And we are live. What's going on guys? Anthony dream John senior today founder. I'm sorry about that Founder of 21 studios co-founder of red men group and founder of the 21 convention today I'm broadcasting live out of Sioux Falls, South Dakota. So remote broadcast today and today's guests will be special guests to the show First time on it and that's Paul Elam founder of a voice for men and an ear for men two different entities actually operates He has been a men's rights leader and men's rights activists for several decades I believe a very long time. You've probably seen him in the red pill documentary that came out. I think it's 2016 That's pretty famous around the world. I was getting banned from movie theaters things like that who's featured in that pretty prominently Before we get into today's episode our sponsors today are the 21 convention as always Upcoming soon in Orlando, Florida October 1st of 4th There'll be a lot of great speakers there for men and fathers at the main event Including myself Elliot Hulls, Jesse Peterson, Richard Granon Greg Adams alfamola strategies and Steve relay and Terence pop you guys might know him Especially Steve who does a lot of shows with Paul Elam himself We also have an event for fathers where we are rebuilding the patriarchy because the feminists smash the old one So we got to build a new one and of course, we're gonna make women great again at the same time So it'll be very fun time. You can get tickets at the 21 convention org. That's dot or g dot com Without further ado and enough with the ads, please let me welcome to the show for the first time mr. Paul Elam How you doing Paul? I'm doing great. How are you? You're pretty good man. I'm a little little mini trip here to South Dakota Really enjoying the freedom and the sunshine on the outdoors and the compared to Florida. It's very cool up here It's like a summer or a Florida winter right now Absolutely, I love it up in that area. Yeah, it's my first time in the Midwest I never actually been up here before and I've been able to carry a firearm for the first time All kinds of fun shit. So I'm really really enjoying the outdoors being up here. Absolutely Yep, so how you doing man? How's your year been? It's been a hell of a year for everybody before we get into the questions I have but absolutely crazy Just not seen so much Insanity, I don't think in any other time in my life is what's going on now around a flu virus and politics Obviously just in chaos so it makes for interesting times. We ought to have plenty to talk about. Yeah, and you're in your Mid-late 50s now Okay, wow Yeah, I'm almost 32 now. I'm feeling it. I'm feeling it slightly But you see you've seen you've seen a lot of America that I haven't I'm as born in late 80s So for you to say that I've heard other men your age say that too and I believe it and that's alarming to say But mind you I watched you know on watched Watts burn and Detroit burn on TV in the late 60s I was alive when that was happening and it still wasn't as crazy as it is right now Wow Yeah, that has to be very reminiscent to what you're saying, but yeah the insanity of it It's been nuts. I don't even I barely remember the Rodney King riots Even that is not even in my memory and that was I think a lot smaller than two and I'll be so what we're saying, right? Yeah, super wild man So Yeah, yep, so some of the first questions I wanted to get into let me pull up my Website here So the first one I was actually a personal one because years ago I was watching your YouTube channel and I was you know as a fan ears and what you were doing to a big degree I was actually I remember first seeing you I think on the spearhead a long time ago the website website Oh, you're going way back now. Oh, yeah, I knew the founder a little bit I think Bill Price he interviewed me one time. Yeah, and I was much more pick-up artist focus at that point So I got a lot of heat from the men's rights guys, but yeah But actually a few of them came out to our convention. They really liked it and they were very skeptical They were like, you know, we'll check it out so But I saw you do a video and it was you so used to work with Christina off summers and he did a YouTube video Criticizing or I was very surprising to me and at first I didn't know what to make of it Because obviously both are very critical of feminism which I liked a lot, but I didn't understand it And I found an article here. It was from way back in 2016 Paulie Lema tax Christina off summers as crypto Miss Andrew Poverty seeking privileged seeking gender parasite Well, I was being dick diplomatic Yeah, he talked to me a little bit about what happened here and why she's like I think she's still some great criticism of feminism But I eventually came around I think to your opinion that there's something kind of off here So if you talked to me a little bit about that Well, sure. Yeah, I mean and mind you I've never changed my opinion. I think Christina off summers is a great voice Challenging the feminist narrative. I think she does a lot of good work. And you know, we're behind her We published her work on a voice for men but she also identifies as a second-wave feminist and that is a pretty accurate description of her she views Things in very distorted terms. There is a lot of female privilege That that comes through and in what she has to say and she pushes for men to be of service to her in ways that I don't think are fitting with What an informed man would want these days? Yeah, and she's very quick to challenge and shame She never tried to engage me about my differences of opinion with her she simply came out in a couple of different places and mischaracterized what I had to say about her And did not address any of the concerns I had for instance one of the things that I picked apart in one of her talks was that she Said she was still a feminist because poverty affects women more than men and That's a lot. Yeah, homelessness is huge for men and small for women, right? Absolutely and There's all sorts of nuances in that too when you look at how they calculate the poverty line for men and women Women who receive spousal support and child support that income is not counted Toward whether or not they're qualified for benefits for people who are below the poverty line So it just doesn't count it But on the other hand for men who are paying that child support and paying the spousal support That income doesn't count toward helping them get benefits either So, you know that the men's expenses is ignored the women's income is ignored They get the benefits. Meanwhile 75% of all homeless people that are sleeping on the street are men so She totally sold a bill of goods there and didn't want to address it and that was just the beginning Yeah, it sounds like typical Orwellian kind of double-think with a lot of that It is I wanted to bring this up to that. I saw a nice tweet from Janice And I wanted to actually let's talk about this for a second But she was this is a March 31st I think earlier this year and Janice tweeted Janice humango you do some shows with her on studio brulee I've always had a great respect for Christina off Summers research into the lies of feminism and the disadvantages created by feminists for boys in school But in this video, she laughs over her own willed ignorance about men's issues sad to see and Looks like Christina was laughing about McTow and men going their own way and stuff like that And she was I believe that that's the video. I think that she tweeted. She was also going after me personally In that for having criticized her Yeah, yeah, Janice is like the So talk to me about your experience with Janice professor Janice humango versus Christina off Summers Because I think a lot of people see similarities between them But at the end of the day, I think Janice is far more intellectually honest and focused Sincerely on men's issues and men's rights. He talked to me about your opinion of that and your experience with her Well, yeah I was to say that Janice is intellectually honest And I have found many times when Christina hot off Summers is not intellectually honest She's quite intellectually dishonest another difference between the two I think the similarity stop where you have both of them are anti-feminist and they both happen to be female Well and Christina off Summers is a feminist anti-feminist. So, you know, people can intellectually play with that all they want to She speaks out against feminism and so does Janice. On the other hand Janice understands concepts like Gynaucentrism Janice Understands that that's a very real thing that men contend with in their daily lives and that Gynaucentrism also pushes its way into our governance into legislation to all manner of Live for for men and women Christina off Summers doesn't know that exists that gynaucentrism exists, but she seems to thrive off of it By placing herself on a pedestal as a woman Yeah All right. Well, what put what put I wanted to switch now shift gears a little bit to some almost forgot before we get further Into the show some positives for men's rights I think that we've seen in recent years and I wanted to get you take on those So one of them that has popped it up on screen a second ago an accident There've been some changes to the Department of Education and the Trump administration for title nine Basically kind of minimizing the kangaroo courts to roll them back that the Obama administration got started years ago for Especially for college age men things like that So I want to know your thoughts on this and any other changes you've seen positive from the Trump administration Or any kind of positive commentary you have what you've seen his administration do Well, I think there's quite a bit that the big one is the one you've got up on the screen there the Challenging of the kangaroo courts the star chambers that have been formed on college campuses across a nation for the past 20 years This is something that was a product out of the Obama Biden administration with Joe Biden pulling the strings on a lot of that To get these star chambers in place and to remove rights of young men who have been Accused of sexual assault and as you may know, I mean we seem some cases so extreme That arrest warrants have been issued for women who were making false allegations because they filed false police reports And the police sought them to arrest them and yet the school said no, we're not dismissing the complaint That happened in the in the case of Caleb Warner and a couple of other case where young men were just Willy-nilly accused of sexual assault after