is Courtney Stiro-Massaro. She is a certified nurse midwives and family nurse practitioner also with her MPH, residing in Boston. She is a C&M at Boston Medical Center and assistant professor of OBGYN at the Boston University School of Medicine. She received her MPH from two main schools of public health and tropical medicine and she completed her RN and MSN. The certification is C&M and FMP at Vanderbilt in Nashville. She has been providing full support midwifery care at Boston Medical Center and it's affiliated Community Health Center since 2014. Welcome Courtney and thank you for stepping in as a replacement speaker for us. You have the floor Courtney. Well welcome everybody and I'm sorry for those of you who wanted to hear about BMI and pregnancy but I hope that you all find this presentation nonetheless interesting even though it wasn't your intended topic. So the objectives for today are to discuss pre-eclampsia rates internationally and nationally, review the negative health and fetal effects of pre-eclampsia, understand the USTFPS's recommendation for prevention of pre-eclampsia and pregnancy, explain aspirin's mechanism for action and helping to prevent pre-eclampsia and discuss how participants might start screening for possible aspirin use in their pregnancy as well as barriers that we at the Medical Center have come across to try and help you not have to go through those similar barriers. And this project was supported by a very generous grant from the March of Dimes. So a little bit of background just to make sure everybody's on the same page. Pre-eclampsia is the onset of hypertension, a blood pressure of 140 over 90 and proteinuria and this is after 20 weeks of pregnancy. Most of the time it's high blood pressure and proteinuria but sometimes there's just the high blood pressure and other symptoms including thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema or cerebral or visual disturbances.  And I should have said when I started if people have questions please write them in the comment box. I'll try to pay attention as I'm talking and so we can go through questions then and if I forget then we'll just go through them at the end. So there are a number of effects for pre-eclampsia on both the mother and the fetus and baby. So there are acute effects and chronic effects. From an acute effect we have eclampsia, stroke, DIC, health syndrome, liver hemorrhage and rupture, pulmonary edema and aspiration, ARDS, acute renal failure and death. From a chronic point of view we also have an increased risk of chronic hypertension, diabetes, renal failure, excuse me, chronic artery disease and neurological deficits. So there are a number of effects both short-term and long-term that are very, very important for moms who have pre-eclampsia. So if there's something that we can do, i.e. taking prenatal aspirin, lotus aspirin in pregnancy to help prevent pre-eclampsia, something that's very important. And Celine, you had asked what do you think about the new American norms? Those norms I believe are not pregnancy-specific. So I think ACOG and ACNM are continuing to maintain the definition of pre-eclampsia as 140 over 90. Those may be adjusted as of now to my knowledge they are not. So the definition of pre-eclampsia kind of maintains the same. And then as far as effects on the fetus, pre-eclampsia is the leading cause of iatrogenic preterm birth and low birth weight. In the United States, 15% of preterm births are due to preeclampsia. So this is a very important issue both from a maternal point of view and from a fetal point of view. And there are other effects including interuterine growth restriction, small for gestational age, oligo-hydramio, placental abrasion, low apgras scores at birth, NICU admissions, stillbirth, neonatal death, an increase in blood pressures in childhood and adulthood. So again, not only are fetuses more at risk for being born preterm, which has long lasting effects on them as babies and children, but many other effects. So a little bit about the epidemiology. Internationally, about 4.6 of deliveries are related to preeclampsia or due to preeclampsia and 1.4% are due to eeclampsia. And 15 to 10 to 15, excuse me, percent of maternal deaths worldwide are associated with preeclampsia and eeclampsia. The WHO estimates about 18% of pregnancies are complicated with hypertensive disorders and that includes not just preeclampsia but gestational hypertension and others. And then from the United States point of view, approximately 3% of pregnancies are complicated by preeclampsia. And 12% of deaths are likely attributed to preeclampsia and eeclampsia. And although morbidity is more common than mortality, it's still both are still very important. And it's estimated that more than one-third of severe obstetric complications are related to preeclampsia. And severe obstetric complications are defined as severe preeclampsia, eeclampsia, severe hemorrhage, severe sepsis, or uterine rupture. So we can see that amongst that large list of very severe complications preeclampsia can account for a third of those severe complications. And in the United States, and I believe internationally as well, rates of hypertension and pregnancy are increasing. So this is why this is a very important topic. And why I'm glad you guys are joining me. And then Selene to get to your question, a little bit about race differences. And this is within the United States, but I again believe that it holds true to some extent internationally. The incidence of preeclampsia in a study that looked at data from 2014 to 2012 showed that the rate for black women was 6.4% compared to 3.75% among white women, which was a statistically significant result.  Black women additionally were 2.4 times more likely to have an intrauterine field demise compared to white women. So we can see that within the United States there are huge discrepancies between white and black women. And Hispanic as well, but the discrepancy between white and black is certainly much more severe. And in another study from 1979 to 2006 looking at that data, black rates of preeclampsia increased more than whites. So for blacks the rate was 40.1 per 100,000 deliveries and for whites it was 28.6. So again, another study showing the distinct rates of differences between black and white. And this is just a visual, a chart, or visual from the previous study and just shows again the significant difference between black and white women in the United States. And that, you know, in the 70s there was a difference and then it seemed to kind of, the black rate seemed to decrease and not by any degree catch up with, but have a less stark difference between black and white. And you can see that just recently, let me use my technology, the huge difference. I mean this is black rates and either white rates. And you can see that there's a dramatic difference between those women and their rates of preeclampsia. And so because preeclampsia does cause 15% or is a result of 15% of the pre-tembers talking about infant mortality is also something that I think is important. And we can see here that in the United States our maternal mortality rate for 2015 was 5.8 per 100,000 live birds. And if you look down at the bottom, this is, the figure shows different countries throughout the world based on their infant mortality rate. And the United States is between the Slovakia, excuse me, yes, Slovakia and Russia. So maybe not, maybe we're not doing the best in the road, no offense to the Russians or the Slovaks. Whereas we see that in Boston, the city where I live and the city where I work, the infant mortality for white women is 1.7. Meaning that we have the white women have the infant mortality rate of those women in cinnamon, i.e. very, very good. Whereas our black maternal mortality rate in Boston is 8.1, excuse me, which puts us right in between Chile and Costa Rica. So you can see that although the United States is not doing very well overall, white women in Boston are doing exceedingly well, or excuse me, white infants in Boston are doing exceedingly well from their mortality rate, i.e. they are dying very, very rarely. Whereas black infants in Boston are dying a rate higher than the United States and a rate that is astronomically inappropriate in my opinion. So a little bit about what we can do to try and help not only women get, not get preeclampsia, excuse me, but also decrease this infant mortality rate related to preeclampsia. And the USPSTF, which is the United States Preventative Service Task Force released recommendations a number of years ago recommending that aspirin, 81 milligrams is what they recommended, be used as preventative medicine after 12 weeks of gestation in women who are high risk for preeclampsia. And this will get into more of the data but has been shown to help decrease the rate of preeclampsia. So the USPSTF has kind of two different, well they have three actually, peers of risk factors. There's women who have a high risk for preeclampsia and who should be on prenatal aspirin if they only have if they have one or more risk factor. And those high risk factors include a history of preeclampsia, having multi-field gestation, chronic hypertension, type 1 or type 2 diabetes, renal disease and autoimmune disease. So again, women with any of those risk factors, one risk factor should be on this aspirin. And then the moderate risk factors is a little bit more debatable or excuse me, not debatable, but a little bit more left up to the provider's judgment. And the moderate risk factors include obesity, a family history of preeclampsia, specifically having a mom or a sister who's had preeclampsia. So if you're demographic aspects including being African American, low socioeconomic status, being over 35, or having had a history of low birth weight, small for gestational age or previous adverse pregnancy outcomes and a 10-year pregnancy, more than a 10-year pregnancy interval. The USPSTF says that women who have moderate risk factors, if you have several moderate risk factors, then they should be on aspirin and pregnancy. And several is a word that although Webster defines it as more than two, that was a point of contention or offered a lot of debate in our practice as far as several was two, several was three. And my take on it is the USPSTF said several to leave it up to the provider's recommendation or the provider's choice, that the provider needs to determine whether or not they find the various risk factors that a patient might have worthy of putting them on aspirin. And then, sorry, the third factor, the third level is just low dose, women who have no risk. And those women do not need to be on, the recommendation is for them not to be on an aspirin during pregnancy. So a little bit about the pathology of aspirin, why we think this works. And one of the things is to acknowledge that first off, we don't have a very good sense of why pre-eclampsia, why women get pre-eclampsia. But one of the thoughts is that it has to do with their body's kind of reaction to the placenta in that pathophysiology. So aspirin has been shown to help so, excuse me, women who are at risk for high blood pressure or hypertensive diseases often have their deficient of prestacean, which is a vasodilator, and they also have excess thromboxin, which is a vasoconstrictor in a platelet aggregate, excuse me. And so that can cause hypertensive disorders in pregnancy. And so prenatal aspirin, aspirin being a anti-platelet aggregate, has been shown to help high risk women to decrease that risk of preeclampsia. And you may be wondering why I'm saying prenatal aspirin, why I keep referring to women should be taking prenatal aspirin instead of low dose aspirin or aspirin 81 milligrams. And this was a concerted effort amongst the providers in the hospital where