Our very first Cribsiders/Curbsiders crossover episode! Learn about cystic fibrosis care across the lifespan. We dive into the diagnosis of CF (don’t lick your patients!), management of pulmonary and extrapulmonary complications, and the future of CF. You’ll also get tips on CF in adolescents and young adults, as well as recognizing undiagnosed CF in older patients. Our guest, Dr. Whittney Warren, is a pulmonary critical care doctor and the medical director of the Adult Cystic Fibrosis clinic in an academic hospital in Texas. Show notes: https:/www.thecribsiders.com/.

Credits

• Writer, Producer, Infographic, CME Questions: Clara Mao 
• Cover Art: Christopher Chiu MD
• Hosts: Justin Berk MD, Christopher Chiu MD, and Matthew Watto MD
• Editor: Justin Berk MD; Clair Morgan of nodderly.com
• Guest: Whittney Warren DO 

Time Stamps

• Intro / Disclaimer 0:00
• Guest bio 2:25
• Guest one-liner, picks of the week 3:15
• Explaining CF to patients, life expectancy  7:00
• Types of CF mutations and phenotypes 11:50
• Presentation of CF in older patients 15:20
• Screening and diagnosis 16:40
• PFTs and airway clearance 25:20
• Nutrition and the “CF diet” 29:10
• CF exacerbations and antibiotic selection 32:25
• Extrapulmonary manifestations 39:35
• Transition of care for CF adolescents (alcohol, exercise, sex) 43:50
• CFTR modulator therapy 51:35
• Lung transplantation 54:45

Goal

Listeners will develop a systematic approach towards long-term management and acute exacerbations of cystic fibrosis.

Learning objectives

After listening to this episode listeners will…  

1. Explain the pathophysiology underlying cystic fibrosis.
2. Identify maintenance therapies that optimize pulmonary function and nutritional status in patients with cystic fibrosis.
3. Choose evidence-based practices in the management of cystic fibrosis-associated pulmonary exacerbations.
4. Recognize common extrapulmonary complications of cystic fibrosis in children and adults.
5. Describe available disease-modifying agents in cystic fibrosis care.

Disclosures

Dr. Warren reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Warren W, Mao C, Watto MF, Chiu C, Berk J. “Cystic Fibrosis Licked-ty Split with Dr. Whittney Warren”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ Original Air Date: July 6, 2020.

This episode is Half COVID Cakes, Half Hotcakes, and entirely enlightening.  Our guest Dr. Utibe Essien MD, MPH @UREssien and Curbsider/epidemiologist, Dr. Rahul Ganatra MD, MPH @rbganatra discuss some Hot COVID Cakes including: racial differences in COVID-19 outcomes, why dogs and dexamethasone may hold the key to defeating COVID-19, how hormonal adjunctive therapies might be key for depression, and when to poo-poo probiotics versus when a side of Lactobacillus may be beneficial. 

Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Rahul Ganatra MD, MPHl Emi Okamoto MD; Sarah P. Roberts MPH; and Matthew Watto MD
• Show Notes and CME questions by: Deborah J. Gorth ScM
• Cover Art: Deborah J. Gorth ScM
• Hosts: Matthew Watto MD; Rahul Ganatra MD, MPH, Emi Okamoto MD, and Sarah P. Roberts MPH
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Utibe Essien MD, MPH

Sponsor

VCU Health CE

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:20 Silver Linings / Picks of the Week: Chicken Run (2000) and Chicken Run 2 on Netflix; Philly Inquirer story on COVID sniffing dogs; Buy some peaches! And check out their Wikipedia page!
• 07:33 Hospitalizations and Mortality Among Black and White patients with COVID-19
• 26:10 Dexamethasone for COVID-19
• 28:55 Hormonal therapy for depression
• 38:16 Probiotics
• 45:00 Outro

Goal

Listeners will learn about the role of race in COVID-19 outcomes, possible hormonal adjunctive therapies for depression, and when to recommend probiotics. 

Learning objectives

After listening to this episode listeners will…  

1. Learn the effect of race on COVID-19 outcomes.
2. Know the indications for adjunctive hormonal treatment for depression.
3. Discuss the role of probiotics for the treatment of common gastrointestinal illness. 

Disclosures

Dr. Utibe Essien reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Essien UR, Ganatra RB, Okamoto E, Roberts SP, Gorth DJ, Watto MF. “#223 Hot COVID Cakes: COVID19 Disparities, Steroids, Hormones for Depression, Probiotics”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original air date July 2, 2020.

Listen as our esteemed guest Dr. Utibe Essien @UREssien walks us through key terminology and evidence necessary to understand anti-Black racism in medicine. Dr. Essien provides insights into ways that racism impacts our work in the clinical and academic settings and offers approaches for addressing anti-Black racism in these settings. 

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Producer and Writer: Joniqua Ceasar MD, Hannah Abrams MD
• Cover Art: Hannah Abrams MD
• Infographic: Beth Garbitelli
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Joniqua Ceasar MD   
• Editor: Paul Williams MD, Chris Chiu MD (written materials); Clair Morgan of nodderly.com
• Guest: Utibe Essien MD

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 00:00 Intro, disclaimer, guest bio

• 02:40 Guest one-liner, Picks of the Week*: Just Mercy

• 09:20 Statement from the show; Importance of discussing racism in medicine

• 14:11 Definitions

• 18:06 Identifying how racism manifests in the clinical setting

• 37:46 Ideas for advocacy

• 49:50 Take points and Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by slinking to Amazon. Simply put, if you click on our Amazon.com slinks and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will understand the way that structural racism pervades medicine and develop approaches for addressing the effects of racism within their clinics and communities.

Learning objectives

After listening to this episode listeners will…  

1. Define common terms: race, structural racism, white supremacy, health disparities 
2. Develop an approach to talking to patients about the effects of structural racism on health
3. Develop an approach for advocating to colleagues and within institutions on the effects of structural racism
4. Identify situations in which historical myths and structural racism in medicine may alter clinician judgment: race-based formulas, disparities in pain management, and disparities in screening and treatment of common conditions.

Disclosures

Dr. Essien and Ceasar report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Essien UR, Ceasar JN, Abrams HR, Williams PN, Watto MF. “#222 Addressing Anti-Black Racism in Medicine”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 26, 2020.

Throw out your down pillows and join The Curbsiders for this lively discussion on interstitial lung disease. While the hundreds of interstitial lung disease types make this topic a bit overwhelming, breathe easy knowing that pulmonologist, Dr. Erin Narewski @erinnarewski (Temple), can boil things down to an easy to approach framework in less time than it takes to complete a few 6-minute walk tests. In this episode, we walk through the classification, relevant patient history, workup, and management of interstitial lung disease. 

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Credits

• Written and Produced by: Paul Williams, MD, FACP; Nicole Kus, David Madnick, and Peter Wikoff
• Infographic and Cover Art: Edison Jyang
• Show Notes: Deborah Gorth
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Paul Williams MD, FACP (written materials); Clair Morgan of nodderly.com
• Guest: Erin Narewski DO, FCCP

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Sponsors

Join the ACP Community!

Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.  

VCU Health CE

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 0:00  Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT
• 00:30 Intro, disclaimer, guest bio
• 03:14 Guest one-liner, career advice, favorite failure, Picks of the Week*: The Strain, FX Horror TV Show; One Hundred Years of Solitude (book) by Gabriel Garcia Marquez; Hypoallergenic pillows; Peanut butter whiskey 
• 10:02 Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT
• 11:00 Case from Kashlak, Definitions
• 16:40 Buckets of ILD
• 32:06 Discussion of testing ILD: Labs and Imaging
• 44:20 Imaging findings in ILD
• 49:44 Basic Management of ILD
• 61:00 Take home points and Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by slinking to Amazon. Simply put, if you click on our Amazon.com slinks and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will feel comfortable with the basic pathophysiology, diagnosis, and management of interstitial lung disease. 

Learning objectives

After listening to this episode listeners will…  

1. Be able to define the lung interstitium. 
2. Develop a mental framework for the basic subtypes of interstitial lung disease. 
3. Learn with the types of questions necessary to elucidate the pathophysiology of their patient’s ILD. 
4. Know the steps to initiate a workup for ILD.
5. Become familiar with the treatment strategy for ILD. 

Disclosures

Dr Narewski reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Narewski E, Gorth DJ, Kus N, Madnick D, Wikoff P, Williams PN, Jyang E, Brigham SK, Watto MF. “#221 Interstitial Lung Disease with Erin Narewski DO”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list . June 22, 2020.

We’re going upstream! Dr. Karen DeSalvo (@KBDeSalvo) talks social determinants of health, arming us with a framework to consider this very challenging aspect of patient care. As Society for General Internal Medicine President and Chief Health Officer at Google Health, she shares her clinical and public health experience, including weathering Katrina in New Orleans. While our clinical care largely focuses on the downstream medical consequences, we must recognize the upstream social context to address the barriers to health and wellbeing. 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Emi Okamoto MD
• Cover Art: Kate Grant MBChb, MRCGP
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Emi Okamoto MD
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Karen DeSalvo MD, MPH, MSc

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for and create your FREE account!

Time Stamps

• Intro, disclaimer, guest bio 0:44
• Dr Desalvo’s one-liner 3:34
• Picks of the Week*- The Great Influenza  5:01
• Dr Desalvo’s advice and past experience 6:10
• Case from Kashlak 10:30
• What about the evidence for social determinants? 13:40
• What to do about this in the clinic, and is it worth screening? 16:06
• Approaching as a team and with the community 19:40
• How do we affect the upstream, before the downstream consequences? 22:40
• NAM recommendations and framework 26:00
• The role of technology 30:00
• What the SDOH are, and who they affect 34:00
• Start paying attention to SDOH 37:00
• Outro 38:49

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by slinking to Amazon. Simply put, if you click on our Amazon.com slinks and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will recognize the ubiquity of SDOH and their effects on individual well-being and disease.

Learning objectives

After listening to this episode listeners will…  

1. Recognize social determinants of health and the impact on health
2. Give a framework for how to improve patient care by focusing on social determinants
3. Recognize how to leverage care teams and technology in innovative ways to improve health of individuals

Disclosures

Dr DeSalvo was a former board member of Humana. The Curbsiders report no relevant financial disclosures. 

Citation

DeSalvo KB, Okamoto EE, Williams PN, Watto MF. “#217 Social Determinants of Health with Karen DeSalvo MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 18, 2020.

Answers to common questions in post-op care with our Kashlak Chief of Perioperative Medicine Dr. Avital O’Glasser. She provides updates in delirium prevention, perioperative medication management, pain control, and even clarifies a lesson from Meredith Grey about causes of post-op fever.

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written: Hannah Abrams MD, Avital O’Glasser MD
• Produced by, Infographic and Cover Art by: Hannah Abrams MD
• Hosts: Hannah Abrams MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Avital O’Glasser MD (written materials); Clair Morgan of nodderly.com
• Guest: Avital O’Glasser MD

Sponsors

Join the ACP Community!

Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.  

VCU Health CE

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 00:00 Sponsors
• 00:30 Intro, disclaimer, guest bio
• 02:53 Guest one-liner, Picks of the Week*: 12 Angry Men 1957 Movie; Hedwig and the Angry Inch Cast Recording; PCSSNow Buprenorphine Waiver Training for Medical Students
• 09:28 Sponsor -Visit acponline.org/member
  
• 10:17 Kashlak case; How to collaborate with our surgical colleagues
• 13:45 Questions to ask at the time of transfer

• 23:00 Routine Post-Op Care: Bowel regimen, pain control, delirium prevention, glucose, antihypertensives, and nausea
• 44:25 Comanaging Complications and Fever/Tachycardia; Brief discussion of VTE prophylaxis

• 57:55 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by slinking to Amazon. Simply put, if you click on our Amazon.com slinks and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will effectively comanage perioperative patients with surgical colleagues.

Learning objectives

After listening to this episode listeners will…  

1. Identify effective strategies to improve safety at the time of transfer acceptance.
2. Develop an approach for asking appropriate perioperative questions to the surgical team.
3. Recognize common mistakes that hospitalists make when accepting a transfer.
4. Become familiar with evidence based post-operative care to prevent and treat common post-op complications
5. Develop a differential diagnosis and management approach for post-op fever
6. Develop a differential diagnosis and management approach for delirium

Disclosures

Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

O’Glasser AY, Abrams HR, Williams PN, Watto MF. “#219 Post-Op Care and Complications with Avital O’Glasser MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 15, 2020.

Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber. Dr. Gerber is an Associate Professor of Medicine at Boston University School of Medicine and serves as Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship. Dr. Gerber edited the textbook, “Trauma-informed Health Care Approaches: A Guide for Primary Care.”  We discuss the framework for trauma-informed universal precautions, as well as basics about the prevalence of trauma, strategies for integrating a trauma-sensitive approach into primary care, practical changes for the office environment,  modifications for physical exam methods, and more.

We recognize this topic may bring up upsetting thoughts or memories for some of our listeners. We will provide some self-care and trauma-informed resources in our show notes. The practice of medicine, especially during times of national crisis, can increase our exposure to traumatic events and reactivate difficult memories, predisoposing folks to depression and suicide risk. We just want to reiterate that you are not alone. If you are struggling with thoughts of harming yourself, the national suicide prevention lifeline number is 1-800-273-8255. 

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Producer/Writer/Graphics: Beth Garbitelli
• Co-Producer: Paul Williams MD
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli 
• Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com
• Guest: Megan Gerber MD, MPH, FACP

Sponsors

Join the ACP Community!

Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.  

VCU Health CE

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• Intro, disclaimer, guest bio (0:00 - 4:09)
• Guest one-liner (4:24)
• Picks of the Week*: Keep Going: 10 Ways to Stay Creative in Good Times and Bad by Austin Kleon; Pilgrim at Tinker Creek by Annie Dillard; Molly’s Challah on King Arthur Flour website from cook/food writer Molly Yeh; OXO Good Grips Stainless Steel Food Scale with Pull-Out Display; Buffy the Vampire Slayer on Hulu, Amazon Prime; Devs on Hulu, Amazon Prime; Terry Pratchett’s Discworld series (Book 1 of 40: The Color of Magic, Night Watch) and The Wee Free Men; On Becoming a Healer by Saul J. Weiner MD (10:16) 
• Kashlak Cases (14:39)
• Epidemiology of trauma (16:11)
• Trauma and #MeToo (19:04)
• Defining Trauma-Informed Care (TIC) (19:56)
• Integrating TIC into primary care (23:42)
• Screening in TIC (25:56)
• Containment and retraumatization (29:56)
• Inquiring about trauma (31:39)
• Recap and Office Visit Mechanics (36:24)
• Building the Relationship (38:56)
• Common Inquiry Mishaps (39:46)
• TIC Physical Exam (41:14)
• Resources for Patients (45:24)
• Office Environment (48:56)
• Provider Burnout (50:56)
• TIC in Covid-19 (53:24)
• Take-home Points (57:14)
• Outro (65:44)

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by slinking to Amazon. Simply put, if you click on our Amazon.com slinks and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will gain fluency in trauma-informed care practices, methods, and perspectives in order to deliver compassionate care to patients who have experienced trauma and reduce the impacts of trauma in the healthcare setting. 

