Point-of-care Ultrasound AKA POCUS ain’t no hocus. Dr. Renee Dversdal (@ReneeDversdal) Director of the Oregon Health & Science University Point of Care Ultrasound and General Medicine Ultrasound Fellowship Director, joins The Curbsiders to discuss her craft. Topics include: Defining POCUS, the value POCUS adds to the physical exam, training pathways and the appropriateness of billing. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date). Follow this link to read the ACP’s statement in support of POCUS in Internal Medicine.

Full show notes available at http://thecurbsiders.com/podcast. 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 by: Christopher Chiu MD and Renee Dversdal MD
• Produced and CME questions by: Christopher Chiu MD
• Edited by: Matthew “Mike” Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Christopher Chiu MD
• Guest Expert: Renee Dversdal MD

Tags: point-of-care, acp, impocus, ultrasound, bedside, POCUS, CLUE, exam, training, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue.

Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist.

N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air.

Full show notes available at http://thecurbsiders.com/podcast

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: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams,
• Images by: Beth Garbitelli and Hannah Abrams
• Editor: Matthew Watto MD
• Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD
• Guest: Vineet Arora MD

Time Stamps

• 00:00 Disclaimer and intro
• 03:15 Guest bio, and one liner
• 05:55 Dr Arora’s Women in medicine moment of awakening
• 11:05 Advice to young women, “Be bold”
• 13:20 Picks of the week
• 16:45 Mistaken identity. Women not recognized as physicians due to appearance
• 22:05 Gender bias starts early in training and why it's important to shout-out accomplishments
• 31:24 Contracts, promotions and the leaky pipeline
• 38:32 Defining coaches, sponsors, and mentors
• 44:06 How to use your team and shout-out your accomplishments
• 52:04 How to write effective evaluations and letters that avoid gender bias
• 53:55 Take home points
• 57:00 Outro

Tags: women, medicine, wim, LeanIn, leadership, mentorship, doctor, education, family, assistant, career, sponsorship, vineet, arora, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Short on time but hungry for knowledge? Curbsiders’ Journal Club gives you the speedy article analysis you crave. We provide brief summaries of recent research and news items in the field of internal medicine, so you can save time and stay on top of the literature. On this episode, we were joined by Kashlak Memorial’s very own Chair of Medicine, Dr. Robert Centor AKA @medrants on Twitter or “Uncle Bob” to the Curbsider Crew. This month’s topics include: estimating atherosclerotic cardiovascular disease risk, whether CT pulmonary angiography (CTPA) effectively rules out pulmonary embolism, discharging low risk patients with pulmonary embolism from the ED, metformin and risk of acidosis in patients with CKD, treating opioid use disorder after a nonfatal overdose, Canagliflozin and renal protection in type 2 diabetes, screening for diabetes among patients below age 40, and the association between nose-picking and staphylococcus. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date).

Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you!

Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.  

Credits:

• Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Editor: Matthew Watto MD
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Guest: Robert Centor MD

Time stamps:

• 00:00 Disclaimer and Intro to Curbsiders Journal Club
• 04:00 Dr. Centor's Pick of the Week
• 06:10 Clinical Implications of the Revised Pooled Cohort Equations
• 12:10 Negative Predictive Value in CTPA for VTE
• 18:34 Can low risk patients with PE be discharged from the ED?
• 23:03 Is Metformin associated with Lactic Acidosis in those with low eGFR?
• 28:45 How do medications for opioid use disorder affect mortality after non-fatal overdose?
• 36:44 Canagliflozin and Renal Protection
• 43:00 Performance of USPSTF screening criteria for diabetes
• 46:08 Stuart on Nose picking
• 50:00 Chiu Bites: Infectious ties and physical attire
• 53:50 Outro

Tags: atherosclerotic, cardiovascular, disease, risk, CT, pulmonary, angiography, CTPA, embolism, ED, metformin, acidosis, CKD, treatment, opioid, use, disorder, oud, mat, overdose, canagliflozin, renal, diabetes, screening, nose-picking, staphylococcus, ACP, CME, MOC, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.  

Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant.

Full show notes available at http://thecurbsiders.com/podcast

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 by: Shreya P. Trivedi MD, Nora Taranto AB
• Produced by: Shreya P. Trivedi MD, Nora Taranto AB
• Editor: Matthew Watto MD
• Images by:  Hannah R. Abrams
• Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD
• Guest: Paul E. Sax MD

Time Stamps

• 00:00 Intro
• 02:17 Disclaimer
• 03:19 Guest bio
• 05:17 Getting to know Guest
• 08:33 Favorite hiking experiences
• 12:20 Disclaimer of Tick-borne illness
• 12:28 Clinical case of recent hiking in endemic area with a rash
• 20:59 Lyme testing limitations
• 27:38 Patient education to doxycycline
• 30:16 Case of elderly outdoorsy healthy male with flu-like symptoms in the summer
• 32:39 Differentiating anaplasmosis and babesiosis
• 33:17 Workup for patient with possible tick co-infections
• 39:22  Post-lyme disease residual symptoms
• 48:02  Case of tick attached to patient
• 56:19  Outro

Tags: lyme, disease, anaplasmosis, babesiosis, treatment, prevention, coinfection, doxycycline, paul, sax, infectious, diseases, nejm, harvard, pcr, antibody, tick, borne, illness, chronic, post, syndrome, removal, endemic, anatomical, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Renal tubular acidosis aka RTA deconstructed by @Kidney_Boy, Joel Topf MD, Chief of Nephrology at Kashlak Memorial Hospital. We review the three buckets of non gap metabolic acidosis, normal renal physiology & acid base handling, points of failure in RTA, complications and treatment of RTA. Check out Dr Topf’s awesome slides on renal tubular acidosis at http://thecurbsiders.com/podcast .

