So just some information about myself. So I went to college at Virginia Tech and I majored in biology. I then went to medical school at the Edward Vi of Virginia College of osteopathic medicine. I did my residency in New Jersey at UMDNJ in South Jersey, which is now renamed Rowan. And then I did a fellowship in breast oncology at St. Luke's Roosevelt and Beth Israel Medical Center in New York. I've worked at Riverview and Bayshore since 2014 and I'm the medical director of breast surgery at the Bayshore Medical Center. And both of our programs are NAPBC accredited, which is a national accreditation program for breast centers. It's a very rigorous evaluation of the centers of all aspects. So I will talk about that a bit later too. Today we're going to talk about reasons for needing breast surgery, different types of breast surgery, some questions to ask before your operation and coordinating care with your other doctors. So why is this important? Well, it's because breast cancer and breast issues affect a lot of women. And eight women will develop right of your family members or somebody, you know, it's something very common. And saying my internet, are you having any internet issues with me? Caitlin, just let me know. Okay. Okay. So it's a very common issue. So which is why it's such an important topic. So the American Cancer Society estimates that there will be 287,850 new cases of invasive breast cancer diagnosed this year. They estimate over 50,000 new cases of ductal carcinoma in situ will be diagnosed, which is stage zero breast cancer, just in this year. And luckily, most of these women will be diagnosed at an early stage, so stage zero one or two, about 66%. And this is important because it means that there's an improvement in their survival rate and then usually less extensive treatment is necessary for these women. But unfortunately, women are still dying from breast cancer. And so the estimate for this year is 43,250 women.  There are now more than 4 million women in the United States alive today who have a history of breast cancer and this number is just increasing every year. The five year survival does depend on the stage when they're diagnosed. So it's a localized disease, meaning early stage breast cancer, located just in the breast, their survival five year survival rate is 99%, which is great. It's a regional disease which is where it started to spread to the lymph nodes. So this could either be a high stage two or a stage three, the five year survival decreases down to 86%. And for women who have distant or metastatic disease, the five year survival is 30%. So what are some of the reasons for needing breast surgery. So just to give you a little background in the history of breast surgery. Up until the 1980s screening mammograms had really just first been introduced, they were only around for a few years, and we're not widely adopted yet. And some of the clinical trials were still ongoing at that point. So not many women were getting their mammograms in the early 80s. The many needle biopsies for breast issues were not available yet. Breast culture sound was not used yet, which is a very common tool for us these days. And the breast surgery that was performed. It was really the main way to diagnose breast issues and so it was performed for a whole variety of breast masses, mainly because they couldn't really figure out the diagnosis until after surgery. The diagnosis was either determined during surgery by having a pathologist look at it or just from the surgeon looking at it, or soon after surgery. So there was a lot of questions of what was going on even going into an operation. And then some women actually went into surgery not knowing if they'd be having a lumpectomy or a mastectomy. And I've had even some of my patients saying that when they had breast surgery back in the 70s and 80s that they they consented for both a lumpectomy and if necessary mastectomy so kind of a scary thing to not know whether or not you'd be coming out of surgery with a breast. Luckily, we can do a lot more with our diagnosis these days so there's a lot more knowledge before even going into surgery. So a lot of advances in the diagnosis of breast cancer and breast issues percutaneous needle biopsies are really performed most of the time and gives us a lot of information before surgery. If a lesion is benign on a needle biopsy then a lot of times this surgery can be avoided. If the if the biopsy shows it to be cancer or malignant, then it really helps to give us a lot of good information to help guide the appropriate treatment. It gives us some information on the staging and what type of surgery to do how extensive the area needs to be excised, whether or not lymph nodes need to be evaluated. It gives us a good idea of whether or not chemotherapy would be necessary. And this is important to know because some women need to have chemotherapy before surgery. So really important to know because often their survival will be improved by having some of that treatment before the surgery. Also it'll help us to know whether or not a patient needs endocrine therapy which targets the hormone receptors on certain cancer cells. And it also helps us to know whether or not a patient will need radiation. So a lot of this information can be determined even before somebody has surgery. So it's really helpful for a patient to know not only are they having the operation but what to expect in a couple months afterwards. Our breast imaging has also greatly improved. We now have digital mammogram and tomosynthesis, which is 3D mammogram, which really gives us great images of the breast tissue and helps to determine the extent of disease. And if there's any other areas of concern, ultrasound is very effective for imaging certain breast lesions and sometimes ultrasound can see something that the mammoth might not be able to see. And also we have breast MRI is a tool which is also very sensitive for detecting breast issues. So, some of the reasons for needing breast surgery are could actually be benign. And it could be very appropriate to have surgery for benign reason reason. One of those reasons would be a fiber adenoma, which is enlarging. Fiber adenomas are very common benign lumps in the breasts really almost every woman has them. Just if you don't feel them we don't go searching around for them because they're really not a risk for developing breast cancer. But sometimes these fiber adenomas can continue to increase in size. You can start to feel lump in your breast or they could grow rapidly and they can sometimes become uncomfortable. If it's a fiber adenoma that's enlarging then often we'll take it out to help to avoid those issues. Or if there's any concerning findings with the imaging appearance of it then we would remove it to make sure there's nothing else involved with the fiber adenoma. Sometimes you could get a breast infection or an abscess which is a fluid collection from an infection. It could happen during pregnancy or breastfeeding or really even other times during your life. And often these infections can be managed just with some minor procedures in the office but sometimes if it's extensive we might have to do surgery for it to help the infection to improve faster. Another benign reason is something called axillary accessory breast tissue. There's a lot of normal variations of anatomy with the breast. One pretty common thing is to have extra nipples located that a lot of women just think they're just like a skin lesion they're really not bothersome. But then one of the other normal anatomy findings is some extra breast tissue that's located in the armpit area so that tends to be the most common area. It almost forms like a lump there and can become very uncomfortable. It can increase in size, especially when a woman's exposed to more hormone variations. So often women will notice this after they've had a pregnancy and then the armpit area will get pretty swollen and it can be difficult to get clothing to fit in that area. And sometimes it gets to the point where we would actually remove it with surgery. So when women come to see me for this we really go over the risks and benefits because it is an operation and sometimes scars can cause discomfort. So we really make sure that they're at a good point to have this area removed. But I found that really once a significant area that the surgery really improves their quality of life. So it's something that you don't hear about too much and a lot of women don't even realize that it's actually part of the breast tissue but that could be removed even for benign reasons. Another benign reason is something called a discordant lesion. So that's when a woman has a percutaneous needle biopsy after either a mammo or an ultrasound or an MRI and the biopsy comes back benign. But then when the radiologist is looking at it, they would have expected it to show something. So either like some abnormal tissue or a cancer or something else like that to describe the finding on the imaging. And so in that case it's considered discordant because the imaging looks very abnormal but the biopsy came back benign so they don't match up. So it doesn't happen too often. I'd say maybe 1 or 2% of the time. But it gives the radiologist, it gives them that extra tool to be able to say you know our needle biopsies are very accurate but sometimes it might not give us the most accurate diagnosis and we really should remove it with surgery. And so this is helpful because a lot of times when we remove it with surgery there's actually something abnormal in the area. So some women come to me with that type of lesion and it's always a confusing situation because the needle biopsy did come back benign. But then I show them the images and I explain exactly why this is something concerning and then after some discussion they understand why a surgery be necessary in that case. And another reason for needing surgery would be this category called atypia or high risk lesions. And so this is something that not everybody hears about but as a breast surgeon I see this very commonly. So this is when the excision of certain lesions is recommended due to the risk of upgrade to breast cancer. So there's certain findings in the breast tissue that we know lead to a higher risk of developing breast cancer in that area. In that case we remove them so that it helps to prevent a breast cancer from forming or if there's a tiny breast cancer hiding nearby it makes it helps us to get it out before it advances too much. So one of those lesions is something called an intraductal papilloma. This is a small polyp that can form an adduct. Often they're very soft so they don't typically form a lump and it's something that we pick up on breast imaging or sometimes it's actually the initial sign could be that a woman's having nipple discharge. So the papilloma can cause irritation of the inside of the duct and that can cause nipple discharge. And then in order for the discharge to stop we remove the papilloma with surgery. There's also something called a radial sclerosing lesion which you might hear called a radial scar. It looks like a scar on imaging and pathology but it's not truly scar tissue. But we can often find these near a breast cancer and so we're very cautious with everything with the breasts. And so if we find radial sclerosing lesions, usually we recommend removing them to make sure there's no breast cancer hiding nearby. Another type of atypia called atypical ductal hyperplasia. You'll hear that abbreviated ADH and that's a precursor to breast cancer. It's where an abnormal cells start to form inside the ducts. And when we find that on a needle biopsy, there's about a 20% chance that there could be a breast cancer nearby. And so I almost always recommend surgery for these lesions just because the risk of breast cancer nearby is pretty high. There's also a category called lobular carcinoma in situ which is somewhat similar to the atypical ductal hyperplasia where it also has a high risk of there being breast cancer located nearby.  