Podcasts about venous

In this episode, Ihsan Kaadan, MD, MS, discusses how he and Rush clinicians provide tailored, wraparound care for patients with peripheral artery disease (PAD) and chronic venous insufficiency. We also profile Dr. Kaadan's unique role in guiding Rush's multidisciplinary approach to treat these conditions, where he works with cardiologists, vascular surgeons and interventional radiologists to deliver optimal patient care. Dr Kaadan is a vascular medicine specialist in the Rush University System for Health; he evaluates and treats patients with complex arterial and vein disorders. “It's a one-stop shop at Rush, which sets us apart. A patient can come to the vascular medicine clinic, get evaluated for their disease, then start treatment either with me or one of my colleagues in cardiology or interventional radiology. Patients can also receive cardiac rehab and occupational and physician therapy, so they're supported throughout their entire experience

Dr. Jasmine Sukumar and Dr. Dionisia Quiroga discuss advances in adjuvant therapy for patients with early breast cancer and BRCA1/2 mutations, including how to identify patients who should receive genetic testing and the significant survival benefits of olaparib that emerged from the OlympiA trial. TRANSCRIPT Dr. Jasmine Sukumar: Hello, I'm Dr. Jasmine Sukumar, your guest host of the ASCO Daily News Podcast today. I'm an assistant professor and breast medical oncologist at the University of Texas MD Anderson Cancer Center. On today's episode, we'll be exploring advances in adjuvant therapy for high-risk early breast cancer in people with BRCA1/2 germline mutations. Joining me for this discussion is Dr. Dionisa Quiroga, an assistant professor and breast medical oncologist at the Ohio State University Comprehensive Cancer Center.  Our full disclosures are available in the transcript of this episode.  Dr. Quiroga, it's great to have you on the podcast. Thanks for being here. Dr. Dionisia Quiroga: Thank you. Looking forward to discussing this important topic. Dr. Jasmine Sukumar: Let's start by going over who should be tested for BRCA1/2 genetic mutations. How do you identify patients with breast cancer in your clinic who should be offered BRCA1/2 genetic testing? Dr. Dionisia Quiroga: So, guidelines on who to offer testing to somewhat differ between organizations at this point. I would say, generally, I do follow our current ASCO-Society of Surgical Oncology (SSO) Guidelines, though. Those guidelines recommend that BRCA1/2 mutation testing be offered to all patients who are diagnosed with breast cancer and are 65 years old or younger. For those that are older than 65 years old, there are additional factors to really take into account to decide on who to recommend testing for. Some of this has to do with personal and family history as well as ancestry. The NCCN also has their own specific guidelines for who to offer testing to. For example, people assigned male at birth; those who are found to have a second breast primary; those who are diagnosed at a young age; and those with significant family history should also be offered BRCA1/2 testing.  I think, very important for our discussion today, ASCO and SSO also made a very important point that all patients who may be eligible for PARP inhibitor therapy should be offered testing. So clearly this includes a large amount of our patient population. In my practice, we often refer to our Cancer Genetics Program. We're fortunate to have many experienced genetic counselors who can complete pre-test and post-test counseling with our patients. However, in settings where this may not be accessible to patients, it can also be appropriate for oncology providers to order the testing and ideally perform some of this counseling as well. Dr. Jasmine Sukumar: Thank you Dr. Quiroga. Let's next review where we are in current clinical practice guidelines. What current options do we have for adjuvant therapy specific to people with high-risk early breast cancer and BRCA1/2 genetic mutations? Dr. Dionisia Quiroga: Our current guidelines recommend adjuvant olaparib for one year for individuals with HER2-negative high risk breast cancer. This approval largely came from the data and the results of the OlympiA trial. This was a prospective phase 3, double blind, randomized clinical trial. It enrolled patients who had been diagnosed with HER2-negative early-stage breast cancer who also carried germline pathogenic or likely pathogenic variants of either the BRCA1 and/or BRCA2 genes. The disease also had to be considered high-risk and there were several criteria that had to be evaluated to deem whether or not these patients were high-risk. For example, those who are treated with neoadjuvant chemotherapy, if they had disease that was triple-negative, they needed to have some level of invasive residual disease at time of surgery. Alternatively, if the disease was hormone receptor-positive, they needed to have residual disease and a calculated CPS + EG score of 3 or higher. This scoring system is something that estimates relapse probability on the basis of clinical and pathologic stage, ER status, and histologic grade, and this will give you a score ranging from 0 to 6. In general, the higher the score, the worse the prognosis. This calculator though is available to the public online to allow providers to calculate this risk.  For the subset of patients who received adjuvant chemotherapy, for them to qualify for the OlympiA trial, if they had triple-negative disease, they needed to have a tumor of at least 2 cm or greater and/or have positive lymph nodes for disease. For hormone receptor-positive disease that was treated with adjuvant chemotherapy, they were required to have four or more pathologically confirmed positive lymph nodes at time of surgery. From this specified pool, patients were then randomized 1:1 to get either adjuvant olaparib starting at 300 mg twice a day or a matching placebo twice a day after they had completed surgery, chemotherapy and radiation treatment if needed. Dr. Jasmine Sukumar: And what were the outcomes of this study? Dr. Dionisia Quiroga: The study ended up enrolling over 1,800 patients and from these 1,800 patients, 70% had a BRCA1 mutation while 30% had a BRCA2 mutation. About 80% of the patients had triple-negative disease compared to hormone receptor-positive disease. Interestingly, about half of all patients enrolled had received neoadjuvant chemotherapy while the other half received adjuvant chemotherapy.  Looking at the outcomes, this was overall a very positive study. We actually now have outcomes data from a median of about 6 years out. This was just reported in December at the 2024 San Antonio Breast Cancer Symposium. There was found to be a 9.4% absolute difference in six-year invasive disease-free survival favoring the olaparib arm over the placebo arm. What was also interesting is that this was consistent across multiple subgroups of patients and the benefit was really seen whether or not they had hormone receptor-positive or triple-negative disease. The absolute difference in distant disease-free survival was also high at 7.8% and additionally favored olaparib. Most importantly, there was found to be a significant overall survival benefit. The six-year overall survival was 87.5% in the olaparib group compared to 83.2% in the placebo group. This translates to about a 4.4% difference and a relative 28% overall survival benefit in using olaparib.  Now, future follow up is going to be very important. Follow up for this study is actually planned to continue out until June 2029 so we can continue to observe if these survival curves will continue to branch apart as they have so far at each follow up. And I think this is especially important for those patients diagnosed with hormone receptor-positive cancers because we know those patients are at particular risk for later recurrences.  As an additional side note, the researchers also noted that there were fewer primary malignancies in the olaparib group, not just of the breast but also primary ovarian or fallopian tube cancers as well, which is not completely surprising knowing that this drug is also heavily used and beneficial in different types of gynecologic cancers. Ultimately, the amount of adverse events reported have been low with only about 9.9% of patients receiving olaparib needing to discontinue drug due to adverse events, and this is compared to 4.2% reported in the placebo group. Dr. Jasmine Sukumar: You mentioned that the OlympiA trial showed an overall survival benefit, but interestingly the OlympiAD trial looking at olaparib versus chemotherapy in patients with advanced metastatic HER2-negative breast cancer did not show a significant overall survival benefit. Could you discuss those differences? Dr. Dionisia Quiroga: I agree, that's a very good point. So OlympiA's comparator arm was, of course, a placebo. So while this isn't the same as comparing to chemotherapy, it does still potentially suggest that there is a degree of benefit that olaparib can provide when it's introduced in the early local disease setting compared to advanced metastatic disease. I think we need more future trials looking at potential other combinations to see if we can improve the efficacy of PARP inhibitors in the metastatic setting. Dr. Jasmine Sukumar: For patients who do choose to proceed with use of adjuvant olaparib due to the promising efficacy, what side effects should oncologists counsel their patients about? Dr. Dionisia Quiroga: The most common notable side effects, I would say with olaparib and other PARP inhibitors are really cytopenias. Gastrointestinal side effects such as nausea and vomiting can occur as well as fatigue. There are some less common but potentially more serious side effects that we should counsel our patients on. This includes pneumonitis. So counseling patients on if they're short of breath or experiencing cough to let their provider know. Venous thromboembolism can also be increased rates of occurrence. And then of course myelodysplastic syndromes or acute myeloid leukemia is something that we often are concerned about. That being said, I think it should be noted that interestingly in the OlympiA trial so far, there have been less new cases of MDS and AML in the olaparib group than actually what's been reported in the placebo group at this median follow up of over six years out. So we'll need to continue to monitor this endpoint over time, but I do think this provides some reassurance. Dr. Jasmine Sukumar: Since the initiation of the OlympiA trial, other adjuvant treatments have also been studied and FDA approved for non-metastatic HER2-negative breast cancer. So for example, the CREATE-X trial established adjuvant capecitabine as an FDA approved treatment option in patients with triple-negative breast cancer who had residual disease following neoadjuvant chemotherapy. So if a patient with triple-negative breast cancer with residual disease is eligible for both adjuvant olaparib and adjuvant capecitabine treatments, how do you decide amongst the two? Dr. Dionisia Quiroga: If a patient's eligible for both, I honestly often favor olaparib, and I do this because I find the data for adjuvant olaparib a little bit more compelling. There are also differences in toxicity profile and treatment duration between the two that I think we should discuss with patients. For example, olaparib is supposed to be taken for a year total, whereas with capecitabine we typically treat for six to eight cycles with each cycle taking three weeks. There are some who may also sequence the two drugs in very high-risk disease. However, this is very much a data free zone. We don't have any current clinical trials really comparing these two or if sequencing of these agents is appropriate. So I don't currently do this in my own clinical practice. Dr. Jasmine Sukumar: Nowadays, almost all patients with stage 2 to 3 triple-negative breast cancer will be offered neoadjuvant chemotherapy plus immune checkpoint inhibitor therapy pembrolizumab per our KEYNOTE-522 trial data. With our current approach, pembrolizumab is continued into the adjuvant setting regardless of surgical outcome, so that patients receive a year total of immunotherapy. So in patients with residual disease and a BRCA germline mutation, do you suggest using adjuvant olaparib concurrently with pembrolizumab? Do we have any data to support that approach? Dr. Dionisia Quiroga: I do. I do use them concurrently. If a patient is eligible for adjuvant olaparib, I would use it the same way as if they were not on pembrolizumab. That being said, there are no large studies currently that have shown what the benefit or the toxicity of pembrolizumab plus olaparib are for early-stage disease. However, we do have some safety data of this combinatorial approach from other studies. For example, the phase 2/3 KEYLYNK-009 study showed that patients with advanced metastatic triple-negative breast cancer who were receiving concurrent pembrolizumab and olaparib had a manageable safety profile, particularly as the toxicities of these drugs alone don't tend to overlap. Dr. Jasmine Sukumar: And what about endocrine therapy for those that also have hormone receptor-positive disease? Dr. Dionisia Quiroga: Adjuvant endocrine therapy should definitely be continued while patients are on olaparib if they're hormone receptor-positive. An important component of this will also likely be ovarian suppression, which should include recommendation of risk reducing bilateral salpingo oophorectomy due to the risk of ovarian cancer development in patients who carry BRCA1/2 gene mutations. In most cases, this should happen at age 40 or before for those that carry a BRCA1 mutation, and at age 45 or prior for those with BRCA2 mutations. Dr. Jasmine Sukumar: And do you also consider adjuvant bisphosphonates in this context? Dr. Dionisia Quiroga: Yes. Like adjuvant endocrine therapy, adjuvant bisphosphonates were also instructed to be given according to standard guidelines in the OlympiA trial, so I would recommend use of bisphosphonates when indicated. You can refer to the ASCO Ontario Health Guidelines on Adjuvant Bone-Modifying Therapy Breast Cancer to guide that decision in order to utilize this due to multiple clinical benefits. It doesn't just help in terms of adjuvant breast cancer treatment but also reduction of fracture rate and down the line, improved breast cancer mortality.  Dr. Jasmine Sukumar: Particularly in hormone receptor-positive breast cancer, another adjuvant therapy option that was not available when the OlympiA trial started are the CDK4/6 inhibitors, ribociclib and abemaciclib, based on the NATALEE and monarchE studies. So how do you consider the use of these adjuvant therapy drugs in the context of olaparib and BRCA mutations? Dr. Dionisia Quiroga: Yeah, so we are definitely in a data-free zone here. And that's in part because the NATALEE and the monarchE studies are still ongoing and reporting data out at the same time that we're getting updated OlympiA data. So unlike some of our other adjuvant treatments that we discussed, where olaparib could be safely given concurrently, the risk of myelosuppression and using both a CDK4/6 inhibitor and a PARP inhibitor at the same time would be too high. In some cases, even if a patient has a BRCA1/2 mutation, they may not meet that specified inclusion criteria that OlympiA set for what they consider to be high-risk disease. And we know from the NATALEE and the monarchE trial there are also different markers that they use to denote high-risk disease. So it's possible, for example, in the NATALEE trial that looks specifically at adjuvant ribociclib, they included a much larger pool of hormone receptor-positive early-stage breast cancers, including a subset that did not have positive axillary lymph nodes.  In cases where patients would qualify for both olaparib and a CDK4/6 inhibitor, I think this is worth a nuanced discussion with our patients about the potential benefits, risks and administration of these drugs. I think another point to bring up is the cost associated with these drugs and the length of time patients will be on for, because financial toxicity is always something that we should bring up with patients as well. When sequencing these in high-risk disease, my practice is to generally favor olaparib first due to the overall survival data. There is also some data to support that patients with BRCA1/2 germline mutations may not respond quite as well to CDK4/6 inhibitors compared to those without. But again, this is still outside of the purview of current guidelines. Fortunately, we have more potential choices for patients, and that's a good thing, but shared decision making also needs to be key. Dr. Jasmine Sukumar: And while our focus today is on adjuvant treatment for people who carry germline BRCA mutations, what about other related gene mutations such as PALB2 pathogenic variant? Dr. Dionisia Quiroga: That's a great question. Clinical trials in the advanced metastatic setting have shown that there is efficacy of olaparib in the setting for PALB2 mutations. This is largely based on the TBCRC 048 phase 2 trial and that provided a Category 2B NCCN recommendation for patients with these PALB2 gene mutations. However, we're really still lacking enough clinical data for use in early-stage disease, so I don't currently use adjuvant olaparib in this case. I am definitely eager for more data in this area as the efficacy of PARP inhibitors in PALB2 gene mutations is very compelling. I think also, in the same line, there's been some data for somatic BRCA1/2 mutations in the metastatic setting, but we still have a lack of data for the early stage setting here as well. Dr. Jasmine Sukumar: Thank you Dr. Quiroga, for sharing your valuable insights with us today on the ASCO Daily News Podcast. Dr. Dionisia Quiroga: Thank you, Dr. Sukumar. Dr. Jasmine Sukumar: And thank you to our listeners for your time today. You'll find links to the studies discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcasts. Thank you. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:   Dr. Dionisa Quiroga @quirogad @quirogad.bsky.social Dr. Jasmine Sukumar @JasmineSukumar  @jasmine.sukumar.bsky.social Follow ASCO on social media:  @ASCO on X   @ASCO on Bluesky    ASCO on Facebook    ASCO on LinkedIn    Disclosures: Dr. Dionisia Quiroga:  No relationships to disclose Dr. Jasmine Sukumar: Honoraria: Sanofi (Immediate Family Member)  