Learning objectives

After listening to this episode listeners will…  

1. Define trauma-informed care and discuss the various forms of trauma. 
2. Develop increased awareness of prevalence of adverse childhood experience, post-traumatic stress disorders, sexual violence, and intimate partner violence.
3. Foster a safe, calm, welcoming clinical environment for patients who have experienced trauma. 
4. Manage trauma disclosures and assess appropriate next steps for care and referrals.
5. Cultivate advanced communication skills and strategies on the topics of sexual violence, intimate partner violence, and other trauma-related experiences. 
6. Be able to engage in harm reduction strategies when caring for patients with trauma history. 

Disclosures

Dr. Gerber reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Garbitelli EC, Gerber MR, Williams PN, Heublein M, Watto MF. “#218 Trauma-Informed Care with Megan Gerber MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 8, 2020.

Introducing our friends, The Curious Clinicians:

Why do human bodies work how they do? Why do medications work, or not work? Do you miss digging into the “why” behind what we do every day? Join Hannah Abrams (@hannarabrams), Tony (@tony_breu), and Avi (@AvrahamCooperMD) in the Curious Clinicians podcast as they delve into these questions & more, starting with episode 1: Why does fingernail clubbing happen in so many different diseases? https://curiousclinicians.com/

Check out their website and subscribe on your favorite podcast player.

Stay current with the emerging COVID-19 research including: ACCT-1 (remdesivir), triple therapy with interferon, and conundrums  about SARS-CoV-2 PCR and serologic testing. We’re led by the one and only Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatr). And...just in case you live outside of the habitat for murder hornets and your anxiety about the pandemic had begun to abate, we touch on the CDCs guidance to beware of hungry aggressive rats. Gross!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Rahul Ganatra MD, MPH, Deborah J. Gorth ScM, Emi Okamoto MD, Sarah P. Roberts MPH, and Matthew Watto MD
• Cover Art: Deborah J. Gorth ScM
• Hosts: Matthew Watto MD, Rahul Ganatra MD MPH, Emi Okamoto MD, and Sarah P. Roberts MPH
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors

ACP

Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.  

VCU Health CE

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps

• 00:00 Sponsors
• 00:30 Intro, disclaimer
• 02:40 Fomites, groceries and killer rats
• 08:22 Sponsor
• 09:22 ACTT-1 trial of remdesivir
• 18:22 Triple therapy with lopinavir/ritonavir, ribavarin and interferon
• 33:10 Background on PCR testing for SARS-CoV-2; How common are false negative PCR tests?
• 44:25 Serologic testing for SARS-CoV-2; Utility of antibody testing; Test characteristics
• 50:30 Outro

Goal

Listeners will practice their critical appraisal skills as they update themselves on the latest COVID-19 research.

Learning objectives

After listening to this episode listeners will...

1. Describe the quality of evidence put forth by and the implications of the recent Lancet paper on triple therapy for COVID-19
2. Be familiar with the results of the ACCT-1 trial or remdesivir for COVID-19
3. Appreciate the complexities of PCR in testing for SARS-CoV2
4. Gain insight into the role of serological testing for SARS-CoV2

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation 

Gorth DJ, Ganatra RB, Okamoto E, Roberts SP, Watto MF. “#217 COVID Cakes 4 the Fourth”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. June 1, 2020.

Learn the nuances of caring for and building relationships with patients experiencing homelessness from expert internal medicine and addiction medicine physician, Stefan Kertesz MD, return guest from Episode 74 on Opioids and Health Policy (highly recommend a re-listen, y’all!).  To teach us the tricks of the trade, Dr. Kertesz draws on his many years of treating the underserved and researching homelessness, housing, and addiction in Birmingham, Alabama, where he currently serves as professor at UAB and Birmingham VA Medical Center.  In the course of this episode, we discuss the challenge of creating a welcoming and useful space for individuals experiencing homelessness (this is the preferred term, per Dr. Kertesz), how to meet patients where they’re at--both physically and mentally--the challenge of managing diuretics for those without stable access to a bathroom (avoid, if possible), and why the foot exam is of paramount importance. 

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by Nora Taranto MD
• Infographics by Nora Taranto MD
• Cover Art by Kate Grant MBChB, MRCGP
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD    
• Editor: Carolyn Chan (written materials); Clair Morgan of nodderly.com
• Guest: Stefan Kertesz MD 

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for and create your FREE account!

Time Stamps

• 00:00 Intro, disclaimer, guest bio 
• 3:17 Guest one-liner
• 8:55 Picks of the Week*: Dr. Kertesz’s Book Recommendation: Saul Weiner’s On Becoming A Healer; Nora’s Pick of the week: BackStory (especially their episode on dynamite!) https://www.backstoryradio.org/ 
• 10:07 Case from Kashlak 
• 10:56 Language: How to ask where a patient lives? 
• 13:25 Terminology: Persons Experiencing Homelessness: 
• 14:35 The stats on prevalence of health and illness in the homeless population, and the importance of both medical and environmental factors
• 20:44 How to start the visit, and how to establish trust early on? 
• 27:40 Why is the mortality rate higher?  
• 35:15 Special conditions and Medication Considerations: Hypertension, Diuretics, Insulin and Food Insecurity, Substance Use Disorders, Feet, and Hepatitis C 
• 54:15 COVID and homeless healthcare
• 57:00 Care Models
• 62:30 Take Home Points and Outro

Goal

Listeners will learn the unique health challenges posed to individuals who are experiencing homelessness, and the best practices for addressing these challenges. 

Learning objectives

After listening to this episode listeners will…

1. Screen for and identify patients experiencing homelessness
2. Identify the unique challenges facing this population 
3. Identify best practices in caring for this population
4. Differentiate between different structures of healthcare delivery, and their advantages and disadvantages for the homeless population.  

Disclosures

Dr Kertesz reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Kertesz S, Taranto NT, Williams PN, Brigham SK, Chan, Caroyn, Watto MF. “#216: Homeless Healthcare with Stefan Kertesz MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. May 28,2020.

Chase that metronidazole with a beer! Pop some 30 year old pills! Retrain your brain as our esteemed guest Dr. Douglas Paauw goes over his popular annual ACP presentation on Medical Myths. Learn about how some common medical myths originate and continue in our practice. We discuss why it’s okay to drink on metronidazole, take expired medications, inject epinephrine into extremities and why recurrent sinusitis may not really exist. 

Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Justin Berk, MD MPH MBA
• Infographic and Cover Art: Beth Garbitelli
• Hosts: Justin Berk, MD, MPH, MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com
• Guest: Douglas Paauw, MD

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org/ for more information.

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:22 Guest one-liner; Career Advice, Picks of the Week*: Being Mortal, book by Atul Gawande; The Band Played On, book by Randy Shilts; Lagunitas Hoppy Refresher: zero alcohol, zero calories!
• 06:15 Medical Myth Definitions
• 10:20 Dogma: Metronidazole and Alcohol; Healthy RCT Metronidazole and Alcohol
• 19:09 Expired Medications; Military Stockpiling Study
• 24:22 Aspirin and Nitroglycerin; Unopened eye drops; Epi-Pens; Expired Med Recap
• 31:13 Sinus Headaches; Trigeminal Nerve; Pearl: Recurrent headaches; Study showing Effectiveness of treatment (92%)
• 41:07 Epinephrine in extremity; RCT of Epi in Extremities
• Study showing Experts use it; Podiatry journal
• 48:39 Take home points and Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will challenge the dogma of specific medical practices that have been spread without evidence basis.

Learning objectives

After listening to this episode listeners will...

1. Counsel patients taking metronidazole on alcohol use
2. Describe the risks associated with taking expired medications
3. Diagnose and treat commonly defined “sinus headaches”
4. Describe the risks associated with epinephrine injections in the extremities 

Disclosures

Dr Paauw reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Pauuw D, Berk J, Williams PN, Watto MF. “#215 Medical Myths: Challenge Dogma with Dr. Douglas Paauw”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 25, 2020.

Elevate your critical appraisal skills as we review the first RCT of remdesivir and share the latest and greatest COVID-19 stories including: Llama antibodies, Stroke statistics, Future Waves, Exit Strategies and Awake Proning. We’re joined by everyone’s favorite Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatra). Rahul provides critical appraisal of the newest randomized control trial (RCT) on remdesivir from the Lancet, and gives us a lesson on why statistical power is so important to consider. We also share updates on strokes, awake proning, pandemic predictions, and we reveal another reason to love llamas (besides those luscious lashes). Llama mia, here we go again!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Sarah P. Roberts MPH, Rahul Ganatra MD, MPH, Emi Okamoto MD, Paul Williams MD and Matthew Watto MD
• Cover Art: Beth Garbitelli
• Hosts: Sarah P. Roberts MPH, Matthew Watto MD, Paul Williams MD, Rahul Ganatra MD MPH, Emi Okamoto MD   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps

• 00:00 Intro
• 02:10 Fun animal facts: Llama antibodies
• 09:10 Remdesivir RCT by Wang et al
• 12:40 Power and Sample Size
• 16:32 Baseline Characteristics, Results and Author’s conclusions
• 19:15 Rahul’s conclusions: How chance and bias effected the results
• 24:00 Right censoring; Viral load and timing of antivirals
• 30:30 Final thoughts on Remdesivir RCT by Wang et al; Looking ahead to the NIAID (ACTT) trial
• 33:53 Are patients really having less strokes and heart attacks?
• 38:20 Awake proning
• 43:30 Paul teaches us not to use the term “happy hypoxemic”
• 45:00 CIDRAP viewpoint on future waves and exit strategies
• 50:22 Outro

Goal

Listeners will hone their skills in critical appraisal as they update themselves on all things COVID-19

Learning objectives

After listening to this episode listeners will...

1. Critically appraise recent research on remdesivir as a treatment for COVID-19
2. Recognize the consequences of COVID-19 on strokes
3. Discuss the potential benefits of proning for COVID-19 patients
4. Describe different scenarios likely for the pandemic’s future

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

Ganatra R, Okamoto E, Williams P, Roberts SP, Watto MF. “#214 COVID Cakes 3: Llamas, Remdesivir, Strokes, Predicting the Future, and More!”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 18, 2020.

Listen as our esteemed guest Dr. Nina Mingioni walks us through her approach to fatigue, from differential diagnosis, to the evidence behind physical exam, laboratory workup, and beyond!

Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Writer, Producer, Infographic, and Cover Art: Hannah R. Abrams
• Hosts: Hannah R Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
• Guest: Nina Mingioni MD, FACP

Announcement

Join in! We’re hosting a LIVE! COVID Cakes discussion of Remdesivir and other hot COVID-19 stories this coming Tuesday May 12, 2020 at 8:30 pm ET @thecurbsiders on Twitter and Periscope!

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org/ for more information.

Time Stamps

• 00:00 Intro, disclaimer, guest bio and a bad pun
• 03:00 Guest one-liner
• 07:10 Case from Kashlak, Defining fatigue; Taking a general history
• 11:36 Most common causes of fatigue and how to elicit them from the history
• 20:39 Physical exam for fatigue; Medications that cause fatigue;
• 25:25 Exam findings and LRs for anemia; Sleep apnea
• 30:55 Lab workup for fatigue; Expanded testing: Ferritin, Vitamins, EBV, Rheumatologic diseases, Celiac disease, Lyme
• 47:55 Spiel to the patient when no answer is found
• 51:14 Other diagnoses to consider: Fibromyalgia, Myalgic Encephalomyelitis
• 55:09 Take home points and Outro

Goal

Listeners will develop an approach to caring for patients with fatigue symptoms.

Learning objectives

After listening to this episode listeners will…  

1. Identify top causes of fatigue
2. Develop an evidence-based approach to assessing a patient with fatigue
3. Describe evidence-based screening tools for fatigue

Disclosures

Dr. Mingioni reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Mingioni N, Abrams HR, Williams PN, Watto MF. “#213 Fatigue for Primary Care with Nina Mingioni MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Air date May 11, 2020.

Summary

Crush those 11 pm “STAT: Patient agitated” pages with this expert guide to assessing for and treating alcohol withdrawal!  Dr. Joji Suzuki MD, addiction psychiatrist extraordinaire at the Brigham and Women’s Hospital, walks us through how to think about the risk of severe withdrawal, the different ways to manage it, and how to engage with patients as they’re leaving the hospital. In the course of this Car-Talk (well, not exactly the same as the critically acclaimed radio show, but he did record in his car….), Dr. Suzuki demystifies withdrawal and debunks some common myths: that we must manage withdrawal inpatient, that banana bags are the cure to a hangover and alcoholic malnutrition, and that we tend to under-medicate with benzos (actually, it’s the opposite!).  

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME

Credits

• Written and Produced by Nora Taranto MD 
• Infographic and Cover Art by: Nora Taranto MD
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Cyrus Askin MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Joji Suzuki MD 

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:52 Guest one-liner; Career advice; Picks of the Week*: Why We Do What We Do (book); Fargo (film)
• 08:10 A Case from Kashlak and Screening for Alcohol Use and Severe Withdrawal Risk
• 17:32 Outpatient Versus Inpatient Treatment
• 25:27 Gabapentin for alcohol withdrawal
• 27:10 Indicators for ICU level Care
• 31:53 Symptom-Driven versus Fixed-Dose Protocols , Benzos vs. Barbs
• 36:55 And which benzo?  
• 39:47 A Natural History of Withdrawal
• 44:10 Banana Bags and Thiamine Deficiency
• 48:17 The Transition Home: Naltrexone, Bridge Clinics, and Motivational Interviewing
• 56:36 Outro and Bonus clip

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will be able to screen patients for risk of alcohol withdrawal and decide on management strategies that are individualized to the patient. 

Learning objectives

After listening to this episode listeners will…

1. Screen and identify for patients at high risk of withdrawal 
2. Identify who would benefit from inpatient withdrawal, and ICU vs floor level care  
3. Identify the best withdrawal management protocol 
4. List indications and contraindications of first line therapy for alcohol use disorder.

Disclosures

Dr Suzuki reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Suzuki J, Taranto NT, Williams PN, Askin C, Watto MF. “#212 Sober Talk: Managing Alcohol Withdrawal with Joji Suzuki, MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 7, 2020.

In this episode we tackle treatment with remdesivir, management with anticoagulation, and presymptomatic transmission. Welcome back to COVID Cakes, a rundown of recent COVID articles and news stories. What does the latest Gilead medication have to offer? Why should we wear masks? And if you thought 6 feet was THE safe distance…we’ve got some bad news about running. But it’s not all bad! We’re joined by everyone’s favorite Curbsider/Internist/Epidemiologist, Rahul Ganatra MD MPH (@rbganatra), who provides critical appraisal of the newest COVID-19 treatment article. Pull up a chair, bring your own syrup, and join us! 

Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Producer: Sarah P. Roberts MPH, Rahul Ganatra MD MPH, Emi Okamoto MD   
• Writer: Emi Okamoto MD, Rahul Ganatra MD MPH,    
• Cover Art: Chris Chiu MD
• Hosts: Chris Chiu MD, Rahul Ganatra MD MPH, Emi Okamoto MD   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors

Apollo

If you’re a healthcare worker looking for an opportunity to volunteer with the COVID relief efforts or you’ve been furloughed and are in need of work, please check out apollohct.com to see jobs and volunteer opportunities in your area and across the states. All you have to do is make a profile, input your preferences, and Apollo will do the searching for you.

VCU Health Continuing Education

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps

• 00:00 Sponsors, Intro, disclaimer
• 02:30 Picks of the Week
• 6:36 Remdesivir trial rundown
• 21:52 Thrombosis in COVID-19
• 29:50 Asymptomatic/Presymptomatic transmission
• 41:42 Quick takes
• 49:00 Outro

Picks of the Week / Links

1. You Bet Your Garden podcast with Mike McGrath
2. Ologies podcast with Alie Ward
3. Frosted Mini Wheats

Goal

Listeners will hone their skills in critical appraisal as they update themselves on all things COVID-19

Learning objectives

After listening to this episode listeners will...

1. Critically appraise recent research on remdesivir as a treatment for COVID-19
2. Review emerging literature and guidelines on thrombotic complications of COVID-19 
3. Interpret new data on asymptomatic transmission of COVID-19 

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

Ganatra R, Chiu CJ, Okamoto E, Roberts SP, Watto MF. “COVID Cakes: Remdesivir, anticoagulation, and presymptomatic transmission”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 29, 2020.

Get inside the black box of transplant medicine as we discuss: Kidney transplant for the internist. Join Dr. Cyrus Askin, @askins_razor, one of our Curbsiders Correspondents, as he teams up with the fine folks from freely Filtered in this NephMadness episode exploring topics in kidney transplant! On this show, the gang turns to Dr. Samira Farouq, @ssfarouk, a Mount Sinai transplant nephrologist, to take the reins during this guided tour of concepts in transplant medicine that internists should be familiar with. During this episode, you’ll learn about indications for kidney transplant, immunosuppressive agents, what to watch out for in your post-transplant patients and so much more! And of course, we will talk a little NephMadness as we wrap things up. So maybe you need to learn about kidney transplant or perhaps you’re still mourning the loss of March Madness 2020 - either way, we encourage you to take a listen and hope you’ll enjoy!

Listeners can claim free CE credit for this episode at curbsiders.vcuhealth.org (goes live at 1200 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME

It's time for NephMadness 2020! Fill out your bracket before the April 30, 2020 deadline and be sure to list The Curbsiders as your team. 

1. Read this year’s region posts here.
2. Submit an individual or team bracket here.
3. Discuss your picks with #NephTwitter!

Credits

• Written and Produced by: Cyrus Askin MD, Matthew Watto MD and the Freely Filtered Crew
• Infographic: Cyrus Askin MD
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Cyrus Askin MD, Joel Topf MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.

Time Stamps

• 00:00 Announcement, Intro to Freely Filtered and NephMadness
• 04:00 Case of advanced CKD; Who/when to refer for transplant
• 12:05 Benefits of renal transplant
• 16:22 Counseling patients with advanced CKD about transplant and a bit on living donors
• 20:40 Medications after transplant; Drug-drug interactions
• 25:50 Dr. Sparks’ 30 second exam for the transplant patient; Diarrheal illness
• 32:07 Calcineurin inhibitor levels
• 36:42 Prophylaxis for long term complications
• 40:21 Allograft rejection; BAMF criteria
• 50:40 Cardiovascular risk; Statins
• 56:11 Malignancy after kidney transplant
• 60:00 NephMadness Transplant Region: Biomarkers vs Biopsy
• 72:23 Outro

Goal

Listeners will learn valuable skills to assist in the management and counseling of pre- and post- kidney transplant patients.

Learning objectives

After listening to this episode listeners will…  

1. Recognize the criteria for kidney transplant referral and evaluation, as well as the importance of referring a patient as soon as they are eligible. 
2. Be able to counsel a patient regarding what to expect before, during and after the transplant process.
3. Know the main classes of medication used after patients have received transplants, to include their side effects and any relevant monitoring. 
4. Be familiar with the different types of rejection, the clinical signs/symptoms of rejection and the utility / limitations of kidney biopsy.
5. Be able to discuss the post-transplant complications of kidney transplantation (cardiovascular, malignancy, etc.) as well as what type of prophylactic medications should be considered in these patients.

Disclosures

Drs. Cyrus Askin MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD report no relevant financial disclosures. Dr. Topf has received honoraria from Astra Zeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures. 

Citation

Cyrus A, Topf J, Farouk S, Swapnil H, Lin J, Sparks M, Watto MF. “#210 NephMadness: Kidney Transplant for the Internist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. April 27, 2020

LIVE! from VCU, we discuss why and how to use Twitter and other Social Media platforms as a clinician educator. Guest Michelle Brooks MD (@michellebrooksMD, VCU) shares her Twitter origin story along with pearls on how to use Twitter for digital scholarship #meded, networking and how to stay out of trouble on social media.  

Check out this recent paper on Twitter in #Meded by Dr. Brooks and friends [Drs. Rebecca Jaffe, Tony Breu, Charlie Wray, Margaret Chapman and Avital O’Glasser (Kashlak Chief of Periop Medicine)]!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by: Matthew Watto MD, FACP
• Infographic: Michelle Brooks MD
• Cover Art: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Clair Morgan of nodderly.com
• Guest: Michelle Brooks MD

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out https://curbsiders.vcuhealth.org/ for more information.

Time Stamps

• 00:00 Guest one liner, favorite failure, career advice, 
• 08:08 Picks of the week*: Culture Code (book) by Daniel Coyle; Crucial Conversations (book); Teaching Naked (book); Dark Crystal (Netflix series); The Outsider (HBO series)
• 11:23 Case of Sosh Al Media; Landscape of social media; Control your digital footprint; Public vs Private profiles
• 23:04 Negative aspects of social media
• 26:44 How to utilize Twitter for medical education; Twitter basics; Milton Packer
• 37:14 Pros and Cons of #medtwitter
• 42:02 Tweetorials
• 44:28 Audience questions: Repercussions from posting on social media; Social Media fellowships; Advocacy on social media
• 51:34 Outro 

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goals

Listeners will develop a framework on how Twitter can be used for scholarship and medical education.

Learning objectives

After listening to this episode listeners will...

• Define the landscape of digital media platforms available to the modern medical educator

• Discuss how digital platforms can be used to promote career development through digital scholarship
• Explain how Twitter is being used to disseminate medical education, future directions and concerns that have been raised. 

Disclosures

Dr Brooks reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Brooks M, Williams PN, Brigham SK, Watto MF. “#209 LIVE! Twitter, Social Media and Digital Scholarship”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date April 23, 2020.

Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid exam...it’s on!

Listeners can claim Free CME credit through VCU Health at https://curbsiders.vcuhealth.org/ (CME goes live at 1200 PM ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by: Elena Gibson MD 
• Cover art and Infographic by: Dr Kate Grant MBChb MRCGP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Emi Okamoto (written materials); Clair Morgan of nodderly.com
• Guest: Susan Mandel MD, MPH

Sponsor

We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out https://curbsiders.vcuhealth.org/ for more information.

Time Stamps

• 00:00 Intro, disclaimer, guest bio

• 02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice

• 09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms

• 13:20 When to Test for Hypothyroidism 

• 17:43 Biotin interaction

• 19:49 Which thyroid tests should we order?

• 26:15 Subclinical hypothyroidism

• 29:00 Etiology/Types of hypothyroidism 

• 33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam

• 37:10 Levothyroxine replacement time of administration

• 42:10 TSH goal 

• 46:00 Levothyroxine manufacturers

• 48:33 Dosing in older adults

• 50:27 T3 treatment

• 56:52 Pregnancy

• 59:42 Dose adjustments

• 61:43 Estrogen and thyroid binding protein 

• 63:33 Who needs a referral?

• 65:40 Plugs, Outro


Goal

Listeners will develop an approach to the diagnosis and management of patients with hypothyroidism.

Learning objectives

After listening to this episode listeners will…  

1. Recognize the different etiologies of hypothyroidism.
2. Identify signs and symptoms of hypothyroidism.
3. Develop an approach to diagnosing and treating hypothyroidism.
4. Define subclinical hypothyroidism and when to treat it. 
5. Recognize how pregnancy influences hypothyroidism management.
6. Be able to counsel patients on treatment for hypothyroidism.

Disclosures

Dr. Mandel reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Mandel S, Gibson EG, Grant K, Williams PN, Brigham SK, Okamoto E, Watto MF. “Hypothyroidism”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 20, 2020.

Welcome to The Curbsiders tutorial on how to create your own medical podcast. @doctorwatto and @paulnwilliamz walk you through how to conceptualize your podcast, build your team, choose your equipment and the basics of how to setup hardware and software recording. Be sure to browse the accompanying show notes for a true step-by-step guide complete with links to videos, web pages, and blog posts that we found helpful when starting our show. If it’s not in this document, then it can easily be found on YouTube, or via a Google search.

Credits

• Written and produced by: Matthew Watto MD
• Cover art and Infographic by Matthew Watto MD
• Hosts: Matthew Watto MD and Paul Williams MD
• Editor: Clair Morgan of Nodderly.com

Time Stamps

• 00:00 Announcement, Intro, Disclaimer
• 02:53 Our top podcasting pearls
• 07:01 Find your niche
• 09:46 Logistics
• 13:25 Business, finances and legal matters
• 14:40 Equipment
• 21:48 Recording and editing
• 24:56 Website, web and media hosting
• 28:53 How to setup and record your podcast
• 35:08 Editing software
• 35:58 Search engine optimization
• 37:45 Post-processing
• 39:49 Take home points and outro

Disclosures

The Curbsiders report no relevant financial disclosures. 

Goals

Listeners will develop a framework for how to create a medical podcast from the original idea to software, equipment, recording and a bit about editing.

Learning objectives

After listening to this episode listeners will...

•  Define your podcast’s content, and who it's for

1. Conceptualize the logistics of recording a podcast
2. Recall the necessary equipment and software for a medical podcast
3. BRIEFLY discuss podcast editing
4. Talk about how to disseminate a medical podcast (website, media host)
5. Review the potential pitfalls and nuances, like intellectual property considerations, SEO, branding, etc.

Citation

Watto MF, Williams PN. "#207 How to create a medical podcast: Tales from The Curbside". The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Air date April 16, 2020.

Breathe easy with these airway management principles and expert tips for managing the patient with COVID-19 related lung disease (i.e. pneumonia, hypoxemia, ARDS). In the COVID-19 era, non-intensivists are being called upon to care for critically ill patients across the globe. At the Curbsiders, we understand that this can be a stressful proposition! Therefore, we’ve enlisted the help of the renowned medical intensivist & USUHS Chair of Medicine, Dr. Kevin Chung (@chungk1031) to teach us what we need to know about airway management  in these challenging times.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 

Credits

• Written and Produced by: Cyrus Askin MD, Michael Rose MD, Kathleen Hiltz MD
• Show Notes: Cyrus Askin MD
• Infographic: Elena Gibson, MD
• Cover Art: Dr. Kate Grant MBChB DipGUMed
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Cyrus Askin, MD   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
• Guest: COL Kevin Chung, MD, FACP

Sponsor

AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.

Time Stamps

• 00:00 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders 
• 00:15 Disclaimer, intro, guest bio
• 03:15 Guest one liner, chicken wings (Miller Lite marinade), career advice
• 07:40 Sponsor - AccessMedicine by McGraw Hill http://bit.ly/MHCurbsiders 
• 08:20 Case of hypoxemic respiratory failure; Rapid evaluation, initial labs
• 16:03 Initial assessment of a COVID-PUI; HFNC and non-invasive ventilation
• 23:40 Proning patients for hypoxemia
• 29:15 ARDS basics: diagnostic criteria, Brief Recap
• 33:22 Mechanical ventilation: Initial settings, following the blood gas
• 40:55 Peak and plateau pressure, Lung compliance and  Troubleshooting a high pressures
• 51:30 Ventilator dyssynchrony; Lung compliance and traditional ARDS vs COVID-19 lungs
• 62:55 Advanced ARDS - The 5 Ps of therapy and differences with COVID-19
• 68:10 Take home points; Plugs; Outro

Links

1. Internet Book of Critical Care (IBCC) Podcast by Dr. Josh Farkas - COVID-19
2. Dr. Jessica Bunin’s Video Lecture on Vent Basics for Non-Intensivists
3. COVID-19 Toolbox
4. One-Stop for some COVID-19 video content, also on the COVID-19 Toolbox Site

Goal

Listeners will be equipped with the basics to provide ventilatory support, to include the use of mechanical ventilation, for critically ill patients in the COVID-19 era.

Learning objectives

After listening to this episode listeners will…  

1. Appreciate the unique challenges faced by the medical community as pertaining to the current COVID-19 pandemic.
2. Be familiar with fundamentals of critical care as pertaining to airway management.
3. Define the diagnostic criteria of ARDS and appreciate early clinical signs that may indicate a patient is developing ARDS.
4. Review the various non-invasive methods of assisting with oxygenating & ventilating a patient (NC, NRB, HFNC, NIPPV, etc.) and any key contraindications.
5. Recognize signs suggestive of impending respiratory failure requiring invasive mechanical ventilation (i.e. indications for intubation).
6. Be familiar with basic ventilator parameters, basic terminology / modes.
7. Know initial vent settings for a patient with resp failure / ARDS based on ARDSnet data.
8. Have an approach to titrating vent settings based on physiologic parameters & the blood gas.
9. Know special considerations for management of ARDS in a patient with COVID-19.
10. Be familiar with advanced management strategies for patients with ARDS such as proning and paralysis

Disclosures

Dr. Chung reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Chung, K, Askin C, Rose M, Hiltz K, Gibson E, Williams PN, Watto MF. “206 Airway Management for the Non-Intensivist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list 04/13/2020.\

Rundown of recent COVID articles and news stories including: Hydroxychloroquine and azithromycin, serologic testing, use of convalescent plasma, economic inequality / health disparities... and COVID in cats?! We’re joined by Curbsider/Internist/Epidemiologist, Rahul Ganatra MD, @rbganatra (VA Boston) who provides critical appraisal of the article that inspired Trump’s infamous hydroxychloroquine and azithromycin comment. Plus, @Paulnwilliamz and @cjchiu give us  some telehealth along with the usual antics. 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 

Credits

• Written, Produced by: Rahul Ganatra MD, Chris Chiu MD, FACP, FAAP; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Cover Art and Show Notes by: Matthew Watto MD, FACP
• Hosts: Chris Chiu MD, FACP, FAAP; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD 
• Guest: Rahul Ganatra MD

Time Stamps

• 00:00 Intro, COVID-19 and cats by Shi J Science Apr 2020; Picks of the week: Kimberly Manning thread Frontline-ish; Steak Umm thread; Some Good News YouTube Channel by John Krazinski
• 07:08 Telehealth (Greenhalgh BMJ 2020), Breathlessness (Roth score calculator), ACP COVID-19 resource site
• 11:50 Telehealth best practices: Postpone routine therapy, Choose therapy that doesn’t require monitoring Treat empirically, Only order tests that will change management, Keep people out of the ED (see attached); Doximity dialer for video calls is in Beta testing
• 16:42 Convalescent plasma and Serology (Chenguang JAMA “Trial” of Convalescent Plasma; Nat’l Academy Sciences 10 pt study; COVID-19 Insights Blog by Bill Rodriguez; FDA Press Release re: SARS-CoV-2 Serologic Testing; FDA Emergency Auth for Rapid IgG/IgM 
• 21:45 Chris discusses the decontamination of N95 masks using CCDS (CCDS, Battele news Report)
• 23:45 Inequality during the pandemic VOX and NYTimes articles on inequality
• 25:30 Hydroxychloroquine background; Rahul provides critical appraisal for HCQ + azithromycin article from France (Gautret et al IJAA 2020) and Rahul’s tweetorial 
• 49:18 Pre-print data; Rahul discusses a newer HCQ randomized clinical trial article (Chen medRxiv 2020)
• 43:05 Outro

Goals

Listeners will hone their skills in critical appraisal as they update themselves on all things COVID-19

Learning objectives

After listening to this episode listeners will...