It's a high risk lesion. It's just something that wasn't quite discovered when they, when they initially found it as a pathology term they thought it was more like a breast cancer but as we've studied this over the years we found it doesn't exactly act like a breast cancer but more of like a precursor to breast cancer so we're very careful with both of these types of lesions. So having biopsy showing either the atypical ductal hyperplasia or the lobular carcinoma in situ, not only do we have to address it when we find it at those spots, but then going forward it means you have a higher risk of getting breast cancer in either breast in your lifetime. So then we start high risk screening to help to detect something else that might come up or that way we can catch it at an early phase. And then another reason for breast surgery is from malignancy or for cancer. So, surgery is often used to treat someone who's initially been diagnosed with breast cancer. It can also be used to treat a breast cancer recurrence. So there's a small chance that a breast cancer can come back to the same breast or somewhere nearby in the breast or to the lymph nodes and so we can remove that with surgery also. Surgery can also be performed more in a palliative fashion where a woman has advanced breast cancer but it's starting to cause some issues. So I can start to cause a wound when it gets very advanced so surgery could help to fix that. Or also surgery could be used to help obtain more tissue to get a more accurate diagnosis which will help to guide treatment. Those are decisions that are made in close discussion with the patient's medical oncologist because the timing would depend on coordinating with their medical treatment. So what are some of the different types of breast surgery. So the main types of breast surgery are an excisional biopsy, a lumpectomy, a mastectomy which is removal of all the breast tissue, a central lymph node biopsy and an axillary lymph node dissection. So an excisional biopsy is performed to excise a lesion in order to obtain a full diagnosis. So very similar to a lumpectomy but the patient does not have breast cancer is not known to have breast cancer. So usually the diagnosis that we have going into surgery is either something unknown so like a discordant lesion. It could be something benign like a fibratoenoma. It could be one of the different types of atypia, or it could be a high risk lesion. A lumpectomy is very similar performed very similarly just for a different reason to the excisional biopsy so lumpectomies performed when we know there's a breast cancer. So, this is usually an early stage breast cancer that's localized within the breast. The tumor needs to be small in relation to the breast size. If it's covering a wide area in the breast, then it'd probably be better to do a mastectomy to remove more of the breast tissue to make sure we get the breast cancer out. Also it's important that there really should be pretty minimal change the shape of the breast after a lumpectomy. So if removing the lumpectomy causes significant distortion to the breast tissue a lot of scarring in order to obtain good margins, then it might be better to do a mastectomy. And typically with a lumpectomy in order to protect the remaining breast tissue on that side, usually radiation is recommended. And so the patient does need to understand that upfront that they that the radiation will likely be recommended so it's important that they agreed to that step in the treatment, which luckily is well tolerated. But if they were refusing to do radiation and a lumpectomy might not be the best choice for them. A lumpectomy can also sometimes be performed after a patient has had neoadjuvant chemotherapy, which is when they've had chemotherapy prior to surgery. Often this type of medical treatment can shrink the size of the tumor. And so if there's signs of a very good tumor response, then something that initially was very large and would have required a mastectomy, it might be possible to have a lumpectomy. But not all the time I usually try to tell the patient upfront whether or not this could be a possibility, because sometimes even if they have a good response, we might still have to do a mastectomy for various reasons. But if it's a possibility then it's another good reason to have that that chemo upfront. So it's important that the patient understands that after surgery they'll be going for additional imaging so definitely their annual mammograms, but often will perform imaging every six months for a bit depending on how the scar tissue looks and if there's any areas of concern. Sometimes they'll also be getting MRIs in addition to the mammogram or maybe ultrasound. So it's important for them to know that that'll be a part of their treatment and monitoring plan. And I also let patients know that we're very sensitive to any slight changes in the breast tissue. And so they might need some more biopsies over the years to help make sure that something's okay that helped to confirm its scar tissue. Or just if anything slightly changes we want to make sure if it is a recurrence that we catch it sooner than later. And then another important thing to know about a lumpback to me is that typically a patient's able to maintain their normal breast sensation. There might be a little bit of numbness near the incision but overall, they're able to maintain that sensation. So mastectomy, several reasons why this would need to be performed. Sometimes it's performed in patients that have not had breast cancer. And so there's pretty specific reasons when this would be appropriate. And so one you've probably heard about is for women who carry a BRCA1 or BRCA2 genetic mutation. And so this is important because women who have these genetic mutations have up to an 80% chance of developing breast cancer in their lifetime, which is very high. And the breast cancers that women with these genetic mutations tend to develop tend to be pretty aggressive requiring chemo, radiation, a lot of treatments. And so it's definitely a very reasonable option for them to have prophylactic mastectomies meaning removal of the breast tissue before a cancer forms in order to help prevent the cancer to begin with. And so it reduces the risk by over 90%. So I tell patients that after they've had the mastectomies, pretty much the risk of getting breast cancer is only like one or 2%, which is a drastic decrease from 80%. And then the other time that mastectomies can be performed when women do not have breast cancer is when they have reasons for being very high risk of developing a breast cancer. And so I'd like to think of it as kind of similar to having a BRCA mutation so like close to the 80% risk would make it worth going through such a major surgery. And so it's important to have a very long discussion with the patients if this is something that they desire. So if for some reason they have multiple family members who've had breast cancer, especially if they're diagnosed at a young age, even if their genetics are negative, that's something to consider. I say, typically, at least three to five family members so not just one or two. Also, if they keep on having biopsies showing different specific types of atypias, so atypical ductile hyperplasia and lobular carcinoma and situ are pretty concerning. And if they just keep having biopsy after biopsy showing these atypias, then the chance that one of these is going to actually be a cancer just increases as time goes on. And so especially if they have a combination of the family history and multiple atypical biopsies, then if a patient doesn't want to do the high risk screening anymore, we have a long discussion about whether or not a mastectomy so be an option for them. Which is very important to understand and go through all the details of surgery and the risks involved, possible additional operations in the future to really determine what the risks and benefits are, comparing surgery to high risk screening. So of course mastectomies are also performed for patients who are diagnosed with breast cancer. This would be recommended when the tumor size is large. In relation to the breast size, especially if a lumpectomy would result in an abnormal shape to the breast, or a lot of scarring, because also you have to keep in mind that women have when they have lumpectomies that they also have the radiation which can add a little more scarring also. And so that combination, when usually more than a quarter or a third of the breast tissue is removed. That's when it's best to start to consider a mastectomy. So if a woman has multi centric breast cancer, which is where breast cancer is found in more than one quadrant in the breast. If there's several areas close to each other in one quadrant, then that could be removed with a large lumpectomy. But if it's spread out throughout the breast, then the risk of there being other areas in between those that could have cancer that we can't quite see yet is higher. The risk of a recurrence after multiple lumpectomies at the same time is higher. And so it's better to remove the breast tissue to reduce that risk of recurrence. Also, if multiple operations have been performed to attempt to keep doing a lumpectomy. And so, due to positive margins. So what that means is that when a lumpectomy is performed, the pathologist looks at the margins, which are the edges of the lumpectomy. And you want to make sure there's no cancer near the edge. If there's any cancer near the edge, that means there still could be cancer in the breast. And so if that happens, then a second surgery is performed to remove additional tissue at whichever margins involved. And after this has been performed multiple times, if you're still getting more tumor at those edges, then then at some point it might be a good idea to do a mastectomy. Because really usually with the first surgery, the whole imaging abnormalities removed. And so what's found at the edges, we usually can't see an imaging we can't feel as a lump. And so it just shows us that this cancer is being very tricky and that's more extensive than what was originally thought. The lumpectomy is an option if a patient really doesn't want to undergo any further breast imaging. Like I explained earlier that breast imaging can often be every six to 12 months for years with different types of modalities. And some patients just really prefer not to have to do any more imaging or risk doing additional needle biopsies. And then patient preference of course factors in. So I tell patients that, you know, if they have the option to have a lumpectomy because not everybody has that option. They also have the option to have a mastectomy. And that as long as it's treating the cancer and that they understand the risks and benefits and how that might change additional treatment. You know, my main goal is to treat the cancer. And so some women decide that a mastectomy is the right decision for them. And then that would be fine as long as I agree with that from their cancer treatment standpoint. So the decision for whether or not to do a mastectomy is also sometimes related to different factors related to radiation. Some patients are unable to have breast radiation and radiation is important because often it's used after a lumpectomy. And so when a woman's pregnant she cannot have radiation because the the dose is very high. And even though it's targeted to the breast tissue there can be some scatter within the breast within the body, which could therefore get to the baby. And so radiation is not performed during pregnancy. Even if the belly shielded it there's still a way that it's possible that that could get to the baby so we definitely would not want to risk that. So the timing of when a breast cancer is diagnosed during someone's pregnancy is important. If it's near the beginning of the pregnancy depends on if they need any other treatments that would get them through the end of the pregnancy. Because we really try to maintain the pregnancy as much as possible it's very, very, very rare that we would ever recommend terminating a pregnancy, even due to a breast cancer diagnosis. But a mastectomy can be performed during a pregnancy. If a patient's near the end of the pregnancy when they're diagnosed and it's something that can be removed with a lumpectomy. There's often about four to six weeks between the lumpectomy and radiation. So if it's within that timeframe, then they could have the lumpectomy, deliver the baby and then have radiation so just a lot of factors on the timing for that, but that's something to keep in mind that could sway what type of surgery we do for a patient. There's also certain connective tissue disorders that sometimes these patients cannot have radiation. And it really depends on the severity of the patient's disease. So I would have them meet with the radiation oncologist to see if the radiation would be possible. One of those is scleroderma, and one is systemic lupus erythematosis. One factor with radiation is whether or not they've already had radiation to that same breast. And so, typically a patient receives the full dose. And so if they receive additional radiation to the whole breast, it could cause some issues with the normal breast tissue wounds irritation. And so, typically we would not recommend having whole breast radiation done to the same breast twice. We previously had mantle radiation for Hodgkin's lymphoma. Some of that radiation overlaps the radiation field for lumpectomy and for the breast. And so we would try to obtain those previous records and coordinate that to see if that would interfere with the radiation, but that's important to keep in mind also. And also, if a patient does not desire radiation for various reasons, it's typically well tolerated, but I've had some patients who saw people go through radiation, especially a long time ago, who had a lot of issues, and they just can't, sometimes just can't get past that, so they just have decided that they wouldn't want to have radiation. And so if it's an early stage breast cancer, the radiation can often be avoided if they have a mastectomy. So for surgery on the lymph nodes, so surgery is performed on the axillary lymph nodes, which is the area the lymph nodes underneath the armpit. This helps us to determine whether or not a breast cancer is trying to spread. And so it tends to be the first area that a breast cancer would spread to. And there's different ways that we can determine if that is occurred and, and different ways we determine how many lymph nodes to remove. So the central lymph node biopsy is the most common type of axillary surgery performed. And this is usually performed on patients who have early stage invasive breast cancer. So stage one or stage two with no signs of lymph node involvement before surgery. So we evaluate the patient in the office and check their lymph nodes on exam to see if I feel any, if I can feel