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is responsible for 9–30% of pregnancy-related mortality in high resource countries and remains a significant, increasing cause of severe maternal morbidity. Peripartum, 50% of VTE events occur in the postpartum interval, which has a 6-fold higher risk compared to antepartum. There is wide variation in LMWH pharmacological postpartum prophylaxis guidance. The RCOG, for example, recommends 10 days of LMWH for all postop CS patients unless it was elective, and additional risk factors exist. The ACOG uses a more selective approach. However, on Jan 16, 2025, a new multicenter retrospective study from the US is raising questions about the efficacy of postpartum VTE pharmacologic therapy. Is there really no need for pp VTE pharmacologic therapy? Or does the answer lie in the reality of VTE as a “low frequency, high acuity” event? Listen in for details!

This week we discuss blood clots A blood clot is a clump of blood that has changed from a liquid to a gel-like or semisolid state. Clotting is a necessary process that can help prevent excessive blood loss when you have a cut, for example. Thrombosis is when a blood clot forms and reduces blood flow. There are two types: Arterial thrombosis occurs when a blood clot forms in an artery. Venous thrombosis occurs when a blood clot forms in a vein. When a clot forms inside one of your veins, it may dissolve on its own. However, sometimes a clot doesn't dissolve on its own, or part of it breaks off and travels elsewhere in your circulatory system. When this happens, the blood clot may get stuck elsewhere and restrict blood flow, known as embolism. These situations can be very dangerous and even life threatening. According to the Centers for Disease Control and Prevention (CDC), 1 in 2 people don't experience any symptoms when they have a deep venous blood clot. When symptoms do appear, it's important to get immediate medical attention. ​ Medical emergency A blood clot may be a medical emergency and life threatening if left untreated. Call 911 or go to the nearest emergency room immediately if you or someone you're with experiences symptoms of a serious blood clot, such as: sudden shortness of breath chest pressure difficulty breathing, seeing, or speaking ​Call a doctor or seek medical attention if you experience throbbing, swelling, and tenderness in one body part.  

In this episode of the PFC Podcast, Dennis and Alex discuss the complexities of trauma surgery, particularly focusing on pelvic injuries and the use of pelvic binders. They explore the subjective nature of truth in medical practice, the importance of research and evidence in trauma care, and the anatomy and physiology related to pelvic injuries. The conversation delves into injury patterns, damage control surgery, and the challenges faced in operational environments. They also engage in a debate about the efficacy of pelvic binders, weighing the evidence and risks involved in their use during trauma care. In this conversation, Dennis discusses the critical importance of evidence-based practice in combat medicine, particularly regarding the use of pelvic binders. He emphasizes the need for medical professionals to understand the nuances of pelvic injuries, especially in a combat environment, and how these injuries differ from civilian cases. The discussion also covers the structured approach to prolonged field care, the management of blood transfusions, and the challenges of imaging in trauma assessment. Dennis advocates for clinical decision-making that prioritizes patient safety and effective care, while also acknowledging the emotional weight of these decisions in high-stakes environments. Takeaways Truth is subjective and varies by perception. Disagreement in medical practice can lead to better patient care. Understanding research quality is crucial in medical decisions. Venous bleeding is more common in pelvic injuries than arterial. Damage control surgery involves multiple phases of patient management. Operational environments present unique challenges for trauma care. Pelvic binders are debated in their effectiveness and necessity. Surgical decision-making requires weighing risks and benefits. Evidence-based medicine is essential but often lacking in operational settings. The role of pelvic binders in trauma care remains contentious. Evidence is crucial in medical practice to avoid misinformation. Dismounted IED blasts result in unique injury patterns. Understanding research and statistics is essential for medical professionals. Pelvic binders may not always be beneficial in every injury case. Timely blood transfusions are critical in managing trauma patients. Imaging plays a vital role in assessing pelvic injuries. Clinical decision-making should be based on patient stability and evidence. Prolonged field care requires a structured approach to patient management. Team collaboration is essential in making difficult medical decisions. Continuous education and training are vital for operational medics. Chapters 00:00 Introduction to the Podcast and Guest 02:58 Understanding Trauma Surgery and Pelvic Injuries 06:13 Research and Evidence in Trauma Care 09:06 Anatomy and Physiology of Pelvic Injuries 12:04 Injury Patterns and Their Implications 14:53 Damage Control Surgery and Patient Management 17:48 Operational Environment Challenges 21:03 The Role of Pelvic Binders in Trauma Care 23:52 Debate on Pelvic Binders and Evidence 26:51 Surgical Decision Making in Trauma 29:47 Conclusion and Final Thoughts 45:19 The Importance of Evidence in Medical Practice 52:34 Understanding Pelvic Injuries in Combat 53:59 Prolonged Field Care: A Structured Approach 01:00:03 Managing Blood Transfusions in Critical Care 01:10:06 The Role of Imaging in Trauma Assessment 01:18:00 Clinical Decision-Making in Prolonged Field Care For more content go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠ Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care

Hey Friend, For those that haven't been following along, I have been struggling with symptoms of Pelvic Venous Disorder or PeVD or better known as, Pelvic Congestion Syndrome, for the last year.  It all started with an ovarian cyst like pain, but I later learned that my “menstrual cramps” I was feeling on and off throughout the month, not just during my menses, was also due to these enlarged veins.  The heaviness and cramping was starting to get so uncomfortable that standing or sitting for too long was painful, and even exercise started to become painful.  Thankfully sex was never painful, but painful intercourse or dyspareunia, especially pain or cramping with and after arousal or orgasm, is a very common symptom of PeVD.  I was not a typical presentation for this diagnosis, so it surprised me when I found out from an ultrasound.  So I share my story so that others with pelvic pain, constipation, heaviness, sharp abdominal pain, low back pain or pain with sitting, standing, or exercising, can start to become aware of this diagnosis and advocate for yourself.  As many gynecologists do not believe this condition is a cause of pain…. And I can tell you… it most definitely IS!   After two procedures using coil embolization and sclerotherapy to close off the dysfunctional varicose veins in my pelvis, it was identified that a compression of my Iliac vein was pretty severe and needed to be treated with a stent.  I am two weeks postop and recovery has been a journey.  Many things I was not expecting, so again, I wanted to share with the World so that maybe you can feel more prepared and aware of the treatment options out there for you! Thanks for following along on my health journey and sending all the love and supporting messages, it has meant a lot!  As always, if you are experiencing any pelvic floor/women's health issue like urinary incontinence/leaking, pelvic pain, pain with sex, urgency, heaviness/prolapse or any other back/hip/joint pain let's get you booked for a virtual coaching session or in person physical therapy session for a more individualized plan and one-on-one instructions so you can feel confident in your body and start healing today!!    Make Sure to reach out to> PTDes@balancedmomtality.com  AND/OR Join my FREE Facebook community for ACCOUNTABILITY and a safe and supportive place to share and support each other!> https://www.facebook.com/groups/1696216757461633/    Join my VIP Insider group and receive my Newsletter full of great tips and tricks and upcoming resources! > https://newsletter.balancedmomtality.com/   Follow and get tips/tricks on:  Facebook> @thebalancedmomtality Instagram> @the_balanced_momtality   Learn > www.balancedmomtality.com

Our guest Dr. Mike DeBord, the visionary Founder and President of B3 Sciences, explains how Blood Flow Restriction (BFR) bands are transforming the fitness industry. Dr. Mike shares the science behind these revolutionary exercise bands and demonstrates their use. Learn how BFR bands can: Boost Growth Hormone production Increase vascular efficiency Help combat osteoporosis and dementia Discover how B3 Sciences is making workouts more effective than ever before. Watch the full episode and see how you can elevate your fitness routine with this innovative technology! #BFRBands #FitnessTech #GrowthHormone #HealthRevolution https://yakking.b3sciences.com Timeline 01:50                     What are BFR bands 02:10                     Osteoporosis myths 12:00                     Using BFR bands 13:50                     BFR bands& cardiovascular issues 20:20                     BFR & growth hormone 23:40                     Venous supply & varicose veins 26:20                     Safety 29:20                     How to get BFR bands 31:00                     Anti-ageing 34:10                     Weight loss 37:00                     Dr. Mike's tip 5 minutes of daily exercise 38:21                     Contact Dr. Mike The Yakking Show is brought to you by Peter Wright & Kathleen Beauvais contact us to be a guest on our show. https://TheYakkingShow.com   peter@theyakkingshow.com    kathleen@theyakkingshow.com  Join our community today so you don't miss out on advance news of our next episodes. https://bit.ly/40GdxCG Here are some of the tools we use to produce this podcast. Kit for sending emails and caring for subscribers Hostgator for website hosting. Podbean for podcast hosting Airtable for organizing our guest bookings and automations. Spikers Studio for video editing   Clicking on some links on this site will let you buy products and services which may result in us receiving a commission, however, it will not affect the price you pay.  

Stroke survivor Molly Buccola inspires others with her recovery from venous sinus thrombosis and her mission to bring connection and hope to others. The post Molly Buccola's Recovery from Venous Sinus Thrombosis: A Story of Resilience and Purpose appeared first on Recovery After Stroke.

Dr. Gillett, James O'Hara, & Jake Fantus MD discuss Testosterone, Sexual Function, & fertility. 00:00 Intro01:47 Secret Shopper Study06:58 Dr. Fantas TRT patients 09:16 Are podcast responsible for popularizing TRT? Subcutaneous TRT.12:38 Coming off TRT 16:22 Testicular fibrosis/fertility with long term use21:56 Varicocele 28:31 Venous leak30:34 Guidlines 34:33 Lifestyle changes to improve ED37:25 Epigenetics and Fertility 39:56 SSRIs 41:18 Clomid 45:30 Lab work overestimating free T52:40 Traverse trial 56:31 Aspirin57:03 FSH and fertility in men 01:00:37 Gonadorelin01:03:05 Male Birth Control 01:06:29 How many people have tried TRT?01:09:49 Did TRT create the Red Wave? 01:12:07 Outro Link to Health Update: https://youtu.be/Fe9_vNE2RgQLink to The Longevity Clinic Movement?: https://youtu.be/QKjMujVZLcULink to calculate your free testosterone: https://www.issam.ch/freetesto.htmFor High-quality labs:► https://gilletthealth.com/order-lab-panels/For information on the Gillett Health clinic, lab panels, and health coaching:► https://GillettHealth.comFollow Gillett Health for more content from James and Kyle► https://instagram.com/gilletthealth► https://www.tiktok.com/@gilletthealth► https://twitter.com/gilletthealth► https://www.facebook.com/gilletthealthFollow Kyle Gillett, MD► https://instagram.com/kylegillettmdFollow James O'Hara, NP► https://Instagram.com/jamesoharanpFor 10% off Gorilla Mind products including SIGMA: Use code “GH10”► https://gorillamind.com/For discounts on high-quality supplements►https://www.thorne.com/u/GillettHealth#testosteron #erectiledysfunction #hormones #podcastAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Africa Melane speaks to Dr Johan Blignaut, a specialist surgeon at Vein Centres South Africa on Chronic venous insufficiency. Dr Blignaut explains the health issue, what to look out for and how to treat it.See omnystudio.com/listener for privacy information.

