few other folks went over there with a group of cash all of our own, you know, what I mean, and we use that for operational costs, which was, you know, feeding ourselves buying diesel in Poland. And then we worked with some more wealthy sympathizers to the cause, who, one person we worked with owns a distribution company, and they have a giant fucking warehouse in Warsaw, Poland. And, you know, they would make sure items that needed to get to folks close to the frontline, where bigger NGOs wouldn't go, could get things that they needed that were not getting there, i.e. like medicine, sanitary products, food, you know, and then later on body armor and diesel. So, this person would basically...they have a bigger organization that looks a lot friendlier on their website, and you can go and donate money and it has pictures of like Ukrainian kids smiling. So, the run would start like this, we'd get a text from this wealthy patron and they'd be like, "Alright, I've organized another run," you know, "Meet me at my warehouse Saturday at four in the morning and bring four vans," you know, "and eight drivers." And like, we wouldn't know where we're going. We wouldn't know what we're doing. And then we'd get there at four in the morning and then there'd be all these like, gnarly angry Polish dudes just like moving boxes around and making piles. And then the, you know, the person who lead everything and orchestrated everything, she's just a very strong, amazing woman. And she would come out and just start barking orders and be like, "You, you're driving this van, and you're putting all this in your van, but like, I have some other shit to hide at the bottom of the pile. So don't load it yet," you know, "load this van." And then she'd like really quickly, have one of her cronies, bring out a pallet full of body armor inserts that were like, made at a metal shop out of like, AR500 steel that can withstand 556 and 762 rounds. Margaret 05:31 Yeah, gun Twitter will be very upset about this. Agatha 05:35 What's that? Margaret 05:36 I said gun Twitter will be very upset that they're using steel. Agatha 05:40 I know. But if you're out there fucking around, you want something more than nothing, and it's not gonna spatter, AR500 is at least not going to spatter on you, you know what I mean? Yeah, it's not going to create any spalding. But, that regardless, you know, she did her own research on what steels are like the most bulletproof and then she fucking contacted a metal shop with a brake press that could you know, bend quarter inch thick steel that was hardened. And then she had them plasma cut out the designs that fit into vests that she had manufactured from different tailors around Poland, you know, it was just like, it was 100%, DIY, you know, ballistic vests. And it was just amazing. And she'd be like, "Alright, you're delivering all this, like toilet paper, and ibuprofen, and like, you know, baby food to this one location, then you're going to meet with my people at this location, and you're gonna give them these 10 boxes," you know, and those had whatever in them. I never asked, you know, but and then she'd be like, "Give them these 50 vests," you know, "they have like a poorly equipped unit that needs them. They have a mortar unit that's taken a lot of casualties because they're so ill equipped," like, blah, blah, blah. And then she'd be like, "Also, the next van, we're gonna fill it with all toilet paper. But, at the bottom of the toilet paper pile, we're gonna hide 300 gallons of diesel, you know, in these little containers." Margaret 07:02 Why are you hiding it? Agatha 07:05 Because there's like tariffs involved with transporting body armor and transporting fuel across conflict zone lines, apparently. I don't know very much about it. I just know that like, there was like, a big to do. And you had to file a lot more fucking paperwork that took weeks and weeks, if not months to get like 50 fucking vests across the border, and then to the east of Ukraine. Whereas she was just like," I don't give a fuck, you're going there anyways." I mean, she was crazy. She was like, linked up, she'd be like, "Alright, these are your things you need when you get to the border. If you get there early, wait till 5:30 shift, change or whatever. And wait till this one dude is working. Show him this paperwork, and he's gonna let you through without giving you hassle or looking in your van. If you go at other times, I can't guarantee you're gonna get through without a hassle." So, she had stuff going on, that I didn't know about. And I didn't care to ask about. I was just into helping and I was good enough just bringing food and medicine. You know. When I found out we were bringing other shit and like hiding it. I was like, "Oh, that's cool." I was like, "I'm into it. Like, I'm sketchy. Like, I'm down." you know? And so we just like, we would wait, we'd pack up all the vans at four in the morning when we met her there. And then there was a few Polish dudes who would run the convoy once we were on the road. And we all had radios. So, it's like, you know, head convoy dudes like, "You guys got to pick it up, we need to make better time." or people in the back would be like, "Hey, head of convoy slow down, we're losing ya." Yeah, because all our shit was painted drab green and had the organization we were working for plastered all over the side of it. So, we wanted to look like a convoy while we were in Poland and the West of the country, and stick together. And then once we'd get across the border, and hit Lviv, you know, then it scattered and we would take magnets off, and we didn't want to look like a convoy, because convoys get targeted and like, all this other junk. So we had basically leave Warsaw at like five or six in the morning, we'd drive for fucking ever, we'd get to the border, we'd sit there forever, you know, we'd give our slips to the guy we were supposed to give them to, they would just wave us through, they wouldn't search our shit. And then we drive fucking forever to Lviv. And then at Lviv, we'd unload like 80% of the stuff, you know, four out of six in the convoy would go back to Warsaw. And then you know, I was generally one of the ones who would go further east. So, I'd stick around, we'd get coordinates to a new warehouse that we didn't know about, and then we would go refill our vans and Lviv with other shit going further east. And then from there, we'd hit Kyiv. We'd drop a bunch of shit of in Kyiv. If we were transporting vehicles, we'd bring them to the specific units that was asking for them, basically just four by four vehicles that can carry around and a little Assault Squad through mud and shit that they didn't have. And then we'd deliver that shit. And then, you know, we'd spend a night in Kyiv and then we'd get more coordinates the next day. We'd go to another warehouse. We'd fill it up with whatever the fuck was planned for us. And then all this is going on while we are like doing our own shit. Like, last time we were in Zolochiv, they needed salt because their bakery had run dry of salt. They had everything to make bread for the frontline troops except for salt. So, they're like, "We need three vans worth of salt" you know, "We need like 5000 pounds of salt." So, we'd be like moving our salt around to make room for our wealthy patron's shit that she wanted to go to specific units that she had friends in, or whatever that were hard up. You know? So we were just have to like, juggle shit around. And then like, make sure everything fit, throw our 50 gallon drums of diesel on the fucking roof of the car and siphon it out and fill our fucking tanks back up, because you just can't get diesel in Ukraine when we were there. So we had to smuggle in all the diesel for the entire trip. And then, we'd be on our way again. And then we'd eventually get to Kharkiv or wherever, in the far east of the country, get rid of all our shit. And then just like, usually pick up some passengers who wanted to get the fuck out of Kharkiv or wherever the fuck they were, and bring people back and get them out of sketchy situations. And then we'd slowly make our way back to Poland. And we didn't really stop when we were driving. So, some days we drive for like 48 hours straight or some couples of days and then we would take naps and switch out drivers. But on the way back, it was a little more relaxed, like we'd get a hotel or something like in between Kharkiv and fucking Kyiv and try and take showers and get like a good night's rest and then whatever. And then we finally make our way back to Warsaw or Krakow, wherever our next pickup was. We'd rest for 24 hours without doing shit. We would just eat food sleep, nap, like fucking whatever the fuck we felt like doing. Go on walks. Then we'd get another another call from from our person who was funding a lot of this and she'd be like, "Meet me at the warehouse, Tuesday at 1"30 in the morning and bring seven vans this time," you know, so yeah, that's pretty much the cycle that was going on when I was there. Margaret 12:42 Yeah. Okay, so I have a bunch of questions about this. There's so much that's curious to me. Yeah, one of them is like, like, what's in it for this lady? Like, I don't know, if you want to like out her specifically or whatever. But like, it's international solidarity? Is it like... Agatha 12:57 I couldn't tell. Margaret 12:58 Is it just like, we don't want Ukraine to fall because then we think we're next? Is it just the same reason you're there, we just got to fucking help each other? Like, what's going on? Agatha 13:09 So, everything I gathered from talking with this person was that she just like, thought what was going on was super fucked up was like, disgusted that like civilians, were paying such a high price for the actions of, you know, a fascist imperialist government's need to try for a land grab and was just like, honestly disgusted about how little the rest of the world seemed to care about these people who, like, were fucking starving to death and are still starving to death and like fucking living in occupied villages that change hands every couple of weeks, and like, can't get anything because NGOs won't go there. Because Red Cross thinks is too dangerous or whatever. Yeah, I mean, it is but like, that's your fucking job. Like, that's what you should be doing. And it like, came down to like, hundreds and or thousands of like, solo operators who have like these little groups, there's a bunch of us, like, but it's like, hard to...It's hard to say what her end game was. Like, she had a bunch of fucking dudes who, I don't speak Ukrainian or Polish, but there's some words that are the same, you know? And I mean, like, we'd be driving and the radio chatter would be all Polish. And I'd hear like "Americanski,"" and then, "Blah, blah, blah," and then nothing for a minute. And then you'd hear like, "Blah, blah, blah, Pistoleta, blah, blah, blah." And I'm like, what do they got in their van? You know what I mean? But I'm not asking, you know. The most I ever asked was like, the lead dude who took us on the convoys just seemed like he knew his way around a warzone, knew his way, you know, bunch of those motherfuckers were into Brazilian jujitsu. And that's where we like, connected a lot, because that's something I'm into, and they all knew how to handle themselves. They all seem like ex military or something. And one day, I was just like, I was like, "Hey, dude, like, are you ex... It's like, don't answer mean if you don't want to, but like, are you ex military or like current military or something?" And he says, "Kind of." and then walked away. And I was like, "Okay, that's enough." You know what I mean? So like, I don't know what their motivations were. They were like, super not into Russia, I can say that. It like, a little uncomfortable for me because like... and especially the closer you get to the border of the Russia, the more you start hearing terms like 'orc,' and like, stuff like that, as opposed to 'Russian.' I don't know, they had seen more shit than me at that point, had really strong opinions and like, as much as I could tell, they just wanted to, you know, kind of ease some of the suffering that normal everyday people were going through because of the conflict. Margaret 15:47 Yeah. Okay. So that brings it back to like, you know, you mentioned that you, you headed out there hoping to specifically work delivering aid to the anti authoritarian units and stuff. Is that work that you got to continue to do or like? Agatha 16:03 in some ways. So, just to clarify, I originally went out to fight in an anti authoritarian unit made up of English speaking foreigners. That was my my first goal. I had issues with getting my passport in a timely manner. And then there was this like, horrible incident where the unit that had accepted me, they knew when I was coming, they had someone picking me up to bring them to the base and get me situated and fucking geared up. But they're like, "You need body armor. You need a ballistic helmet. You need your own IFAK. You need like, your own fucking compass, you know, basically full kit was needed to be provided by me, because all they were going to....they're going to stick me on a mortar team and I was going to be like, stuck with that mortar team with whatever I brought, or essentially, and then, on my way over there, something happened where the platoon leader was found dead on base. They got assigned a new Platoon leader. This dude was like, "You guys can still fly you're anti anti authoritarian and anarchists flags as a unit, but we're not taking in any more foreigners. And that's that." So while I was on my way there, I was told, you know, "No go on the, on the infantry unit. Blah, blah, blah." So I just like, didn't know what to do. I had like $5,000 worth of tourniquets, and quit clot and fucking chest seals. You know, I had I had ballistic helmets, I had a level four ceramic plates with me. I had more shit than I could carry. I looked like an asshole coming from the Warsaw airport to my hostel, you know. And then I couldn't leave my hostel for like, a week and a half, because I had like, all this gear in there that wouldn't fit in my tiny little safe and like, everyone was like, "What the fuck are you doing with all this shit? And like, why are you here?" And I didn't want to say anything. So I just like seemed sketchy. And then I eventually found a group that was working directly with anarchists fighters at the front. And I was like, "Hey, I brought all this medical supplies. It's basically only heavy bleed stop supplies to treat gunshots and amputations and things of this nature. Do you want it? Like, how do I get it to you?" And they're like, "Yes, totally. One of our people, we'll get with you soon," you know. And this is when I started my waiting game in the hostel trying to like, not leave my shit for too long. And be there waiting for the call. And like a week and a half went by before I got any kind of information. And honestly, I was like, kind of bummed out. This group seemed like they knew what they were doing. Their social media presence was like on point. They were like, just vague enough to like, promote their cause, but like, not giving too much information out. You know, they're just like, whatever. So, I was like, I'll deal with these guys. Fine. I'll give them this medical equipment. And then they just like, totally dropped the ball. And like, they kept saying, someone's going to call me. Every day I texted them. I'm like, I'm sitting on all this crap, I need to get rid of it and be on my way and try and find another way to like, do what I'm trying to do. And it just kept going on. And then, you know, a week and a half. I'd never left the country before I left for this. And I speak no other languages. I'm