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 by: Matthew Watto MD and Joel Topf MD
• Produced by: Matthew Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Joel Topf MD

Time Stamps

• 00:00 Announcements
• 01:02 Disclaimer
• 01:40 Intro and guest bio
• 04:00 Joel’s one liner
• 06:05 Joel’s “favorite failure”
• 11:45 Paul shares a failure
• 13:20 Tweetorials
• 16:39 Clinical case of non gap metabolic acidosis
• 18:06 Three buckets of NAGMA and GI losses
• 21:02 Chloride intoxication and normal saline
• 25:14 Renal tubular acidosis and normal role of kidney in acid base
• 35:03 Proximal (type 2) RTA
• 40:33 Cases of proximal RTA
• 43:38 Distal (type 1) RTA
• 53:15 Bicarbonate dosing and titration
• 55:28 Type 4 RTA (hypoaldosteronism)
• 62:09 Urinary anion gap and ammonium
• 67:26 Replacing GI losses of bicarbonate
• 70:25 Joel reviews quick cases of RTA and NAGMA
• 74:49 Outro 

Tags: renal, tubular, acidosis, non, gap, rta, nagma, metabolic, kidney, diarrhea, sodium, normal, saline, ringer's, lactate, tubule, bicarbonate, physiology, acid, base, ammonia, ammonium, nephrolithiasis, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.  

Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician.

Full show notes available at http://thecurbsiders.com/podcast

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:  Stuart Brigham MD
• Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD
• Guest: Gurpreet Dhaliwal MD
• Images by: Beth Garbitelli
• Edited by:  Matthew Watto MD

Time Stamps

• 00:00 Disclaimer, Intro
• 02:25 Guest Bio
• 03:57 Pun
• 04:25 Dr. Dhaliwal
• 05:57 Pick of the Week - Move, “Jiro Dreams of Sushi”
• 08:00 Pick of the Week - Podcast, “Unspooled”
• 09:06 Pick of the Week - Water Putty, “Durham’s Rock Hard Water Putty”
• 10:20 “Clinical Case” Introduction
• 12:00 Developing expertise, introduction
• 15:50 Developing a patient log
• 21:30 Asking the wrong question leads to the wrong answer
• 23:35 Telling a colleague they were wrong
• 26:00 Five to one ratio
• 28:58 Understanding the why
• 33:57 Simulation in practice
• 37:35 Quote on learning… Just listen.
• 41:00 Quizzing and consolidating memory
• 44:24 Reading the literature as a clinician
• 50:10 Bottom line
• 57:10 Outro

Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

Curbsiders’ Journal Club features rapid summary and critical appraisal of recent articles and news stories in internal medicine by The Curbsiders. This month’s topics include: asthma, maintenance versus as needed inhaler use, procalcitonin, Pneumocystis pneumonia prophylaxis, colon cancer screening, smoking cessation, cannabis and cognitive impairment, LDL cholesterol and mortality, plus some medical podcast recommendations.

Over the last month, we have developed a list of more than 40 interesting articles and news stories that we have been feeding our own brain holes. From this list we have plucked a select few that we really wanted to highlight and share with you.

Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Credits:

• Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Editor: Matthew Watto MD

Time Stamps:

• 00:00 Announcements
• 00:20 Disclaimer
• 01:00 Intro to Curbsiders Journal Club
• 03:07 Mild asthma and as needed versus maintenance inhaler use
• 09:50 Smoking cessation, e-cigarettes, and financial incentives
• 17:23 Pneumocystis pneumonia prophylaxis
• 22:18 Cannabis and cognitive impairment
• 26:15 Colorectal cancer screening update by American Cancer Society
• 30:37 Procalcitonin for lower respiratory tract infections in the ED
• 37:29 Cholesterol, baseline LDL-C, mortality and cardiovascular events
• 41:01 Incorrect symbology and some podcast recommendations
• 46:22 Outro

Tags: asthma, maintenance, inhaler, procalcitonin, Pneumocystis, pcp, pneumonia, prophylaxis, colon, cancer, screening, crc, smoking, cessation, marijuana, cannabis, cognitive impairment, LDL, cholesterol, mortality, cardiovascular, podcast, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Cirrhosis. Take control of cirrhosis and treat your patients like the pros! In this episode of The Curbsiders, Dr. Scott Matherly, assistant professor in the Dept of Medicine at Virginia Commonwealth University and board certified hepatologist, builds upon his introduction to cirrhosis. You already know what to look out for and how to diagnose these patients, now it’s time to build your knowledge and medical repertoire against this deadly condition! Topics include: high protein diet, ascites, diuretics, hepatic encephalopathy, lactulose vs rifaximin, portal hypertension, esophageal varices, beta blockers, spontaneous bacterial peritonitis prophylaxis and more pathophysiology!