I work, who are working on our aspirin or low dose aspirin or prenatal aspirin program. We very specifically wanted aspirin to be associated with pregnancy in America, or at least in Boston, sometimes people call it baby aspirin or 81 milligrams aspirin. And so we just, we wanted to take away those, that wording and have aspirin be related to pregnancy. We wanted patient providers and pharmacists to understand that the aspirin is being used to it's being prescribed for risk reduction in pregnant women, excuse me. And so that linking pregnancy risk reduction to aspirin we found that prenatal aspirin seemed like a very good way in order to do that. Additionally, some initial studies in Europe have shown that higher doses, higher doses than 81 milligrams might be necessary. And so we felt that rather than saying 81 milligrams of aspirin leaving it something, leaving it more neutral, so that there could be a little could be a possibility of changes if necessary in the future. So prenatal aspirin's benefits, there are a number of them. The US PSPS in their analysis said that aspirin, prenatal aspirin reduces the risk of preeclampsia by at least 10%. The less conservative estimates say it can be up to 24%. So that's a huge, huge dramatic decrease in women getting preeclampsia. There's also a reduced risk of preterm births by 14%. It reduces the risk of intrauterine growth restriction by 20%. A newer meta analysis of many women, 20,000 women who initiated prenatal aspirin before 16 weeks showed that it prevented preeclampsia, prevented severe preeclampsia, and also prevented fetal growth restriction. For a preeclampsia point of view, the risk ratio was down to 0.57. Severe preeclampsia, the risk ratio was 0.47. And for fetal growth restriction, the risk ratio was 0.56. So again, with both of these studies, we can see and many other analysis that have been published since then. The benefit of prenatal aspirin in pregnancy. And so cost benefits, you know, cost is always very important looking at how much each intervention costs and saves. And so the cost of preeclampsia, at least in 2012, was $2.8 billion to the United States health care system. This included 1.03 billion in maternal costs and 1.5 billion in infant costs for infant costs, excuse me. A more recent study in 2015 looked at the savings studies. We implemented the USPSPS guidelines. It would save the United States $3.77 million in direct medical costs. So we estimated that approximately it's $5 or $10 for a woman to get prenatal aspirin for their entire pregnancy. And the cost, the savings, excuse me, are many, many millions of dollars, which our health care system certainly could need. And then a little bit about safety, because I think that's one of the things as we started to implement this in our hospital. There were a lot of concerns from OBGYNs, midwives, pediatricians, pharmacists about the safety of prenatal aspirin. And from a maternal point of view, aspirin is, prenatal aspirin use of pregnancy is not associated with an increased of placental abruption or postpartum hemorrhage. Additionally, aspirin is not associated with first trimester defects, first defects, excuse me, is not associated with birth defects when used in the first trimester. And it is not associated with premature closure of the ductus arteriosus, intraventricular hemorrhage, or neonatal bleeding. So it is something that is very safe in pregnancy, which is. And then a little bit about the timing. There was a study that looked at the best time for taking prenatal aspirin. And it looked at kind of three different times upon waking up, eight hours after waking and at bedtime. And the results showed that at bedtime it was the most beneficial time to take prenatal aspirin. So that's at least in our practice when we recommend women to try and take their prenatal aspirin. And then a word about compliance, which is something that I think many of us struggle with our patients not taking the medicines that we recommend quite to the extent that we would like. And a recent study has shown that greater than 90% compliance is important in decreasing preterm preeclampsia rates. So it is something that is necessary for patients to be taking at a regular basis. And in this study compliance was positively associated with a family history preeclampsia. But interestingly, negative associated with smoking, maternal age less than 25, Afro-Caribbean or South Asian racial origin, or a history of preeclampsia in a previous pregnancy. And I found that to be very interesting because it seems like if your mom had preeclampsia then you're more likely to take your prenatal aspirin. But if you had preeclampsia you are not necessarily more likely to take it. And the researchers don't really go into it but it was just an aspect of the study that I found interesting and worthy of paying attention to given that I typically assume that if my patients have had preeclampsia before they would be more likely to really want to prevent it in their next pregnancy. But at least in this study that was shown not to be the case. So a little bit about the health belief model of self-efficacy. How we can kind of help our patients or why our patients might actually want to take prenatal aspirin. And this is a model that was developed in the 1950s. And so patients need to perceive that they have susceptibility to the problem, that there are consequences to the problem. And if they have that they perceive that there is a threat. Additionally they need to perceive that there is benefit to the action. And they need to understand their barriers to the action. And that allows them to have expectations of the intervention's effectiveness. And both those perceived threats and the expectation of intervention outreach to their self-efficacy. And specifically from a prenatal aspirin point of view what that means is that patients need to have a perceived susceptibility that they might have preterm birth. They might be susceptible to getting hypertensive diseases or hypertensive diseases in pregnancy. They also need to understand or have an appreciation of the consequences of hypertensive disease and preterm birth. And that leads to their perception of the danger. And then they also need to perceive the benefits of aspirin for risk reduction and acknowledge their barriers to being able to take prenatal aspirin. And that then affects their expectation and action's effectiveness. And again all of this leads to their self-determination towards aspirin for risk reduction of hypertensive diseases in pregnancy and preterm birth. So then a little bit about Boston Medical Center and the hospital where I work and where we're going to talk a little bit in the next couple minutes about the interventions that we have done to try and increase our aspirin use in pregnancy. So Boston Medical Center is New England's largest safety net hospital. 50% of families have an income less than $20,000. 30% of our patients are non-English speaking and 68% of patients speak in a language other than English in the home. And 68% of patients also identify as black or Hispanic or black. And within our labor and delivery so our pregnancy the patients that we see who are pregnant, 70% of those patients so we take care of 70% of the black and Latino women in Boston. So one of the reasons why the race disparities are so important for me and for the hospital where I work and the providers where I work is because of this difference. We see the vast majority of the black women and the women who are at high risk for developing preeclampsia in the city of Boston. And so again we went over this but I just want to put BMC is kind of epidemiology to me into play. So internationally we have about 4.6% of deliveries related to preeclampsia, 1.4 related to preeclampsia, and 10 to 15% of maternal deaths associated with preeclampsia and eclampsia. That's nationally. Excuse me, that's internationally. Nationally in the United States approximately 3% of pregnancies are complicated with preeclampsia. At BMC however a recent study showed that approximately 30% of our pregnancies are complicated with some type of hypertension disease preeclampsia gestational hypertension and or intrauterine growth restriction. So compared to the national and international data that's a dramatic increase and a much higher rate of those diseases. And approximately 40% of our preterm births are due to preeclampsia gestational hypertension or intrauterine growth restriction. So it just shows again the level of need and the level of importance within our patient population for making sure that we as providers are screening and prescribing prenatal aspirin and then our patients are taking it. And so we developed a intervention, a quality improvement initiative to try to increase prenatal aspirin prescriptions to 90% and use to 90% in high-risk women in Boston Medical Center. And so there are kind of four primary drivers within which we were trying to implement this quality improvement. First was to screen. To have our patients try and arrive in the first trimester if possible and for providers to screen appropriately. The next thing that was necessary was providers then not after they screened to prescribe and for providers to identify the risks. And then for the other thing, we developed a new graphic which is our electronic medical system to allow the script to be written. Initially when we started this project, whenever a provider would prescribe prenatal aspirin, a pop-up would say, oh, this patient is pregnant, that's unsafe. Are you sure you want to continue? And so providers would have to click through and say, yes, I do. I understand that it is safe. And then the patients need to take the medicine. So they need to go to the pharmacy. They need to be aware of the benefits. And the family needs to be supportive of the patients taking the medicine. And then they need to maintain. They need to maintain taking their prenatal aspirin. They may pick it up, but if they don't take it, then as we already talked about, their compliance, the effects are much finished. So providers need to check in with their patients to make sure that they're taking it. Patients need to continue throughout their pregnancy to believe that it is helpful and so therefore need to take it. Other prescribers need to not discontinue it. And so as we kind of just talked about in our previous slide, our stakeholders include providers, pharmacists, patients, and their family. Those are the ones that we identified. And so from a provider point of view, we did a number of focus groups to kind of get a sense before we started our intervention, before we started our project on how providers felt about prescribing prenatal aspirin. And these focus groups included physicians and midwives who are the main two groups of providers who care for pregnant women, both prenatally and non-laboratory. And so amongst our providers there was an agreement that the high-risk women, the high-risk categories of the USPSTS guidelines, everyone felt very comfortable prescribing prenatal aspirin to those women. There were some concerns about certain moderate risk factors. And again, the debate of is several two, is several three, what does several mean? There were also some concerns about the secondary effects of aspirin that have yet to be studied. Although as I previously mentioned, the studies that we currently have show that prenatal aspirin is safe in pregnancy. There were some concerns that maybe five years down the road, ten years down the road, or one year down the road, there might be some effects that we don't yet know about that we could be unintentionally harming our patients or their patients. And then also from a midwifery point of view, there was that struggle of thinking of pregnancy as normal and believing