any lymph nodes, then we would do imaging to determine if I feel any lymph nodes to be involved with lymph node, but then ultimately it's confirmed with imaging and needle biopsy ahead of time if necessary. So the central lymph node biopsy looks at the first few lymph nodes in the chain usually it's only between one and three lymph nodes. You have about 30 to 40 lymph nodes under the armpits is just checking the first few. And we found that if we look at the first lymph nodes in the chain that this can accurately predict whether or not any lymph nodes have gone further up the chain. And so if those lymph nodes are negative, then we know the cancer has not passed that point. And so we don't have to look at any more lymph nodes. This was not always the case. This just started like in the early 90s. And so before that point women had full axillary dissections for every breast surgery with cancer, which led to side effects. And so that's why we tried to do less extensive surgery yet still come up with the best diagnosis and treatment for the patient. And luckily the central lymph node biopsy was able to be adopted. And then this is especially important for obtaining accurate staging. And so as a woman's going through the breast cancer treatment process we're looking at the staging the whole time with the imaging and the biopsies. Then we get the lymph node result that further confirms the staging and really that that staging is confirmed after surgery with the full pathology diagnosis. So excellent axillary lymph node dissection is performed still performed when we know that the cancer has spread to the lymph nodes. And then this helps us to determine how many lymph nodes have cancer in them, which again helps us to determine the difference between the stage two and a stage three breast cancer. And so typically between 10 and 20 lymph nodes are removed. And then after those are evaluated they see how many of the lymph nodes have cancer in them. The lymph node dissection is more extensive than the central lymph node biopsy so often women have a little more numbness under the armpit compared to the central node. The risk for lymphedema increases to about 12%, which is swelling in the arm on that side. Luckily it's easily treated physical therapy but if we can help to decrease that risk we really try to as long as it's safe from a cancer standpoint. And sometimes the having surgery in that area since it's under the armpits in a sensitive area, it can, especially during the healing process can limit the mobility to the arm a bit. And it can take a little while to regain that mobility with stretching and exercises often physical therapy. So what are some questions to ask before your operation. So, it's important to ask about what you should do to help prepare for your surgery. So of course it's good to try to sleep very well every night and try to get your full eight hours. It's important to eat a healthy well rounded diet. You should make sure to ask your diet doctor if any specific foods or drinks should be avoided, either leading up to surgery or the night before. Oftentimes I'll ask you not to eat or drink anything after midnight the day of surgery but sometimes this can vary sometimes it's important to take your medicines with a small sip of water so it's important to ask the details of exactly what you should eat and drink. It's important to stay active and to exercise, leading up to surgery, you know try to maintain what your normal activity is. But if you don't normally exercise. It is good to help to start to do some light exercise, you know don't do anything too strenuous because you don't want to hurt yourself, but just walking stretching, you know ask your doctor what would be good to help out, leading up to surgery. I found that the more active patients are, and the more exercise that they do the better they're able to handle a surgery so even if you just started a couple weeks ahead that could help out with your recovery. It's also important to ask your doctor if there's any medications, vitamins or supplements that need to be stopped prior to surgery. The main one you'll hear about is blood thinners. So aspirin, Coumadin, Plavix, there's a whole variety of them these days. These often need to be stopped a few days before surgery but the timing really depends on what medication it is and what reason you're taking it. I have some patients who have to take it up until surgery so it's just important that the other medical issues are considered and your other medications. So with diabetic and blood pressure medications sometimes those need to be adjusted right around the time of surgery. Certain blood pressure medications are very important to take before surgery other ones, it's best to skip a certain dose with diabetic medications they're often adjusted because you're not eating or drinking on the day of surgery. You have to keep a close eye on your sugars so your primary care doctor or whoever manages your diabetes will let you know how to adjust those medications leading up to surgery. Also vitamins or supplements are very important because some of those can also have a blood thinning properties to them so they should also be stopped prior to surgery. Before surgery it's really important to make sure your other medical issues are under control and so the breast cancer, the breast surgery is just one component of your whole body. But when you're going through surgery it's anesthesia and the recovery process and whether or not you have other medical issues can factor into all of this and can affect your risk factors. So it's important that whatever medications you're taking that you continue to take them as directed. It's helpful for you to see your primary care doctor for physical to make sure that everything else with your medical history is is going well and is stable and overall if your other medical issues are stable. It'll decrease your risk of having any complications after surgery. So make sure to ask is what's actually performed during the operation. And so your doctor really should be prepared to answer this in a lot of details and I think it's important for my patients to understand almost every step to the surgery I don't want them to be surprised with anything or blindsided. So just starting from what's the name of the operation. So, so I always explain that exactly to the patient that way they know what side we're operating on why we're operating how they're going to be shown to that area. And how will this name for the surgery what will it be anything different than what's on your consent form. So you have to sign a surgical consent prior to the operation that you're agreeing to do the procedure you understand the risks and the benefits. And sometimes the wording can be kind of funny. I think the one that I find the most confusing for patients is something called a modified radical mastectomy. And so it sounds very scary but pretty much what it means is that it's a mastectomy. Plus we're also doing the lymph node dissection at the same time. And so I always spell that out for patients that way they know the different components that are all lumped together in the same term. It's important to ask what type of anesthesia you'll be receiving. Is it a locally anesthesia or twilight will be generally anesthesia. Would you expect there to be a breathing to place with which you wouldn't remember but you might get a scratchy throat afterwards it's just good to know that that's what that could be from. What exactly will be removed during the operation is it just breast tissue is that lymph nodes. It's made size for the lumpectomy and does your surgeon expected to be some type of cosmetic defect, because if that's the expectation then sometimes some plans can be started ahead of time to, to help to treat that. It's also important to ask about the risks for the operation. Most commonly the risks involve bleeding infection, a poor cosmetic result or reaction in anesthesia. So you can also ask your doctor what the risks are so for patient blood then there's the risk for bleeding increases. For patients who are diabetic or have other issues sometimes the risk for infection is higher than normal. So it's just good to know what to expect and you could even ask what the treatment would be if one of those issues happens to occur. It's just good to ask what's expected during the recovery after surgery. It's typical to feel more tired than usual. It's important to listen to your body and to rest when you need to, but also it's really important to walk very frequently after surgery. This will help you to feel better give you more energy. It's something that's pretty easy for the body to do, but it also greatly reduces your risk for developing blood clots. If you're in a home and don't move around. Unfortunately, you could get a blood clot which is very serious. So that's just a simple way to help prevent that. It's important to expect how intense the pain will be, and what type of medication is typically necessary. Is it something over the counter. Will you get a prescription. How often do they expect does your surgeon expect you to take the medication. Can you use ice packs after surgery. And so for my patients it depends on the surgery so ice packs help a lot with breast pain after a look back to me but if my patients having a mastectomy I don't have them use ice packs because then it can start to affect the blood supply. And then what are your restrictions after surgery. When will you be able to drive again. How much of a lifting restriction will be for how long will this affect your job. And also it's important to ask what type of dressings will be placed on the incision. Will the dressings need to be changed. Will you need help with that. Do they expect to have to place a drain. Will you need a home care nurse, especially if you have a drain placed. And when will you first go for your follow up appointment so typically it's a week or two after surgery when that pathology comes back. So it's best to know when to expect that to be so you can make sure to attend the appointment and you know to bring any of your family who can help to listen to the pathology result also. And also what other specialists do they think that you'll need to meet either before after surgery so this could include plastic surgeon a medical oncologist, radiation doctor, even a genetics counselor, and ask them what the timing would be sometimes this is set up before surgery other times we wait until after the pathology comes back. So next important thing with breast surgeries coordinating care with your other doctors. So this is really improved as as breast centers have increased over the past number of years. So the first breast center was the Van Nuys breast center, which was found in the 1970s out in California by Dr. Milton Silverstein. And before breast centers were developed patients complained that their work up and treatment for breast cancer was very fragmented. There was long delays occurring between each step in the process. And we used about when to do which step. These breast centers help to centralize the diagnostic work up and treatment for breast cancer. So, then in 2008, the National Accreditation Program for breast centers began we call this any PVC. And this is an important program because it has a series of standards that the accreditation focuses on the multidisciplinary treatment of breast cancer. This includes presentation of a patient's case at a multidisciplinary breast conference. Also this leads to improvement in the quality of care and programs who participate in this accreditation program monitor outcomes for their patients. Also, they made sure to make the criteria so that all different types of hospitals could participate, not just major hospital institutions, but teaching hospitals where there's residents and students and then also just normal community hospitals. So that really across the country you can find different types of hospitals that all have this accreditation, and you know that their standards are all equal. So, each of these accredited breast centers have achieved outcomes that meet or exceed the national standards. The standards that are evaluated are that a multidisciplinary team approach is used to coordinate breast care and treatment and the different treatment options available. It helps to improve access to breast specific information education and support. When our data is collected, they look at quality indicators for different subspecialties involved with the breast cancer diagnosis and treatment. There's ongoing monitoring and improvement of care for the patients. And there's also information available to patients about participation in clinical trials and new treatment options available. It's a very extensive application and the reevaluations every three years and includes a site visit with each reevaluation. So you show the surveyor your program and each of your components and explain exactly what your team's doing. So it's a really good way to make sure you're staying up to date and that you've all the best options available for your patients. So some of the specialists that are on the multidisciplinary team include the breast oncology surgeon, which would be myself, a medical oncologist, a radiation oncologist, the radiologist pathologist, a plastic or reconstructive surgeon, nurse navigator, social worker, genetics counselor, nutritionist, physical and occupational therapist and palliative care. Thank you.


