EP 290 SUB __HOT__
The rail cost adjustment factor (RCAF) is an index formulated to represent changes in railroad costs over time. The Surface Transportation Board (Board) is required by law to publish the RCAF on at least a quarterly basis. Each quarter, the Association of American Railroads (AAR) computes three types of RCAF figures and submits those figures to the Board for approval. The most recent RCAF figures are below.
EP 290 SUB
Tommy Stoner served for over 29 years in the U.S. Army as both an enlisted soldier and as a commissioned officer with the majority of the that time in the Special Operations community including the Ranger Regiment and the Special Forces. Tommy joins Robert and Paul on this episode to discuss his career and what he's doing now with the Social Operations Transition Foundation.Taped at 15 Perry Street.______________If you enjoy our content and you want to help support our show, visit to become a donor of our podcast for as little as $2.Affiliate:UnCanna - use code Mentors4mil for 10% offFollow Mentors for Military:Instagram: : : :
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Special guest Christina Warren joins the show. Topics include the App Store and antitrust, the general crumminess of video streaming service UIs, and historical examples of when Apple gets something wrong.
0:00:00.2 Ruth Werner: Join Til Luchau on a floating raft house in Thailand, surrounded by a jungle eco-preserve for 10 days of myofascial bodywork, Zoga movement and restorative learning starting February 20th, 2023. Or join Til for some powerful at-home learning with his monthly subscription, giving you unlimited access to more than 35 curated classes including advanced myofascial techniques, movement for bodyworkers, Feldenkrais and more. It's super affordable, and you can pause or cancel at any time. Sign up now at advancedtrainings.com.
0:00:41.7 RW: Hey, I Have a Client Who listeners, did you know I have a growing library of NCB-approved one-hour online self-paced continuing education courses that you can do any time, anywhere? Well, now you know. Current classes include, What's Next? COVID-19 Updates for Massage Therapists and A Massage Therapist's Introduction to Pharmacology Pt 1, and brand new, A Massage Therapist's Introduction to Pharmacology Pt 2. Classes are $20 each, and they confer one hour of continuing education credit. Wanna know more? Visit my website at ruthwerner.com and check it out. Be sure to sign up for my mailing list so you'll never miss a new class.
0:01:37.2 RW: Hi and welcome to I Have A Client Who, pathology conversations with Ruth Werner, the podcast where I will discuss your real life stories about clients with conditions that are perplexing or confusing. I'm Ruth Werner, author of A Massage Therapist's Guide to Pathology, and I have spent decades studying, writing about, and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice. And sometimes, as we have all learned, that is harder than it looks. Today's I Have a Client Who story comes from a massage therapist who got quite a surprise while they were working with their client's neck. And it goes like this, "Dear Ruth, I have a client who has a deep brain stimulation or DBS device. I'd met this gentleman at the franchise I work at a few days a week, and it wasn't mentioned in his previous SOAP notes or it slipped somebody's mind, I'm not sure, but you can imagine my surprise when I went to work on his lateral neck and felt either the tightest, thinest sternocleidomastoid I've ever palpated, or a bass guitar string under his skin."
0:03:04.9 RW: "Palpation plays such a huge role in what we do as therapists. And thankfully, my thumb felt this just as I was about to progress into an effleurage down and across his traps. He obviously picked up on how I went posterior to it and then palpated up and down, and finally he let the cat out of the bag about the device. It's like a pacemaker for his Parkinson's. The battery implanted in his chest and the cable runs along his SCM into his skull, delivering small electrical impulses. And he admitted that he somehow forgot to mention this. He had difficulty speaking at times, but it was definitely an interesting learning moment for me. I had no idea such a thing existed, never came across one with other patients who'd had Parkinson's. And as I read and learn more, apparently, DBS doesn't work for everyone, but for him, it seems to get the job done. He's used to it and says he's never had any issues. Have you ever come across this device?" Well, contributor, that must have been a shock. We could make this into an episode about the importance of good client intake forms so this kind of information gets communicated even in high traffic settings like spas or franchises, but let's not. Also, here is a long awaited I Have a Client Who story about someone with Parkinson's disease.
0:04:28.1 RW: But DBS is used for many conditions other than Parkinson's, so I'm gonna put Parkinson's off until I get a question with a more specific focus on that condition. So for today, let's turn our attention to deep brain stimulation devices because this is really cool. Parkinson's disease, essential tremor and dystonia, and we had an episode about dystonia quite recently. These are all movement disorders, they can involve tremors, that's arrhythmic oscillation of one or more parts of the body, usually on a single plane, or movement disorders can involve random choppy multi-plane muscle contractions. Tremors and contractions might be painful, they often interfere with basic activities of daily living. These disorders can also involve problems with muscle tone, this can look like rigidity in parts the body, especially in flexure, like the abdominal muscles and flexures of the upper extremities, and unsteady gait, and bradykinesia, technically that means slow movement. Brady means slow and kinesia, of course, is movement. But in practical application, we use the term bradykinesia to mean that it is really hard to initiate movement. People talk about feeling stuck or glued to the floor when they wanna move, and then that movement might be over-exaggerated because it takes so much effort once it begins.
0:05:58.9 RW: You can imagine this is exhausting with tense, tight muscles, a high risk of falling and lots of other challenges. But what if we could send a controlled and targeted electrica