Pediatric Meltdown

How can we help teens with bipolar disorder manage their symptoms and transition successfully into adulthood? 

In this (part 2) episode of Pediatric Meltdown, host Dr. Lia Gaggino and child psychiatrist Dr. Jeanette Scheid discuss managing bipolar disorder in young adults during major life transitions. From medications for bipolar disorder in youth to support resources, they explore how parents and healthcare providers can identify early signs of a bipolar manic or depressive episode and implement effective treatments. Dr. Scheid shares practical strategies for maintaining stability, including sleep schedules, substance use prevention, and the vital role of college support services. 

Whether you're a healthcare provider or parent seeking to understand bipolar disorder treatment for teens, this conversation offers clear guidance for helping young people thrive.

[00:33 -10:28]   Critical Warning Signs and Transition Risks for Young Adults with Bipolar Disorder

• Poor sleep patterns often emerge as one of the earliest indicators of potential manic episodes
• Early symptom recognition training for both parents and youth helps prevent severe episodes
• Regular psychoeducational conversations with everyone in the youth's support system enhance management success
• Living independently introduces new challenges that require careful monitoring and support

[10:29 - 19:29]  FDA-Approved Medications for Youth Bipolar Disorder: A Primary Care Guide  

• Key antipsychotics including aripiprazole, quetiapine, risperidone, olanzapine, asenapine, and lurasidone are FDA-approved, for adults with bipolar disorders.  There are fewer medications approved for youth due to lack of clinical studies.  
• No anti-seizure medications currently hold FDA approval for bipolar disorder in youth, though some are approved for adults
• Most common lithium side effects include headache, nausea, increased thirst, and mild tremors
• Regular thyroid function monitoring is essential, often requiring collaboration between pediatricians, endocrinologists, and psychiatrists

[19:30 -39:22]  Understanding Lithium Treatment in Youth Bipolar Management

• Therapeutic window for lithium is narrow, ranging from 0.6 to 1.2 milliequivalents per liter, requiring careful monitoring and frequent lab work
• Dehydration and changes in salt balance can trigger dangerous lithium toxicity levels
• Family medical history plays a crucial role in treatment decisions, as demonstrated by cases where lithium proved more effective than second-generation antipsychotics
• Regular lithium level monitoring (1-2 times yearly) is necessary for stable patients, with more frequent checks during dose adjustments

[39:23 - 50:50] Building Knowledge Bridges: What Primary Care Needs to Know About Youth Bipolar Care

• Utilizing child psychiatry access programs as learning resources for medication management
• Understanding safety profiles of common medications, even when not directly prescribing
• Recognition of medication effects similar to monitoring diabetes care in primary practice
• Value of ongoing consultation with psychiatric specialists for medication questions

[50:51 - 1:04:37]  Closing segment Takeaway

Links to resources mentioned on the show

Resources Part 1:

AACAP Facts for Families:  Facts for...

In this episode, child psychiatrist Dr. Jeanette Scheid joins Dr. Lia Gaggino to discuss the complexities of pediatric bipolar disorder, and sorting through the diagnostic possibilities is central to making an accurate diagnosis  Dr. Scheid offers insights to tease out what are the childhood behaviors that are developmentally normal, for example imaginary friends, and  what are concerning symptoms such as auditory hallucinations.  Dr Scheid highlights the critical role pediatricians play in the early identification of youth bipolar disorder with enormous implications for decreasing serious illness in adulthood. 

With mental health in children becoming increasingly important, this conversation offers practical guidance for pediatric clinicians.

[00:33 -10:49] Key Diagnostic Criteria for Bipolar Disorder

• Major depressive episodes often appear as the first signs, lasting at least 2 weeks with predominantly low mood
• Grandiosity and racing thoughts are significant indicators, particularly when accompanied by uncharacteristic risk-taking behaviors
• Sleep patterns change dramatically, with some people feeling rested after less than 3 hours of sleep
• Increased talkativeness, faster speech, and heightened distractibility are common symptoms

[10:50 - 19:01]  Challenges in Early Identification

• Distinguishing between normal childhood behavior and pathological symptoms
• Complexity increases when combined with autism or intellectual disabilities
• Initial misdiagnosis as oppositional defiant disorder or treatment-resistant ADHD
• Need to differentiate between typical defiant behavior and true mood episodes