Full show notes available at http://thecurbsiders.com/podcast. 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 by: Cyrus Askin MD
• Infographics: Beth Garbitelli
• Produced by: Cyrus Askin MD and Matthew Watto MD
• Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Scott Matherly MD

Time Stamps

• 00:00 Announcements
• 00:54 Disclaimer
• 01:30 Guest bio
• 02:28 NASH, diet, vitamin E, pioglitazone and prevention of cirrhosis
• 06:56 Clinical case of decompensated cirrhosis
• 09:02 Pathophysiology of circulatory dysfunction in cirrhosis and use of diuretics
• 18:25 Hepatic encephalopathy, ammonia, lactulose and rifaximin
• 25:10 Timing of medical therapy
• 26:39 MAP of 82 mmHg, beta blockers and variceal bleeding
• 31:04 Use of midodrine for hypotension
• 33:45 Prophylaxis of SBP
• 36:05 Take home points
• 38:04 Outro

Tags: cirrhosis, liver, high, protein, diet, sodium, restriction, ascites, diuretics, furosemide, spironolactone, hepatic, encephalopathy, lactulose, rifaximin, portal, hypertension, esophageal, varices, beta, blockers, spontaneous, bacterial, peritonitis, prophylaxis, pathophysiology, sbp, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Cirrhosis. Finally. Take your liver game to the next level with tips from @liverprof, Scott Matherly MD, Assistant Professor of Medicine at Virginia Commonwealth University. Topics include: exam findings in cirrhosis, interpreting liver function tests, incidental cirrhosis on imaging, fatty liver disease, steatohepatitis, hep c, shear wave elastography, screening for varices and hepatocellular carcinoma, pathophysiology, and lifestyle measures for initial management. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date).

Full show notes available at http://thecurbsiders.com/podcast

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 by: Cyrus Askin MD
• CME questions by: Cyrus Askin MD
• Produced by: Cyrus Askin MD and Matthew Watto MD
• Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Scott Matherly MD

Time Stamps

• 00:00 Announcements
• 00:45 Disclaimer
• 01:19 Intro to the show and our guest
• 04:15 Guest one liner, books recommendations, and career advice
• 09:04 Cyrus’ pick of the week
• 10:14 Clinical case of abnormal liver functions tests
• 11:12 Seven hand findings of cirrhosis
• 13:28 Should we screen for NASH?
• 15:28 Incidental finding of cirrhosis on imaging
• 17:47 Next steps after diagnosis of cirrhosis
• 20:36 Non-invasive scoring systems to predict cirrhosis
• 23:55 Liver biopsy
• 25:33 Shear wave elastography
• 29:10 Recap of what we learned so far
• 31:58 Three ways cirrhosis can kill you
• 33:56 Counseling patients about cirrhosis
• 36:05 Management of NASH and early  cirrhosis
• 42:55 Screening for varices and hepatocellular carcinoma
• 46:28 Outro

Tags: cirrhosis, liver, function, shear, wave, elastography, fibroscan, imaging, fatty, liver, disease, nash, nafld, steatohepatitis, hepatitis, hep c, hcv, screening, varices, hepatocellular, carcinoma, pathophysiology, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Step up your primary care of cancer survivors with tips from Dr Regina Jacob, Assistant Professor of Medicine at Temple University. Care of the cancer patient does not end when their cancer treatment is over, and there is more to a past diagnosis of cancer than surveillance. We discuss cancer survivorship care with Dr. Regina Jacob, including the changing demographics of survivorship, the importance of survivorship care plans, and how survivorship is largely just good primary care.

Full show notes available at http://thecurbsiders.com/podcast

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 by: Paul Williams MD
• Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD
• Produced by: Paul Williams MD
• Edited by: Matthew Watto MD
• Guest: Regina Jacob MD 

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro to the topic and guest bio
• 02:15 Guest one liner, book and app recommendations
• 06:58 Paul’s pick of the week.
• 07:40 Clinical case, definitions, and phases survivorship
• 12:36 Survivorship statistics
• 15:04 Co-survivorship
• 17:41 Care models for survivorship
• 20:56 Assigning roles in care of cancer survivors
• 22:59 Sample survivorship care plan
• 27:39 Childhood, adolescent and young adult cancer survivorship
• 34:18 Sexual dysfunction in cancer survivorship
• Turn down Watto and Regina tracks
• 35:56 Stressors in young adult cancer survivors
• 37:33 Fatigue
• 43:28 Guidelines on survivorship
• 45:06 Late cardiac toxicity
• 46:23 Support groups and resources
• 49:04 Take home points
• 50:29 Outro 

Tags: Survivorship, cancer, breast, ovarian, colon, radiation, chemotherapy, side, effect, fatigue, sexual, dysfunction, care, plan, surveillance, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Knee pain is easy with practical tips from Orthopedist, medical educator, car-builder, and inventor extraordinaire Dr. Ted Parks. He teaches us the four buckets of knee pain, how to perform a 30-second knee exam, choose a knee brace, order x-rays, and the red flags to look for in a history and physical that should have you shouting for your closest neighborhood orthopedic surgeon. This episode is brought to you in partnership with the American College of Physicians. ACP members can claim free CME-MOC credit at acponline.org/curbsiders. Check out our video of the Parks-Approved 30-second knee exam!