1. Discuss the limitations in the evidence for hydroxychloroquine and azithromycin as treatment for COVID-19
2. Discuss some challenges of telehealth during the COVID-19 pandemic
3. Be aware of racial disparities during the COVID-19 pandemic
4. Explain the rationale for serologic testing and the use of convalescent plasma in COVID-19 disease

Disclosures

Dr Ganatra reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Ganatra R, Williams PN, Chiu CJ, Watto MF. “#205 COVID Cakes and Hotakes with Rahul Ganatra MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 10, 2020.

Get under the hood of SGLT2 inhibitors! Listen as our guests Dr. Harish Seethapathy, Dr. Matt Sparks, and Dr. Joel Topf give us a tour through the NephMadness 2020 SGLT2i region! How do these promising drugs work, and what evidence is there for using them in non-diabetic kidney disease or kidney transplant patients.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Hannah R. Abrams
• Cover Art and Infographic by: Hannah R. Abrams
• Hosts: Hannah R Abrams, Matthew Watto MD, FACP   
• Editor: Clair Morgan of Nodderly.com (audio), Emi Okamoto MD (written)
• Guests: Harish Seethapathy MD; Matthew Sparks MD; Joel Topf MD

Sponsors

AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.

Join The Curbsiders! 

Pre-med and medical students, we need your help with production of the show! You’ll learn all aspects of podcasting, get to network with national thought leaders and join an amazing global team of Curbsiders. We are especially in need of folks with experience creating video content, developing websites and using social media tools. Application deadline is Friday April 10, 2020. Send an email to thecurbsiders@gmail.com and include the following:

[  ] A half page on why you’d make a great Curbsider

[  ] A copy of your CV

[  ] Your social media handles on Instagram, Twitter, etc. 

[  ] Samples of prior work (e.g. videos, websites, etc.)

Time Stamps

• 00:00 Sponsor
• 00:26 Intro, disclaimer, guest bio
• 02:57 Guest one-liner and Pick of the Week: Michael Pollan audiobook on Coffee and Caffeine Addiction
• 03:52 SGLT2i definition, background, and why we now consider CV endpoints in diabetes
• 11:16 Sponsor
• 12:00 Tubuloglomerular feedback; Balloon analogy
• 17:40 Other mechanisms for SGLT2i
• 23:05 Back to the case; Risks from SGLT2i; Counseling and Monitoring
• 34:18 SGLT2i for non-diabetic kidney disease; Possible mechanisms: Joel’s caution against early adoption
• 41:42 SGLT2 inhibitors in kidney transplant
• 45:20 Take home points and picks for the SGLT2 inhibitor region
• 49:50 Outro

#NephMadness 2020: SGLT2i Region – AJKD Blog

Goal

Listeners will recognize the different potential mechanisms for SGLT2i mechanisms and the different populations which may derive benefit from treatment. 

Learning objectives

After listening to this episode listeners will…  

1. Identify the theorized mechanism by which SGLT2i improve outcomes through their effect on tubuloglomerular feedback and other theorized mechanisms for SGLT2i effects
2. Develop a pathophysiological understanding of SGLT2i adverse effects, including acute decrease in GFR and genital infections
3. Recognize the potential benefit of using SGLT2i in non-diabetic patients, including for kidney disease, heart failure, and kidney transplant

Disclosures

The Curbsiders report no relevant financial disclosures. Drs. Seethapathy and Sparks report no relevant financial disclosures. Joel Topf lists the following on his blog “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018.”

Citation

Seethapathy H, Abrams HR, Okamoto E, Sparks M, Topf J, Watto MF. “#204 NephMadness 2020: SGLT2 Inhibitors”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 6, 2020.

Create your own online curriculum for #meded with this Step-by-Step guide for medical educators by Drs. Kat Zechar MD, @inked_caduceus and Amreet Sidhu MD, @Brosencephalon. They teach us how to identify learner’s needs and develop an online curriculum complete with self assessment tools, remote lectures, audio & video content and interactive cases. We discuss specific software tools and the basic hardware that you’ll need to get your online meded curriculum up and running. You should also check out this guide to building your online curriculum at https://www.brosencephalon.com/onlinecurriculum. 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 

Credits

• Written and Produced by: Paul Williams MD, FACP
• Cover art and Show notes by: Matthew Watto MD, FACP
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Kat Zechar MD and Amreet Sidhu MD

Join The Curbsiders! 

Pre-med and medical students, we need your help with production of the show! You’ll learn all aspects of podcasting, get to network with national thought leaders and join an amazing global team of Curbsiders. We are especially in need of folks with experience creating video content, developing websites and using social media tools. Application deadline is Friday April 10, 2020. Send an email to thecurbsiders@gmail.com and include the following:

[  ] A half page on why you’d make a great Curbsider

[  ] A copy of your CV

[  ] Your social media handles on Instagram, Twitter, etc. 

[  ] Samples of prior work (e.g. videos, websites, etc.)

Time Stamps

• 00:00 Announcement: We’re looking for pre-med and medical Student members. Send applications to thecurbsiders@gmail.com by deadline April 10, 2020.
• 01:22 Intro, disclaimer and guest bios
• 03:38 Guest one-liners, Picks of the week*: Gumption (book) by Nick Offerman; Man Search for Meaning (book) by Viktor Frankl; Death Stranding (videogame); Alita: Battle Angel (film)
• 09:30 Why you might need an online meded curriculum
• 16:33 Overview of Amreet and Kat’s online curriculum
• 21:15 Website, domain name, media hosting, software (Vimeo, Zoom meeting software) and WordPress plugins; Zoom can record audio, video or screen recording (i.e. for a speaker going through slides) and equipment
• 36:35 How to generate self-assessment tools: ABIM blueprint, quiz questions and interactive cases (from twinery.org)
• 46:35 Time commitment
• 50:55 Take home points and Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goals

Listeners will learn the basic tools needed to develop their own online curriculum and educational model.

Learning objectives

After listening to this episode listeners will...

1. Outline the benefits of creating an online curriculum.
2. Identify the necessary tools to create an online curriculum.
3. Recognize the potential benefits and pitfalls of asynchronous education.
4. Discuss the learning theory that supports asynchronous learning.
5. Explain how an existing curriculum can be quickly modified to adapt to evolving learner needs.

Disclosures

Drs. Sidhu and Zechar report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Sidhu A, Zechar K, Williams PN, Watto MF. “#203 How to Create an Online Curriculum for Medical Education”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. April 2, 2020.

LIVE! from Mayo Clinic, a practical approach to lymphadenopathy with Carrie Thompson MD @cathompsonmd (Hematology Oncology, Mayo Clinic). Dr. Thompson provides her simplified approach to the history, differential diagnosis, high yield lab testing, imaging, how to counsel patients with adenopathy and tips on when, where and how to biopsy!

Special Thanks!

The Curbsiders are insanely grateful to the Mayo Clinic  Internal Medicine Residency Chief Residents @mayomn_imres (@JasonEckmannMD @SamiRyanMD @BHuffmanMD @CourtHarrisMD) and their amazing program director @AmyOxentenkoMD for an amazing trip to Rochester! 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com  

Credits

• Written and Produced by: Carrie Thompson MD and Matthew Watto MD, FACP
• Infographic: Matthew Watto MD, FACP

• Cover Art: Kate Grant MBChB DipGUMed

• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Carrie Thompson MD

Join The Curbsiders! 

Medical students, we need your help with production of the show! You’ll learn all aspects of podcasting, get to network with national thought leaders and join an amazing global team of Curbsiders. We are especially in need of folks with experience creating video content, developing websites and using social media tools. Application deadline is Friday April 10, 2020. Send an email to thecurbsiders@gmail.com and include the following:

[  ] A half page on why you’d make a great Curbsider

[  ] A copy of your CV

[  ] Your social media handles on Instagram, Twitter, etc. 

[  ] Samples of prior work (e.g. videos, websites, etc.)

Time Stamps

• 00:00 Announcement: We’re looking for Medical Student members. Send applications to thecurbsiders@gmail.com by April 10, 2020.
• 01:20 Intro, guest bio, one-liner, career advice; Pick of the week*: In Shock by Rana Awdish


• 07: 00 Lymphatic system

• 
09:19 Differential diagnosis for lymphadenopathy


• 11:38 Taking a history (ALL AGES mnemonic), Red Flags


• 19:15 Physical exam for lymphadenopathy

• 
22:30 Which labs to order; Flow cytometry

• 
26:05 Imaging

• 
28:30 Counseling patients with LAD


• 31:10 Biopsy: How to choose type and location


• 37:35 Take Home Points

• 
39:00 Audience Questions


• 42:25 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goals

Listeners will develop a framework and systematic approach to evaluating the patient with lymphadenopathy. 

Learning objectives

After listening to this episode listeners will...

1. Describe differential diagnosis of enlarged lymph nodes.
2. Summarize the evaluation of lymphadenopathy.
3. Identify the most appropriate type and timing of lymph node biopsy.

Disclosures

Dr Thompson reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Thompson C, Williams PN, Brigham SK, Watto MF. “#202 LIVE! Lymphadenopathy: Taking Your Lumps”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 30, 2020.

Listen as the pioneers of the COVID pandemic share their experiences taking care of some of the first COVID patients in the US. Our guests have a broad range of expertise and experiences. This episode features hospitalist Dr. Francisco Alvarez (University of California at San Francisco, @fnalvarez), Infectious Disease fellow Dr. Karolina Maciag (University of Washington, @KMaciag), Critical Care and Pulmonology Fellow Dr. David Furfaro (Columbia University, @david_furfaro) and intensivist and founder of onepagericu.com, Dr. Nick Mark (Seattle, WA).

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 

Credits

• Written and Produced: Justin Berk MD MPH MBA
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Justin Berk MD MPH MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Dr. Francisco Alvarez, Dr. Karolina Maciag, Dr. Dave Furfaro, Dr. Nick Mark

Sponsor

Primary Care Internal Medicine of Ithaca

Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.

Time Stamps

• 00:00 Sponsor - https://www.primarycareinternalmedicineofithaca.com/.
• 00:20 Intro, disclaimer, guest bios and a bad pun
• 04:28 Francisco: Process leading up to first case
• 07:42 Karolina: The perspective of the consultant- calm in the storm
• 11:40 (Karolina) Seattle Flu Study as early warning
• 16:00 Dave: ICU patients
• 20:30 Nick: making decisions with a moving target

• 25:05 Sponsor - https://www.primarycareinternalmedicineofithaca.com/.
• 25:53 Francisco: data available on Twitter
• 28:00 Francisco: the role of generalist during the COVID pandemic
• 31:15 Karolina: on vulnerable populations during pandemic
• 38:26 Dave/Nick: how generalists should be preparing themselves
• 45:16 Avoiding aerosolized procedures / nebulizers
• 47:46 What was the big surprises
• 54:20 How do you address the anxiety
• 60:12 Plugs64:20 Outro

Links*

1. The Seattle Flu Study research team helped identify first patterns of COVID in the US
2. A New York Times article highlighted the story of the Seattle Flu Study  was one of the first 
3. A published case series of the first 12 US COVID patients (Dr. Alvarez is a co-author)
4. The CDC offers a very comprehensive video for donning and doffing
5. A previous “Things We Do For No ReasonTM” article suggests MDIs are non-inferior to nebulizer treatments
6. COVID Communications Guide
7. CardioNerds: Episode #20: COVID-19 in the ICU
8. UW COVID Resource Site
9. OnePagerICU.com

Goal

Listeners will recall the perspectives of the first providers taking care of COVID patients and will be able to apply some of their insights to when the epidemic hits their region.

Learning objectives

After listening to this episode listeners will…  

1. Be familiar with the ICU and hospitalist challenges in taking care of COVID patients.
2. Describe how to learn new information and connect with others in the COVID community.
3. Recognize the social challenges associated with the epidemic for patients and providers.

Disclosures

Drs. Maciag, Mark, Alvarez, and Furfaro report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Alvarez, F, Maciag K, Furfaro D, Mark N, Berk, JB, Williams PN, Watto MF. “#201: COVID Narratives: Stories from Physicians at the Front Lines”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 26, 2020.

Practical tips and discussion of what we do and don’t know about COVID-19 transmission, testing, NSAIDs, ACE inhibitors, quarantine, treatment, personal protective equipment (PPE) and more with Paul Sax MD, @paulsaxMD (Brigham and Women’s Hospital/Harvard Medical School). This episode is sure to go viral!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com 

Credits

• Written and Produced by: Sarah Phoebe Roberts MPH; Chris Chiu MD; Beth Garbitelli; Hannah Abrams; Rahul Ganatra MD, MPH; Matthew Watto MD, FACP
• Cover Art and Infographic by: Beth Garbitelli
• Hosts: Rahul Ganatra MD, MPH; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest: Paul Sax MD

Sponsor

Primary Care Internal Medicine of Ithaca

Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.

Time Stamps

• 00:00 Sponsor- Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/
• 00:20 Intro, guest bio, guest one-liner
• 04:12 SARS-CoV-2/COVID-19 vs. SARS, MERS, and influenza 
• 07:00 Rahul highlights areas of caution interpreting COVID cases studies 
• 12:35 Sponsor- Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/
• 13:20 Case of cold symptoms; Wearing masks in public; Advice on self quarantine with mild symptoms
• 18:05 Patient with mild symptoms and COVID exposure; Duration of quarantine and PCR positivity
• 21:15 Who merits testing for COVID-19
• 23:19 Case of confirmed COVID with mild symptoms; Instructions to patient and family about quarantine
• 25:50 COVID-19 testing characteristics (sensitivity, false negatives); Does co-infection occur?; Advice on when to send patient to a hospital 
• 30:10 ACEIs, ARBs, NSAIDS; Is reinfection possible?
• 32:20 Pharmacotherapy: Hydroxychloroquine, Remdesivir, Tocilizumab; Definition of the “high risk” patient; COVID-19 vaccine
• 36:50 Case of healthcare worker (HCW) with COVID exposure; How long can COVID live on surfaces? 
• 40:20 Do exposed HCWs without symptoms require quarantine?
• 41:30 Personal Protective equipment (PPE)
• 45:00 COVID-19 in pregnancy
• 47:30 COVID-19 and vulnerable patient populations (patients who are immigrants, homeless, incarcerated, etc.) 
• 50:45 Where should you get your COVID-19 information?

52:30 Closing remarks and outro

Goals

Listeners will review the current research on COVID-19 including transmission, protection strategies, testing, symptoms, and basics of management.