Send us a textIn dieser Folge dreht sich alles um die Frage rechts vs. links bei der ultraschallgestützten ZVK-Anlage in die V.subclavia: Shin KW, Park S, Jo WY, et al. Comparison of Catheter Malposition Between Left and Right Ultrasound-Guided Infraclavicular Subclavian Venous Catheterizations: A Randomized Controlled Trial. Crit Care Med. 2024;52(10):1557-1566. doi:10.1097/CCM.0000000000006368Im Studio mit dabei: Lena Gaissmaier, wiss. Mitarbeiterin der Klinik für Anästhesiologie am UKHD

Soft Cock Appreciation Week know that when maintaining an erection is a challenge, there may be a physiological root that unfortunately is not easily or commonly treated by traditional medicine.  “Imagine pumping up a bicycle tire that has a pinhole leak, no matter how you pump it, that tire just isn't going to stay firm, so too is the way of Venous leak”. This is the wisdom of Nigel Shaw, the creative innovator and inventor of Xialla, an easy to wear, uniquely designed penis ring for men with Venous leak. Erica Leroye and Nigel delve into the world of Venous Leak and Xialla: What IS Venous leakage, understanding the frustrations that come with this particular challenge, how it's underserved in traditional medicine, and differentiating physical from the psychological roots when maintaining is the predominant concern.  Some unique signs and symptoms of VL and lifestyle changes that may help Innovating a new solution and how the Xialla ring works for venous leak as well as for other sexual enhancing play The Xialla community as a resource and tips for others who want to support men's fears and vulnerability. For More Information and to Connect With Nigel Shaw Xialla.com For More Information and to Connect With Erica Leroye https://www.flowcode.com/page/creativebodyrelease.com For More Information and to Connect With Soft Cock Appreciation Week https://www.softcockweek.com/ We have MERCH! Check out our storewww.softcockweek.com/store and support both Soft Cock Week and this year's, once we make a profit, partner SELFED (getselfed.org) Chapters 00:00 Introduction to Soft Cock Appreciation Week 03:25 Understanding Intimacy and Erection Dynamics 06:20 The Invention of the Xialla Device 09:13 Personal Journey and Health Challenges 11:54 Exploring the Market for Erectile Dysfunction Solutions 15:13 The Mechanics of Venous Leak 17:53 Demonstrating the Xialla Device 19:36 demo of Xialla ring 21:06 The Magical Benefits of the Xialla Device 24:04 Understanding Venous Leak in Depth 24:22 New Chapter 26:27 The Psychological Aspects of Erection 27:53 Conclusion and Final Thoughts 34:45 Navigating Interruptions in Intimacy 35:51 The Impact of Masculinity on Mental Health 37:48 Understanding Erection Challenges 39:22 The Role of Xialla in Sexual Health 42:16 Integrating Xialla with Other Treatments 47:41 2nd demo 49:25 Creating Safe Spaces for Men to Share 52:45 The Emotional Side of Erectile Dysfunction 56:38 Exploring Alternatives to Traditional Intimacy 58:01 The Limitations of Medical Solutions 01:01:44 Benefits of Xialla Beyond E Soft Cock Appreciation Week, erectile dysfunction, venous leak, intimacy, Nigel Shaw, Xialla device, sexual health, men's health, psychological effects, innovation

In this episode, we discuss for educational purposes only, the concepts associated with VTEs and the relevant pharmacotherapeutics, for pharmacists in training. ---- Note: The views of this podcast represent those of my guest(s) and I. -- Note: Purpose of these episodes- not at all, for advice or medical suggestions. These are aimed to provide support for peer pharmacists in training in educational and intellectually stimulating ways. Again, these are not at all for medical advice, or for medical suggestions. Please see your local state and board-certified physician, PA or NP, and pharmacist for medical advice and suggestions. --- Note: Some of the content produced involved the use of A.I. .

Hey Girl, Do you suffer from chronic pelvic pain or heaviness? Hemorrhoids? Ovarian pain or cysts? What about bloating or constipation? Is it worse with standing or exercise? Maybe sex makes it worse? It's possible you have Pelvic Venous Disorder (PeVD) or recently known as Pelvic Congestion Syndrome. This Diagnosis is so under diagnosed and missed and many times the same symptoms are attributed to things like Endometriosis, PCOS, IBS, or ovarian cysts and fibroids. PeVD is a part of my story and I have a few episodes talking more about the disorder itself and how to identify it and many holistic things you can do to help so check those out if you would like! Inside this week's episode I am diving more into my personal journey and updating my tribe on how I am doing since my embolization procedure.  I share my hopes, my struggles, and my experiences with chronic pain and what my plan is moving forward.  Thank you to all of my amazing listeners and friends who have reached out to check in on me and let me know that sharing my journey has been helpful for you! You all give me so much strength and support and just know, I'm here to do the same for you!  As always, if you are experiencing any pelvic floor/women's health issue like urinary incontinence/leaking, pelvic pain, pain with sex, urgency, heaviness/prolapse or any other back/hip/joint pain let's get you booked for a virtual coaching session or in person physical therapy session for a more individualized plan and one-on-one instructions so you can feel confident in your body and start healing today!!    Make Sure to reach out to> PTDes@balancedmomtality.com  AND/OR Join my FREE Facebook community for ACCOUNTABILITY and a safe and supportive place to share and support each other!> https://www.facebook.com/groups/1696216757461633/    Join my VIP Insider group and receive my Newsletter full of great tips and tricks and upcoming resources! > https://newsletter.balancedmomtality.com/   Follow and get tips/tricks on:  Facebook> @thebalancedmomtality Instagram> @the_balanced_momtality   Learn > www.balancedmomtality.com  

Today's episode is a throwback to ESVS Annual meeting in Krakow. Prof. E.Avgerinos has shared his knowledge about pelvic venous disease, while also taking opportunity to raise awarness on this condition. We focus on an overview of the disease with detailed information on pelvic embolisation- take a listen, you won't regret it.

Dr. Megaly on Intro to Peripheral Arterial & Venous Disease

0-20: Chet Paulsen introduction and talking about the birth of Rockcuffs, understanding Blood Flow Restriction, design of BFR cuffs. Design problems are the main cause for safety issues. Truly dissecting research and understanding improper or misrepresented studies. Hormonal response to BFR, endocrine response, cause for DOMS. Using BFR for pain reduction for up to 24 hours afterwards.20-30: BFR reduces pain, improves strength and muscle size, improve adherence to use, uses for recovery. Ability to improve Vo2 Max levels. Importance of using BFR on both limbs.30-40: Targeting both sides with BFR as both limbs become affected after an injury/surgery. Average person does not know their 1 Rep max, can use BFR with minimal exercises with process of tightening and loosening to have benefits. BFR can have benefits during passive range of mobilization and joint mobilizations. BFR is not just mechanical it is endocrine, metabolic hack. Hormonal release is systemic, hypothalamus will put hormones in motion. Cells become more permeable to IGF Insulin growth factor. M Torque 1 is where it makes transition from blood stream to the muscle. BFR can have benefits for slowing diseases like Parkinson's due to angiogenesis process. Importance of using BFR post injury.40-50: Contraindications to using BFR. Safety and injury issues with BFR come from high pressure. Pressure changes when exercising, Arterial Occlusion pressure changes on muscle based on position of muscle and also from rest to exercises as blood flow increases. Venous pressure is 1/10th of arterial, veins are more compliant as they have a smaller muscle around them, hold 70% of blood volume. Venous occlusion happens between 20-70mm of pressure. Rock cuffs are rigid and equal efficiency pressure of 2 inches. Pneumatic cuffs tend to bubble and limited adequate pressure, too much pressure in the middle. Most pneumatic cuffs are shiny object tools. Understanding cuff size and efficient pressure to limb size.50-60: Pressure doubles under cuff during exercise, more pressure is not better. Time it takes for set up and ease of putting on cuffs being a factor. Understanding measuring venous pressure, difference between lean individuals and bigger individuals and use of pressure on cuff. Reinforcing again that the pressure in the cuff when the muscle is relaxed changes when the muscle is contracted. 30-15-15-15 with the rest breaks is the aerobic capacity of the muscle. The middle part of the last set, fatigue should occur. Reps should be consistent without a pause, pause means fatigue is setting in and too much pressure. Don't need fancy equipment to tell you how tight a cuff needs to be.60-70: Understanding proper placement and use of Rockcuffs, adjusting pressure, dosage of exercise. Arterial flow is never full occluded, do not need to fully occlude arterial flow. 18-20 minutes is max time of being occluded. Feedback and observation are best clues to understanding occlusion and fatigue levels. Lactate levels above normal for 10 minutes 3x week, hypothalamus will start it's process. BFR has to be consistent and used as a supplement to exercise not just one set of exercise or one time use during a week.70-80: BFR is a partnering with body system response not a punishment or trick system like most training programs. Calorie consumption is important for during use of BFR. Central aminos, hydration are key for building blocks IGF, and M Torque 1 process. Protein synthesis will be optimized with BFR, hydration and central aminos. Avoid caffeine for 90 minutes beforehand using BFR routine, Have caffeine after because it is a vasoconstrictor. Following BFR want vasodilation response after Un occluding. BFR allows to do exercise with less weight and less injury due to lower resistance and focus on form and technique. Understanding 30-15-15-15 and 30-30-30 regimens. Want to keep pressure low and regimens prescribed the proper way to ensure adherence and reduce DOMS. And more…

Venous Ablation is a minimally invasive office procedure to fix leaking superficial veins in the legs using radiofrequency heat.

Audible Bleeding editor Wen (@WenKawaji) is joined by 1st year vascular surgery fellow Richa Kalsi (@KalsiMD), 3rd year medical student Nishi (@Nishi_Vootukuru), 4th-year general surgery resident Sasank Kalipatnapu (@ksasank) from UMass Chan Medical School, JVS editor Dr. Forbes (@TL_Forbes), JVS-VLD associate editor Dr. Arjun Jayaraj and JVS social media liaison Dr. Haurani to discuss some of our favorite articles in the JVS family of journals.   This episode hosts Dr. Amy Felsted, Dr. Salvatore Scali, and Dr. Arjun Jayaraj, the authors of the following papers. Dr. Arjun Jayaraj and Dr. Haurani will also spend time discussing a virtual special issue, centered around iliofemoral venous stenting published in the Journal of Vascular Surgery, Venous and Lymphatic Disorders that includes six articles published between August 2023 and May 2024.    Articles: Part 1: A patient-centered textbook outcome measure effectively discriminates contemporary elective open abdominal aortic aneurysm repair quality by Dr. Felsted, Dr. Scali and colleagues.    Part 2: Virtual special issues on contemporary role of iliofemoral venous stenting    Show Guests  Dr. Amy Felsted (@aefelsted): Completed fellowship at Dartmouth-Hitchcock, Currently an assistant professor of surgery at Boston University School of Medicine and practicing vascular surgeon at the VA in Boston   Dr. Salvatore Scali: Professor of Surgery at University of Florida Division of Vascular Surgery and Endovascular Therapy, program director of the vascular fellowship at University of Florida.   Dr. Arjun Jayaraj: Vascular surgeon at the RANE Center in Jackson, Mississippi with a focus on the management of venous and lymphatic diseases, Associate Editor of JVS-VL.  Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

VISIT US AT ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠NCLEXHIGHYIELD.COM⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ No matter where you are in the world, or what your schedule is like, access the entire course at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.NCLEXHighYieldCourse.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  The NCLEX High Yield Podcast was featured on ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Top 15 NCLEX Podcasts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠! Make sure you ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠JOIN OUR NEW VIP FACEBOOK GROUP!⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@NCLEXHighYield ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. Subscribe to our newsletter at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠nclexhighyield.com⁠⁠⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/nclexhighyield/support