Credits:

• Written by: Nora Taranto BA, Matthew Watto MD
• Produced by: Chris Chiu MD and Nora Taranto BA
• Edited by: Matthew Watto MD.
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD.
• Guest: Ted Parks MD.  

Full show notes available at http://thecurbsiders.com/podcast. 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. 

Time Stamps

• 00:00 Announcement
• 01:00 Disclaimer
• 01:35 Intro and guest bio
• 04:08 Dr Parks’ one-liner, book recommendation, inventions, and career advice
• 10:52 A case of knee pain, and recognizing emergencies
• 14:17 Four buckets of knee pain
• 17:40 Initial approach to treatment of knee pain
• 20:19 Corticosteroid injection controversy
• 22:47 Hyaluronic acid injections
• 24:50 Topical agents
• 27:03 Taking a history about knee pain
• 29:39 Knee locking or giving out
• Practical Office Orthopedics by Ted Parks
• 31:44 How to order knee X-rays
• 36:45 Knee braces
• 41:00 How to perform a 30 second knee exam
• Ms Anita Bones has left knee pain and recent fall.
• 53:00 PRP, stem-cell injections
• 61:00 Glucosamine chondroitin
• 63:09 Take home points
• 64:36 Outro

Tags: orthopedics, knee, pain, ortho, joint, exam, osteoarthritis, arthritis, xray, physical, injection, corticosteroid, hyaluronic, hyaluronate, prp, stem, cell, bracing, nsaids, glucosamine, chondroitin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way.

Join our mailing list to 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Credits:

• Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH
• Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD
• Editor: Matthew Watto MD

Time Stamps: 

• 00:00 The Curbsiders need a web master
• 00:50 Disclaimer
• 01:25 Intro to the format
• 03:25 Ambulatory BP monitoring and mortality
• 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets
• 14:14 Repeated BP measurements important at office visits and future directions of BP management
• 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality
• 38:12 Outro

Tags: Hypertension, blood, pressure, monitoring, cuff, automatic, ambulatory, prostate, cancer, screening, Intimate, Partner, Violence, alcohol, mortality, DPP4, sglt2, glp1, IBD, risk, BNP, teaching, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Get schooled on hemoglobin a1c targets in type 2 diabetes mellitus by American College of Physicians guidelines coauthor, Devan Kansagara MD MCR, Associate Professor of Medicine, Oregon Health Sciences University. We summarize outcomes from the landmark diabetes trials (ACCORD, ADVANCE, VADT, UKPDS 33 & 34), how a1c targets effect microvascular and macrovascular events, estimating life expectancy, and how to personalize diabetes control for your patients. We’re proud to announce our new partnership with the ACP to provide free CME credit and MOC points on select episodes of The Curbsiders. ACP members can visit acponline.org to redeem free CME/MOC credit.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list to 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 edited by: Matthew Watto MD.
• Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD.
• Guest: Devan Kansagara MD, MCR

Time Stamps

• 00:00 Announcement
• 00:48 Disclaimer and intro
• 03:11 Getting to know our guest: one liner, book recommendation, mentorship
• 06:50 How and why did ACP write their guidance statement on diabetes, A1C targets
• 09:18 Landmark trials in type 2 diabetes
• 11:36 Does tight control prevent micro or macrovascular complications
• 13:20 Trials of newer agents like SGLT2i, GLP-1 and DPP4i
• 14:33 How do ACP’s guidelines differ from other published guidelines
• 17:20 Quick recap of landmark trial findings
• 22:24 Personalizing glycemic control
• 24:30 Controversy over an A1C goal of 7-8%
• 28:05 Clinical inertia
• 30:26 Legacy effect and metabolic memory
• 34:00 Deintensifying therapy
• 38:29 Life expectancy and comorbid conditions
• 43:15 Performance measures in diabetes
• 44:42 Take-home points
• 46:30 The Curbsiders recap and give some closing remarks
• 49:13 Outro 

Tags: diabetes, a1c, target, dm, hypoglycemia, glycemic, intensive, tight, glucose, control, cardiovascular, risk, outcome, mortality, death, metformin, insulin, acp, guideline, accord, advance, vadt, ukpds, microvascular, macrovascular, aace, ada, VA, DoD, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Separate the wheat from the chaff when it comes to food allergy, food intolerance, and celiac disease. Featuring renowned gastroenterologist and current president of the American Gastroenterological Association, Dr. Sheila Crowe MD FRCPC FACP FACG AGAF, we discuss how to differentiate a food allergy from an intolerance, what diagnostic testing is appropriate, and why fructans might be the real culprit in patients with ‘gluten sensitivity’.