Learning objectives

After listening to this episode listeners will know…

1. The basics of COVID-19 including epidemiology, prevention, transmission, and treatment
2. Where to find reliable data sources and how to interpret new studies with caution 
3. The importance of PPE and limiting disease exposure 
4. What drug regimens are recommended and what experimental treatments are available
5. The role of virtual visits, telemedicine and other non-traditional methods to reduce patient contact
6. Impact of COVID-19 on at-risk populations 

Disclosures

Paul E. Sax, MD, has disclosed the following relevant financial relationships:  Served as a director, officer, partner, employee, advisor, consultant, or trustee for: Bristol-Myers Squibb Company; Gilead Sciences, Inc.; GlaxoSmithKline; Janssen; Merck. Received research grant from: Bristol-Myers Squibb Company; Gilead Sciences, Inc.; GlaxoSmithKline; Merck.

The Curbsiders report no relevant financial disclosures. 

Citation

Sax P, Roberts SP, Chiu CJ, Garbitelli B, Abrams H, Williams PN, Watto MF. “#200 COVID-19 with Paul Sax MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 22, 2020.

NephMadness 2020 is here! Listen as Dr. Ryann Sohaney (@ryannsohaney), Dr. Deborah Clegg and Dr. Joel Topf (@kidney_boy) discuss this year’s first Nephmadness topic, Hyperkalemia in CKD. They will (1) review the use of potassium binders for management of hyperkalemia in CKD (2) identify the potential health benefits of dietary potassium and challenge the use of low-potassium diets in CKD, and (3) describe how exercise influences serum potassium and consider exercise recommendations in CKD.

Check out the regions and fill out your brackets for NephMadness 2020 here! Sign-up as a part of The Curbsiders team!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Elena Gibson MD 
• Infographic: Caitlyn Vlasschaert MD 
• Cover Art: Elena Gibson MD
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan Nodderly.com (audio)
• Guest: Ryann Sohaney, MD; Deborah Clegg, PhD; Joel Topf, MD 

Sponsors

AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.

Time Stamps

• 00:00 Sponsor - AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders
• 00:20 Intro, disclaimer, guest bio
• 02:55 Guest one-liners; Intro to NephMadness 2020
• 07:28 Sponsor - AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders
• 08:15 Hyperkalemia in CKD; Case of hyperkalemia; Meds, supplements and a bit on diet
• 17:07 Patiromer, Sodium zirconium, SPS
• 31:08 Diet and potassium
• 46:00 Exercise and hyperkalemia. Is it safe in CKD?
• 51:51 Take home points and Outro

Learning objectives

After listening to this episode listeners will…  

1. Recognize when and how to manage hyperkalemia in CKD 
2. Identify when to use potassium binders in CKD 
3. Define the pharmacology, adverse effects and evidence behind different potassium binders 
4. Develop an approach to using renin-angiotensin-aldosterone system inhibitor (RAASi) medications in patients with hyperkalemia
5. Define the potential benefits of high-potassium diets and the potential harms of low-potassium diets 
6. Recognize how exercise influences potassium

Disclosures

The Curbsiders report no relevant financial disclosures. Joel Topf lists the following on his blog “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018.”

Citation

Sohaney R, Gibson E, Clegg D, Topf J, Williams PW, Brigham SK, Watto MF. “#199 NephMadness: Hyperkalemia, Diet, Potassium Binders, Exercise”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 16, 2020.

Polycystic ovary syndrome (PCOS) is more common than we think!  Listen as our esteemed guest Dr Katherine Sherif (@katherinesherif) reviews common patient complaints that should trigger PCOS in the differential, its pathophysiology, key physical exam findings, an algorithm for lab evaluation for PCOS diagnosis, and common treatments (OCPs, metformin, spironolactone and more!).

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Molly Heublein, MD
• Cover Art and Infographic: Kate Grant MBChB DipGUMed 
• Hosts: Matthew Watto MD, FACP; Molly Heublein, MD
• Editor: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Katherine Sherif, MD

Sponsors

AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.

Primary Care Physician Opportunity in beautiful Ithaca, NY! Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/. 

Time Stamps

• 00:00 Sponsors - AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/
• 00:35 Intro, disclaimer, guest bio
• 03:00 Guest one-liner, book recommendation; Picks of the Week*: The Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, by Dr BJ Miller and Shoshana Berger; Overdrive App to download audio books and other media from libraries
• 07:58 AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/
• 09:30 Case of PCOS; Definition; Common presenting complaints
• 14:40 Hirsutism and terminal hair growth
• 17:05 Alopecia
• 20:25 Acne; Hidradenitis suppurativa
• 23:05 Irregular menses; Lab workup; Non-classic congenital adrenal hyperplasia
• 28:38 Hyperandrogenism lab workup (Testosterone, DHEA-S, Anti-Mullerian Hormone, utility of LH and FSH); Quick word on US
• 37:15 Recap of how to diagnose PCOS
• 38:15 Insulin resistance, body habitus in PCOS
• 40:04 Pathophysiology in PCOS (two schools of thought: Hypothalamus vs Insulin)
• 43:27 Dr. Sherif’s spiel to patients newly diagnosed with PCOS
• 46:40 Long term risks in PCOS
• 50:35 Approach to treatment of PCOS (OCPs, metformin, spironolactone, hair removal)
• 60:35 Treatment of alopecia; Lifestyle factors
• 63:55 Take home points and Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will explain the basic pathophysiology, diagnosis, and management of PCOS.

Learning objectives

After listening to this episode listeners will…  

1. List the criteria for diagnosis of PCOS.
2. Explain the relationship between PCOS and metabolic risks.
3. Determine first line treatments for PCOS symptoms including oligomenorrhea, hirsutism, acne and alopecia.
4.  Counsel patients on long term risks associated with PCOS and how to mitigate these.

Disclosures

Dr Sherif reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Sherif K, Heublein M, Grant K, Okamoto E, Watto MF.  “#198 PCOS: Polycystic Ovary Syndrome with Katherine Sherif MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 9, 2020.

Join us as we demystify the world of pulmonary nodules & lung cancer screening. During this episode, Dr. Denitza Blagev (@mybetterdoctor) makes her triumphant return to The Curbsiders to help us tackle this topic. She is currently the Medical Director for Quality/Specialty-Based Care at Intermountain Healthcare and a Pulmonary & Critical Care physician. We learn to take command of the recommendations for lung cancer screening, disambiguate the terms used by pulmonologists and radiologists, and appreciate some of the nuances of lung cancer screening all with the hope of making YOU a better primary care physician!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by:  Cyrus Askin MD & Leah Witt, MD
• Infographic: Leah Witt, MD
• Cover Art: Dr. Kate Grant MBChB DipGUMed
• CME/MOC: Cyrus Askin, MD
• Hosts: Cyrus Askin MD; Leah Witt, Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editors: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Denitza Blagev, MD

Sponsor

ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order!

Time Stamps

• 00:00 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders
• 00:15 Intro, disclaimer, guest bio
• 02:15 Guest one-liner; Picks of the Week*: Educated (book) by Tara Westover; Cheer, Netflix series; The Witcher, Netflix series; Uptime /  Downtime -album by The
• 06:24 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders
• 07:25 Case: Incidental pulmonary nodules; Defining terms: mass vs nodule
• 15:20 Spiel/Counseling a patient with an  incidental lung nodule; Analogy about skin findings and lung nodules
• 20:50 Types of nodules, duration of monitoring; Tracking nodules; Recap on incidental pulmonary nodules
• 27:54 Case: Lung cancer screening (USPSTF, NLST criteria and CMS guidelines); Shared decision making
• 41:56 Lung-RADS and lung cancer screening; Types of CT scan; When to refer
• 48:22 Take home points on Lung Cancer screening
• 52:35 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will develop an approach to incidentally found pulmonary nodules, lung cancer screening and what to do with the suspicious lung nodule or mass.

Learning objectives

After listening to this episode listeners will...

• ...be familiar with the differences between nodules & masses and some of the common etiologies for these findings.

• ... appreciate the difference between the incidental pulmonary nodule and those found during lung cancer screening and thus the different systems (Fleischner vs. Lung-Rads) used to assess nodules.

• ... have a framework for how to approach incidental pulmonary nodules, particularly with respect to the 2017 Fleischner Society Guidelines .

• ... be able to educate peers & patients regarding who qualifies for lung cancer screening and who does not.

• ... understand what makes a patient “high risk” vs. “standard risk” with respect to incidentally found pulmonary nodules.

• ... appreciate the background and reasoning behind the current recommendation for lung cancer screening

• ... discover how to determine follow up of a lung nodule found as part of a lung cancer screening CT using Lung-Rads.

• ... learn strategies regarding how to discuss incidental nodules and nodules found on screening CTs with patients, as well as how to approach the discussion of whether or not to screen with the use of various readily available resources .

Disclosures

Dr. Blagev has received research grants from Astra Zeneca, Zebra Medical and GSK through grants to Intermountain Healthcare and joint publications. We did not discuss any of these products or services during this recording. The Curbsiders have no relevant financial disclosures.

Citation

Askin C, Witt L, Blagev D, Williams PN, Watto MF. “#197 Pulmonary Nodules and Lung Cancer Screening with Denitza Blagev MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 2, 2020.

Develop your approach to refugee health in the primary care setting.  We discuss important considerations for primary care of the refugee patient with Dr. Tanuja Devaraj (Penn State), an internist with expertise in migration health.  We review barriers to primary care, how to take a migration history, and common health concerns that occur in this patient population.  We also discuss strategies for screening for trauma and mental health issues, which are common among patients who have gone through migration.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Producer: Paul Williams MD, FACP
• Writer: Tanuja Devaraj MD and Paul Williams MD, FACP
• Infographic: Emi Okamoto MD
• Cover Art: Paul Williams MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Clair Morgan of Nodderly.com (audio), Emi Okamoto MD (written)
• Guest: Tanuja Devaraj MD

Sponsor

ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order!

Time Stamps

• 00:00 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders 
• 00:15 Intro, disclaimer, guest bio
• 02:08 Guest one-liner, book recommendations, career advice
• 07:12 Picks of the Week*: Full Catastrophe Living - Jon Kabat-Zinn (book); Exit West: A novel - Mohsin Hamid; Ad Astra (film); Snuff - Terry Pratchett (book)
• 09:36 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders 
• 10:30 Defining terms refugee, asylee, migrant
• 12:08 Bhutan and The Buthanese refugee population
• 15:08 The overseas medical examination (prior to arrival in the US)
• 17:28 The initial domestic medical examination, primary care visit; Vaccinations; Initial lab testing
• 21:54 Barriers to refugee health
• 26:12 Taking a migration history
• 29:25 Who’s paying for refugee care?
• 31:08 Mental health and the refugee population
• 34:20 Screening and addressing past trauma, torture
• 40:14 Recap; Quick discussion of parasitic infections
• 45:08 Audience questions: Visits with multiple family members; Additional resources available for refugee health
• 47:50 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will develop an approach for the management of the refugee patient in the primary care setting.

Learning objectives

After listening to this episode listeners will…  

1. Describe the differences between refugees, asylees, and migrants.
2. Recognize the exposure to healthcare and health screenings that have occurred prior to the initial primary care visit.
3. Be able to obtain a thorough and relevant migration history.
4. Navigate the potential barriers that can arise during the refugee primary care visit.
5. Demonstrate the ability to screen for trauma and common mental health concerns in the refugee population.

Disclosures

Dr. Devaraj reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Devaraj T, Williams PN, Brigham SK, Okamoto E, Watto MF. “#196 LIVE! Refugee Health with Tanuja Devaraj MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list February 24, 2020.

Discover common practices that persist in the hospital wards despite no proven benefit! We review how potassium replacement goals should not drive you bananas, extra oxygen should not give you comfort, and how you should maybe calm down with antipsychotics for delirium. Join returning guests: high-value care specialist Dr. Lenny Feldman (@DocLennyF, Johns Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 3 of “Things We Do for No Reason^TM.

SHM members can claim CME-MOC credit at https://www.shmlearningportal.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Note: The planners and faculty for this activity have no relevant relationships or conflicts to disclose.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Burton H. Shen MD, Justin Berk, MD MPH MBA
• Infographic:
• Cover Art:
• Hosts: Justin Berk MD MPH MBA; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FaCP
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Lenny Feldman MD, Tony Breu MD

Sponsors

The Society of Hospital Medicine

Hospital Medicine 2020 (HM20) is the Society of Hospital Medicine’s Annual Conference April 15th through the 18th in sunny San Diego. Don’t miss the largest hospital medicine meeting. Register now at https://shmannualconference.org/ and use the code CURBSIDERS to receive a $50 discount.

Primary Care Internal Medicine of Ithaca

Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/. 

Time Stamps

• 00:00 Sponsors -SHM’s Annual Conference, HM20 (use code CURBSIDERS) and Primary Care Internal Medicine of Ithaca (email: arcostello@gmail.com)
• 00:38 Intro, disclaimer, guest bio
• 02:10 Guest one-liners
• 03:35 Picks of the Week*: Knives Out (film), Priced Out by Uwe E. Reinhardt; Crisis in the Red Zone by Richard Preston; CardioNerds podcast; Outbreak (film); Teaching Physiology on the Fly (faculty development course)
• 07:55 Sponsors -SHM’s Annual Conference, HM20 (use code CURBSIDERS) and Primary Care Internal Medicine of Ithaca (email: arcostello@gmail.com)
• 09:30 Case of Eric Lokay; Repleting potassium. Is it necessary to “buff the lytes”
• 20:30 Pathophysiology of hypokalemia; Final recommendations on potassium repletion
• 24:30 Supplemental oxygen; pO2 vs total oxygen content; Oxygen, vasoconstriction and potential harms
• 30:33 Evidence of harm from supplemental O2
• 35:00 Tony’s recommendations for use of supplemental O2
• 41:55 Case of delirium; Definition and diagnosis
• 46:20 Can we prevent delirium? Melatonin and ramelteon
• 50:33 Should we use antipsychotics? Benzodiazepines?; What should we do instead?
• 58:25 Take home points, Outro and a terrible pun

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr. Feldman and Dr. Breu report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Feldman L, Breu T, Shen BH, Berk JL, Williams PN, Brigham SK, Watto MF. “#195 TWDFNRTM 3: Potassium, Oxygen, and antipsychotics”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 17, 2020.

Dismantle alcohol use disorder with some evidence based tools for your toolbelt! We cover everything from ways to screen patients for risky drinking, to all the different treatment options with our guest expert Dr. Marlene Martin, @MarleneMartinMD, Director of the Addiction Care Team and Assistant Professor of Clinical Medicine at the UCSF. We learn how to initiate medications such as naltrexone and acamprosate for the treatment of alcohol use disorder, how to define treatment success, if psychosocial interventions such as Alcoholics Anonymous are effective, and what’s the deal with baclofen and gabapentin? After listening to this episode, listeners will feel ready to start prescribing medications such naltrexone to treat alcohol use disorder.  Your patients need you!

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Carolyn Chan, MD
• Cover Art and Infographic: Carolyn Chan, MD
• Hosts: Carolyn Chan, MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Marlene Martin, MD

Sponsor

ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order!

Time Stamps

• 00:00 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders 
• 00:45 Intro, guest bio
• 01:30 Guest one-liner, book recommendation, favorite failure, career advice
• Picks of the week*: Project Runway (TV show); The Quiet Place (film); Tattoos on the Heart: The Power of Boundless Compassion (book) by: Gregory Boyle; Cats (film)
• 08:20 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders 
• 09:05 Case of Mr Hops; Defining unhealthy alcohol use
• 13:37 Screening and diagnosis; assessing for tolerance; stratifying severity of AUD
• 16:56 Spiel and first steps after diagnosing a patient with unhealthy alcohol use; Motivational interviewing; Exploring motivation to change
• 22:12 Pharmacologic treatment options: Naltrexone, acamprosate, disulfiram
• 26:40 How effective are medications for alcohol use disorder; Defining success
• 29:41 Naltrexone prescribing, dose titration
• 34:25 Acamprosate prescribing; Naltrexone in advanced liver disease
• 38:05 Off label use of baclofen, gabapentin and topiramate
• 43:39 Risk stratifying for inpatient versus outpatient treatment; Non-pharmacologic interventions
• 49:26 Deciding duration of therapy
• 52:24 Take home points; Plug for AMERSA conference
• 53:57 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr Marlene Martin reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Martin M, Chan, C, Williams PN, Brigham SK, Watto MF. “194 Treatment of Alcohol Use Disorder”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 10, 2020.

Join us as we discuss how to approach “The Struggling Learner” with Dr. Melissa McNeil (@missydoc0128), Professor Medicine and Associate Chief of General Internal Medicine at the University of Pittsburgh Medical Center (UPMC), recorded LIVE in Pittsburgh, PA!  In this episode, we discuss how to approach the struggling learner, highlighting the 5-Step process discussed in a recent article co-written by Dr. McNeil (Merriam 2019).  This episode is not intended to give educators a roadmap for how to develop and implement a corrective action plan, but was put together to provide a common toolset on how to approach a struggling learner.  As such, the topics discussed can be applied to all kinds of learners that struggle, not just in medicine. However, the techniques discussed involve a common framework routinely taught in medical education (assessment, diagnosis, and referral) and, therefore, is communicated using this shared language.

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Stuart Brigham MD
• Infographic: Matthew Watto MD, FACP
• Cover Art: Stuart Brigham MD
• Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham, MD
• Editor: Stuart Brigham MD (written materials); Clair Morgan at Nodderly.com
• Guest: Melissa McNeil MD, MACP
• Special thanks to Dr. William Kelly, FACP, FCCP

Sponsor

ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order!

Time Stamps

• 00:00 Sponsor - ACP’s MKSAP 18!
• 00:15 Intro, disclaimer, guest bio
• 05:50 Guest one-liner, favorite failure
• 10:30 Picks of the Weeks*: Book: Radical Candor; Movie: Clue (1985); Book: Awareness by Anthony De Mello; TV Series:  The Expanse (Season 4) on Amazon Prime
• 13:28 Sponsor - ACP’s MKSAP 18!
• 14:14 Case of a struggling learner; defining terms
• 20:24 Gathering data; Clarifying questions; Timing and feedback
• 28:30 Develop a differential diagnosis; Naming the behavior
• 37:42 SRL tool to evaluate deficits
• 42:55 Case of an overconfident learner
• 48:40 Concern for substance use in a struggling learner
• 52:02 Educational handoffs
• 54:53 Identifying learners who struggle with empathy
• 56:36 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will identify practical tools, tips, and techniques using skills developed for patient care and appreciate what they can do when a learner is struggling.

Learning objectives

After listening to this episode listeners will…  

1. Develop an appreciation for how to approach the struggling learner 
2. Recognize how to “diagnose” learners using clinical reasoning skills
3. Appreciate the importance that timely, specific feedback plays in identifying why a learner struggles
4. Identify why lack of insight can make addressing these struggles more difficult

Disclosures

Dr. McNeil reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

McNeil M, Brigham SK, Williams PN, Watto MF. “#193 The Struggling Learner with Dr Melissa McNeil”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 3, 2020.

Kidney Boy Returns! Compare the types of dialysis, learn how nephrologists approach medication management in ESRD, and avoid the most common mistakes non-nephrologists make in patients on dialysis! Kashlak Chief of Nephrology Dr. Joel Topf, @kidney_boy, walks us through what you need to know to take care of a patient on dialysis and gives us an idea of how nephrologists think through mineral bone disease (calcium, phosphorus and vitamin D), anemia, iron repletion, and hypertension. We answer all your questions about co-managing patients on dialysis!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Producer: Hannah R. Abrams
• Written and produced by: Hannah R. Abrams
• Cover Art and Infographic by: Hannah R. Abrams
• Hosts: Hannah R. Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials), Clair Morgan of Nodderly.com (audio)
• Guest: Joel Topf MD

Sponsor

ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20

Time Stamps

• 00:00 Sponsor -ACP’s Internal Medicine Meeting 2020
• 00:15 Intro, disclaimer, guest bio
• 01:45 Guest one-liner, Picks of the Week*: KidneyCon, CATS (film)
• 06:00 Sponsor -ACP’s Internal Medicine Meeting 2020
• 06:50 Case of Anne Yuric; Assessing risk of progression to dialysis; Candidacy for dialysis and renal transplant
• 12:20 Why is mortality so high on dialysis
• 15:47 When to initiate dialysis
• 19:40 Types of dialysis; the importance of residual renal function
• 25:45 Why is peritoneal dialysis underutilized
• 28:10 Dialysis access
• 34:25 Return to our case: Mineral bone disease, and phos binders; Calcyphylaxis
• 44:40 Which problems are under the domain of the nephrologist and the dialysis unit?; Hypertension management in ESRD; Midodrine; 48:18 ACEI/ARB, spironolactone
• 51:55 Anemia and iron in ESRD; Screening in Primary Care for patients on dialysis; Statins in patients on dialysis
• 57:42 Medications to avoid
• 61:50 Renal diet; Warfarin and DOACs on dialysis
• 66:48 Common inpatient mistakes: Labs, PICC lines
• 69:36 Takes Home Points; Plug: NephMadness 2020 is coming!
• 72:19 Outro

Disclosures

Dr Topf lists the following disclosures on his website: “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders report no relevant financial disclosures. 

Citation

Topf, J, Abrams, HR, Williams PN, Watto MF. “#192 Dialysis for the Internist with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 27, 2020.

Trailer for season 9 of The Curbsiders! Plus, our friends from NephJC and the Freely Filtered Podcast will be at KIDNEYcon 2020! It features 6 amazing hands on workshops and lots of celebrities from #NephTwitter. The deadline for travel grants is approaching (See below).

What: KIDNEYcon 2020 (www.kidneycon.org)

When: April 16-19, 2020

Where: Little Rock, Arkansas

Who Should Attend: Internal Medicine Residents, Pediatric Residents, Adult and Pediatric Nephrology Fellows, Attending Nephrologists

Travel Grants: Available for Adult and Pediatric Residents and Nephrology Fellows (Deadline to apply: February 1st )

Click HERE to Register in January 2020

Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! 

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

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Credits

• Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli 
• Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA
• Infographic: Beth “Garbs” Garbitelli
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP   
• Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Erin Michos MD MHS

Sponsor

ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20

Time Stamps

• 00:00:00 Intro
• 00:01:52 Getting to know Dr. Erin Michos
• 00:O6:50 Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel
• 00:11:50 Digging into ASCVD Risk Calculator
• 00:16:12 Who should get 10 year ASCVD Risk assessment and what are the categories?
• 00:18:13 How Dr. Michos discusses healthy lifestyle and “Primordial Prevention”
• 00:19:42 What are “Risk Enhancing Factors”?
• 00:22:36 Who should get biomarker testing vs CAC scoring?
• 00:29:35 How Dr. Michos discusses statin therapy with her patients
• 00:32:18 How to address risks of side effects
• 00:37:57 Primary vs Secondary Prevention
• 00:39:40 “What should my cholesterol be?”
• 00:42:03 How often to follow-up labs?
• 00:46:00 Differences between stain intensity
• 00:47:57 How to manage side effects
• 00:52:05 PCSK9 inhibitor discussion
• 00:55:06 Aspirin, Fibrates and Icosapent Ethyl
• 01:02:13 High Risk vs Stable ASCVD
• 01:06:50 Take home points and the future
• 01:10:50 Outtro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will feel comfortable managing both primary and secondary prevention for ASCVD among different patient scenarios. 

Learning objectives

After listening to this episode listeners will…  

1. Recognize the different risk levels and further ways to hone risk-stratification.
2. Describe primary prevention management including how to discuss lifestyle changes, statins, and managing common statin-related complaints.
3. Recognize the importance of lipid reduction for secondary prevention and different medications to achieve this.

Disclosures

Dr Erin Michos reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Michos E, Devgun J, Garbitelli B, Chiu C, Berk J, Williams PK, Watto MF. “#191 Lipids Update with Erin Michos MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 20, 2020.

A Curbsiders classic with a fresh intro by Hannah Abrams @hannahRabrams (soon to be MD)! Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. Get deeper into potassium physiology with a FREE pdf copy of Joel’s book The Fluid Electrolyte and Acid Base Companion here.

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Sponsor

ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20

Credits

• Written, edited and produced by: Matthew Watto MD, FACP
• Intro: Hannah R Abrams
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
• Infographic and Cover Art: Matthew Watto MD, FACP
• Guest: Joel Topf MD

Time Stamps

• 00:00 Sponsor -ACP’s IM Meeting 2020 in LA
• 00:28 Disclaimer, intro and guest bio
• 03:00 Guest one-liner
• Picks of the week* —Peloton indoor bike; The Nice Guys (film) by Shane Black; Forgotten Anne (PS4 videogame), “your local library”
• 09:00 Sponsor -ACP’s IM Meeting 2020 in LA
• 09:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia
• 17:00 Hyperkalemia and the EKG
• 20:31 Threshold for treatment of hyperkalemia
• 24:20 Use of telemetry and the U-shaped curve for potassium and mortality
• 27:11 Choice of therapy for acute hyperkalemia
• 30:13 Albuterol for hyperkalemia
• 31:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring
• 36:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron
• 40:10 Fludrocortisone for hyperkalemia
• 42:05 Calcium for elevated potassium
• 45:43 SPS, potassium binding resin
• 49:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis
• 55:28 Sodium bicarbonate for acute and chronic hyperkalemia
• 58:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia
• 60:05 Threshold for admission; Diet and potassium
• 62:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods
• 65:45 Patiromer and sodium zirconium
• 68:51 Loop diuretics and empiric potassium supplementation
• 71:12 Can diet alone be used to treat HYPOkalemia?
• 72:26 Take home points
• 74:40 NephMadness is coming! March 2019
• 76:53 Outro
• 78:00 Stuart’s shares a few puns

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr Topf’s blog lists the following disclosures “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders were sponsored by ACP’s Internal Medicine Meeting 2019 for this episode.

Citation

Topf J, Williams PN, Brigham SK, Watto MF. “#137 Hyperkalemia Master Class with Joel Topf MD.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date: January 28, 2019. 

Beth Garbitelli and Nora Taranto MD add a new intro and share their own insights on this Curbsiders classic!

Physician suicide is a problem. There, we said it. We all have that story; Many of us have experienced the symptoms of depression or suicidal ideation ourselves, or have the colleague, mentor, friend, teacher, sibling, parent, or significant other who has experienced these signs and symptoms. Some of us (probably more than you’d think) have lost someone meaningful to suicide. And yet, we don’t talk about suicide and mental health in medicine, or at least, not enough. So, today, we at the Curbsiders are trying to change that. 

The problem of depression and suicide is a particularly real one in medicine, a profession that is, by its very nature traumatic and emotionally draining (both in terms of work demands and also the sick and dying patients we treat). In this episode, we talk with expert Dr. Elisabeth Poorman about the natural history of depression in residency and beyond. We share some of our own personal stories, and discuss how we can support one another and reach out for help, how to take care of our mental health in an emotionally demanding career, how to deal with licensing questions and worry about stigma, and what systemic changes may be coming (read: we think need to be coming) down the line. 

N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available via email at doctorpoorman@gmail.com, or you may reach out to any of us on Twitter. We are happy to talk and see that you get the support you need.

New episodes return January 20, 2020!

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Sponsor

ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20

Credits

• Written and produced by: Nora Taranto MD, Shreya Trivedi MD
• Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD
• Edited by: Matthew Watto MD 
• Guest: Elisabeth Poorman, MD 

Time Stamps 

• 00:00 Sponsor - ACP’s Internal Medicine Meeting 2020 in LA
• 00:45 Fresh intro by Beth Garbitelli and Nora Taranto MD
• 10:15 Sponsor - ACP’s Internal Medicine Meeting 2020 in LA
• 11:08 Guest one-liner
• 12:18 Wellness Recommendations: Find a Therapist 
• 15:05 How to find a therapist in training; Licensing and Mental Health 
• 21:07 Disclaimer and Trigger Warning: Stories are Sensitive. National suicide hotline info 
• Next, Dr Poorman and each of The Curbsiders share their personal experiences with mental health (see below).
• 22:25 Shreya story
• 30:30 Stuart’s story
• 40:12 Elisabeth’s story
• 45:10 Watto’s story
• 55:27 Passive suicidal ideaiton, a definition; Suicide and Depression: Do they always coexist? (No); Life Cycle of Depression and Suicide in the Medical Profession 
• 56:07 Depression and Suicide in Primary Care 
• 56:44 Mini-Cases 
• 62:39 Noticing signs in a colleague: how to help 
• 66:40 Specific programs doing things well 
• 71:55 Questions from Social Media: Burnout vs. Depression; Will getting treatment affect your board applications 
• 75:03 Take home points
• 76:49 Outro

Goal

Listeners will learn about the risk factors for depression and suicide in medical training, and be empowered to advocate for themselves and their colleagues to be safe.

Learning objectives 

After listening to this episode listeners will

1. Learn about the life cycle of depression in training and its prevalence at different stages in our careers.
2. Analyze the risk factors that lead to depression and why depression is becoming more prevalent in doctors over time.
3. Evaluate barriers to effective care for physicians and the impact of stigma on those experiencing depression or suicidal thoughts.
4. Assess effective strategies for supporting physicians and physicians-in-training facing depression at different stages in their career.

Disclosures

Dr. Poorman reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.

Citation

Poorman E, Trivedi S, Taranto N, Brigham SK, Watto MF. “#129 Depression and Suicide: Occupational Hazards of Practicing Medicine”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date December 10, 2018. 

Recap extravaganza 2019 featuring top pearls from our staff’s favorite episodes of 2019 and voicemails from Kashlak faculty, Dr. Avital O’Glasser (@aoglasser), Dr. Kimberly Manning (@gradydoctor), Dr. Renee Dversdal (@DrSonosRD) and The Curbsiders team. Topics include: HFpEF, the PARAGON-HF trial, Buprenorphine, Opioid Use Disorder, Cirrhosis, Coagulopathy, SBP, Hyperkalemia treatment, Multimorbidity, and how to think about NNT. Plus, the team shares a bunch of other favorite moments and random pearls!