[19:02 -31:42]  Understanding Trauma's Relationship with Mental Health Symptoms

• Trauma symptoms can overlap with other mental health conditions, making diagnosis complex
• Flashbacks from trauma can present similarly to perceptual disturbances or hallucinations
• Content of experiences often connects directly to past traumatic events and safety concerns
• Both trauma and other mental health conditions can coexist - it's not an either/or situation

[31:43 - 32:13]  Adapting Primary Care to Modern Mental Health Challenges

• Pediatricians can't opt out of mental health care, just as they didn't opt out of COVID care
• Primary care providers are being called upon to manage medications when psychiatric access is limited
• Professional relationships and collegial connections make difficult cases more manageable
• There's a growing recognition that early intervention in mental health can prevent future complications, including involvement in the juvenile justice system

[50:51 - 58:26]  Closing segment Takeaway

Links to resources mentioned on the show

AACAP Facts for Families:  Facts for Families

AACAP Resource Center Bipolar Disorder

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What happens when the wealthiest nation in the world fails its children? 

In this short but important solo episode, Dr. Lia Gaggino, speaking as a mother, grandmother, and pediatrician, shares her concerns about the state of children's welfare in America. She addresses multiple challenges facing our youth today, from healthcare and poverty to gun violence and education. As the November 5th election approaches, Dr. Gaggino makes an impassioned plea to voters to consider the impact their choices will have on the next generation. Her message transcends political lines, focusing instead on fundamental human values and the moral imperative to protect and nurture our children. 

After all, as she poignantly asks, “who will lead, teach, build, and protect our nation if we continue to fail our children today?”

Links to resources mentioned on the show

CDC https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html

Commonwealth Fund:  https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison#:~:text=Recent%20Maternal%20Mortality%20Trends,deaths%20per%20100%2C000%20live%20births.

Annie E. Casey Kids Count:  https://datacenter.aecf.org 

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Key quotes for Twitter:

"In the United States, 25% of children live in poverty. 50% are covered by Medicaid insurance."... Dr. Lia Gaggino on the child poverty crisis

"Should they bleed out on waiting room floors? Should they die of sepsis because they can't get the care they need to treat a miscarriage because doctors are afraid in states that ban all abortion?".... Dr. Lia Gaggino on the reality of abortion bans

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What if the key to happiness lies in thinking like a toddler? 

Dr. Lia Gaggino's Pediatric Meltdown podcast features Dr. Hasan Merali, who unveils the wisdom hidden in toddler behavior. Uncover the science behind child development, learning how to handle toddler tantrums and why the "terrible twos" might be a misnomer. Dr. Merali offers unique parenting tips, from encouraging kindness to establishing sleep routines. Explore how childhood creativity can enhance adult life, and gain strategies for improving work-life balance. This episode challenges conventional wisdom about child behavior, offering fresh perspectives on fostering kindness and learning from kids. 

This episode will leave you eager to embrace your inner toddler and find joy in life's little moments. 

[00:33 -11:26]  Toddler Brain Development and Adult Learning

• The less-developed prefrontal cortex allows toddlers to live in the moment
• Toddlers have enhanced visual attention, noticing tiny details adults might miss
• Young children think differently due to fewer preconceived notions
• Toddlers exhibit twice as much laughter as adults

[11:27 - 22:28]  Positive Mindset: Reframing Tantrums and Embracing Toddler Traits  

• The median time for a toddler tantrum is 3 minutes, occurring on average once a day
• Changing vocabulary from "Terrible Twos" to "Terrific Twos" promotes learning from toddlers
• Toddlers have a basic tendency to be nice to others, even when faced with selfish behavior
• Toddlers focus on building relationships and learning

[22:29 -30:14]  Self-Talk Strategies: Enhancing Adult Mental Well-being

• Self-talk is prevalent when kids are little, especially in the toddler preschooler age
• They use it to guide themselves through tasks and to encourage themselves
• MRI studies show we can decrease our emotional reactivity if we talk to ourselves in 2nd and 3rd person
• Instead of "What am I feeling right now," ask "What is [your name] feeling right now?"

[30:15 - 39:18]  Toddler Sleep Routine for Better Adult Sleep

• No screens 1 hour before bedtime
• Take a hot bath or shower to cool down core body temperature
• Perform a quiet activity, preferably reading
• Plug your phone in a different room, not beside your bed

[39:19 - 45:41]  Closing segment Takeaway

You can reach Dr. Hasan Merali

LinkedIn: https://www.linkedin.com/in/hasan-merali/

X: https://twitter.com/Hasan_Merali

Facebook: https://www.facebook.com/HasanMeraliMD/

Links to resources mentioned on the show

1. Dr. Merali, website: HasanMerali.com
2. Book:  Sleep Well, Take Risks, Squish the Peas:  Secrets from the Science of Toddlers for a Happier and More Successful  Way of Life:  https://www.amazon.com/Sleep-Well-Take-Risks-Squish/dp/0757324711 
3. NYT Article:

What if the key to unlocking your child's potential lies in their natural curiosity? 

In this enlightening episode of "Pediatric Meltdown," host Dr. Lia Gaggino welcomes developmental-behavioral pediatrician Dr. Prachi Shah to explore the fascinating world of child development. Together, they unpack the importance of play in child development and reveal strategies to encourage exploration. Dr. Shah shares her expertise on early brain development and cognitive growth. Discover how play and exploration shape a child's future, and learn easy practical strategies for encouraging your little one's inquisitive nature.

This episode is a must-listen for parents and caregivers eager to nurture their child's innate wonder and set the stage for lifelong learning.  

[00:33 -15:43]  Fostering Curiosity in Young Children: Key Strategies

• Curiosity starts with the child's intrinsic motivation and captures their attention
• Entering a child's world helps adults see things with "a new set of eyes"
• Observing nature, like watching insects or plants, stimulates curiosity
• Simple activities, like using a "play right here stick," can encourage wonder and exploration 

[15:44 - 26:32]  Impact of Curiosity on Academic Achievement in Early Education  

• Higher curiosity at kindergarten correlated with higher academic achievement in reading and math
• At low levels of curiosity, there was lower academic achievement
• Safe, stable, nurturing relationships (SSNRs) provide the foundation for exploratory behavior
• Promoting curiosity can foster academic resilience in children from under-resourced environments

[26:33 -36:22]  Early Childhood Curiosity and Parental Interaction

• Children from under-resourced areas hear fewer words, creating a 30-million-word gap by kindergarten
• Frequent conversational exchanges between parents and children are associated with higher curiosity
• High-quality linguistic environments lead to better academic, occupational, and social outcomes
• Serve-and-return conversational exchanges are recommended by pediatric anticipatory guidance 

[36:23 - 55:50]   Promoting Curiosity in Pediatric Care:

• The American Academy of Pediatrics recommends prescribing play at every well-child visit
• Unstructured play time and playful learning with parents are crucial for building cognitive and social-emotional skills
• Safe, stable, nurturing relationships (SSNRs) are foundational for the development of a child's curiosity
• Pediatricians can encourage parents to engage in scaffolding and special "sunshine time" with their children to boost curiosity 

[55:51 - 01:02:58]  Closing segment Takeaway

Links to resources mentioned on the show

AAP Resources Early Relational Health:  https://www.aap.org/en/patient-care/early-childhood/early-relational-health/

AAP Early Relational Health Implementation Guide:  Early Relational Health Guide

Reading Tips from AAP http://Healthychildren.org Falling in Love with Reading..

Reach Out and Read https://reachoutandread.org

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In the realm of pediatrics, can a child's ZIP code be a stronger predictor of health outcomes than their genetic code? 

Dr. Lia Gaggino examines this critical question alongside pediatric residents Dr. Nicole Hickman and Dr. Kathleen Kelly. These passionate advocates for health equity discuss their innovative work integrating social influencers of health into pediatric residency programs and primary care practices. They address the complexities of tackling food insecurity, housing instability, and other social influencers of health that significantly impact children's well-being.

Drs. Hickman and Kelly provide practical strategies for screening patients and implementing community resource referral systems, showcasing how targeted interventions can yield substantial improvements in care. Their groundbreaking approach to the medical education curriculum and inpatient systems interventions aims to reduce healthcare inequities. Their dedication to advocacy and addressing social determinants in pediatric residency will inspire listeners to become catalysts for change in pediatric healthcare.   

[00:33 -14:46]  The Role of Social Influencers of Health in Pediatric Care

• Social influencers, such as access to healthcare, education, and neighborhood environment, significantly affect children's health outcomes.
• Pediatricians must recognize the importance of community context, economic stability, and access to quality resources in shaping child health.
• Families living in food deserts face challenges in accessing nutritious foods, affecting children's overall health and development.
• Addressing social influencers can help mitigate health disparities, offering opportunities for intervention to improve pediatric health.

[14:47 - 24:08]  Addressing Structural Racism and Intersectionality in Pediatric Health Outcomes

• Structural racism, reinforced through housing, education, and healthcare systems, significantly affects health outcomes, particularly in marginalized communities.
• In Chicago, a stark 30-year difference in life expectancy exists between predominantly white and Black neighborhoods, exemplifying the impact of systemic discrimination.
• Pediatric care must acknowledge and address the broader societal factors, like redlining and economic disinvestment, that contribute to health inequities.
• Developing pediatric training to address structural racism is critical for reducing the health gaps caused by these deeply rooted societal factors.

[24:09 -32:16]  Trauma-Informed Approaches in Pediatric Social Health Screenings

• Using sensitive language during screenings encourages trust, which helps families feel comfortable discussing social challenges over time.
• Normalizing the screening process by introducing it as a routine part of every patient encounter helps build rapport and reduce stigma.
• Pediatricians should reassure families that resources are available to help address needs identified during screenings, reinforcing that support is ongoing.
• Offering social work support and providing a list of community resources upfront can prepare families for future needs, even if they don’t require immediate assistance​(pm03).

[32:17 - 43:44]  Pediatric Screening Tools for Addressing Social Determinants of Health

• The hospital system uses a comprehensive screening questionnaire that includes housing insecurity, food insecurity, and physical violence.
• The tool incorporates questions related to gun access in the home, combining different social screeners and abuse screeners.
• Pediatricians can track outcomes using a closed-loop referral system, ensuring patients receive the resources they need.
• Screening tools are integrated...

How do we address the often-overlooked sexual health needs of individuals with Autism Spectrum Disorder (ASD)? 

Dr. Zakia Alavi, a seasoned child and adolescent psychiatrist specializing in pediatric mental health and developmental disabilities, joins Dr. Lia Gaggino to unpack this critical yet often neglected aspect of care for individuals on the autism spectrum. Drawing from her extensive experience in child and adolescent psychiatry, Dr. Alavi reveals the patterns she's observed in patient referrals, particularly concerning autism and behavior problems, including inappropriate sexual behavior. This frank discussion covers everything from understanding puberty in children with autism to addressing the complex challenges surrounding sexuality education for neurodivergent individuals. 

Dr. Alavi emphasizes the need for tailored sexual health curricula and the importance of behavioral therapy for youth with autism to manage sexuality-related issues. She also touches on the pressing concern of victimization of youth on the autism spectrum and the role of promoting comprehensive sexual education for these youth.. 

Listen in and discover why Dr. Alavi believes sexuality is not just a basic human need, but a fundamental right for all, regardless of their neurodevelopmental status, including those with neurodevelopmental disorders like ASD.  

[00:33 -10:59] Autistic Traits and Abuse Risk

•   Explores the higher risk of abuse due to social awareness and communication deficits in youth with autism.
•   Non-verbal children or those who misinterpret situations are especially vulnerable.
•   Defines sexual awareness as understanding feelings, desires, and sexual situations.
•   Highlights the struggle of youth on the autism spectrum in independently navigating sexual awareness.

[11:00 - 22:49]  Discussion on Sexual Awareness  

•   Defines sexual monitoring as understanding others' impacts on one's sexuality.
•   Emphasizes the importance of sexual assertiveness and consciousness for protection.
•   Single parents, in particular, may struggle with providing comprehensive sexual education.
•   Suggests the presence of another person during these discussions for better handling.

[22:50 -28:59]  Victimization and the Role of Media

•   Notes the heightened risk of victimization, especially among females with autism spectrum disorders. 
•   Emphasizes the need for protective measures and greater awareness.
•   Role of parents and educators in continual skill-building around privacy and sexual norms.
•   Suggests personalized approaches tailored to each child's level of understanding.

[29:00 - 32:13]  Sexuality as a Human Right:

•   Encourage self-reflection about perspectives on sexuality for oneself and others.
•   Highlight the importance of helping children achieve their fullest potential in all aspects.
•   Reiterates the significance of protecting neurodiverse youth from victimization through education.
•   Encourages proactive approaches to ensure youth understand and navigate normal sexual behaviors

[32:14 - 40:00]  Closing segment Takeaway

You can reach Dr. Zakia Alavi

LinkedIn:  linkedin.com/in/zakia-alavi-7289a9118

Links to resources mentioned on the...

Vaccine Hesitancy and Refusal:  Fact and Emotion

Have you ever wondered why vaccines spark such strong opinions, even as they play a pivotal role in infectious disease prevention and public health response?

Join Dr. Lia Gaggino and guest Dr. Robert Frenck as they unravel the complexities of vaccine hesitancy in our pandemic-prepared world. They delve into how the effectiveness of the COVID-19 vaccine and childhood vaccinations paradoxically fuels skepticism, and how public health communication strategies can bridge the gap between medical professionals and parents.

Dr. Frenck shares real-life stories and explains the benefits of childhood vaccinations, emphasizing straightforward conversation to discuss childhood vaccines including the COVID-19 vaccine, side effects, and the importance of herd immunity. Discover strategies for overcoming vaccine hesitancy and infectious disease outbreak management—listen now to rethink your understanding of vaccinations, their role in our society, and their impact on vaccine preventable disease outbreaks..

[00:33 -16:05]  Vaccine Hesitancy and Public Health Challenges

• Infectious diseases like respiratory illnesses, diarrheal diseases, and malaria are still leading causes of death in children globally.
• Vaccines play a crucial role in protecting communities through herd immunity.
• Skipping vaccines can have a significant impact on disease transmission and outbreaks.
• Healthcare providers have an ethical duty to make recommendations and address vaccine hesitancy.

[16:06 - 26:41]  Public Health Challenges: Overcoming Politicization and Misinformation

• Recognize that infectious diseases do not discriminate based on political affiliation, race, religion, or other factors.
• Address the concerning trend of public health becoming a political issue, rather than a matter of keeping everyone healthy.
• Combat the misconception that vaccine-preventable diseases are gone or no longer a threat.
• Highlight the need for expertise, coordination, and preparedness in public health responses to infectious diseases.

[26:42 -35:33]  Mandatory Vaccination Policies for Healthcare Workers

• Prioritizing workplace safety for patients, especially those with compromised immunity
• Addressing concerns about mixed messaging from unvaccinated healthcare providers
• Considering vaccination as a fundamental requirement for healthcare professions
• Highlighting the ethical responsibility to protect vulnerable populations 

[35:34 - 56:57]  Pandemic Challenges: Adapting Medical Practices and Communication

• Acknowledging the need to alter recommendations as new data emerges during a rapidly evolving pandemic situation.
• Emphasizing the critical role of healthcare professionals as experts and trusted sources of information during public health crises.
• Highlighting the ethical responsibility of leaders and public figures to prioritize public health over personal or political gain.
• Underscoring the value of respectful dialogue, finding common ground, and starting from areas of agreement in addressing divisive issues.

[56:58 - 1:09:23]  Closing segment Takeaway

You can reach Dr. Frenck

LinkedIn @Robert Frenck

Links to resources mentioned on the show

AAP Immunization Resources for Parents:

Have you ever wondered how missing a few school days could dramatically alter a child's future?

In this eye-opening episode of Pediatric Meltdown, host Dr. Lia Gaggino and guest Dr. Heidi Schumacher unravel the staggering disparities in school quality and attendance amplified by the pandemic. As a general pediatrician and health policy advocate, Heidi discusses the urgent need for systemic support, the hidden toll of chronic absenteeism, and the crucial interventions needed to ensure educational equity.

While truancy often leads to punitive measures, chronic absenteeism requires a supportive and compassionate approach to unveil the deeper health and social issues behind missed school days. Pediatricians can play a transformative role by addressing these needs early, fostering environments where every child thrives. Are you curious about the actionable steps you can take to combat chronic absenteeism in your community? Listen to this episode now and empower yourself to make a difference!

[04:39 -15:21] Understanding Chronic Absenteeism in Schools

• Chronic absenteeism differs from truancy and includes both excused and unexcused absences.
• Chronic absenteeism is defined as missing about 18 school days a year, or approximately 10% of the school year.
• The response to chronic absenteeism is more supportive rather than punitive, focusing on understanding and addressing family challenges.
• Economic impacts of absenteeism include affecting educational opportunities and potential long-term financial stability.

[15:22 - 26:48]  The Critical Role of Health Professionals in Boosting School Attendance  

• Clinical visits offer an opportunity to discuss the importance of regular school attendance with families.
• Some clinics are piloting the addition of questions about missed school to pre-visit questionnaires or child check-ups.
• By understanding the reasons behind missed school days, health practices can address specific needs that may hinder attendance.
• Collaborating with school nurses and advocating for more healthcare resources in schools can improve attendance and engagement.

[26:49 -35:25]  Addressing Barriers to School Attendance through Health and Community Support

• Factors such as toxic exposures, food insecurity, and lack of reliable transportation are identified as key barriers that affect school attendance.
• The lack of reliable electricity, food, and secure housing strongly correlates with issues in school attendance.
• Pediatricians are encouraged to inquire about school attendance when they encounter social drivers or chronic conditions in children.
• Understanding attendance patterns helps identify disparities in educational access related to health and social determinants.

[35:26 - 45:46] The Importance of School Attendance and Engagement Strategies

• The Everyday Counts Summit emphasized the need for federal investments to support school reengagement and consistent attendance.
• Leveraging pandemic recovery funds for enhancing school attendance and engagement has been a focus for many states.
• Collaborative partnerships between government entities and organizations, like the American Academy of Pediatrics, are crucial.
• Evidence-based interventions and localized data analysis are essential for closing equity and opportunity gaps.

[45:47 - 54:28]  Closing segment Takeaway

You can reachDr. Heidi Schumacher

linkedin.com/in/heidi-schumacher-md-3504433

Links to resources...

Have you ever wondered how ancient practices like mindfulness and the Pranayama breathing technique could revolutionize the high-stress environments like the NICU? 

In this episode, Dr. Nitin Ron, a neonatologist with a unique perspective, shares his journey of integrating meditation and compassionate care into his medical practice. From scaling Mount Everest to working in an art museum, Dr. Ron's multifaceted experiences have shaped his approach to healing. Discover how these techniques not only benefit patients but also provide crucial stress relief for healthcare workers, particularly during the challenging times of COVID-19. Learn about the science behind these practices and their potential to prevent burnout in medical professionals. This episode offers a rare glimpse into the transformative power of combining ancient wisdom with cutting-edge medicine, promising a new era of holistic healthcare that nurtures both patients and caregivers alike. 

[05:42 -17:20]  Awareness and Resilience in Pediatric Healthcare

• Babies demonstrate an inspiring ability to have present moment awareness, even in challenging medical situations.
• Healthcare professionals can find inspiration by observing the strength and resilience of babies in the NICU.
• The ability of infants to smile despite medical interventions serves as a powerful lesson in maintaining a positive outlook.
• The practice of pediatrics is referred to as a "calling" rather than just a job, emphasizing its profound impact on practitioners. 

[17:21 - 23:54]  Ancient Breathing Practices Meet Modern Medical Science 

• Pranayama, an ancient Indian breathing technique, has similarities with modern high-altitude acclimation methods
• Research presented at the Pediatric Academic Society's meeting compared ancient pranayama to current medical science
• The book serves as a textbook for meditation and pranayama research, as well as a practical guide
• The project brought together contributors from four different countries, showcasing global collaboration in healthcare 

[23:55 -44:47]  COVID-19 Pandemic: Lessons in Isolation and Community Support

• The pandemic highlighted the negative effects of isolation on human well-being
• Children were particularly affected by the inability to see friends and grandparents
• The crisis emphasized the crucial role of community in maintaining hope and mutual support
• The experience reinforced the importance of human connection and support systems in healthcare

[44:48 - 55:17]  Mindfulness and Meditation in Healthcare: Practical Applications

• Even 3 minutes of watching thoughts without reacting can be beneficial
• Regular practice of meditation helps maintain mental equilibrium, like a movie screen unaffected by the images
• The intention to meditate and practice self-care is 95% of the journey towards happiness
• Research shows brainwaves start changing in 6 weeks with just 8 minutes of practice once a week

[55:18 - 59:34]  Closing segment Takeaway

Links to resources mentioned on the show

Book - Pranayam Breathing:  Techniques for Health, Healing and Tranquility

Pranayam Breathing Techniques for Health, Healing and Tranquility:...