thrombosis

This podcast features an interview with Laurie Sardo and Julia Bayadinova, experts on Cancer-associated Thrombosis, from Hamilton Ontario, authors of a series of publications in the Canadian Oncology Nursing Journal on Cancer-associated Thrombosis, called Spot the Clot.

Laurie Sardo is a Nurse Practitioner in the Thrombosis Service, Department of Hematology at St. Joseph's Healthcare in Hamilton. 

She graduated with her NP from McMaster University in 2014, and her Doctorate in Nursing Practice from D'Youville University in 2022. Laurie’s thesis work focused on patient VTE education in the high-risk cancer population.

Her professional interests include patient and staff education and remains active on a number of educational interest groups including the Thrombosis Canada Patient & Family Education committee, the ISTH Nursing committee and the US-based Anticoagulation Forum.

AND

Julia Bayadinova, is a nurse practitioner specializing in Thromboembolism, serving both inpatients and outpatients at St. Joseph’s Healthcare Hamilton. In 2014, Julia graduated from Ryerson University with a combined Master of Nursing and Primary Care Nurse Practitioner Program, and has since found her passion in Thromboembolism. Her research interest lies in patient education. Julia is currently in pursuit of a Doctorate of Nursing Practice degree at Post University and is completing a thesis on the importance of patient education.

In this episode, the two guests review some of the key take-aways from the series of articles.

 The articles can be accessed here:

CAT Series in Canadian Oncology Nursing Journal:

The significance of VTE in cancer: Introduction of the ‘Spot the CLOT’ series

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1234

Spot the CLOT’: What cancer patients want to know https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1262

Spot the CLOT’: Awareness of cancer-associated thrombosis in healthcare providers

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1277/1067

Spot the CLOT: Treatment considerations for CAT

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1372

https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

As physicians taking care of young girls and women with HMB, we are often faced with a challenging patient who is at a high risk for developing thrombosis due to a family history, a past personal history of thrombosis or medical conditions that could be a trigger for developing blood clots. In this podcast, we will be speaking with our experts on thrombosis and HMB to help us navigate through these difficult decision-making scenarios. We will be referring to certain brand names of hormonal therapies as our listeners are familiar with those rather than the complicated generic nomenclature. We will use gender-neutral language whenever possible, but when discussing the results of clinical studies, we may refer to women or girls because that is the language specifically used by the authors. 

Today we are joined by Dr. Brian Locke, recently graduated pulmonary-critical care fellow, who takes us on a journey of avoiding statistical fallacies. Does metformin reduce the likelihood of long COVID? Should we give platelet transfusions to thrombocytopenic patients before central line placement? Did the CANVAS trial change practice in cancer associated thrombosis? Should patients with a stroke due to atrial fibrillation start oral anticoagulation earlier or later? We discuss all these questions on more on today's episode. Check it out!

Metformin for Long COVID
Definition of Post Acute Sequelae of Sars-CoV-2 Infection
Platelet Transfusion before CVC Placement in Thrombocytopenia
DOACs vs LMWH in Cancer Associated VTE
Early vs Late Anticoagulation for Stroke with AF







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In this episode, we talk to Ariela Marshall, a hematologist specializing in disorders of thrombosis and hemostasis (bleeding and clotting) in women. In this interview, we discuss blood thinners, the role of estrogen in blood clots and disorders of thrombosis and hemostasis throughout a woman's life.

Remember to like, rate and subscribe and enjoy the episode!

Guest bio

Dr. Marshall is a hematologist specializing in disorders of thrombosis and hemostasis (bleeding and clotting) in women.  She is a graduate of Harvard Medical School and completed her residency in Internal Medicine at the University of Pennsylvania followed by a fellowship in hematology-oncology at Dana Farber Cancer Institute/Massachusetts General Hospital.  She worked as a hematologist at Mayo Clinic in Rochester Minnesota from 2015-2021 and in 2021 she moved to Philadelphia to became the Director of Women’s Thrombosis and Hemostasis at the University of Pennsylvania.  Dr. Marshall is currently planning to move back to Minnesota in summer 2023 and will establish educational platforms and advocacy initiatives centered on women’s health, particularly women’s blood disorders.  In addition to her clinical work, Dr. Marshall is a medical educator with a focus on career development, leadership, mentorship, and work-life integration.  She has a particular interest in gender equity for patients as well as for physicians.  She leads several national advocacy initiatives, co-chairs several national working groups and task forces, and speaks regularly on a national scope to discuss her efforts to advance fertility/infertility awareness, parental health, and gender equity.  

FemTech Focus Podcast bio

The FemTech Focus Podcast is brought to you by FemHealth Insights, the leader in Women’s Health market research and consulting. In this show, Dr. Brittany Barreto hosts meaningfully provocative conversations that bring FemTech experts - including doctors, scientists, inventors, and founders - on air to talk about the innovative technology, services, and products (collectively known as FemTech) that are improving women's health and wellness. Though many leaders in FemTech are women, this podcast is not specifically about female founders, nor is it geared toward a specifically female audience. The podcast gives our host, Dr. Brittany Barreto, and guests an engaging, friendly environment to learn about the past, present, and future of women’s health and wellness.

FemHealth Insights bio

Led by a team of analysts and advisors who specialize in female health, FemHealth Insights is a female health-specific market research and analysis firm, offering businesses in diverse industries unparalleled access to the comprehensive data and insights needed to illuminate areas of untapped potential in the nuanced women’s health market.

Time Stamps

[04:10] Ariela’s background

[06:00] Definitions - hematology, hemostasis and thrombosis

[07:52] How does bleeding and clotting affect women?

[09:25] Disorders in younger women

[11:50] Contraception

[13:06] Blood clots

[20:39] Blood thinning

[22:58] Sex specific recommendations 

[24:24] The role of estrogen in blood clots

[30:40] Bleeding and risk factors for menopausal women

[32:33] Bleeding PSA’s for women’s health

[36:48] What’s an area of women’s health and wellness that still needs innovating?

[38:03] Insurance for blood thinners

[38:58] What does the femtech industry as a whole need the most right now in order to be successful?

[39:37] Are medical schools starting to have the conversation about sex as a biological variable?

Call to Action!

Don’t forget to subscribe to the FemTech Focus podcast, and leave us a review!

Episode Contributors

Dr. Ariela Marshall

LinkedIn: @Ariela Marshall, MD

Twitter: @AMarshallMD

Dr. Brittany Barreto

LinkedIn:  @Brittany Barreto, Ph.D.

Twitter: @DrBrittB

Instagram: @drbrittanybarreto

FemTech Focus Podcast

Website: https://femtechfocus.org/

LinkedIn: https://www.linkedin.com/company/femtechfocus

Twitter: @FemTech_Focus

Instagram: @femtechfocus

FemHealth Insights

Website: https://www.femhealthinsights.com/

LinkedIn: @FemHealth Insights

In this episode, Daniel J. DeAngelo, MD, PhD; Kjeld Schmiegelow, MD, DMSci; and Emily Curran, MD, answer key questions asked by the audience during a live satellite symposium at the 2022 American Society of Hematology Annual Meeting on optimizing pediatric or pediatric-inspired regimens containing asparaginase for the treatment of young and older adults with acute lymphoblastic leukemia.

Topics discussed include:

• Practical considerations for management of allergy-like reactions and hypersensitivity to asparaginase
• Indirect methods for measuring asparaginase activity
• Strategies to mitigate adverse events with asparaginase treatment, including hepatotoxicity, pancreatitis, and thrombosis
• Considerations for use of asparaginase in special populations (eg, high BMI, older age)

Presenters:

Program Director
Daniel J. DeAngelo, MD, PhD
Professor of Medicine
Department of Medicine
Harvard Medical School
Chief of the Division of Leukemia
Department of Medical Oncology
Division of Hematologic Malignancies
Dana‐Farber Cancer Institute
Boston, Massachusetts

Emily Curran, MD
Assistant Professor
Division of Hematology/Oncology
University of Cincinnati Cancer Institute
Cincinnati, Ohio

Kjeld Schmiegelow, MD, DMSci
Professor
Department of Pediatric Oncology
Righospitalet University Hospital
Copenhagen, Denmark

Content based on an online CME program supported by an independent educational grant from Jazz Pharmaceuticals.

Link to full program:
http://bit.ly/3YXkLyj

In this collaborative episode with JPGN, Drs. Jennifer Lee and Jason Silverman talk to Dr. Danielle Wendel, the first author of the Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group published in JPGN. The discussion highlights important principles to consider and an overview of central line management in this population. Dr. Wendel is medical director of the intestinal transplant program at Seattle Children’s Hospital and Associate Professor at the University of Washington School of Medicine.

This episode is eligible for CME credit!  Once you have listened to the episode, click this link to claim your credit.  Credit is available to NASPGHAN members (if you are not a member, you should probably sign up).  And thank you to the NASPGHAN Professional Education Committee for their review!

Learning Objectives:

1. Understand the potential impact of, and strategies for preventing central line-associated bloodstream infections (CLABSI)
2. Understand the approach to management of thrombosis in the setting of a central line.
3. Review strategies and preparation essential to balance quality of life and medical needs in patients on home parenteral nutrition.

Links:

1. Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group

As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.

Produced by: Jason Silverman

This episode is eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!

As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.

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In this episode have a conversation with Dr Michelle Sholzberg on her recent publication from the British Medical Journal entitled Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial (BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2400) which was co-authored by an international team on behalf of the RAPID trial investigators.

Dr. Sholzberg received her MDCM and residency training in Internal Medicine at McGill University, completed additional postgraduate training in Hematology at the University of Toronto and a research hemostasis fellowship in Toronto and internationally. Dr. Sholzberg has a Master of Science from the University of Toronto in Clinical Epidemiology and Health Care Research and was awarded the Claire Bombardier award for career promise as a scientist. She is a clinician-investigator with a focus on coagulation, the Division Head of Hematology-Oncology and the Medical Director of the Coagulation Laboratory at St. Michael’s Hospital. She is also the Director of the Hematology-Oncology Clinical Research Group and Co-director of the Hematology-Immunology Translational Research Theme of the Li Ka Shing Knowledge Institute. Dr. Sholzberg is the associate editor for illustrated materials at Research and Practice in Thrombosis and Haemostasis. Currently, she is involved in the study of: prediction tools for perioperative and traumatic bleeding, the intersection of women’s health and bleeding disorders, treatments for iron deficiency anemia, new treatments for immune thrombocytopenia and the management of COVID-19 coagulopathy.

Follow us on Twitter:

Dr Michelle Sholzberg: @sholzberg

Thrombosis Canada: @ThrombosisCan

 Reference:

Sholzberg M, Tang GH, Rahhal H, AlHamzah M, Kreuziger LB, Áinle FN, Alomran F, Alayed K, Alsheef M, AlSumait F, Pompilio CE. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ. 2021 Oct 14;375.

https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Welcome to Episode 1 of CLOT Conversations from Thrombosis Canada. In this episode Dr Jameel Abdulrehman and David Airdrie are joined by Dr Sameer Parpia and Dr Kerstin De Wit,  two of the authors of a recently published paper entitled Diagnosis of deep vein thrombosis with D-dimer adjusted to clinical probability: prospective diagnostic management study. The paper was published in the British Medical Journal (BMJ 2022;376:e067378 https://www.bmj.com/content/376/bmj-2021-067378) earlier this year. The lead investigator was Dr Clive Kearon, who unfortunately passed away in 2020. The study was co-authored by a cross-Canada team of researchers.

The authors discuss the study outcomes and their clinical relevance with the hosts in this 20 minute program.

Kerstin de Wit trained in internal medicine, emergency medicine and research in the UK. She completed a Thrombosis Fellowship in Ottawa in 2013. Since then, she has worked in both emergency medicine and thrombosis. She leads a research program which focuses on the diagnosis of bleeding and clotting disorders in the emergency department, and is funded by CIHR

Sameer Parpia is an Associate Professor in the Departments of Oncology and Health Research Methods, Evidence, and Impact at McMaster University. His interests and expertise are in the design, conduct, monitoring, statistical analysis and reporting of randomized clinical trials. As a senior biostatistician, he provides statistical and methodological leadership for clinical trials in thrombosis.

Thrombosis Canada Tools related to the content:
Wells Criteria calculator: https://thrombosiscanada.ca/tools/?calc=wellsDVT
DVT Diagnosis Algorithm: https://thrombosiscanada.ca/tools/?calc=vivomap263

Follow us on Twitter:
Thrombosis Canada: @ThrombosisCan
Dr Sameer Parpia: @ParpiaSameer
Dr Kerstin De Wit: @kerstindewit

https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

The Wolf and The Shepherd Podcast

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Action Items

Remove Elected Officials by Pulling Bonds - https://bondsforthewin.com/

150 Studies Show Ineffectiveness and Harms of Masks - https://www.theepochtimes.com/more-than-150-comparative-studies-and-articles-on-mask-ineffectiveness-and-harms_4230904.html?utm_medium=epochtimes&utm_source=telegram

146 Studies Show Natural Immunity is Superior - https://www.theepochtimes.com/evidence-on-natural-immunity-versus-covid-19-vaccine-induced-immunity_4244570.html?utm_source=Health&utm_campaign=health-2022-01-30&utm_medium=email&est=RXSvWCfgf%2B0iqCSSxdOjxplzaHMNErj8wi2nYP3IiyTae93vIujjN14uDZk%3D

News Items

Trudeau Flees Capital as Trucker Convoy Arrives - https://www.thegatewaypundit.com/2022/01/brigade-trucks-reaches-canadas-capitol-spineless-pm-trudeau-hides-covid-isolation-despite-2-negative-tests-guidelines-saying-fully-vaxxed-dont-need-isolate/

BBC News Claims Ottowa Protesters Harass Businesses - https://www.bbc.com/news/world-us-canada-60190452

AP News Claims Protesters Are Carrying Swastika Flags - https://apnews.com/article/coronavirus-pandemic-health-business-justin-trudeau-canada-45778ef0bdca45501411fb21066c46a0?utm_source=Twitter&utm_medium=AP&utm_campaign=SocialFlow

MSM Admits Firing Naturally Immune Workers Was a Mistake - https://www.wsj.com/articles/the-high-cost-of-disparaging-natural-immunity-to-covid-vaccine-mandates-protests-fire-rehire-employment-11643214336

FDA and Pfizer Attempt to Once More Prevent Release of Vax Data - https://www.thegatewaypundit.com/2022/01/covid-cover-pfizer-interferes-just-days-massive-foia-vaccine-data-drop-fda-claims-vaccine-manufacturer-must-help-review-redact-documents-public-release/

UK Funeral Director Sees 500%0600% Increase in Thrombosis Deaths - https://www.thegatewaypundit.com/2022/01/never-seen-many-deaths-around-500-600-increase-funeral-director-uk-reveals-increasing-number-death-vaccinated-young-adults/

DoD Docs Show Massive 1000% Increase in Post-Vax Disease - https://renz-law.com/attorney-tom-renz-discovers-leaked-dod-covid-files/

Video of Thomas Renz Testimony on Capitol Hill About Increase in Military Disease Post-Vax - https://twitter.com/_YvonneBurton/status/1485706103770034179?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1485774218855915523%7Ctwgr%5E%7Ctwcon%5Es3_&ref_url=https%3A%2F%2Fwww.independentsentinel.com%2Fvax-data-300-more-miscarriages-300-more-cancer-1000-more-neurological-disease-in-u-s-military%2F

www.soreadyforhealth.com

Somehow we got through 7 articles today, and none of them are about COVID-19!

Happy Thanksgiving!

Chlorthalidone in CKD

Milvexian for VTE Prevention

Risk of Recurrent VTE in Subsegmental PE

Rivaroxaban associated with higher rates of GI bleeding

Depression and Residency

Mental-Stress Induced Myocardial Ischemia

Patient Outcomes for Part Time Hospitalists







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Action Items:

Who Recognizes India Ivermectin Success - https://www.thegatewaypundit.com/2021/10/dr-campbell-reveals-reason-behind-indias-ivermectin-blackout/

Vox Magazine Story Inverts Reality - https://www.vox.com/coronavirus-covid19/22686147/covid-19-vaccine-betadine-hydroxychloroquine-ivermectin-trump-conspiracy

Israel Tightens Covid 'Green Pass' Rules, Sparking Protest - https://report.drudgenow.com/article/?u=https://apnews.com/article/coronavirus-pandemic-middle-east-health-jerusalem-israel-25ec5e9141c72080876bfe4f481bf50f&n=0&s=2&c=1&pn=Anonymous

7,200 Doctors and Scientists Sign Declaration Against Politicians for Crimes Against Humanity - https://amgreatness.com/2021/09/24/over-3000-doctors-and-scientists-sign-declaration-accusing-covid-policy-makers-of-crimes-against-humanity/

Website Mocks the Unvaxxed Dead - https://www.thedailybeast.com/mocking-unvaccinated-covid-victims-is-the-new-pandemic-blood-sport

Where to Go to Report and Defund This Filth - https://www.patreon.com/vaxman

NBA Players Say No to Jab, Lose Pay, Banned From Games - https://report.drudgenow.com/article/?u=https://thehill.com/policy/healthcare/574927-nba-iconoclast-kyrie-irving-becomes-leagues-anti-vaccine-face&n=0&s=2&c=1&pn=Anonymous

CDC Director Walenski Hones Double-Speak to a Fine Art - https://www.thegatewaypundit.com/2021/10/cdc-director-walensky-covid-vaccines-cannot-prevent-transmission-china-coronavirus-video/

CNBC Host Grills Fauci on Breakthrough Cases, Fauci Responds Condescendingly - https://www.thegatewaypundit.com/2021/10/vaccinated-also-covid-spread-entire-family-cnbc-host-grills-fauci-vaccine-breakthrough-cases-video/

Fauci Channels Karl Marx by Telling Canadians Society Trumps Individual Rights - https://www.thegatewaypundit.com/2021/10/fauci-vax-mandates-comes-time-give-consider-individual-right-making-decision-video/

Senator Ron Johnson Drops Truth Bombs: 63% of UK Delta Deaths Were Vaccinated - https://www.thegatewaypundit.com/2021/10/boom-sen-ron-johnson-drops-truth-bomb-senate-floor-63-uk-delta-deaths-last-7-5-months-fully-vaccinated-video/

European Union Links J&J Shot to Blood Clots - https://report.drudgenow.com/article/?u=https://thehill.com/policy/healthcare/public-global-health/574992-jj-vaccine-could-be-linked-to-another-clotting&n=0&s=2&c=1&pn=Anonymous

Biden Fakes White House Photo Shoot of Booster Shot - https://thetruereporter.com/confirmed-biden-faked-white-house-photo-shoot/

Pfizer Allegedly Experimenting on Orphan Babies in Poland to Test Covid Vaccine - https://theexpose.uk/2021/10/01/breaking-pfizer-stand-accused-of-experimenting-on-orphan-babies-to-test-their-covid-19-vaccine/

Australian Police Contradict Themselves Over Right to Protest - https://www.thegatewaypundit.com/2021/10/crazy-australian-authorities-show-womans-home-harass-social-media-posts-instructions-posting-things-video/

Today we have special guest Dr. Natalie Como to talk about Hospital at Home and what it's like to practice hospital medicine at a rural critical access hospital.  We also look at a retrospective paper on ACE/ARBs in veterans with pulmonary hypertension and talk about vaccine-induced immune thrombotic thrombocytopenia (VITT).  Check it out!