Get caught up on the current best practices and guidelines in venous interventions. Dr. Adam Raskin covers this and more, with host Dr. Sabeen Dhand in this discussion of DVT and PE treatments. Dr. Raskin is an interventional cardiologist, medical director of Cardiac ICU, and Co-Director of the PERT program at Mercy Health in Cincinnati, Ohio. --- CHECK OUT OUR SPONSOR Imperative Care https://imperativecare.com/vascular/ --- SYNPOSIS Dr. Raskin shares his comprehensive approach for treating patients with DVT and PE, highlighting recent advancements in thrombectomy systems, as well as underscoring the need for more randomized trials to further build on current venous disease treatment guidelines. The doctors also touch on the significance of accurate diagnostic tools and thorough follow-up to improve patient outcomes. --- TIMESTAMPS 00:00 - Introduction 10:58 - Approaching DVT & PE Patients 19:04 - Thrombectomy Advancements 24:02 - Iliofemoral Interventions & Standard Practices 26:32 - Accessing Tibial Veins & Clearing Clots 38:59 - Follow-Up & Data Collection 41:09 - Future of Venous Interventions --- RESOURCES The 2023 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part II Endorsed by the Society of Interventional Radiology and the Society for Vascular Medicine: https://www.jvsvenous.org/article/S2213-333X(23)00322-0/fulltext

Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Ana I. Casanegra, M.D., M.S. Venous thrombosis is an under diagnosed and potentially serious health condition, yet in many cases its preventable and certainly treatable when found.  Its most serious potential complication is embolization, most commonly to the lung. As a medical condition, venous thrombosis has been known for many years. In fact, the triad of contributing factors to venous thrombosis including venous stasis, vascular injury and hypercoagulability were discovered in the mid-1800's. Despite the long duration we've been diagnosing and treating the health problem, there's still much we need to learn about it. The topic for today's podcast is venous thrombosis and we'll discuss its risk factors, how to diagnose a DVT and the best management recommendations. My guest will be Ana I. Casanegra, M.D., M.S., a vascular medicine specialist at the Mayo Clinic. Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Welcome to the Sterile Technique Podcast! It's the podcast about Surgical Technology. Whether you are a CST or CSFA, this podcast helps you earn CE credits and improve your surgery skills in the OR. This episode discusses the cover article of the January 2017 issue of The Surgical Technologist, which is the official journal of the Association of Surgical Technologists (AST). The article is titled, "Radiofrequency Ablation as a Treatment for Chronic Venous Insufficiency". "Scrub in" at steriletpodcast.com and on Twitter, @SterileTPodcast (twitter.com/SterileTPodcast). This podcast is a Dybas Media production. Sound effects adapted from GarageBand and sindhu.tms at https://freesound.org/people/sindhu.tms/sounds/169065/ and licensed courtesy of https://creativecommons.org/licenses/by-nc/3.0/.

This week we turn back the clocks to re-review a recent research letter from the team at the Harvard Congenital Heart Program about venous insufficiency in the Fontan patient. Why do patients with Fontan circulation develop chronic venous insufficiency and what are the implications of this problem in the Fontan patient? What sort of evaluation should be performed on the Fontan patient presenting with lower extremity venous changes? How worried should the cardiologist be when presented with a Fontan patient with these changes? These are amongst the questions reviewed on this topic with this week's guest, Associate Professor at Baylor University, Dr. Tony Pastor.JACC Adv 2022 Mar, 1 (1) 100002

Is venous leak sabotaging your sex life? Discover the shocking truth about venous leakage and how it's stealing your erection. In this episode, we'll dive deep into the science behind this common yet often misunderstood condition. Learn how to spot the signs, understand the impact on your overall health, and explore practical solutions to boost your bedroom performance. Don't let venous leakage hold you back – tune in now and reclaim your confidence!--------------Ready to take control of your penile health? Enhance blood flow, prevent atrophy, and ensure long-term functionality with the SOMA penis pump. Don't wait – invest in your health today and experience the benefits! Click here to purchase your SOMA pump now!--------------If you liked this episode, please SUBSCRIBE, like, leave a comment, and share so we can keep bringing you valuable content that gets results!--------------Follow Me On:InstagramTwitterFacebookTikTokYouTube--------------For all links and resources mentioned on the show and where to subscribe to the podcast, please visit https://sexualhealthformenpodcast.com/venous-leakage-ed-cause--------------Ready to empower your health journey? Secure your FREE PDF copy of the “5 Natural Solutions to Overcome ED” today! Dive into knowledge that could transform your life. Click the link below to claim your copy

Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques. --- SYNPOSIS Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device. --- TIMESTAMPS 00:00 - Introduction 02:02 - Defining Superficial Venous Disease 05:43 - Diagnostic Techniques and Imaging 08:29 - Current Treatment Options for Venous Insufficiency 20:07 - Introducing SOLVEIN 29:42 - FDA Approval Pathway 33:37 - Advice for Aspiring Medical Entrepreneurs --- RESOURCES Dr. Ali Golshan's Practice: https://www.beachwellnessmd.com/

Commentary by Dr. Candice Silversides

Superficial venous disease can pose significant management challenges, particularly after patients have exhausted conservative and invasive therapies. This week, our host, Dr. Sabeen Dhand, interviews Dr. Ali Golshan, an interventional radiologist and the founder of SOLVEIN. Dr. Golshan discusses the latest advancements in treating superficial venous disease, highlighting both the benefits and complexities of thermal and non-thermal ablation techniques. --- CHECK OUT OUR SPONSOR BD Advance Clinical Training & Education Program https://page.bd.com/Advance-Training-Program_Homepage.html --- SYNPOSIS Dr. Golshin introduces SOLVEIN, his innovative medical device designed to address these challenges. The conversation also includes practical tips for managing patients with venous insufficiencies, along with insights into the entrepreneurial journey involved in developing a new medical device. --- TIMESTAMPS 00:00 - Introduction 02:02 - Defining Superficial Venous Disease 05:43 - Diagnostic Techniques and Imaging 08:29 - Current Treatment Options for Venous Insufficiency 20:07 - Introducing SOLVEIN 29:42 - FDA Approval Pathway 33:37 - Advice for Aspiring Medical Entrepreneurs --- RESOURCES Dr. Ali Golshan's Practice: https://www.beachwellnessmd.com/

Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105 II GLP1-s and Blindness Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808 III GLP1-s and Cancer Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients With Type 2 Diabetes https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820833 IV Screening ECG Routine Electrocardiogram Screening and Cardiovascular Disease Events in Adultshttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2820721 Clinical outcomes in systematic screening for atrial fibrillation (STROKESTOP)  https://doi.org/10.1016/S0140-6736(21)01637-8 Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study) https://doi.org/10.1016/S0140-6736(21)01698-6 IV TEER for Secondary Mitral Regurgitation Randomized investigation of the MitraClip device in heart failure: Design and rationale of the RESHAPE-HF2 trial design https://doi.org/10.1002/ejhf.3247 Percutaneous repair of moderate-to-severe or severe functional mitral regurgitation in patients with symptomatic heart failure: Baseline characteristics of patients in the RESHAPE-HF2 trial and comparison to COAPT and MITRA-FR trials https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.3286 Jun 21, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001237 Stats Blog https://www.r-bloggers.com/2023/07/the-benjamini-hochberg-procedure-fdr-and-p-value-adjusted-explained/ You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Ask the Experts: Management of DVT and Post-Op Venous Complications Thomas T. Terramani, MD, FACS; Sigurd H. Berven, MD; Brian Kuhn, MD; Johnathan N. Grauer, MD

In this episode, we discuss the concept of venous admixture and the effect of supplemental oxygen on it in adults.

In this episode of the Life of Flow Rant Series, Lucas and Miguel are joined by Brian D. Lepow, DPM, and Jill Sommerset to explore managing normal revascularization versus Distal Venous Arterialization (DVA) from a podiatrist's perspective. They discuss the importance of verifying flow volumes in the OR to ensure optimal patient outcomes and address potential complications such as pain and hematomas. The conversation highlights the necessity of meticulous post-operative care and building strong relationships with ultrasound technicians for accurate measurements. They emphasize the challenges of integrating new methods into standard practice, with Brian discussing the difficulty in gaining colleagues' trust in new techniques.    Follow Jill Sommerset on Twitter Follow Dr. Brian Lepow on Twitter Follow Life of Flow on Twitter Follow Miguel Montero-Baker on Twitter

Today, I'll be discussing a paper authored by two physicians based in France.Titled Frequency of lipoedema in patients consulting a vein clinic for mild to moderate superficial venous disorder with symptoms: A retrospective analysis, this paper was published in the peer-reviewed journal Journal of Vascular Medicine in April 2023.The study sets out to investigate the prevalence of lipedema among female patients seeking treatment at a vein clinic for chronic leg pain.The authors highlight the underrecognition and misdiagnosis of lipedema, emphasizing the importance of understanding the frequency of lipedema cases among patients visiting vein clinics.For further information, you can download the blood pressure pamphlet HERE.

Host Dr. Lily Wang and guest Dr. Alisa Kanfi discuss an article about Neuroimaging of Neonatal Stroke focusing on venous strokes. Neuroimaging of Neonatal Stroke: Venous Focus. Lai et al. RadioGraphics 2024; 44(2):e230117. 

In the third installment of the Life of Flow podcast Rant series, hosts Lucas Ferrer and Miguel Montero Baker are joined by special guest Jill Sommeret for an engaging discussion centered on the optimization of arterial flow through meticulous preoperative imaging. Delving deep into the complexities of vascular procedures, the trio navigates through the nuances of ultrasound mapping, emphasizing its pivotal role in identifying suitable candidates for arterialization, especially in cases of chronic limb-threatening ischemia (CLTI). Jill Sommeret sheds light on the importance of evaluating venous system integrity, from assessing compressibility to detecting post-thrombotic disease, underscoring the necessity for thorough preoperative assessments to ensure optimal patient outcomes. As the conversation unfolds, the hosts and guest explore the intricacies of obtaining approval for additional imaging studies and advocate for empowering technologists to conduct such assessments when needed. They delve into technical aspects of ultrasound mapping, including the evaluation of venous loops and structures, while also discussing the assessment of volume flow and pedal acceleration time (PAT) in vessels to predict post-procedure outcomes. Through their insightful dialogue, Ferrer, Montero-Baker, and Sommeret underscore the critical importance of comprehensive perioperative imaging in guiding surgical planning and enhancing patient care in the realm of contemporary vascular care. Follow Jill Sommerset on ⁠Twitter Follow Life of Flow on Twitter Follow Miguel Montero-Baker on Twitter

Hey Love! This is an update on my own health journey with pelvic pain from Pelvic Congestion Syndrome, which I am learning is now termed Pelvic Venous Disorder or PeVD.  Signs and Symptoms of PeVD can be misleading as it mimics many other conditions like interstitial cystitis, vaginismus, constipation, endometriosis, cysts, prolapse and more.  Pelvic Venous Disorder is a widely underdiagnosed condition that can affect many women, especially postpartum moms who have had multiple babies. Since I have decided to go through with an Embolization procedure, I have been navigating and creating a Holistic toolbox for me to make sure I am giving my body the best chance going into this procedure and recovering on the other side and optimizing my venous and lymph return.  Inside this week's episode I will update you on my journey as well as inform you of the many various holistic strategies, herbs, exercises and other tools that can also help you manage your PeVD or just optimize your venous and pelvic health! I want you to better understand your symptoms and how to advocate and take better care of yourself.   While we can have many things contributing to pelvic pain, there is still so much we can do to relieve and resolve symptoms and bring you back to not only a pain-free but enjoyable life. So stay tuned and let me know what you think and if you would like any more support in achieving any goals around pleasure, intimacy and pelvic pain! As always, if you are experiencing any pelvic floor/women's health issue like urinary incontinence/leaking, pelvic pain, pain with sex, urgency, heaviness/prolapse or any other back/hip/joint pain let's get you booked for a virtual coaching session or in person physical therapy session for a more individualized plan and one-on-one instructions so you can feel confident in your body and start healing today!!  Make Sure to reach out to> PTDes@balancedmomtality.com  AND/OR Join my FREE Facebook community for ACCOUNTABILITY and a safe and supportive place to share and support each other!> https://www.facebook.com/groups/1696216757461633/    Join my VIP Insider group and receive my Newsletter full of great tips and tricks and upcoming resources! > https://newsletter.balancedmomtality.com/   Follow and get tips/tricks on:  Facebook> @thebalancedmomtality Instagram> @the_balanced_momtality   Learn > www.balancedmomtality.com  

This podcast is a discussion on central venous catheter (CVC) safety in pediatric patients on parenteral nutrition who have intestinal failure. The CVC is their lifeline and Dr. Danielle Wendel discusses complications, prevention, and treatment of those events in these children. Business Corporate by Alex Menco | alexmenco.net Music promoted by www.free-stock-music.com Creative Commons Attribution 3.0 Unported License creativecommons.org/licenses/by/3.0/deed.en_US February 2024