Full show notes available at http://thecurbsiders.com/podcast

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 by: Sarah P. Roberts, MPH
• Guest: Sheila Crowe, MD
• Hosts: Matthew Watto, MD; Stuart Brigham, MD; Paul Williams, MD
• Producers: Sarah P. Roberts, MPH and Chris Chiu, MD
• Editor: Matthew Watto, MD

Time Stamps:

• 00:00 Disclaimer
• 03:35 Getting to know our guest, book recs, and career advice
• 10:35 Clinical case
• 11:40 Defining allergy, intolerance
• 14:05 Food intolerance and FODMAP
• 18:02 Taking a history in patient with potential food allergy vs intolerance
• 21:34 Dermatitis herpetiformis, gluten ataxia, and extraintestinal manifestations of celiac
• 26:12 Diagnosing celiac disease
• 30:53 Next steps if celiac testing is negative; lactose, fructose intolerance, IBS
• 33:48 Non-celiac gluten sensitivity (NCGS)
• 37:48 Study of NCGS
• 40:41 Olmesartan and drug-induced enteropathy
• 43:38 Dieticians, dietary recs, elimination diets
• 48:10 “Voodoo” testing
• 52:36 Counseling patients on diet
• 54:35 Take home points
• 55:50 Outro

Tags: food, allergy, intolerance, sensitivity, celiac, disease, diarrhea, diet, fodmap, paleolithic, paleo, weight, loss, lactose, olmesartan, refractory, protein, gluten, fructan, wheat, anaphylaxis, tTG, genetic, gene, testing, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

A random serving of knowledge food for your brain hole with returning guest, Dr. Alan Dow, Professor of Internal Medicine at Virginia Commonwealth University School of Medicine. Our final live recap show from ACP 2018 covering: human microbiome, copper deficiency, POTS syndrome, substances of abuse, drugs for delirium and how to be more like Leonardo Da Vinci. Please let us know what you liked, didn’t like and how we can make the show better.

Full show notes available at http://thecurbsiders.com/podcast

Join our mailing list and receive a PDF of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.

Time stamps:

• 00:00 Disclaimer
• 01:30 Guest bio
• 03:19 Getting to know our guest, podcast, and book recommendations
• 08:55 Human microbiome
• 11:05 A case of anemia and neuropathy
• 13:30 Physiology and treatment of POTS syndrome
• 17:00 Novel substances of abuse
• 20:17 Benzodiazepines for delirium
• 24:00 Leonardo Da Vinci versus the modern physician
• 27:18 Outro

Tags: microbiome, transplant, bupropion, gabapentin, pregabalin, copper, POTS, substance, use, disorder, leonardo, da, vinci, acp, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

A fast moving recap of hot topics and clinical pearls live from Internal Medicine’s largest national conference, ACP 2018 in New Orleans! Dr. Nina Mingioni, Clinical Associate Professor and director of Undergraduate Medical Education in Internal Medicine at Thomas Jefferson University Hospital serves up some knowledge food for our brain holes. Topics: the athlete as a patient, sports physicals, food as medicine, medical marijuana (cannabis), and more! Listeners, please let us know what you liked, didn’t like and how we could make this better. YouTube video of this episode available here: ACP 2018 Recap with Nina Mingioni. 

You can 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. 

Time stamps:

• 00:00 Music and disclaimer
• 02:48 Getting to know our guest
• 06:07 The athlete as a patient
• 10:20 Relative energy deficiency in sports
• 12:00 Drug interactions
• 15:51 Food as medicine
• 21:56 Marijuana
• 30:24 Outro

Credits: 

Written by: Nina Mingioni MD, Hannah Abrams. Producer/videographer: Chris Chiu MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Editor: Matthew Watto MD

Tags: food, microbiome, marijuana, athlete, ekg, ecg, physical, sports, training, energy, relative, deficiency, cannabinoid, entourage, effect, cannabidiol, thc, cannabis, acp, 2018, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Wow the crowd with your knowledge of pulmonary embolism! What are the red flags? What tools are available to guide you? How on Earth do you triage a patient with pulmonary embolism (PE)? What exactly is the RV spiral & how do PEs really cause morbidity and mortality?! Get schooled by pulmonary embolism expert, Dr. Oren Friedman, associate director of the Cardiac-Surgical Intensive care unit at the Cedars-Sinai Heart Institute. Doctors Cyrus Askin and Chris Chiu join as co-hosts. Test Yo’ Self Pulmonary embolism quiz

Written by Cyrus Askin, MD, Justin Berk, MD, MBA, MPH. Figure by Cyrus Askin, MD. Edited by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 5:10 - Start of Interview / Introduction
• 10:00 - Case Presentation - Introduction of DVT / PE Spectrum and Pathophysiology
• 16:18 - How to Triage and Work-Up Pulmonary Embolism (CT, Echo, troponins, “eyeball”)
• 23:30 - Other ways to risk-stratify (Other CT findings, clot burden)
• 28:45 - What does a low-risk patient look like?
• 30:35 - When to consider treatment modalities other than general anticoagulation
• 35:12 - Anticoagulation treatment options
• 36:38 - Next step intensive interventions after anticoagulation
• 42:00 - Evidence behind catheter-directed lysis
• 44:05 - IVC Filter discussion
• 47:22 - Discharge criteria for PE
• 50:00 - Incidental PEs
• 52:40 - Interdisciplinary PERT Team

Tags: pulmonary, embolism, thrombolysis, heparin, anticoagulation, right, ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC, vena, cava, filter, catheter, TPA, echocardiogram, CT, scan, computed, tomography, shock, bleed, clot, deep, vein, thrombosis, vte, venous, embolism, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Random clinical pearls from day 2 of ACP 2018 live in New Orleans. Topics include: Perioperative medicine, DOACs, anticoagulation, reversal agents, ACP statements on hidden curriculum, physician well being and burnout, modeling behavior, dermatology pearls, rashes, venous stasis ulcers, pentoxifylline, biotin and Grave's disease, dermatology pearls, Stuart's tips on sports doping, and how chocolate milk improves recovery time. Doctors Chris Chiu and Chris Thrash join us to discuss their favorite teaching points from today's sessions.