like super neurodivergent, have like really high anxiety and was just in this foreign city where I didn't understand anything. And just like, every day felt like a week. You know, I was just waiting for my phone to ring and then I could hand the shit off. And like, I had a couple of leads on folks who were like, "Yeah, when you're done doing your thing, like, give us a call and we'll set you up doing some aid work." So I was just waiting and waiting. And then they finally called me. They're like, "Go meet this person at this address. And they'll take all your shit from you." And I was like, "Okay, great." So, I take a fucking cab like across Warsaw, I ended up at this place. I eventually find out it's like, basically like a methadone clinic for like houseless people. I was like, oh cool, whowhoever's doing this also works doing this kind of work you know, but then I just look like a sketch ball, sitting outside of this place with like three fucking duffel bags, waiting for.... Agatha 20:09 Yeah, I have no idea who's coming to meet me. Every person that walked by I'm like, "Are you them?" You know like, yeah, I don't know shit. I'm there. Like the time they're supposed to meet me goes by. I got there like half an hour early because I just wanted to not fuck this up. And then like the time they're supposed to meet me comes and goes and then it's like an hour later. And I call my dudes and I'm like, "Hey, your person's not here yet." They're like, "They're on their way." and then they hang up and I'm like, okay, like literally like four hours goes by of me doing this. Like I'm just like, whatever I'm so bummed and then this like, door flies open to this place and this little person comes out and they're like, "Hey, are you Agatha?" And I was like, "Yeah," and they're like, "Alright, I'm gonna take this shit. Like thanks a bunch." and then like, drags in three duffel bags really quick and slams the door shut and I'm like, fuck like they knew my name, but like I'm pretty sure that was who I was supposed to give this to you know, and then I go back to my hostel and then like whatever. So like, it was like super disheartening to be told I couldn't be in this fighting unit, and then like it was super disheartening to have trouble handing the shit off, but like, in the end, it was probably the best thing that could happen to me, because like, after being there for a while, I was like fuck, "I don't know if I could have been of service in a unit where I have no military training," like, you know, I probably would have been a liability more than anything. So like, Thank God that happened. And then I got hooked up with these people who like, it was like perfect for me. You know, I just drive for 30 hours and then like that was fine with me you know? Like I traveled the country a million times as like a dumb useless punk. Like this was like the same shit, just like felt better because I was like helping people you know what I mean? Margaret 20:09 Thousands of dollars of gear. Agatha 20:36 For everyone that's listening. That's how we that's how we know each other, is being dumb, useless punks traveling the country. Agatha 22:02 So, I just applied whatI knew about like traveling and being comfortable being uncomfortable with like, doing shit and it was like a perfect fit. So, I originally went over to do that. Yeah. And then it switched to this. And then I was only there for like six more weeks. But, I did a bunch of shit while I was there. And, you know, I will probably get into it later. But, I needed to do like a lot of trauma therapy once I got back and like, it's been a year and I just felt comfortable enough to buy another plane ticket there and I'm on my way back. But this time, I don't have to figure anything out. I already have a crew. We have a fleet of nine vehicles. We have deliveries lined up for fucking months. So it's like, I can just jump right back in you know, and like, it's just nice when you like hand a bunch of fucking hungry people food or you know, yeah, like. And that's the thing that struck me most is I went out there as an anarchist and then while I was there, I kind of just turned into like a humanist. I was like, you know, I just didn't give a fuck who I was working with anymore. I was like, "Oh, you're hungry and you need food. I'm gonna bring it to you," and it didn't matter to me anymore who was picking it up. You know, I even worked with some known fascist units who supposedly kicked all the Neo Nazis out, and anti Semites got kicked out, but they still have unscrupulous pasts as like street gangs and stuff, but like, you know, I was bringing them stuff to like, keep people alive. I didn't. I just stopped caring, you know, about political affiliation and shit. Margaret 23:39 No, it makes sense to me though, like, because one of the things that has been so interesting to me about like studying disaster stuff and disaster responses, right, are these like, you know, there's this moment that I wasn't there for but sticks in one of my head, my head is that one of my best friends. I've probably mentioned this on the show before, but one of my best friends is this, you know, crusty traveling punk kid who went to go do flood relief in a place that you could normally drive into, but could only be flown into. And the people who were flying in, were all of these people with like, tiny airplanes, which means rich libertarians. And you know, and so my friend is like talking about being like, and you know, and they're nervous person, and they're in this tiny airplane driving and like flying into a storm with this, like, random libertarian guy, right? And it's just like, and they were fine. And they landed and they delivered supplies and they got food out and got stuff out to people who needed it who were trapped and hungry. And I think that's what's so interesting about disaster, whether it's, quote unquote natural, like the accelerating climate disasters, or, you know, the invasion of an imperialist power into your country is just this like....like the goal isn't to help anarchists. The goal is to help people who are being destroyed by an imperialist power. You know? Agatha 25:05 Yeah, exactly. Margaret 25:07 It's interesting to me, because I do have I have a...like it's like cool, right, supporting the anti authoritarian unit specifically. It's cool and like anarchists organizing this is cool, but a lot of that is like...well, I'm excited that an anarchist is at least one of the drivers of this organization that you're working for, you know. Like you. You know? What is it? What is it like interacting as an anti authoritarian person within this like...you know, yeah, you have this like, rich industrialist lady who's just like, pouring everything and all kinds of risk into just providing things for people and I presume you have this very...like is it this melting pot environment. Like, what is it like socially? Agatha 25:50 It's fucked up, man. Like the guy I got stuck with like, when the group I started driving for wanting to vouch for me, they're like, "We have a solo run. It's like not very sketchy. We're not going that far east. We're just going like outside of Lviv. It's like a fucking shit ton of sanitary products. And then like, you're going to come back to Częstochowa and you're going to fill up the van full of strollers and bring it to this orphanage that's only run for orphans that were victims of losing their parents in fucking Bucha you know. Margaret 26:21 Well, it better be anarchists babies, because otherwise they don't deserve strollers. Agatha 26:24 Yeah. But, the fucking guy picks me up and he's wearing a fucking Black Rifle Coffee Company t shirt. Margaret 26:30 Oh shit. Agatha 26:31 And I was like, What the fuck is this? You know? And I was like, this sucks. And I was like, cuz I knew they weren't going to be anarchists. But I was like, this dude is wearing just a straight up fascist companies t shirt. Margaret 26:44 Yeah, this dude wants to kill you in the United States. Agatha 26:47 Yeah, well, he's from Canada. And that's the thing, like, his view on it was like totally different. I was like, you know, after like, nine hours in the van and like 18 cups of coffee. I was like, "So what's up with your shirt, dude?" And he's like, "Well, I just really like their coffee. And like, they have pictures of guns on their shit. It's like good advertising." I was like, "You know those are the assholes who like bailed out Kyle Rittenhouse, right?" and he's like, "Who the fuck is Kyle Rittenhouse." and I'm just like Jesus Christ. And, it was just like, super fucked up and like, we had like really long conversations about what like being an anarchist means to me. And you know, the more we talked, the more I realized our like end goal was exactly the same. He was like, just a farm boy from from South Central fucking Canada who grew up on a fucking....what's that stuff called? I don't want to say the name of it cause I hate it. And there's another name for it. He's from a canola farm. And he joined the military when he was young. And he's like....I'm a pretty tall person. I'm like 6'2", and he's like three inches taller than me, built like a brick shithouse.Just look like the dude you don't want to run into as an anarchist in like a war zone wearing a fucking Black Rifle Coffee Company t shirt. But the more we talked, the more we were just like yeah, we just want to fucking help people. And like that's it. Like, I just don't care anymore. Like it basically came down to everyone in our group wanted to ease some suffering that was happening at the behest of like, fucked up agitators who were acting on like imperialist like logic, you know? And yeah, that's basically what it all boiled down to. So, like I went there as an anarchist trying to support anarchist endeavors....and because they were helping just normal people, right? And and then it just turned out like, you know, circumstances change. They didn't...like multiple groups didn't want any more foreigners. You know, I was never given explanations as to why....Someone said it was because my social media presence was too hard about going to Ukraine, and they didn't want people getting their spots blown up. But, I was like literally all I said is I'm going to Ukraine, bringing medical supplies to anarchists units. And if you want to donate, donate here. I gave zero information on what unit I was delivering to, where I was going, who my contacts were. It was like vague as possible to just get donations, so I could buy more tourniquets. That's like all I was doing. That's that's the most explanation I got, which never added up. Margaret 29:19 They must have had their own shit going on. There must have been like something that had happened recently or like something within the internal structure where they were like trying to hold on to their anti authoritarian unit within an authoritarian structure, you know? Agatha 29:34 Exactly. And I later found out like, once I was back from a couple runs, and the unit that had originally accepted me, and said no more was like, "Hey, we got a guy coming to Warsaw and he wants to meet you." And I was like, "Okay," and it was just like the most giant man I've ever met and he was just like, decked out in like fucking workout gear and he's like, "I'm coming from the gym and I only got an hour I'm going back to the gym. I'm with this unit. I'm on leave blah, blah, blah." And I guess what it was was like, you know, it was other foreigners who were in the group who were posting shit online they shouldn't have been, you know, and one example was, there was someone who posted a picture of themselves outside of a building being like "Training for the good fight," or whatever. And whatever fucking Russian like ops that we're monitoring social media saw a picture of the building, did a bunch of fucking research, found out where it was, what the building was, and fucking a missile strike happened and like 500 volunteers died or some shit. Agatha 30:39 It was like super fucked so like, I totally got it, but like, and I wasn't gonna argue with them, you know what I mean? I was like okay, I'll find something else to do, but like that's not me. And that's not what I'm doing, but like, whatever I'll try and help out some other way. So, I think that's the kind of shit that was happening that led to me not being invited into these like strictly anarchist groups, because I mean, you know, fucking anarchists. Everyone's like security culture. Like the feds are like bugging my phone because they want to know what dumpsters I'm hitting or whatever. You know what I mean? It's like... Margaret 30:39 Oh my god. Margaret 31:12 Only here, it's like they're actually throwing missiles at you. Agatha 31:15 Exactly. Exactly. So I was like, I get it but, like whatever, so I think that's really what it was and like I couldn't fault them for it. I was like whatever, but yeah, I'm just some like scumbag from America anyways. Like you don't know me. Like you don't know if you can trust me like. Sure, I have tattoos on my face, but like whatever. Like you know what I mean? Like yeah, so I got it but like, I don't know. I'm kind of rambling at this point. I'm gonna let you direct the conversation a little more. Margaret 31:39 No, no, I'm really curious about all of this kind of stuff, like I'm very curious and I think the audience will be curious about....I mean, even down to like how do people take you as this tall, you know, person who presents somewhat masculine, but often has a non masculine name, has face tattoos, doesn't have like, you know isn't like mister Mr. heterosexual cis man, but also is like a tough as fuck looking, like face tattooed punk, right? Like, what do people make of you? Like how did that go? Agatha 32:18 It just depended, you know, some people were just like, "Who the fuck is this guy?" Like? Yeah, cuz I mean, I do have a lot of visible tattoos, but just to like, give it some context. Like my tattoos are like of puppies and like, I have a giant heart on my throat. You know what I mean? They're not like tough guy tattoos. Aside, I have some air 15 magazines tattooed underneath a "Do not resuscitate," tattoo on my chest. My chest looks like some pre-schooler went to prison and got tattooed or something. It's like light hearted. There's like skulls and puppies and yeah, rifle parts and like a 'do not resuscitate,' banner and like shit, but like, that's not stuff people generally saw. But they'd see my heart tattoo on my throat and my shit on my face. And like my hands were all blacked out. And you know, people were either like...A good example is like, people either didn't say anything, or they'd be like...like, one time we were in Kyiv we're kicking this grifter who had gotten caught up in our shit out. We needed like five to six hundred litres of diesel that we had shoved in his van. We needed to get that out before we kicked him out. Because we knew he would just steal it from us. I mean, I found out the guy had gone through my phone when I was sleeping. There was like links to his aid organization to the like, PayPal link on my phone. Like my Safari was open. And it was like, please enter your Paypal password to donate to this group. And I was like, "Who the fuck is this group?" And then we realized it was this guy and we needed to kick his ass out. But like, whatever, we didn't know where to kick him out. Like we didn't know if he was gonna get violent with us. So we picked like a super populated spot and Kyiv which is where we were at the time. And we're like, "Meet us here," you know, "at this parking lot for this fucking train station." But the parking lot was closed. And, it was like, all the spaces were empty, but we couldn't get in, and there was this like drunk ass dude wearing a body camera in this