that pregnancy is normal and that the woman was doing great and her body was doing everything necessary, balancing that with the need for prenatal aspirin and the fact that although your pregnancy is normal, this is something that might need to be taken in order to try and help make it even more safe. And then interestingly, there was also a question by one provider about if withholding prenatal aspirin, if not giving it to patients, was a problem because we know that it's worthwhile and how could we withhold it when we knew that it was beneficial. And so again, we also talked to pharmacists to get a better sense of what they were thinking and their opinions. And they had a number of self-reported hesitations about prescribing prenatal aspirin, including bleeding, harm to the fetus, the risk versus benefit, and just a general lack of knowledge. And 73% of the pharmacists that we pulled or talked to said that they were unaware of the USPSTS guidelines that prenatal aspirin was something that was recommended and something that was safe in pregnancy. Again, we can see from this slide the question asked if a pregnant patient came to my pharmacy with a prenatal aspirin prescription, I would feel comfortable prescribing her prescription and you can see that the vast majority of people either strongly disagree, disagree, or are neutral and that it really is only 23%, it's a very small number of those pharmacists who feel, who would agree or strongly agree to this statement. So it showed us that we had a lot of work to do with the pharmacists. And it was interesting because initially when we started off our project, we honestly hadn't really taken into account the pharmacists importance in helping us make sure that our patients get the prenatal aspirin. We just had assumed that if a provider prescribed the medicine that the pharmacist would dispense it. And clearly we learned very quickly that that is not the case that a lot of the pharmacists had a very difficult time felt unsafe prescribing prenatal aspirin or dispensing, excuse me, the prenatal aspirin to their patients. And then we looked at patients and we had focus groups with the patients and the patients said that their providers had told them that they shouldn't use aspirin. One woman said that in her last pregnancy she had a migraine and her doctor told her to use Tylenol and definitely not use aspirin. And we have another instances of just quotes from patients who said the doctor told me not to use aspirin or that they thought that it was contraindicated. So that's one part of our barriers that we were trying to overcome that have patients realize that, you know, yes, Tylenol is something great for a headache, but aspirin, prenatal aspirin in this aspect is something different than analgesia or other pain medicines. And then there was also the barrier of patients beliefs. A Haitian woman said that she was told that she shouldn't take aspirin when she was pregnant. An Ethiopian woman said that in her country she was told that aspirin can increase the rate of miscarriage. Another woman from El Salvador said that aspirin is not safe because it can act as a contraception. So we see that from a patient point of view we not only have their perception of what their providers are telling them that aspirin might not be safe in pregnancy, but also maybe what they culturally believe or what they hear at home. And so those are other barriers that we saw to overcome. And then looking at their opinions just a little bit more, we see that you know, low dose aspirin is safe in pregnancy when patients were asked that. 27% agreed or strongly agreed, but the remaining 83% did not. They either were neutral or they disagreed. And then for those who were asked about, low dose aspirin can prevent hypertensive diseases in pregnancy, 32% agreed or strongly disagreed. But again, there is a large number of women who were either neutral or strongly disagreed who, when prescribed prenatal aspirin, maybe without the appropriate counseling, would not fill the prescription, would not maintain their taking of the prescription. And so this is kind of a busy chart, I apologize, but it looks at the interventions that we did. So in the bottom, or the top left-hand corner, we see pharmacists. So as I said, we kind of initially hadn't had pharmacists in our wheel and very quickly brought them in and realizing that they were a very important partner within helping our program to succeed. And so we developed educational materials for them, including continuing education lectures. We sent out a newsletter to those who worked at Boston Medical Center and we developed pharmacist algorithms. So the pharmacist would feel safe understanding why prenatal aspirin was safe in pregnancy and helped them to be involved in that risk reduction. And interestingly with CDS Health, we when providers were prescribing prenatal aspirin and prenatal vitamins, those providers would then get a very polite fact from CDS Health, which for non-Americans is just a very large pharmaceutical company in the United States, or pharmaceutical store, saying, I think you probably made a mistake, you prescribed prenatal aspirin and prenatal vitamin to this patient. And if this is not a mistake, please let us know. And so it was something that we were able to reach out to CDS and they were wonderful in sharing our concerns about this fact and we presented them with data and UTSTS and they now have taken that, they have removed that kind of warning label. And so we at least at Boston Medical Center have not been getting that fact anymore, which speaks to the power which speaks to the fact that it was wonderful that they listened to us and were able to adjust their guidelines and their warnings based on new evidence. And then from a patient point of view, we developed educational cards, educational videos, and posters and clinics, which I'll show briefly in the next couple slides as we talked about before. We did focus groups to get a sense, focus groups and surveyed, excuse me, to get a sense of what the patients were feeling and their comfort level with aspirin and their knowledge with aspirin. And in addition, we also developed inpatient counseling for women who had pregnancy induced hypertension, preclampsia gestational hypertension and IUGR, so that those women who had had maybe a preterm birth, who had been induced for preclampsia would know that for their next delivery, for their next pregnancy, excuse me, that they would need to be on prenatal aspirin to try and help decrease their risk of it coming again. And then from a provider point of view, we had focus groups, we did, we do presentations, we have quarterly QI presentations, presentations like this. We also have monthly newsletters, which we send out to our providers. And then we standardize within our electronic medical record. Not only we removed that epic flag that was saying, oh, aspirin is not safe in pregnancy, but we also developed what's called a dot phrase, which just allows patient or provider, excuse me, to have type in one little phrase, and then it pops up all of the risk factors. So providers don't have to remember if chronic hypertension is a moderate risk factor or a high risk factor. It's all there and very easy. And then from a community point of view, we've also been working with a number of groups in Boston who are helping to improve birth outcomes for at-risk women because it seemed like a very logical extension of our program, not only for our hospital, but within the community. And we've asked Google to change their listing of the order of prenatal aspirin sites. Initially when we started this program, if you googled aspirin in pregnancy, it would come up a number of less evidence-based sites. And so we're working with them to try and have the more evidence-based sites come up first so that when patients Google it, that they can have the best information readily available to them. And so this is an example of our education cards that we give to our patients. And it just goes over what you need to know about high blood pressure, who may or may not be at risk for high blood pressure, the different risk factors. And then the safety and the benefits of aspirin in pregnancy, prenatal aspirin in pregnancy. And this is our algorithm for our providers. And we have this displayed around clinic and they've all been emailed it. And it just helps them go through of, you know, risk factors if the patient qualifies for prenatal aspirin and help them to very clearly just kind of walk through the risks and how to go about making sure that they're taking their aspirin. And then the posters, we have a very large Spanish and Haitian Creil speaking populations as well as our English populations. So currently we have posters in Spanish and Haitian Creil and English. And this is just an example on our left. We have a poster in Creil and a poster in a right in Spanish and we have displayed those in our clinic and our ultrasound areas just to help patients if the provider hasn't talked to them about it, helps them to learn about it, but also helps them feel more comfortable. One of the physicians that is the lead in this initiative is an MFM and she was doing an ultrasound and she was counseling patients, a patient about prenatal aspirin and the patient was like, oh yeah, I know about this. I saw the poster in the waiting room. I'm totally on board. And so it was a wonderful way for us to see that our posters had helped the patient feel comfortable about accepting the prenatal aspirin prescription before the provider had even been able to counsel them about it. And then we do have a website at www.prenatalaspirin.com. Our posters are there, our education cards are there, the provider risk assessment. We also have a wonderful video that we made about prenatal aspirin and pregnancy. Well, we certainly think it's wonderful and we hope you think it's wonderful. And as I said, our resources are in Spanish, English, and Haitian Creole right now just because those are the main populations that we, non-English speaking populations that we have at Boston Medical Center. And then just a little bit about our data, how we're doing. You know, it's been a lot of up and down about the... Courtney? Courtney, just to say that we're actually only got two minutes left of the whole session. So you'll need to kind of speed up a bit or come to a conclusion. Well, so to conclude, it's been a long process but we are working on continuing to increase the number of last months that we have. We have 100% a rate of prescription for the high risk for prenatal aspirin. So it's something that we're very proud of. So yes, questions. Well, Courtney, thank you for a very key topic. Looking, it seems to be the major question from the audience was about the posters. Would the posters be available for reproduction? Probably by other practices to use. Are they available to modify or are there any special permissions better that? Because I do see one or two, you know, things in the new population system. That is an exception. I forgot to include my email address embarrassingly on the presentation. We'll type it into the chat box right now. And if people are interested in the posters or the educational part, please just let me know. And I will see what I can do about getting you access to those. Thank you very much for a wonderful presentation, Courtney. And I see you have given us your email address for those of you who are interested in getting additional information about this very key topic. Which I think impacts every single one of us in our practices. Thank you all for your time.


Make sure you click the link to subscribe to my youtube channel and also click the notifications button to be notified for when my next podcast goes live You can also follow me on my social media platforms to find out whom our latest guest is. I hope you enjoy this week's episode. Thank you In the simplest form pirates get on a ship They hold a gun to the captain's head and say your ship's been hijacked We're going to Somalia now. Our job was to protect them. So we were armed security I also was a What they call a bag dropper so I would go and pay the pirates as well So when they'd agreed a fee with the ship owner the insurance companies would send me out to Somalia to drop a bag with a couple of 100 million or a couple of million dollars in these people have quit the jobs You know, they've applied for hunted. They've got on the show. They've left work We obviously hackle their accounts their social media their PCs the laptops. I'm reading emails where they've already spent the money You know, they they're planning what they're doing with the hundred grand You know the booking holidays the point deposits down on cars and and it's it's pretty brutal And as you can imagine when when they get caught they're pretty aggressive as well You know in that in that moment of emotion where they realize there is no hundred grand anymore Boom we're on and today's guest. We've got Jordan. Well, how are we brother great good to see you mate? Good to see you mate. You've just finished a marathon there You're doing 15 marathons and 15 days. How are you feeling is that the fourth one today? It's the fourth one today, and I'm definitely feeling like It's it's been pretty brutal and I probably if I'm honest I probably underestimated it being in Rony on day four and I've got another 11 to go What's a money? What's the most you've ever done in a row? I've done one marathon before today before before this challenge started. I did and the the marathon of Afghanistan in 2018 that was the only marathon I've ever done in my life and then four days Four days notice. I decided I was gonna do 15 in 15 It's it's the 70th anniversary of the national trust She's the sort of charity of the national parks of the UK And they said why don't you come and have a look around our national parks? And I said, you know what I'll come have a look but I'm gonna run around them and here we are four days in You're sitting here talking to me when you should bend your bed. Yeah. Yeah. Yeah But all good all for a great cause and you know as we were talking off record before It's as it's as much about helping me as it is about helping the charities It's great for mental health, you know, I suffer a lot with things like depression anxiety Still take medication today, which I'm sure we'll dig into but really good for me being out in Scotland as well Like, you know, we're up here and it's not often you get the English saying great things about the Scottish For me, it's probably one of the the most beautiful parts of the UK And I think Scotland and especially the north of Scotland It always shows me that you don't have to travel far You don't have to travel to the other side of the world to see natural beauty because when you get up in The Cairngorms in Loch Lomond, the National Parks are just absolutely stunning. It's an honour to run around them As it's stunning here, you've got the fresh air, you've got the scenery and sometimes you're taking for granted because it's in your own backyard Some people will be travel around the world to see beautiful things But Scotland you have got it in the top of Scotland. There's Whites and the beaches yet that I've never seen So it's something I would like to eventually do myself. You do massive things Jordan You've raised over a million pounds for charity. You like to help the kids from the war zones You've did your marathons, you've did your runs in some of the most rundown places in the world You've got your rowing thing coming up this year where you're going to row also round Where are you rowing again? So I'm rowing The gateway to the Gulf of Ireland. Yeah, where is that? I was gonna say that there but the fucking butcher bit, mate So it's called the Babelmandab Straits No, so it's It's the most dangerous strait of water in the world For various reasons for the pirates for the terrorists for the sharks You know for for many different reasons It's the busiest shipping lane in the world for cargo commercial ships as well So I'm gonna get in my little rowing boat and head across there later on this year It's never been done successfully before by any person. So you know touch wood fingers crossed I can be the first person in the world to achieve that and and hopefully the main objective this year is Is to raise a quarter of a million to build a school on the Horn of Africa? Which is 27,000 child refugees there and for me having you know left school with no education I've gone back to education later in life and I found it's one of the ways that actually Certainly if you're in a war zone or a conflict environment as a child You can inspire a lot of hope by giving them access to understanding the wider world And that's a great thing mate So massive respect goes to you for that I always go back to the start with my guests as well and Get a wee bit more information about you and how you get involved in the life you're in because I know you serve the Name for over 10 years and whereabouts did you grow up and stuff? Yeah, so blackpool was home for me the last Vegas of the north Easter yeah, no, it's a great. It's a great weekend You know and we were probably the victims of all the old you lot on the stag dues and everyone else who comes to abuse But now I'm really proud to be from blackpool and I live down in Hampshire these days But grew up in blackpool on a pretty rough council estate But I didn't come from you know a terrible background or anything like that Whatever I lacked probably materialistically I gained in love from from two very inspirational parents who you know I think they installed good values in me good morals and you know I was how was it probably a bit of a naughty boy got in trouble with the police as a youngster a few Cautions for this that and the other a few nights in in the cells, but you know, I wasn't I wasn't the worst child or most misbehaved But unfortunately left school as I say we know qualifications So it was joining the army was process of elimination You know like a lot of people from sort of deprived and run down areas you join a military or you end up going in Jail, it's it's not it's not too common. We could say the military was for me and you know a lot of my friends Unfortunately did go down, you know the drugs and and the crime route and still good friends today And it would have been very easy for me to slip into that a lot of my cousins and family members did as well But for me join the army and I guess it turned me from a boy to a man And I learned a lot about the world learned a lot about life. I got to meet some incredible people and Very thankful to the military for everything they've given me because I probably without a doubt made me who I am today I'm sure because you joined when you were 16. Yeah joined when I was 16 So, you know was serving in a conflict environments by the time I was 18 and did a couple of tours of Iraq, Northern Ireland And yeah, I'd had a great career and obviously lots of lows lots of high points losing friends on operations was You know, obviously the ultimate low and I always find it really important to tell their story, you know And and and if I give presentations and things I'll always put their faces up on slides because you know to to pay the ultimate sacrifice for your country is you know, it it well, it is what it is It's you know, nobody got joins the army thinking they're gonna lose the lives or pay that price So for me, you know huge respect and still today for the armed forces and the job they do I still think they often we don't seem to value them enough in in modern-day society But it's it's for people like those who allow us to speak freely do freely, you know, what we do in this day and age Yeah, it's difficult as well because war is war and No matter what country you're fighting for or what where you're going. It's difficult because I don't think you can justify Losing lives or fighting for someone but it's it's difficult Especially seeing all that trauma because I've had them calling the clacklin on Yeah We speak about PTSD Very openly and it's difficult especially if you're seeing people dying and it fucks me mentally as a human being I don't think we should be seeing that stuff. I don't think we should be Looking at that and thinking it's just It's grim because so many men are struggling just now suicide is on the rise and it's doesn't help that I don't think there's enough things in place for people to go and open up and speak to a lot of men I've got too much pride to open up and it's difficult when you've got guys that call in yourself to open up about Their struggles and seeing bad things Which is I think it's a good thing because it makes other people realize it's okay to speak out And it's okay to have problems when you were in because you were Where do you are? Not a negotiator but interrogator. Yeah, what's part of my job? I was in a tank regimen my sort of normal trade But I ended up being a tactical questioner interrogator Which essentially meant dealing with with the bad guys the enemy prisoners and extracting information that we could use for military operations to and counter counter insurgency operations to to hopefully put them under arrest and detain them and prosecute them Which was wasn't always easy But it was it was it was challenging and presented a lot of different issues because I know you were on the hunted So that's kind of searching people get looking for people and catch you know, man Yeah, it's a lot of fun say that say the things Yeah, it kind of it's kind of the same thing did that when you were in the army. How did that affect you mentally? Yeah, I think he was it was really it was really tough actually You know I people talk about things like post-traumatic stress disorder. I always say let's drop the disorder I always say that it's not a disorder because actually, you know seeing things and experience things that are abnormal You can't expect a normal reaction, you know that the human body and the human mind is very complex If you're seeing people being killed on a regular basis if you're putting friends in body bags That's not a normal set of circumstances. So you're not going to have a normal reaction. So for me, I don't believe it's a disorder I think it's a very normal reaction to a set of abnormal circumstances And I think like, you know, Colin's doing a great job But it is important for people to speak out and and to talk about these challenges because as you rightly say We're losing a lot of people on a daily basis now veterans, especially through suicides through Tempted suicide, you know in the suicides are the only ones that we often hear about homelessness as well homelessness as well so many issues in the in there not just with veterans but in the wider community in the social circles but To answer your question Yeah, it was tough But I always try and take positives out of these negative situations Which isn't always easy at the start when it's happened, you know You're in that sort of negative mindset But I think I use reflection quite a lot to sort of take the lessons and I'm somebody you will go away and digest What's happened digest the discussion and reflect at the end of a day on you know, whether it's an argument with your Misses or a fallout with your family or whether it's on operations in the military I think reflection is a key part of our growth as an individual to because we often act Emotionally and we don't often think logically we think with our emotions We say things we don't mean we do things that we don't want