2 Episode results for "Caitlyn Rogers"
NEJM This Week April 18, 2019
"Welcome. This is the New England Journal of Madison. I'm Dr Michael bearer this week April eighteenth two thousand nineteen we feature articles on early or delayed cardioversion for atrial fibrillation. Anti thromboembolic therapy in atrial fibrillation after PCI or an acute coronary syndrome correction of skid x one with gene therapy, an anti for antibody for HIV one and valuations of surgical procedures in the Medicare fee, schedule a review article on catheter ablation of ventricular arrhythmias. A case report of a man with weakness and difficulty chewing and perspective articles on structural racism, una Belmont report for health data and on diabetes and disclosure. Early or delayed cardioversion in recent onset. Atrial fibrillation by Nikki plumbing, cours from Maastricht University Medical Center, the Netherlands patients with recent onset. Atrial fibrillation commonly undergo immediate restoration of sinus rhythm by pharmacologic or electrical cardioversion, however, whether immediate restoration of sinus rhythm is necessary is not known since atrial fibrillation often terminates spontaneously in this trial, four hundred thirty seven patients, presenting within thirty six hours after the onset of atrial fibrillation were randomly assigned to undergo early cardioversion or to receive rate control medication. Followed by delayed cardioversion within forty eight hours. If there was no conversion to sign his rhythm. The presence of sinus rhythm at four weeks occurred in ninety one percent of patients in the delayed cardioversion group and in. Ninety four percent in the early cardioversion group in the delayed. Cardioversion group conversion to sinus rhythm within forty eight hours occurred spontaneously in sixty nine percent of patients and after delayed cardioversion in twenty eight percent in the early cardioversion group conversion to sinus rhythm occurred spontaneously before the initiation of cardioversion in sixteen percent of patients and after cardioversion in seventy eight percent. Among the patients who completed remote monitoring during four weeks of follow up a recurrence of atrial fibrillation occurred in thirty percent of patients in the delayed cardioversion group and in twenty nine percent in the early cardioversion group within four weeks after random ization, cardiovascular complications occurred in ten patients and eight patients respectively. The wait and see approach was non inferior to early cardiova-. Version in a cheering return to sinus rhythm at four weeks. Jeff Healy from McMaster University Hamilton, Ontario, Canada writes in an editorial that the results of this trial greatly simplify the current controversy regarding the safety of cardioversion between twelve and forty eight hours after the onset of H Roe fibrillation for most patients with recent onset. Atrial fibrillation, the wait and see approach may become the preferred strategy unless they have a history of persistent atrial fibrillation or there are barriers to implementing this approach. Early. Cardioversion remains an option for patients who have had atrial fibrillation for more than thirty six hours. If they are receiving long-term anti coagulation have been classified as low risk on transit SAFA Geel echocardiographic or have a low risk of stroke and atrial fibrillation with a jurisdiction of thirty six to forty eight hours early cardioversion remains. Option for any patient with hemodialysis instability within one year after a visit to the emergency department for atrial fibrillation. Five to ten percent of patients will die from any cause and ten to twenty percent will have a stroke embolism or my cardio and FARC Shen or be hospitalized for heart failure since the early cardioversion strategy did not significantly increase. The rate of sinus rhythm at four weeks. It is implausible that such treatment would improve long term outcomes of finding that is consistent with the results comparing long-term rate control with pharmacologic rhythm control. However, long term prognosis can be improved with oral anti coagulation and risk factor. Modification which can be initially addressed in the emergency department. Visit and then effectively managed with routine specialist followup therapy to prevent recurrent hosp. Title ization for atrial fibrillation is another key component of long term care since. Most patients who present to the emergency department have recurrent, atrial fibrillation the management of atrial fibrillation in the emergency department is not only a sprint to eliminate symptoms and facilitate safe discharge, but also the start of a marathon to improve long term outcomes for patients. Anti thromboembolic therapy after acute Carnera syndrome or PCI in a trio fibrillation by Renault. Lopez from Duke University school of medicine Durham, North Carolina. Appropriate anti thromboembolic regimens for patients with atrial fibrillation who have an acute coronary syndrome or have undergone perkiness. Carney intervention PCI are unclear in this international trial with a two by two Factoria. Design four thousand six hundred fourteen patients with atrial fibrillation who had an acute coronary syndrome or had undergone PCI and were planning to take a p two y twelve inhibitor were randomly assigned to receive a pixel Ben or a vitamin k antagonists and to receive aspirin or matching placebo for six months. There were no significant interactions between the two random ization factors on the primary or secondary outcomes. Major or clinically. Levent? Non major bleeding was noted in ten point five percent of the patients receiving a picture ban. As compared with fourteen point seven percent of those receiving a vitamin k antagonised and in sixteen point one percent of the patients receiving aspirin as compared with nine percent of those receiving placebo patients in the picture ban group had a lower incidence of death or hospitalization than those in the vitamin k antagonist group twenty three point five percent. Versus twenty seven point four percent and dissimilar incidents of his schemic events. Patients in the aspirin group had an incidence of death or hospitalization and of schemic events that was similar to that. In the placebo group in patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a p two y twelve inhibitor and anti thrombosis regimen. That included a pixel van without aspirin resulted in less bleeding and fewer hospitalizations without significant. Differences in the incidence of his schemic events than regimens that included a vitamin k antagonists aspirin or both. In an editorial Shamir meta from McMaster University in Hamilton health sciences writes that given these data clinical decision making should continue to be based on a balanced assessment of three competing risks cardio embolic stroke KARN area, schemic events and bleeding. This assessment should include not only demographic and clinical variables regarding these risks. But also the clinical setting as well as the end geographic complexity of PCI and risks associated with the procedure in patients with a low risk of from body events such as those undergoing elective PCI who do not have high risk, clinical or angiographic features or a high risk of bleeding early. Omission of aspirin therapy and treatment with a direct oral anticoagulant plus clopidogrel is entirely warranted. However in patients undergoing complex multi vessel or high risk PCI or. In those presenting with high risk acute coronary syndrome, aspirin should probably not be routinely omitted for at least several weeks or longer depending on bleeding risk, although guideline committees will now have to grapple with incorporating the results of this trial into specific recommendations, it is clear that a one-size-fits-all policy is unlikely to apply in these patients. Lenti viral, gene therapy combined with low dose byu south N in infants with skid x one by Evellina mom cars from Saint Jude's Children's Research Hospital. Memphis, Tennessee, allogeneic Jimeta poetic stem cell transplantation, for x linked severe combined immunodeficiency skid x one often fails to reconstitute immunity associated with t cells b cells and natural killer cells. When matched sibling donors are unavailable. Unless high dose chemotherapy is given these investigators performed phase one to safety and efficacy study of a Lenten viral vector to transfer I l to RG complementary DNA to bone marrow stem cells after low exposure targeted buechele fan conditioning in eight infants with newly diagnosed skid x one. Bone marrow. Harvest bue self end conditioning and sell infusion had no unexpected side effects in seven infants the numbers of CD three CD four and naive. Cd? Four t cells and natural killer cells normalized by three to four months after infusion and were accompanied by vector marking in t cells, b cells natural killer cells myeloid cells and bone marrow. Progenitor 's the eighth infant had an insufficient T cell count initially, but t cells developed in this infant after a boost of gene corrected cells without buechele fan conditioning. Previous infections cleared in all infants I g m levels normalized in seven and three head response to vaccines. This study showed the successful use of a viral vector combined with low exposure targeted youself. Dan conditioning as the primary treatment the overall safety profile was favorable at the time of this. Interim analysis. Effective anti for antibody you before twenty one on HIV one rebound after treatment interruption by Chon. Ye Wong from United. Biomedical? Hop hog. New York administration of a single broadly neutralizing HIV specific antibody to HIV infected persons leads to the development of antibody resistant Firas in the absence of antiretroviral therapy, RT it is possible that monotherapy with you before Twenty-one an antibody that blocks the virus binding site on human CD, four t cells could induce sustained viral logic suppression without induction of resistance in HIV infected persons after analytic treatment interruption. This phase two clinical study evaluated the safety pharmacokinetics and antiviral activity of you before twenty one monotherapy in HIV infected persons undergoing analytic treatment. An interruption administration of you before Twenty-one maintained viral logic suppression, less than twenty copies per milliliter in all the participants ninety four point five percent of measurements at study visits to through nine during analytic treatment interruption with intermittent viral blips observed in twenty eight percent of participants. No study participants had plasma viral rebound to more than four hundred copies per milliliter. Cd four t cell counts remained stable throughout the jurisdiction of the study rash. Mostly of great one was a common and transient adverse event. One participant discontinued the study drug owing to Arash a decrease in the population of CD for regulatory t cells was observed during you before Twenty-one monotherapy you before Twenty-one maintained viral logic suppression during the eight to sixteen weeks of. Study in participants in the absence of a RT. Accuracy evaluations of surgical procedures in the Medicare fee. Schedule by David Chan from Stanford University school of medicine, California. The relative value scale update committee ruck of the American Medical Association. Plays a central role in determining physician reimbursement. The rucks role and performance have been criticized but subjected to little empirical evaluation this study, analyzed the accuracy evaluations of two hundred ninety three common surgical procedures from two thousand five through two thousand fifteen the rucks estimates of procedure time were compared with benchmark times for the same procedures derived from a clinical registry at the time of one hundred eight ruck reviews. The mean absolute discrepancy between ruck time estimates and benchmark times was eighteen point five minutes or nineteen point eight percent of the. Tuck time, however, ruck time estimates were neither systematically shorter nor longer than benchmark times overall these analyses suggest that whereas orthopedic surgeons and urologists received higher payments than they would have if benchmark times had been used one hundred sixty million and forty million dollars more respectively in Medicare reimbursement in two thousand eleven through two thousand fifteen cardiothoracic surgeons neuro surgeons and vascular surgeons received lower payments, one hundred thirty million sixty million and thirty million dollars less respectively. The accuracy of ruck time estimates improved in forty seven percent of rock revaluations worsened in twenty-seven percent, and was unchanged. In twenty five percent percentages do not sum to one hundred because of rounding these authors found subside. Stansel absolute discrepancies between intra operative times as estimated by the ruck and the times recorded for the same procedures in a surgical registry. But the ruck did not systematically overestimate or underestimate times. Catheter ablation of Ben trickier arrhythmias a review article by Colin I'm shift Kumar from the university of California, Los Angeles, ventricular Tackett, cardia arises from an abnormal electrical, focus or circuit in the myocardium of the ventricle, and is usually manifested as tacky arrhythmia with a wide q r s complex on electrocardiogram, easy with or without clinical consequences, ranging from dizziness to syncope or sudden, cardiac death management requires an assessment of the risk of sudden death posed by the arrhythmia evaluation for the presence and extent of underlying heart disease, and weighing of the risks and benefits of treatments catheter based management of ventricular, tack cardia was inspired by surgical studies, which showed that reception of my cardio scars could result in control of and tricky attack Ikaria. Successful catheter based ablation of ventricular tack cardia was initially reported in nineteen eighty three and its use has increased in the past two decades with the development of radiofrequency ablation in the nineteen nineties catheter ablation of and trickier, tack cardia involves identifying the mechanism of focus with abnormal impulse formation or a re entrant circuit mapping, the ventricular tack cardia and using radiofrequency current to obliterate the tissue involved ablation is typically considered for the treatment of intrigue tack cardia. When drugs are ineffective or have unacceptable side effects. Ablation has a high rate of success for patients with premature ventricular complexes and those with idiopathic ventricular tack Ikaria among patients with structural heart disease. Success rates are not as high. A sixty year old man with weakness and difficulty chewing a case record of the Massachusetts General Hospital by Christopher doughty and colleagues. A sixty year old man was evaluated in the neurology clinic because of difficulty chewing and progressive, generalized weakness. Six months earlier weakness developed in the muscles of the patient's shoulders and arms, and he found it difficult to carry objects two months later, the patient began to have difficulty chewing food he described mile difficulty chewing at the beginning of a meal with the severity increasing during the meal, the weakness and difficulty chewing persisted and the patient was evaluated in urology clinic at another hospital, he reported excess salvation slurred speech, mild constipation and a weight loss of three point six kilograms over a period of three months atrophy and facilitations of the deltoid. Muscles were noted therapy with pure dose stigma and was initiated on presentation to this hospital. The patient reported that peer too Stig mean had had no effect on his weakness or chronic diplo Pia, but that his difficulty chewing had improved however, five weeks after the initiation of treatment, the difficulty chewing worsened, the patient reported new weakness in the legs with difficulty rising from a seated position overall this patient's diffuse predominantly, proxima weakness suggested a disorder of the peripheral nervous system, the most common motor neuron disease to occur in. This patient's age group is a Maya traffic lateral sclerosis, a degenerative disorder that affects both upper and lower motor neurons. Any J M knowledge, plus pain management and opioids a new adaptive learning module and editor he'll by ole Petter hummed Nick from Brigham and women's hospital Boston in two thousand seventeen more than eleven million persons reported misusing prescription opioid analgesics during the past year more than two million reported opioid use disorder and there were on average one hundred thirty overdose deaths involving an opioid every day. Primary care providers are the front line of managing pain and addiction. But they report insufficient training in these areas at any jam group. We believe in improving health through education. We are now announcing the launch of the any J M knowledge, plus pain management and opioids module this module available free of charge at knowledge, plus dot any J M dot org. Features more than sixty case. Based questions on pain management safer, prescribing of opioid analgesics and the recognition and treatment of opioid use disorder to ensure that development of high quality unbiased content in this module. We partnered with experts at Boston University school of medicine's scope of pain program. The new any J M knowledge, plus pain management and opioids module uses an innovative learning platform that is based on active testing rather than passive reading, which increases the efficiency of knowledge retention. We hope that through this program. We can help clinicians provide safe and effective pain management while supporting the effort to reduce the devastating impact of the opioid crisis. Structural racism. A sixty year old black woman with breast cancer, a perspective article by Kristen Palikhe from rush Medical College, Chicago, MS M from Chicago's primarily black south side was seen for a breast lump at a community hospital, the emergency medicine physicians suspected an infection and discharged her with a prescription for antibiotics when the lump persisted MS M obtained a mammogram which revealed potential breast cancer, she was referred to a general surgeon at the community hospital who excise the cancer and recommended a mastectomy with accelerator no dissection, MS M was neither informed of her cancers stage nor referred to an unconscious te however, a navigator from the metropolitan Chicago breast cancer, taskforce, rerouted her to a qualified medical center. There a specialist informed her that she had stage three. Three infiltrating, Dr carcinoma, which required a needle biopsy, not an exhibition will biopsy, and that a mastectomy was unnecessary hospitals that serve Chicago's minority. Neighborhoods often face financial constraints that limit the breadth of their cancer care services. Structural racism refers to the ways in which historical and contemporary, racial inequities in outcomes are perpetuated by social economic and political systems including mutually reinforcing systems of healthcare education housing employment. The media and criminal Justice it results in systemic variation in opportunity according to race or ethnic background, for example in racial differentials in access to healthcare. A Belmont report for health data perspective article by Femi Ohs potus, CDs from Ohio State University. Columbus. Legal safeguards for health. Data are limited in scope in the United States, the large swaths of data held by digital health pioneers. Raise a host of ethical concerns related to the reporting of incidental findings misuse of private information, re identification of de identified data discrimination and health. Profiling last year Facebook sought to purchase de identified. Patient records match the records with his identifiable user data and create digital health. Profiles of Facebook users a practice, not precluded by hippo life. Insurers are transitioning to contracts that instruct policyholders to wear products that continuously monitor their health companies can increase customers premiums on the basis of information gained from the surveillance, but they have no. Obligation to provide health warnings concerns about data use can affect clinical care, particularly when patients seeking to protect their privacy, either avoid care or withhold relevant health information from their provider just as indignities common in human subjects research led to the articulation of ethical principles in the Belmont report. Forty years ago contemporary concerns about data use call for stakeholders to promulgate ethical guidance for health data meaningful ethics review can take many forms. Diabetes and disclosure perspective. Article by Caitlyn Rogers from the university of North Carolina school of medicine Asheville, three surgeons and medical students stand around the operating table and attending and surgical resident are working on the patient's left side, the third surgeon. Another attending maintains tension on the suture as Caitlyn closes the long incision on the patient's, right? It's the last week of her third year, surgical rotations. But the first time she has met any of these men. So after the expected questions about anatomy indications for surgery and alternative treatments. The conversation turns to the personal where is she from? What did she study? Does she want to be a surgeon? Caitlyn replies. As she starts her next stitch about eighty percent of the time. I think I wanna go into primary care and the other twenty percent, I think endocrinology is really. Cool. The resident interjects I hope you like working with diabetics. Actually, I am diabetic the OR is quiet as Caitlyn repositions her needle in the needle driver. I've always liked working with diabetic patients type one and type two another moment of silence as she places her neck stick her attending in the OR examines the incision, which is now three quarters closed. You're sure you don't wanna be a surgeon with suturing skills like that. How do you manage during surgery? The resident asks Caitlyn recalls her glucose level as she walked into the OR and contemplates dry, bitter taste of prolonged hyperglycemia lingering in her mouth. I run myself high on the days, I'm in surgery. She says so I don't have to leave to eat. Our images in clinical medicine features. A twenty year old woman who presented to the emergency department with Arash involving the arms legs trunk and scalp which had erupted that morning. She also reported generalized muscle aches, fever and pain in both ankles two weeks earlier the patient had had vaginal intercourse with a new partner without barrier protection. The physical examination was notable for era theme, it has pustules near the wrist and on the fingers and on the trunk scalp and both ankles. There was mild, swelling and pain with passive motion in the right ankle and Tino Sino Vitus involving the tendons of both ankles given a high suspicion for disseminated Ghana cockle infection treatment with Steph Triax zone and Zithromax in was initiated blood cultures grew gram negative dip Lowcock Cy that were identified as nice Syria gonorrhea, which confirmed the diagnosis the pace. Tient symptoms abated with antibiotic treatment at three months of follow up. The patient was feeling well with no recurrence of skin lesions or joint pain. A thirty five year old man presented to the emergency department with a two day history of abdominal pain headache and Brown urine on examination. His temperature was thirty seven point five degrees centigrade. He was alert and oriented to time place and south and he had no purple or Petit. I laboratory evaluation revealed a haemoglobin level of eight point six grams per deciliter and platelet count of six thousand per cubic millimetre levels of indirect Billy Rubin and lactate dehydrogenation where elevated have to globe in was undetectable and the serum creating level was one milligram per deciliter. A peripheral blood smear showed numerous schist ascites. These findings were consistent with micro NGO Pathak hemolytic anemia. Plasma exchange for suspected Thrum botox from side a peanut Perpere was started immediately without the prompt initiation of treatment mortality from from botox. Rambo side of peanut purple is high the patient underwent plasma exchange and received intravenous methylprednisolone for five days and had resolution of symptoms and an increased platelet count. The diagnosis was confirmed two days after initiation of treatment with Adam T S thirteen activity of one percent. He was discharged with instructions for tapering glucocorticoid treatment, three months after discharge he remained. Well, this concludes our summary. Let us know what you think about our audio summaries. Any comments or suggestions may be sent to audio at any J M dot org. Thank you for listening.
Bonus - Lauren Ash on The Power of Sisterhood, Setting Intentions + Preventative Self-Care at Propel CoLabs Fitness Festival
"We talk a lot about equality but the fact is that when we are born inherently because of our various social locations than identities. Some of us are just born with more of an advantage. Some of us are inherently more more of a disadvantage and so people can really recognize that works to create more of a level playing field so to speak or work towards creating that. It's just it's amazing. You're listening to the almost thirty podcast hosted by christa williams and lindsay simsek almost thirty started as a conversation station about the transition from our twenties or thirties but then we realized life is full of transitions so be expanded our mission. We are an intuition. Shen lead wellness focused lifestyle podcast that promises to deliver authentic conversations diverse points of view an insights rooted in optimism growth and intention attention. The almost thirty nation community is a group of purposeful dreamers who are smart passionate and always seeking the full potential in every aspect of their lives at almost thirty were making magic together. We dream it and then we do it. Thanks so much for tuning into the almost thirty podcast here we go. Hello hello. It's us lindsay and krista of the almost thirty podcast. Thanks for joining us. This is a special friday treat for you. All we rely at the propel collapsed fitness festival in los angeles this summer dumber the fourth year of one of the biggest fitness festivals out there it was such a blast and we got to interview some of the most incredible people yeah we i love propel co labs because it's a place where we could all learn grow inspire and celebrate fitness and wellness together and almost thirty podcast we are all about coming in community to learn in grow and inspire one another so it was a perfect alignment of our two brands. We were lucky enough to interview leaders and fitness and all of our mind body health and wellness and are are excited to bring you the series powered by propel. Today's interview is with lauren ash lauren ashes a wellness visionary yoga and meditation guide had sought after speaker and writer and founder and executive director of the culture shifting lifestyle brand synonymous with black women's wellness black girl in home. This interview is powerful and insightful and we loved talking to lawrence. Please enjoy this episode and we're excited to have her first palmer station with lauren here with you today this afternoon and we would love to welcome tom her on stage. We have founder of black girl lauren ash we're all working during coordinated today which his amazing yes we. We only slightly plan to so. I'd love to talk about your impact. You've had in the wellness space and you have such a heart centered approach to everything you do and i think that's what makes you stand out and that's what makes block girl home so different. Can you talk a little bit about the beginning of black girl and on and where you got at the idea to start it absolutely and i'm really excited to talk about this. I love telling the story of the journey especially for those who are like young and creative and you have perhaps vision and you're like how the heck do. I amplify this way for me. I it all happened very organically so i've been practicing yoga for a few years i i gravitated towards the practice because i was a stressed out grad student so i did not sign out because it was acute or popular. I was signing up for very practical reasons to stop a local yoga studio because i noticed all the embodied tension i was holding in my body a lot of the work that what i was doing as a grad student was also very intense like beautiful but intense. I said he black feminism. I studied a lot about black culture and i was just noticing how much i was kind of weighed down on and my spirit by a lot of it and so i started practicing and of course i fell in love with it of course and i even took a yoga for transformation in series why we dove into the eight limbs of yoga and realize the philosophy and the spirituality and they're really rich history behind this practice that oftentimes gets attention just because of physical postures right and how fair tone or whatever you can get from it but i was like this is a whole a whole just expansive <hes> spiritual tradition as as well so fast forward you know had been about three years of practicing consistently. I found myself in chicago very serendipitous. The i had moved to chicago and i i found myself also really disillusioned with just this idea of a traditional career that i was really trying but struggling to to grasp and so that disillusionment disillusionment wound me up in in terms of <hes> committing to a yoga teacher training i was not signing up to become a yoga teacher. I also i always tell people that like that was is not a part of my vision. I was simply really deepening my own practice you know and and curious about what that would spark for me and i literally signed signed up the day that yoga teacher training began a sagittarius embrace spontaneous so that's very normal for me and that first week was when i received all these downloads loads about black girl and home like literally a yoga practice. I received the phrase black girl in home. So that wasn't something that i conceived of later you know brainstorm like what is the name of this pot from going to be. It was just like it came to me and i wrote it down and i really started at that point and more intentional manifestation practice i. I didn't know that's what i was doing at the time but i know that now looking back so i really was dwelling on okay what is black girl home you know and i realized that it could be this way for me to merge together my passion for holistic wellness <hes> my passion for yoga in particular with my love of cultivating intentional attentional sisterhood with other black women you know that was something that was huge for me and really caused me to be so lifted <hes> throughout my graduate studies as as well like i formed really intentional relationships with people who are like my closest friends so this day and i knew from experience that i had an undergrad <hes> where i really experienced dance more overt racism for the first time that i also had this like deep empathy for creating like really intentional spaces for as as we say within black girl and for us to breathe these right so it just grew from there i mean after yoga teacher training. I started hosting <hes> black rome yoga sessions in the in the living room of a really good friend now mentor of mine's apartment so when people are also like oh. How do you get started. I'm like start starting your friend's house like really you know i did not know many people in the city that i was at the time i was just in there for <hes> i was just in chicago for about a year at that point and so i think i started it with like maybe fifty instagram followers and i was like come through and people did and you know fast forward. It's almost five years later. We also have a a podcast. We reached over a million downloads last year. We have an online publication with just i don't even know how many people visit the site but we share resources about what it means to be well and sustained and and thrive honestly as women of color we also have ongoing experiences in the way of like self care sunday experiences and retreats and it's just been something that has grown into this really beautiful global sisterhood and like wellness movement that really centers women of color in the conversation about healing gene self-care is self empowerment and self love and it's just been a beautiful journey gets beautiful to think that the entity black on found you and it's almost all you have to to do is is get out of the way and be that conduit for its energy and what it wants to bring to the world and it it is like a sense of peace you know you don't have to exert too much. It's the allowing so that's really beautiful is yeah yeah but i mean there are moments. I'm sure you all can relate where you're just. You're trying to like you know. Put on all the pressure put on what you think. It should be how you think it should or other. People are telling you that so. It's a constant practice. I can imagine absolutely yeah so we know that there is a problem in mainstream wellness. <hes> there is a lack of diversity across the board and i just i you know i admire and respect your brand so much in the sense that it is <hes> giving you know women of color an opportunity annuity to see themselves you know and so what is the importance there and in canoe educate us on where this is happening and not happening within the wellness industry industry yeah absolutely and it's so incredible thinking back to twenty fourteen when i got started i have no doubt that there were phenomenal women of color alert leading spaces and initiatives and yoga classes and all that stuff for women of color and buying but i did not see it in this broader waterway like i did not have access to it like if i would google for it. I wouldn't find it. You know what i mean. So that's why i started a fast forward to now. There has been so much power for work done and it's beautiful because black girl no has kind of been a magnet and an umbrella like brought a bunch of people who should have been in conversation who should have been connected together so so i see it i see a lot of work towards like more equity and justice within the wellness space being done by a lot of individuals joel's who are black and brown folks who have had either experiences that were just you know again overt discrimination that really like me. You like lit a fire. It was like no we gotta really we gotta really do something and then i see a lot of really awesome work being done with allies like i think it's so crucial to like a firm that it can't just be marginalized folk who are doing the work to you know center more of us within the wellness base is absolutely has to be allies like quite allies. <hes> and focus was more power implemented general working together and so i've been personally so positively benefited and and from and also in relationship with <hes> specific allies and i just wanna shout them out because i think they're fantastic human so <hes> caitlyn rogers go <hes> peres she she and her business partner rashida graham washington have this phenomenal issued of this developing right now called sweet rest and caitlyn is a white woman and ally a. and rashida is a black woman and has a lot of work within the justice and faith movement and they have come together to create a platform that provides sweet rests basically rejuvenating even eating experiences for black women so caitlyn as a white woman has identified. I have certain access to wealth and power and i want to use that to both dismantle whole white supremacy and also provide access for black woman who are doing phenomenal work in the community and who are always going right like always always always going to just sit down and be and that is a radical act and so for the two of them. I feel like the model that they've created and black number. Partnering among very exciting ways in the future including providing two sabbatical sleet rests like month-long sabbaticals for black women so that'll be announced during our five. Have your anniversary this november. I also really love the work that i'm ali boroughs. She's the co founder of mindful. It's a really phenomenal meditation city in new york city. She's another example apple of an ally who has provided specifically space like i don't think people realize how radical it is that if you have space to provide did again for someone who is from marginalize background who doesn't have access wells capital like just providing someone's space. You know what i mean to host. I l wellness session to come together and have a safe space debris the easiest safe space to be that radical active. She has given me space. She has trained me. I got a train invaded meditation with her last month in it has changed my life providing not thinking about it like a donation but in thinking of it like a you you may otherwise not get to have this or the rate that someone might be offering issue is the rate that they would also offer someone who has more wealth than who has more access than that doesn't don't even make sense you know not to me is about is about equity like we talk a lot about equality but the fact is that when we are born inherently because of our various social locations than identities. Some of us are just born with more of an advantage. Some of us are inherently more and more of a disadvantage and so people can really recognize that and works work to create more of a level playing field so to speak or work towards creating that it's just it's amazing so yeah i look i mentioned sweet resume mentioned elliott because i feel like both the connection of of allies shipped with <hes> rasheeda and with caitlin and sweet rest and then allie realizing again her the space that she can provide the training that she can provide. It's just absolutely essential in terms of models that we can look to about what's possible. That's beautiful and we've done a little bit of the work but it's been some of the most powerful transfer made a transformative opportunities for me as a person you know in my life life so highly recommend. I wanted to ask you about self care and rest. You know you're talking about eating these women sabbaticals for a month so what is the power you've seen of south breast self karen rest in your life and then with other black women. I love this question moment yes at the top of this year y'all and it went on this phenomenal retreat and bali. It was a manifestation retreat for women of color and it was the right around the new year so you know i'm huge intention setting huge. It's like i live by intentions as much as possible. I'm always setting a new one with the new moon but i also always free one at the top of the year and what i really really was receiving through all these experiences that we were doing our was that my words my concepts for twenty nineteen were rejuvenation and regeneration. That's why i'm just like ooh. I love talking talking about rest because that's so resonate with the ideas of rejuvenation redecoration so literally rest is everything i want to also chatted a really powerful platform called the nap ministry into yes so it was founded by a black woman fortunately <unk> remember her name but it's a instagram page agenda overall movement if literally about taking naps and sitting down and resting and for again marginalized peoples stiffly. I'm a black woman. I can only speak to my experience. Yeah we are so condition on so- socialized to gogo to work harder because you know in some cases we have to order to get experiences at others might get for you know we just have to work. We have to work harder and also just when you think about like the history too of black women in terms of our relationship with labor and providing for others there's and being of service to others and that being passed along intergenerational. We had a quick little chat about intergenerational everything right before this and it's like those things clearly get passed down right and so i have to literally as a black woman especially as a black woman who is leading a movement that has all about self care. I have to model the kinds of like the kinds of ways of being and the kinds of consciousness that i think more of us has to in order to be freer and in order to like love love ourselves and love others more so for me rest looks like so i love this. I really listen. I committed to taking mike quarterly week long. <hes> spiritual retreats and i can look different look like an official retreat or me just like turning everything off for a week right and even the the the fact that that sound so radical like people are like oh every quarter like a week off in you know in for me. It took me a while to get there a recently revisited journal of mine from two thousand fifteen. I wrote down that. I wanted to do that here. We are in two thousand nineteen and i finally i meant both a position to do that. And also i feel will like i deserve it. You know what i mean. That is a huge thing to for any of us who are like struggling with the idea of taking time for ourselves whatever that looks like a nap or her a vacation. That's truly vacation him a lot of times. We go on vacations. Were still plugged in something wrong with that but if you feel like you're always plugged in you. You do need to take a break from the screen right. You need to take a break from the content whatever but for me to also just know that i can do it and also i'm deserving of it. <hes> that's really powerful you know not because i have worked hard but just because i as a being need to give that to myself and that giving not to my cell phone pouring into myself in that way allows me to give to other people i really loved lisa nichols really powerful motivational speaker black woman as well and she always talks about about giving from the overflow so not giving from this place of of deficit of course but not even giving proper place of like i just have enough let me give that see you know like literally pouring hiring in myself and i am at then joyful to give to other people because i have so much together not to me can only come from giving myself really rejuvenating restorative experiences as much as possible every day. I have a really like beautiful long morning. Ritual and i have remind myself on those days where i wanna cut it shorter. Sorry i feel like i can't but that is exactly why i need to again. Giving from the overflow guy you mentioned but deserving of the self care. I'd love to know like what what stories have you had to kind of rewrite or detangle surroundings healthcare or anything at all. You know we all have our stories so i just love to know what you've done around that i- legit love these questions we should do this job so he's yes breath so off unconditional love and support and rewiring and i'm literally in this state right now rewiring what i was living by for thirty years of my life which was that i was loved. Conditionally both by other people blend my life so they love me for what i was doing or providing to them and also i could only love myself and only give myself if i was doing x._y._z. and i usually x._y._z. Were unrealistic expectations and this was another realization that i had when i was in bali so i'm always going to talk about the all the change my life but you know sometimes if you plan maybe give yourself something or like this is going to be what i focus on forgiveness or this is going to be when i focus on like my fitness or whatever but sometimes when you set that intention universal start giving. It's you a little earlier because it's like okay. You said you wanted to do this. So before i went on a retreat already started to get hints of unconditional love kevin support being a big thing that i was going to start owning and practicing literally the day that i flew to bali. I get on the phone with my best friend. We were having a heart to heart you know when i was in your best friend. You've gotta take a little break this is this is coming back together after a break she's like i can't let you go all the way to asia without us really coming together again and she was like lauren. I've really realized that every time the word gather. I noticed that you're always trying to do something for me. Always giving me something trying. Teach me something. She's like. I don't need to do all that. He's like all i need you to do is be yourself and affirm me. That's all i need and such a beautiful thing me who i am now looks at that and i'm just like jews literally just letting me know that she loves me unconditionally and she wants me to love her unconditionally but in that moment i literally was devastated and i didn't know hawaii didn't have language for it. I didn't know why and why that feeling arosa me but i literally like felts internally off and on the final was just like okay girl yeah but but i was like going through it inside. I get the bali on the first day before the retreat even started. I'm like walking around trying to find breakfast us and i overhear this father talking with his daughter she had to have been five years old and all i hear from the conversation was telling her always remember that you are not loved for or what you do your love for who you are and i like i was so emotional. It felt like he was talking to me and it felt like he was my dad and i actually we have like a very complex relationship my dad historically and so it was also like a methods that i think you know he's talking about. Healing the inner child. I feel like my inner child like young. Little lauryn needed to hear that message to and in a moment i did not connect all that moment with what my best friend had told me literally twenty four hours prior at no connection made so we're at the first like dinner of the rich breed and they're talking about how much unconditional love and support is going to be what we focus on so. I'm getting emotional. John like okay. This is purely a message for me right and one of the first activities that we did on retreat was calling in mind a moment in our lives where we can and always think back on to know that we are unconditionally loved and supported. I was already. I was like yes. We're supposed to draw symbol of this moment. I have my market that i have my paper out yes and then i sat there and i realized that nothing was coming to mind and then the things that would come to mind to me in that moment or only connected enacted things that i had done for people so it's like okay well fish up for me in this way but that's because i did this and then i was like really again emotional <hes> carleen the person leading activity was like everyone dying and i hadn't even thought of a moment yeah i eventually did in the government it was with my best friend and it was like really heart warming but i was still really struggling with the fact that it took me so long even think of a moment right 'cause i knew intellectual level that i am unconditionally loving supported by breath many of my close friends and family like they don't expect anything from me. They don't want me to be anything else other than who i am this moment and who i was when they first met me right it but something something was troubling me about why it took me so long and i had a major realization over the course of the retreat that when when i was young you know being a deeply creative child and my parents channeling me into all these activities and theater and lawson's all the oftentimes on stage you know i mean much like i am now. <hes> and that the celebration of the affirmation that i've received afterwards i translated that into they love who i'm being in terms of performing offense. They love what i'm giving them in that performance and not they could care less i could have gone up there and saying crazy or like the lines or not done this activity at all and just ben myself in like not done anything and they would still love me so it was a major realization so it was two things number one me then starting to lean into the love that has been around me and not thinking that it's something else expecting something from me right and also me giving myself unconditional love which which means doing things for myself just because you know what i mean just because that was really powerful because i was thinking through of the condition out of conditionality 'cause i've thought about that a lot in my life with my parents and my relationships and that was something that recently i uncovered you know understanding what that meant and that that relates it's a lot to your life and i think for a lot of us we can kind of think through different situations with our parents and that's when we talk about the ancestral piece of situations or conversations that you've had that still still stick with you today and still impact decisions you make at all times for you that was conditionality in your relationships like with your best friend saying that and then you now realizing and it's so beautiful that you saw the dad and the daughter at that moment as a healing as a healing modality for you so that i love that okay okay on the self care piece just a second question to that what is preventative self-care yeah preventative self care is for me knowing i wanna. I wanna make sure that i'm sustained tomorrow so i'm gonna do this for me today. I'm not gonna wait and sime exhausted. Not gonna wait until i'm in desperate need not gonna wait until i'm feeling depressed or anxious right now to set myself up. I'm gonna pour into me. Not also requires a level of awareness right. It's like taking attention to our patterns attention to our triggers for me. It's like i know that if i don't check myself from the amount of time that i spent on social social media just like scrolling not like creating content and sharing something but like just being on there to be on there but that is gonna make me feel a way that i don't wanna feel you know what i mean so it's like i set up the screen time on my phone because i wanna make sure that i get at least a reminder right <hes> or for me. It's also like really knowing that. I have to lovingly force myself to be vulnerable with my friends. I have a tendency to old space for other people and not hold space space for myself so i had to like when my friend actually asked me how i'm doing remember again okay. She allows conditionally so she's actually asking you from a place of deep love and care. You're not just going through the motions like a lot of us. Do s how are you you know. It's just like a rhythm that we do so. I need to actually be like you know. I'm feeling this today you know and not not necessarily knowing that i'm going to receive anything other than a listening ear in that moment <hes> but that that's also phenomenal to receive someone who can actually hear me me and holds whatever it is that i have so yeah. It's really key that we all pay attention to our patterns into our trigger because then that allows us to know what's you set up in terms of the preventative self care you know i stray away from telling people what they should do in terms of self care because we all have wildly different journeys some some of us yoga is our everything releases at listed empower is some people that's never going to actually be what allows them to feel cared for. You know it might be need a walk so simple but it can be so released. We're talking about walking earlier to like it could be everything right so really paying attention to what you need and in and setting yourself up to receive that in a sustainable way yeah on that i mean it's so entrusting i think just by nature we wanna nurture and give and the receiving receiving kind of comes second and it's a thing that we really have to learn how to do so in that receiving creating a sisterhood around you to support that ability to receive to to to exchange the energy of love of support of creativity. How how have you been able to do that yourself. And how do you not each others to do that in a way that feels authentic to them because not everyone is a social being but they want community so what are unique ways that you've been able to do that yeah a cultivates sisterhood. I love this again. I think everything starts with intention for me so if you are desiring like nourishing nourishing relationships particularly sisterhood right thinking about okay. What is it that i need. What is it that i require in a relationship to feel loved and cared for. Are you know because different kinds of friendships serve serve different kinds of purposes and i think that's okay you know so thinking like what is it that i need and then giving it to yourself. I you know i've been reading this book. Calling in the one sounds very cheesy getting it tomorrow this. It's actually heard it's good. We've heard of so <hes>. I forget the author but it's basically a book. That's all about kali. That's all about expanding your capacity to love and be loved abdrei one of the activities in it. She has you identify the things that you desire to partner or actually need in a partner to feel loved and then spoiler. The activity is giving that to yourself so she has you read all these affirmations where it's not just about that person in the future giving the but like you south giving that to you and not just like open my eyes. Oh wow because there's a power of attracting than that energy and your life once you start giving that to yourself you know so if you desire a a sister a friend who is a a companion in your life. You know to share life experiences with you. Sorry doing those life experiences if you have it on your board to like take a quarterly retreat or it's you sign up for a yoga session but you feel like a lot of times. It can feel timid about doing things like that by ourselves do it. Do it like literally do it. You're gonna learn so much about yourself and then when that person is attracted into your life. You're going to be able to enjoy it in in a way. That's not considered the fact that like you're doing it with the friend but you're doing it because you love. It and they're doing it because they love it. You can share that experience together so yeah my my close sisters sisters and i definitely have a lot of similar values and it started out with me getting clear on my values i that's beautiful about the love thing you know it is your capacity not to love and that love is available to you at all times you know within you and <hes> that's really beautiful so looking forward. What are you looking forward to in two thousand nineteen twenty twenty for yourself and black girl and all yes. I am looking for its to elevating reading everything that i'm doing now. You know think about twenty funny. I'm like ooh. That's just a great number right there so <hes> i really love guiding meditations nations. I think that's my own meditation. Practice has deepened my my excitement guide. Them just heightened and again. Attraction is like i've been attracting more meditation experiences the more that even in my practice what's so beautiful like i haven't sought them out. It's just happened <hes> so i'm looking forward to producing even more audio meditations that are are really rooted in topics and damatic set. I feel like i just again blackout on my started it because i needed it. I'm gonna be creating these meditations on themes that i feel like the world needs more of an already have a few and i just have seen so much how resonated with people. I'm looking forward to hosting my first a tree in the spring of funniest funny so i'll be sharing details about that as soon as it is already but <hes> in it's like really my first destination surgery because i have a host of retreats on a local level but it's like an a really beautiful place and it's going to be released entered out of writing and self care because my own journaling practice has been so oh essential to my wellbeing and semi <hes> just sustainability by growth and it really changed ally during a i- birthday month last year when my best friend gifted me a journal that she was like this is your feelings journal. She's like i know you're all about manifestation like writing down what you want to attract but you're running away from your feelings like you need really own your emotions and honor them and so once i started religious also writing down the things that i wasn't as comfortable acknowledging jiang that literally changed me. I want to invite more people into how profound that practice can be as well so that's going to be a central part of that retreat experience <hes> i am slowly but surely working on my first book as well and so whenever that is ready to be births. You know i'm not fresh. I'm not putting a lot of pressure on it but it is a process that has been really revealing and i've realized that for me like sewri telling being in such a way that i connect with people and storytelling such a way that i heal as well so this journey of writing this book is deeply healing to me and i know that it will also also he'll a lot of other women because that's always my i mean communities so wondering when the book was coming so yeah development uh-huh yeah your time as always divine yes being here and she's new so she will be here. Are you can follow lauren at at black girl in home and it's just such a beautiful community and we admire it so much just as we build community so we we thank you for being so open. Thanks guys we're having one is left news. Thank you so much for tuning into the almost thirty podcast live at propel co labs this summer in l._a. We will see one the next one you can connect with us at almost almost thirty podcasts dot com and almost podcast on instagram <music> <music>.