Target heart should be obtained 1) to avoid symptoms of heart failure and 2) avoid side effects of medications such as dizziness. From bradycardia and hypotension. With that said, On average HR 70-80 is reasonable. A heart rate of > 77 bpm on optimally tolerated beta blocker therapy would be consideration for the use of lancora (ivabradine) to help lower the HR further.

The decision to resume anticoagulation in a such a patient must be individualized weighing the risks of recurrent bleed with that of stroke. Consultation with a neurologist would be recommended to help with decision making. Patients considered at significant risk of AF related CVA who are considered at significant risk of re-bleed could be considered for left atrial appendage closure device implantation. There is observational data that suggest that patients considered at low risk of recurrent ICH benefit from resumption of anticoagulation for stroke prevention.

"Yes, it is safe to use an interauterine contraceptive (either copper IUD or hormonal IUS) and use combined hormonal contraception (CHC) simultaneously. The mechanism of action of the CHC does not interfere with the mechanism of action of the IUC. "

There are documented cases where activity tracking or heart rate tracking for example has resulted in tangible consequences. There is a famous case for many years ago when Nike started to have a monitoring apps and one person was found to be "excessively physically active" at a time when he told his partner that he was at work and it was discovered by their partner that they were having relations with someone else. So having shared Data Tracking is something that can reveal things that we don't want revealed.

On the other hand it amazes me that people constantly don't check their social media settings and reveal information about their activity, purchases, location and much more on a regular basis so it's important to do a few things

(1) inform patients of social media risks, and they are multiple
- mental health issues
- FOMO
- body dysmorphism
- disturbed sleep
- misinformation and more
directly to their health and indirectly via data collection

(2) to opt of of data collection wherever possible. This is frequently phrased as 'sending analytic data' to help programmers etc.. TURN IT ALL OFF, and go into the options when setting up apps. Nobody reads the terms and services and sometimes a few clicks will reduce data collection

(3) assess risk versus benefit, like anything else. Does the person really have anything 'critical' that could result from data collection? Insurability issues? work issues ? confidential activities that could be revealed? Is there a benefit to health - are you recommended this for well-defined objectives (as we discussed in the talk where there is noted benefit) or 'general health improvement' and only a vague idea of why it might help? Will it help you adjust the dose of a medication for example - that could be very valuable

"The main finding on examination is documenting orthostatic hypotension. In severe cases, you can also see loss of pupillary reflexes. If we review the different domains affected by the autonomic nervous system: Gastroparesis: On hx, ask for weight loss, early satiety, frequent post-prandial nausea. Not much on exam. You can ask GI for a gastric transit study. Bowel and bladder dysfunction: ask for retention, urgency or urge incontinence, or severe constipation or diarrhea or fecal incontinence. Not much on exam. I don't usually check anal tone for this. Urology can document a neurogenic bladder if needed. Sweating: you can ask for loss of sweating in the feet (expected in all neuropathies as there is usually some autonomic involvement) versus more generalized loss of sweating. Not much on exam. Can be documented on QSART testing in an autonomic lab. Skin changes: These are not super reliable in my experience as other conditions can confound this. In some small fiber neuropathies, you will see change of skin color and swelling in the feet. Loss of hair too. But other conditions (venous insufficiency, weakness, CHF, renal pbs) can all contribute to this so I would not rely too much on these findings."

"The main finding on examination is documenting orthostatic hypotension. In severe cases, you can also see loss of pupillary reflexes. If we review the different domains affected by the autonomic nervous system: Gastroparesis: On hx, ask for weight loss, early satiety, frequent post-prandial nausea. Not much on exam. You can ask GI for a gastric transit study. Bowel and bladder dysfunction: ask for retention, urgency or urge incontinence, or severe constipation or diarrhea or fecal incontinence. Not much on exam. I don't usually check anal tone for this. Urology can document a neurogenic bladder if needed. Sweating: you can ask for loss of sweating in the feet (expected in all neuropathies as there is usually some autonomic involvement) versus more generalized loss of sweating. Not much on exam. Can be documented on QSART testing in an autonomic lab. Skin changes: These are not super reliable in my experience as other conditions can confound this. In some small fiber neuropathies, you will see change of skin color and swelling in the feet. Loss of hair too. But other conditions (venous insufficiency, weakness, CHF, renal pbs) can all contribute to this so I would not rely too much on these findings."

The presence of polyclonal gammopathy may be due to infection, liver disease or an autoimmune disease. So as this condition is non-specific I would rely on the clinical picture to guide my investigation.