Cochrane Review on Venous Ulcers https://bit.ly/2JdQAMu

Joinour 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.

The Curbsiders share random clinical pearls from day 1 of ACP 2018 live in New Orleans. Topics covered include: breast density and cancer risk, patients before paperwork, diverticulitis, social determinants of health, migraine prevention, PrEP and thunderclap headaches. Doctors Chris Chiu and Chris Thrash join us on air to discuss their favorite teaching points from today's sessions.

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.

Keep up-to-date with this fast moving discussion of recent journal articles and thought-provoking headlines in medicine. Welcome to the first-ever Curbsiders journal club covering landmark articles from March to April 2018, plus rapid fire hot takes and the unveiling of our new hotcake based rating system. Please let us know what you liked, didn’t like and how we can make this better next month. Topics: Resident work hours, saline versus balanced IV fluids, barber shops and hypertension, coffee causes cancer, Twitter based medicine, clonidine versus spironolactone, opioids versus nonopioids and aromatherapy for nausea!

Written by: Chris J Chiu, MD; Producer: Sarah Phoebe Roberts MPH; Edited by: Matthew Watto, MD

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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. 

Time stamps:

• 00:00 Disclaimer
• 00:35 Host intros, featuring special guest and correspondent Chris Chiu, MD
• 01:30 Introducing a new Curbsiders segment!
• 03:20 First article: Duty-Hour Flexibility Trial
• 08:55 Second article: Trial of Blood-Pressure Reduction in Black Barbershops
• 14:27 Third article: SALT-ED Trial
• 20:00 Hot takes—intro
• 20:36 Hot take #1, Dr. Milton Packer and Twitter-based medicine
• 24:07 Hot take #2, Coffee and cancer risk
• 26:24 Hot take #3 Aromatherapy for nausea
• 28:10 Hot take #4 Opiates vs. non-opiates for chronic pain
• 29:00 Hot take #5, Surgeon general’s statement on naloxone
• 29:46 Hot take #6, Spironolactone vs clonidine for resistant HTN
• 31:54 Outro & announcements

Tags: duty, hours, salt, balanced, ivf, saline, normal, barber, shop, hypertension, alcohol, nausea, spironolactone, clonidine, coffee, cancer, opioid, pain, naloxone, twitter, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here

Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine.

Learning objectives:

After listening to this episode listeners will…

1. Develop an appreciation for clinical reasoning.
2. Recall the importance that the educator plays in role modeling.
3. Learn how to improve diagnostic accuracy by keeping a patient log.
4. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy
5. Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice.
6. Explain the difference between experience and expertise.

Time Stamps

• 00:00 Disclaimer, Intro
• 02:30 Guest Bio
• 04:50 Dr. Dhaliwal
• 06:45 Book recommendation
• 09:14 App recommendation
• 11:34 Advice for learners and teachers (Pearl #1)
• 12:40 Can a computer out-think a human?
• 15:49 Defining Clinical Reasoning
• 18:38 “Train the Brain” introduced
• 20:30 Knowledge is a precondition
• 21:46 A learner who lacks synthesis
• 24:23 How to provide learner feedback
• 27:04 Defining problem representation, illness scripts, etc.
• 29:20 How to start teaching clinical reasoning
• 31:00 Focus on the “why” and not the “what”
• 32:11 Teaching the nomenclature of clinical reasoning
• 36:07 “You can’t get the right answer if the brain is solving the wrong problem”
• 36:34 Osler and his “Incessant Watch”
• 40:40 Being wrong feels exactly the same as being right
• 42:00 Patient tracking (Dr. Dhaliwal’s recommendation)
• 45:30 Why keeping a patient log is so important
• 47:00 Are heuristics beneficial?
• 48:55 Can you debias yourself?
• 50:00 “Going slow just makes you slow.”
• 52:00 All evidence has flaws, but knowledge is still king.
• 55:13 Clinical reasoning on multi-disciplinary teams
• 59:27 Take-home points

Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

Revolutionize your approach to the red eye in pr-eye-mary care! Dr. Glaucomflecken (of GomerBlog/Twitter--fame) teaches us to recognize and manage common eye complaints. You’ll develop an approach to diagnosing and treating your patient with the dreaded red eye. We answer: What presentations should have us running down the hallway for that prized ophtho consult? What on earth does glaucomflecken stand for? Which eye drops are best? What is an eye dentist? Plus, answers to your twitter questions, and so much more! By the end of this episode, you’ll be sure to say “Eye Understand!” Self Assessment Questions: Take the ophtho self-assessment!