Which of the following interventions is contraindicated for the treatment of venous insufficiency ulcers? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects. Free NPTE Premium Course in Chicago, Feb 29-Mar 1 (Free housing and meals) 

Is your relationship navigating the choppy waters of midlife? Then you are not alone. In this week's deep dive on "The Hormone Prescription Podcast," we unpack the conversations you need to have but might be dreading. This episode, we tackle erectile dysfunction (ED) head-on with the formidable Dr. Elliot Justin. Let's not skirt around the issue—the man in your life's ED affects both of you deeply. It's essential to address it not just for his well-being, but for yours and your relationship's health. Dr. Justin strides into the studio with an awe-inspiring list of credentials: urologist, innovative thinker, and couples' counselor extraordinaire, renowned for bringing new perspectives to midlife challenges. Today, he shares the collective wisdom garnered from years at the forefront of men's health and intimate relationships. Midlife can feel like a carnival of changes and curveballs. But when the elephant in the room is ED, that jovial atmosphere quickly transforms into a solo tightrope walk. Dr. Justin encourages us to transform this walk into a joint tightrope act, one that strengthens your bond and navigates the complexities of progesterone to performance. About Dr. Elliot Justin: ELLIOT JUSTIN, MD, FACEP, is the CEO and Founder of FirmTech, the first sex tech company dedicated to improving men's erectile fitness. He has a background in Emergency Medicine and healthcare technology consulting. Dr. Justin is also a serial healthcare entrepreneur, having founded and sold Pegasus Emergency Group and Swift MD. He has provided guidance to various services, telemedicine, and tech startups. Dr. Justin pursued Slavic Studies at Harvard University and studied medicine at Boston University. Happily married for 35 years, and father of three children, Elliot and Ann live in Montana with three energetic mares and a flock of chickens So, what can you expect to uncover in this eye-opening chat? Insights You Can't Afford to Ignore: Understand just how much ED can influence your daily life, and how to navigate these changes with grace. The Expert's Plan for Partnership: Dr. Justin's wealth of knowledge and experience is distilled into practical strategies to face the ED challenge as a team. Innovative Approaches to Speak Up and Heal: Discover modern ways to approach ED—no more outdated stigmas, only up-to-date solutions. Communication is Key to Connection: Learn the importance of open and honest conversation, and some powerful dialogue strategies for building bridges. Success Stories that Give Hope: Real-life experiences and victories will inspire you on your own journey through midlife. This episode bears all, from tender anecdotes to strategic wisdom, and catapults us into a space where ED isn't just a problem to overcome, but a journey to undertake together. So gather your wits and your earbuds—this one's going to shake up the midlife conversation in all the best ways. Tune into "The Hormone Prescription Podcast" now. And remember, don't just listen—subscribe, review, and transform the narrative of midlife with us.   Speaker 1 (00:00): “What goes up does not have to come down until you're ready.” Dr. Elliot. Justin, stay tuned to find out why your partner's ED is essential to address and how. Speaker 2 (00:12): So the big question is, how do women over 40 like us keep weight off, have great energy, balance our hormones in our moods, feel sexy and confident, and master midlife? If you're like most of us, you are not getting the answers you need and remain confused and pretty hopeless to ever feel like yourself again. As an O-B-G-Y-N, I had to discover for myself the truth about what creates a rock solid metabolism, lasting weight loss, and supercharged energy after 40, in order to lose a hundred pounds and fix my fatigue. Now I'm on a mission. This podcast is designed to share the natural tools you need for impactful results and to give you clarity on the answers to your midlife metabolism challenges. Join me for tangible, natural strategies to crush the hormone imbalances you are facing and help you get unstuck from the sidelines of life. My name is Dr. Kyrin Dunston. Welcome to the Hormone Prescription Podcast. Speaker 1 (01:05): Hi everybody. Welcome back to another episode of The Hormone Prescription. Thank you so much for joining me today as we dive into the topic of erectile dysfunction for men. You know, it's kind of interesting that, you know, we women actually get erections of our clitoris. It's really a mini penis and most women aren't aware of that. And if you are not getting erections, that's something that needs to be addressed. I think we dive into this in this episode. In the interview we talk a little bit about this. He calls it something else for women, but for men and women, it really can be a sign of larger health issues, particularly related to your cardiac function, to your heart that can be lethal. So it's something you need to pay attention to. A lot of guys don't talk to their doctors about this issue because they're embarrassed and really, yeah, those days are over. Speaker 1 (02:02): You need to start talking to your doctors about your sex. You just do. It's imperative. Your sex is not separate from . Your total function, your liver function, your hormone function, your brain function, your gastrointestinal digestive function, your heart cardiac function, your sex is an essential part of your body, of who you are, how you function, your vitality. We get into that in this episode. Dr. Justin is on the same page with me. So if your doctor is ignoring your sexuality and not talking to you about it, it's time that you brought it up and demand to have it addressed and also for your partner. But I know that we women sometimes play that role for the men in our lives to be the one to help them get over themselves and talk about this with their doctor. So we're gonna talk about how to do that in this episode and more. Speaker 1 (02:57): Dr. Justin is not only a physician who's treated many, many patients, but he's a researcher, he's a developer, and he, like me, is always thinking about how we can serve people better? How can we help them live healthier, happier, longer lives? So I think you're gonna love Dr. Justin as much as I love talking to him. Just note, this is an explicit interview. So we do say some words that you might not want your kiddos to hear. So if you don't want them to hear it, you might wanna switch to a different episode and listen to this when you are in privacy. Just a note and I'll tell you a little about Dr. Justin. Then we'll get started. So, Dr. Elliot, Justin is a medical doctor fellow and CEO of the founder of Firm Tech. It's the first sex tech company dedicated to improving men's erectile fist fitness. Most sex companies are just sex toy companies, but this is a tech company to improve erectile fitness. He has a background in emergency med and healthcare technology consulting, and he is a serial healthcare entrepreneur, like I said, always developing things to help people live better lives. And he founded and sold multiple companies and provided guidance to various services. And he's just an all around badass who loves helping people. So I think you're gonna enjoy this episode. Without further ado, please help me welcome Dr. Elliot Justin to the show. Speaker 3 (04:31): Thanks. I welcome the opportunity to speak. Speaker 1 (04:32): Yeah. I'm really excited to have you on because you and I both know that men are not talking to their doctors about their erectile difficulties, their sexual difficulties, or low libido, all the problems they're having in the bedroom. We know that they, there are women, female partners are aware, and therefore we're really the ones that need the information. So if you're a woman listening, listen up, because really, I always say that erectile dysfunction could save a man's life, and we're gonna talk about that and you're probably scratching your head going, how could that save a man's life? But I wanna start by, I could explain that, know you have a background. Yeah, we'll get to that. You have a background in emergency medicine and healthcare technology. So what got you interested in diving deeper into the subject of men's sexuality and erectile dysfunction and men's sexual health? Speaker 3 (05:34): Well, my background, I'm an emergency medicine physician, and since 2015, my, I've been doing medical technology. That's how I got to this as an emergency medicine doctor, I can assure you that's short of a heart attack or a stroke. There are a few emergencies I could concern a man as much as a lip dick. So this is something that's of, of, you know, of vital importance to men, both their self-esteem and their health. I got involved in this. I was actually working on a very complicated catheter to regulate blood pressure after a stroke. A urologist heard what I was doing and said, I see you've done some research with neuromodulation of erectile function, which I had a neuromodulation for. We mean placing electrodes by a nerve and nerves. The paradigm for that is cardiac pacemaker that controls your heart, your heart, even have to even after you're dead. Speaker 3 (06:17): My thought was if we can control sexuality, the impact on, on, on an aging population would be enormous. I will say that project failed. I tried to neuromodulation the cous nerve, which everyone's favorite nerve no has heard about. Suppose the nerve that's responsible produce orgasms in men or women. We try it out on, on some, on some sheep. And actually, and on myself. We, we to no effect. I actually don't think that we know how orgasms are produced. It's very complicated. Well, oddly, even more complicated than, than the heart. So this urologist came to me about in 2015 and said, I wanna count the number nocturnal erection, not two, excuse me, came me three years ago, 2020, and said, I wanna count the number of nocturnal erections that are leading indicator of mass cardiovascular health. And I said, really? I know, I know anything about it. Speaker 3 (07:03): I, you know, I mean, everyone knows about morning wood. We poke up partners where it, we made, we laugh about it. But a healthy man has three to five nocturnal erections per night. And if that number goes down, it's a sign of an impending heart attack or stroke. So it's not just an association. Blood take, taking a blood high blood pressure is associated with stroke and heart attack. Declined number of nocturnal reactions is actually a leading indicator. It's predictive. So that I thought, gee, that could be enormous as an emergency medicine doctor. But a, that's another vital sign and a vital sign that would be much more compelling to men probably than any other than the other, other vital signs. And we live in this age of healthcare wearables for pretty much everything except for sex. And what do men, frankly, women care more about? Speaker 3 (07:43): How many steps they took yesterday or their calorie count or this or this or, or their sexual health. And that's, you know, that's a, that's a rhetoric, rhetoric question for most people. So the numbers are enormous, as you indicated earlier. I mean, 50% of men by age 50 have erectile dysfunction. It's even higher for women. And why is it higher for women? Because postmenopausal women lose their hormonal protection against heart disease. So postmenopausal women have all the same problems that men deal with. Diabetes, high blood pressure, atherosclerosis, auto attacks, et cetera. But premenopausal women take SSR antidepressants and they take hormones all which have, both of which have a significant impact upon their sexual performance as a health. So with d with data, we give people data. We can now transform the quality of, of, of, of health, of healthcare. We can transform how things are managed. Speaker 3 (08:35): 'Cause There's a cliche, if you can track it, you can hack it. So right now, when it comes to sexual health, doctors just really just have opinions. If I go, I'm 70 years old. If I went to a urologist or a sexologist right now and said, I like where my, where my sexual health is right now. I can perform every day. My wife and I are happy, but I wanna keep it there. What can ha what can you tell me? Or I told him, you know, I'm having, I'm, I'm, I'm, I'm struggling getting erections. They can wave an ultrasound over my, over my penis in the office, but I'm not getting aroused. I'm not finding out what I really wanna know, which is what's happening when I'm trying to, trying to perform. So if we can give people data, they can then measure the impact of diseases, medications, diet, self effects, all these claims that are made and see what works for them. Speaker 1 (09:18): Yeah. You know, you, you've made so many great points in that. I just wanna go back and highlight a couple of them. Sure. So number one is that most women don't realize that erectile dysfunction is a problem for women. Women, yes. We get erections, ladies, right? 'cause Our clitoris is a small penis and they do get erect with sexual arousal. And that we women just write off that we're not getting aroused. We don't have orgasms as, oh, it's only a pleasure problem. But it's not just like for men, like you said, it's a leading indicator for cardiac disease. It is a leading indicator for cardiac disease and hormonal poverty for you ladies. So I just wanna highlight that because I think that's essential. But now I wanna go back. So this is great. Okay. That you, you really saw that there was a need for this. And you probably recognize men aren't gonna go to the doctor for this. They're not gonna talk about it. And so you started looking at ways that they could actually measure this themselves, right? Speaker 3 (10:22): Correct. Well, the doctors are really ignorant about this. Mm-Hmm. , I'll, I'll give you two examples in, I was approached by Dr. Hot Hotel and professor of urology at University of Utah to count the nerve nocturnal erections. And he wanted to embed sensors into a device like a condom ring that had six mm-Hmm. But it would have six times the elasticity of the condom ring. And I looked at this device and said, well, that's not gonna work because condom rings break. So have he been a urologist unaware of the fact that this piece of common technology is actually vulnerable to breaking also condom rings can rotate, which means, which means, means you have rotational artifact. And my thought to hit the response was, well, let's do better than that. Let's try to do more than just count the number in external erections. Let's try to figure out the health of all erections. So my thought was to embed sensors into an advanced form of an erection ring or cochran instead of colloquially known as this doctor, I've never used the cockran. Now I have yet to find, well, here's a joke we have at medical, at medical congresses. I'll ask you, how do you tell the difference between a straight doctor and a gay doctor? You ask one question, Rin, Speaker 1 (11:27): Have you used a coching? Is that the question? ? That's Speaker 3 (11:30): The question you got. How have you used a coching? You got, and the answer is, and, and a straight doctor's like nine is like never. 'cause They just, whether it's male pride or I don't, you know, straight doctors treat rings like a Suman kryptonite. I don't need that. Gay doctors will be like, yeah, like last night you got a better one. So gay straight doctors aren't open to the really, what should be the, the first line of therapy for man who has dysfunction? Then you have, there's no, there's no sense from these doctors about what is, what is normal sexual behavior. The scoring systems that are used by urologists, by sexologists to evaluate men or women for that matter, are focused on penetrative sex. There's the shim score, the atom, the eye, you're probably familiar with these. They don't reflect what people are actually doing. Speaker 3 (12:14): Mo most se most, most sex between, between partners over the age of 40. Penetration is just a part of it. It's not the focus, it's not the endpoint. And these studies, like something out of the 1950s or 60, are focused on that as an endpoint. Then urologists think, okay, the first line of therapy is to give a PD five medication with Viagra, Ali, p and d, you know, the, the top ones. But those medications put more blood into the penis, but they don't keep it there. Mm-Hmm. most men's problem is not getting it up. Most men's problem is losing an erection. That could happen for a whole variety of reasons from anxiety, diabetes, hypertension, alcohol, drugs. And then the most common one that urologists don't think about because all men get it, all women get it too, which is venous leak syndrome. Speaker 3 (12:57): Urologists are sure are surgery oriented. The pill doesn't work. They wanna put an implants into a penis or, or do some sort of surgical procedure. So venous leak syndrome is something that we can be born with. Very, very few men have it where you get blood, the penis, but it leaks out because the muscles that control the veins to hold the blood of the penis aren't, aren't very strong. Venous leak syndrome is something we all experience as we get older. I don't know how old you are. I'm 70. If I sit on a plane for five or six hours, my socks will start to pinch. My wedding band will, my finger will be hard, hard to take off my finger because I have venous link. 