Upcoming shows: The next two weeks will feature REBOOT episodes with fresh intros from The Curbsiders team. Season 9 starts January 20, 2020 with a Lipid Update from Cardiologist Dr. Erin Michos (@ErinMichos)

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Produced by: Sarah Phoebe Roberts MPH and Chris Chiu MD, FACP, FAAP 
• Writer: Sarah Phoebe Roberts MPH
• Infographic: Sarah Phoebe Roberts MPH
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Chris Chiu MD, FACP, FAAP; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Chris Chiu MD, FACP, FAAP (audio), Matthew Watto MD, FACP (show notes)

Time Stamps

• 00:00 Intro and disclaimer
• 04:25 Picks of the year*: The Expanse (TV show) -Chiu Man’s pick; Midsommar (film) -Paul’s pick; Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick; Sleep!!! -Stuart pick
• 08:37 Hyperkalemia Master Class Joel Topf MD
• 14:53 Multimorbidity Games with Josh Uy MD
• 21:54 Buprenorphine Master Master Class with Michael Fingerhood MD
• 27:50 Cirrhosis TIPS for Acute Complications with Scott Matherly MD
• 31:55 HFpEF with Clyde Yancy MD
• 39:50 Chronic pain, sickle cell disease, opioid tapers
• 43:13 Teaching in the Hospital
• 46:00 A quote from Paul Williams
• 47:35 Celebrity voicemails from Avital O’Glasser MD, Kimberly Manning MD,  and Renee Dversdal MD
• 51:55 Voicemails and favorite pearls from our Curbsiders team!
• 62:23 Outro

Goal

Listeners will recall some of the top pearls from Curbsiders episodes on cirrhosis, buprenorphine, HFpEF, multimorbidity and hyperkalemia.

Links*

1. The Expanse (TV show) -Chiu Man’s pick
2. Midsommar (film) -Paul’s pick
3. Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick
4. Sleep!!! -Stuart pick

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

Roberts SP, Chiu CJ, Williams PN, Brigham SK, Watto MF. “#190 Recap Extravaganza 2019”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 30, 2019.

Team up with the authors of the JAMA Medicine series on Medical Overuse, Dr. Dan Morgan @dr_dmorgan (University of Maryland) and Dr. Deborah Korenstein @DKorenstein (Memorial Sloan Kettering). We discuss procalcitonin (again!), the dangers of incidentalomas, risks of chest CT for lung cancer screening, the easiest place to get antibiotics for a viral infection, and why not to treat subclinical hypothyroidism despite guidelines. Trying to find ways to shed the fat off of some common medical practices? Look no further. 

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Justin Berk, MD MPH MBA
• Infographic: Justin Berk, MD MPH MBA
• Cover Art: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Molly Heublein MD, Matthew Watto MD, FACP, Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
• Guest:  Daniel Morgan MD, Deborah Korenstein MD, FACP

Time Stamps

• 00:00 Intro, disclaimer, guest bios
• 04:45 Guest one-liners
• Picks of the Week*: The Fifth Season is part of The Broken Earth Trilogy by NK Jemisen; The Great Believers: A Novel by Rebecca Makkai; A Constellation of Viral Phenomena by Anthony Marra
• 09:22 Best advice
• 11:18 Defining Medical Overuse and defining categories
• 19:20 Procalcitonin testing for pneumonia
• 27:42 Imaging and incidentalomas
• 37:38 Lung cancer screening CT scan; the Bach model
• 46:25 Urgent care and antibiotic prescriptions for viral illnesses
• 52:43 Subclinical hypothyroidism
• 58:32 Take home points
• 61:00 Outro and Stuart tells us about his knee pain

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will consider 5 of the top articles from 2018 that demonstrate signs of medical overuse that seem to offer more harm than benefit to patients.

Learning objectives

After listening to this episode listeners will…  

1. Define medical overuse
2. Discuss recent data about the utility of procalcitonin for antibiotic stewardship in respiratory infections.
3. Recall the frequency incidentalomas on imaging and which modalities are associated with the highest risk.
4. Identify the differences in benefits of annual lung cancer screening with CT based on baseline risk
5. Recall the lack of evidence for treatment of asymptomatic subclinical hypothyroidism
6. Describe the locations that are associated with more antibiotic prescriptions for viral infections.

Disclosures

Dr. Morgan and Dr. Korenstein report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Morgan D, Korenstein D, Berk J, Williams PN, Brigham SK, Watto MF. “#189 Medical Overuse”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 23, 2019.

Delve into the diagnosis and management of GERD and dyspepsia with Dr. Amy Oxentenko (@AmyOxentenkoMD), Gastroenterologist and the Internal Medicine Residency Program Director, Associate Chair for the Department of Internal Medicine, and Professor of Medicine at Mayo Clinic in Rochester, MN. Our discussion features a review of the standard presentations of GERD and dyspepsia, alarm symptoms and who needs referral for endoscopy or other specialized testing (pH, impedance testing, screening for Barrett’s esophagus). Additionally, we comprehensively cover proton pump inhibitor (PPI) therapy including: choice of agent, dose, frequency, how taper, how to counsel patients about risk, what labs should be monitored and the use of adjuvant therapies like H2 blockers, antacids and even carafate. After this episode, you will be flexing on reflux!

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli
• CME Questions: Beth Garbitelli, Matthew Watto MD, FACP
• Infographic: Beth Garbitelli 
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan at Nodderly.com
• Guest: Amy Oxentenko MD

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:47 Guest one-liner, Picks of the Week*: Reality TV Shows: Survivor  and Naked and Afraid; Book: Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder by James B. Stewart
• 08:50 Favorite failure
• 10:55 Best Advice
• 13:34 A case of GERD, Defining GERD, basic pathophysiology and risk factors
• 19:18 A bit more on diagnosis of GERD
• 21:56 Chest pain, mimics of GERD, red flag symptoms
• 25:12 Are labs required for diagnosis?, testing for Barrett’s esophagus
• 28:43 Who needs lifelong PPI therapy?, Choice of PPI
• 33:09 Lifestyle changes and GERD
• 37:50 H2 blocker vs PPI therapy, Risks of PPI therapy
• 44:40 How to counsel patients about the risks and benefits of PPI therapy; Recent 3 year RCT investigating safety of PPI therapy
• 48:18 Adjuvant therapy and further workup for patients with refractory GERD
• 51:57 pH and impedance studies
• 54:29 Duration of PPI therapy; Intermittent and On-Demand PPI therapy; Weaning off long term PPI therapy
• 59:30 Who may benefit from anti-reflux surgery
• 63:48 Dyspepsia
• 68:17 Workup of dyspepsia; Definition and diagnosis of functional dyspepsia
• 74:09 2nd line therapy for dyspepsia (TCAs, Buspirone, GI psychologist, STW 5, complementary and alternative therapies, etc.)
• 78:13 Take Home Points; Plugs

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr. Oxentenko reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Oxentenko A, Williams PN, Garbitelli B, Watto MF. “#188 GERD and Dyspepsia with Amy Oxentenko MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 16, 2019.

How to initiate buprenorphine like a pro. Treating people with Opioid Use Disorder can be the most rewarding part of your practice!  Get comfortable with counseling and pharmacotherapy for OUD with tips from Dr. Michael Fingerhood, Associate Professor of Medicine at Public Health at Johns Hopkins.  We review building a therapeutic relationship with people with substance use disorders, the differences between the three FDA-approved medications for opioid use disorder (buprenorphine, methadone and extended-release naltrexone), and the nitty-gritty of prescribing buprenorphine.

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Justin Berk, MD MPH MBA, Joseph “Seffy” Muller MD
• Infographic: Hannah R Abrams and Justin Berk MD, MPH, MBA
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Justin Berk, MD MPH MBA
• Editor: Matt Watto MD, FACP (written materials), Clair Morgan at Nodderly.com (audio)
• Guest: Michael Fingerhood MD

Time Stamps

• 00:00: Introduction
• 04:40: Guest introduction & questions (great stories about addiction)
• Picks of the Week*: Papillon (film) and Papillon (book) per Dr. Fingerhood; Miami Connection (film) per Stuart, Watto and Paul; Use GREPMED as “the Pinterest of medical education”, per Dr. Justin Berk; ASAM Handbook of Addiction Medicine by Dr. Fingerhood and Dr. Darius Rastegar; Bup App (from Yale School of Medicine)
• 16:45: How to approach someone with addiction looking for help
• 20:00: Choosing between methadone and buprenorphine
• 24:15: Different formulations of buprenorphine
• 26:45: Coverage and costs of buprenorphine
• 28:20: Safety considerations of buprenorphine
• 33:40: How to divide buprenorphine films for specific dosing
• 35:00: Discussion of buprenorphine diversion
• 36:20: Home initiation of buprenorphine 
• 40:00: Use of urine toxicology screens and addressing concurrent use
• 41:00: Initiation of buprenorphine in patients actively using
• 42:30: How to address precipitated withdrawal
• 45:00: Treating chronic pain and transitioning to buprenorphine
• 47:00: Treating acute pain for patients on buprenorphine
• 51:00: Dosing of buprenorphine
• 52:15: Perceived barriers to buprenorphine (e.g. counseling resources, “trading addiction”)
• 57:10: Historical context of opioid use disorder
• 60:00: Take home points
• 62:40: Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Dr. Fingerhood reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Fingerhood M, Berk JL, Muller J, Williams PN, Brigham SK, Watto MF. “#187 Buprenorphine 2.0: Managing Opioid Use Disorder for the Generalist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 9, 2019.

Make some gains with Drs. Feigenbaum (@Jordan_theCoach) & Baraki (@AustinBaraki) of Barbell Medicine as we delve into the topic of sarcopenia! Together we’ll learn what exactly is sarcopenia, how it is diagnosed, and explore approaches to both management and counseling including: exercise prescriptions,  recommendations for protein intake, and even how to treat patients with multiple comorbidities.

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by:  Cyrus Askin MD
• Infographic: Cyrus Askin MD, Hannah Abrams
• Cover Art: Dr. Kate Grant MBChB DipGUMed
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editors: Matthew Watto MD, FACP; Clair Morgan of Nodderly.com
• Guests: Jordan Feigenbaum MD; Austin Baraki MD

Check Out our friends at Barbell Medicine!

Learn more about Barbell Medicine through their website at www.barbellmedicine.com or their YouTube channel - Barbell Medicine. They also have their own Podcast, The Barbell Medicine Podcast and can be found on Instagram: @barbell_medicine, Twitter via @BarbellMedicine.

Drs. Feigenbaum and Baraki can be found on instagram via Jordan_BarbellMedicine & Austin_BarbellMedicine. They can also be found on Twitter via @AustinBaraki, @Jordan_theCoach.

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 03:20 Guest one-liners;
• Picks of the Week*: Explain Pain (book) and Explain Pain Super Charged; Range Why Generalists Triumph in a Subspecialized World (book) by David Epstein; The Sports Gene: Inside the Science of Extraordinary Athletic Performance (book); The Mind’s Eye (book) by Oliver Sacks; The Predator High Five (Gif); The Bacterionomicon
• 08:50 How Austin and Jordan got into coaching, fitness and lifestyle medicine
• 14:30 Case of chronic pain, lack of exercise and loss of muscle mass; Defining sarcopenia, cachexia, frailty
• 22:30 How to diagnose sarcopenia -measures of physical performance (Repeat Chair Sit to Stand; Timed Get Up and Go Test; Gait Speed); DXA scans; The SARC-F questionnaire; Serum Creatinine
• 33:30 Anabolic resistance; Sarcopenic obesity and Osteosarcopenic obesity
• 37:00 How to counsel patients about physical activity
• 40:00 The 10,000 step thing is based on marketing, not evidence
• 41:30 How to sell exercise to patients with comorbidities; Barriers to and safety of resistance training
• 49:39 Finding a physical trainer
• 53:18 Dietary protein intake recommendations
• 61:33 What kind of results might patients expect
• 65:55 Take home points
• 68:11 Plugs: Barbell Medicine podcast, Instagram, YouTube and Twitter
• 69:15 Outro and a pun

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

By the end of this episode, listeners will be familiar with sarcopenia as an important clinical entity, the risk factors for sarcopenia, how to assess a potential sacropenic patient and how to provide treatment and counsel towards preventing or reversing sarcopenia. 

Learning objectives

After listening to this episode listeners will…  

1. Appreciate the clinical relevance/importance of sarcopenia
2. Know who is at risk for sarcopenia and how to screen them
3. Master the most recent exercise and nutrition recommendations for adults
4. Be familiar with motivational interviewing techniques to help promote diet and exercise changes to combat sarcopenia

Disclosures

Dr. Feigenbaum is the owner of Barbell Medicine LLC which provides free, paid and retail content to include strength/nutrition coaching, strength/nutrition seminars, shirts, training gear and protein / pre-work out supplements.

Dr. Baraki works part-time for Barbell Medicine LLC as a writer and coach for which he is paid. He does not receive any proceeds from the sale of supplements or other retail goods. 

Citation

Askin C, Baraki A, Feigenbaum J, Williams PN, Brigham SK, Watto MF. “#186 Sarcopenia: Raising the Bar in Primary Care”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 2, 2019.

“Guidelines” galore! From Community-Acquired Pneumonia to asthma to...red meat? While you may be listening to this around Thanksgiving, we actually recorded on October 30th‒the best and spookiest time of the year. To really set the mood I wanted to include some terrible skeleton puns, but the ones I found weren’t humerus. What we do have for you are some tasty knowledge treats, courtesy of our ghosts‒oops, I mean our HOSTS‒Chris, Matt, Stuart and Paul. Join us as we review the most terrifyingly relevant research findings and creepiest clinical pearls!

Today also marks the debut of our newest Hotcakes team member, the frighteningly talented Dr. Rahul Ganatra. Rahul will now be our resident statistician/study design expert, and will use his research skulls‒no wait, SKILLS‒to provide even more insight into the practice-changing findings we love to highlight for you.  

ACP members can claim CME-MOC at CME credit https://www.acponline.org/curbsiders. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 

• Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
• Statistics Expert: Rahul Ganatra MD
• Editors: Christopher Chiu MD (audio/text), Emi Okamoto MD (text)
• Cover-Art: Sarah Phoebe Roberts MPH
• Music: Stuart Brigham MD

Time stamps

• 00:00 Introduction/Disclaimer
• 03:18 Getting to know Dr. Rahul Gantra
• 05:35 Community-Acquired Pneumonia Guidelines
• 15:13 Sarah explains Hotcakes ratings
• 16:45 A new Asthma Strategy
• 17:26 Chris forgets what LABA stands for
• 27:37 Stuart makes a joke
• 29:00 A lot of meat talk
• 37:22 Rahul’s Napkin Calculations
• 51:40 Honorable Mentions
• 52:42 Take-away Points & Outtro

Meet Rahul:

Rahul Ganatra is a Medical Attending and Director of Continuing Medical Education for the Medical Service at the VA Boston Healthcare System.  He fell in love with clinical epidemiology and public health while taking night classes for his MPH during medical school. and went on to become an applied epidemiology fellow at the Centers for Disease Control and Prevention.  He completed his residency and chief residency in internal medicine at Beth Israel Deaconess Medical Center, where he worked as a hospitalist for two years before coming to the VA, where he is currently the faculty mentor for the resident journal club.  In addition to critical appraisal, he loves cool animal facts and subjecting friends and colleagues to tirades about animal physiology.