to do and so I think you know reflection is really important And that's something I've come to respect and appreciate a lot more as I've got older Yeah, again It's must be difficult because as human beings To be seen that stuff But again, it's how you react to that as well and the strongest men have became also the weakest whether I'm gonna say It's a weakness but mentally they became weak where they think it's a better option to take their own life Which is difficult and it's not just men who service serve the country It's anybody that can be the most successful businessman even you've seen a lot of musicians lately as well It's difficult Do you think all the stuff you're doing like they're running the rowing and pushing your your mind and body to the limits? Do you think that's to balance out some of the stress that you went through your life and seen some of the dead Bodies and stuff to kind of balance it out and get that natural chemical They feel good factor than dolphins the serotonin and and try to balance out a bit the anxiety and stuff Yeah, I think so I think you know, I got us recently You know, I still take medicine medication today I still take search reline and I've started on a hundred milligram down to 50 25 now But I would always say that running or exercise is the best medicine in the world You know, you get them feel good factors. It's good for the mind. It's good for the body So without a doubt, you know, even though I'm doing these these crazy adventures for charity It's helping me equally as much if not more than it is the people who have been a benefit benefiting Yeah, definitely and exercise is a key to be feeling good Even if it's walking doesn't matter if it's going up the stairs or even walking around the corner Just getting out and getting fresh air and again medication It's not something I really agree on but if it does help people to a certain extent What's the medication you're taking and what's the effects of it because a lot of medication as well It tells you on the box that you can be suicidal and it's trying to prevent suicide So for me, I struggle with that to you know, I do you know, I completely agree I'm not of someone who is promoting or and dorsen medication because actually I You know, I was really against it and still I'm in many respects, but I think When you've tried it and you've tested it If you can feel the benefits of it And I think you know if they tell me that the specialist the doctors tell me it helps balance the chemicals in the brain I was always and still I'm faithful that you become reliant on it and you can never get off it And you know, I'm trying to withdraw slowly at the moment and but if it does help you then You know, I think, you know, if it's the help that you need and they'll be get why not but like you I'm skeptical The thought it's a pharmaceutical injury pharmaceutical industry is a business, you know people's businesses companies rely on you buying drugs And that's one of the downsides and negatives to it. I completely agree. Yeah, they're creating customers They're not creating your oceans. Do you know what I mean?  I'm not here to say do this and do that But for people who have spoke to who it's trying to get off the medication They struggle with the hardest because then they rely on it because I had a guy called Mark Demsteren who's a Counselor and he says that a lot of people have chemical imbalances where they don't get that enough endorphins to the brain so we either crave it from drink drugs sex to get that extra wee boost and Obviously the pharmaceutical drugs come into play as well because it picks up your your buzz But then eventually does drop again, and then you become yeah I miss a few days. I have a really, you know, it takes me to a quite a low place if I you know Sometimes I go away for the weekend and I forgot my tablets. I can after two three days I can feel I'm like a different person my my girlfriend will tell you you know She'll say to me most frustrating things should go you haven't had your tablets Have you? And she'll see a distinct change in my behavior where I'm I'm quite snappy, you know Things will I'm very irritable things that wouldn't normally bother me and we'll get on my nerves quite quickly So there is a distinct behavioral change, and then I'll go back on the tablets And I'm alright again, and you know that it's not a positive thing But it the tablets at the moment they're working for me. Do I want to be on them forever? Absolutely not and I'm doing my best to get off them But you identify you're aware of it and you're very intelligent to realize that What you want anyway, and if it's helping them out and it's good But again is when you're going through the agitation stage or the two three days Is that you or is it we're not free tablets coming through your system? Do you know what I mean? Yeah, yeah, it's a good question So it's difficult because everything has a side effect and a lot of people promote weed and say joints are great this and that but If they did a test actually the scientists did a test they did a text on the brain. They did it through alcohol They did it for sex and Meditation and The ayahuasca and stuff like the psychedelics so they did a test on the brain when you take these stuff how much the brain reacts and The best chemical your brain receives when you're taking these stuff alcohol get an 8 out of 10 I think Sex get a 9 out of 10 psychedelics get a 9.5 and they want to get a 10 out of 10 was The meditation and there was no calm down from it either the other three who give you that buzz was always a calm down from it This is the meditation was a 10 out of 10. So basically take control of the mindset. Yeah, even techniques It's funny you say that I just been started doing yoga about a month ago, and I found it's so therapeutic and What you know highly recommend it to anybody because it's an actual buzz We're 100 mile an hour the brains always say it's 60,000 thoughts a day So it's constant so actually take half an hour an hour out your time And breathe Exercise quiet down the mind and focus on the day because if you're taking all the other stuff to replace a lot of people smoke weed And they say oh, I need that it makes me do things and or it makes me lazy A lot of people who smoke weed are already lazy anyway or a lot of people smoke weed were already active So again, it's you're kind of trying to numb something you're kind of trying to help you hide for the pain So again those scientists was 10 out of 10 was Meditation, but even techniques quite and I can believe that and the rest was all Let's say a short stimulate for 20 minutes 30 minutes And then it becomes a solo because you do a lot of stuff now for the kids all around the world raised over a million pound What made you get into that? I? think For me to realize, you know a lot of ex-military or veterans they will talk about The the bombs and the bullets not that they'll talk about but the things that would affect their mind would be the things that they'd Experienced and saw and it's the same for me But it's not so much there the trauma or the bombs the bullets the blood for me It was always the faces of the children I always think when you see children in a conflict zone or a war zone I think that you know for me they're the ultimate victims of war because they have no say they have no Influence on being there, you know, they've been brought into this world They can't just get up sticks and leave and and and go somewhere else, you know a lot of them have lost their family They've lost their homes And there's just something there's a there's a there's a sheer innocence. I think about children in a war zone You know, I met a child recently a little boy from Syria who was nearly seven years old He'd only ever known war, you know So when bombs were dropping in he didn't even flinch anymore because that was just normal to him Conditioned he was conditioned himself naturally by the environment he was living in and that's that's pretty sad for me and As I say, I think to help the children for me is Is the most important thing because they're the next generation, you know Adults although yet they're important and we can help them They have an element of control over their lives. They can get up. They can do something.  It becomes an on So for these kids to accept that it's normal for people to take places to get bombed for To see dead bodies. It's scary because we're all human beings.   We'll bleed. We'll bleed the same our heart pumps the same before We're all connected in my eyes. I believe and again I always say this but It's easy to control the masses if people are divided and it's difficult to see such fatalities in the world where It becomes normal, but again social media like mainstream media don't help that because it's constant wars rapes Robberies the world is a good place also and if you don't think it has then become good yourself But again, you're doing a lot of good stuff and try to give back Do you think that's because The misery and the pain you've seen as well and the tragedies of the lost families you try to help to Um, I think so. I think I think when you go there and Doesn't it doesn't have to be a war zone a night and you don't have to be a soldier But I think if you go and see something firsthand Um anywhere in the world or even in your own cities, you know Like the homelessness that the great work that you've done if you if you see it every day firsthand You know, you feel almost I think I think human nature says if you can do something to help people You should do especially if you're in a position where you can whether it's because you've got a voice of influence Whether it's because you're financially in a position to support Um, and I think it's no different, you know, I'm not many people Certainly from the uk will will voluntarily go to afghanistan and and try and help because it's a war zone It's a dangerous place most most people see um You turn on the news and you'll see lots of negative things But actually if you get out there and you meet the people, you know, I I did an interview recently with um With the bbc and I came back from iraq and afghanistan and they said, you know You're you're crazy. You go into a war zone on your own with no security teams and you're going running. That's that's pretty reckless Um, and it's very dangerous. I said no. No, I said I went to I went to afghanistan iraq somalia I didn't see any any stab ins any shootings, but I got back and in manchester There was three stab ins with murders. There was two in london one in glasgo But I didn't see any of that when I was in afghanistan everyone was very friendly They welcomed me into their homes. They looked after me Um, and as you say the media control the minds they control the masses of the world and we're in tune to think that You know dare I say it?  Everybody's had that kid one time Do you know what I mean? It will make mistakes But that's where the mainstream media kick in when you see the bad things you think oh, that's bad And but portray that it's normal to go to other countries because britain as well we've invaded every other country bar 22 So I think there's only 22 countries never invaded so Again, it's who we fighting for Also, you've got to ask yourself the question they were fighting for because our country is in danger We're fighting for the elite who's what to be more powerful I question everything and we spoke about that earlier everything's like conspiracy to me unless I've seen it with monies I don't know. Yeah, it's it's difficult when When you were over in arachn afghanistan, how are these places and how are the people? I find I find the people who We would perceive in the west to have nothing are often the most generous the happiest, you know, you go I went to afghanistan iraq. I spent a lot of time there I see more smiles there than I see in the west in england, you know, we're we live in a society now where our head is down It's in our phone every five minutes, you know, we're influenced by what someone's tweeted what someone's posted You know, we're we're living a society that we're we're all self obsessed, you know from from filming on hunted You know, I learned that the uk is the most surveillance country in the world We're also the most fame hungry even compared to the us We post more about what we're doing we take more pictures than anyone else Based on the size of the country and the ratios. It's incredible, you know You know what everybody's doing at every moment of the day and that's a culture There's nothing wrong with that but that's a culture that we now live in in the society um people in places like africa places like afghanistan they they don't worry about this that, you know, they Having a phone and tweeting and things he's alien to them You know, they're worrying about playing out in the in the in the mountains with the children doing all the things that we might have done 20 years ago We're from a we're from a very different generation. We have different priorities and the world is changing a lot And I think there's still what you find in in these remote parts of the world Is there's something quite nice and peaceful even when I was in scotland for the last two or three days in the north You know being switched off with no signal for 48 hours is something quite refreshing about that still today Your brain the most Scary as it sounds the most relaxing time I had was actually when I was seven days homeless because I never had a phone Yeah, and I had so much time to think and analyze my life and think right what do I want to do I looked at my phone yesterday. I spent 11 hours on the phone. It's this new tell you how long your screen time is It's scary, isn't it? I love the numbers. Yes. I get it. It's my work, but for me. I'm not living I don't feel as if I'm utilizing my words more constructively.  So we're constantly craving that to balance that out. So it becomes what's real and what's fake anymore Yeah, absolutely. I think I think you raise a great point there and I think You know, we we have sort of our insta world and we have normal world and You know, somebody said to me last night Like somebody said Jordan, you're doing a great job, you know, and I posted a video of me through And I thought, you know what? I said, I'm I'm now at the side of the road in a campervan. I'm freezing I'm eating some, you know, some some sandwiches from the garage that are out a day from yesterday And I thought that is not but I'm not posting that on social media telling the world that I'm showing them Of how great it was at the end of the race, you know, it's two different sizes. There's always again There's always different sides to our story. We always put through a life to be great But always say if the lives are that really great, we don't need you post about it No, no, but again, it's self-seeking.  Who had on last week?  We're looking at everything different.  But you know what?   So there's so much technology I think it's going to be acceptable to actually get chipped and then you're easily more controlled You do a lot of hope you do all the the children stuff. So I've wrote down some figures For the charities and the children. There's 1.9 million children raised in war and conflict.  It can be volunteering you some time You know, there's lots of ways you can help even raising awareness Yeah, even speaking to someone for two minutes. Yeah, like the homelessness, you know, just taking the time out your day You don't have to give them any money. You don't have to buy them a drink. Just just acknowledge them Yeah, and the scary thing about war as well. We spend throwings on it And they say only one of the most lucrative industries in the world Yeah, yeah, and it says it was for to white poverty or world poverty It would only cost 175 billion to give everybody food and shelter And the stats are saying that we spend billions and throwings on war Yeah, so again incredible the world can be a great place and I hopefully I don't know if I'll see it in my lifetime, but I believe people are waking up. I believe people are becoming more aware of what's the surroundings and what's right and what's wrong As soon as we're born, we know what's right and what's wrong But again, you're a product to your environment where it's growing up in Iraq or where it's growing up in Glasgow or Blackpool You get conditioned.    People are generally good. They're good.  Yeah, I just want to make conversation I try to make conversation with everybody because everybody's got a story I love to hear people's stories their background where they're from what they're doing But people sometimes are thrown back when you actually make conversation Do you know what I mean? Yes? I was in um, I was in Somaliland in northern Somalia in February last year Group of muslim female women they invited me into the home and they made me a cup of tea And they chatted to me in broken English and I remember thinking that evening got back to my hotel And I was thinking That won't even happen anywhere in the society that I live in you would never get a group of muslim women Um, inviting me insane. Hello to me acknowledging me looking me in the eye It goes against all the stereotypes that I have thought about a muslim women that you know And I just thought and that's in a muslim country as well You know because I've been tuned to believe that that'd be really bad What you know for them to do that that would be against all their faith their religion Goed against their family code of conduct the morals, but actually They're just people they were nice people We're all human and I read as well that there was there's 38 million churches in this world 38 million But yet they say there's over 200 million who are homeless. Yeah as well. And this is supposed to be a religion that Love and peace and this and that.  Why not? Why is there not opened and again the catholic church as well as a billion dollar industry? Yeah, yeah, make billions and billions and billions of pounds and again, I always question things What's the motive behind that? I would really help people where's the money going and stuff because I know you give a lot of your money to The kids and we spoke about earlier some big charities only give like five and six percent Which is a major factor So we can touch on that a wee bit that the stuff that you do because you've rosed over a million quid Which is unbelievable. That's phenomenal. So fair play. No, I think with the with the The charities as you say a lot of them are being run like Commercial beasts commercial operations almost like limited limited companies in many respects where they've got high level salaries You got CEOs on six figure sums For me, I'm not saying it's right for me. It's not what I believe in I think it's unethical. I think in people I have debates about this all the time You know people will tell me that no you need a very experienced entrepreneur business man to be innovative to be creative To bring the money into to motivate the staff and and all this But I just think when you're talking charity charity is not about paying people large sums of money When you look at the statistics on what percentage of your your donor or your sponsorship goes to the aid of where it's supposed to go It's pretty pretty eye-opening Which is why we ended up setting up a charity called frontline children Which is charity that I'm a trustee of we have no salaries. So we we know that 99 percent of every penny In every pound goes directly to the aid where it's needed And on the odd case where money is needed It's typically be an expense for some sort But even down to flights into afghanistan iraq after the normally sponsored every And I think there's a big gap in the charity market for showing the donor Exactly where the penny goes, you know, I tell anybody if you're going to drop a pound in a bucket Or you're going to spend 10 pound on an online charity page Just dig a bit deeper and scratch beneath the surface to see where that money's going because you know Sad as it is to say more often than not you're going to be funding a lot of people who are earning a lot of money somewhere I had a guy called brad well showing a good guy from edinburgh and he was exposing some of the charities that I constantly got adverts for people who are just donating money, but the money's He looked up the money's going fucking nowhere.  Uh, I'm Marathon a 10k and a 5k's a marathon half marathon 10k. Yeah, so how did that come about? Um, it was just that you know, I I needed to go back to these countries to I guess deal with some of my own Challenges in my head. I wanted to go back and uh see the people I wanted to help raise we raised about 100 100 000 plus for that um So yeah, it was I always try and do things differently. You do yourself. Yeah. Yeah completely on my own And are you safe enough for those other people try to take your life or I do I do all the risk assessments and I you know Manage every risk accordingly. Um, I was diagnosed with epilepsy a couple of years ago So that was for me one of the biggest risks, you know, having a seizure without the right medical support and things So how do you deal with that then? So for me it was training people who I met in letting people know awareness Training them what to do if I had an incident I wear a medical wristband Um, I have it in arabic as well. So people could if they found me they could know what to do with me Um, so yeah, just awareness, but but again, it was showing people even with epilepsy that Because the doctors and nurses said you can't do this project. He's too much stress on your body extreme climates Dangerous. It's not good. It goes everything against what epilepsy, you know says. Um, so again, it was So I started challenging saying who said this what some some doctor who doesn't have epilepsy Who's never ran a marathon told me that I can't do it. Well, you know, let's start Let's start challenging that and the same with the rowing, you know, somebody said this this can't be rolled It's too dangerous. Well, hopefully by the end of October.    I don't you know, I don't people say I've different philosophies and different theories and beliefs but for me all our cards are marked And when it's time to go we'll be going. Exactly, you know, so make the most of it Exactly And I know people who've done three four tours of Iraq, Afghanistan and then fell off a motorbike in the UK and died, you know We'll survive four rounds with a Taliban, you know for two years Um, it's time to go. It's time to go. Exactly.  It's just When you again just go out and do it. I pulled it Yeah, take a risk out your comfort zone I find With great risk with great risk often comes great reward if you're prepared to you know to put yourself out there and do something Um, you know you you'd be amazed and it's quite addictive as well because when you realize the benefits and you see the success from it Um, and I said in fact not even success I think there's I think you can go through life and you can be successful maybe in In love in business in your job in the workplace, whatever it might be But you can be successful but often not feel fulfilled And I think if you try and help other people And you can also do something you enjoy which for me is adventure, you know, that is fulfilling Which is different than success. Definitely. So fulfilling is eternal.  You can't do it. You're too fat. You're too heavy.  