Good morning, Greg. This is Jack Lipton again, and today I'm interviewing Greg Andrews, the CEO of Search Minerals. Good morning, Jack. Greg, before we start, I want to make a point. I've been reviewing your company's public information, and I was quite impressed by the stuff I read on your website about your direct conversion metallurgy, hydro metallurgy, and I just want to tell everyone that I give a seminar on rare earth processing every couple of years, and this last June when I did it, I called Dr. Bruce Moore of U.S. Oak Ridge National Laboratory and asked him to find for me a general information paper on solvent extraction that my audience is typically a few chemical injures are mostly businessmen. So he recommended a paper by Dreisinger from 2013, and I looked at it and I said, wow, this is wonderful because it's so clear, and if you don't understand it, maybe you shouldn't be in the business. So I used it and handed it out and got a lot of reviews, and I didn't think about it again until yesterday when I was reviewing your company's information and found out that Dr. Reisinger is, I believe, a board member, and not only that, he's designed a very clever front-end process for your mind, and I was going to ask you things about grades and minerals, but now I don't have to because I see what you're doing. It's what I really think junior miners should do, which is to understand what they're deliverable is to the next level in the supply chain. Congratulations, Greg. You're the first junior I've ever talked to that actually agrees with me and did that, and I think what you're going to deliver to SS Processing is exactly correct to make a PLS. It's perfect. So it's a great business model. Congratulations. Now that I've talked so much, can you please tell us more about what your company is doing right now and where you are in your development? Well, thank you, Jack. And one thing I would say is when we started off in this business back in 2010, 2011 with everybody else, and Dr. Reisinger has been with us since day one and he is a board member, and we recognized at that time that capital costs were going to be the key driver of what projects are going to move forward. And so when we started off with our resource and finding our product, it was a unique resource in that it hadn't been seen before in terms of the type of resource carrying with Alanine, Ferguson, and whatnot. And so we started off with the normal flow sheet, traditional flow sheet, and David Reisinger then that's when he tried something unique in that he eliminated the grinding, flotation, magnetic, and separation beneficiation issues. So that was what really started our process to make our project more economic with low capital costs so that we could be a scalable technology start small and grow big. And that's what we've started back in 2010 when we first got in this game. Well, that was the exactly correct business model as far as I'm concerned. And I was not aware of what you're doing. And obviously there's a fantasy among junior minors that someone can come and look at some operation and suddenly understand it. Well, I looked at the flow sheet on your website and I do understand it. I understand what's going on here. It doesn't matter what the details are. The plan is first class and if you can deliver sufficient 99.8 percent total rare earths as chlorides to the next stage in the supply chain, well, that's exactly what they want and you're going to get a much better price for your PLS ready concentrate than people who produce a mixed con. I love that nonsense term. Okay, because it's worthless mixed con. But your stuff is first class. So what are your target dates and how much do you expect to produce annually and when? Our production rate right now, Jack, what we're looking to do is we've completed two pilot plants. We completed the $1.9 million pilot plant and we're just finishing off our optimization. And what we're looking for is again to tweak those capital costs and get the operating costs down. Our next steps was then to build a demonstration plant and we're hoping to initiate that and we're looking at doing about a one 100 scale of that. And the key thing there again is to be able to deliver more product for the company's refineries to go down further and get into that offtake sort of discussions that are quite needed now. Our quantities on 1,000 tons per day you could see was about 3,200 tons of mixed rare earth. It is mixed rare earth concentrate right now, but we can change that to be the chlorides or whatever we need in our process to suit the market, but that was the measurement that we started with. And that's at 1,000 tons per day, but we look with our DeepFox addition that we can expand that now to increase that to 1,500 tons per day to 2,000 tons per day, which of course will multiply that number, you know, 6,500 to 7,000 tons per year. Okay, net of total rare earths. Yeah, I see that you don't have the distribution of rare earths in your deposit on your website. Can you give us some idea of what's in it? Which rare earths you'd be supplying? Yeah, once again, we're blessed with our deposit and that we can carry both mainly the permanent magnet elements, neodymium, praesodium and a mix of disposium and terbium. So on 1,000 tons per day production with the 3,200 tons per year, we were produced about 650 tons of neodymium, praesodium, sorry, and about 50 tons of disposium and 10 tons of terbium. So it's quite a surprising mix when people start to look at our composition to see that we can supply all those four elements. All right, in your final step in your flow sheet where you showed 98% total rare earth product, is that the composition, that composition delivered would give 660 tons of neodymium, praesodium, and 50 and 20 of disposium, terbium. Is that what you're saying? That's correct. Okay, look, that would be exactly, exactly what the US Department of Defense thinks they need per year. Okay, now as I'm going to segue here for a second, I was asked today why why Canada is not actively participating in the US current US interest in reviving domestic rare earth supply chain. My answer was simple. Yesterday the Secretary of Commerce of the US met with his counterpart physically in Washington, the Australian Minister of Resources, and what are they talking about? Critical metals and rare earths. Okay, and a lot of money is being, the Australian government has committed to billions of dollars into their resource sector to get the rare earths and other critical metals up and running. Okay, now I go to Canada and I hear a lot of crickets. Okay, so what I'm asking you, I read on your website that you have very good relations with both the federal and provincial governments of Canada on your project as it should be because your project seems to me to be an excused expression shovel ready. Okay, so I'm wondering, Greg, what's your opinion on why the Canadian government isn't doing more? That's a simple answer. The Australians are really pushing this and why is, I did a study years ago and I can tell you that most of the deposits undeveloped on this planet or in Canada and of those half of them are in Quebec and where you are a little further east of the Labrador. So what's going on, Greg? What's your opinion? Well, I can say that with the government funding that we've been getting, our funding with the provincial and federal governments have been for our pilot plant with a co-op, which is the Atlantic Canada Opportunity Agency and Innovate NL, which is provincial. But we also work with NRCan and that's the federal division and we're working with them and I know that they're talking, they've been into Washington and been in those boardrooms and talking and being representation of Canada's contribution. And maybe we're just not pushing hard enough and being vocal enough and we just have to continue that because it's certainly very timely and we have participated in the request for information to the US back in July. So they're well aware of search and search is deemed a domestic supply under that Defense Protection Act. So we qualify for that to make sure and yeah, so it's very positive in what we're trying to move forward to and we have to continue to engage our Canadian government. We have very strong support at the provincial level and I know they're engaging with their counterparts in the federal part of the government also. I'm interested in also in the fact that your pilot plant or demonstration plant at 1% of the total output projected is exactly what chemical engineers require when they're proving a concept with a pilot plant. I congratulate you because you're the first junior minor I have ever met honestly that knows that. People keep telling me, well, I made three grams in the laboratory and I say, so what? Okay, you're planned output is 3,000 tons. You need to show me a 30 ton plus pilot plant.  They go, huh? Well, you are obviously ahead of me and I suspect Dresinger is involved in this also, but that's good work. So you're doing everything right and where are you in the process of raising capital? That's a silly question to a junior. Yeah, so where we're at now, Jack, is a couple of months ago we were simply a company that had the Foxtrot resource which was a 14 year life mine, eight years open pit, six underground and we've been working on our project DeepFox which we were able to create a resource out of only drilling down to 100 meters and spending a million dollars. So what that has done for us is added more material so that we can update our PEA and that's allowing us to increase the production rate which allows us to have better economies of scale. So that's really been in the last couple months, like I said, is kind of the new beginning of search of really identifying this district with two resources within close proximity in a district that's 70 kilometers long and that's all led by Dr. Randy Miller and his team, another PhD who has been with us since day one that's leading the charge on the resource. So that's what's really got us focused that we can now look at those economics and really enhance this district and build it out. When do you expect this revised PEA to be done? We're going to probably look for that later in the year probably the third quarter next year and the reason that we want to do that is with the drilling only down to 100 meters even though it's a resource going down to 200 meters for $600,000 is quite significant in changing the economics which is important. That was the plan and so that's exactly what we're going to do, increase the resource and then do the PEA. Assuming that you can raise the necessary capital, when do you expect to have production? In the perfect world we would say probably three years for a decision to build and one year to build. Okay. So four years. Well, look, I think that you've been flying under my radar anyway and I'm now going to follow your company very closely because I think you're doing everything right and I would say it's amazing but the amazing part is that I didn't know it. You've been working and congratulations on that and I wish you the best of luck and I certainly want to follow your developments and I really look forward to when Driesinger publishes a paper so I can read what that process is. Thank you. Well, Jack, one thing I will comment on is we were working hard like the pile plant was in 2006 and 2016 and 17 when no one was really working in Rarus but we have such a great deposit in technology we continued to work and that's paying off the dividends now. I'll tell you something that puts you in the same class as Linus for example and even Northern Minerals. Both of them continued slogging through and at times when they were looking to see if the sheriff was coming with the quick notice. So congratulations again. Good luck. Thank you, Jack.