Goals and Learning Objectives

Goals: 

Listeners will learn about relevant medical literature, with emphasis on breaking news and recently published research. 

Learning objectives:

After listening to this episode listeners will…

1. Learn about important journal articles and their salient points
2. Develop a framework to critically analyze journal articles in a practical way
3. Learn what medical news is being widely reported in the lay media and the underlying evidence in the literature
4. Review the current literature on the following subjects: (1)American Thoracic Society and Infectious Diseases Society of America updated guidelines for the diagnosis and treatment of Community Acquired Pneumonia; (2) updated asthma treatment strategy and recommendations from the Global Initiative for Asthma; (3) the association between red meat intake and mortality and cardiometabolic outcomes. 

Disclosures: 

The Curbsiders report no relevant financial disclosures.

Citation: 

Chiu CJ, Roberts SP, Ganatra R, Williams PN, Brigham SK, Watto MF. “Hotcakes: CAP, Asthma and Red Meat”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. November 27, 2019.

Score some great insights and clinical pearls from Dr. Christine Won on the incredibly important topic of sleep medicine during this live recording at CHEST! On this episode we’ll tackle why we sleep, how to treat insomnia, the “Z-drugs” and more! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Cyrus Askin MD, Matthew Watto MD, FACP 
• Infographic: Matthew Watto MD, FACP
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP; Emi Okamoto MD
• Guest: Christine Won, MD MSc

Sponsor

The American College of Chest Physicians

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 06:10 Guest one-liner
• 10:15 Picks of the Week*: Become Your Child’s Sleep Coach (book) by Lynelle Schneeberg;
• Sleep in Art: How artists portrayed sleep and dreams in the last 7000 years (book) by Meir Kryger; The Toxic Avenger (film); Ballistyx Jump Rope; Weird Al - The Essentials
• 12:28 Case of Mr. S. Andman; Why we sleep
• 16:04 Spiel on how sleep affects health, testosterone
• 21:05 How much sleep do we need; Teens and sleep
• 28:05 Spiel to patients self medicating with sedatives; CBT for insomnia (CBTI) including online CBTI
• 32:10 Sleep hygiene, naps
• 34:10 Z drugs
• 39:17 How sleep apnea differs in women
• 41:52 Sleep trackers (wearables); Blue blockers and screens
• 45:00 Audience questions: Alarm clocks; Cultural sleep issues;  Shift work; Melatonin; 5-hydroxytryptophan
• 55:45 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will gain a broad overview of the purpose of sleep, its implications for promoting health and preventing disease, tips for improving sleep quality, plus answers to the most common sleep questions from patients.

Learning objectives (After listening to this episode, you should be able to...)

1. Explain the theories behind why we sleep and recognize the link between sleep, overall health, and various comorbid conditions
2. Counsel patients about sleep and recall tips to improve their own sleep
3. Answer common questions about over the counter supplements and prescription medications used for sleep 
4. Discuss approaches to therapy for insomnia, specifically the role of prescription medications in conjunction with cognitive behavioral therapy and sleep hygiene

Disclosures

Dr. Won reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Won, M, Williams PN, Brigham SK, Askin C, Watto MF. “#184 Update in Sleep Medicine: LIVE from CHEST 2019!”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 25, 2019.

We want to live longer… and healthier too! Dr Peter Attia, a physician focusing on the applied science of longevity, walks us through lifespan and healthspan, exploring tactics aimed at extending both. Listeners will challenge the conventional approach to primary care and explore tactics to optimize exercise, nutrition, and health, including counseling on different dietary patterns, fasting, exercise, emotional well-being and how to prepare for the Centenarian Olympics!

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Matthew Watto MD, FACP and Elena Gibson MD 
• Cover Art and Infographic: Elena Gibson MD
• Hosts: Elena Gibson MD, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Emi Okamoto MD
• Audio Editor: Clair Morgan of Nodderly
• Guest: Peter Attia MD 

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 04:22 Guest one-liner, Career Advice, Picks of the Week*
• 14:30 Case: A couple seeking maximize longevity; Defining longevity, healthspan, lifespan and the 4 types of death
• 19:30 Lifespan, the longevity curve and the long tail
• 23:50 Peter’s approach to shepherding patients toward longevity; Exploring motivations
• 32:06 Back to our couple: What exercises should they perform
• 42:09 Peter’s advice on nutrition; the standard American diet; Intermittent fasting; Dietary Restriction
• 51:20 Periodic fasting and water only fasting
• 54:33 Genetics and longevity
• 56:40 Metformin; SGLT2 inhibitors; Allopurinol and uric acid lowering
• 61:47 Peter’s take home points and a plug for David Foster Wallace’s commencement speech from Kenyon College
• 66:40 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will learn a framework for thinking about longevity and practical tips for improving lifespan and healthspan.

Learning objectives

After listening to this episode listeners will…  

1. Define longevity, healthspan,and lifespan 
2. Recall the four types of death.
3. Explain the objectives of improved aging (longer lifespan, delayed rate of decline, and compressed period of morbidity).
4. Learn basic dietary principles to improve lifespan/healthspan and compare various dietary patterns
5. Describe some tactics to promote lifespan/healthspan (in nutrition, exercise physiology, sleep, distress management, medications and supplements, etc.)
6. Explore the possible longevity benefits of fasting

Disclosures

Dr Peter Attia reports the following relevant financial disclosures: Peter receives speaking honorariums from organizations including hospitals and health-related businesses when he is asked to speak on longevity, metabolic-related topics, athletic performance, and his personal experience. Peter is the co-founder and Chief Medical Officer of the fasting app Zero. Peter is an advisor to, and/or investor in, the companies Virta Health, Hu Kitchen, Oura Health Oy, Magic Spoon Cereal, Inevitable Ventures, Salutoceuticals, and Supercast. Further information can be found at his website https://peterattiamd.com/about/. 

The Curbsiders report no relevant financial disclosures. 

Citation

Attia P, Gibson E, Williams PN, Brigham SK, Watto MF. “#183 Longevity, Healthspan and Lifespan with Peter Attia MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 18, 2019.

This podcast covers several concrete steps that residents can do or program directors can suggest to help residents transition to assuming the role of PGY3. A year is a long time, but requires a strategic approach to ensure that residents get the most out of it. It’s our latest offering from ACP’s IMpower series for residents featuring our friends from Walter Reed IM Residency: Joshua Hartzell MD (@joshuadhartzell); Kim Fabyan MD (@kfabsMD); Jeff Gray MD (@theotherDrGray).

If you are a PGY3 you should: LEAD like someone’s life depends on it!

Credits

• Written and Produced by: Joshua Hartzell MD, MS-HPEd, FACP, FIDSA; Kim Fabyan MD; Jeff Gray MD
• Infographics: Joshua Hartzell MD, MS-HPEd, FACP, FIDSA; Kim Fabyan MD; Jeff Gray MD
• Cover Art: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Matthew Watto MD, FACP
• Guests:  Joshua Hartzell MD (@joshuadhartzell); Kim Fabyan MD (@kfabsMD); Jeff Gray MD (@theotherDrGray)

Sponsor - ACP IMpower: Catalyzing your professional future

Each month, ACP IMpower offers non-clinical tools and resources expertly crafted to support residents during their training and catalyze their professional future.

Crafted by ACP leaders, experienced internists, and prominent podcasters, IMpower covers a wide variety of topics valuable to residents at every stage of their training, and beyond. Visit https://www.acponline.org/impower.

Time Stamps

• 00:00 Sponsor, disclaimers, intro, guest bios
• 05:10 Guest one-liners
• 07:43 Precocious Passion for teaching
• 09:30 Picks of the Week*: High Life (film); @MedicalPuns; The Culture Code (book); Quiet: The Power of Introverts (book); Every Patient Tells A Story (book)
• 14:02 How does PGY3 differ from PGY2
• 18:18 Coaching in Medicine
• 23:42 Goal setting (short, intermediate and long term)
• 32:25 Tips for Internal Medicine Board Prep
• 40:30 Skills to develop during PGY3 year
• 42:28 Improve your skills as a medical educator;  Developing Leadership Skills
• 47:47 Feedback Fridays
• 50:00 Coaching the PGY3 resident to run rounds
• 55:20 Quality improvement and IHI
• 56:31 Take Home Points from Josh, Kim and Jeff
• 60:04 Outro

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Disclosures

Doctors Hartzell, Fabyan and Gray report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Hartzell J, Fabyan K, Gray J, Williams PN, Brigham SK, Watto MF. “#182 Becoming a PGY3: Not Just a Repeat of PGY2”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 11, 2019.

Learn how to approach the geriatric patient with multimorbidity and how to parse through and prioritize a mile-long problem list with Dr Josh Uy, master geriatrician at the University of Pennsylvania. We review different approaches to a clinic visit with a patient who takes fifteen daily medications with just as many chief complaints, all in a thirty minute (or less!) appointment time. We discuss what the term “multimorbidity” even means, how to ask about patient preferences and use them to inform the treatment plan, and what the evidence has to say about adjusting treatment goals of common conditions for individual patients. (Spoiler alert: It all depends on the patient, comorbid conditions and goals!) 

Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Producer: Nora Taranto MD 
• Writer:  Nora Taranto MD, Leah Witt MD 
• Infographic:  Leah Witt MD 
• Cover Art: Nora Taranto MD 
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Leah Witt MD, Paul Williams MD, FACP
• Editor: Matthew Watto MD, FACP; Clair Morgan
• Guest: Josh Uy MD

Time Stamps

• 00:00 Pun, Intro, disclaimer, guest bio
• 04:30 Guest one-liner; Career advice; 
• Picks of the Week*: Unbroken (book), Down Dog Yoga (app); Check out Dimash’s music on YouTube; Off Your Rocker (TV show); Finishing Well to the Glory of God (book)
• 12:30 A case of multimorbidity; Where to start?
• 15:30 How to focus the visit; Lumping and the problem list;
• 18:20 Dr Uy’s framework for multimorbidity
• 28:08 Questions (scripts) for eliciting patient preferences
• 30:20 Hypertension; All cause mortality; Number needed to treat; The danger of adding blood pressure medications in the hospital, the Jenga analogy
• 35:30 How to frame  potentially ineffective treatments (e.g. statins for primary prevention of stroke) and align treatments with a patient and family’s goals
• 44:18 Dr Uy runs through common comorbid conditions and time to benefit starting with longevity minded (45:43); Palliative minded approach (47:50)
• 48:49 Afib, anticoagulation and falls; Cancer screening
• 54:30 Take Home Points

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Goal

Listeners will develop an approach to managing older adults with multimorbidity in primary care  

Learning objectives 

After listening to this episode listeners will... 

1. Define multimorbidity and its implications for triaging multiple chief complaints and chronic conditions
2. Recognize the time frame to benefit of treatments for several chronic conditions
3. Learn to ask patients about health care values and goals of care in order to optimize shared decision-making
4. Identify the barriers to treating multimorbidity and strategize approaches for optimal primary care delivery for patients with multimorbidity

Disclosures

Dr Uy reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Uy J, Taranto N, Witt LJ, Williams PN, Brigham SK, Watto MF. “#181 The Multimorbidity Games”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 4, 2019.

CHEST 2019 Recap Part 2 featuring random pearls and highlights from #CHEST2019 in New Orleans including: tips for addressing futile end-of-life care, bleeding in the ICU, DOAC reversal agents, use of procalcitonin and monocyte distribution width to identify sepsis, vitamin C for sepsis treatment, small particles and lung cancer risk, augmented reality/virtual learning, and tech as a teaching tool. Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality. 

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written, produced, and co-hosted by: Sarah Phoebe Roberts MPH; Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP
• Edited by: Matthew Watto MD, FACP
• Special Guests: Nina Maouelainin DO, MBA (@lungsolutions); Erin Narewski DO, FCCP (@erinnarewski); Chidinma Chima-Melton MD, FCCP (@LABritishLady), Kim Fabyan MD (@kfabsMD)

Time Stamps

• 00:00 Pun, Disclaimer, Intro
• 03:58 Dr Erin Narewski on end of life conversations
• 13:30 Bleeding in the ICU
• 15:40 DOACs and reversal agents
• 18:40 Dr Chidinma Chima-Melton on ICU visiting hours
• 22:50 Vitamin C use in the ICU, Stuart’s Vitamin C rant
• 29:22 Monocyte distribution width for identifying patients with sepsis
• 30:55 Sarah Phoebe Roberts on Procalcitonin and CRP for sepsis
• 39:36 Dr Nina on technological innovations in MedEd: Virtual bronchoscopy; Dropping a computer in a remote village
• 46:49 Sarah Phoebe Roberts on Small particles and lung cancer risk
• 54:48 Outro

Citation

Narewski E, Chima-Melton C, Maouelainin N, Roberts SP, Williams P, Brigham S, Fayban K, Watto MF. “CHEST 2019 Recap Part 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. October 30, 2019.

Recap of random pearls and highlights from #CHEST2019 including: A pop quiz on inhaler use, interstitial lung disease, pulmonary fibrosis (IPF), limitations of supplemental oxygen, lung cancer screening, imposter syndrome, and is it safe to use beta blockers in COPD. 

Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality. 

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written, produced, and cohosted by: Sarah Phoebe Roberts MPH; Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP
• Edited by: Matthew Watto MD, FACP
• Special Guests: Leah Witt MD (@leahJwitt); Nina Maouelainin DO, MBA (@lungsolutions); Erin Narewski DO, FCCP (@erinnarewski); Hassan Bencheqroun MD, FCCP (@drBcalifornia); Chidinma Chima-Melton MD, FCCP (@LABritishLady)

Time Stamps

• 00:00 Intro, disclaimer
• 05:20 Dr Leah Witt @leahwitt (UCSF) quizzes us on inhalers.
• 09:55 Dr Leah Witt on ILD in geriatric patients
• 13:09 Dr Erin Narewski @erinnarewski (Temple) on supplement oxygen. 
• 15:07 Dr Erin Narewski discusses the brand new BLOCK trial.
• 18:11 Dr Chidinma Chima-Melton @LABritishLady (UCLA) discusses the latest in interstitial lung disease (ILD) treatment and gives a rapid overview of ILD.
• 29:15 Dr Nina Maouelainin @lungsolutions discusses lung cancer screening
• 39:40 Dr Hassan Bencheqroun MD @drBcalifornia on how to overcome imposter syndrome by asking yourself “what if”.
• 44:39 Outro

Citation

Witt LJ, Maouelainin M, Narewski E, Bencheqroun H, Chima-Melton C, Roberts SP, Williams P, Brigham S, Watto MF. “CHEST 2019 Recap Part 1”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. October 28, 2019.

Catch up on the latest guidelines and insights on tuberculosis with help from Dr. Laila Woc-Colburn, @docwoc71 (Baylor)! We cover new recommendations for screening health care workers, treatment of both latent and active TB, and best practices for counseling patients throughout the process. Listen to find out more… And say goodbye to the annual PPD?

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Full notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

• Written and Produced by: Hannah R. Abrams
• Cover Art and Infographic by: Hannah R. Abrams
• Hosts: Hannah R. Abrams; Matthew Watto MD, FACP
• Editors: Matthew Watto MD, FACP; Emi Okamoto MD
• Guest: Laila Woc-Colburn, MD, FACP