Hospital at Home with Comprehensive Geriatric Assessment
RAAS Inhibition and Pulmonary Hypertension
Vaccine-Induced Immune Thrombotic Thrombocytopenia 










Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)

More cases of blood clots in those vaccinated against COVID-19 — this time in six women who took the J&J shot — has US regulators recommending that vaccination efforts be paused. In this episode of the Xtalks Life Science podcast, Ayesha discusses the type of thrombotic events reported in these patients, and the team explores whether the benefits of getting vaccinated outweigh the risks of getting COVID-19, and suffering infection-associated thrombosis. 

Also in this episode, Ayesha talks about the approval of the first non-surgical option for patients with severe pulmonary valve regurgitation, a system developed by medical technology veteran Medtronic, called the Harmony Transcatheter Pulmonary Valve. The team debates the ethical and religious considerations of using pig tissue in heart valves.

Read the full articles here:

First Non-Surgical Heart Valve Wins FDA Approval for Severe Pulmonary Valve Regurgitation

US Regulators Recommend Pause on J&J’s COVID-19 Vaccine, But Just as a Precaution

For more life science and medical device content, visit the Xtalks Vitals homepage.

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The big news this week has been the risk of cerebral venous sinus thrombosis post-AZ vaccine and it's been giving us all a headache, but this has overshadowed further new data confirming benefit of inhaled corticosteroids for acute mild covid and guidance that we can offer this to older patients on a case-by-case basis.

In the latest Hot Topics podcast Neal Tucker discusses the facts, figures, management and ethics of post-AZ vaccine thrombosis, reviews the Principle trial showing we now have a viable treatment for mild covid; and data on the rate of multi-organ dysfunction and death at 4 months post-hospital discharge for covid.

References
MHRA data on AZ vaccine and thrombosis risk
CDC Data on Johnson&Johnson vaccine and thrombosis risk
CDC Data on Transmission Reduction
STOIC trial Lancet Resp
Principle trial
NHS recommendations from the Principle trial data
BMJ post-covid syndrome data
UnHerd Did I Give My Patients COVID?

www.nbmedical.com/podcast

Whether due to occlusive or nonocclusive obstruction of the arterial inflow or obstruction of venous outflow, acute mesenteric ischemia (AMI) continues to be associated with high mortality rate. Early recognition based on a high index of suspicion is critical to early diagnosis and intervention, particularly among patients presenting with pain out of proportion to physical exam findings. In this episode, we discuss the pathophysiology of AMI, together with common causes, the initial clinical presentation, and management strategies for patients with this life-threatening and elusive surgical disease process.

Today we are doing double duty: podcasting and parenting.  Fortunately our babies were well-behaved.  We talk about three trials for semaglutide and weight loss and a new 4 level pre-test probability rule for diagnosing PE.  We also talk about a retrospective study of cefazolin vs nafcillin for epidural abscess, a ferritin/procalcitonin ratio for differentiating bacterial from COVID pneumonia, and a new randomized controlled trial of intermediate thromboprophylaxis for ICU patients with COVID19.  Check it out!


Semaglutide for Weight Loss (STEP 1)
Semaglutide for Weight Loss in Diabetics (STEP 2)
Semaglutide + Intensive Calorie Restriction for Weight Loss (STEP 3)

4PEPS for Pulmonary Embolism
Nafcillin vs Cefazolin for Epidural Abscess
Ferritin/Procalcitonin Ratio for COVID-19 vs Bacterial Pneumonia
Intermediate Thromboprophylaxis for COVID-19 (INSPIRATION)








Music from https://filmmusic.io
"Sneaky Snitch" by Kevin MacLeod (https://incompetech.com)
License: CC BY (http://creativecommons.org/licenses/by/4.0/)

Hall of the Mountain King Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
http://creativecommons.org/licenses/by/3.0/