Donate at FirstDescents.org to support young cancer survivors like Dr. Glaucomflecken!

Written and produced by: Nora Taranto AB, Carolyn Chan MD; Original art by: Bryan Brown, MD. Edited by: Matthew Watto, MD.

Full show notes available at http://thecurbsiders.com/podcast

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. 

Times Stamps

• 00:00 Disclaimer
• 02:33 Guest bio
• 04:15 Dr Glaucomflecken
• 05:40 Best advice as a learner
• 06:05 Book recommendation
• 07:33 App recommendation
• 08:32 Clinical case
• 10:02 Corneal ulcers and contact lense hygiene
• 12:10 Indicators of urgent eye problems
• 13:39 The eye exam
• 18:00 Visual acuity exam without an eye chart
• 21:15 Approach to the red eye, blepharitis, allergic conjunctivitis
• 23:45 Approach to vision loss
• 25:52 Angle closure glaucoma, and other emergencies
• 27:37 Bacterial conjunctivitis
• 29:00 Viral conjunctivitis
• 31:26 Return to school or daycare after “pink eye”
• 34:00 Rundown of common eye medications
• 38:35 OTC redness relievers
• 40:30 Breast milk eye drops?!
• 42:07 How to correctly use an eye drop bottle
• 44:16 What does Glaucomflecken mean?
• 45:40 Questions from Twitter: Floaters, diabetic retinopathy treatments, blurry vision from high glucose
• 50:15 Eye dentists?
• 53:10 Take home points
• 54:28 Plug for First Descents charity
• 56:54 Outro

Tags: eye, ophthalmology, eyedrop, GOMER, conjunctivitis, twitter, red, glaucoma, glaucomflecken, acute, angle, closure, glaucoma, bacterial, viral, blepharitis, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital.  Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint.

Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 00:00 Announcement
• 01:00 Disclaimer
• 01:34 Intro
• 02:45 The setup and guest bio
• 03:15 How does Dr Topf compensate for difficulty
• 07:10 What has helped Dr Topf become successful as an educator
• 10:40 With which electrolyte do you most closely identify?
• 14:05 Picks of the week
• 16:05 Nephmadness explained
• 19:50 Joel’s big picture look at acid base
• 22:17 Acid base and logorhythmic scale
• 24:28 A caution about ABGs
• 27:23 Clinical case from Kashlak Memorial Hospital
• 28:05 Misinterpretation of low bicarb on a metabolic panel
• 29:20 Step 1 of acid base
• 32:00 Metabolic disorders and One Direction
• 35:15 Acidemia vs acidosis; alkalemia vs alkalosis
• 37:52 Compensation for acid base disorders
• 40:45 ABG apps and analyzers
• 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate.
• 51:31 How to determine if respiratory compensation is acute or chronic
• 54:26 Step 3 The anion gap
• 57:21 Correcting the anion gap
• 60:33 What causes a low anion gap?
• 63:58 Anion gap acidosis
• 66:05 GOLDMARK
• 69:15 Step 4 Is there an osmolar gap?
• 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol
• 76:15 Calculating the osmolar gap
• 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before”
• 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip
• 88:15 Bicarbonate in DKA
• 90:18 NephMadness plug
• 91:10 Outro

Tags: acid, base, anion gap, metabolic, respiratory, toxic alcohol, goldmark, mudpiles, albumin, acidosis, alkalosis, compensation, nephrology,  Henderson-Hasselbalch, equation, ABG, VBG, bicarbonate, pCO2, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Want to look cool like a toxicology consultant, sipping coffee on rounds? Ever check a patient for armpit sweat? Learn the secrets of tox from the titans of toxicology podcasting, The Dantastic Mr. Tox & Howard (AKA Dr. Dan Rusyniak and Dr. Howard Greller), as they loquaciously dish on all things tox. Topics include: how to approach the patient with an unknown overdose, are toxidromes clinically useful, clues on physical exam, is GI decontamination still recommended, and why they hate bupropion and tramadol. We recommend cautious ingestion of fluids while listening because this was a seriously funny episode. Try our Self Assessment Questions Toxicology 101 Quiz.

Written and produced by: Christopher Chiu, MD; Graphics by: Beth Garbitelli; Edited by: Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 00:00 Disclosures
• 00:35 Intro
• 01:19 Guest bios both real and sarcastic
• 04:38 Getting to know our guests
• 06:33 Multiple choice toxicology
• 09:13 Book recommendations
• 11:30 Advice for learners and teachers
• 15:48 Clinical case from Kashlak Memorial Hospital
• 16:27 Initial approach and some thoughts on toxidromes
• 21:59 Physical exam, a toxicologist’s approach
• 27:09 Review of physiology: anticholinergic, cholinergic, sympathomimetic and how to recognize these findings on exam
• 34:18 Different speech patterns seen in toxicology
• 35:30 History taking and how much detective work is truly necessary
• 40:05 The approach to overdose on multiple substances or in setting of polypharmacy
• 45:52 Seinfeld, ipecac, and the controversy about gastrointestinal decontamination
• 63:10 Antidotes and when to give them
• 67:15 EKGs and overdose. Antidote for long QTc versus wide QRS
• 71:25 Tramadol and Egypt
• 73:45 Bupropion and bath salts
• 78:00 Outro