It's been a while since we talked like I mean Really talked for those of you don't know me. My name is Isaac. I'm 21. I'm from Winnipeg, Manitoba, Canada and I'm scared to get older at least sometimes Maybe a lot of times Let me just explain how I think about life and I know this is going deep really quick But look we ain't got much time. So literally and figuratively I Think of I think of life in this way, right?  And along the way you're trying to figure out what is your thing, right? Your purpose Finding meaning in your life. What are the things that you enjoy? What are the things that you're striving towards your goals your aspirations? Finding success in some way and so along the way, you know finding meaning through maybe a spouse or marriage or and kids and all that kind of thing And so you're in the stage of of you know, especially in teens young adults You feel like you're in the in-between, right?   You'll never get there You're scared that you'll wake up one day and you'll be 30 and you've never accomplished anything or you'll be 40 and You've never accomplished anything and you've wasted The years you have what people talk about You know, what's insane to me. I hate when people do this.  We we think At least in my mind, I think I've always wanted to get to a place or a certain specific goal Where certain things measure up and they line up and for at least one moment of time where I have, you know I'm financially sad and I'm relationally set and I am, you know Emotionally set and and all these things align and then I've made it. I've won. I've done it I've accomplished what I wanted to do and I can be at peace, but that doesn't exist. I Have to believe it doesn't exist Every everything I watch every person I talk to that that has that has accomplished what they wanted to accomplish They're still hungrier. They're still looking for approval. They're still looking for love They're still looking for meaning. They're still looking for purpose so cornering myself off into believing that like There needs to be I need to get to a certain place at a certain time and accomplish a certain thing in order for me to be happy or be fulfilled or be Be accomplished, I think it's a sham I think it's a complete lie along the way my journey over the last two years at least with this ministry I set numerous goals of like stats and and and and all you know A amount of followers or screw subscribers and and goals and aspirations I wanted to get to and each time I would pass one of those milestones. I Would look back and think back and and remember myself Before saying if I can only get here then I would be satisfied then I would be Happy then I would be fulfilled, but I got to that place and then all of a sudden that didn't look too hot Actually that honestly the fact that I got there was a failure in itself because I should have got there sooner and That that applies to a lot of aspects of my life I think of oh when I get to this spot then I'll be fulfilled and then I get there and then I Then I take it as a negative because it took me a lot too long to get there because I should be further along than I am and so you you you torture yourself because you have these expectations that are You have expectations, but on top of those expectations is your is your really life motivation It's it's connected to that So if your expectations aren't met Then your life motivation is just shriveled up your meaning your sense of purpose your sense of peace is all connected to that every day Every day that I don't feel like I've I've made a dent like into something more something meaningful something that Something that has legacy to it Every day that I haven't done that I feel I Feel angry I feel frustrated I feel discouraged and so I feel like in some ways every day I wake up with that motivation to to do it to make it To to to tap into that more that that God would have for me But but along the along the way things pop up like my own desire to find love and and and acceptance from other people and to find Find identity right as long as I find my identity in in in my productivity, I'll never find peace Right because I'll never be productive enough to give myself license To let go Because it will never be enough It will never be enough and I think God designed it that way he designed it that that That we can do we can wake up early we can You know Grind and we can rise and grind or whatever the whatever the heck we can do all that We can strive we can even make an impact But at the end of the day if if our identity is disconnected from the one who who created us We will always be disconnected from who we truly are in Christ And so as long as I find my identity in in being that kind of person that makes an impact or find that identity in Being somebody that is is successful or or somebody that is productive or somebody that is smart or or Liked or loved as long as I find my identity in that I Will always be disconnected from who I truly am and I will never find the piece that passes all understanding and So what I'm trying to do and I know this is just a weird big therapy session I guess but you need one of those every once in a while what I'm trying to do What I'm trying to do is tap into My identity in Christ step into that letting go of The proof the the pressure to perform in order to gain God's love but rather as I step into my identity I want My productivity and my faithfulness to God's Work the work that he's given me to be an outflowing of his love and I know I've talked about this before and At certain points in my life. I felt like that was the moment. That's the one. I like I've made it I get it now. I can do it. Yeah, but then I just Would go back to where I was before same mentality same mindset same anxieties and discouragements all fueled by this concept that that That I'm not where I'm supposed to be and that feeds into you know Every year I feel like I'm running out of time and And look I don't want to live this way. I don't think anybody wants to live this way. I love That God I'm thankful that God has given me a desire for more for more more of him and what he would have for me and you know and all that But I'm also I need to be aware and I'm and for those of you who are like this You need to be aware that you need to fight off The Things that will that will steal steal your joy and things that will will take this This identity in Christ and you'll they'll pull it pull it to things that that shouldn't be like identity and In in money how much you're making or your status or how much you're working or you know How how busy you are all these things are? Gonna distract you from the point of all this I Could wake up every day and work my butt off For God but where Where is my relationship with God? Where is my Identity in God because it seems like it seems like sometimes We're the people that Tony Miano gave this example once we're the people that or the young man that goes to the the door Of somebody and knocks on the door and you know older guy answers it and the young man asked If I mow your lawn, can I be your son? And that sounds crazy Guys like no you can't be my son if you just mow my lawn that doesn't make any sense but if that you know that older guy first adopts that young man as his son then the outflowing of that Will be could be mowing his father's lawn and so we're getting this out of order here We're looking for more. We're looking for purpose. We're looking for identity. We're looking for love We're looking for these core like existential Fundamental aspects to our human nature And yet we abandon The one thing that is free the the a love acceptance a peace So glorious as is available to us can only be a gift we can never earn it But it's not good enough for us. We we want to earn it. We want to work for it. We want to find it in other things But it always leaves us empty it always leaves us discouraged it always leaves us asking Is this all there is? When you've got to the peak of where you wanted to go when you've accomplished the things you wanted to accomplish Will it be enough for you? If you're scared of getting older my question for you would be where Where is your foundation? It is it in God's sovereignty Over your life Or is it in your own self-reliance on doing enough earning enough succeeding enough achieving enough To gain God's love to gain other people's love to gain meaning to gain purpose. Where is your foundation? That's pretty much all I have to say. I know this is kind of weird video if you sat to the whole thing Thanks, I Love you guys. I really do and I really am thankful for a platform that I can just get on and talk. I Mean Yeah, we're all working We're all trying to figure this out, you know It takes it takes time takes a lifetime and The more honest and open we can be about what we're going through about what we're feeling Especially with the people around us That can only be beneficial It can only be beneficial Thanks for watching guys. I'll see you next time. God bless


So it was just announced that Aaron Carter not only sold his guns but he's tapering off of Xanax. So we're going to be talking about Xanax addiction, we're going to be talking about Aaron Carter because I've gotten a lot of requests from all of you to discuss it and I'm actually finally going to address another creator who's made I think like over 15 videos about me. So stay tuned. What's up everybody? This is Chris from the Rewired Soul where we talk about the problem but focus on the solution. And if you're new to my channel, what I try to do is take different topics going on in the YouTube community or pop culture, try to see what lessons we can learn from them. So if you're into that stuff, make sure you subscribe and ring that notification bell. And while you're at it, make sure you follow me over on Instagram and Twitter at the Rewired Soul, alright? So today's video, this video and I'm actually going to record a video right after this too. The theme for this video is we need to start recognizing how we justify and rationalize. And this is something that became very apparent to me when I was recovering from my addiction. But this is something that you don't have to be an addict to struggle with this, alright? But it might help you understand what Aaron Carter is going through. So those of you who don't know me, by the way, I'm not a licensed therapist or psychologist or anything like that. My experience is I am seven years clean and sober from drugs and alcohol. I haven't had any drugs, any alcohol since June of 2012. Not only that, but I worked at a drug and alcohol treatment center for a little over three years and I'm currently halfway through my CADC, which is certified alcohol and drug counselor license. Alright, so although I'm not a licensed therapist or a psychologist, I have quite a bit of experience, okay? So anyways, like I said, a lot of you have been requesting videos about Aaron Carter. Um, you guys let me know when he was hanging out with Trisha Paytas. A lot of people were worried that her and Aaron were using together. They did a live stream that was a little, a little odd. But anyways, I started following Aaron Carter on Twitter and yeah, like, I don't know. It's really sad, man. Like you can tell he's going through some stuff. But anyways, he, he recently went on the show The Doctors and he talked about how he's been sober for 10 years or not 10 years, two years. And he said his drug of choice was huffing, right? And yeah, I've worked with a lot of people who huffed and things like that.  