obviously consensual sex The women were proved to be liars and the school said no, we're still expelling the men That's how rigged the system is and so the Trump administration. I think rightly Took a very cold calculated factual look at what was going on and they've responded with the headline that you're reading there on the screen I I think it's fantastic And I think a lot of that is because men's rights activists have been hammering on this subject for 10 years now Yeah, and I think we're finally seeing the results of this for so for the All the crowd that says MRAs never get anything done. Just take a look at the screen. Yeah Yeah, another one. I wanted to ask you about I'm not too familiar with a bit I was talking with dr. Warren Farrell about it about a month or two ago And that was the I think it was 2018 or 2019 in Kentucky. I think they got equal-shared parenting as a default And it's not perfect, but it's pretty close. So I wanted to ask you about that one for men's rights, too That's pretty big. Yeah, it's huge and it's happening in more places than Kentucky there is finally incrementally being some Advances made toward shared custody and Kentucky is one of the the prime places where it's actually already happened But these efforts are happening in other states, too Much to the chagrin of feminist activists who come out at every turn to try to stop shared parenting Even though, you know the official position of the national organization for women is that the only reason women get Custody in so many cases is because they are unfairly and misogynistically perceived to be Better child caregivers than men. Wow Yeah, and but when it comes to alright, but let's just split the duties between the men and the women Oh, they don't want anything with that because that robs women of the ability to extract Child support and other funds out of the men. They're divorcing So it's all a big hippocritical mess, but that's another area where men's advocates are actually making a headway legally Into these areas and it's finally starting to happen across the board So I give another score for our team on that Yeah, yeah, I'd say so I know it almost got passed in Florida not too long Or is making progress it got killed at the last minute But I think some of the guys I know working on it They're very passionate about it because like you say it's a big win for men and fathers And it's real and it's actionable and that affects families and men and children You know another thing that happened in Florida Unfortunately was Rick Scott when he was governor of Florida. They passed legislation ending lifetime alimony and Scott vetoed it Wow Our great conservative friend Rick Scott vetoed that pandering to the women's boat Yeah, it's kind of a scumbag. I'm much more of a dissentist fan myself. Yeah, me too. Believe me Not not a bad enough Scott at all Regarding the the Trump administration, I mean obviously this is massive for the country in a million ways 2016 when he won Are there any other ways that he has helped men that I haven't brought attention to and are there any things That you wish he had done during his first term for men that he has Well, there's things he's done. I wish he hadn't done There's also Things that he've done that have been unprecedented but are sort of hard to put your finger on he was the first sitting President who openly acknowledged that it was open season on young men in college campuses He actually said that but that it was a dangerous time to be a young man Of course, you would have never heard that from bathhouse Barry or or his buddy Or any other sitting president that was great one of the mistakes he made in the tax cuts though is that he ended the the income tax exemption or at least the write-off for alimony and child support that men hand-bid Guiney and That was I think a Definite move in the wrong direction Okay. Yeah, it was the 2018 tax cuts. Yeah, yeah But I mean the man's record is not perfect But when I see what we have to compare him to when it comes to the lives of men I'm going with Trump all the way. Yeah. Yeah. Yeah. Yeah. I'm pretty sure Hillary would have castrated all this given the opportunity so Yeah, if Hillary was president guys like you and I might be in jail by now Yeah Yeah So speaking of politics as it relates to men, so we've recently seen of course here we go You know Kamala here's it heals up Harris was picked as Joe Biden's VP But the more important thing I think with this, I mean, she's our own clusterfuck of problems and shenanigans but Basically, he had to pick a female VP a man was basically any man even in the Democrat The Looney Tunes and stuff he was excluded from even the potential of being considered based on the way he was born We're garellis of what his race was and what how he how he performed in the primaries And what he pulled all that crap was out the window because he had a penis and balls and a Y chromosome So talk to me about this and how the country has arrived at a point where an a major political party excluded And the supposed, you know gender equal utopia were trying to live in it was excluded specifically Inexplicitly we're even getting the position and then it was given to heels of Paris, you know Kamala Kamala blow or whatever they call her Well first of all though, I have to chastise you it's Kamala, you know, you're racist if you say Kamala I found that out That you could you could never say Kamala it's Kamala You're culturally insensitive if you mispronounce that Yeah, it's I think it's part and parcel to the times here Anthony If they would have had their way, I think it would have been a female nominee for president and Look at what this tells you the pickings among women Were so bad so awful that even this, you know newly woke Enlightened Democrat Party that was going to put women in positions of leadership Couldn't find a single one to break the three percent Support in the polls. They're awful candidates all of them Kamala Harris is hated across the board she dropped out of the race even before California numbers came in because I don't think she wanted the humiliation of losing her ass in California and So now she is the presumptive or nominee for vice president and She actually is a heart beat away from a presidency That may not last four years if the guy gets elected Joe is not doing well Apparently he looks sort of physically okay, but he's obviously entering the early stages of senility That's happening. And so they in effect have put their presidential nominee up there in Kamala Harris who? Couldn't again couldn't break three percent in popularity I hope that has the expected impact on the election, but I don't know if it will Yeah, there's so much going on with it right now the potential voter fraud election fraud male the mail-in ballots all garbage Question. Do you think if a female? Demo, there was plenty that were running right? There's Kamala. There's Pocahontas all these chicks are running You think if a female had won the Democratic nomination over Biden over all the others Do you think they would have also picked a VP female as well just to double up the female primacy of it? probably That would be my guess. I could see a scenario certainly where they would have chosen a man Trying to make some sort of appeal for the votes of male Democrats But I think it would have gone To be a woman only ticket Yeah, to contrast it looks like it would be good against the evil white man of the Pence and Trump Absolutely, and of course, you know Women nowadays the culture of women that we've raised Halfway maybe they don't even accomplish something they aspire to accomplish something and they immediately begin celebrating as though It's already been accomplished and I think it would have been in that spirit They would have picked a second woman for the ticket Just so they could dance around for the cameras and and say look at us Yeah, they make a big spectacle out of it Yeah, I look at us over the first dual double female, you know ticket. Oh, yes women rule boys Yep So I wanted to take this somewhere, but I'm having a brain fart with it right now. That's pretty important Yeah, it's part of getting older my 30s here. Oh, yeah, you're really pushing it dude Let's back up here for a second. So you've been a men's rights leader and Activists and all these things a writer and you know a podcast or many things What is your experience been with that? From start to start not to finish but from start to now. It's been a long time.  It's been the greatest thing in the world honestly when I started this The narrative that we embrace About men in this culture was absolutely Almost not heard of anywhere I mean there was a few obscure forums in places across the internet where guys were talking about these issues some and Every once in a while in the comment section of a mainstream Miss Sandrick hit piece Bashing men you would see one or two items of dissent In the comments now But since after I got started after Karen strong came on board with this stuff and some others down the road We've seen this narrative Reach the point that now they're challenging title nine.  I've seen in the past. I would say 12 years That much of a shift. It's been huge and it's been a pleasure to watch and It's been a pleasure to see feminists have to go on the defensive so much get back on the heels Because they were at the time that I started feminists were used to nothing.  It's been hard sometimes.  