little booth. And he was like....we just went up and we're like, "Hey, are you the one watching this parking lot right now?" And our interpreter could not understand a fucking word this guy was saying. He was so drunk. And it's like the farther east you go like, the more the dialects change, so like our interpreter was 18 years old from from Lviv. He had never been this far east, you know, which Kyiv isn't even that far. But like, you know, if you've never been to Kyiv really and you get there and then there's people from the opposite end of the country who you know, I mean, it's just like, there's a big disconnect with with local dialects. He could only you know, figure some shit out. And we eventually paid the guy like a bunch of grivna not to fucking, just do this deal real quick. We're like, "Hey, we'll give you this wad of cash. Just let us park here for like 20 minutes, this guy is going to meet us. We're going to move a bunch of shit around from Van to van, and then we'll be out of your hair," and he's like, "Alright, fine." But, he was like fucking hammered. And he would not leave us alone. And he was like, uncomfortable drunk where he was like in our faces, like breathing on us, asking us questions. And our interpreter was trying their best to like, fucking answer. And then it just got hot during the day, and I went to take my shirt off, and all my tattoos are black line work. They look like fucking prison tattoos. And this guy, I see him catch my eye as my shirts about to go over my head for a second. And I pulled my T shirt down real quick. And he's like, "Ah, prison." And I was like, "No, no, no, no, not prison," and he's like, "Prison." And I was like, "No, it's not prison," and the guy just wouldn't shut up about it. He just kept saying "prison" to me and like, give me the 'okay' sign with his hand. And I'm like, "No, dude," you know? So, it's like, it was like, stuff like that. And then other people just being like, "You're a fucking freak American? Are they all like you", kinda shit. it was just like, I don't know, it was super weird. I got some shit for it. But like, most people, like I would talk to them for five minutes. And they'd be like, "Oh, you're just a person who wants to like, do shit." You know what I mean? But then, the more I got into this shit, and the more I was like, getting deeper into the east of the country, like, it got like, less and less about personal identity and what you what you were presenting to the world, right? Like I am an assigned male at birth guy who's six foot two inces and like, I have tattoos everywhere. And I carry myself like, like, really confidently, because I'm a martial artist, and blah, blah, blah. I'm just like...and I don't take shit from people like...It just was like a little easier for me to get by. But like, I was with this really well known fascist unit, who was giving personal protection to this trans woman, who was in the east of the country and had been there for months. Like she had gotten fired from her news organization because she started using the term 'Orc' in her in her pieces, and they're like, "You're no longer unbiased." And she and she was like, "You can't be unbiased. If you've been out here," like, "These Russian soldiers are fucking pigs. Like, they're like, they're raping people. They're killing children. They're doing all sorts of shit. They're bombing schools. They're bombing hospitals, like, and all these people could just shoot their officers and come across the line with a white flag. And the Ukrainians would treat them fine, right? Like yeah, but they're not doing that they're doing what they're told. And they're being complicit in these atrocities, blah, blah, blah." So she was like just going around doing all these pieces and her personal protection unit was all these supposed fucking homophobic, you know, fascist pieces of shit and granted, I never got drunk with these guys. I didn't have beers with them. I don't know what they really think but, they thought what she was doing was important enough to like give her a pass, you know what I mean? And like protect her, and get her to these like places to interview these people. And that's the kind of like, shit I mostly ran into, was like, you know, you don't have to agree with me right now, but we have a goal in mind. And once the Russians are gone, fuck it. We'll figure out our differences later, but like right now, like were chill, and I got like pretty hopeful about it till I met this like, platoon leader in an infantry territorial defense unit who, after...we were bombed at one point our fucking vans got destroyed, and we were looking for a mechanic to fix our shit, so we could get out of the east of the country. And this dude who spoke perfect English came up to us and was like, "What are you doing? What are y'all doing?" We told them what was up and he was like, "I'll try and find a mechanic. I got a mechanic buddy, like right around the corner, blah, blah, blah." And then while we were waiting for a callback, me and him just like got some coffees and like, talked for a while it turns out, he's like, uh, you know, he was a fucking, like, a human rights activist who was a lawyer forever, and like, graduated college in '92, and started his own organization to help like, LGBTQ refugees from like Belarus and shit, you know? And I mean, he was like, super fucking cool. Yeah. And the guy just eventually was like, "Yeah, I went to school at a military accredited college. So when I joined the territorial defense units, they're like, "You're an officer. You're, you're in control of a whole platoon,"" and he like, tried so hard to convince them that he was not their guy. Margaret 39:44 That he has the wrong platoon. Agatha 39:46 Yeah, he's like, "No, dude, I don't know how to fight blah, blah, blah. These are all like seasoned infantry men that I'm supposed to be...." So he's like, "I just fucking started listening to the most experienced dudes in my company and like, like, let them decide basically," and then, but like I got talking to him, I was like, yeah. You know, I introduced myself to him as my birth name. And he's like, yeah, you know? And then we started talking and it became apparent that he was not straight and all this other shit. And I was like, "Yeah, like, we've been working with this one group," and he's like, "Oh, yeah, they're bad news, you know?" And I was like, "Are they, though? Because like, they've shown me to be like, pretty decent to like, a lot of marginalized folks. As far as I can tell. I don't know." Yeah. And I was like, "I go by Agatha in the states and like, my crew calls me Agatha. But like, I do feel scared enough to not introduce myself as Agatha to the people in this unit, because they're, they're staunchly fascist, right? Like, you know, they, they're not into it." and they're like quick like without missing a beat they're like, "Oh, yeah, no, do not introduce yourself to these motherfuckers as Agatha. They're like, they did get rid of a lot of antisemites, they did get rid of a lot of overt racists, but there's like homophobia is still a huge problem in the Ukrainian military and population in general. It's very conservative. And so like, he like really opened my eyes that like, I was like, "Yeah, we're all in this together. Like, who gives a fuck your political affiliations? You know?" And then he was quickly like, "Yeah. No, people still disappear all the time during wartime. You know what I mean? Like, yeah, watch your fucking ass and like, keep doing what you're doing. But like, don't get too comfortable with these people." And it was just like....It was hard because like, I fucking was just feeling good about, working with people of different ideological backgrounds. And it felt good to just feed people and have this shared goal. And then just to be like, brutally reminded that, like, that's not actually the case. And it could get backwards really quick. You know what I mean? If I like yeah, said the wrong thing to the wrong person. Like, I have like an antifascist action pin on my hat. It's just like, you know, the little two black flags. It says "Anti-fascist action." He's like, he's like, "I wouldn't wear that, you know, I just wouldn't. you know, and I was like, "Okay." I listened to the guy, you know, he's fucking awesome. And I like, kept in touch with the dude through Telegram, and it was fucking on and then he got captured by the Russians, and he's still in captivity, and like, they're trying to act like he's a super Neo Nazi, because, like, that's what they do to human rights...and you know, people who are obviously leftist who get who get taken prisoner. But, you know, he's facing fucking 12 years in prison in the Donbas now, you know, and I'm just hoping, because he's an officer, they're going to do a prisoner swap, you know, but they're like not into it. And I, you know, if I had weird questions, I'd ask them, and then they'd always give me like, a nice response. And, you know, didn't treat me like an idiot American. They're like, yeah, "You just don't know the culture, blah, blah, blah." So, now what? Margaret 42:48 Yeah, that's, that's a really good...it's a sad, but it's an important counterpoint in this conversation we're having is to realize that like some of the civility between these units is probably short term, probably a veneer, and like, probably necessary veneer to drive out the invading force, but it makes sense to not to get too comfortable with it. And that's sad, but it's interesting because it's like, I hold, perhaps naively, that a lot of center Right, people really are distinct from far Right people, and like, have, you know, some really good ideas in terms of "Hey, what if we all left each other alone and sometimes took care of each other?" And it's like, easy for me to say as like someone who lives in a rural center Right area, but not a far Right area. And that's an important difference, you know? Agatha 43:45 Yeah, but I think that's like a pretty fair assessment too, of people out there. It's just it doesn't...you just can't count on that for long because even though like you could be a center Right, dude, and then you spend nine months in a fucking infantry unit full of fucking mutant goons who are espousing all this hate and it's easy to go from center Right to far Right, you know? Margaret 44:05 Yep. Yeah, no, totally. And it's...Yeah, fuck. Well, to go from that light subject to another really light subject. You mentioned that you were attacked, your caravan was attacked. Agatha 44:20 Yeah. Margaret 44:21 Do you want to talk about that? Do you want to say what happened? Is that right? Agatha 44:24 Sure. It's hard for me to just like, do it kind of like, you know, like, give you the synopsis. Like I kind of rant about it when I start going into details, because I start going into like lizard brain thinking about how I felt while I was there. So, with the caveat that like I want you to like be like, "rein it in," if you're like...if I'm given too many details, or if I'm going off on a fucking rant or whatever. Basically, we had done....we had been driving for like 48 hours on and off. We left Krakow. We got to Lviv. We dropped a bunch of shit. Picked up a bunch of shit. Got to Kyiv, dropped off a bunch of shit, picked up a bunch of shit, and this all started like insane. I was at the fucking ladies warehouse, loaded up like usual. And that grifter dude we were working with....so his thing was, he was working with the....What the fuck is their name? Not the Rotary Club. They're like something like that. The Lion something? Do you know what I'm talking about? Margaret 45:28 Yes, one of those like weird things. It's like not the Masons, but it's basically the Masons. Agatha 45:32 Yeah, t's not the Masons, but it's kind of like the Masons, and they do like whatever.....So, he, I don't know how he fucking did it got a bunch of funding for them, bought like two brand new vans and was out there, under the auspice that he was working for them. But he had all these weird things he was doing that he wouldn't share too much information on. And he had a Land Rover and it was one of those fucking British Land Rovers with a steering wheel on the wrong side, or the other side, not the wrong side. Margaret 46:01 When we're British people, we can say the wrong side. That's fine. Agatha 46:06 So, we're loading up all the shit. I'm waiting for the rest of my crew to get there. We got there a couple hours early. We get all loaded up. And I'm like, "Hey, person who runs the shit, like, what can I do to be of help while I wait for other people? Do you have shit that needs to get like moved around in the warehouse? You know, like, what do you need for me? She's like, "I need you to get this fucking guy off my back. He won't leave me alone. He wants to leave right now. And I told me, he's got to wait till the rest of the convoy gets here so you all get to the border crossing at the same time when you're supposed to. And you can give this paperwork to the guy who needs it." And I was like, "Okay." So the guy won't shut up. Eventually, they get in a huge fight. He says, "We're leaving," and looks at me. And I was like, "What?" and the lady's like, "Alright, good luck crossing the border," you know. And he's got his own van and he's like, "You're gonna drive this Land Rover full of shit by yourself. And you're just gonna follow me to Kyiv where we drop this off to a unit of American volunteers who are all ex military. And they're working on their own outside of the Ukrainian military. And they need a four by four vehicle to get in and out of like weird spots." And I was like, "Okay, fine." And then. So, I call the main planner of my group and I'm like, "Yo, dude is trying to be sketchy. He got in a fight with Lady. They're at each other's throats. He just wants us to leave. She wants us to get the fuck out of there just so she doesn't have to deal with like, this, like sketchy male bodied person yelling at her. She just doesn't need this, you know?" And he's just like, "I'm so sorry to do this to you. But like, just go with him. Just like get out of there with him, like, help him out. We need his van space once we hit Kyiv because we have more supplies than we can bring to Kharkiv in the space we have. So, I was like, "Okay, fine, whatever." And this guy like we eventually....She looks at me, she gives me a big hug. And she says, "I'm so sorry about this." And I was like, "Sorry, about what?" And then she looks at the guy and she's like, "Have fun crossing the border," and handed him a thing of papers and like was like, "See you guys." And then she's just like, "Please stay safe, Agatha." And I was like, "Okay." And and then I was like, I don't know what's going on. This dude throws a radio on my lap. I had never used a fucking CB radio at this point in my life. And he's just like, he's like "Try to keep up." And then he like fucking takes off on me. And I was like, What the fuck, and I'm like, racing to keep up with him. But, he's passing all the semis on the highway and I'm driving a right handed vehicle. I have to get all the way in the other lane to see if there's oncoming traffic, which is sketchy as fuck. I have never driven one of these things. It's still like normal driving lanes, you know what I mean? It's just a different driving side on the car. And it just was like the most stressful thing that's ever happened to me. For four hours trying to keep up with this guy. And then we finally get to the Ukrainian border. We're well outside that window of time she told us to get there. And he's like, "Don't worry, let's skip the line. Let's drive on the outside of the line in this like break down lane and get up to the gate and I'll get us through." And I was like, "I don't think that's gonna work, bro." And he's like, "Whatever." We get all the way up there. I'm still sitting in the car. I see him arguing with the border guard. The border guard's just pointing to the back of the line and then I'm like, "Fuck," and then eventually he's like, "Oh, we gotta try again blah blah blah." And he like turns around and we go...we do this like three times. He argues with three different border guards. And eventually we just have to sit in line for like eight fucking hours like Lady told us we were gonna have to do if we didn't fucking wait and he's all griping about it and blah blah. Yeah. And I'm just like I want to be like, "I fucking told you so." I don't like this guy already. He's like, super macho, has no regard for other people's emotional like capacity for anything and it's just about him and blah blah blah and he's got to get this vehicle to this unit or they're fucked and blah blah blah. We finally get through. He does the same shit, and I don't know if you know anything about Ukrainian roads, but they are that was fucked up roads I've ever seen in my life. Like, before the war. Like there's just like...they are fucked up. It's like the main highways are just packed with potholes that like, are just so devastating when you hit them. You're like, Oh my God, and like, he's just flying down this highway and like, he's like, "Keep up," like I keep hearing in the radio get more and more staticky. He's like, "I can't see you back behind me. Like keep up. Blah, blah, blah." And I was like, "Dude, you're going too fast. Blah, blah, blah. We do this for a whole day. And we get to Lviv and then whatever....I missed a detail. It wasn't Kyiv we were going to deliver this vehicle to. It was Lyviv, which is much closer to the border. We get we get to Lviv, and he's like, "We gotta meet this fucking dude, and hand off this fucking vehicle. And I was like, "Okay, fine, whatever." We finally get to this gas station. And there's these two dudes dressed in fatigues with their weapons out, like totally out of place, and they're holding gas cans. And he's like, "There's my dudes." And I was like, "Okay." Margaret 51:16 From the Lions Club or whatever? Agatha 51:18 Yeah, yeah. Well, no. He didn't tell me how he knew these guys. He alluded to the fact that he was in Afghanistan for a while working with Blackwater motherfuckers doing the same shit, but just equipping Blackwater units like not other stuff. So, I was like, alright, this dude's got sketchy friends. Whatever. Turns out this dude doesn't know the fighter at all. They met through the internet. He's not donating this vehicle. He's selling it to them and then fucking dudes like all sketched out because he looks at this Land Rover and is like, "So, this thing's good to go. It's all like mechanically sound?" And dudes like "Yeah, it's good. I had a mechanic look at it and everything in Poland blah, blah, blah." And I was like, "Yo," I could not shut up. I was like, "Yo, I drove this thing from fucking Krakow and it is not sound. Like you at least need new tie rod ends." Like I'm a proficient mechanic. "I was like, You need new tie rod ends and or like fucking drag link for your steering unit. And like, I don't know if you've looked at the back hubs, but like, they are rusted to fuck, like, Good luck getting the rotors off of the hubcap kind of shit. You know what I mean?" And he's like, "Well, what the fuck, I can't use this dude, we already paid you. I told you this was to get infantry units into hot zones, to do some sketchy shit. And to get out. Like, you told me this thing was going to be mechanically sound, and it just wasn't and like, blah, blah, blah." And I still had my whole kit from when I thought I was going to use my time there fighting. So, I feel bad for this guy. And I was like, "Hey, do you guys need any like, PPE or anything for one of your members of your unit? Like, he's like, "Yeah, the Russians just overran our base. And we lost everything. Some of our dudes are wearing jeans and sneakers." And I was like, "Okay, I got like, three sets of BDUs. I got a pair of combat boots. I got knee pads. I have a fucking thermal imaging camera. I have weapons sights. I have, like, you know, weapon attachments," all this shit. And he's like, "Oh, fucking A. Thank you so much." And he's like, you know, "Fuck this dude. I don't know how I got mixed up." I was like, "Whatever, just take all my shit. And we're gonna get out of your hair. I'm so sorry this happened. Yeah, blah, blah, blah." We get to Kyiv. We kick them out like I told you we did with a drunk dude. And then. And then like, another day later, we finally ended up in Kharkiv. We get rid of all our shit. Margaret 53:32 Okay, how much of this is lizard brain? I'm just... Agatha 53:35 A bunch. But I'm I'm at the point now it's starting to matter. Margaret 53:40 I appreciate that you're telling like a hitchhiking story. So it's like, it's very relatable to me. Yeah, please continue. Sorry. Agatha 53:46 So, we're in Kharkiv. We've given up all our shit. We've re-supplied and done that shit like four times. We have one more delivery to do. And then we're going to head back to Poland. And.... Margaret 53:57 Wait, who you with at this point? This is the rest of...The rest of your crew has caught up with you at this point? Agatha 54:03 Yes, yes. The rest of the crew has caught up. They caught up with us after we handed off that vehicle to the unit. And they caught up with us in Kyiv. We did a bunch of drop offs. We did a bunch of pickups and then we all drove as a unit after we kick that dude out to Kharkiv, which is, I don't know. It's like 20 miles from the Russian border or something like that. I could be wrong. It's not far. I mean, while we were there, you could hear artillery going off in the background. Yeah. You know, whatever. So we have 75 IFAKs to deliver to this one particular unit who, we had another wealthy benefactor, those two were in contact, the unit and this wealthy benefactor, this wealthy benefactor said "I know these people who will deliver it to you," and that was us. So, we have 75 IFAKs. I don't know if you know what an IFAK is. Margaret 54:51 Yeah. Individual first aid kit. It's a trauma kit for gunshot wounds, for anyone who's listening. Agatha 54:56 Yeah, it's got a tourniquet. It's got some quick clot. It's got a chest seal. It's got like a aluminum brace, it's got all the shit you need to like, stop some bleeding for 20 minutes to hopefully get them to like a more well equipped place but... Margaret 55:08 They save a hell of a lot of lives. Agatha 55:10 They save so many lives and they're so important and like...So, we were delivering 75 of those. We're meeting this unit at this restaurant. It's one of the only restaurants open in in Kharkiv that we can find. There's like three Ukrainian families eating there. And we just start hearing artillery getting closer and closer to us. And we're like, "Fuck, this is getting scary." Like, we start feeling it in the table. Our glasses start shaking. And my friend with the Black Rifle Coffee shirt, he's like, "Fuck, they're bracketing us." And I was like, "What is that?" And he's like, "It's when you have a, you know, an end goal in mind of where you want to hit. And then you like launch a round of munitions. And through whatever means whether it be like drones or whatever you see where it hits you readjust your calibration on your aiming device, you launch another round. It gets closer and then you're getting closer to your target, right? Yes, I think they're bracketing us." The shit is getting closer and closer, because we're at the base of the Soviet monument. And it's like a 100 foot tall statue of a Ukrainian dude wearing like Russian combat gear from World War II and it's like, supposed to be a Soviet monument to people who lost their lives fighting the Nazis in World War II, but someone had climbed all the way up there and taped a huge Ukrainian flag to their to their gun and it was like...it just seemed like that's what they had to have been aiming for because it was like a big "Fuck you," to Russia, you know what I mean? And yeah, so we're like okay, and you know, we're trying to get our social media presence up so we can get more donation so we ended up with this fucking Tik Tok'er with 2 million followers with us. And he doesn't want anything to do with us most of the time. So, he got an Airbnb. We're getting bracketed. We're waiting for the.... Margaret 56:56 This sounds like a movie. You've got a Tik Tok guy with 2 million followers.... Agatha 56:59 It's insane. It was fuckinginsane and we're waiting for this military unit to come pick up the 75 IFAKs. We have our food boxed up. We're like as soon as we give these dudes this shit we're out of here. We're leaving Kharkiv. And then someone's like, my buddy, who's the main planner is like, "Yo, y'all need to go get dude, he's at an Airbnb, like fucking 10 blocks away." So, we're like, okay, so me and Canadian infantry dude get in a van and we start like going like 110 kilometers through the middle of Kharkiv literally shit blowing up all around us. We're trying to get to this fucking dude. And we finally get there. And we're like, "Where are you?" on the phone? We're like, "We're down here. Get the fuck in the van." He gets in the van. We throw him a fucking vest with like body armor and give him a helmet and we start racing back to the fucking restaurant and it's just like...there are just like artillery munitions going off all around us. it was fucking terrifying. And then we finally get to the park where this monument is that and we have to park, walk through the park itself to get to the restaurant where all the rest of our crew is at, right? So, we park our last two vans we have in the convoy. Me and Tik Tok'er get out. Dude I'm with gets out. Se start walking across the park and I mean even with....like people are just used to artillery going off in the city right, so there's like old people everywhere soaking up the sun on benches and shit like that and people just like ignoring it and then we get like about I don't know 30 minutes or 30 meters into the park and then all of a sudden I hear this explosion really close behind me. I turned around I see all the glass in our vans get shot out all at once. And then something blew up like right next to me and I lost consciousness. I woke up on the ground. Tik Tok'er was confused and like we both didn't know what was going on. I couldn't hear anything. All I heard was like the biggest like ringing in my ears I've ever heard. My chest hurt from the impact of like the sound wave hitting me. Agatha 59:10 Yeah, yeah, I couldn't breathe. I was just like freaking out. I just started like grabbing my body armor and seeing if there was like blood anywhere. I was like whatever, and then I realized I'm okay and then I'm like, "Fuck all the windows of the the restaurant that my buds were in are blown out and it's like fucking on fire. It was like....so I run over there. Buddy is trying to....military dudes trying to tell me to get back in the van. I was like "I'm not getting back in the van, like that things like destroyed and blah blah blah." And so I just follow him and we both run in and he's just like "Boys, boys, where are you?" and we hear them yelling from the kitchen and everyone that was in the the dining hall went to the kitchen and we're hiding behind this like knee wall and the military unit we were supposed to give this shit to was there and I was like "Fucking great. Like, there's someone who knows what they're doing." Yeah. And everyone's like, "Are you okay? Are you okay? Like, what's going on?" And Meantime, there's still rounds hitting all over the fucking place. And he's like...everyone's like, "What do we do? What do we do?" And I was like, "Yo, we got 75 IFAKs in the van right now. And there are people like hanging out with like, missing limbs and like, screaming, bleeding everywhere outside, like, we need to get out and try and help people. And I tried talking to the medic who was with the unit that we were meeting up and he just like, didn't understand me. The interpreter was having a hard time. They lost their shit, you know? Yeah, everyone's freaking out. And like, I'm just trying to get these people to follow me. I was like, "Just come to the park. Like, we know how to put tourniquets on. We know how to pack wounds, like, please, like, let's just do this." And everyone's like, I don't know." A few of the people in my crew were like, "Yeah, let's do it." And then the people of this unit, like pissed me off, they're like, "No, we should just hang out here till the artillery barrage stops." And I was just like, "Fuck you. I'm going." And then like me and four people went out. We ran to the vans, we fucking grabbed all these IFAKs and then we just like, dumped them on the ground and started ripping out tourniquets. And then we split off into different little teams and just started fucking tourniqueting people who were bleeding everywhere, like this one dude was like missing limbs and was just like screaming. It was like the most intense thing I've ever experienced. He ended up fucking dying. Like, it was just like, so nuts. And that went on for like, 25 minutes, 30 minutes. And, um, and my personal IFAK that I wore on my chest rig was like, that was the first one I ripped off, you know, and yeah, tourniqueted at this lady was bleeding heavily from her inner thigh and I was scared it was like a femoral artery or something. And, after like, 30 minutes, this ambulance shows up. And they're just creeping by the park. They're not stopping. And I was like, "Fuck," and I like, stopped what I was doing because I had treated everyone I could find at this point. And I was like, in like, crazy mode. I was like hiding under a tree that would provide me no protection from an artillery round, but I was like, freaking out and then I saw them ran up. I was like, "Yo, you guys gotta get out of here. There's people bleeding all over the place. Blah, blah, blah." And then the military dude, I realized the medic had never even opened his fucking med kit. He was just standing there with hi AK watching us like tourniquet up...watching us of civilians like tourniqueting up all these people, and then fucking whatever. They're like, as soon as the EMTs arrived, they eventually get out. They start tending to the people, we had been triaging. And then the military dudes just like, "Alright, we gotta get out of

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Meagan welcomes Julie back today to celebrate 200 episodes of The VBAC Link podcast! They celebrate this milestone with a special live Q&A podcast recording session joined by followers of The VBAC Link Facebook community. Topics include: how to talk to your provider, all about Spinning Babies, adhesions, managing sciatica pain, induction, nipple stimulation to induce labor, VBAMC, C-section consent forms, and much, much more.We can't wait to continue sharing new episodes with you as we stay committed to our mission of making birth after Cesarean better!Additional linksSpinning Babies websiteThe VBAC Link Blog: Pumping to Induce LaborFear Release YouTube VideoEpisode 18 Leslie's HBAC + Special ScarsJulie's InstagramThe VBAC Link Community on FacebookHow to VBAC: The Ultimate Prep Course for ParentsFull transcriptNote: All transcripts are edited to correct grammar, false starts, and filler words. Julie: Welcome to The VBAC Link podcast. This is our 200th episode and yes, you are listening to Julie. I'm back just for this episode and probably some more in the future at some point, but we are so excited, Meagan and I, because this is the 200th episode. We are now live in our Facebook group. Not now when you are listening to it, but right now in this moment in our timeline. It took us way too long to get in here live, but we are doing a Facebook Live podcast episode. We have never done that before and we probably will never do it again because this was kind of traumatic.Meagan: Yeah, this was a little rough, but that's okay. Now that we know, now that we know, we are good. We're good. Julie: Now we know.Meagan: It just took 34 minutes to figure it out. Review of the WeekJulie: Oh my gosh. Cool. So, let's get started first. There is a Review of the Week. Meagan, are you ready? Do you have one?Meagan: Yep, I do. This is from blpinto and it's from Apple Podcasts. It says, “Wonderful resources for ALL moms, not just VBACs.” It says, “I didn't have a C-section for my first birth, but I had a traumatic experience with a forceps delivery and an induction that was not at all what I was looking for. I started listening to the podcast before I even got pregnant a second time to prepare for a better experience. Julie and Meagan were a huge part of my process and journey. I ultimately had a beautiful home birth and a 10-pound, 6-ounce baby. I felt this podcast helped me overcome my fear that I couldn't push my baby out without help because many VBAC moms had the same feeling.”I love that. I don't know many first-time or second-time moms who haven't had previous C-sections that have listened and left a review. So that was awesome. We truly believe that this is also a podcast for everybody. Just like wonderful Brian says at the beginning of this podcast, it's for all expectant parents who want to avoid a Cesarean and want to learn their options and learn what's happening out there. So that is so exciting that we had someone who hadn't even had a C-section before. If you know someone who is expecting and has fear or maybe a first-time mom who has some doubts and problems and traumatic experiences in birth, definitely share the podcast. These stories are amazing for all to listen to. I would 100% agree with her.Julie: I love that. Do you remember years ago when we first started and we were trying to figure out how we could make something, maybe not separate, for first-time parents? We were like, “How do we get first-time parents to understand that these are things they need to know?” Because you didn't. I didn't. As a first-time mom, I didn't even think about a C-section until the doctor said, “We need to do a C-section,” and we never really got very far with that because the focus of The VBAC Link is a vaginal birth after Cesarean. Yeah, so we love that. We, I say “we”. I will always say “we” talking about The VBAC Link. Meagan: Literally, just earlier today, I was recording a podcast and I was like, “we”. I mean, “I”, but Julie is just over here. Julie: My spirit and presence exist in the VBAC realm.Meagan: Yes. But it's so much fun. It's so fun to be here and I'm excited. If you guys haven't had a chance or if you are watching live right now, we would love your reviews. Love, love, love your reviews. You can send us an email. You can write right here and I will copy it over and put it in the reviews. We are excited to dive in today on episode 200!Q&AJulie: Yeah. All right, all eight people who are watching. I guess one of those is me and maybe you, so six. Six people. Drop your questions. Nothing is off-limits. We are going to talk about everything you want to know. Everything you want to hear. We are going to get down and dirty with everything VBAC, wives, and kids. If you want to know what Meagan's kid is doing right now in the background, we will talk about it. Meagan: Yeah, drop your questions. I'm posting here letting people know that we actually are live now. Julie: Oh heavens. VBAC: Where do I start?Meagan: Yes. It's so funny. I keep looking on the wrong forum. Okay, who do we have in here? Who do we have? Kathryn, Jen, and AJ thank you so much for being here. Let us know your questions. I want to maybe start off just on VBAC options. We had someone write in yesterday and was like, “One, I didn't know VBAC was an option. I didn't even know what it was.” So that's wonderful that they're starting to find out that VBAC is an option, but let's talk about how we can have a conversation about VBAC being an option with a provider. That's just random, I know. But what would you think, Julie, if you're starting to discover VBAC, learning what it is, feeling like you want to feel it out, maybe you want to learn more about it and do it, how would you suggest approaching your provider?Julie: Oh man, that's a great question. First of all, we've got some good questions coming in too so I'm excited to answer these. Provider, honestly, I would just ask where their thought process is. I would approach them and say, “Hey. this is what I'm considering. What are your thoughts about it?” And I will tell you what. No matter what their response is and no matter what ultimately your birth plan is, you're going to get a really good feeling for how your provider feels about body autonomy, informed consent, and birth in general because if they answer and say, “Oh, well I don't think you are a great candidate. I don't do VBAC. I don't support them,” or anything that's very sounds set in stone, so, “I don't do this. We won't let you do that. We would have to look at this and make sure your percentage is high,” or whatever. Anything that is set in stone shows you that your provider is not as supportive of other options or your provider has a very set way of doing things and may not be a good choice for you. But if they answer and say, “Yeah. We can consider VBAC as an option. Let's talk about some things about what your goals are. I do VBACs a lot. I love VBACs” or anything like that with a more open or a more fluid answer is going to let you know that your provider is going to not only be good with whatever outcomes that you choose but is also very open to having the parent or the mother be part of the birth process and be involved in the decisions regarding their care. That's really what you want to have on your side no matter what type of birth you're having or where you are giving birth. You want to have a provider that is going to be open to your input, be a little flexible, a lot flexible based on what your needs are and the type of birth you want, and is able to accommodate that. Meagan: Yeah, and just that's willing to have that conversation because a lot of providers don't honestly come out and say, “Hey, do you want to have a TOLAC?” which is a trial of labor after a Cesarean. That may be something that you have to take charge of and say, “Hey. I'm learning about this. What are your thoughts? How do you feel about it? Tell me about some experiences.” We always talk about open-ended questions but really, truly if you can ask an open-ended question, you're going to be able to get more information than a “yes” or a “no” or an, “Oh yeah. Sure,” versus, “Yeah. I feel really comfortable with that. We do that all of the time. This is why.” So I love that. I know it was a random question, but a lot of people are asking, “How do I even approach this topic with my provider?”Okay, are you ready? I'm going to read some questions. We'll bounce back and forth. Julie: Yes, let's do it.What is Spinning Babies?Meagan: So Ms. Kathryn says, “I just found your podcast last night.” Yay! And now you're here on the first live one. It says, “Bingeing ever since. What is Spinning Babies? I've heard it talked about a lot on the podcast.” Spinning Babies is a wonderful resource. They have all sorts of circuits and tips and tricks on ways to navigate babies through the pelvis. Breech positions, so if you have a breech baby, they have positions and exercises to do that. We've got posterior. We talk and they also do baby mapping to help figure out where your baby is. Julie: Belly mapping. Meagan: What did I say? Julie: You said “baby mapping.”Meagan: Baby mapping. I meant belly mapping. Julie: They're the same thing.Meagan: That's what I meant. Baby mapping. I almost said it again. Belly mapping to help you figure out where your baby is. They can educate on if a baby is posterior, what types of things to do and what to do if a baby is asynclitic or comes over the pelvis, and what tips and tricks you can do. A lot of doulas are really educated in Spinning Babies. It is so awesome. So awesome when the client, don't you think, is educated in this and they are familiar with it. Julie: Yeah. Meagan: So obviously, we talk about it a lot in the podcast, but we really encourage people to check out their website. They have updated their website and it's really quite great now. It's really friendly to navigate, so check it out. It can be a game changer. I have had positions in labor where things were just hanging out, stalling, not really going anywhere, and then we have done a Spinning Babies technique and boom, that baby rotates and labor is speeding along. Julie: Yeah, I love that. I think one thing that I really like about Spinning Babies too is that it puts less emphasis on babies being in this specific position and it creates more emphasis on creating room and space in the pelvis.Meagan: Balance. Julie: And with the connective tissues and yes, balance and all of those things because sometimes, babies need to enter into the pelvis in a little bit what you would call “less than optimal.”Meagan: “Less than ideal”, yeah. Julie: But as long as baby has enough space and room to wiggle and progress through the pelvis in the way it needs to, then you're going to have a great, not a great, that's a bad promise. You're not going to have a great labor necessarily, but you're going to be able to encounter less problems that are created by a poorly positioned baby or tissues that might be more difficult to move and things like that. So yes, balance, space, and flexibility. Do adhesions impact fertility?Meagan: Yeah, absolutely. Okay, let's see. AJ Hastings. “Do adhesions really impact fertility? Currently trying to conceive for seven months and was told by acupuncture that I need 12 months of weekly treatments. I definitely want another opinion.” So the short answer is yes it can. It can affect things. In fact, we have an episode and I will go find it here. I'm going to go find it. I'm going to drop it. It's so weird because we are on Zoom, but we are on Facebook over here. I'm going to drop it in the Facebook group right here because it definitely impacted her. It impacted her and adhesions, depending on how dense and how thick and everything, it can impact fertility. 12 months of treatment? I don't know. I mean, I'm not a specialist in how intense that needs to be. I have adhesions as well, but I don't know how dense they are. I was fortunate enough to become pregnant, but it can impact it and it's something to look into. I don't think it's bad to get a second opinion for a whole year of treatments, but I also wonder if scar massage, starting with scar massage by yourself, or going to a pelvic floor specialist and starting there might be beneficial. Julie, what would you think?Julie: Yeah, right along with what you said, it can. That's the thing. It doesn't always, but it might. Adhesions, especially ones that are denser or thicker can tug and pull things in the wrong way. They can make it harder for eggs to implant and can cause a whole slew of problems for your overall health depending on the relation to different organs that they might be adhered to. All sorts of things, but it doesn't always, right? One thing that I would ask my provider that's recommending that is what other options are available, what other things might be impacting my fertility? Have you seen any other types of providers? Have you seen an OB/GYN or maybe a fertility specialist in that regard or gotten a second opinion from them? Sorry, I think she said. Yep. I'm trying to see that it was told by acupuncture. Yeah, so I would maybe consult another type of provider. But trying to conceive for seven months is kind of a long time, but it also could take up to a year without there being any problems at all for just any random average to get pregnant too. That is just what was going through my mind. Is that the only thing that you are treating and addressing or is it part of an overall care plan? Are you seeing anybody else? That type of thing. Meagan: Mhmm, yeah. And like she was saying, maybe a different provider, maybe a pelvic floor specialist to even just dig into what those adhesions look like or a care provider, but yeah. It can. I'm going to go find it. I was just scrolling, but I'm going to go find it. Do you remember, Julie, do you remember her name? Julie: You're asking me if I remember anybody's name?Meagan: I'm the name person. I keep thinking it starts with a J. I'm going to find it though and I'm going to drop it in for you, AJ. Okay, “I just had a VBAC a few months ago and,” awww. “I'm so thankful for both of you.” Thank you, Allison. That's so sweet. So, so sweet. Julie: Thank you. How to manage sciatica painMeagan: Congratulations! Okay, Jenn. “I'm 39 weeks. My sciatica only allows me to walk for about 20 minutes without cramping. I see a chiropractor twice a week, but other than that, what can I do to help keep my baby in a good position and get labor going?” I would suggest the Miles Circuit right off the bat. Miles Circuit is wonderful. You can do it multiple times a day. There are three circuits and you want to try to do it for a minimum of 30 minutes but sometimes you have to lead up to that. That would be something that I would suggest. Maybe giving it a try. Also, Spinning Babies is very much a balance factor in creating balance.It sounds like your sciatica is not loving you right now and that is hard. That is hard, so being mindful also of being symmetrical and getting out of the car. I know that sounds really weird, but not stepping out with your left. Stepping out with your right. Trying to move out together because that separation with relaxin and things like that can cause the pelvic to shift, which then causes sciatica issues and all of those things. But I would suggest Miles Circuit. I would also suggest a massage. Getting things relaxed and soft because sometimes when things are tense, we've got that sciatica issue. Julie, what else would you suggest on that?Julie: Yeah. First of all, I would say that if you are in pain, then don't do anything. It's okay to stop. You don't want to hurt yourself and cause pain, tension, and stress in your body because that could interfere with your natural labor hormones. But honestly, I would think going to a chiropractor twice a week and walking 20 minutes a day is great. I think that's great to do. If that's all you can do, then I don't think you need to do anything else. 39 weeks could still be early based on when your baby wants to come, so don't feel like you urgently have to do anything. If your provider is pushing you a little bit, then it might be time to have a conversation about what your boundaries are and where you are willing to go as far as how far along gestationally before you interfere. But yeah, what Meagan says for sure. The Miles Circuit, absolutely. Two positions in the Miles Circuit are that you are resting pretty much and just creating more space in the pelvis. I would say maybe if you want to try changing it up from walking, one of my favorite things is going up and down the stairs sideways two at a time. It's kind of like walking, but you are really opening up that pelvis. So you go up with the right foot first, down with the right foot first, then switch to the left foot first, up and down. That's creating a nice, flexible, open space and lots of equal balance like Meagan said. Meagan: And listening to your body on that. Listening to your body. If it's too much, stop or just do three sets of stairs, three stairs. Just don't push your body. Yeah. But I like that one. I actually did that with a client at a birth center where there were some stairs. We did that to get labor going and it totally helped. It was amazing. Julie: Yeah, I love that. That's my favorite or curb walking. You just walk right foot on the curb and left foot off the curb and then switch with the other foot to keep that balance and stretch both sides of the pelvis. But yeah, change it up a little bit. I think you are doing great, personally.Meagan: Mhmm, yeah. Going to the chiropractor that often is amazing. Realigning. But yeah, 20 minutes, maybe cut it down to 15 minutes. Just a little less before you are in too much agony. Yeah, yeah. Julie: It's okay to take a rest. It's okay to not do it one day too, or a few days, or every other day or twice a week. Meagan: Yeah. I would also say shaking the apples which is a Spinning Babies thing, but that actually really relaxes and softens down there and can help with sciatica pain. That's just where you put the rebozo around your bottom and have someone sift, so you're kind of doing this.Julie: It's so fun. Meagan: This is so hard to be on a Live because I talk a lot with my hands. If you can see this in this video, Julie is very much here and I'm dancing.Julie: I even brushed my hair today. Meagan: You kind of get sifted and it really is nice for that sciatica. Okay, oh let's see. Just listened to all,” oh my gosh, “all 198 episodes of you guys.” Oh yes, yes. I just can't believe that we are at 200 episodes. I was telling my husband today and he was like, “Whoa. That's a lot.” Yeah, that's awesome. So awesome. Okay, do you guys have any other questions coming in on here? What else would you like to talk about, Julie, while we are waiting on any other questions? It's been a minute. It's been a minute since you've been on here. Julie: I know. It was 15 minutes before it was about to start. I was editing photos all day, so I was like, “Oh shoot, I should brush my hair and change my shirt,” because I had this frumpy little shirt on. I'm like, “We're going to be on video today. We never usually do that.” Meagan: Yeah. You don't have to be induced at 39 or 40 weeks!Julie: So it's just interesting. Let me think. I was just trying to think what has been bugging me from The VBAC Link Community lately. Not bugging me, but you know when you just want to grab ahold of people's shoulders sometimes and say, “This doesn't have to be this way. You don't have to do this!” Or just like, “It's okay to stand up for yourself.”I think a lot of the things I have been seeing lately a little bit is when people talk about induction or their doctor not letting them go past a certain amount of weeks. Meagan: Yeah. Julie: That's really kind of heartbreaking because, in America, we have a really frustrating maternal health care system. It's really easy to get trapped in that if you're not comfortable standing up for yourself if you don't know that it's okay to stand up to you're provider, and if you don't have an opinion about everything that you possibly can in birth. It's hard when I see people going in and getting induced. We'll see posts all of the time where people will be like, “Oh my gosh, I'm 6 centimeters. I've been soft for 8 hours. I was induced at 39 weeks. My provider said this and that and the other.” I just want you to know, everybody. You do not have to be induced at 39 or 40 weeks in order to get a VBAC.Meagan: You don't. You don't. I also wanted to talk about the opposite. On the flip side of that, I want to say that you can have a VBAC if you are induced. Julie: Yes. Nipple stimulation to induce laborMeagan: So there are both sides where it's like you have to be induced or you can't go for a VBAC or it's, “I will not induce you.” And so anyway, it's so hard. I was just looking. We have a group member that posted a couple of hours ago and she said, “I have a question about nipple stimulation to induce labor. I've been trying since yesterday and I do get contractions although they might just be Braxton Hicks because they are not really painful. But as soon as I stop, the contractions also stop. Any advice?”I just want to talk about this. In fact, I think Julie wrote a blog about this. I think, didn't you write a blog about nipple stimulation and pumping to induce labor? I'm pretty sure you did. Julie: I'm pretty sure that was you.Meagan: It might have been. I don't remember. Julie: That doesn't sound like anything I would write. Meagan: Well, yes. So this is something that I actually did when I was in early labor. I wanted to talk about that, but my midwife kept saying, “Hook up to the pump. Hook up to the pump.” I hated that thing. That thing was not my friend, but it worked. It helped, I should say. But sometimes it doesn't. And so kind of similar to what this group member is saying is that it sounds like it is releasing oxytocin in your body and it's stimulating something. Something enough to cause your body to contract or have some sort of spasms in your uterus, right? Which is a contraction whether or not it is strong.But when you stop, it stops and so that is– this is what I tell my clients too. That is a sign that your body is not quite ready or it's not going to respond to this type of method right now. Pumping is a really great option, but if it's not going, I would say to pause. Maybe just give it a break and see what happens. You can try again later or follow the advice of your provider. I would say that it's not bad that your body is not responding and it doesn't mean anything like it's not going to work ever, but it just sounds like your body may not be ready. So my advice is to maybe give it a break, try it a little bit more, try it a little bit longer and see, or maybe go have sex instead and try to release oxytocin in a different way in your body. So anyway, I just saw that. Are there other questions that have come in? Do you see any?Julie: Yes, there is. Meagan: Okay.Julie: Hi Paige, by the way! Hi Paige. Paige commented on the pumping to induce labor blog. Meagan: Oh yeah. Julie: Okay, so Tiffany, nope. Not Tiffany. It's before that one. Tiffany, I'm going to get there. Angel said that if we want to read her post in the group that she would love some thoughts. So I found Angel's post and I will read it. I love this. I have lots of thoughts, so Angel, if you are still watching, could you drop your location in the comments so I know? Oh, you're in New Zealand. You already said that. VBA3CJulie: She said, “I would love your opinions. I have contacted 15 midwives in New Zealand and all have said ‘no' to a VBAC after 3 C-sections. The main reason why I don't want a fourth Cesarean is because fentanyl is in a spinal block.” P.S. a lot of people don't know that. When you have an epidural or when you have a spinal block, the epidural is not the medicine. It is the method of giving it into your body. An epidural has lots of different medications in it. Fentanyl is one of them. Tramadol is another one. Sometimes there are antibiotics in there with them. But a lot of people don't know that fentanyl is in an epidural and a spinal block. Okay, so she says, “Tramadol is the pain relief afterward.” Tramadol is a form of morphine. That will be present in the milk which is one of the reasons why she doesn't want it. Antibiotics afterward, milk again, and all of her children have had severe colic and reflux to the point of sleeping four scattered hours overnight until they are 16 months old. All day naps are held upright. This is physically and mentally shattering. Could there be a link between colic, reflux, and antibiotics? It may be a possibility. “I live a 100% organic, tox-free lifestyle. I don't even take pain relief for headaches. Cesareans go against my holistic lifestyle.”“That being said, the first two Cesareans, I believe, were medically necessary.” Cord wrapped very tightly around necks, very thin and short. Babies were wrapped up by their necks tightly and couldn't move down, couldn't descend. Fetal distress straightaway for the first baby, second repeat Cesarean for the same issue. The third, the cord was fine, loosely on my tummy, but the amniotic fluid was a 4. It should have been a 7. She was pressured into a repeat Cesarean in case there was the same issue as the first two. She said, “I just need tough love, realistic answers.” Should she just have a fourth Cesarean and do everything else holistically? Meagan: That's tough. Julie: Yes. Meagan: We had a message come in earlier. I'm wondering if it's the same person because it sounds strangely familiar. New Zealand. I can't speak. But wow, that's tough. That's tough because you have good, solid reasons, beliefs, and feelings. Yeah. You know, it sounds like you are getting a lot of pushback in your area. A lot. That's a lot. There may be somewhere underground there that would allow it, but yeah. I don't know. It seems like you have enough reason to not do certain things. I don't know. I would maybe. I would maybe, actually. What would you do, Julie?Julie: Well, she says she wants tough love and I love tough love. So when I get permission for it, I will fork it out. Meagan: Yeah. Julie: So here's the thing. First of all, vaginal birth after three Cesareans, I love, love, love that we are seeing more stories come out about VBAC after 3 C-sections. Meagan: Me too. Julie: There's not a lot of data to support its safety or not. We have a few studies if you want to google VBAMC. We have a whole blog about the information that is available, but there's just not a lot out there. The way we get a lot of information out there is for more people to do it, right? That might not be a risk that a lot of people are willing to take. Personally, I would probably try it because I kind of know all of the information and everything, but I don't know because I haven't been there.So here's my tough love, okay? It sounds like you have talked to a lot of providers. This sounds like the providers you have talked to do not want to support you in your choice. And so when that happens, and this is for anybody who can't find a supportive provider not necessarily just directed at you, Angel, you have a few options. First is to go into labor and wait as long as you can and go to the hospital and fight and fight and fight. Out-of-hospital probably wouldn't take you on as a patient. But depending on, I don't know how the healthcare system is set up exactly out there. So go to the hospital, show up pushing, which I would never recommend that ideally if you could, but that's an option for you, okay? Go into labor. Go into the hospital. Maybe get a doula. Have your partner on board or somebody there who can really heavily advocate for you and be fighting the whole time. Or you can birth unassisted at home, which I also don't necessarily recommend, but there are a lot of people that can do it and do it smartly. Meagan: They have a lot of solid resources.Julie: A lot of resources, have a really solid backup plan, know everything that you need to look for as far as warning signs in labor, maybe labor close to the hospital or in the hospital parking lot or something like that. Neither of those might be good options for you, but it sounds like there's not really a good option anyway. I think also, sometimes I appreciate and envy, to some degree, the holistic lifestyle that you have. Sometimes, if you don't feel comfortable fighting in the hospital or having a baby unassisted, your third option is to have a repeat Cesarean. Meagan: Make it really special. Julie: Maybe you won't have a holistic lifestyle at that moment. ** You're going to have to get some medications that you don't love, right? You're going to risk having those things *** began with the colic and maybe the upset digestive tract from the antibiotics and things like that, but that also might not be the worst thing to have ***. The only thing that you are going to be able to know is what the best choice is even though there is not a good choice. I don't know if that makes sense or not, but yeah. I mean, you can create a nice, beautiful space like Meagan just said. You can ask for the spinal block and see if there are any alternatives to the fentanyl or other kinds of medication that they can put in there. You can ask for a shorter hospital stay. You can look into ways to heal your baby's gut after the C-section. You can look into vaginal seeding which can get the baby's gut populated with your flora from the vaginal canal which is really helpful for the baby's microbiome and things like that. I feel really angry for you a little bit. Meagan: I know. Julie: –that the system is set up to work against you in such ways. But I feel like this is something that you are really going to have to sit with and tune into your intuition hardcore and figure out what risks you want to accept, right? Because it sounds like you are going to have to accept some whether it's birthing with a C-section and not having the birth you want and introducing those different things to your baby, birthing unassisted without a provider present, or fighting as hard as you can in the hospital for your VBAC. Meagan: It infuriates me that people even have to be in this space at all.Julie: Yeah. Meagan: The providers are so worried about supporting people doing vaginal birth after multiple Cesareans, yet they're pushing people and making people feel like they have no choice other than to birth with no provider. I am not saying that someone who births without a provider– I'm not shaming anybody for sure, but I think it's nice to have that supportive provider behind you, that trained, skilled provider. A lot of people that do go unassisted, I'm not kidding you guys, they dive in deep. They are prepared and that's awesome. Good for them. Absolutely good for them. But it just makes me so mad that someone even feels like they are stuck in making that option. Julie: Yeah, I agree. Angel also asked a follow-up question if she could decline antibiotics. Here's the thing. You can decline anything you want to decline. It's just going to depend on what's going to make your providers nervous and if they're willing to provide care or not. I don't know. I don't know if your provider will be comfortable doing a C-section without having antibiotics available during and after the C-section or not, but that's something that you can talk with your provider about ahead of time and see what that looks like. Or have a minimum dose or only one round or something like that. Meagan: Mhmm, yeah. I love that. Sorry, my little boy, this was also part of our technical difficulties. Look at his head. Show everybody your head. Julie: He got konked. Meagan: And your arms, huh. Yeah, he fell today at recess. Julie: All right, let's move on to the next question. Angel, I give you all of my love and support. Meagan: I wish you luck. Julie: Yeah, I do. Please keep us updated. Us, again. You guys, this is killing me. Meagan, you have to let me know when Angel updates you because I'm invested now. Gentle induction plansJulie: Okay, what's next? We have– oh, yes. Let's get to Tiffany. Hi Tiffany. Tiffany M. Okay, so she said that her doctors told her that they will not allow her to go past 39-40 weeks. She was able to control her blood pressure thus far and she had hypertension in her last two pregnancies. Her doctor doesn't want to induce because it allegedly increases the risk of rupture. Meagan: Your voice. Julie: Sorry. “They've been insanely supportive of VBAC but this contradicts what I've been seeing.” Yes. This is what we were talking about before, right? Induction. You can have a VBAC after being induced, but also you don't want to have to be induced at some arbitrary deadline to have a VBAC. Induction does increase the risk of rupture slightly, but when it's managed appropriately, the risk is very minimal. So definitely look into that. Poke your provider. I say “poke your