'cause As I get older, the, the muscles and my small veins don't pump blood back to my heart as effectively. Speaker 3 (13:32): It's the same thing for the penis. As we get older, our, our our, the smooth muscles weaken in our penis. We get an erection and we lose it. Now, that loss could be accelerated by anxiety or it can be the very cause of anxiety or, or caused by medications. Our research shows the big cocktails are SR antidepressants and anti antihypertensive and or in combination. But the solution is a plumbing solution. The P five medications put more blood in the penis. A properly used Cochran holds the blood in the penis, allowing a man to sustain erection for more, for a more satisfactory time period. Coing should be mainstreamed. I look at vibrators in my lifetime. My mother's vibrator was in a bottom dress drawer of a supply closet. Just thought we'd never find it. . We didn't know what it was. Speaker 3 (14:15): We found it. You know, I don't, my wife probably owns seven or eight. My daughter takes 'em on dates. They've been mainstreamed. It's no longer considered to be shameful for women to use a vibrator. Most women, I think in the latest report there were 60 women, 60 million women in the United States own more than one. What do men have? Well, they have these monstrous things called strokers. Like somebody could beat something to death with, they don't have anything, but, but they do have rings. But cochlea have been made the wrong way for many years. Can I, may I explain? Yeah. So I want to come up with a ring that could be worn overnight. Well, this cause I want to count data. I want to count these nocturnal erections. I also want to come up with a ring that could be worn comfortably during sex with sensors inside of it in order to record the duration of the firmness. Speaker 3 (14:56): Every erection. So we get baseline data on man's sexual health. But ings have been made for 150 years out of tight silicone rings. You have to have an erection before you put them on. 'cause They choke off the blood supply. It's like a NOIs on of penis. I mean, it's like some design by a hangman. I mean, so I thought, let's make coch rings out of a soft elastomer. So these are, I dunno if on camera right now, but these, these, our rings are unique. They're, they're made out of a, out of a soft elastomer. So they're comfortable with us. Silicone makes us adapt to them. I also wanted the ring to be safe, easy on, easy off. Many men are overweight. They, they, they can't, they can't even see their penis. Men who they're, they're anxious. These things need to be made very, very easy for them. Speaker 3 (15:35): I would suspect that about half the se heterosexual sex in the world starts when a man is scratching his wife's back. When she takes a bra off at night. Women don't like bras in their back because they're silicone in the back. It's itchy to the skin. I was looking at my wife's bra on the ground and I thought, oh, a hook. Women don't put on bras over their heads. A bras is a ring that opens and closes with a hook. Let's make an erection ring with a hook. So it's easy on, easy off. And then let's also design a ring. But that man can put on when he is flacid. So we can put on discreetly, put on hours before second. It could be worn for hours. So it doesn't block the arterial flow. It only constrains the return. And then let's also try to design a ring that will make a man's pleasure more intense. Speaker 3 (16:19): It's not a vibrator. The way we do that with a man is we draw out the. So we tested a ring on a group of men between the ages of 27 and 70. The goal is that if we put the right, we want to increase the ejaculatory phase by 50%. So with this ring, my ejaculatory phase goes from four seconds to seven seconds. That's a significantly more powerful orgasm. I think it's good as a vibrator, but it's, if it's for an instantly more powerful orgasm. But more importantly now, by putting sensors into it, we, we have a ring that's comfortably worn overnight to count nocturnal erections, which are leading the indicator mass. Cardiovascular health and wandering sex. The ring can measure the duration of firmness of erections. So now men can measure the impact of everything from medications, diseases, supplements, diets, relationships. Mm-Hmm. on sexual performance and say what works, what doesn't work. Speaker 1 (17:07): So I wanna ask you, because you mentioned this before we started recording, and then we touched a little bit on it just then that vibrators are mainstream for women. I mean, there are all kinds you can get like, what did I see online? It was like a superhero shaped vibrator. And I mean, they got everything. So sex toys for women are really mainstream, but not for men unless they're gay men. Why do you think that is? Speaker 3 (17:34): Well, I think there's several reasons. I think women, one, represent a much larger market. Women do women make what? Like 80% of the purchases overall in the United States or, I, I I think that might, I think it might be worldwide women purchase. If you exclude condoms, women purchase the majority of the sex toys. So when people look at numbers in, in the sex toy area, they say, oh, well men buy more. Well, not, that's not that. Once you exclude condoms, then it's, you know, then it's women. I think women are more open-minded rep represent a larger market. I also think the vibrators have been so enormously successful. No one else has figured out something equivalent for, you know, for men. I think for gay men, it's different. They're really, really focused on, on sexual pleasure and much less inhibited. Mm-Hmm. . And also anal sex requires a harder penis. It's harder to penetrate the anal sphincter than it is to penetrate a vagina. So a ring becomes, you know, it's almost a necessary tool. Speaker 1 (18:28): Okay. You, you made a comment though before we were recording. There's something about you, the way you said it was pretty comical because you said if a woman brings sex toys into the bedroom, so can you share that, that no problem. Yeah, sure. But if a man, then what happens? Yeah. Speaker 3 (18:44): When managers introduce sex toys, the industry surveys say they get used one or two times and then they get thrown out. If a woman introduces a sex toy, it, it gets used for as long and as often as she wants, wants it to be used. But, that also inhibits men from buying sex toys as well too, because they're not gonna get used. I also, I don't think any effort has really been made by the industry to make sex, make conquering sexy. But, but I, but the data shows this, this is a really important 'cause and there's, we, we've had an internal study to this effect. And there's gonna be big paper, two pi papers, spout rings at the American Neurology Association and Congress coming up, coming up in in May one is going, is going to show that if a man wants to have a longer lasting erection, a ring is more, more effective than a PD five medication. Speaker 3 (19:27): Well, big pharma's not gonna like that. And the heterosexual doctors have frankly been, they should have caught on this a long time ago. And if we're using rings, they would realize it. But a ring to dil in our internal data will keep, we were looking at D 2 cent data. So no one has studied D two ence. D two s is the time it takes for an erection to go down. We didn't measure time to go up because there's so many variables involved in that. Are you with a partner? Are you masturbating just by watching porn? You're drinking? We are just interested in the time it takes for erection to go down. 'cause That would be a measure of how much blood is held in the penis. So the ring alone, dala fill alone sustains an erection on the average of two, two to three minutes afterwards. The ring is about four and a half minutes long. And a ring plus the film is about five and a half minutes. So that those are men without Ed. So the takeaway message really is for all men would be, if you want to have a longer lasting, harder erection, put a ring on it and take a pill. Also, if you're a man who suffers prematurely and you want to keep thrusting afterwards comfortably, not uncomfortably, put a ring on it, take a pill. Mm-Hmm, Speaker 1 (20:30): , you made the comment several times, and I don't wanna bypass it because I think it's worth talking about. 'cause I know somebody listening is wondering why are doctors so phobic about talking about sex? You know, sexual function is a leading indicator of your overall health and vitality. So looking at a male man or woman's sexual functioning, I think is vital to their overall health assessment. And if there's any difficulty there, it's essential to evaluate it because it corresponds to cortisol stress hormone levels, and there are other sex hormone levels and vascular function, cardiac function, but also as a preventative practice, just like drinking enough water, just like enough aerobic exercise, weight bearing exercise, sex, regular, active, pleasurable sex is vital in promoting vitality. So what are we missing? Because I know women are listening, why isn't my doctor talking to me about this? Why isn't my doctor talking to my partner about this? What is the problem with doctors here? Speaker 3 (21:41): I have so angry about this issue because we physicians are doing our patients a horrific disservice. I'm seven years old, I'm a doctor. Doctor should feel comfortable talking to me. I've never had a doctor warn me about the sexual side effects of medication. I've never had a doctor ask me about my marriage. Did not ask those questions. Is stupid. It's insensitive. Now. One reason is there are no boxes to check for those things. There's no way of making money addressing those things that they should. And, and, and it actually applies to urologists as well too. They often don't take complete sex stories with people, but just, Hey, here's a PD five medication. We'll do an ultrasound. You're not working. You need an implant. You're not helping a person that way. I completely agree with you. Studies show that if someone has sex every day, their cortisol levels significantly improve. Speaker 3 (22:27): If men were in control study, big study was done. Whales, I think of Scotland. If men have men with equivalent cardiovascular disease at age 70 start having sex twice a week, their risk of cardiac arrest goes down 50% over the next five years. The benefits are enormous. And we should be recommending to people to have more sex. We doctors make recommendations about diet, about exercise, about sleep, and we don't speak about sex. And if we do speak about it, we are embarrassed. We have, believe me, people wanna talk about it. My, my last year of emergency medicine clinical practice, I said, you know what, I'm just going to do what I was trained to do in medical school. I'm gonna add a sexual history to pretty much all my exams. Well, it turned out even people came in with an ankle sprain. Wanna talk about both? A lot of 'em just wanna talk about their sex lives and they don't wanna talk about this spouse who wants to tell you all about it. Speaker 3 (23:15): So people, men and women are hungry for this information. And they're, to your point, and I would like to bring it up, Dr. Dustin, we doctors are doing them a tremendous disservice. But I don't know if doctors, mostly doctors are even capable of discussing it because they're kind of, they're relative as, as, as a group. They're relatively pr and conservative in conservative sort. An old, an old fashioned kind of, you know, you know, meaning about sex. Before I got involved in this field, I never, I never went to sexual congresses of urology or society of sexual methodology, which is no one's talk. There's very little talk about pleasure. All the focus is on surgery and pills. And it's not focused on what most con what concerns most people, which is how do I maintain my sexual health if I, if I'm poor sexual health, how, what can I do to reverse it? It's, you know, the, the focus of the doctors is, is on things, I'll be blunt things that make them money. Yeah, Speaker 1 (24:06): That's unfortunate. And really sex has been relegated to the closet for everyone. And it's such a vital part of health prevention, of promotion, of vitality, prevention of disease. I would be remiss if I didn't ask about, you mentioned some causes and contributors to erectile dysfunction, sexual dysfunction in men. If we didn't talk about porn, because that's epidemic among men in the United States all over the world, globally, how does that affect, and I know there's some women listening who are like, my husband watches porn. Is that part of the problem? Well, Speaker 3 (24:42): I'm, I'm, I'm ambivalent about porn because for a lot of men it is an escape to a world where they, where they, where in fantasy they, they get what they want and the things that they're not getting from their partners, male or female partners. For some people porn is beneficial. And so are we gonna ban porn because it's also harmful to some people. I wish that people could discuss porn with their partners. That's really where the where it comes in porn becomes. It can become a window into finding out what someone else's fantasies are. And most people, too many people don't have sex regularly. They, so before I talk about, talk about porn, because I'm, I I'm gonna get, I'll get you the mail, the major male complaint about porn in a moment. Mm-Hmm. men, too many people stop making love. Hmm. That's, they need to plan for pleasure. Speaker 3 (25:23): I mean, I, it it, I bring this up with guys at the gym or women, women too, which is like, Hey, you these, because they know what, they know what I'm doing. You, you let me know your love life is not satisfactory. How many hours do you spend working out a week? It'd be like, oh, 10, 14 hours. And I'll say, if you could just take two hours of that away and put that into your relationship, and they look at me like, men and women look at me like I'm nuts. Well, it's that, that that can't be done. I said, yeah, it can be done and should be done with planning. You know, a good love making is no more spontaneous than a good exercise session or, or a great meal meal. I don't just up a great meal Speaker 1 (25:57): Meal or a great vacation. I Speaker 3 (25:58): Don't, I don't go there, I don't, I don't know the refrigerator and say, Hey, what, what are the leftovers? Let's have leftovers again, . And that's what, and that's, let's have rotisserie chicken for the third night in a row. And that's the problem with a lot of people sex . They, they, they get bored with what they're doing with their partners and they don't talk about it. Speaker 1 (26:15): That analogy. But I love it. It's great. It's so true. You know, and, and I recently, I've really been diving the past six or so months into sacred sexuality and womb wisdom and the whole, you know, three types of orgasms or more, actually five, that women can have. And in diving into this, I've read a lot where the biggest problem for most women regarding sex and why they don't wanna have it, is because their men don't know how to properly work the machinery, how to please them, the different types of orgasms, what's required to get their motors going. And for them to become satisfied and actually to make love. They know how to wham bam, thank you man, kind of ma'am have sex, but they don't know how to make love. And so I'm wondering, where do guys supposed to learn this? Where Speaker 3 (27:06): Are women supposed to learn? I mean, you, you, because men have all the same complaints about women, men my age and men younger. It's like, oh, she's all, you know, she's, she, she thinks she tugs on my, my penis. Like, like, like, like an arm a machine or, you know, so people, this, this issue cuts both ways. Okay? And this is where people, people need to, people need to, my opinion, they, they need to, to communicate better about what they want. I mean, I, I'll get back to, I'll get back to, to my food analogy. Mm-Hmm. My wife is in the room right now. I don't know what she wants for dinner. And I could eat, you know, I, you know, so I, if, if I want, if I want to, if I wanna really make her happy with, for dinner tonight, I should explore what her, her ideas are. Speaker 3 (27:45): I think when it comes to sex, people kind of settle into both parties. I go down on her, she comes and then I penetrate her. That's kind of pretty, pretty standard and pretty boring sex that goes, that goes