I Reveal in this this is the SPLC is a hate group They're a fraud group the all they do is con old people from you know Who were coming of age and starting their careers in the late 60s and who are now a senior population? There that's still their source of money. They're still Drumming up scare tactics to tell the people and now one of the scare tactics is the misogynists are coming for your children That sort of thing so they're raising money on it and I'm I mean I'm fine with that It didn't bother me in the leads that they did it and I would have expected it because they are liars and fraudsters There's no doubt about it. Yeah. Yeah, you know, you mentioned a minute ago, too You know women speaking up against feminism and this feminist bullshit One of the things I wanted to mention of course is make woman great again, which we talked about earlier this year I love that that is just that is a stroke of genius Yeah, I fell in love with it as soon as I saw it that this logo in a long time ago Although I did find later that's the fun Malani who had done a video the same title But it was more it's pretty strictly political. It wasn't designed to be kind of a cultural social shift But this reminds me to like, you know, you guys are seeing feminists or not not feminist But women speak up against feminism. I think in a more political realm So especially it relates to family law and things like that, but this is a whole like cultural thing even That's not too like I am, you know, much in favor of what you're talking about politically and legally But it's also cultural and social. It's anti thought culture. It's anti, you know hook up culture for women I think promiscuity is very bad for women. It can be bad for men maybe too But for women, I think it's pretty pretty horrible very fast And this is pushing against all that I think it's the first time ever and this is why the feminists are freaking out all year The beginning of the year like we reached like a hundred millions because it's the first time I think that women now have something to grab on to and it's it's pretty positive It's like, yeah, women were better before and now they kind of suck and we need to change that You know, we were talking earlier about the differences between Christina Huff Summers and Janus via Mingo I can put that in a nutshell with this I know Janus via Mingo reacted to that hat in a very positive way He thought it was great because she recognizes by the way that women do suck In modern times for the most part they're defective And they've outlived their usefulness in many ways and it's a very sad thing. That's very sad for women and very sad for men Christina Huff Summers, of course would hate that hat Well, you're right. I think you're right.   They suffer depression alcoholism drug addiction All these social maladies Impact men much more than they do women yet men are happier than women go figure women are suffering and Disrable because they've been infantilized for the past 50 years and when you infantilize somebody they're never going to be happy And feminism is the primary driver that in your opinion, yeah I think feminism is the primary driver of that But I also think that we have a big strong streak in the conservative community that still deifies women and And is quick to kiss but Because the next one I wanted to pull up article It's from actually a marriage and family therapist I believe Suzanne Venker and it's pretty great article and she was criticizing Tommy Lauren who's a conservative I think a fake conservative kind of fake mug. I thought I Think she's 28 years old now, so she's pushing 30 and as you probably know She went on a 30-minute rant the other day on Instagram. Oh, yeah, something and actually the title But it's Tommy Lauren's anti men's creed demonstrates why dating is dead. This is written by a woman. Yes, I liked her She's another one of the the precious few that are are very very worthy of attention Yeah, but talk to me about what you your thoughts on Tommy Lauren and the state Like she's saying or the state of modern dating and why it's why it's dying I mean Tommy Lauren is a I think she's fairly attractive. She's not ugly. Obviously. I think I think people saying she's gorgeous It's pretty over. It's just makeup. Oh, yeah, she is fairly attractive in a sort of Fox news rubber stamp a News at female news anchor kind of way They they all look kind of alike to me use a term She's perfect for the Fox news cameras and what have you on the other hand She is 28 and by God in the entertainment industry where Tommy Laren is 28 is the wall 28 is when you're you're used by date is starting to collect some dust And I don't think it's any coincidence that she's hit that age in life And that what she came out with in this ridiculous screed against men Seemed more like a petulant 14 year old who was angry because a boyfriend didn't act the way she wanted him to Yeah, and that seemed to just ooze out of her commentary for the whole time. It was a 14-minute and 58 second Taylor Swift song And that's it I think she shot herself in the foot with this and I think that the fact that she shot herself in the foot with This is definitely a sign of the changing times of what you're talking about this pushing this cultural narrative in a different direction Five years ago Everybody would have been bowing at her feet. Yep for doing this and and saying you go girl You really tell those men they need to man up and grow up and be more like what you want Because that is the world that Tommy Laren grew up in that was the narrative of her life And I think she just got a very rude awakening That That isn't the world anymore and baby you ain't all of that I'm gonna offer a ticket a press ticket press pass to the make woman great again convention She needs it and she probably will hate it and reject it.   It's true internally. She's very She's decent looking on the outside and inside just pretty ugly And you know with a change in personality, she would be a lot more attractive than she is I think that's one of the things that a lot of people don't recognize about men is that okay Yeah, we are geared for physical attraction.  She loses her attractiveness She will actually when I watched Tommy Lahren do that rant against men She was less attractive at the end of it than she was at the beginning The way fairers on the head didn't help her in the end she still looked like a conceded Entitled princess that was basically having a temper tantrum because she didn't get her way Yeah, she's a brat and so you would say that we need to make Tommy Lahren great again. Yes Absolutely, and she could be a great asset. I mean she's not You know ready for prime time in many ways politically as much as some of her peers I've saw her when she was doing purely political commentary. She's a little rough. She could use some polish Be a little bit smoother, but she had potential and she still could do a good job But she's gonna have to get knock the chip off of her shoulder and the halo off of her head that she imagines is there That's not yeah Let's shift gears a little bit Our good friend Steve Berlay at Studio Berlay He did some videos recently on getting to know BLM black lives matter specifically the organization The formal one that think has the website versus the larger kind of Disorganized movement around it which are interrelated obviously He did some great videos on that everyone watching should go check those out on this channel ASAP There's some of the best I've seen by far But I would did want to get your opinion Paul your personal opinion What do men and fathers need to know regardless of their ethnicity or race about the LM? What have they not maybe it's seen the mainstream news even in Fox News for example and Breitbart and stuff like that What do they need to know? Well, I think as far as black men and fathers are concerned especially black fathers what you need to know about BLM Is that you don't exist? It's written right into their charter that you do not exist. They mentioned mothers. They mentioned parents They mentioned children and they mentioned families not a mention anywhere of fathers They have been intentionally omitted from the conversation in view of the Marxist Model of families which is to strip masculine leadership out of the home Give women the illusion of power in the home and some real power And basically tear down the family unit with that as a vehicle That's been the Marxist approach since the 1930s when they were calling Soviet women to come out of the Oppression of the kitchen and enter the factories alongside the working class And it didn't work out Yeah, we say the old Soviet Union for a reason because it didn't work out And and this won't work out what we see happening in Almost all the maladies affecting black families and the black culture in America Almost all of it is rooted back to stripping men out of the home Yeah Every last bit of it and removing their authority from the home And we've gotten to the point now where even the idea of two men sitting here talking about the importance of male authority in a home is Tremendously taboo and to be avoided at all costs yet. It's exactly the antidote to what's happening What we're seeing with black lives matter what we see with with antifa and all these other radical fringe groups This is all a fatherless generation. This is what fatherlessness breeds and We should be paying attention to this and doing something about it. Yeah agree hundred percent As soon as the the riots popped off in Minneapolis. I immediately kind of called it the fatherless rebellion We've made an episode of the show called the father's rebellion with a larger panel and yeah, I agree whether it's in teeth or BLM It's all just these fatherless emasculated boys Regardless of how they're acting out and how they look and where they're from It's all the same crap and none of them have strong present fathers or any fathers at all Whether that's because the guy left her because the mother chased him away or the courts chased him away Or you know, whatever happened with with all that stuff. Yeah, it's a huge I don't I don't think you could find a single antifa member a Male member who had a sort or a female member for that matter who had a strong relationship with their father I don't think those sort if they do exist their anomalies They're they're just the exception to the rule what we see is a bunch of fatherless kids acting out They're angry.  Oh, this is good You didn't need him anyway And so they grow up into angry adults and you give them a chance to express that anger even though They're not aware consciously of what it's all about Then you see when you see these rocks being thrown Fire bombs cities burning in flames. What I'm looking at is a bunch of kids Acting out the anger from the absent fathers in their lives Yeah, yeah, it's this madness man. I did want to mention so I did want to bring up You mentioned the BLM being anti-father and emitting fathers from the conversation explicitly in writing And a very Orwellian kind of way because like you said they mentioned mothers and parents and then basically the male version of a parent Is just conveniently omitted We couldn't do that. I'm you couldn't do that on accident. I mean it's on purpose. Oh Absolutely, well the women these are lesbian feminists that founded BLM. I mean make no mistake about it And they're Marxist they have told the world that they are proud acclaimed Marxist and that's their you know They've examined all different political philosophies and that's the one they settled on and then you get them out on the streets I think it was just yesterday telling Anybody who cared to listen that the looting and the destruction was reparations Wow Yeah, and this was a BLM leader on television saying I don't care if they loot I don't care if they destroy property if they're taking something It's going to help them eat and they're owed it anyway You see children raised with fathers one of the things fathers do is they instill discipline in children and a sense of empathy Without the father You have unempathetic children and we have a crisis in lacking empathy You have to totally lack empathy to be able to rationalize that hey If I break your storefront window and steal your life's work In the form of all the merchandise in your store, and I wreck your business I don't have to feel anything for you. I can just say this is Reparations what's because burning and looting is mostly peaceful. Didn't you hear Paul? Oh, yes It's very peaceful looting and burning They certainly didn't mean any harm by that But yes, and now their leadership is out there saying this is morally just Yeah, I even this way You don't get people who had intact families with fathers in the home That grow up to become adults that say burning down your business and stealing all your property is morally just That doesn't happen Molotov's for peace man. Yeah, it's absolutely right And I'm fear more of this is coming Yeah, yeah, I think uh, I think trump's gonna gonna win even in For a number of reasons even considering all the fraud and the potential problems and the the democrat garbage and the manipulations and shit And I think what's gonna happen then is november 4th or some day in november or december There's gonna be a huge wave a second wave Of peaceful burning and looting Oh, yes, I think no matter who wins and I agree with you I think trump will probably win Uh, I I I think that they're the democrats are killing themselves in swing states right now with the policies that are You know ending fracking and and supporting antifa and blm. I don't think all this is going to play well with Undecided voters in swing states and I think that'll probably get trump the election But I think regardless of who's elected We're gonna see an explosion of violence right after the election In the street I've been gearing up man Even Florida's been pretty good with a lot of this with the exception of like major cities like miami and tampa Orlando's had almost nothing and that's like one of the biggest cities in florida So I think I'll be fine, but even so i'm not taking my chances and me and a lot of guys I know have been really preparing for something like that Absolutely And you should be We moved I mean Nearly four years ago now We moved out of houston Uh to southwest virginia best best decision I could have ever made in my life when we came here To visit before we bought a home 2016 election was uh, It was leading up to the 2016 election and it was wall to wall trump signs around here And we said here's the spot Nice I did want to ask you before move off blm so they they specifically attack I think the western patriarchy they call it or western patriarchal institutions blah blah blah And even today I I've even seen in florida. There's a state rep She's like the florida miniature aoc we call her Uh, I forget her name.   If not 100 years now But what do you think and what should men when men here have smashed the patriarchy even today? What does that really mean? Is it it's there? I mean, especially since there is Oh, it means attack and disempower men. That's all it means. It's there is you're right. There is no Patriarchy, I mean there was a patriarchy at one time but just in the sense that You know property was handed down from fathers to sons and names were kept in in in men and to that extent Yeah, there was a a patriarchy, but it it didn't mean much more than that Um, there there was if there was a real patriarchy By the feminist definition, which is a system that oppresses and abuses women And for the betterment and for the benefit of men Uh, there would have never been feminine feminism It would have never been allowed to emerge if the if the society was structured the way feminists claimed it would Uh, these bitches would be in jail Uh or something like that. Of course, it's it's nonsense. It never existed It never has not in the way that they've defined it and all they have is this poor substitute, which means Find anywhere men have freedom or empowerment in their lives and seek to destroy it Yep The the the family is just one area look at the ways that women have encroached into to men's sphere with banning all male, you know country clubs Ending that ending any form of male space they can find while creating an expanding female space, which is exactly What has happened? That's what's going on and nothing else their idea of smashing the patriarchy is just a power grab That's all it's kind of a euphemism then you would say for smash men smash fathers smash family male power completely Absolutely. Good way to put it. That is exactly what it is euphemism for destroying men Yeah, yeah reminds me of the old, uh, I think george carlin comedians talk about euphemisms a lot and just It's a term I heard when I was very young and I was like this is like a huge euphemism for just smashing Very positive things like the nuclear family and fatherhood and all these things Yeah, that's what here's a little bit back to politics one more time. I did remember what I wanted to ask you So this you know, this is a some website of the conversation whatever there's talking about, you know, kamala and the vp pic and all that Um, but the image here is very striking that it has all these potential vp candidates It's all women all trying to vie and of course kamala ended up getting it for the vp position for the democratic party Would you say the democratic party a major political party in america? Is fundamentally anti man at this point Absolutely. Are you kidding me?  I think it's it's it's just hugely ironic and in a very hysterical way That the anti man pro woman party still had to get an old white guy to leave the ticket Almost like their behavior is so ingrained They couldn't even come up with a female candidate. They they did in 16 and of course that ended very badly for them because Because their attitude was any woman You know, just one imaginable Absolutely picked the worst candidate you could possibly come up with one of the Just Disgraceful dishonest horrible human being That hillary clinton is and of course she lost Yep Yeah Yes, it was I was the the the liberal tears after that election were very entertaining and i'm Hoping and anticipating that the 2020 election will come out the same way because I think they're going to be even more enraged Yeah But Yeah, it's uh, it's crazy the they Are the female party?  This time around to put out there.  I think uh, the tulsi gabber chick was slightly less offensive than the other ones But they but she hated you know, they hated her and she hated them because she was not going with the narrative She was kind of you know being more combative And tulsi gabbered was the only one in the field that really did exude some competence some Some good bearing about her Again, I don't agree with a lot of her politics But the way she's conducted herself the way she challenged Uncomfortable truths in the democratic party the way she just comported herself Did speak of leadership and she has military background and and all this She could have done something the democrats didn't want a real female leader Yeah Yeah, I didn't get the feeling either that she hated america with the other ones I just feel like I was like yeah this person just hates america male or female with her. I didn't get that vibe What the democrats want is a winer in chief And tulsi gabber wasn't going to fit that bill so they got rid of her And the women that could couldn't measure up the the population didn't want them And it's going to force the democrats to contend with one very basic fact that they may not like very much People men and women both want male leaders Yeah Yeah, I know that I've thought about a lot for the for any presidential candidate that the end of the day They're very different from any other elected official Because they're an executive civilian command of an entire military the most powerful military in the world and men don't follow women Not well, and we don't we It's very unnatural like when in history have men done that there's no behavior pattern In 300 000 years of human history where men are really following women like that You have queens along the way and some things but it's it's unusual and the queens are violent. They go crazy and they Yes, they start wars and And do all kinds of crazy things And you say that men don't follow women and there's a reason for that because women don't know how to lead A lot of them. I would say most of them. They really don't know how to leave you hear this complaint from feminist all the time saying Well, when a man is strong And in charge he's considered a good leader when a woman is strong and in charge She's considered a bitch and they complain about this double standard in perception.  It's not the same thing It's a when you're leading you take a very different posture than just barking out orders and telling people what to do You know people don't want somebody like martha stewart running the free world. They just don't And until women if women want women leaders They better start waking up to this that they're not going to be leading anybody women don't want to work for women And women don't want to follow women and there's reasons for that and it's uncomfortable to talk about those reasons But not talking about them doesn't mean they doesn't they don't exist Those reasons are there and if you if you don't like it ladies Look, I get it. You want your shot at running something. That's fine Prove you can run something prove you can be a leader. Don't just stand up and say because i'm a woman That's not going to cut it.   So what are your thoughts on I view as a I don't I don't think it's uh super important, but I think it's interesting to look at and it could be important There seems to be kind of a little miniature civil work occurring in feminism And I think Karen is kind of part of that. They seem to be ostracizing the white Feminists out of the feminist movement and jk rallying speaking out against uh trans stuff And in defense of women and in her view Uh, I think is maybe a part of that. So do you have any thoughts on Any kind of feminist civil war they have internally going on between the white feminists and the black female royal cons stuff like that Oh, I think it's emerging certainly I don't know if the Karen phenomena is a part of that it may be but I do know that Feminist of color God, I hate that term, but I'm I'm going to say it just for reference.  Sure And I again, I think it's eventually what it's what happens with all Marxism eventually you eat your own Uh, that's that's what's going to happen. And I'm fine with uh enjoying the show I mean, that's that's a reason to make popcorn You guys go after uh, you know men love cat fights So, uh, I'm like, come on. Let's bring it on But let's get a Texas death match going and put them in the ring Uh, I'm all for it. It's very entertaining to watch the feminists beat each other up and stuff. Yeah, it's good I mean, it's a very nasty movement. It's very disgusting and I think it's very evil and wrong and it needs to end And yeah, if it helps it along that's some for it, you know so Uh shifting gears a little bit. I had a more uh, kind of practical question for you What would you say to and I'm sure you have some thoughts on this What would you say to young men today? Say millennials and even older, uh, you know gen Z men What would you say to the young men who want to build families today in america and in canda in the west? I would say first thing you need to do is get a mentor And and by that I I don't mean somebody to tell you how to live or To treat teach you a trade But to find somebody A man a few years older than you at least who has an investment in your life To have a connection with I mean it's just that simple um one of the Things that feminism has destroyed in this culture and that that men allowed to be destroyed Was the whole art of mentoring of older men teaching younger men How to take care of themselves how to succeed in the world that sort of thing That's been a lost art And for any young man approaching all the decisions you're going to have to make about like marriage and dating and career And and everything else that goes into it Your when you're talking to millennials gen z gen y You're generally talking to young men who are part of a fatherless generation And this is why the the mentoring is is so important And it doesn't even matter if they actually were some of the few that had their fathers and families intact Their culture their peers all are part of a fatherless generation And they're disconnected and they're angry and I get it, you know It was on men of my generation and my father's generation to stop this bullshit from happening and we didn't um And so I totally get it when a young man looks at a guy of my age and says I don't have a you know, Is it like okay boomer? I don't have a a thing. I want to listen to from this guy Can't blame them, you know, they've been disappointed along every step of the way but If they can get past that they're going to get a lot of benefit out of some sort of connection with an older man Who's been through some of the ropes?  They need to fix the system first They need to make it so that you're not, you know, if I said anthony tell you what let's go in this casino bring all your money And you've got a 50 50 chance of walking out of here dead broke You wouldn't do it That's exactly what marriage is You know, I have a interesting so my next question was going to be on actually you've hit the nail in the head It was your general thoughts on mig tile the movement in the community Which is in my opinion operating parallel Uh within the manisphere as another kind of tribe two men's rights to the pickup artist and even to the right pill community It's the four tribes Yeah Well, and to me I would also like to call it four reactions the men's movement If we want to talk about a movement Happens in different ways Men are reacting To feminism the effects of feminism and the effects of gynocentrism on their lives and own this society Some men react to it by Going the pua route and being a lot more calculated about their their interactions with women Some men Shwear off women Some men try to work to make things better for men in the legal sense We're all In one way or another reacting To the reality on the ground between men and women And that's basically risk and threat assessment to feminism is what you're saying. Absolutely Absolutely, right and some guys choose different ways to express that now when it comes to mig tile individually It's it's wisdom I really do see it as wisdom. I mean, uh, of course it depends on the degree And I I've had a lot of disagreements with some guys in the mig town community One because if you're ideological Shit, I don't I don't even want to hear it Ideology is part of the problem. I don't go for Mininism or or anything like that Um, if you're either they're kind of married to the ideas and they're not they're no longer active minded to talk and then debate Exactly when a guy says The only way to survive is to swear women off entirely That's where his mind is and he's full of shit In my book I'm in a relationship for 18 years and I'm sitting here happy and healthy I know many others that have done the same thing Your claim that there's no such thing as a successful relationship long term is wrong It's absolutely an error Yet there are guys out there who Swear adamantly that no man can ever survive the gauntlet of relationships And that they already it's factually incorrect. There's the minority of relationships that do work Absolutely, and there's but I think you have to be realistic enough To recognize that you are not in the majority if you have a long term Working relationship and that there are characteristics that men must have or should have Going into it like boundaries And their own values that they're going to live by and they're not going to sacrifice for a piece of ass I think a lot of the guys that are what I call Ideological mig towel are guys that never found out How to keep themselves intact? They're powerless with women Which is to say they're very gynocentric And so for them the only way they can survive is to shut off women entirely Yeah, and I have a personal I have a personal anecdote. Yeah, I think you'll find pretty interesting that you were partly influential to So there's a story on youtube a speech I gave called marrying medusa how to survive a female psychopath Is a speech I gave back in 2016 actually in uh, june at one of my conventions for young men actually We have a young men's version too. We don't do it that often but sometimes And it was my two hour speech on my experience of accidentally or not accidentally but unknowingly marrying a bpd hooker Uh crazy chick super bpd come over to I think with other you could say other disorders probably That's us armchair psychoanalyzing of course. I'm not a professional But she was she was a hidden prostitute an escort for a long time All kinds of shenanigans people can look it up on youtube But even though we were In a sense married for two years and had dated for two and a half years prior to that I did not get legally married Specifically because of the horror stories I heard in the pickup artist community which are very similar to men's rights guys would come into the pickup community Because they went through a nasty divorce.  I was interviewed by the founder I was reading some of your work and the men's rights, uh, you know websites and things And then on top of that I was a very big fan of ron paul congressman ron paul And his son ram paul who were the only senators and public politicians I knew that were Philosophically opposed to the government getting involved in marriage.    That to me is the only role So at 24 years old I concocted this idea of a private marriage in my own style And I looked up the laws of kamala marriage and things like that To avoid it because I wouldn't get roped into that either and we had a wedding families came out We had a honeymoon in hawaii.   It doesn't matter if she's the best woman in the world There's no purpose to her having this marriage license in me It doesn't do anything to bring the government into my life in my home Anything positive anyway. It's just stupid So I think that's a pretty good option for young men today in america if they Can do it in the state they live common law marriage is a big problem in some states, but not too many So yeah, I think a continuation of what I said would have said when with your question What would you tell young men?  And so it's much easier to stay unmarried. I've made it a point 18 years in the same relationship. I'm not getting married It's just not going to happen.  The problem is legally sanctioned marriage Why are you allowing the state to license your relationship?  What benefit does it bring? The only thing I should do is enforce a contract if you have one written and that's it and signed absolutely if you have Considered a contract if you have one written the state does have a valid purpose in there To regulate contracts But the fact of the matter is you're crazy to want the state Involved in your life in that way anyway because guess what guys The woman in most every case is temporary We don't have to we don't have to like it We we but it you have to accept That the numbers say that there's no such thing or there's very rarely You grow old and you both die within a few days of each other at 95 That doesn't happen for the most part. The woman will go away But the state will be there forever Because you're not really marrying a woman. You're marrying the state You're inviting the state to go in and regulate that part of your life And just when you think about it, it makes no sense. I wasn't worried about gay marriage Destroying the sanctity of the man-woman relationship They started destroying the sanctity of the man and woman relationship the moment they allowed the government to To intervene and regulate Those relationships and then things like no fault divorce just just put pelt salt on a wound It's got worse and worse and worse Absolutely. Thank you, ronald reagan for that actually Again, we could you know, I definitely lean conservative in many ways but The conservatives are are not any Any more of a friend to men Than liberals are and it's important to know that We've got the exception of donald Yeah, he's a fun one did so we have a question here from super chat ray patson. Thank you for the looks like australian five dollars I appreciate that I like migtab but practically as i'm getting older i'm feeling more loneliness I want to ask paul about what having woman partner as for company tips absolutely Don't ignore your feelings. Um, the fact of the matter is The human beings are not wired to fly solo and I know there's going to be a guy in the audience as I am Okay, I'm not questioning you dude I'm sure that you're just fine living in a cave without another human being around you for the rest of your life I'm sure you're great that way But guess what 99.9 of the human race is not wired that way We are wired to cohabitate We are wired to pair bond as A species it's there's no getting away from that and for most men You will have something missing in your lives if you're single in perpetuity Again, there's going to be exceptions to that i'm sure But the fact of the matter is You want that your that loneliness is telling you there's an incomplete part of your life The challenge is in who you connect to and how what boundaries you bring into that What values you bring into that because if your value is i'll just take any woman as long as she'll have me That's how guys end up under rocks and how they end up going migtail Because they go into the relationship with my standard is will she sleep with me and let's face it guys That's the standard for a lot of men Am i attracted to her and if i am if i'm attracted to her and she's attracted to me the screening ends right there I think you just subscribe tommy lauren's entire instagram following All these thirsty thirsty beta males. Yeah Yes, anything to for even for the illusion why you see so many white knights on the the internet They come in to rescue the maiden because it makes them feel this much closer to her Uh, that's what they want. Well, guess what you don't have to do it that way You can have standards Uh, I told my partner at the very beginning of our relationship that if I had 10 million dollars in the bank I wouldn't finance a relationship That if she wanted to be with me she would have to bring her purse I went through about 20 women Before that and as soon as they heard that line, they were like, thank you.  Of course I did I have a job. I don't want you to carry all the weight We'll share this that bingo 18 years later. I'm still with her because I wouldn't tolerate anything less than that Yeah Final kind of closing out here. Um, so you mentioned boundaries and things like that and I think you're kind of hinting at toxic relationships that men get into And I think you've done some videos on the subject. But do you have any thoughts on Uh, specific let's say this you have any thoughts on the relationship between bpd chicks cluster b women with personality disorders and feminism like as feminism as a cultural force enabled toxic behaviors and Malicious behavior even in a sense. So the relationship between cluster b disorders and women and feminism Well, yeah, and to really expand on that a little bit more There's a correlation between The indices of cluster b and personality disorders and just being female in in modern culture Borderline traits in women are common place you the entitlement the histrionics the uh willingness to engage in Exaggerated drama in order to get their way The use of false allegations in order to get their way or to punish or to Make excuses for their own behavior. This happens all the time But to more directly answer your question. Yes You you can put the characteristics of feminist and their behavior on a page And set that next to the diagnostic and statistical manual of mental disorders definition of borderline or or narcissistic personality or histrionic personality and you're going to see i'm line up Write straight down the column Feminism is a mental disorder And it is in there with the personality disorders. There's no doubt in my mind Uh that it is the codified Personality disorder. That's what feminism is Yeah, it's well put feminism is a mental disorder It's like it's like the it's like the personality disorder of an entire couple generations of women now And it's it's unique. It's unique to the west, you know, it's most it's a lot less prevalent I think in eastern europe the parts of south america And i've been i spent a month in poland last year for our convention We held there in warsaw and then i went to the other city there. They're uh, basically the cultural capital They call it krakow krakow in the south and feminism there is so much less prevalent. It's beautiful Uh, the women there make fun of feminism. They saw my hat and they would ask me like are you a feminist? You know, is it getting accusatory kind of stance?  They're poland check republic Hungary all these areas that know marxism very well that know where marxism goes They tend to be non-feminist And it's because feminism is a is an offshoot of marxism There's not really any distinction between the two and they still have a cultural memory there in central europe For what happens, which is, you know, dead people and things like that Ultimately, that's what happens with marxism Yeah, gulags firing squads gas chambers famine starvation tyranny totalitarianism Just mass. Yeah misery.  It's amazing that communism is still as popular as it is. It's worse than nazism Yes, it is Here's a comment from a viewer paul should be in charge of the new feminist studies that they teach in every university I'm in favor of that Well, that wouldn't last very long because paul would dismantle all the feminist studies in every university We shouldn't be funding.  Yeah, thank you again for the super thread here from sydney mc sydney mctown paul's video daddy's little nightmare details a significant part of the problem we have now Is that on your channel? I haven't seen that. Uh, yes, that is on my channel and uh, also It is on the regarding men website where i'm working now with uh, janice friemmingo and tom golden But it is about the roles that fathers play in breeding entitlement Into their into daddy's little girl and this is it, you know feminism is a big problem Uh, it's huge and I don't want to distract from that for a minute But we also need to take a look at you take the average married man and I mean very average Who is pulling his own hair out?  She's never happy with him. She always wants him to make more money She always wants him to do more for her.   Yeah And the end of the cycle of insanity, you know, it's interesting too the princess thing you're mentioning here I mean, I've seen that I know exactly you're referring to but now I'm not sure if you're aware of this probably But millennial women in particular I see an older gen z they had this queen thing now Uh, they're queen hashtag queen this queen that on instagram They even even when the the pandemic the pandemic hit earlier this year They started saying, uh, I'm a quarantine queen quarantine queen. Everything's queen queen queen queen queen And really that's it's a very to me. It's a very obvious, uh, just older version of a princess Sure, and in the 80s they had had the for about 10 years there. They had the big goddess binge Uh, it was everything that was women who were goddesses and there were goddess groups and and and books written about your inner goddess um Yeah, you know that and other fairy tales Your inner demon Unicorn grows a second horn absolutely Well, paul, this has been a very pleasant conversation. I'm really happy you came on the show very much appreciate your time I've enjoyed it very much. I hope your audience enjoyed it. Uh, look forward to doing it again sometime Yeah, for sure And like I mentioned, we'd love to have you at the 21 convention in the future I know you can't make it this year, but we do it every year now 14 years in a row And that's always going to be open for you. Let's try it next year. I'll see if I can make it. I would love to do it Yeah, 21 convention in 2021 sounds good Everyone make sure you do Let me get just a one little pitch in here come visit us on regarding men.com We have set up now We're doing discussion groups seven days a week 90 minute groups For any man that wants to join us talking about the issues that anthony and I have just talked about other issues Marriage divorce family parental alienation False accusations all those things and this is going on live right now seven days a week So I want to invite everybody to join us if they want to Sounds good guys make sure you check it out regarding men.com. Sorry my hotel internet here is a little slow You can also learn more paul. Yeah, you can learn more from paul at paul elam.com He's also on youtube if you just type paul elam. I think you'll pull up his channel right away And the actual the title is an ear for men as the current title Last but not least make sure you check out the 21 convention.org get your tickets now Early bird sales still going on we are 47 days out from 21 summit super triple conference event We got one event for men one for fathers the one for women Whatever your whatever your demographic is we got you covered. We'll make you great again That's it paul. Thank you again for your time. I'm going to end the broadcast And everyone else will see you next week on the show Take care. Bye. Bye


Hi friends, so today we will talk about localization of parathyroid lesions, anatomical considerations and imaging techniques. So mainly we are going to talk about 4D CT or four-dimensional CT scan for parathyroid adenoma detection. So what is 4D CT? It sounds fancy, but it's only multi-phase CT scan dedicated for the diagnosis and localization of a parathyroid adenoma. When a radiologist is presented with a study for parathyroid adenoma localization, it is generally in a patient who is biochemically diagnosed with hyperparathyroidism. So the question is usually not that the patient, like whether the patient has hyperparathyroidism but it's usually where is the pathology or where is the parathyroid adenoma. And 4D CT has a lot of advantages, which is anatomical localization and detection of multi-glandular disease, also detection of other relevant pathology in the neck. So what the surgeon wants to know from a radiologist is the number, size and specific location of parathyroid lesions with respect to relevant surgical landmarks and the radiologist's opinion and confidence about these particular lesions. The other relevant information that the surgeon is looking for is ectopic or supernumeric parathyroid tissue, concurrent thyroid pathology and arterial as well as recurrent laryngeal nerve anomalies like anatomical variations in these structures. So let us go over the parathyroid glands. They include two superior and two inferior glands and there are less commonly there can be some anatomical variations in their location and knowledge of embryology will help us aid in detection of additional lesions and also anatomical localization since not uncommonly there are numerous parathyroid adenomas or hyperplasia in a person with hyperparathyroidism. The superior parathyroid glands are derived from the fourth pharyngeal pouch and the inferior parathyroid glands are derived from the third pharyngeal pouch and the migration pathways explain the variable positions of the gland. Another phenomenon is called acquired ectopia. So what that means is the relative superior or inferior position of parathyroid gland does not denote its embryological origin. So sometimes an enlarged superior parathyroid gland will descend into the superior mediasnum. So this phenomenon is called acquired ectopia and this is not very accurate in saying whether this is the superior or inferior parathyroid gland. What helps us more is the tractorisophageal groove. So if you see in the image on the right this enlarged superior parathyroid gland has migrated inferiorly but it is still posterior to the tractorisophageal groove and hence it is the superior parathyroid gland. So generally the superior glands are dorsal to the tractorisophageal groove and the inferior parathyroid glands are positioned anteriorly. One more thing I want to add is why do we use the tractorisophageal groove as an anatomical landmark because it closely mimics the plane of the ritter and laryngeal nerve which we usually cannot see. So tractorisophageal groove is the proxy for the RLN. So these four images and four different patients are examples of ectopic parathyroid tissue. Top left image demonstrates retrofaryngeal parathyroid gland and top right demonstrates an intra-thyroidal parathyroid adenoma. The bottom left demonstrates a mediasthenal adenoma and bottom right demonstrates adenoma within the carotid shape near the angle of mandible. Working in parathyroid adenoma is very helpful to the surgeons and radiologists need a certain level of expertise to reliably detect and localize parathyroid adenomas. So it is imperative that we take our time and effort to get better as there is a little bit of a learning curve here and it is also doubly important in recent like prior surgical candidates like patients who have already had surgery before. So what are the two types of surgeries there is minimally invasive parathyroidectomy that is MIP and the other one is bilateral neck exploration for people with multi glandular disease or in patients on home adenomas or hyperplasia was not diagnosed on imaging. So the surgeon has to do a BNE or bilateral neck exploration and try to search for the pathological gland imaging in that localization and not diagnosis because it is generally biochemically diagnosed and various techniques just aid and support the diagnosis like ultrasound nuclear imaging and four dimensional CT and what helps a radiologist is detailed knowledge of embryology and anatomy for accurate interpretation. Most of us may have performed ultrasound for detection of parathyroid adenoma during our training and it's as you know it's fairly simple straight forward parathyroid adenomas appear hypoechoic on ultrasound and thyroid is relatively hyperechoic but ultrasound also has other advantages it will help diagnose concurrent thyroid pathologies and the need for finatal aspiration cytology which it can aid and assist. So this is a diagrammatic representation of the locations of superior parathyroid glands and inferior parathyroid gland. So the superior parathyroid glands are usually within the red outline over here and the inferior within the blue outline. So as you see on the frontal projection they seem to overlap but on the lateral projection it is clear that the superior parathyroid lies posterior to the recurrent laryngeal nerve or the tracheoesophageal groove which we use as a proxy on CAT scan and the inferior parathyroid gland lies anterior to it and hence that helps us determine if it is the superior or inferior parathyroid gland. So the goal of HODCT for parathyroid adenoma detection is accurate localization and creating a roadmap for surgical planning and using the appropriate surgical landmarks. So as radiologists we tend to use cervical vertebral levels as anatomic landmarks which are not helpful to the surgeon. The surgical landmarks that are helpful to the surgeon include the cricoid cartilage, the tracheoesophageal groove which is a proxy to the recurrent laryngeal nerve. Some other surgical landmarks include the thyroid gland like the upper pole, lower pole and isthmus and the suprasternal notch and we should refrain from using cervical vertebral levels as anatomical landmarks. Also additional information such as thyroid, pathology, nodules have to be described and variant anatomy of the subclavin artery or recurrent laryngeal nerve and arch of aorta have to be mentioned because those help the surgeon in determining the surgical approach and preventing nerve damage. Also while interpreting HODCT we have to mention certain words which convey the level of confidence we have in this particular scenario. For example if we are fairly certain about the pathology being parathyroid edinoma or a hyperplastic gland we have to say something like this lesion posterior to the thyroid gland is consistent with, consistent being the key word consistent with parathyroid edinoma or parathyroid hyperplasia so on and so forth and then if you are less confident you can use words like hyperatenuating lesion on post contrast images posterior to the thyroid gland may be a parathyroid edinoma or parathyroid hyperplasia so may or probably being the words that are used to convey the level of confidence. So generally parathyroid edinomas are lower attenuation than the thyroid gland except in patients with chronic hypothyroidism who have less iodine in the thyroid gland so they may be like isoatenuating the parathyroid edinoma may be isoatenuating to the thyroid gland this is like a special circumstance. And the classic description of a parathyroid edinoma is that it is hyper enhancing on the arterial phase and demonstrates a washout on the venous phase but this is only seen in like 20% patients rest of them are type B and C which we will talk about in the upcoming slides also if there is some other pathology you have to describe it as either being associated with the thyroid gland, it being a lymph node or a blood vessel and extreme caution has to be taken in detecting parathyroid edinomas because not uncommonly they are like they are quite numerous so we have to be careful and not be satisfied with the search so if you find one edinoma we have to like sort of keep that in the back of the mind and keep searching for others. This is a typical protocol that can be used so point of note is it is a multi phase CT scan using a slightly higher tube voltage of 140 kVp and arterial phase imaging at 30 seconds and venous phase at 60 seconds with a slightly higher amount of contrast of 100 cc and from maxilla to the carina. What also helps in proper imaging is like shoulder lowering techniques using traction straps and like or improvised bed sheet placement. The third and final thing is to use the right arm as much as possible for contrast administration to reduce the streak and scatter artifacts from like the veins on the left side of the neck so we want to reduce that so try to use the right arm so this is the classic description of a parathyroid edinoma on post contrast imaging so the top left image demonstrates non-contrast axial scan through the neck demonstrating the left parathyroid edinoma which is hypo attenuating like hypodense and the center image demonstrates arterial phase with hyper enhancing edinoma and the top right image demonstrates venous phase with washout. This is type A enhancement and it is only seen in 20% of patients. Type B enhancement is different in the sense that the lesion is not hyper enhancing on the arterial phase so it appears hypodense on the pre-contrast, isodense with the thyroid on the arterial phase and demonstrates washout on the venous phase. Type C enhancement demonstrates the adenoma as hypodense compared to the thyroid as usual but it is iso attenuating meaning iso dense to the thyroid on both arterial and venous phase. As we talked earlier we have to be very careful in detecting multiple gland disease because that is not uncommon so once you find an adenoma like you have to keep searching for additional lesions which are separate from the lymph nodes, arteries and thyroid glands. So also we have to remember that sometimes when you don't see any pathology it is more likely to be multi glandular disease like parathyroid hyperplasia and an adenoma of size less than 7mm is sort of 88% specific for multiple gland disease. So differentials to parathyroid adenomas we know intuitively those are exophytic thyroid nodules or even large thyroid nodules and lymph nodes. So what helps us be more confident is the non-contrast images and correlation with ultrasound findings. Dual energy CT can also help us in this situation by negating the need for multi-phase imaging. So this is an example of multi gland disease as you can see both superior and inferior parathyroid glands are mildly enlarged. Variations in parathyroid lesions are as above so top left demonstrates a cystic appearing parathyroid adenoma. Top center and top right demonstrate nodules with intralesional fat and bottom right demonstrates parathyroid adenoma with calcification which is concerning for parathyroid carcinoma. So whenever you see calcification the possibility of carcinoma has to be raised and the referring physician has to be informed about this. So there is a recommendation on how to approach a 4D CT of the neck and to minimize missing any parathyroid lesions. So in searching the superior parathyroid glands you have to start along the posterior aspect of the upper thyroid lobes and then focus on the retro pharyngeal and retro esophageal positions. So much like less commonly the superior glands will be located within the carotid sheath or will be intra thyroid or in the scalene fat. In the search for inferior glands you have to start adjacent to the lower thyroid lobe and then look along the thyrothymic ligament and within the mediastinum. And less commonly the inferior glands will be within the carotid sheath and intra thyroidally. So in conclusion what the radiologist can provide to the surgeon and help them plan a great and accurate surgery is the number of lesions, the size of lesions, precise localization of the lesion and the radiologist opinion and confidence level like using particular words like this lesion is consistent with or using words like this lesion may represent or probably represents if you are less confident and then describing associated pathologies of the thyroid gland if present also mention ectopic or supernumeric parathyroid tissue.


The secret to success is to consistently do worthwhile things that lead you to your goals, right? But what's in the way? Primarily your emotions are in the way and the secret to consistently doing worthwhile tasks is to reform your emotions for those tasks. So that you don't procrastinate anymore, so that you don't resist them and avoid them and find the many, many possible excuses we have to not do them. Oh, because somebody else needs my help. Now, I'm not saying you don't help other people. Obviously you do and people do need your help and you do need to help them, but boundaries and planning and having time where you actually are taking actions towards worthwhile tasks, you can plan the time, but you might still be avoiding them and your brain is so subtly tricky. It is so genius at making you feel like something else is more important than whatever it is that you've planned to do, right? So here in this video I want to share with you a method to reform your emotions to any worthwhile task to essentially bring joy into any activity. So the secret starts with this framework called deliberate practice. Now, this was popularized by an author, a scientist named Anders Erickson. I think that's his name, correct me if I'm wrong below. And he studied, you know, I think he studied violinists, so, you know, elite musicians who are performing at the highest levels. And he saw that the ones who got the most benefit out of their practice because they practiced hours a day, but not every kind of practice is beneficial. Some people just kept playing the same passages wrong, you know, day after day, year after year. And some of them took a specific short passage and made sure they got it right. Just that might even just be like three seconds, something like that, or two seconds. And then they just made sure they got it right. And then they kept playing until there was a next passage that they're like, you know, I really could do this more skillfully. So then they practiced that next passage. Maybe it's a few seconds. Practice, get it right and practice it the right way. Again and again until it became muscle memory. Muscle memory. Muscle memory, what is that? That means you don't even think about it. It becomes instinctual to you. It just in that situation, when they're playing that passage, it just they naturally play it brilliantly because they practiced it so many times. And then they strung together those little passages, of course, into a brilliant masterpiece. And now they can play the entire thing very skillfully. So how do we implement their liberate practice into finding joy for any task? Well, essentially, the liberate practice, like I said, is creating muscle memory. And I'll give you another example where when I used to walk into the kitchen, it was very natural to open the snack drawer and get some junk food and eat that instead of something healthy. So I said, let me try the liberate practice and muscle memory to reform that habit. So what I did was I practiced walking, I walked into the kitchen, walked past the snack cabinet, opened the refrigerator, took out a carrot, you know, washed the carrot and took a bite. That's it. And then dried it up, put it back into the refrigerator, closed it, walked out of the refrigerator, walked out of the kitchen. So that entire exercise of getting the carrot, you know, watching it a little bit, taking a bite, drying it, and then putting it back, that took like what, two minutes, something like that. And so I did that two minute exercise two more times. So three times total, walked into the kitchen, got the carrot, took a bite, do it three times. And so my surprise, and maybe I shouldn't have been surprised. The next time that was like a day later or later, it was either later the afternoon or the day, the next day, when I walked into the kitchen to get a snack, I found myself being able to pause because I was like, wait, I, for, you know, months now I've been getting, getting some junk food, but okay, I suddenly actually don't need to open the snack drawer. I have a choice, choice moment here. And I realized, oh, I actually want to get something healthy. So I went to the refrigerator and got, so you see what happens is that what we, what we are essentially trying to do is to break our instinctual patterns that are not helpful or purposeful for our goals and the kind of life we want to live. If we can break those instinctual patterns and instead replace them with a helpful action, even if it's just three seconds or two minutes, whatever it may be, helpful action for just a very short amount of time, then we have a choice moment every time we come to that situation to be able to choose something better. So what I did, so I'm sorry, before I say about the joyful productivity thing, I want to give you one more example, which is from the research of Albert Bandura. He was a psychologist that was trying to help people reform habits.  I don't know if any of you are scared of snakes. I think a lot of people are, but he took people who were certifiably scared of snakes. And he was able to transform them into handling snakes no problem. Now you might say, was that hypnosis? No, there was no hypnosis involved. It was, it was completely conscious. And here's how he did it. He got, he took, he had those fearful people first watch a television show where some people were handling snakes with calmness, even with fun, with interest, with curiosity. And, you know, they didn't have to handle any of the fearful people. They just had to watch a television show. And maybe at first they're like, Oh, but they kept watching that show maybe a few times until they're like, okay, watching the show. Like you practice. So the first step was helping them deliberately practice watching that show of the people handling the snakes without, without fear and with curiosity even with fun, with no problem. So now they've practiced watching that show several times and now they can watch a snake show with no problem. Great, wonderful. Now the next deliberate practice they did was to just be in the room where there are snakes in a glass container, just to be able to, to look at snakes there. Okay, just to be in the room. All right. And then they did that several times they walked in. Okay, I'm kind of scared right now there's snakes in the room. Okay, walk out, walked in. Okay, maybe this is not so bad walked out, walked in. Okay, I'm fine with hiding snakes in the glass container. It's no problem. Right. So progressive exposure, essentially. And then the next step, they practiced being in the room while someone else was handling the snakes. And now they're actually in the room watching someone handle the snakes. Just fine, no problem. You see, so they just kept practicing this deliberately until they were handling the snakes themselves. No problem. Wow, this is actually no big deal. And they practice it several times. Oh, it's no big deal. I can do this now. So essentially, that's what we can do with any task or activity that serves our purpose that we naturally resist or procrastinate about. So for you, maybe it's making videos, you get scared of making videos. Okay, well, then you need to watch someone like me make a video. I'm on Facebook. I'm actually making this on Facebook live right now. So I only get one take. I can make all the mistakes. I can, I can, you know, I can make mistakes, forget my train of thought, whatever. But I'm still here. And you notice I'm still okay. So I have lots of imperfect videos, right? Most of my videos are imperfect. Purposefully, because I want to show you all that I don't have to dress up. I don't have to do makeup. I don't have to have any special hair. I don't have, I mean, I'm grateful for a nice background, I guess, but you could use zoom to make your background nicer, whatever. It's like, I'm here to show you it's okay, you don't have to be scared of making videos. Same thing with writing. Some of you resist writing I have for most of my life. And if you know my story, I basically practiced progressive exposure to writing until I'm now able to write without writer's block. But that took a lot of practice. So what is it for you? Is it videos, making videos? Is it doing your taxes, doing bookkeeping? Is it reaching out to potential clients, potential referral sources? What is it that scares you? And do you realize that you can reform that by doing a deliberate practice of writing down specifically? Okay, let me practice. Step one is, you know, if I'm scared of sending out an email to a potential client, for example, then step one, I might practice, you know, opening up the email software and opening a blank message. Okay, that's it. And practicing doing that with calmness and with even curiosity and compassion. That's it. We're not sending anything yet. Right. And then practice that several times. And then you practice starting to write that message with calmness, with joy. If it's still scary for you, practice just the starting of the message with calmness and joy. Try that several times, three times. Really three times is all you need to practice to start kind of breaking some instinctual resistance and bad emotions about any task. Just three times. If you can practice more than three times in the same setting, sitting, that's great. Another example is how many of us, when we come to our computer, we automatically open up social media or we open up email to check the email. When we know it's probably more beneficial if we open up the computer and look at our calendar or prioritizer to-do list. So you can practice that. You can practice getting out of the room, coming back to your computer and before you open email or social media, you open up the calendar or you open up the to-do list and practice feeling joy and feeling gratitude for that moment. Okay, that was two minutes. Now go out of the room, come back to the computer, open, or now close the software before. Now open up the software again, practice joy and gratitude that you get to do something purposeful and then practice one more time. Now I'll give you my example of how I reformed my every single working session to practice more joy. So what I did was instead of coming to the computer and getting worked up right away and trying to do some project or solve some problems or whatever, the check email, whatever it may be, what I did was I practiced coming into the room, sitting down to the computer and doing my energy reboot for 30 seconds. And then opening up my calendar or my to-do list, just like I said before, and doing what's purposeful next for one minute, just for one minute, opening up the calendar. Okay, I'm supposed to be writing an article right now and then just start writing for one minute. Okay, and then stop. And then practicing this whole exercise again, walking out of the room, coming back, computer, energy reboot, opening up the calendar, looking at what I'm doing next, writing an article. Okay, and then practice writing for one minute in that state of more gratitude, more joy. So I did that three times. And not surprisingly, the next day when I came to work to be at the computer, I just instinctually had this mode of choice to go, oh wait, I can instead of checking email right now, I can go and open my calendar, see what I'm doing right now and do that thing. Well, first do my energy reboot, opening account, etc. So I hope that this is inspiring for you to realize that you are completely flexible. You can become anything you want to be. You can learn to enjoy any task that is purposeful and productive and helps you move towards your goals. You can learn to enjoy it. You don't have to discipline. I actually think of the word discipline in a positive light. I know a lot of you hate the word discipline because you have been brought up, trained, you deliberately practiced hating discipline or avoiding it or resisting it. And I actually, when I think of discipline, I think of joyful, deliberate practice, gentle practice. That's what I think of.  And that's what I invite you to do, looking at your to-do list, looking at your calendar. What do I procrastinate? What do I avoid? Well, let me practice bringing joy, just three minutes at a time. Imagining joy as you do that task and then try it again and then try it again. Just do it three times and see how that starts to change your emotional relationship to that task. And bit by bit, you can reform your relationship to any item on your to-do list. If you have a difficult time with technology, why do you have to frustrate yourself and like this, trying to figure out tech problems? No, you don't. You could do everything with joy. Everything can be done with gentle, calm joy. So if you have a tech problem, okay, practice. Oh, I have to figure out how to do this Facebook ads thing. Okay, instead of furrowed eyebrows and frustrating emotions and constricting whatever, I'll probably practice for one minute, approaching, opening up the Facebook ads manager and looking at these things and practicing breathing and joy. Okay, let me do it again. Close it, open it back up, breathe joy. Close it, open back up, breathe joy and just bit by bit. Okay, now I'm on to the next section of the Facebook ads manager. That's very confusing. Okay, close it, open it, open to that section, breathe joy, close it. You see what I mean? So with deliberate practice three times, you start to break the old emotional resistance towards something. And when you learn how to bring joy to every task like this, I now actually have a trigger point for myself. I've practiced this so much that I actually noticed throughout my day, I become aware quickly when I'm not in joy for a task. I'm like, I catch myself, wait, I'm not enjoying, I'm not enjoying this task right now. Let me stop, do my energy reboot and reform that relationship to that task. And like I said, if it's a difficult task, I might do the practice three times to start to relate to it in a more healthy and joyful way. I hope this is helpful. I'm George Cao, KAO, authentic business coach. And I love talking about this kind of stuff. How do we actually build and grow our business from a place of true heart connection to our spiritual path? And with continued practice, naturally comes success. I hope this is helpful. I'm always open to your comments. If you found this helpful, or if you have any questions, let me know below. And I will see you in the next video. Be well.


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