provider”. Don't poke the bear, right? Don't poke the bear. Ask your provider. Talk with them and see because that might not be a provider that is that supportive. It is sad that when you have a provider that you absolutely love and there's this one thing. There's one thing and it sounds like this is the one thing.Meagan: But that's a big deal. Julie: It is a big deal, yeah. Meagan: A big deal, yeah. Julie: And people won't allow you to go past 39-40 weeks. I would bust out the ACOG bulletins on VBAC and the late-term management of pregnancies or something. Meagan: Yeah, and induction. Yes. I was just going to say. Bring them, even if it sounds over the top because I'm going to tell you, print it all off and take it to them. Julie: Do it. Meagan: And say, “But this is what this says. This is who you are under and this is what they are saying, so why can't we discuss a gentle induction plan?” Or, “Let's observe and do more monitoring with all of these things and take it day by day. Take it every other day. I'll do an NST. Let's break it down so you're comfortable. I'm comfortable. We're all doing what is safe for me and baby of course.” Sometimes it sounds extreme, but it might take bringing it in and saying, “Hey. This is what I have found. Let's talk about it. Let's break it down.”Are you going and getting that for her? Is that what you're doing?Julie: I'm responding to whatever comments. Meagan: Oh okay.Julie: Obviously now, I'll just do it verbally. So she said, “Managed how? Through a slow administration of induction medicine?” Yes, absolutely. Yes, so this is the thing. Sometimes you'll hear the phrase “Pit to distress” where nurses will, this is a real thing. It's sad but it is, where nurses will up the Pitocin so aggressively that it literally forces the baby to go into distress so they just do a C-section. It's a very aggressive way to administer Pitocin. You don't want that. You want to do a nice, slow dose. Increase it by 1 or 2 every 45 minutes to an hour. Give your body a chance to respond before upping it even more. I've seen VBAC inductions where they konk out the Pitocin by 4 every 30 minutes and before two hours happens, you're up at the max dose of Pitocin and then the baby gets so stressed out and you have a C-section.Meagan: And the body isn't responding fast enough. Julie: The body's not responding at all because it doesn't know what the crap is going on. It's being slammed with Pitocin, this artificial hormone. That is not an induction that is managed well. A managed well induction is nice and slow. Start with a Foley bulb. Start with a nice, slow dose of Pitocin. Rest during the beginning of it. Give your body time to catch up. While being monitored, that's a nice compromise and making sure everything is being tolerated well. If your body is responding, stop turning the Pitocin up at all or even turn it off after your body kicks into labor. Meagan: Yes. I was also going to say there is something called a “Pit holiday” where sometimes our uterine receptors get too full and overstimulated with Pitocin. It's okay to do a “Pit holiday” and cut it in half. So say you're at 20, let's cut it down to 10 and see how our body responds because sometimes we can be overstimulated and our body is like, “This is too much too fast. I don't know what's happening.” It's not responding and then we cut it in half, our uterine receptors empty, our body kicks into that natural labor, and then boom. We're in labor and we don't even need 20 mL of Pitocin, right? Or like Julie said, we get into this active phase and we feel like we have to keep upping the Pitocin, but if we're getting into the active phase and we're making progress, we don't need to keep pushing Pitocin. And yeah, slow dose. Sometimes, some people, we recorded a story just now and talked about this. It's coming out in October, so let's talk about it right now. Sometimes we get in a space where induction is what's needed this time, but we're not cervically progressed enough to just put in a Foley or a Cook, right? So sometimes, we have to start a low dose Pit, maybe 2, 4, 6 mL max and just let it be for hours. It could take hours, you guys. I'm not kidding. Not three hours, not four, but ten plus hours it can take sitting at that slow, low dose to get the uterus stimulated enough to open just enough to get a Foley or a Cook catheter in comfortably. And then, we start from there. We work with the Foley and the Cook. Maybe you leave Pit right there or maybe they start increasing it or they just do the Pit at 6 or 8 or 10, and then just let the Foley do its thing until it falls out and then we start from there. There are so many ways that we can manage and take things slowly. Walking in, breaking someone's bag of waters is not necessarily slow, managed, and controlled but that's what a lot of providers will do also. They say, “Oh, I'll just bring you in. We'll just bring you in and break your water.” Sometimes, the body doesn't respond to that and it takes hours, and then we've got Pitocin coming into play anyway. But then sometimes, that's the perfect way, right? So we have to take it slowly. We have to decide what's best for us and where we are at cervically can make a big difference of where we start. Julie: Where we are at cervically, I love that. Meagan: Yeah, where we are at cervically. Julie: Cervically, cool. All right. Thank you, thank you. All right, let's move on. Christine, Christina. She says, oh I think it's maybe more of a review. Thank you. Okay, so she says, “Listening in from South Africa.” We have lots of people from South Africa lately by the way. Meagan: Yay. Julie: I say “we” like I'm, anyways. “Been listening to the podcast, binge listening all the time and so amazed at how much I'm learning in each story and from you both. I also love how listening to everyone's stories, especially the C-section stories have helped me process mine and helped me feel much more peace going into my VBAC at the end of this year. Thank you so much for the podcast and everything you guys are doing. I keep sharing relevant episodes with friends that are currently pregnant with their first. Things I wish I had known despite having done a lot to prepare for my first birth.”Meagan: I love that. Thank you. Julie: Aww. I love that. Thank you. Yes, Meagan. Grab this and drop it into the review spreadsheet. Meagan: I know, will you copy and paste it for me? I'm going to read this. I pulled into the group and found a question that just was posted. We actually got a lot of recent questions here in the group and so I figured I'd throw this one in. Julie: Wait, but there are more in these comments, though. Meagan: Oh, keep going. Julie: Do you want me to do the comments first?Meagan: Yes, sorry. I didn't see it. What happens if you don't sign a C-section consent form?Julie: No, you're totally fine. There's AJ, Juleea, and maybe more. Okay so AJ said, “Hypothetically, what happens if you don't sign a C-section consent form? I know they can't just make you take you back, but how would you handle this if they were being forceful?”Meagan: Now that one's super hard because you have to be strong. You have to be really strong. But how I would handle it, I would break it down. I would ask them to break it down and talk about why. “Why are you asking me to sign this form? Am I in danger? Is my baby in danger? Are we facing death?” Julie: Facing death. “Will I die?” Meagan: Yeah, complications by dying. “Are you telling me that my baby and I are going to die right now? Because if we are having this conversation then that probably means that it's not the case.” But yeah, break it down and say, “No. I don't consent to this. I don't feel comfortable with this. If this is not life threatening right now, and this is not emergent, then I want to continue on the path that I'm going.” This sounds really bad and it's so hard because everyone can be– we've got people all over the world, right?Sometimes it's saying, “Okay. I'm going to leave. I'm going to go somewhere else.” We've had that. Julie and I personally have had clients say, “Okay, I'm leaving then. If we're not going to do this, if this is not what's going to happen, then I'm going somewhere else.” And sometimes they change their tune right there because they don't want you to leave. They usually don't want you to leave, so they change their tune and say, “Okay, hold on.” But sometimes, it takes leaving and going to somewhere else that is supportive. But that's not what you really want to do in labor. Julie: Yeah, this is why you want to figure it out before labor starts. Meagan: Yeah, it's not the space that you deserve to be in during this labor journey, but sometimes it's fighting. It's fighting and it's hard. It goes back to what we were talking about with Angel. It makes me so mad that there's not the support that everyone really deserves. We deserve the support, you guys. We're just going in to have babies. That's all. We're just going in to have a baby just like everybody else, but sometimes we're not viewed as that. So yeah. Any other tips, Julie? I mean, yeah. I would say breaking it down and having that conversation, but what would you say?Julie: I mean, I would kind of say the same thing. A lot of the times, I feel like, they just have you sign all of the forms that you might possibly ever need while you are in labor at the beginning of labor because it saves on admin time and it saves on things you have to do later on and things like that. But what I would ask about the C-section form, when they're going through that whole process is, “Do you make first-time moms sign this form?” Because I bet you, I know their answer because they don't make every laboring person sign a C-section form, but they will if they are getting you ready for a C-section or they think that you are at an increased risk for one.And so, we all know what the numbers are surrounding VBAC and what your chance of success is and how, if given the option to try, you are very likely to succeed. So I would just ask that. And if they say, “No,” or whatever their answer is, I would change my next question or next statement. My next statement after they answered would be that, “I will sign it if it is looking like that is going to be an option, but for now, I am planning on a vaginal delivery. Until a C-section becomes imminent, I will refrain from signing the form.” And then if they raise a big fuss after that, I might go to more extremes like what Meagan talked about. But I mean, this is the thing. If it's a life or death situation and you're not looking great or baby is not looking great and I'm not talking about, “Oh, we have some concerns.” I'm talking about, “We need to do something now.” They're not going to care whether the consent form is signed or not, they're going to wheel you to the operating room and save your life or save your baby's life. And so I think that waiting and asking to wait until it looks like a C-section is needed or necessary is a perfectly reasonable option. Meagan: Yeah, I agree. Okay, so I realized that I didn't see because I only saw one last comment from Tiffany saying that she is anti-Pitocin over there.Releasing fear around childbirthJulie: Yeah. Julie has one. And this is a great one for you, Meagan, too. It's how do you release fear around childbirth? I'm 40 weeks today and I'm anxious for labor. My first arrived via C-section at 37 weeks due to high blood pressure and being breech. I never experienced any part of labor and I'm just fearing the unknown. Fearing uterine rupture, not progressing, tearing, all of it. Meagan: Yeah. You know, fear release is so important. So important and I think I've talked about this maybe on my story or maybe in other things, talking about how I thought I released everything, and then I was in labor and there were still stuff that I was processing and working through and having to go through. But a few tips that I have are actually Julie's fear release that she did a long time ago on our YouTube and it's a smokeless or flameless. Julie: Smokeless fear release except that's used very loosely because we did create smoke at a fear release once. Meagan: We did. We did. We did. Julie: There were a lot of people releasing their fears, but yes. Meagan: Yes, I actually remember. That was really crazy. We did that in a VBAC class actually. Julie: Yeah, at my house. Meagan: Yeah, so I actually really, really, really love that activity and suggest it all of the time. I've actually done it with my own clients in labor. We've done it in living rooms on the floor. Obviously, it's hard to do if you're in a hospital at this place, you can't just break that out. Julie: Light a fire, yeah. Meagan: But doing it, and even if it's every night because for me, when I was preparing, I had different thoughts and being on social media didn't help me quite honestly in that very end. And so some of the tips would be the fear release activity, going through, writing them down, burning them, and truly burning them. Burning your fears. Letting them go. Letting them go and accepting whatever is coming your way. Know that you have done all that you can to prepare for whatever does come your way. So that and I also suggest doing that with partners because sometimes partners' fears will trickle in and create fear. Not that they're meaning to do it, but they have fears and then they say things and our minds are like, “Oh, I didn't think about that.” And we have to process that. Another thing would be a social media break. Sometimes social media in the end is wonderful and motivating and positive and keeps us in a great place, and sometimes, it just starts creating more fear. So sometimes we think that taking a total social media break is really healthy and helps process because you can just be with your own thoughts and not with all of the other hundreds and thousands of people on social media's thoughts because everyone is going to have an opinion. Everyone is going to have an experience. You love hearing those just like we love hearing this podcast and these stories, right? But sometimes, those feelings and those experiences can rub off on us, sometimes in a negative way. So if you're noticing that some of your fears and things you've seen and heard on Facebook or social media, any social media platform, maybe take a break from that. I would say journaling is one of the best things I did for myself in processing fear. I was told by my OB that I was for sure going to rupture. He told me that. As I was on the table, he was so glad I didn't have a VBAC because I for sure would have ruptured. For sure. When I heard the words “for sure”, that was very dominant in my mind and it hung with me. So when I'm laboring with my third, I was feeling that in my head. “What if I rupture? What am I doing? Am I doing the right thing?”I knew in my heart that I was doing the right thing but I had self doubt. And so if that starts creeping in, voice it. I would say that my suggestion would be to get it out. Get it out. I'm sure that Julie has seen it, but as a doula, sometimes we can see our clients are thinking really hard in here and they're maybe having self-doubt and things like that. It's just so good to get it out. Get it out. Processing. Getting it out, talking, saying it out loud, hearing yourself say it is the first step to processing it as well. So if you're doing a fear release, don't just write it down. Write it down. Say it out loud and then burn it. That would be some of my suggestions. And then keep educating yourself. Keep educating yourself. You said tearing, rupture, and these are all valid feelings and fears. I want you to know that. These are all valid and you're not alone. But yeah. Fearing not progressing, that's a big fear. I know that. But again, setting yourself up with a great supportive provider who's