Yeah, don't let anybody tell you what you can and cannot do The same as yourself going out and running traveling the world But again, if we've got those chemical imbalance when you're Setting those goals and achieving them that sense of fulfillment for you You cannot buy that in any medication any drug any drink no matter what that's Where you feel alive and that's why you constantly crave it and keep doing it same as myself Setting goals achieving them doing good things because it's a natural buzz It's an actual chemical to fucking feel good in life. That's what it should be all about. Yeah. Yeah It's difficult again because we're dealing with a material world and we do some people Make their success through materialism or through money But again, it's the things that are free the things that you're doing to make other people feel good and other people are Rewarding from it. So when you do your row as well this year, what's their own? How long is it for? So the roll take a couple of days. Hopefully, um, I get the boat in about two weeks It's being built specifically for this mission if you like Um, and I'll head out to the Horn of Africa. I'm gonna wait out there till The stars align the conditions are perfect the security situation the weather the sea state all the different risks You know people think when you do these these big expeditions, you know, people think that oh, it's really dangerous It's really tough Enduring actually it's the everything that comes before the expedition the sponsorship the training It's the stuff It's the stuff that goes on behind the scenes that no one ever sees which is the hardware You know doing the actual row across the water. That's the enjoyable bit. That's where Spotlights on you, you know Nobody sees the struggle behind the no, no, no, you see there was quotes on us saying boat as well is The the hours as thousands and flowers thousands and thousands of hours of training But yet when they won the Olympic gold medals The hundred meters and ton of years only showed that two two minutes of all the running he did But it never showed you the thousands and thousands hours it put in to run those two minutes to win the three consistency Consistent gold medals and free Olympics and that's what people see on the social media.  There's the guys that people can't see behind the camera Just as well for that though I bet i'm the first guy to give you some mention The weather that out I do all this myself But again consistency is key The key you have written is consistency People don't people fail after two free attempts because I think it's too hard but everything consistency consistency is key failure Yeah, you don't get it first time. You've got to fail. You've got to fail. You've got to fail. That's where you learn That's where you grow Do you know what I mean? So how can people get in contact with your channel? It's how can people support you how can people look in your social media and stuff and find out what your next activities are Yeah, um on my website, uh, jordanwiley.org or at mr. Jordan Wiley is my handle on on all platforms I got a book out which details my time in the military and what I did after the army fighting pirates off Somalia How can we get the book and the books available in in waterstones all good book shops amazon Or find it on the website and the new book which will document last year's running project Which is called running for my life that'll be out in the 7th of november this year Um, but yeah, we're all big year ahead looking forward to it. Yeah, good. I'm excited for you and you were on channel four's hunted Yeah, so it was on that. I'm a hunter on hunted. Um, we start filming the new series 25th of may so coming up soon, um, which will go on for a couple of months. Um, so we I'll be running around the UK Um and driving around the UK. So pretty much doing what I'm doing now Carrying it on. So how did how was the celebrity one? Is that run for 14 days? Yeah, celebrity one's 14 days and the sort of main series is is just short of a month. Um, the celebrity one is It's for stand-up for cancer. So it's got a charity aspect to it. Um, it's a bit more fun It's obviously quite hard for celebrities because people know who they are So it's not as easy for them to hide in there in the public domain Who is it jayme lang spencer mafios? Yeah, they were on the first one. Yeah They were on the first on the last one we had um some guys from love island chris and kem We had some politicians. We had kabe early from sky news Um some strictly come dancing people. Um celebrities, but I don't really know So how does it work then? So what is the plan for them to get do they have money and they try and hide from use So they got uh, they got to go on the run Right if they get to the end they get to an extraction point. Um, so on the main series got say they got 30 days If they get to day 30 and they get on the extra they get to the extraction point, which could be a plane It could be a helicopter. It could be whatever, you know, um, they win a hundred thousand pound So our job is to stop them getting the hundred thousand pound Um, so it's pretty brutal as well because you know outside of the celebrity show These people have quit the jobs, you know, they've applied for hunted. They've got on the show They've left work, you know I've seen I was you know, we obviously hackle their accounts their social media their pcs the laptops I I'm reading emails where they've already spent the money, you know, they've they're they're they're they're they're planning What they're doing with the hundred grand, you know, they're booking holidays. They're putting deposits down on cars and And it's it's pretty brutal and as you can imagine when when they get caught they're pretty aggressive as well You know in that in that moment of emotion where they realize there is no hundred grand anymore It's pretty it's pretty real then that they've actually quite have to think as they think they're really well You know, people think sometimes that it's staged or itself You know, we might we might reshoot a scene But what you see is how it happened, you know the moment we catch him the moment we're chasing him That's how it obviously people edit things People are creative with the editing No different than any other part. Of course, I'm not sure.  Yeah, you need to You know, you need to keep moving you need to people make the same mistakes though You know, they use a bank card they try and contact them more more All the things that you wouldn't Yeah, but they've all got in fairness as well. They've all got to get on the show They've got some incredible backstories, you know, they've been through some real challenges in their life You know, whatever it be, you know, some people we had on last show had Several times it had cancer some had lost their parents real and actually lovely individuals all pretty much all of them You know and you sort of afterwards when you've caught them you sort of going on thinking I wish you don't Let them go Because you've got a football as you're organizing a celebrity football match Yes, we've got a celebrity football match on sunday the 5th of may at the blackpools ground bloomfield road So we've got military veterans Who have won sort of gallantry awards people who've been on calling actually calling McLaughlin's one of our players Yeah, yeah So hunted sas who dares wins those sort of guys versus Coronation Street, Emmerdale, Collie Oakes, EastEnders and So you do you play yeah, yeah, I'll play as well. Yeah, and how have you ever had an episode by epilepsy? Have you ever had no no, you know Touch wood.  Yeah For me it was the only negative I found was Um, I couldn't drive for a year. They took my license.  I got did more exercise, but you know, I have a positive outlook on it I don't see any negative to it. Yeah, do you think that keeps everything at bay? I believe everything can be rewired I believe everything can be reversed um again people who have had like Diabetes and stuff the reverse that we're changing their diet and exercising I don't know many people though. It's had Epilepsin and then yeah, I don't I don't think so you can you can when you've got epilepsy You've got it and you can maybe you won't have another seizure, but you'll never sort of know till it happens But what ease did you get what age only two years ago? And what does it what does that come from stress anxiety? No, no, so for me it was a bit It's quite a unique um a unique case So I went to do a documentary in the Horn of Africa and I took an american tv channel to To basically go and look at what pirates do off Somalia. So I took them out there I went on a boat for a couple of weeks and Um, I got bit by a mosquito and I caught something called dengue fever Which is like it's a mosquito-borne virus a bit like malaria similar side effects put me in hospital for a few a few months and A side effect of that was people start having seizures and the odd person gets epilepsy You don't really see it in the uk because you don't have mosquitoes and dengue fever But in Africa, it's quite common and I was one of the unfortunate ones that got bit by the mosquito on that time Which is is pretty pretty random But I always think someone give me a piece of advice a few years ago a A friend of mine called Laura D's she's a An olympic winter olympian. She won the bronze this year last year in the skeleton event, you know, they lie down on the ice And uh, she said to me I was having a bit of a tough time with the old depression and what have you when I my family broke down And she said to me Jordan. She said Control the controllables. That's the best piece of advice I can never give you and I try and apply that to every aspect of my life You know just control the things that you can control don't worry about anything else because we stress And we build ourselves up about things that we have no influence over no control and again in all business love and so on Just worry about what you can control if you can control it Then what you worry about because you can do something about it We worry about things that we can't control at all Um, and and and they're the things that we shouldn't worry about because we can't do anything It is what it is. Yeah, exactly. How was the the pirates? Did you see them? Yeah, yeah, so I spent I spent How how throughout is it that the the pirates take over ships and oh, yeah, yeah big the big yeah serious Yeah, so I spent after the military. I left in 2009. I spent Best part of five years Up and down the Somalia coast Indian ocean west Africa east Africa southeast Asia protecting ships from pirate attacks You know, I was It was a multi-billion dollar industry for the pirates. Um, she's died down significantly now Because you know security have done a great job military operations and so on but It's incredible. Yeah for a long time So when they take control of the ship, where did where did I take the ship as a ship not registered? Does it not yeah back to Somalia? So, you know in the source in the in the simplest form pirates get on a ship And they hold a gun to the captain's head and say your ship's been hijacked We're going to Somalia now And that's you know, that's obviously a bit more complex than that But that's how it isn't as simple as yeah as did I kill the hostages or did I let them go? There's been cases where to kill them So the business, you know east off lots of different types of piracy But the famous one what most people know about if you allow the infamous one is the Somali based piracy where pirates would hijack a ship The ship would then be taken back to Somalia And then the pirate commanders and leaders They would then Try and sell the ship back to the owner and say if you want your ship and your crew and some of these The cargo on board, you know oil gas could be worth a couple of hundred million dollars So for them to sell it back for five ten million dollars So