on for most people. This, they would, they would communicate. And that's what, that's, that's where I think porn can be valuable. People watch, if people explore porn together, they will expl expand their vocabulary for love, you know, for, you know, for love making. Also, there are a lot of guys for porn, porn is an outlet for them. The way shopping is for women and people like to say that, that porn built the web, but porn might have built the web originally. But shopping sustains the web, women do 85 to 90% of shopping online. Women have done studies showing that women get the same dopamine hits in their brain that men do from shopping, that men do from Washington porn. So gone to the point of Congress as people like to blame the other sex, but they need to, you know, examine what they're doing. And then they, then they need, they, they need to communicate better about what, about what their mutual needs are and be more. Right. Not saying nothing. Speaker 1 (28:45): That's fascinating information about shopping. I didn't know that's the case. So you're kind of equating the two. Speaker 3 (28:51): If women think it's ridiculous that a man wants to look at eight, eight bodies online, a guy might also think it's ridiculous that the woman needs to look at 25 shoes online. It's, it's, it's . You know, it's, I mean, but meanwhile to your, you know, Dr. Doc, Dustin, to your point, they could be making love. They could be. They could be. And that's the problem. They're not talking, they're not not playing for pleasure. They're not communicating. In addition to which there are other problems, which circle back to which we, people are taking a lot of medications to interfere with their sexual performance with, you know, half the adult population being diabetic, hypertensive 20, 25% taking anti antis antidepressants. All these drugs have, have, and these diseases have significant impact upon, upon their sexual performance. And people. And the doctors don't do a good job about wanting people to know about the sexual side effects. Speaker 3 (29:37): So with data, about how long they last, how firm they can get, we have, we're starting to get some data about women with the, the, the trial protocol. We can, they, people can then say, you know what? My doctor prescribed 300 milligrams of whatever antidepressant, but I noticed that around 150 milligrams my erection starts to soften or I can't. So people, I mean of course we, we, we recommend to everyone if they don't make changes, but with their medications before, let's discuss it with healthcare providers. But I know people are doing it because the healthcare providers don't know about them, don't know about these issues and don't prioritize. You know, they, as you said, you said earlier, the least priority for most doctors is someone's sexual performance. But if someone's taking Sri SRI antidepressant and lisinopril for their blood pressure and they can't get it up, but they can't, you're not making, you're not helping, you're not helping the depressions very much and you're not helping their their partner either. Speaker 1 (30:29): Right? Sex is a natural antidepressant. So , if you fix the sex, you probably wouldn't need the medication. So there's a woman listening now and she's really paying attention because she's thinking, wow, we don't have sex. We become like roommates. Either one of us could take it or leave it. Maybe she hasn't gotten out of hormonal poverty. So that's part of her issue. And if that's you, you definitely wanna listen up. 'cause , we are gonna run a special at her hormone club this winter if you wanna join us. But she knows her partner, she's observed that he's having some difficulties, whether obtaining an erection, maintaining having short or premature. How do you suggest that she approach this and talk to him? Because I've heard complaints from women before that when they've tried to bro this subject with their partners, that it has not been met with openness. So as a man, what would you say? How do we approach this with our partners? Speaker 3 (31:30): That's a great question. Hopefully you have some background information on the guy, because someone, it depends upon the person's age, but if, if it's, if it's a man over 45 or 50 it's the, the likelihood of that person having a physiological problem increases. So you really need to know what someone's blood pressure is, what their blood sugar, hemoglobin A1C is and the blood sugar, what their testosterone level is. There are, there are tests and then there are medications. I, you know, with, I've been impressed with the work that I've done over the last year, speaking to our patients, how many men could be helped just by, just in their medications and 'cause they're often taking multiple medications that that, that often a combination with alcohol are, are affecting their sexual performance. So you need to find out about the base, these, these baseline health factors. Speaker 3 (32:16): Another issue is these are all hard, such such just discussed, which is if a man can get it up with pornography and if a man is having erections at night when he's sleeping, he should be able to get up with his partner. And if he's not getting up with, with his partner, there's some issue in the relationship more, far more likely not some anxiety producing issue that's built up over the over built up over the years that need that, that needs to be addressed. Addressed. Mm-Hmm. between the two of them or, or addressed with, with, with the benefit of, of therapy. That's where ring comes in handy because a lot of those men get, they can get up and then they lo then they lose the erection and then they avoid sex because they, they, they feel I've got it up with her, but I've lost it. It hasn't worked out. That's where ring ring comes with confidence build up because a male erection things very differently than a male without erection. And, and Cochran will keep the blood in the penis even if people are having an argument of some erection. Speaker 1 (33:05): Is the way for her to approach it with him to maybe say, honey, I have some concerns I'd like to talk to you about. Can we set aside some time this weekend and then secure a time and then just couch it as a health concern and say, you know, I've noticed a, B, C when we are making love and I'm concerned because I heard Dr. Justin talking on Dr. Kirin show that this could have indications, meaning that you're at increased risk for heart disease, heart attack and early death, or any of the other things we've talked about. Or that the medications you're on might need to be adjusted. And I'm really wondering if we might be able to go to your doctor or if you could make an appointment with your doctor. Does that sound like a reasonable approach? Speaker 3 (33:52): Yeah, definitely. Speaker 1 (33:53): It's non-threatening. Uhhuh . Speaker 3 (33:55): Absolutely. And it does have to be approached as a partner issue. I mean, men often need the support of their partners just to comply with their medicines. Mm-Hmm. , I mean women are much more likely to comply with their, with it, with their medicines. Also, I think people need to think about what happens when they try to have sex. And his significance, if a man never gets an erection, doesn't have a a morning erection, this is where a device that can count the overnight that could be worn overnight comes in handy. I'll take it at both extremes. If a man, if a, if a man has a tech ring that can count, he wears overnight and he has nocturnal erections three or more, that man's sexual health is good enough to have to have sex. So that indicates that the issue is not medication related, disease related. Speaker 3 (34:36): The issue is probably is partnership related at the other extreme, the other extreme, and this happens, we, we, if a man has two or less nocturnal erections or those not, and those erections are, are either weak or not, they just don't occur that partner is getting risk fatigue or jaw fatigue for nothing. 'cause It ain't gonna happen. That man has a significant erectile problem that man needs to, to your point, that man needs to see a urologist and a cardiologist because he has a cardiovascular, cardio urological problem of, of profound significance and he needs help. Mm-Hmm. . So, and that's what, that's, that's where the data really comes in handy. 'cause The data ought to assess what's going on. So it could be, Hey honey, I noticed that, you know, the last six months have been really bad, you know, been difficult for you in, in bed and you start taking medication X just around the same time. Maybe the medication is the problem and maybe we can, with data, we can test whether that is the Speaker 1 (35:30): Issue. Right. And so the device that you developed actually they can wear overnight and it gives data in the privacy of their own home. Is that correct? Speaker 3 (35:39): That's correct. It can be one during sex as well too. Speaker 1 (35:41): Okay. And so how often do they have to use it to get enough data for how long a week takes a month? It Speaker 3 (35:48): Takes about up to about four uses for the sensors to calibrate the, to the individual's body. 'cause People's, you know, penises vary and, and how firm they get, they vary and, and you know, just variability. Variability in how long, how, how long people last. So I use it the way I use blood pressure. I take my blood pressure once a week. I take my, I measure my sexual health once a week. Oh, Speaker 1 (36:10): Okay. And then you kind of can follow it over time. Speaker 3 (36:13): Yeah, we have, we have men who use it every day and we have men who use it frequently. I mean it's been really valuable. There's a whole other issue here too, which can discuss prostate disease, which is, is another issue that prostate disease can, erectile dysfunction can mean a warning sign of prostate disease. So if a man Oh mm-Hmm Speaker 1 (36:27): Yeah. We even Speaker 3 (36:28): Talk that, I'm sorry, sorry I It's okay. So Right, if a man develops is starting to develop erectile dysfunction that man does need, you know, especially an older man, not, you know, old man over the age of 45, 50, that man needs, needs a a ur urology exam as well too. Speaker 1 (36:42): And men should be getting a rectal prostate exam annually. Correct. Speaker 3 (36:47): Annually. At least every two, every every two or three years. And if there's a family history, it should, it might need to be done more frequently. Right. I mean the PSA test remains controversial. I think it's a good idea. There might be some false positives, but, you know, why take a chance? Speaker 1 (37:00): Well what's the current age at which they should be getting that and is it annual? Speaker 3 (37:03): It's annual, I think it's 55. I I have to look. The indications change so frequently I have to look it up. Speaker 1 (37:09): Same for women . Yeah. So yeah, make sure that your partner is getting the PSA prostate specific antigen and a rectal prostate exam at whatever the current recommendations are. They should be getting that Women you need to be getting your rectal every year . They also need the rectal for screening for blood as well. Oh my gosh. This is such good information. And I think you've helped save some men, some women, and some marriages and couplings today because it's vital. Lemme Speaker 3 (37:41): Talk about that. 'cause We've had two men who had significantly declining nocturnal erections who went to their doctors and, and, and went to cardiology, actually got a cardiology workup and they, and they got catheterized and they got treated. They would've, they could've gone to have a heart, have a heart attack or something more, more disastrous. So the data, the data's fun, but the data's also really, really valuable. Yes. Speaker 1 (38:01): Very valuable when it comes to health. So ladies, don't ignore it. If your partner is suffering with any of these conditions, take steps to assess what's going on and get it addressed. Because it could be a sign of deeper health issues that could be life threatening, number one. But number two, a great sex life is really an important part of your, not only your physical vitality, but your emotional wellness and your connection to your partner and to the world at large. So thank you so much Dr. Justin for coming on and sharing this wonderful information. You've got some information to share with everyone about where they can find out more about you. We'll have the links in the show notes, they can find out more about your device and about how you are helping men. Speaker 3 (38:54): Yeah. If I could just add just one other thing, Dr. Dunston, which is that Sure. We're working, we're working on similar technology for women. So we've retested on, on, on, on 38 women and it's, it's our goal by early 25 2025 to deliver data for women that will also allow them to hack their sex, their sexual health in order to have a long, a longer lifetime of, of love making. Speaker 1 (39:13): Okay. You gotta give us a sneak peek in like one to two minutes . Sure. So we can know about that. Speaker 3 (39:19): Uhhuh we are measuring, it's all about blood flow in men and women. So just as, as the male device firmness is a marker of blood flow in a female device. I don't call it so much erection, but I call it arousal. We are measuring blood flow in the CLS overnight. Women have nocturnal chlor arousal and we are measuring that as a leading indicator of their cardiovascular and cardiometabolic health. And in one during sex, we are measuring their chlor arousal as well. So women can then measure the impact of diseases, diets, supplements, creams, all the, all, all things that that which claims are made for, for their sexual health and see what works best for them. Speaker 1 (39:54): That's amazing. Thank you for that. Do keep me updated on that . I will. So yeah, tell everyone where they can find out more. Speaker 3 (40:01): Sure. You can find us at my firm tech M-Y-F-I-R-M-T-E-C h.com and you can find me directly at elliot E-L-L-I-O t@myfirmtech.com. And thank you much so much, doc Dustin, for this opportunity. Speaker 1 (40:15): Yeah, thank you so much for coming on. I think this has been such valuable information. We will have that link in the show notes and you can go there to click and find out more and stay updated. I'm gonna stay updated on what's coming down the line for women and I'll certainly let you know. So thank you again for joining us for another episode of the Hormone Prescription. I know you are inspired to create a better sex life for yourself and your partner for all its wellness and vitality benefits. I look forward to hearing from you on social media more about this. Have a great week and until next week, peace, love, and hormones y'all. Speaker 2 (40:55): Thank you so much for listening. I know that incredible vitality occurs for women over 40 when we learn to speak hormones and balance these vital regulators to create the health and the life that we deserve. If you're enjoying this podcast, I'd love it if you'd give me a review and subscribe. It really does help this podcast out so much. You can visit the hormone prescription.com where we have some free gifts for you and you can sign up to have a hormone evaluation with me on the podcast to gain clarity into your personal situation. Until next time, remember, take small steps each day to balance your hormones and watch the wonderful changes in your health that begin to unfold for you. Talk to you soon.   ► Learn more about Dr. Justin's works on erectile fitness - CLICK HERE.   ► Feeling tired? Can't seem to lose weight, no matter how hard you try? It might be time to check your hormones. Most people don't even know that their hormones could be the culprit behind their problems. But at Her Hormone Club, we specialize in hormone testing and treatment. We can help you figure out what's going on with your hormones and get you back on track. We offer advanced hormone testing and treatment from Board Certified Practitioners, so you can feel confident that you're getting the best possible care. Plus, our convenient online consultation process makes it easy to get started. Try Her Hormone Club for 30 days and see how it can help you feel better than before. CLICK HERE.   ► Do you feel exhausted, moody, and unable to do the things that used to bring you joy? It could be because of hormonal poverty! You can take our quiz now to find out if your hormone levels are at optimum level or not. Take this quiz and get ready to reclaim your life; say goodbye to fatigue and lack of energy for good. We want every woman to live her best life — free from any signs or symptoms of hormonal poverty, so they can relish their everyday moments with confidence and joy. Imagine having a strong immune system, vibrant skin, improved sleep quality… these are all possible when hormones are balanced! CLICK HERE now and take the #WWPHD Quiz to discover if you're in hormonal poverty — it only takes 2 minutes! Let's get started on optimizing your hormone health today.