going to give you time, trust, and giving you the things you need to progress. That will help. Anything you'd like to add? Julie: No, I love that. I want to get a little bit sciency and nerdy on here. I don't know. It's not a secret or anything but I've been doing a butt load of therapy over the last year and a half and part of the things that, at some point, I learned this in therapy, but your brain, I think we all know that your emotional brain and your logical brain are in separate parts. They do not touch each other. They do not talk to each other. They do not know what each other has going on, right? Your emotional brain is very reactive and responsive. It's where a lot of this anxiety comes from. It's where your fear comes from. It's where all of your negative feelings live, well, all of your emotions live. All of your big things. Your logical brain doesn't know what's going on in your emotional brain. They do not communicate with each other or else we would probably all be a lot more reasonable about our entire lives. In order to process your emotions and reconcile them and get rid of your fears, the best thing you can do like Meagan just said, in lots of different ways, is to get them out there. Get them out. Verbally talking about them, writing them down, talking to a therapist, talking to whoever is a nice, safe space for you. Any safe way that you can get them out of your emotional brain, then your logical brain can say, “Oh. That's what's going on over here.” It gives your logical mind a chance to take over and reconcile a lot of these things that are going on and put this emotional brain at ease so they're not fighting and conflicting. They're able to reconcile with each other. I don't know if that makes sense. That's a big thing for me which is like, “Oh yes. I need to get these things out.” Don't stuff your emotions down or stuff your feelings down. Get them out and it helps your brain process and work through them together so that you're not so isolated and your feelings are not so isolated from the other parts of your body that are a lot more logical. Meagan: Yes. Oh my gosh. I love that. Thank you, Julie. Julie: You're welcome. Meagan: Okay, let's see. She has been thinking about taking a social media break, actually. It's really refreshing. Worried about tearing more than uterine rupture. And yeah, tearing is scary. It is scary to think about. Lots of people do tear and it is repairable, but I would say my tip for that would be to really follow your body when it comes time to push whether it be unmedicated or medicated, really listen to your body and when that baby is crowning, just little, little nudges, assuming all is going well and that will help. And then really, baby position, right? We want to work on baby's position because the more the baby is in an ideal position, the better it is for baby to come out. But sometimes we have these little things where we have babies doing this and sometimes we have babies doing this. Julie: Or doing this. Meagan: Or doing this or they come out like this and they do funny things. Tears happen, but try your hardest and let gravity help. Squatting on your side, positions that may reduce tearing and may focus on centered gravity versus a perfect spot, I don't know the word that I'm looking for. A specific spot of gravity. Does that make sense? On your back, the bottom of your perineum has more direct pressure than when you're squatting. It's more central. So working on positions and even if you have an epidural, you can push on your side. You can push squatting assisted. It's totally possible. But yeah, anyway. Tearing is scary. Julie: Tearing happens. I love that you said that. Meagan: Tearing happens. It does. I mean, I'm going to be honest. Julie: Most of the time, it's not that bad. Most of the time. Meagan: No. Julie: I had a first degree with my first VBAC. I didn't tear with my other two. I heard somebody say once, maybe it was on social media or something recently, but the biggest impact on whether you tear or not and how bad is your provider. Meagan: Yeah. We've got providers that just are a little rough. Julie: They force you to push on your back or stretch your perineum out so much. A lot of people think that helps, but it can actually increase your chance of tearing too. I don't know. But yeah, give that a chance too, and talk to your provider seriously about not pushing on your back. Even with an epidural, you can push on your side. Meagan: Yeah. Totally. Totally. Love it, love it, love it. Okay, any other questions that you are seeing coming in? I love that she was like, “Yeah. People say this and then we just nod and assume they're scheduling a C-section.” They just nod like, uh-huh. We have a ton of questions coming in on social media, so are you okay if we do a couple more?Julie: Yeah, I just have to grab my kids in 25 minutes, so I've got some time. And then I want to wrap up and do a little short catch-up on how I've been doing since The VBAC Link. That would be fun, right? Do you think? Meagan: Yeah. Yes. Julie: Okay. Labor expectations Meagan: Okay, so this is from an Instagram follower and she says, “VBAC after a scheduled C-section. Should I expect labor as long as a first-time mom?” Julie: Can you say that again? You broke up just a little bit. Did she say what should I expect as a first-time mom? Meagan: “After a scheduled C-section, should I expect,” assuming she's going to VBAC, “Should I expect just as long of labor as a first-time mom?” So meaning that she's scheduled the C-section, never went into labor, never dilated, things like that. In short, yes possibly. Julie: Yes. Meagan: Yes, right? So my VBAC was my third baby, my first real labor. It was kind of freaking long. It was long. But then, we sometimes have moms that had a breech baby and it was a scheduled C-section. They go in, right? Yes. Julie: Pick me, pick me. I've got some stories. Meagan: Don't share her story. Julie: Did she talk to you?Meagan: No, but I'm going to talk to her. Julie: Okay, good. Meagan: So anyway, but sometimes it just goes really fast and we don't know. So just like a first-time mom, not everyone goes long. Some people are precipitous. Some people can go really long. That can happen too and so yes, maybe is my answer. Okay, let's see. Julie: Wait, wait, wait, wait, wait, wait, wait. Before you go on. Meagan: Oh, you really wanted me to pick you. I pick you, Julie. Julie: Pick me. Pick me. Pick me. Okay, so I just want to let you know that yeah like Meagan said, you are more likely to labor for longer identical to a first-time mom, but man, sometimes this baby is going to fly out and it's going to catch you off guard. And I have two stories, I'm not going to tell them, but I have two stories where the labors were super short. Moms got their VBACs at home on their bathroom floors because the labor just catches you off guard so much. Meagan: It can happen. Julie: Plan on going to 42 weeks. Plan on a 24-hour labor because it's probably not going to be that long, but the more you can, if you expect that, then anything shorter is just going to be encouraging rather than planning on a shorter amount of time and having a longer thing being discouraging. That's my advice. Double-layer suture versus single-layerMeagan: Yeah, for sure. For sure. Okay, this next question is, “Does the type of suture matter much? I had a single-layer but read that double was better.” Julie: Oh, pick me again. Meagan: Yeah. Julie: Sorry, you're looking at me. Meagan: I'm looking at you. Julie: All right, so here's the thing. There used to be a belief that a double-layer suture is, because there are several layers of the uterus, right? The single-layer versus double-layer. A single-layer closure means they sew all of the layers up with one stitch, one suture. Double-layer is where they close it in two separate layers, right? So there used to be a belief that a double-layer suture was safer and would decrease your risk of uterine rupture if you go through vaginal birth, or I guess, overall because you don't have to go for a vaginal birth to have a rupture. But since then, there have been several studies come out that show that there's no significant difference in rupture rates between single-layer versus double-layer closures. So, no. It doesn't make that big of an impact. Now, there has been one recent study that shows that a double-layer closure is optimal, but that one study isn't very big. It's not very credible. It's not as big and not as inclusive as a Cochrane review and things that show that there are not really big differences. So sometimes, people will say, “There's this one study in 2021 that shows this.” See, probably not in that voice, but anyways. But the majority of information that we have shows that it does not matter. However, ten years ago, people used to think that it would make a big impact. Things have shifted since then. Meagan: Yeah, we still have many providers that say it actually determines eligibility based on that. Like, tons. We get emails all of the time. It's like, “Hey, I really want a VBAC but I found out that I only have a single-layer suture, so I can't. Is this true?” So yeah. Okay, ready for the next one? Julie: Yeah. Special scarsMeagan: Low, transverse uterine incision that extends one side vaginally. Vaginally? Can I VBAC? Vaginally? Julie: Vaginally? I wonder if it's a J? Meagan: That's what I'm wondering. Julie: Except she said, “Vaginally.”Meagan: I've actually never heard of a uterine incision extending all the way. Julie: I don't think it can. It can go down into the cervix. Meagan: Yeah, the uterus is up and then it has the cervix. It goes like this. Julie: Yeah. Meagan: Yeah, and then that comes down into the vagina, but they're separate.Julie: I wonder if there's some word confusion there. Meagan: Maybe. I will ask her, but I'm wondering if this is meaning a special scar. Julie: Well, yeah. Meagan: I'm wondering if maybe there is some confusion about a special scar and yeah. People still VBAC with special scars. They do. We have special scars on the podcast. Julie: Leslie's is my favorite birth story. She goes into such detail about the data and everything about that. Meagan: Yes, Leslie did a home birth, right? Julie: Yeah, I think it's episode 18 or something in the teens I think.Meagan: She was really early on. So yes you can. It's still possible. You still want to educate yourself. Just because you can doesn't mean you are going to choose to or that you're going to want to. Julie: Or that you're going to find a provider that's going to support you. Meagan: Or that you're going to find a provider that's going to support you, and so we encourage everybody to do the research, look at the education. We have some blogs. We talk about special scars in our parent's course. We have some episodes, so there is information out there for you guys. Julie: Yeah, the risk of rupture is a little bit higher with special scars, so that's something to consider too, but what an acceptable risk is to you is going to be different for everybody. So I think it goes from about half a percent to maybe 1.2% or something in that range. It's less than 2% overall, and so is a less than 2% risk of rupture acceptable for you? You're going to be the only one to answer that. Meagan: Yeah. Yeah. Julie: Does that make sense? I feel like I didn't understand the words coming out of my mouth. Meagan: Yeah, no. No, it made sense. Julie: Okay, do you ever do that? Anyways. Warning signs and symptoms for uterine ruptureMeagan: Yes. Okay, next question was, “Warning signs and symptoms for uterine rupture?” This is a really great question because we were talking about that, the fear of uterine rupture, and there are signs. There are, I should say, symptoms. Some of the signs and symptoms may be one, pain. Pain down there and if there's an epidural in place, it might radiate up. The uterine rupture that I attended a long time ago, she had an epidural and they kept calling it a hot spot, but it was way, can you guys see me? Way up here in her ribs where it was hurting which is kind of an interesting spot, but it was just radiating where she wasn't numb, where she could feel. So yeah, pain. And also pain that doesn't go away. Pain and discomfort during a contraction or surge comes and is there, and then it goes away, that may be different than the pain that is there, increases with contractions, doesn't go away, and is still very intense. Bleeding, lots of bleeding, lots of bleeding. Stall of labor, where your labor is just not progressing. Baby going up, so moving stations, but dramatically. Like your baby was +2 and now your baby is -2. Stations can be subjective, they say their baby is a 0 but now it's a -1, and they're saying that maybe it's a 0 to +1. It's kind of subjective. Julie: Yeah, they're just centimeters that we're talking about with baby's station. It can vary from provider to provider. Meagan: If you think about my hand to Julie's hand, right? Our hands are very different. They look different. I have long skinny bony dumb fingers that I can't stand. Julie: Not dumb. Meagan: Really wide palms, so my long, skinny fingers versus someone with shorter fingers may be different. One of the number one things that providers look for, although I will say that this isn't always the number one first symptom is fetal heart tones. Fetal heart tones that are just tanking and not recovering, that is a concern. That is a concern and that is a sign. Let's see, what else am I missing? Julie: I'm trying to think. I think that's it. Meagan: I think that might be all. Julie: Yeah, and that's the biggest reason why they're really particular about continuous fetal monitoring for a VBAC. But yes, if you can feel the head on top of your pubic bone, it's kind of weird to really describe that, but I'm not going to show you. Meagan: You can usually see it. There's a bulge. Baby's not in the right spot.Julie: Yeah. Meagan: We also have a blog on that. So, okay. Are there any other questions in the Facebook group that I'm missing, Julie? Because I'm on Instagram right now. Julie: Let me check. Meagan: This one is, “My C-section was because of failure to descend. Do I still have a chance to VBAC?” Absolutely. Failure to descend means that baby just didn't come down. A lot of the time, that's due to positioning, that's due to more failure to wait and let the baby have time to come down. Just because you've reached 10 centimeters doesn't mean it's time to have a baby necessarily. Sometimes baby needs to have time to rest and descend and come down, but yes. Absolutely. You guys, on Instagram, if you're not there, we did pull over. So if you're over here, yay. If not, then I'm going to try and get these answered on Instagram as well. Do we have any other questions?Julie: I didn't see any. Yep, nope. Still no. Meagan: Okay, any other final questions for the eight of you that are left? We'd love to finish up, but yeah. While we are waiting for any other final questions, Julie, did you want to update everybody on how the last couple of months have been for you? Julie's updateJulie: Yeah, I think it was a little bit of a hard transition for both of us. Meagan is doing amazing trucking along, keeping everything going and I'm super excited to see all of the changes and stuff that are going on over on social media and the website and everything like that. I'm really proud of you. You're doing amazing. Meagan: Thank you. Julie: And welcome the new admin, Katie, helping. She's doing an amazing job too, it seems like so that is really great. Yeah, I mean, I've been trucking along with the birth photography thing. I think we talked about that on the podcast episode where I made the announcement that I was leaving, but it's been going really good. I've been to several, many births since the