dropping the ocean if you've got three hundred million dollars of liquefied natural gas on board And so they made a very successful business model and Our job was to protect them. So we were armed security. Um, I also was a What they call a bag dropper So I would go and pay the pirates as well So when they had agreed a fee with the ship owner the insurance companies would send me out to Somalia To drop a bag with a couple of hundred million or a couple of million dollars in Um, which was quite interesting because it's quite interesting because people always think that was a really dangerous job But I can assure you if you're giving someone five million dollars, they don't want to hurt you So you had to go and meet them with the door. Yeah, he was going to meet so it was you know You got I always use the analogy of think of think of a drug dealer in in Glasgow think of Um, you know, you've got the guy on the street who's shifting the gear But then you'll have you've sort of kingpin fervor up the chain Um, who's calling the shots, you know, he's the guy Probably doesn't get his hands dirty that often but he's the guy making the decisions And that's how the pirate chain of command would work You know the four or five six pirates who get on the ship who do the dirty work the hard graft They they hijack the ship, you know, you might get a 10 million dollar ransom They'd be lucky to get 50 grand out of that. Yeah, that's that. Yeah If that if that yeah, you know a couple of grand and these are 16 17 year olds uneducated poorly trained Limited equipment, you know rustile weapons. There are real chances taking a big risk Um, and yet you got some guy Sat often often not even in Somalia You know a lot of the money was traced back to places like Dubai even London, New York You know, they were being funded by some some serious influential players I don't know who but you know a lot of intelligence to suggest that they weren't necessarily all coming out of Somalia They're not sitting in a hut. No, they're not sitting in a hut when you're getting 10 million dollars So when the devil's trying we were on the boat the devil's trying Yeah, so my book actually, um It's like it's like you've played me nicely into a plug for my book now. So So citadel the book so the name of the book citadel a citadel is is them is the the the technical term for a safe room So if you imagine On the ship the plan would be if pirates ever got on board a ship The crew would always have what they call a citadel or a safe room where they would all go to seek refuge They would lock themselves in and they would call for the naval forces to come and rescue them And in there you'd have like emergency rations medical kit and whatever else So on my on this particular occasion eight years ago now I took a ship into Somalia and that the plan was to deliver the cargo was for the will food program We're delivering rice and grain and bits and pieces for the Somali people We didn't have any weapons on our ship because depending on what registration the ship is what flag it's carrying depends on if you can have weapons or not on board every country's got its own rules around firearms no different than we have on land um So we were on a ship as the security team, but we didn't have any weapons So our job would be put the razor wire out put the fire hoses out Um and come up with like a crisis management plan. Anyway, we went to Somalia We supposed to be in and out in 24 hours. We ended up getting delayed, which is quite common in shipping And the the delay from a few hours went to a few days to a week And as you can imagine was sat there off Somalia the sort of lions then the pirate hot spot of the world off Mogadishu And pirates armed pirates boarded our ship So I was the security team leader at the time So I took all the crew about 20 20 odd crew mixed nationality and my security team So come down into the safe room in the citadel The drill is when you're in there you stay in there when you call for a rescue So we got in there. We locked ourselves in I went to use the satellite phone and we're in a black spot in the ocean a bit like on your mobile when you haven't got a signal if you like And so I always stuck with the problem because if you don't tell someone you're there nobody's coming to get you Um, we had pirates on board with rocket propelled grenades ak47s um And if you want to know what happens next you got to go back Wait, are you bastard? I'll find out when the cameras are gone So you're doing the 15 days 15 marathons. Yeah You're on your fourth day How did this become about as well? What was the plan for this? Yeah, literally it was it was like a week's notice. Um Training yeah, no, I didn't I haven't trained for it. Um, I thought obviously I go to the gym I'm training for my rowing project. So I'm doing loads of It must be fit then if you can do 15 and 15 days. Well, I ain't done them yet. I'm only on day Text me make sure you're alive Yeah, but it's not easy. Um, I'm not I'm not I'm an adventurer. I'm not an endurance runner I'm not an athlete, you know, I'm I'm still the guy who on a weekend goes and watches the footy in the pub and has a beer I'm I'm you know, I love a takeaway every other weekend or whatever. So, you know, I'm not I'm not super fit But I think, you know, like you a lot of it is resilience in the mind Um, you know, if you believe it that's off the battle probably more than off the battle if you can believe you can do it Um, but also breaking it down, you know, I'm not trying to break any world records I'm not trying to run, you know, sub three hour marathons for me. It's about doing 26.2 miles every day Um, yes today this morning when I did lock loman, I broke that down into four 10.5 runs, you know Started at 5 30 this morning and just did four runs and had a break in between each one Um, I still completed the 26.2 miles and I think If we approach that same mindset and mentality towards life, we can conquer most challenges and obstacles and problems And it's sometimes we've just got to look at the bigger picture and and just think of stepping stones instead of stumbling blocks Yeah, we're trying to get everything done straight away. Yeah, we really wrong wasn't built in a day I think if you plan for five years and 10 years, you'll soon realize that Your dreams and vision actually work. We just want it all now.  Trust me your goals and dreams will work 100% and I think also people need to have we mentioned it earlier about reflection when you've achieved something Even if it's doing the local 5k park run Stop and acknowledge what you've done. You'll just just take two minutes to look back and go I've done that this morning. Did it, you know brilliant great news I think we're so focused so quickly on that tunnel vision. What's next? What's next? What's next and we stop We often also forget what's important.  You know, even though I might be out here in my campervan driving round You know, I've got a missus who's looking out for me. I've got people sponsoring donating I've got people tweeting retweeting about the project You know, it's always a team effort like you said you same bolt the amount of people in his support team You know, yes, he's under the spotlight when it matters, but without them people you never get to that point in the first place Thanks stiff Yeah, definitely and for the plans for the future for this year, you've got your run. You've got your 15 days You've got your own. What's other plans for you? Yes, anything sorted. Yeah next year's plans We'll keep them sort of under wraps, but it's going to involve Going to the ends of the earth literally. So we're going to the north and south poles next year Which will be pretty special, but we're going to release all the details of that in in november So we've got an abseil of the angel falls will tires waterfall in december this year as well I'm taking six people who are scared of heights to go and abseil the will tires waterfall Which should be fun. Um, so yeah lots lots of good projects and always looking out for more You know, I always tell people if you've got something, uh, you know, it doesn't have to be my project It might be your project or somebody listening if you if you want us to get involved I'm in fact, I'm cycling helping some guys cycle paris to Paris to blackpool is tower to tower Eiffel tower to blackpool tower. They're doing that in june Some lads from blackpool. So we're trying to chip in with a few miles for them as well So, you know, if you're doing a cool project if it's interesting if it's for a good cause, you know Give us a shout because if you know, I'm always happy to join and get involved Because it helps me as much as it helps you Because it sounds if you crave the adrenaline as well that that but yeah, I think do you know what I think? I think when you when you Especially in Hostile environments conflict zones or not even that but being out your comfort zone. I find that That's when you feel most alive You know, your senses are heightened. I feel that you can smell things You can touch things you can hear things at an extreme level when you're out of your comfort zone But people never experienced in that because 99% of people will live in the comfort zone People believe they can't do things. They can't achieve things I'm trying to convince my mum to do a skydive, you know, she's she's So I'll be careful.  Everybody's yeah, yeah people limit themselves and that's where people go wrong in life There shouldn't be any limits. There should be limitless.  You're crazy. Your back's going to be sore.  You're going to do this.  So it's difficult. But again, it's Becomes a lonely journey as well doing things and I only speak to Steve And I'm constant. I'm on everything's changing for me. I need I'm constantly new ideas So it's difficult because I don't want to just stay.  I don't I don't I don't see it as a negative. I see it I see it as time for reflecting time for, you know Sort of analyzing where I am what I'm doing So I don't I don't find it lonely and I'm maybe I'm a bit sad because I'm I'm quite comfortable in my own You know, I've got I love nothing more sometimes than sitting at home in my own company on my being peaceful I'm and then going out into the public and doing what you need to do So I don't I don't really find it lonely at all to be honest. I find Maybe I'm a lonely person because I enjoy being on my own. Yeah, but that's good The same life if you can handle your own Your own mental state being alone then everything else that comes at your life then becomes a bonus Do you know what I mean? So sometimes we can be actually lonely in a crowd. Yeah. Yeah, no, absolutely Yeah, and I think we social media we see that, you know, you know People are portraying lives that they don't live and And often when you again when you scratch beneath the surface, it's it's a very different reality than what you've probably seen Definitely Jordan and for it people I know you've already said it but how can people get in contact with your charities are trying maybe Fund you or help you or any new ideas or your email addresses or social media where people can contact you Yeah, yeah, please. Yeah get in touch um at mr. Jordan Wiley on on twitter facebook youtube instagram Jordan Wiley.org the website and even if you're not supporting me Um, but if I can help you in any way if you want some advice you're thinking about doing something Just just reach out, you know, I'll always message you back Maybe not straight away sometimes if I'm busy, but I'll always try and help you if I can But you know chase your dreams believe in it. You can believe it you can achieve it. I love it Me and Jordan for coming on today, brother.  You're doing amazing work me and keep it up, brother I appreciate that. Cheers buddy. Thank you