Today I'd like to tell you about a paper by two physicians in France.The paper is titled, Frequency of lipoedema in patients consulting a vein clinic for mild to moderate superficial venous disorder with symptoms: A retrospective analysis.It was published in the peer-reviewed journal Journal of Vascular Medicine in April 2023.This study aims to understand the frequency of lipedema in female patients who come to a vein clinic with chronic leg pain.The authors comment that because lipedema remains largely underrecognized and misdiagnosed, it is important to know how often patients with lipedema are coming to vein clinics.Download the blood pressure pamphlet HERE

Episode Notes That soft buzzing in your neck might sound alarming, but it's actually just the normal sound of blood flowing through your jugular vein. Listen to understand the harmless causes behind "the hum" and learn when it could indicate a more serious issue. Venous Hum Instagram // Facebook // YouTube // Twitter WikiWalks.net Support Wiki Walks by contributing to their tip jar: https://tips.pinecast.com/jar/wikiwalks

In this second installment of the "Rant of Venous Arterialization of The Foot" on the Life of Flow podcast, hosts Lucas Ferrer and Miguel Montero Baker continue their in-depth exploration of arterialization procedures. The episode covers various aspects, including addressing complications with wires and lasers, stenting techniques, and post-dilation strategies focused on vein preservation. The hosts emphasize their preference for distal stenting, and share insights into challenges related to early failure and neointimal hyperplasia. The conversation extends to ongoing histological studies, highlighting the potential trauma caused during the procedure. Additional topics include coiling for flow modulation, valvulolysis of metatarsal veins, and stenting proximal segments. The hosts conclude with a disclaimer that their techniques are based on personal experiences and may not be universal. They tease a future episode focusing on postoperative care, rounding out another engaging and informative discussion in the realm of venous arterialization.

On this episode of Week In Review The FARM clinicians discuss a complex case involving cerebral venous sinus thrombosis and the roadblocks that stood in the way of an easy diagnosis, how losing sight of truly treating function can prolong treatment and reduce effective outcomes, and how treating something like chondromalacia patella should be less about the diagnostic moniker and more about the individual case presentation. --- Send in a voice message: https://podcasters.spotify.com/pod/show/thefarmcast/message

Join vascular surgeons Dr. Lucas Ferrer and Miguel Montero-Baker in the debut solo episode of "Life of Flow." In this candid conversation, the hosts delve into the intricate world of Critical Limb-Threatening Ischemia (CLTI), providing listeners with a glimpse into their professional dynamic and humorous exchanges. The core discussion navigates a challenging CLTI case, exploring nuances in patient selection, metatarsal access, and the delicate balance between open and endovascular techniques. The surgeons address the pivotal question of arterialization as a primary care pathway while underscoring the significance of pedal mapping. As the episode unfolds, ethical considerations in CLTI procedures take center stage, with a special focus on patients with end-stage renal disease. The interplay between scientific knowledge and practical experience offers listeners valuable insights into the complexities of vascular surgery and the ongoing quest for optimal patient outcomes.

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Dural Venous Sinuses⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Neurology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbull --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Blood gases are really commonly used in ED, Critical Care, Respiratory Medicine and Prehospitally. In fact, you'd do well to walk 10 meters in an ED without being given one to sign off! But it's for good reason, because they give you additional information about what's going on from a respiratory and metabolic perspective in the patient. And it's probably worth mentioning at this point, this episode is going to be pretty ‘science-heavy', there should be something in here for everyone; from the clinician that's been looking at these things for the last 30 years, to those that haven't started interpreting gases. So arterial blood gases can tell you about the efficacy of the patients ventilation in terms of their partial pressures of oxygen and carbon dioxide levels and also from a metabolic perspective about other disorders of their acid-base balance.  In the episode we'll be covering the following; -Overview of blood gases -Respiratory & metabolic sides of the gas -Acidaemia -Alkalaemia -Bicarbonate or base excess? -Compensation -Oxygenation -Anion gaps -System of interpretation -Venous gases -Clinical application & examples of interpretation We'll be referring to the equation listed on our webpage, so make sure you go and have a look at that and all the references listed. Once you've listened to the podcast make sure you run through the quiz below to consolidate the concepts covered with some more gas examples and of course get you free CPD certificate for your TheResusRoom portfolio! Once again we'd love to hear any comments or questions either via the website or social media. Enjoy! Simon, Rob & James

Belinda is a 46-year-old patient with a history of diabetes presents with a non-healing ulcer on the plantar surface of the foot. Upon examination, the therapist notes a well-defined ulcer with a punched-out appearance surrounded by callused skin. Which type of ulcer is this most indicative of? A) Venous stasis ulcer B) Arterial insufficiency ulcer C) Neuropathic ulcer D) Pressure ulcer LINKS MENTIONED: Did you get this question wrong?! If you were stuck between two answers and selected the wrong one, then you need to visit www.NPTEPASS.com, to learn about the #1 solution to STOP getting stuck. Are you looking for a bundle of Coach K's Top MSK Cheatsheets? Look no further: www.nptecheatsheets.com --- Support this podcast: https://podcasters.spotify.com/pod/show/thepthustle/support

To close or not to close - that is the question!  Internal hernias following bariatric surgery can be a vexing source of delayed postoperative morbidity.  Join Drs. Matthew Martin, Kunoor Jain-Spangler, Adrian Dan, and Vincent Cheng for this EXCELLENT Journal Review in Bariatric Surgery.   Article #1: Stenberg 2023 - Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery Two mesenteric defects are created during Roux-en-Y gastric bypass (RNYGB) Petersen's Defect Jejuno-jejunostomy mesenteric defect  Consensus does not exist regarding the standard of care for mesenteric defect closure (e.g., closure of one or both defects, material used for closure).  Risks of leaving defects open: internal herniation with or without bowel ischemia  Risks of closing defects Kinking the bowel (especially near the jejunojejunostomy) leading to obstruction  Chronic abdominal pain This article discusses a randomized controlled trial of obese patients undergoing bariatric RNYGB Randomized into two groups: a closure group and a non-closure group  Followed patients for 10 years with 95-96% follow up rate Results analyzed using a Cox proportional hazards regression that included risk factors like BMI, total weight loss at 1 year after surgery, and the other  Highlighted outcomes  Within the first 30 postop days, there was a higher rate of SBO in the closure group (1.3%) compared to the non-closure group (0.2%). This was attributed to kinking of the jejunojejunostomy  After 30 postop days and up to 10 years, reoperation rates for SBO were higher in the non-closure group (14.9%) compared to the closure group (7.8%). This trend was consistent regarding each site of mesenteric defect.  No significant differences between the two groups regarding chronic opioid use as a metric of chronic abdominal pain. Article #2: Nawas 2022 - The Diagnostic Accuracy of Abdominal Computed Tomography in Diagnosing Internal Herniation Following Roux-en-Y Gastric Bypass Surgery Unless there is an indication to immediately operate on a RNYGB patient in whom internal herniation is suspected, computed tomography (CT) is the recommended diagnostic test This article is a meta-analysis of 20 studies published between 2007 and 2020 that analyzed the accuracy of CT or detecting internal hernias in adult patients who underwent RNYGB for morbid obesity. A collective total of 1,637 patients were included.   Accuracy was determined by comparing diagnostic CT with exploratory surgery or the combination of negative CT and a negative 90 days follow-up Internal herniation was defined as presence of herniated small bowel with or without obstruction or ischemia through a visible opening at the mesenteric defect Results Pooled sensitivity of CT was 82% and specificity was 85% Positive predictive value of CT was 83% and negative predictive value was 86% CT signs with the highest sensitivity (sensitivity of finding)  Venous congestion (79%) Swirl sign (78%)  Mesenteric edema (67%) 15% risk of an internal hernia even with a negative CT scan In conclusion, CT can provide useful information, but these are just additional data points to consider in the overall evaluation of a patient. Surgeons should still have a low threshold for diagnostic laparoscopy even with negative CT findings If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

For patients with insufficient future liver remnant (FLR) volume, adequate hypertrophy after Portal Venous Embolization (PVE) is associated with reduced likelihood of post-operative hepatic insufficiency. But what happens when PVE isn't enough to obtain adequate volume prior to surgery? In this episode from the HPB team at Behind the Knife, listen in on the discussion about advances in venous deprivation techniques that can potentially increase resection rates and hypertrophy  Hosts Anish J. Jain MD (@anishjayjain) is a T32 Research Fellow at the University of Texas MD Anderson Cancer Center within the Department of Surgical Oncology. Timothy E. Newhook MD, FACS (@timnewhook19) is an Assistant Professor within the Department of Surgical Oncology. He is also the associate program director of the HPB fellowship at the University of Texas MD Anderson Cancer Center.  Jean-Nicolas Vauthey MD, FACS (@VautheyMD) is Professor of Surgery and Chief of the HPB Section, as well as the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center Learning Objectives: - Develop an understanding of Portal Venous Embolization (PVE)  - Develop an understanding of Sequential Hepatic Venous Embolization (HVE) - Develop an understanding of Radiological Simultaneous Porto-hepatic Venous Embolization (RASPE) - Develop an understanding of the traditional two-stage hepatectomy with PVE - Develop an understanding of the Fast Track Two-Stage Hepatectomy Papers Referenced (in the order they were mentioned in the episode): 1) Niekamp AS, Huang SY, Mahvash A, Odisio BC, Ahrar K, Tzeng CD, Vauthey JN. Hepatic vein embolization after portal vein embolization to induce additional liver hypertrophy in patients with metastatic colorectal carcinoma. Eur Radiol. 2020 Jul;30(7):3862-3868. doi: 10.1007/s00330-020-06746-4. Epub 2020 Mar 7. PMID: 32144462. 2) Laurent C, Fernandez B, Marichez A, Adam JP, Papadopoulos P, Lapuyade B, Chiche L. Radiological Simultaneous Portohepatic Vein Embolization (RASPE) Before Major Hepatectomy: A Better Way to Optimize Liver Hypertrophy Compared to Portal Vein Embolization. Ann Surg. 2020 Aug;272(2):199-205. doi: 10.1097/SLA.0000000000003905. PMID: 32675481. 3) Nishioka Y, Odisio BC, Velasco JD, Ninan E, Huang SY, Mahvash A, Tzeng CD, Tran Cao HS, Gupta S, Vauthey JN. Fast-track two-stage hepatectomy by concurrent portal vein embolization at first-stage hepatectomy in hybrid interventional radiology / operating suite. Surg Oncol. 2021 Dec;39:101648. doi: 10.1016/j.suronc.2021.101648. Epub 2021 Aug 16. PMID: 34438236. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/