Tags: antimuscarinic, anticholinergic, cholinergic, sympathomimetic, overdose, tramadol, bupropion, quetiapine, wellbutrin, seroquel, pupil, overdose, naloxone, narcar, toxicology, tox, toxidrome, poisoning, gi, decontamination, charcoal, ipecac, antidote, dantastic, howard, ekg, qrs, qtc, bicarbonate, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Take a deep breath and tune in to this week’s episode full of COPD diagnosis and management pearls, with expert Dr. Denitza Blagev, a pulmonologist, intensivist, and Medical Director for Quality, Speciality Care at Intermountain Healthcare in Utah with a particular interest in physician wellness and issues related to women in medicine. We cover: history taking, interpreting PFTs, patient counseling, inhalers and medications, exacerbations, antibiotics, steroids, and who needs BIPAP...so basically everything you ever wanted to know about chronic obstructive pulmonary disease. Take our self assessment here.

Sponsored by @nephmadness. Registration opens March 15th at AJKDblog.org

Written and produced by: Leah Witt, MD, Cyrus Askin, MD. Edited by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 NephMadness announcement
• 01:10 Disclaimer
• 01:45 Intro
• 03:50 Guest bio
• 05:03 One liner; What advice would you give our younger self?; Should I do a fellowship?; Book recommendations
• 10:30 Picks of the week
• 15:50 Case of COPD from Kashlak Memorial
• 16:55 Initial approach to a potential case of COPD
• 18:34 Misdiagnosis of COPD
• 20:10 Classic spirometry in COPD and GOLD 0
• 21:30 Diagnosis of emphysema
• 23:18 Diagnosis of chronic bronchitis
• 24:54 Counseling the patient with a new diagnosis of COPD
• 27:00 Spirometry
• 28:45 How to read PFTs
• 33:29 How to order PFTs and get what you want
• 36:00 Why does pre- and post-bronchodilator response matter?
• 38:45 Asthma COPD overlap syndrome
• 40:13 Staging of COPD, does it matter?
• 42:50 Prognosis in COPD
• 45:00 Therapies with mortality benefit
• 48:29 Therapies to improve symptoms and prevent exacerbations
• 52:00 Azithromycin as chronic therapy
• 53:00 Counseling patients on therapy
• 55:00 Short acting inhalers in COPD
• 56:20 Treatment of COPD exacerbations
• 59:18 Antibiotics, who needs them in exacerbation
• 61:52 Nebulized inhaled steroids
• 63:18 Duration of antibiotics and steroids during an exacerbation
• 66:30 Who needs BIPAP chronically?
• 69:22 Who needs BIPAP during an exacerbation?
• 71:33 How often should PFTs be repeated?
• 73:00 When should we suspect PE in COPD exacerbation?
• 74:25 Which labs should be check in the initial COPD workup?
• 76:46 Take home points

Tags: copd, chronic, pulmonary, disease, asthma, emphysema, bronchitis, inhaler, nebulizer, steroids, embolism, exacerbation, bipap, cpap, antibiotics, azithromycin, doxycycline, mortality, oxygen, spirometry, dlco, fev1, fvc, pfts, #nephmadness, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz!

Written by: Molly Heublein, MD, Beth Garbitelli and Sarah Roberts, MPH. Edited by Matt Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro
• 01:32 Guest bios
• 03:45 One liners, app recommendations, picks of the week
• 09:32 Picks of the week
• 12:45 Intro to contraception and a clinical case
• 13:33 Starting a conversation about contraception
• 16:55 Is having a period needed? And, which agents cause amenorrhea?
• 19:28 The menstrual cycle reviewed
• 23:29 Pros and Cons of long acting progesterone only agents
• 26:55 Choosing between IUDs
• 30:00 Who should get a copper IUD
• 30:53 Mechanism of hormonal IUDs
• 31:37 Risk with IUDs
• 34:05 Why are there so many OCPs?
• 36:05 Counseling patients on risks of OCPs
• 38:00 Risk of breast cancer with hormonal contraception
• 42:10 Benefits of hormonal contraception
• 43:38 Migraines and hormonal contraception
• 44:53 Mono- vs bi- vs triphasic pills. Does it matter?
• 46:15 Starting dose for OCPs
• 48:31 Is the mini pill effective?
• 49:37 Patches and rings
• 51:15 Take home points
• 52:40 Whoops, almost forgot emergency contraception!
• 56:32 How do copper IUDs work?
• 58:10 The Curbsiders recap the episode, plus some clinical pearls from Molly about birth
• 65:00 Outro

Tags: contraception, birth control, IUDs, LARCs, mirena, skyla, lilletta, Paragard, OCPs, minipill, birth, control, pills, menstruation, follicular, phase, luteal, side, effects, emergency, contraceptives, ulipristal, ella, plan B, levonorgestrel, women’s, health, internal, medicine, internist, primary, care, family, practice, nexplanon, depo-provera, breast, cancer, family, planning, CDC, MEC, eligibility, criteria, bedsiders, pregnancy, ovulation, meded, foamed, nurse, student, physician, assistant, doctor

Abolish anemia, and iron deficiency w/tips on IV iron therapy from real life iron man, