19 Burst results for "Stenosis"

"stenosis" Discussed on Cardionerds

Cardionerds

05:06 min | 6 months ago

"stenosis" Discussed on Cardionerds

"In the apex. We are adam had a lot of experience with news with posted polka polka out. So we started using cdt to predict where were were to. Who's things we learned that the only thing that really seals ms valves the external skirt that in order trying to land a very short landing zone with an external skirt that's only a few millimeters. It was a little bit like blunt lending a seven forty seven on a parking lot so that the rails actually did a a little bit with that. We had modified we could change. Which would nose was was directing by falling wire. We can also change the back of the valve using a technique called pool. A was Where we could flex back particularly for those people that we had a very distance from the turnbuckle. Punctured the annual apply. So we started mixing all these things together including modification of the sapien valve in the central skirt. Try and improve outcomes. What ultimately we started noticing a lot of these patients had these very small hyper contract. Our hearts that counter yoder's enosis and all this had to be had to be dealt with in order for for tomake technically successful procedure with oracle benefit which means that the patient had to not be hurt by the procedure and be able to get up at increased their activity not to sit in the bed with the low elvia t gradient or no mine just nelson or no mitral regurgitation. The leak business has gotten considerably. Better in is also a major source of morbidity for for our patients because trans transfusion or repents transfusions of people with with hemolytic anemia. To the small pair of our leaks were very difficult to manage as as containing peel back the onion we see as part of the most challenging case that we're doing at this point ended is the valid mac in the valve in rings in the the outcomes have improved tong in which the number of patients denominator has improved a ton. There have been some larger registries following the data on these patients or trying to ultimately you see respectively. Make better outcomes for better patient selection more understanding which i think is is important but but all ultimately is all these adjuncts that have created some movement and until we get dedicated delivery system. Dedicated were still left with off shelf. Adjuncts to improve this and so we the people that are interested in this technique. But i would say unless you're prepared for for all these extras accessorising your.

hemolytic anemia adam yoder
"stenosis" Discussed on Cardionerds

Cardionerds

02:20 min | 6 months ago

"stenosis" Discussed on Cardionerds

"Every single case and that nutrients catheter techniques. That we've described here can really provide durable treatment for mitral valve disease in these high risk. Nonsurgical patients you guys talk about triumph innovation. Just have to apply our few guides and your team for the incredible work for this patient. And just thinking through what you did so successfully you completely alter the trajectory for valvular heart disease you obliterated equity and the blood can now easily. Pass the la to the lv. It's a difference. You made i just over the course of a couple of hours in the procedure sleep and this is a situation where so many things can go wrong in procedurally and with the outcome just thinking about itself you can have valvular league mcgregor Through the leaflets. A clotting of the vowel functional stenosis potentially from a patient prosthesis mismatch got a big hole in the septum Essentially 'cause ast nino lv ot obstruction in addition to the peri procedural risks of guinea access. Putting catherine the body of on corey blood vessels and rain compare the valve in procedures in the mitral position valve valve valve in green valid mag unit all had nice paper between nineteen where they essentially showed the alvin mack procedures where the riskiest right with the lowest procedural success rate the highest shorter.

"stenosis" Discussed on Cardionerds

Cardionerds

03:46 min | 6 months ago

"stenosis" Discussed on Cardionerds

"You deploy the valve whether it's a mitral position or the arctic position here in the mitral position you're deploying in a stable standstill angeles exactly and only those with the strongest of heart will look back at anesthesia while matt is going on and so what's our valve is deployed. It is an immediate rush to make sure that everything is properly positioned in that the blood flow through the valve annual assists. Correct in so immediately. We go to your graphic by plane in the short and long access of the newly deployed valve to make sure that it is seated. Well if you do have access to the online supplementary material you'll notice in the short access that although this is a commercially available tavern vowel. That's being used off label for the mitral valve. It's not a totally circular structure. I think that really belies. The different shape of the mitral analysts versus the arctic anyalysts lists there and then we take a look with our three d. t. e. in what we can see is that there is a well seated valve in place. We see that there is trace leaks still through the valve. That's just there because we have a wire going across it. From april rail but overall the valve is well seated. It's opening the patient is getting good blood flow through it in when we check. Continuous wave doppler through the newly deployed. Trans catheter valve. We see the patient. Now has a mean pressure gradient across their mitral valve two millimeters of mercury whereas they started the procedure with a mean pressure gradient of sixteen millimetres of mercury as just amazing the other important aspect of this like john lewis go was talking about earlier is to make sure there's no lv ot obstruction that something that we check both at the time of the procedure and with a follow up. Transfer rasic echocardiogram the next day and in the patient's trance the razek echo the next day. What we saw was fantastic flow through the mitral valve itself and trans Gradient of eleven millimeters of mercury indicating that there was no significant lv ot obstruction in patients. That get this specific procedure. It's also important for us to do a follow up. Cat scan so that we can really review the anatomy of where the valve is how it sitting in its relation to other cardiac structures and so on the follow ct of the patient. What we were able to see is that valve is once again very well. Seated in the calcified mitral angeles the tips of the struts are just poking into the septum near the lv not in mid sicily and then in some of my personal favourite pictures on the c- t. Were able to reconstruct the narrowest point of the elvia not in see visually the open cells in that trans catheter. Mitral valve open and ready to allow blood to flow through insistently and so as far as our patient is concerned. They tolerated the procedure. They were excavated immediately following the procedure and transferred to the see. Cu for monitoring overnight by the next morning they were ambulation independently in re transferred to the floor there trans-pacific echo post op day. One shooter an injection fraction of sixty percent. Mitral valve mean gradient of six millimeters of mercury in order valve mean gradient of eleven millimeters of mercury. Our patient was restarted on their home. Coupon on post op day. Two in discharged home several days later after. Their einar became therapeutic in his done very well since that time i think ultimately for us the big points. We wanted to drive home with this talk. Is that mitral stenosis. Like you said it's very difficult to manage and often affects patients who are high surgical risk. Previously we had very few good surgical options. The main option being balloon valvular plastic. The which if you have any experience with patients who undergo balloon valvular plastic is a very fleeting treatment in almost.

mitral valve stenosis sicily matt john lewis einar
"stenosis" Discussed on Cardionerds

Cardionerds

06:11 min | 6 months ago

"stenosis" Discussed on Cardionerds

"Louis jar the wires then electrified and snared in the left atrium once snared. You've now made a wire loop around the anterior mitral valve leaflet. The wire is a long exchange link wire so it's externalised. Area of the wire is kinked. In denuded to make something. We lovingly called flying v after the famous jimi hendrix guitar. In that flying v is then re entered into the body in position the base of the a to scallop dextrose is injected which flushes away ionic blood in confines the ablation of energy of electrified wire to that flying service and once electrified it's cooled and laceration occurs in the direction of the elbow t. So you now have an anterior mitral leaflet with a mid line laceration in the amazing thing about this is because it's not electrical aspiration the valve continues to co op. So the a trans catheter. Valve is placed inside of the native mitral valve in when it's inflated the valve opens to its fleet expanded area and the native valve leaflets harmlessly slid to the side so blood flow can exist through the open strikes of the trans catheter. Heart valve and again. The supplementary cartoon online is very easy to follow following that. We also have some supplementary images show with this laceration. Looks like in the swine model of which you can see online so again. Retrograde lampoon was shown to be effective in prohibitive risk overboard but the limitation with the technique becoming more widely used was the technical complexities associated with it and that pushed us to go back to the drawing board and say. How can we make this simpler. So that it's teachable in reproducible. In patients can get the benefit of it not just a highly selected sites in the country but closer to their home and because of that we worked in made in alcohol. Anti-gay lampoon been published outcomes first seven patients in circulation interventions at integrate. Lampoon is what you'll see. Further described in this case where a single transept of punchers used to deliver two steerable sheets through which to catheters or placed in now last Still mid line. But it doesn't require you to cross the arctic using retrograde catheters in it's technically simpler to perform third variant of lampoon that has also been very effective in recently accepted for publication. Jack interventions is a technique called tip. Base lampoon so if you think about how we describe lampoon so far in both the retrograde technique in the integrate technique..

mitral valve Heart valve jimi hendrix left atrium Louis
"stenosis" Discussed on Cardionerds

Cardionerds

03:42 min | 6 months ago

"stenosis" Discussed on Cardionerds

"The diastolic pressure halftime grade than or equal to one hundred fifty milliseconds and can be greater than or equal to two hundred and twenty milliseconds with very severe Noces hema dynamically will appreciate severe left. Atrial enlargement and elevated pulmonary artery systolic pressure of more than thirty in. These are the patients that we classically see with decreased. Exercise tolerance and Yes this this table that we're looking out for the different stages of mitral valves. To says is so useful in his contract is a concert. We've begun over multiple times or any abnormality on imaging or any structure of melody. Whatever it is whether it's hcf where michaels in this case we think. What does the structural problem the anatomic problem in. What is the hema. Dynamic consequence and soil with worsening stages you have worsening level of mitral valve stenosis the structural features of the cause of mitral valve stenosis structural problem. And then we think what he dammit consequence the left atrium we said before like the of sided feeling pressure so the left atrial may become larger as pressure. Backs up your pulmonary pressure your pulmonary pressures go up as you develop worsening progressive group to me hypertension and this deisler pusher halftime concept. I think is very useful kind of intuitive right because as the degree of obstruction worsens. It's gonna take longer and longer for the pressure gradient to go down it's gonna take longer to fill blood to move flood from the la into the lv because of obstruction as it takes longer and longer the deisler pressure have increases. Which is the time. It takes for the pressure gradient to decrease to have which is again. Just the flip side of saying that look if a patient heart rate is higher. You have less time in. Yes she may not even get to a point where you've fairly. Lv all the way because you're di- slight pressure halftime diastolic. Time overall is increasing to gren-grenada A lot of details there but the core concepts. What is a structural problem with a humid namic consequence in here. The human dynamics consequences of mitral stenosis are longer dice our times to fill from the l. a. to the lv increasing size and worsening plummer pressure so very intuitive just in terms of bringing it down in that way yet thank you. There was a lot of information. I think you really distill it. Down to the core aspects and the acc aj have amazing figures in tables for the management of different types of mitral valve Beer rheumatic mitral stenosis. In symptomatic cases Favorable morphology. You don't have a clot in the left. Atrium have no or mild mitral regurgitation. A perkiness mitral valve ballooned or pnb see is a class one recommendation and when you don't have favorable anatomy then a mitral valve replacement is class one and when we were talking about this case earlier as john richton mentioned for the longest time either periodic monitoring or a surgical mitral valve replacement or valuable plastic. Were really our main options. But this keys really highlighted that we can go beyond these interventions their highs in is really expanding on what we can do for these patients who have mitral stenosis and finally..

mitral valve stenosis pulmonary artery Atrial enlargement left atrium michaels hypertension john richton
"stenosis" Discussed on Cardionerds

Cardionerds

02:47 min | 6 months ago

"stenosis" Discussed on Cardionerds

"Blood through that orifice in again just to reiterate how important at heart rate is in mitral stenosis allowing the ventricle to fill despite obstructed orifice and how that plays theologies really can be very challenging especially in a feb. Or if they think you're really highlighting the salient points when it came to the physiology in really highlighting the point about a coordinated each contraction. We thought it would be a good idea. Something that i think all of us benefit from is reviewing the ha sec guidelines. So we'll go through the stage how to define valve anatomy valdemar dynamics the consequences and the symptoms for mitral stenosis and again. This is from the aj an sec guidelines so beginning with stage a which is defined as being at risk for mitral stenosis for this with the anatomy we can appreciate mild valve domingo during diaz steely. There will be a normal trans mitral flow velocity usually no hema dynamic consequences or any symptoms stage b is defined as progressive mitral stenosis in. But this there is rheumatic ballots changes with cars roll fusion and diastolic dorming of the mitral valve. Let's in a planet matured mitral valve area a more than one point five centimeters square. There is increased trans mitral flow velocities mitral valve area of more than one point five centimeters squared and a diastolic pressure. Halftime of less than one hundred and fifty milliseconds. He moved dynamically. We can appreciate a mild to moderate left atrial enlargement and normal pulmonary pressure at rest with no symptoms for stage. See this is defined as as symptomatic severe mitral stenosis in this romantic ballad changes with control fusion and diastolic. Dome ing the mitral valve leaflets. The plummeted marshall valve areas less than rico to one point five that can be less-than-regal to one in cases of very severe disease. Diastolic pressure halftime is greater than or equal to one hundred and fifty milliseconds and can be great and wrinkle to two hundred and twenty in cases of severe mitral stenosis. We can appreciate severe left e. tone large man and an elevated pulmonary artery systolic pressure of more than thirty in no symptoms because these patients are classified as being a symptomatic that brings us to stage d. was defined as symptomatic severe mitral stenosis. And in this there are romantic. Bell changes with comedy fusion and diastolic domingo without leaflets and planet mitral valve area less than or equal to one point five centimeters squared. Now this can be less than one centimeter square but very severe disease..

mitral valve stenosis domingo diaz pulmonary artery atrial enlargement sec aj Bell rico
"stenosis" Discussed on Cardionerds

Cardionerds

03:37 min | 6 months ago

"stenosis" Discussed on Cardionerds

"So our case starts with the chief complain of shortness of breath our patient as a seventy seven year old female with the past medical. History of rheumatic valve disease both for a arctic and mitral valves status post surgical erotic valve replacement in nineteen ninety as well as a redo in twenty thirteen. At which time she had a saint jude. Twenty one millimeter. Mechanical bi leaflet valve placed. She also has heft path. Non obstructive coronary artery disease type two diabetes hypertension hypothyroidism and sick sinus syndrome. Status post duly pacemaker. Who presents us with progressively worsening shortness of breath. So this patient has a history. Of rheumatic valvular disease resulting initially in severe a arctic stenosis that required surgical valve replacement in nineteen ninety with a subsequent redo in twenty thirteen. She tolerated both procedures. But for about the past three years she's been complaining of progressive worsening in both her baseline shortness of breath as well as worsening disney on exertion. This patient was felt by our primary cardiologists. These symptoms were due to worsening. Her rheumatic mitral valve is and so in september of twenty nineteen due to moderate mitral stenosis. That time she had a mean gradient across the valve of about seven millimeters of mercury in about two plus. Mr the patient underwent shockwave balloon. Litho trixie of her mitral valve hoping for improvement in her symptoms however by january of twenty twenty her symptoms it continued to worsen and by this point arresting mitral gradient was up to sixteen millimeters of mercury in a heart rate of sixty five. Beats per minute until at this point. She was referred to the structural heart team at emory for consideration for advanced trans catheter valve therapy. As far as the patient's past medical history we already discussed. She has severe extend noces status posts sabir times to in nineteen ninety and twenty thirteen. The patient has severe hypertension hyperloop. Anemia type two diabetes and six sinus syndrome status post duly pacemaker as far as surgical history. She's had to stir nominees with surgical valve replacement as far as cardiac medications. she's on imploded. Pink tin milligrams a day hydrochlorothiazide twenty five milligrams a day lose certain one hundred milligrams a day mmatobole sucks innate or tow all xl hundred milligrams a day in his on war for anti coagulation as far as her allergies. She's to several antibiotics including penicillin. Clinton mason in vancomycin for her family history. Both her father and mother passed away at age. Eighty seven they both suffered from heart disease and diabetes and her mother also suffered from stroke. Socially the patient denied any tobacco alcohol or recreational drug use on initial presentation. Her vital signs were largely within normal limits. Temperature was thirty six point six centigrade. Her blood pressure was slightly elevated at one. Forty nine over seventy six. With a heart rate of seventy one in the patient was saturating. Ninety six percent on room air physical exam largely normal once again other than for her respiratory exam. Which did show some by basil or crackles but non labored respiration symmetrical chest while expansion in her cardiovascular exempted have diastolic murmur. That was fairly significant. Best at the apex she also had that systolic. Click from her mechanical valve. She did have sort of one. Plus bilateral pitting dima for laura extremities but most of her symptoms were last cited elements for exam including gastrointestinal musculoskeletal neurologic and psychiatric. Were all within normal limits. As far as her lapse once again largely normal sodium was one thirty three potassium as little low at three point to be winning six zero point..

mitral valve stenosis diabetes heart disease sick sinus syndrome hypertension emory hydrochlorothiazide penicillin dima Clinton mason vancomycin hypothyroidism laura
"stenosis" Discussed on Cardionerds

Cardionerds

08:46 min | 1 year ago

"stenosis" Discussed on Cardionerds

"Interventional cardiologists at Johns Hopkins Hospital Assistant Professor Professor of Medicine and Assistant Program Director of the Interventional Fellowship. Most recently he was named the Director of the structural program at Suburban Hospital title. He obtained his medical degree from Johns Hopkins University Completed Residency Training at University of Pennsylvania and came back to complete his cardiology fellowship at Hopkins during his fellowship. He earned an emmy chess in the graduate training program in Clinical Investigation at the Bloomberg School of Public Health Dr Hudson and has been an absolute mentor and a guide throughout my cardiology training. I feel like every time I worked with him in a case in the lab. I definitely get made fun of a lot but I come out completely better for it. I spend in about seventy five plus percent of the time with my foot in my mouth and I'm just overcome with Giddiness when I'm working with them so without further Ado let's welcome Dr Ronnie's onto the show. Glad to be your guys were so excited to have you and get your expert opinion on the management of a Arctic stenosis. So we'll start with our first question. What one of the factors that you consider when evaluating patients for possible Tabar Warriors? Let me say that. This is a very dynamic area that is rapidly changing over time time as we procure more data regarding the efficacy of tavern different populations. But I think right now it's still starts with the patient's history and namely family is the patient symptomatic. Does the patient have severe symptomatic. erotics to knows now. That is something that may change guys may have already heard from. Ha there's been one major randomized trials suggesting that even in symptomatic patients with very severe aortic stenosis. There may be a benefit at least in that case of Surgical Agr in terms of reducing outcomes even after thirty days but for the time being for most of our Tabar patients especially those who are more elderly or the goal is really to maximize quality of life for me. The symptoms are still paramount. So do they have severe symptomatic. Eric Stenosis the next consideration for us used to really be what would be their risk to undergo conventional surgical valve replacement or. Save our savvy for short as we call it now vis-a-vis tavern and that's changing now with the approval of tavern for patients at low surgical risks. What we start to think about now is rather than think about? The is the patient at elevated risk for complications with Sabir and therefore should be Tabora candidate. We think more about what is this. Patient's expected life expectancy of vis-a-vis the life expectancy of their bio prosthetic valve. So if you've got a younger patient WHO's likely to go through at least two bioprosthetic valves. Maybe you're thinking of that. Patient is low risk. Maybe they shouldn't have surgery first and then get a tavern for their next foul and maybe if they need a third valve they can get another tavern tower on the other hand. If you've got somebody on the other end of the spectrum maybe canarian and known Genera on who who is GonNa need one valve and or who's clearly going to be at elevated risk for surgery then you're GonNa perform a tavern and then the patients in between you really have to look at each patient individually and come oftentimes to a shared decision making approach especially in younger patients to make sure the patient understands the issues with the durability of the devices vis-a-vis vis-a-vis their life expectancy how may more procedures they may need. That's wonderful and it's a really rapidly evolving field so it'll be exciting waiting to see how the guidelines change with regards to recommendations for Tavern based on varying risk profiles. Now let's say you've decided added that a patient is a great candidate for tavern. What are your thoughts about the pre tavern workup with regards to left heart? Catheterization Bruce's coronary. ICTSI so one of the most important considerations will revive wedding somebody for tavern or even trying to determine what the best approach is savvy versus tavern is a cardiac CTA PTA of the chest coupled with abdominal pelvic imaging to look at the peripheral vascular. So that tells us about the rude anatomy the size of the vow. It configuration of the coronaries relative to the order vow and whether there is sufficient size in the sinuses to accommodate the tavern of ice and the prolapsed Iraq valve leaflets. or No we do a tavern. We don't remove the Ovau there's no cutting involved. There's another section of leaflets. flits the native leaflets going to be splayed open and pressing against the into the sinuses of fell salve essentially. So you actually need a place for those bulky calcified leaflets stand up and where you don't want them to go. Is the name of a coronary. So we pay very close attention to the Oregon Anatomy to us to ensure that we have sufficient efficient sinus dimensions both diameters and heights. So that your leaflets are not going to obstruct your coronary or sequester. The sinus and then of course we're looking at the annual or diameter. We WanNa make sure we pick the right size device. All the device vendors of different sizes in generally told the patients there's a small medium large and extra large size is And then of course I WANNA make sure. We have a path to deliver the valve. So in ninety plus percent of cases we can go from access you with continuous puncture. But in rare cases there may be performed disease that may be prohibited in terms of allowing for large Bortis access required for tavern even though Komo devices now or down to fourteen to eighteen French there are still some patients who cannot tolerate that from from all approach and of course they're alternative approaches. That are can we used strategies that can be used so those pieces of information are really the most important planning now in terms of looking at Korea disease. I think this is an area. That's is also undergoing some vinik change over time when we first started doing taveres we believe everybody needed angiogram and if somebody had obstructive disease we needed to be vasseur career is it a feasible and so most people were doing standing and it's probably about a third of Tabar patients at least in the early trials who would have coexisting Cordero disease. I think we moved away from routine query vascular station. If somebody has a engineer that we think maybe driven by their coronaries inasmuch as their vow then sure we fix it but more and more. So we're we're finding that we do the angiogram really to help stratified them. For example if you have somebody with severe corridors easy might not want to rapidly pace them for a balloon expandable animal how that might leanest towards if al self expanding device Also somebody had corey disease that you think you might have to potentially come back and fix slater one elise leave that door open to be more easy than we might put a balloon expandable valve is. Somebody has a single or two vessel disease that you wonder. Oh maybe I might have to come back and fix this down the line. So but in terms of using the C. T. I think most of us still rely on a invasive according to Angiogram the main reason being as long as patients with severe Also have calcified coronaries and so we worry about the diagnostic accuracy of Cardiac C.. T. A. and was looking for corner corner instruction so I think for now most people will still do invasive angiogram in addition to the chastity that we get to evaluate the oric anatomy to to help ascertain the coroner's status before we embark on tavern versus ever and other than the coronary anatomy are there any other considerations that you take into cleese With regards to deciding whether to use a self expandable versus Berlin expanding so when I say a lot of this has to do with operator preference difference there are some institutions and operators who really have mastered one device platform. They're happy with it. They use it for everything We hear Are More more flexible in terms of our choice of devices that we try to tailor the choice to each patient's unique characteristics. So for me a patient. I shouldn't say with if they have really severe coronary disease where I think it would be higher risk to rapidly pace and it's unlikely we're going to try to reverse the rise in the future. I may go go with a self expanding of the vice similarly in somebody with very low e f Roy also want to avoid the stress of rapid pacing than a self expanding getting device would be preferable. The other circumstances were self expanding device would be preferable isn't a valve valve and we basically exclusively use self expanding device for valve in vows. You're treating a previous gate of existing but failed erectile prosthesis on the other hand if somebody has you know previous coronary vast Croatian withstanding and you think well they're working.

stenosis Tabar Johns Hopkins Hospital Assistant Professor Professor Johns Hopkins University Giddiness Interventional Fellowship Eric Stenosis Director University of Pennsylvania Suburban Hospital Hopkins Clinical Investigation Dr Ronnie Surgical Agr Dr Hudson Bloomberg School of Public Sabir
Trump's Trade War Inflicts Pain On Manufacturing States

Bloomberg Surveillance

02:32 min | 1 year ago

Trump's Trade War Inflicts Pain On Manufacturing States

"Right now Diane swore joins us grant for here in the American economy Diane I'm gonna go to your charm which is the middle west of this nation and right now that is in the heartland of a trade war give us the local update from Chicago what we would hear from Charles Evans what we would hear from James Bullard of Saint Louis and all their good economists what is the tone of a trade war so we'll media in our nation's middle west well we are seen the trade war is to is taking a toll on manufacturing activity there's no question about it and Jack General Motors strike added insult to injury to that trade war to manufacturers particularly in Michigan and Indiana so that really was sort of a very hard situation that said Kelly avances already come out and said listen we've made a half percent cut and I'm optimistic that you know that's enough for now and I want to wait and see said okay interesting this services ambiguity because they have put some stenosis system and what we're gonna see later today is some of that stimulus paying off in terms of strong home sales we have we think we've got enough home sales the curious out through the end of the year next year's another issue but this is the first positive quarter for the housing market in seven quarters just a quick program note I'm pleased to sail speak at length with Mister Evans of Chicago in the early November at the council on foreign relations really looking forward to a lengthy conversation on this moment Diane swanky say we've got existing home sales out there do we have fiscal space in America I'm looking to trillion dollar deficits this is in swanky economic say we have fiscal space well this is one of those hard issues we have fiscal space to make one term investments when interest rates are so low that pay off in terms of infrastructure investment we have less system maneuverability should we had a recession and what we really need is the automatic stabilizers to kick in much sooner and not wait for things to get so bad that we noticed them that Congress then has to enact things to extend things like unemployment insurance and out and in fact we have fewer automatic stabilizers says things that kick in when we do have a recession than we did during the last recession and I think that's really important to acknowledge one of the things people are talking about is using something we call the psalm role which one see an employment rate goes up by a certain percent we know we actually are in a recession and instead of waiting for it to be declared there actually be an automatic sort of movement to be able to get longer term unemployment insurance in this

Diane Chicago Charles Evans James Bullard Saint Louis Jack General Motors Michigan Indiana Kelly Avances America Congress Diane I Stenosis Diane Swanky Trillion Dollar Seven Quarters
"stenosis" Discussed on News 96.5 WDBO

News 96.5 WDBO

03:20 min | 2 years ago

"stenosis" Discussed on News 96.5 WDBO

"Neuropathy. I've taken several different things. Get opinion all them things. I'm getting some fairly good results from horizontal which is kind of a form of Penn keeps me off. I have no use a cane, however, none of them sex, they just covered up and why. Greg. Why do you have neuropathy disease? It's a compression neuropathy in my back. There's a tight thing in the head and operation and been it moved up from the bottom of my feet to the top of my seat. Okay. So you have spinal stenosis is that during a bell, I guess that's what you call it. That's important. Okay. But anyway, but, but anyway, there's a new over here in Brevard county their advertising. It's a new process that's covered by Medicare that tries to get the capillaries of blood, your nerves in order to, to get relief from neuropathy uses some infrared lights and a couple of things it wouldn't cost me anything but does, does it work or can it work. Okay. There are a lot of gimmicks that are out there for this, okay? And so far. At what you're describing. There is sounds chiropractic. Okay. What they'll do is, they'll couch car practic treatment, and you do have chiropractic coverage under Medicare to a point. All right. So what, what you need to understand, though, is that the neuropathy that used to be at the bottom of your feet is now at the top of your feet. Okay. Probably reflects the fact that it's starting to heal okay? Now understand that the nerves in your back, oh, all the way to the bottom of your feet and toes. And as they start to heal though, he'll in reverse order, okay? The first the first place that gets injured is the bottom of your foot. It'll be the first place you start to fix it. So if I were you okay, I would be looking at things that are a little bit better. Okay. To do this, now the gap Penton, is helpful to some extent. But if you go ahead and adds some backlift into it. You're gonna find that the neuropathic discomforts construct to improve how much back within does it take their ten milligram tablet? You take a half twice a day with a hole in a bedtime. I've been using back within Detroit. Referal polyurethane for forty years. The stuff is awesome gabum, Penton. I wrote the first article on these together penetrate pain in the English literature been doing it since the stuff came out, does it work. And the answer is kinda does, but they're better medications for this Lyrica or pre gabbling being one of them. Then what can you do nutritionally to improve this, now the nerves are damaged? Okay. So there's one cell actually bundle these cells. But one cell runs from your spinal the way to your toe. It's one cell. Right. Okay. Then you take these cells in your group them into bundles, then we call them nerves when you collapse on the Exxon, which is the extension of that nerve the body, the nerve hasn't been compromised. That's actually in the dorsal root ganglion of your spine. But you can fix the acts on. Okay. Nutritionally. And if you can hang on over the break, okay, I'll give you some tips as to what you should be doing says, Greg hang tight. We'll come back after the news. That's right. The three big things you need to know. And we are. Are keeping.

neuropathy disease Medicare Penton Greg Penn Brevard county stenosis dorsal root ganglion Neuropathy. Detroit Exxon forty years
"stenosis" Discussed on KDWN 720AM

KDWN 720AM

03:23 min | 2 years ago

"stenosis" Discussed on KDWN 720AM

"You're having spinal stenosis, and you're having pain that's deep deep deep in the spinal cord, there's really not much you could do right on top of the skin that's going to locally and directly numb the spinal cord your body protects against that. You don't want anything that your body touches 'cause then paralyze you so in essence that doesn't happen. However, if much of your pain is let's say, you know, gerbil, shingles, etc. If some of the pain is perceived, you know, placebo can be very effective. And so the reason why some people have been touting these from these creams is because people will say, no it. Works. Give it to me. Just give me the creek. It works. And you're not supposed to work. But if you say it works, that's fine. By me. That's how I feel about a lot of things out there. If you say, it works is not hurting you. Fine by me, if it's better than the alternative, but. With this study coming out and saying may not work. I think there are some creams that do provide fit. But again, it may just be localized and may just be placebo. But also, you know, doesn't make sense if you have neuropathy if you have diabetic neuropathy and your feet hill because of nerves if it's superficial nerves bothering you. Yeah. Maybe these creams can help. But if it's the deep deep nerves. Oh, no. It's just not going to touch it. So what do we do? Well, we try to you know, we try to come up with medicines. That can either affect the nerves which we have to be very careful about because nerves innovate everything or affect your brings perception of the nerve pain. Now, we have to be careful with that. Because the reason why we heard is it's a defense mechanism. If you are sitting there next to a flame, you really need to feel it needs to hurts. Otherwise, you'll just let yourself burn. And I know that's not the most often occurrence. So people would rather be numb. But the like, for example, the reason why diabetics run the risk of losing their leg. Are there? Yeah. Losing a leg and foot is because they're not. They get a cut or sore other foot, and it may not hurt. They may not feel anything, and then it festers and investors plus lack of nerve function also doesn't aid in infection fighting. So they ended up getting a big nasty foot ulcer that ends up going to the bone. Now. They've infection the bone, and you know, many loser lake. So just going number aiming for numbing a nerve doesn't necessarily solve a problem. It can make things worse. One eight seven seven belly. You.

diabetic neuropathy stenosis foot ulcer
"stenosis" Discussed on WINT 1330 AM

WINT 1330 AM

02:44 min | 2 years ago

"stenosis" Discussed on WINT 1330 AM

"Fighter. What's your question? Are you? Nosebleed Olympic the okay. I'd be a lot of bear in Boston at the medical. They have a. Just take care of me. And this. Dr. Recommended to all have to option. One was open heart surgery. And yeah, that was these alcohol ablation, right? And the only my opinion, and I said at my age seventy six and all that. I'd rather have the ablation less invasive that makes sense. So let me tell our listening audience. What this is about. Okay. Hold on a second. You have you something called I h as as idiopathic hypertrophic sub aortic stenosis, which is okay. So what happens is the heart enlarges, and it's not the usual type of heart enlargement is when the heart and largest in relation to high blood pressure. You know, blood pressure causes the heart to work harder heart largest like an athletic hard. And then you may have problems hard may become baggy and not work as well. In this case, there's this it's idiopathic fancy medical word. Meaning we don't know why that is it probably genetic, and it gets worse as agent at the wall, the heart. Becomes so large that it blocks the outlet of the heart, and it causes the heart to work harder. And ultimately the heart Ken fail. Because of this added must hypertrophic muscle that gets in the way of the pumping action heart full. So how does it work? Yeah. Just listen, just listen, Al Potter down. So the so the the way to treat it is to zap it or cut it out. And it sounds like the less invasive route is helpful for you. Now, there are some studies that suggest the things like coenzyme q ten may be helpful for this carnitine may be helpful for this. But ultimately when it gets to certain point, the volume of of the hypertrophy of the enlargement is so great that you have to actually take care of that. And so, you know, I'm not a cardiologist. I'm not the world's expert on which procedure is most beneficial. But I would suggest. That at your age ablation is less invasive option, and maybe help away for you to deal with the problem. Okay. Thanks for your call Maria on Dr Ronald Hoffman. And our number eight seven seven seven two six eight to five five for intelligent medicine..

Dr. Recommended Boston stenosis Olympic Dr Ronald Hoffman carnitine Al Potter Ken Maria
"stenosis" Discussed on 1150 AM KKNW

1150 AM KKNW

02:48 min | 2 years ago

"stenosis" Discussed on 1150 AM KKNW

"Does this sound stenosis out the bourgeois Jong the wealth? Sure that your doors. You wanted to house with your show? And. Don shooter to shooter. Why are you going on your thumb by the whole weekend? You measure it wasn't then I she Albouy down digital what do the war now J shorter? John young. The need to kneel shoes to shoot. Oh, man. Should I see me? That's your shelter their shower, shadow, Missouri. Hence, south child points. Cool how sure Shanghai pampa made Hongkou on this year show with on the answer Hani Talladega as the narrow liken Charlotte ratio lightly out. Almost highlights trillion shaky not the financial inclusion officials how the tissue Teton Cohen McGown seagoing Leo sugar. And Joe Sanger the whole Madame found. To the Shanghai with hunkered. How did how now? Hi, Sheila how somewhat should thought? I should say. The whole Weisel. Why would still just how Halligan had idell can and have had? And how hard I doubt hashes had you kinda within. How are you? I'll go down to pay yet lesion till let your whole magazine or allow Shankar narrow a whole so trough the visit the whole. So crate cheerful kind hatch out. Trishul hood -til sounds leading usual Milan. Good issue. One you hides agendas. Tell you go around you LaLa Ilam here and the young boy watches hand Panadol. What physically it hang on your holiday challenge? Joel on the occasion Sando creates. So do. Well, porno Jacob contained Janika. Two. There were it out had your whole. Gotcha. Prevention via so sure was. Kumgang on your policy to the show, what did our show or or Mel Bizet on tinian? What is your engine agenda negotiation?.

Shanghai stenosis Hani Talladega LaLa Ilam Mel Bizet Joe Sanger John young Jong Halligan Missouri Sheila Shankar Jacob Janika Milan Joel Hongkou
"stenosis" Discussed on News Radio 810 WGY

News Radio 810 WGY

03:53 min | 2 years ago

"stenosis" Discussed on News Radio 810 WGY

"Ralph gay welcome to the program. Dr gates nice to meet you. Thank you. Glad to be here. Good to have you on the program. So it's interesting, isn't it that this is so common? Eight out of ten people will have back pain at some point during their lives. It's the leading cause of disability for men over. At the age of forty five. What is the problem with the low back? The problem is that we're all aging that's part of it. But low back pain concerns people have almost all ages. We see significant low back pain and adolescence and young people. The most common age group for discrimination is between the ages of thirty and fifty. We're seeing a lot more people who are living longer and trying to be active, so many more people who have spinal stenosis. Tell us what that means. Knows this means, narrowing and you can have stenosis of many structures near body stenosis of your arteries to go to your heart. Stenosis of the spine has to do with the canal that the nerves go through. And there's a main canal that goes down through the middle. Then there's too small at each level between the vertebra. There are two small canals called Freeman and they can become narrower stenosis. Well, the common spinal stenosis is to notice of the main canal that can cause pain when you stand in walk because that can get smaller at that time, and you get pain in your buttocks or legs typically, and you sit down and goes away. So that's a common cause of of butter can leg pain, and sometimes back pain as well in more elderly patients, and then we all are aging and our spine ages are spine starts aging on microscope level by our late teen years by the time, we hit our twenties. We start seeing this bulges and protruding discs. And it just gradually ages as we get older. We don't know exactly why this is not something where it's a bad, gene. We do know that a lot of it is genetically determined based on twin studies where we can look at people who have identical DNA this is primarily done in northern European countries like Denmark where the contract people throughout their life. But a lot of this is genetically determined and we're living longer and ruining be more active. And so we see back pain throughout the course of life. So is this a skeletal problem because of that stenosis of the spine or is it a muscle? I always just think my low back pain is a muscle problem. But it doesn't sound like it is. Well, that's a very good question. And it's one that we don't have a very clear answer to when you look at studies that try to isolate what is causing back pain as far as a specific tissue is at adjoining deserve muscle nerve. We can't do that very well. And some of the studies would suggest that no more than maybe ten to fifteen percent of the time. Can we isolate a structure that we know is causing the person's pain most often, it's multifactorial if you have arthritis join in your back, and it's aggravated the muscles get tight, and they become painful, we're very good at at finding nerve problems pinched nerves or injured nerves. But when it when we get out of the realm of the nerve tissue into the musculoskeletal tissues, we say, the bones and the joints, and the discs were not very good at isolating exactly where the pain is coming from. And it's very difficult to do that clinically. There are a few of the tissues that we can within reason say are causing pain such as the small joints in the low back that often are affected by arthritis. But there are other structures that we know cause pain such as the..

stenosis leg pain Dr gates Ralph Denmark Freeman fifteen percent
"stenosis" Discussed on Freedom 95 Radio

Freedom 95 Radio

04:57 min | 3 years ago

"stenosis" Discussed on Freedom 95 Radio

"Was sought from leading medical experts all around the nation nothing helped we thought for sure that tyler would die within weeks he didn't tower sent home from the neonatal intensive care unit after two months and we're convinced that this day that he was sent home to die he had eight specialists needing to see him every week most of them needed to see him to three times a week and so every single day we took him to doctor's appointments two or three appointments a day it wasn't twelve different medications we used to have to feed him by using a syringe to shoot the food down the back of his throat because he was too weak to suck and swallow you'd be back in a hospital in about a month had billy area trees your surgery and bilateral hernia repair and hypospadias surge against business surgery and exploratory procedures and gastrointestinal intervention for reflux oesophagitis and thrush and other issues and because of his condition he needed to eat every two hours so it's been an hour getting his food medicines prepared and then we'd get him into his stomach but that's the rindge and then we'd spend the next hour beating up his projectile vomit all day every day tyler was sick everyone thought for sure he died within months but he didn't and the biggest threat to his life i haven't even mentioned yet tolerated hypertrophic cardiomyopathy and pulmonary stenosis arteries are way too narrow and in the world is heart muscle is way too thick four times the curtain than it should have been he weighed five pounds and his heart was thick of that of a forty year old man we've got an cardiologists pretty well at this point we're seeing pretty much daily so we had a relationship and we asked him be straight with us for our sanity we needed an honest prognosis and he has a tated has doctors do when their asset sort of a question but then he said there was no medical reason why tyler was alive even at that moment and he would likely not see his first birthday and there is just no way you would see a second he should have died in less than two years he didn't why god had a plan and the purpose for this boy born sick fast forward a number of years we have a ten year old boy who still couldn't eat solid foods everything had to be put through the blender first parade recently learned to feed himself with a spoon so that was good we prayed in the name of jesus christ not just us it was a dedicated circle of prayer warriors praying with us for years and when tyler was thirteen he finally was able to eat non blender is food for the first time we throw a party we celebrated this answer to prayer with all of our prayer warrior friends we vitamin them over with an official invitation we had an invitation blown up the poster size and everybody who attended the party signed it you come to our house is one of the first things you will see it hangs in our foyer as a constant reminder that god answers prayer so the lung problem went away resolving itself on its own so the doctors told us the liver problem with the impossibly high billy ruben count went away in spite of the failed efforts of the medical community many of his physical and developmental issues were successfully addressed by highly trained professionals doctors and therapists with unreal effort love and patience for my wife dina sustained by god's grace and now after thirteen years he could eat real food amazing answers to prayer but this was still this ticking time bomb his heart the hypertrophic cardiomyopathy the pulmonary stenosis were not getting better he saw specialist in orlando new york syracuse buffalo baltimore dc the best in the world at what they do and there was nothing to be done every few months and needed to go see his local cardiologists beautiful muslim man dr asandra dollar every visit dina would say we're praying for a miracle doctor dollar he'd smile and encourage then tyler started having these episodes where he couldn't get his breath and.

tyler thirteen years five pounds forty year two months two hours two years ten year
"stenosis" Discussed on Hot Talk 1080 KOAN

Hot Talk 1080 KOAN

04:56 min | 3 years ago

"stenosis" Discussed on Hot Talk 1080 KOAN

"Leading medical experts all around the nation nothing helped we thought for sure the tyler would die within weeks he didn't terrorist sent home from the neonatal intensive care unit after two months and we're convinced that this day that he was sent home to die he had eight specialists needing to see him every week most of them needed to see him to three times a week and so every single day we took him to doctor's appointments two or three appointments a day it wasn't twelve different medications we used to have to feed him by using a syringe to shoot the food down the back of his throat because he was too weak to suck and swallow he'd be back in a hospital in about a month had billy area treasure surgery and bilateral hernia repair and hypospadias surge against business surgery an exploratory procedures and gastrointestinal intervention for reflux oesophagitis and thrush and other issues both serious and relatively minor and because of his condition he needed to eat every two hours and so it's been an hour getting his food medicines prepared and then we'd get him into his stomach but that's syringe and then we'd spend the next hour cleaning up projectile vomit all day every day tyler was sec everyone thought for sure he died within months but he didn't and the biggest threat to his life i haven't even mentioned yet tolerate hypertrophic cardiomyopathy and pulmonary stenosis arteries are way too narrow and in the world is heart muscle is way too thick four times the current and it should have been he weighed five pounds and his heart was as thick of a forty year old man we've got an hour cardiologists pretty well at this point we're seeing pretty much daily so we had a relationship and we asked him be straight with us for our sanity we needed an honest prognosis and he has a tainted has doctors do when their assets sort of a question but then he said there was no medical reason why tyler was alive even at that moment and he would likely not see his first birthday and there is just no way he would see a second he should have died in less than two years and he didn't why god had a plan and a purpose for this boy born sick fast forward a number of years we have a ten year old boy who still couldn't eat solid foods everything had to be put through the blender first parade in recently learned to feed himself with a spoon so that was good we trade in the name of jesus christ not just us was dedicated circle of prayer warriors praying with us for years and when tyler was thirteen he finally was able to eat non blender is food for the first time we throw a party we celebrated this answer to prayer with all of our prayer warrior friends vitamin them all over with an official invitation we had an invitation blown up to poster size and everybody would tend to the party signed it you come to our house is one of the first things you will see hangs in our foyer as a constant reminder that god answers prayer so the long problem went away resolving itself on its own so the doctors told us the liver problem with impossibly high billy reuven count went away in spite of the failed efforts of the medical community many of his physical and developmental issues were successfully addressed by highly trained professionals doctors and therapists with unreal effort love and patience for my wife dina sustained by god's grace and now after thirteen years he could eat real food amazing answers to prayer but there's still is ticking time bomb his heart the hypertrophic cardiomyopathy and the pulmonary stenosis were not getting better he saw specialists in orlando new york syracuse buffalo baltimore dc the best in the world at what they do and there was nothing to be done every few months needed to go see his local cardiologists beautiful muslim man dr asandra dollar every visit dina would say we're praying for a miracle doctor dollar he'd smile and encourage tyler started having these episodes where he couldn't get his breath and.

thirteen years five pounds forty year two months two hours two years ten year
study says seniors are satisfied with their sex lives

02:16 min | 3 years ago

study says seniors are satisfied with their sex lives

"Satisfied not got a lot of younger listeners listen to the show we've got about twenty five girls twenty eight year olds a lot of millennials listen and i know what they're thinking when they see a headline like this sixty five to eight year olds having sex really someone's gonna dislocate a hip someone's going to lose their cain the dentures are gonna fall out any of you who are young and millennial ish okay get that out of your head that older people are old they're not and having a mom that's you know out there in the dating world and on the single scene they look like they're having a hell of a lot more fun than us younger folk now i'm generation x so i'm not a millennial trying to pretend to be a liking out the money sitting there but at much i will blend y'all and somebody's like bam make sure your children they're eating vegetables i like second there now my children then i could have had a guess technically had a wanna my age anyway not just for the young and by the way sixty five to eighty i think we're changing the definition of older i mean as far as i'm concerned sixty five you're still middle age sixty eight sixty nine still middle age we're living longer the essential the opioid epidemic killing us off we're doing pretty damn good in terms of being more youthful and our life expectancy they say seventy three percent are satisfied with their sex life does some of you will say way nobody's going to admit they're not none of that you forget the generation we're talking to we're talking to baby boomers baby boomers have no problem telling the truth baby boomer generation will tell you exactly like it is have you ever gone to thanksgiving please they got nothing to be afraid raza's younger generation like that'd be careful because it's going to be spreading online if i say one thing it's to be you know an infamy and the cyprus fear the baby boomers they don't give a damn they don't give a damn so the survey released today shows that sex declines with age and illness is so you know you got you know spinal stenosis kinda harder to have sex i get that but finds an older van claimed to be more sexually active in sexually interested in than older women but many women are reporting more sexual satisfaction because the sexual revolution of the sixties left a lot out and in the ninety s and the two thousands maybe even this year we've learned a few more things like oh that works yeah that works among seniors was spouses or partners fifty percent say they're sexually active fifty four percent of our senior population then you know actually you know when you're absolutely having activities such as the short bursts of activity and so the vice let me i hit my case let's absent on the short every time all right so overall they say this is important part of people and it doesn't get the attention observes the poll looked at a thousand participants they say two and five older people say physically active now the number does fall with age only twenty five percent of people over seventy six or having sex right so only twenty five percent p okay that's a lot that's a good number hey thirty nine percent of those over seventy by sexual activity that inequality too much detail some are married some are men seems to be a little bit more interested in sex and women that's because everybody's on testosterone these days seventy three percent content with their sex lives now there's other surveys out there and there's other studies but i think what we need to do as a population that's tell all young people to quit us older people as nope things from us and to not throw in the towel when you turn sixty five or seventy or seventy five you have so much life so the let we all have decades now more than our parents did and let's have some fun one eight seven seven dollars have you ever wanted to learn the basics spanish greetings asking how someone is doing body parts and if you're in the healthcare profession have you ever wanted to learn medical

Daniels USA Salmonella Allergies Dr Dalia Twenty Eight Year Eight Year
"stenosis" Discussed on Ben Greenfield Fitness

Ben Greenfield Fitness

01:43 min | 3 years ago

"stenosis" Discussed on Ben Greenfield Fitness

"Or an athlete it's important to remember that the ideas staged inflammation stage becomes infosys staged so when you go from isis owes his you get osteoporosis or tendon notices or spinal stenosis and once you're in that state the grass those from being lacking water in the inclination stage in being browngrass that you have to dig up and read plant so uh the counter meth comes as pain comes as challenges relationships it comes as the inability to have a healthy sex life it comes as cognitive dissonance or chaos on the mining comes as it hearing originally behaviors when the environment is suggesting that any other ways relating and at least two of a person hitting bottom at some point and oftentimes because of the way we approach things in the west with a lot of hills in your pocket there opposing than and making all her as illogical systems and their capacity regenerate uh much much cleaning and so the counter with is really what's happening in reality is what's happening right now in this year story does not match what's happening than you're in trouble in overseas if these story you're telling yourself it doesn't match the story you're telling other people the chances are good that you're gonna get a t sick burnout or die in in paraphrase so whenever the story telling ourselves does not match the story we're telling unequal store storytelling of the on stage is look at me unhealthy i'm a bad asked what the story you're telling yoursel.

osteoporosis stenosis
"stenosis" Discussed on WFAN Sports Radio_FM

WFAN Sports Radio_FM

01:54 min | 3 years ago

"stenosis" Discussed on WFAN Sports Radio_FM

"Spinal stenosis thursday night football patriot with patriots at bucks excuse me nick fulci will want to forget about this one right away this is a mustache forty nine yard a attend for nick full the approach at fault not even signing gold westwood one who was discussed during the second of three is on the night first ovik god sakes the forty nine or there and then from thirty one vital margin of defeat for the bucks had 5 points beaten at home by the patriots nineteen to fourteen head coach dirk cutter on folks future with be something that will be forthcoming but you don't want to make any rash decisions that doesn't sound he's not going to say after the game cutting the guy who course thing should not going to say i did hear rommel on the one to thirteen point your harder oh no oh my goodness ziege's feel so bad and then killed cutter on there i i think it was this one the forty nine yards it was a fourth in one he's like you have to go for it there yeah those your various thanks very outspoken narrative on denver on a good night none of having a less he was in good kicker he wo really gonna hit a lotta much field goals for the jets yep his counter apart steven gostkowski four for four of the pats he's now 12 for twelve on the air pats got it down without rubbed in caskey he missed the game with a thigh contusion wasn't pretty but they do improve to three until now they have extended time to prepare for next week against the jets who of course visit the winds brown's on sunday jason pierrepaul added giants camp yesterday his reaction after the defense of players led film review of their latest loss beyond is all about pendulum bestball we have waddell game yet so not out of step big tom for shoddy gaza us that were him as well and what does he think he's been the biggest problem so far other teams play play that we were jarred on thing they they don't feels and will we put all films will put on you know very blunt has it's an honest assessment and you know who says he doesn't want to let that happen again i i hope he's right and you know they lose this week at home to the.

stenosis nick fulci patriots dirk cutter rommel denver steven gostkowski caskey jason pierrepaul tom gaza football brown waddell forty nine yards forty nine yard