Alright, and he says he got those from rehab and he went to rehab and everything like that. Well, people have been worried because not only has he been acting very erratic, but he also owns guns. But anyways, today, after he got a restraining order from his brother, Nick, dude from the Backstreet Boys, he ended up selling his guns. But he also said he's been tapering off Xanax for the last, I believe, five days. I think he did an interview with TMZ, alright? So some of you might be wondering, why is he tapering off of Xanax if he was sober? Right? Because when people hear sober, they think no addictive substances. Well, this is something that's actually quite common. Because again, our braids, they justify their rationalized, right? And this is something extremely common in the realm of addiction where we quit one thing and think it's okay to take another, right? So in Aaron Carter's mind, he felt that huffing was the problem, but he can still use Xanax, right? And Aaron Carter is a prime example of no, you probably shouldn't, alright? Because Xanax not only can it become addictive, but you become physically dependent. And I hope that he's going through some kind of medical detox because Xanax withdrawal is extremely dangerous. And I talked more about this in my video about Jordan Peterson going to rehab just the other day. Now, my experience with that, my primary drug of choice when I first started, it was alcohol. I was a full-blown alcoholic. And then I found my new love, which was prescription painkillers. And in my mind, going from alcohol to painkillers was better, okay?  I'm not hungover. I don't smell like booze. I don't black out, right? But I was just swapping one addiction for another. The last time I tried to get sober about eight or nine years ago before the most recent time, I smoked weed, right? Because I thought, hey, I can do that. And what that did was it led me right back to the opioids and led me right back to alcohol. And this is why most programs, whether it's rehabs or 12-step programs, they teach complete abstinence, alright? There are some fringe programs out there that try to teach like harm reduction, right? But I don't really agree with that. That's my opinion. I haven't seen it work out for anybody. I see people use that as a way to keep using. So sometimes they try to teach you how to use that drug or drink in moderation. It works for some people, but the majority of the time from my experience, I haven't seen it work, and that's one of the reasons I recommend against it. So with Aaron Carter, I'm glad to hear that he got off of Xanax, but this gives me the opportunity to talk about another situation. So the other day I made a video about Jordan Peterson and some people went around saying I was pill-shaming and everything like that. I made a video yesterday morning and I showed all of the statistics of overdoses and addiction rates and everything like that. But a lot of people were upset, but Aaron Carter, Jordan Peterson are examples of how benzodiazepines can become addictive. So I'm about to talk about another creator, and I haven't talked about him. So remember how we're talking about justifying and rationalizing. So I like to think I'm pretty self-aware and I'm about to justify and rationalize. Alright? Like, that's just something that we do. It's part of our nature. So there's another creator out there who has made 15 videos about me at least. Alright? And I've never, to my knowledge, I don't think I've ever mentioned him in a video. I might have mentioned him in a podcast a long time ago once, but anyways, he's a smaller creator and I don't believe in punching down. So here's my rationalization for bringing up this other creator. One is that he's made 15 videos about me. Alright? I'll talk about that later, but combined with his 15 videos plus, I would estimate he's had probably about 10,000 views, maybe more. So my rationalization is, even though I'm a bigger channel, none of my videos have really been getting that many views. Now the other justification for this is Primink has hundreds of thousands of subscribers and the YouTube community is alright with him making videos about me and the distance between my channel's subscriber count and Primink's is much bigger than my channel's and this guy's channel's. But anyways, this creator, his name is Driven Industries. And listen, I don't think he's a bad guy. And I'm going to talk about that in a second. But I felt I would address this because this is a prime time to address it. Because he is somebody who says he's sober and I haven't shared my opinion about it. But he's labeled me as a bully, which I don't really mind. But he's also labeled me as dangerous and here's my problem. He's somebody who says he's in recovery and he's not. Alright? So you don't have to take my word for it because I know it's going to set a lot of people. I try not to judge other people's recovery, but the fact that he's made this many videos calling me dangerous and he has an audience, you know, I feel that we should talk about it because it's important that you know about this too, in case you have somebody who just left rehab and said, hey, I'm taking Xanax and Adderall. So Driven Industries, he says he's been sober, I believe for 26 months now. Now again, you don't have to believe me. I would challenge you to call any rehab facility or any sober living house and ask him this. Can I be in your facility and still take Xanax and still take Adderall? Because something that Driven Industries will try to tell people is that I'm dangerous. I'm not a licensed professional, which I've always found kind of hypocritical because he's giving all of this advice and he's like not in the mental health industry at all, whereas I've actually worked in it. But anyways, I've worked in rehabs and we don't let people in there who are taking Xanax or Adderall. So Driven Industries is saying it's okay to keep taking Xanax and Adderall. The other issue that I have is he promotes 12-step programs and I don't know. I don't know. Maybe he goes to him, maybe not, but here's the thing. In my experience of seven years sober and thousands of meetings, it would be very difficult for you to find a sponsor who would work with you if you're still taking Xanax or Adderall. And again, if you don't believe me, if you have a loved one, friend, family member who has been to a 12-step program, ask them. Ask them, hey, could you be in that program and get coins if you're still taking Xanax or Adderall? Because my guess is they're probably going to tell you no. So again, although this man has labeled me as dangerous 15 times, people are taking advice from him when he's not really sober. And here's the rule of thumb that I like to use. If you can crush it and snort it to get high, you probably shouldn't take it while you're sober, all right? So people might call that pill-shaming. They can if they want to. But in programs like Narcotics Anonymous, they have literature, as well as in Alcoholics Anonymous, they have literature that talks about taking medications in sobriety. And all of them are pretty clear not to take addictive medications, such as Xanax and Adderall, which driven industries is taking, all right? So the weird thing is, too, if you've ever been to a Narcotics Anonymous meeting, and I'm not a representative of any of these 12-step programs, I'm just sharing with you information about these programs. But in Narcotics Anonymous, one of the readings at the beginning says something along the lines of, let us not be fooled, alcohol is a drug, all right? And it talks about how many addicts have made the mistake of thinking alcohol is not a drug. So based on that, do you think anybody in a 12-step program of Narcotics Anonymous would say it's okay to take medications like Xanax or Adderall? Probably not. And at the end of the day, it's none of my business. Like driven industries, you're going to see this. Take whatever you want. But here's the thing. Like I said, I don't think driven industries is a bad guy. I've been making a lot of videos talking about moral psychology, moral philosophy, and, you know, we all think that we're the hero. We all think that we're right. Like I don't hate driven industries. In his mind, he does believe that I'm dangerous. In his mind, he believes that.  He believes that, right? And it would be extremely hypocritical of me to just say that he's this bad, awful person because before everything happened with me and I was making videos, you know, when I like, for example, talking about Trisha Paytas. In my mind, I was like, this is a bad influence. We need to discuss it. In driven industries' mind, he believes I'm a bad influence. So he's talking about it. So everybody has a right to their own opinion. All right? And in this video, I shared my opinion based on a lot more experience. And I want to end with this. One of my first interactions with driven industries was I think his first video about me, he said something about not caring about peer-reviewed studies, all right? So again, if you're online on YouTube taking mental health or addiction recovery advice from people who don't believe in peer-reviewed studies, you really need to check in with that and see if they're a credible source because I personally, just my opinion, I would not trust anybody who doesn't believe in science and all the studies they've done around mental health and medications and things like that. All right? But again, you don't have to take my word for it. Call any rehab you want. Most of them have a 24-hour hotline. Call one right now. Call any sober living house and say, hey, can I be in that rehab? Can I be in that sober living house and take Xanax or Adderall? There's a reason why they say no. All right? So I wish the best for Aaron Carter. I hope he's getting on a better track. I'm thinking about watching his podcast interview that he did with Adam 22. I think he said he was unimpulsive too. So I might check that out. But anyways, that's all I got for this video. If you liked this video, please give it a thumbs up. If you're new, make sure you subscribe and ring that notification bell. And a huge thank you to everybody supporting the channel on Patreon or getting my books or merch and all that kind of stuff. All right? Thanks again for watching. I'll see you next time.


Wow And you can follow us on Instagram and Twitter for our juicy content There's also some posts on our page follow us on Twitter to see if you can't remember one of our publications BANG BORKING Also, follow us on our personal YouTube channels so you can find us on the description below. Today we're reacting to a devotional song.  Why does that always happen? The times when I'm the most irreverent, it's the most reverential reaction.  You do it on purpose. Sometimes. Bastard! Because I think it's funny. Anyways, this is called Jagadodhara. I don't know if you say that. Jagadodhara. Jagadodhara. And say these names right here. Vandi Guru Parampram and Rahul Velau. I think this is one of the boy kids we've seen before sing. Oh! I think we've seen him sing with the little girl. And the guy the teacher was conducting and going in and out with the stuff with the boy. Alright. And the language of this is Kannada. Cool. Language. Great. Here we go. It makes you feel like you have no talent at all. Incredible. It's insane. The amount of work that I know, if you're watching Young Man, that's more than just your gifting, that's part of it. But the amount of work that I know that you've put in over the years and the joy in his eyes of doing what he was made to do. You know, you can see he's really enjoying what he's doing. That was gorgeous. And I really loved, I thought the whole video was really beautiful. Yeah, the way it was done that he explained actually what he was singing about in parts as well. I thought that was really nice. Really nice. That was so much lovelier than those moments where it would have been fine if he was standing with the beautiful background and he was just letting the music go. But to be taught those things with such beautiful visual work, that was just a really nice video. And a gorgeous, gorgeous song. Yeah. A little kid. What is his name? I don't want to keep calling him a little kid. Rahul, right? Rahul Vela? That's him, yeah? Is it? Rahul. I am 99.9% certain that that's him. I think he said it right at the start. There, Rahul. Rahul. Dude, he got some talent. Beautiful. Not that we, once again, need to tell you that. But you got some talent. That was incredible. Such a beautiful song. And something else to note, I'm pretty sure he was lip syncing. He had pre-recorded that in studio. And he was doing the video, like a lot of music videos are done where it's already recorded. He was lip syncing? Or do you think he was actually singing and then he went over again? Well, he was clearly singing. The way you can tell he's singing it is because you could see the vein in his neck. He was giving the breath. He was giving everything. But I think the sound we had was either pre-recorded and he lip synced, or he sang it here and then went back in and dubbed. Whether he lip synced a pre-recorded thing or he dubbed and matched the visual, that's either one of those is really hard to do with that kind of complexity in the music. So it was either that or you had one of the greatest sound technicians capturing that sound because it sounded studio quality microphone right here. Yeah. So everything about that was great. Great job, man. That was fantastic. Let us know more videos of him or other children. And can make us feel inadequate. Forgive me for butthead at the beginning of this beautiful video. The f**k!


Hello everybody hooded Cobra Commander 788 here, and this is a quick look at the 1987 Cobra jetpack. GI Joe had its own jetpack of course in 1982 It was much smaller and more realistic than this modeled after real-world jetpacks This is not modeled after a real-world jetpack. This is modeled after a brick It is the color of a brick. It is the shape of a brick It tries to answer that age-old question. If you put a jet engine on a brick, would it fly? The Cobra jetpack replaces the previous small Cobra one-man flying vehicle the Claw from 1984 In comparison, the Cobra Claw is exquisitely designed. You could imagine this really flying. The Cobra jetpack is a brick Let's look at the features of the Cobra jetpack. It had two gray missiles that pegged onto these tiny little wings It has a peg for an action figure this four barrel gun on top kind of Moves up and down and that's pretty much it to demonstrate putting a figure on the Cobra jetpack Let's use crystal ball since this is the character that was on the box art And of course crystal ball is qualified to drive an air vehicle He doesn't have a lot else going for him. So yeah, let's give him the Cobra jetpack The back peg on the underside of the jetpack goes in the hole in the back of the action figure That's simple enough. It's not super secure, but it'll hold him on reasonably well Then there are these control sticks on this gray control panel They are too big to fit in the action figures hands, but you can place the figures hands on them Don't force that that will break the figures thumbs if you try to actually force them into the figures hands There you have the Cobra jetpack with the most logical pilot crystal ball That's because if you fly this thing you will want to consult a crystal ball to find out if you will survive Wow, I was actually able to get crystal ball to stand up with this thing on his back I didn't think I'd be able to do that one obvious problem with the Cobra jetpack is severe spinal damage This is a Cobra vehicle. So that makes sense. This must have been designed by Dr. Mindbender. He is just crazy enough to invent something like this. That was a quick look at the 1987 Cobra jetpack. I hope you enjoyed it I do full vintage GI Joe toy reviews on this channel, and I have a huge back catalog Please subscribe and check those out. You can find me on social media on Facebook and Twitter, and I have a website HCC788.com support on patreon helps me continue making these videos So if you'd like to help out, that's a great way to do it. You could get your name in a video I'll be back soon with more vintage GI Joe toy reviews and until then remember only GI Joe is GI Joe


My name is Nancy Movedi. I'm a professor of political science at Tulane University. I'm also the author of this new book. Came out at the beginning of 2019. It's entitled Glass and Gavel, the U.S. Supreme Court and Alcohol. And this is the original cover art depicting a cartoon commissioned by the press, original cartoon art, showing three famous judicial personalities in an imaginary encounter imbibing favorite cocktails. That's Chief Justice John Marshall, Justice Ruth Bader Ginsburg, and Chief Justice William Howard Taft. They all represent different periods on the U.S. Supreme Court and it's a nice way of encapsulating what the book is about and the fun I had in writing it. If I were to summarize the book in a single sentence, that kind of elevator pitch, I would say it's a cocktail by cocktail survey of the history of the Supreme Court, looking at the justices behavior with respect to drinking, drinking in the political culture they were part of at the time, and the justices judicial decision making behavior with respect to cases involving alcohol, alcohol in the Constitution. And there are surprisingly a lot of such cases. So the reason I wrote the book, the reason I decided to do this somewhat unusual kind of fun book, was because I've always wanted to write a more popularly accessible book about the history of the Supreme Court, which is my field. I'm a law and court scholar, American Supreme Court and Con Law studies, are the things I teach, and I'm also a great cocktail aficionado. And so I wanted to marry these two interests and decided that there really was quite a lot of overlap historically and legally between the Constitution and alcohol. And I think we see that right now in the public health and public policy responses to the COVID-19 pandemic. There are a lot of very interesting moments involving the regulation of alcohol, the regulation of drinking behaviors, and some rights issues that those regulations raise. So our current situation in many ways reflects what has been a historical pattern that we've seen really since the beginning of the American Republic. And so what the book does, what Glass and Gable does, is it traces the American cultural history with respect to alcohol. How alcohol was used in popular culture and in political culture to inspire political behaviors and inspire legal questions about how alcohol should be distributed and regulated. So probably some of the highlights of the book concern the different periods of the Supreme Court in which there were special challenges regarding the Constitution and alcohol. One of those periods would of course be the period of prohibition, which spans and includes the tenure of one of the chief justices depicted on the book's cover, Chief Justice William Howard Taft. So prohibition was a constitutional experiment in nationally regulating or prohibiting the sale and distribution and consumption of alcohol. It was a failed experiment because prohibition was of course repealed. But I think what we notice when we look at these different periods of the court and the periods of the regulation of alcohol is that there's a lot of correspondence between major jurisprudential or constitutional interpretation challenges of the time and alcohol's role in helping to shape that jurisprudence and precedence about interpretation of the Constitution. So the book would be of interest to people who are interested in constitutional law and the court. The book would also be of interest I think to cocktail historians because what I also do in the book is encapsulate for each judicial period, and I use the tenures of the chief justices to periodize court history, I use those eras to encapsulate what drinking was going on in the United States at that time, what kinds of alcohol or liquor were popular, what kinds of cocktails were invented, and what sort of social behaviors around alcohol existed. And I do this up through the present era including our current court, the Roberts bench, which coincides with what we might notice is a renaissance in the craft cocktail industry. A renaissance that of course is on pause at the moment during the COVID-19 shutdown of many bars in many jurisdictions. But I think readers who are interested in popular culture and also in the history of cocktails will find the book interesting as well. What I do in each chapter is designate an iconic cocktail for each judicial period that I attach to each chief justice. And sometimes I have good archival evidence that the chief justice did in fact enjoy that drink. Other times I'm engaging in author's license and a legal historian's judgment about what would be the appropriate iconic cocktail for the period, what was very popular, what was an innovative drink of the time, and what swept the nation in terms of consumption patterns. I'll conclude by just noticing one irony, which is that the manuscript was completed and the book went into production just before one of the most famous incidents of the nexus between a Supreme Court justice and alcohol. And that's of course the now infamous moment in the confirmation hearing of now sitting justice Brett Kavanaugh in which he announced to the assembled Senate and members of the attending public, I like beer. Unfortunately, a second edition will have to await my inclusion of this moment and its relevance to our understanding of the U.S. Supreme Court and alcohol. Thanks for your attention. Here's the book again available widely and I look forward to talking to you in some future Q&A about your interests that the book might have inspired. Thanks very much.


Hello friends, a brand new Pokemon Mystery Gift event has just went live in Scarlet and Violet. We're going to cover all of the details in today's video. So earlier on this morning, a brand new Mystery Gift has went live in Pokemon Scarlet and Violet in celebration of the new Piri Piri single that's been released by Yoosabi. To get this Mystery Gift, you're going to hop over into your game, make sure you are connected to the internet and then come down to your poker portal. You'll be able to get this over the internet and you don't need an Nintendo Online subscription to get this. Once you're in the Mystery Gift screen, like we are here, go to the option of get with code or password and then enter the code Yoosabi, Bury, Bury. The code will be on the screen as always and this event is running for quite a long time. It is running until the 28th of February 2025. If you put the code incorrectly, you will be able to see Yoosabi's or more gift appear and then you can click into it and grab yourself this Mystery Gift Pokemon while it is running. So you've got a little while to grab this Mystery Gift event in-game but if you'd like another Mystery Gift Pokemon, why not? Then you can grab this one for free this morning when this event is starting. And as you can see, the Pomot is in a cherished ball. It has the Yoosabi original trainer name as well and then the moves Double Shock, Discharge, Quick Attack and Nuzzle and it does have a classic ribbon attached to it as well. A very nice Mystery Gift to get while the event is running if you do collect the Mystery Gift Pokemon when they do come around. You've been out for this Friday though because there will be another Mystery Gift Pokemon I believe in association with Pokemon Horizons over in Japan. So we'll cover that on Friday morning when we know more information about that one but I hope you found today's video useful friends. Do drop a like if you have. Do subscribe to the channel to stay up to date with all of our Pokemon scholar and violet content and I'll see you all in another video very soon. Take care of yourselves. Bye.


Our next item is a briefing on the aviation five-year capital improvement plan. Mr. Welsed welcome There pro tem Council good afternoon. I'm bill Welsed aviation director for the city of Fort Worth Today, I'll be presenting on the department's five-year capital improvement plan, which includes alliance meets them in Sphinx Hey Kevin, there you go. There's your photo again. Just in case we forgot it. That's actually why I put it there Sorry, let me get this I'd like to start with a few assumptions that we considered as part of our financial planning efforts in relation to our CIP Gas well revenue has declined Significantly, this wasn't unexpected, but it does continue to drop Aviation funding levels are tightening at the federal level and we've seen the impact of this over the last few years With a continual decrease in grant funding demand is high for Fort Worth aviation assets We have a hundred percent occupancy at all three airports And we have for some time with an extensive wait list because of this We're able to maintain our rates and charges at market value while remaining competitive with other regional airports Here are a few of our goals pertaining to CIP development over the next two years. All airports will develop a new master plan federal funding will cover 90% of that cost Although we're representing a presenting a five-year CIP for your consideration We actively manage a 20-year CIP to anticipate funding shortfalls 10 15 years out This also gives the state and FA justification for increased funding levels One of the more difficult objectives was the gradual adjustments of our rates and charges Over the past four years. We've slowly increased fees to market value Which has in turn prepared us for the downturn in gas well revenues and Finally, our goal is to maintain a three-year grant match reserve We expect a minimum level of funding per year for each airport from the state Through the FAA with counsel's approval. We provide the match to secure these grants It's not uncommon for additional funds to become available at the end of the year This three-year reserve allows us to accept these additional discretionary funds if they come available Now we're into the individual airport capital improvement plans Alliance the primary project at alliance is the dual runway extension project total project cost is around 250 million We expect completion in 2017, but with the rain we've seen this could get pushed well into 2018 We'll continue to apply for needed federal discretionary funding to complete to complete this project for years 2018 through 2021 entitlement funds will be used for many of the improvements which is calculated off of the cargo tonnage handled by alliance Since alliance is cataract categorized as a commercial airport. We get the benefit of this fairly dependable revenue source with these funds in 2018 will rehabilitate and replace some of the existing runway and taxiway lighting components and in 2019 will move to the runway shoulders for rehabilitation With the type of aircraft and level of operations alliance sees it's time to begin replacing some of the taxiway pavement on the airfield in 2020 we intend to replace taxiway foxtrot and papa The two pieces of pavement shown in blue which will ensure continued safe operation on those two runway access points Finally in 2021 will rehabilitate taxiway pavement across the airfield extending the useful life of all pavement on the airport Meacham airport CIP is focused on reinvention Over the next two to three years. We're going to see a rapid change in the in the appearance of Meacham airport This has been driven primarily by our limited gas or revenue funds in 2017 will have completed phase one of the airport frontage improvements Which includes placing all overhead utility and electrical wiring underground Phase two with council's approval will replace all fencing with black ornamental perimeter fence with most strip and New gates as well Phase three isn't programmed until 2022 but with a recent total on Chesapeake settlements, we may be able to move this phase up Which includes new sidewalks landscaping and new lighting The Meacham administration building will be complete in January of 2017 This is already funded American Arrow the new Meacham FBO is excited about the anchor tenant Excited about becoming the anchor tenant in this facility We also have all of our other tenants moving back into the building from the temporary facilities that we set up Also in 2017 we expect to receive a grant for the construction of taxiway echo Which runs along the front of the Texas jet FBO and provides access to numerous tenants at the north end of the airport In 2018 we'll begin the process for redevelopment of the old runway 927 land in partnership with the state Many of the businesses at Meacham are excited at the opportunity to expand into this area 2018 will allow for a coordinated master plan effort by the city state and tenants in 2019 will construct new parallel taxiway tango That's the name of the taxiway tango which gives access to undeveloped land on the west side of Meacham and in 2020 and 2021 will begin Rehabilitating tax away's Juliet and apron Delta taxi lane. I know the mayor pro tem asked for a kind of a schematic design I couldn't help it. I had to show it how it exists today This is the new administration building as it stands today This photo was just taken completion as I mentioned is expected in January of 2017 But I would say along with the Alliance project rain could delay that completion date This is a schematic drawing of the front of Meacham airport. That was made a good two to three years ago we're making progress on it the the Wall has been constructed and the entrance Here on the south end Has also been put in leading up to the administration building Spinks Mr. Jordan We have a lot happening at Spinks as well with the new perimeter road construction being complete in spring of 2017 Airport vehicles including loaded fuel trucks will now be able to drive around the runway instead of across it It also opens up access to undeveloped land to the north of the FBO and establishes access to the new Community fire station 42 which will serve south for a worth Also in order to meet yes, I agree our financial goal of making Spinks financially Self-sustainable we're proposing to buy out the leasehold interest in specific hangers at Spinks in 2017 This allows us to receive revenue for the hangar itself and not just the land that it's built on We expect that Spinks will cover its own expenses right Aaron by 2021 Also in 2018 will replace and expand tax away Charlie Which will again open up land for hangar development on the northeast side of the airport? Spinks airport is seeing a significant jump in developer interest and in response were prioritizing access to undeveloped land Also in 2018 will begin construction of the 12-unit hangar complex previously approved by council This is a schematic design of station 42. It'll be located Just off of the new perimeter road on the northwest portion of Spinks Airport We're moving to LED airfield lights in 2019 and we're looking forward to the energy savings of this project Maybe it'll help you balance the budget Aaron and finally in 2020 will begin We'll begin the process for extending the runway and parallel tax away at Spinks through an environmental assessment and construction planned in 2021 Now this project is dependent on the type of aircraft based at Spinks as well as the transient aircraft that operate out of there The transient aircraft that we can attract to Spinks We believe it's needed. We've we've known this for some time The numbers show this to be the case and the tenants have expressed their support for many years now Over the next 20 years. We're looking to ensure we have a diverse and dependable source of revenue for our CIP needs Our ability to cover CIP expenses through operating pay-as-you-go funds is Improving all of our equipment and some of our grant matches are now being made through operating revenue The decision by council to establish the aviation trust fund and the annual investment income Realized puts us in a more competitive position to seek additional Discretionary funding and to keep rates at a competitive level Although gas will revenue continues to drop. We're still seeing the benefits of this revenue Our goal is to spend these one-time funds in a manner that produces long-term operating revenue and Finally the FA continues to recognize the Alliance land credits that have been so valuable to the runway extension project at Alliance We expect these credits to assist us with our Alliance Airport grant matches through 2026 total investment for our three airports over 60 million dollars Over the next five years for Alliance Airport 27 million from each of them and 23 million for Spinks That's with no private dollars considered The department's next step is to seek council approval of the five-year CIP at the June 28th council meeting And with that I can take any questions you might have. Well Bill excellent Presentation I want to commend you and the entire aviation staff for the great work that you all are doing It's clear that the four airports are really going in a great direction And refresh my recollection in terms of an economic impact study. I know that there was one I don't know it was with mechum Spinks or all three, but because I know there's an out There's an old economic impact. So at least with mechum. What's the status of that? That's a good question We actually do not have one programmed right now We do have the existing studies that shows just over a quarter billion dollars annually from each of my report alone But we will take a look at that and see where that falls in our capital improvement plan to update our economic impact Study yeah as councilmember German Zimmer and frequently remind us the city forward has a rich aviation history And it's great to see that the city's airports are progressing very well And the city is making much-needed improvements at the airports To keep up both with trends in the general aviation industry private industry and the whole aviation industry as a whole so Any comments or questions for mr. Well said? Yes, sir. Great job. Thank you. All right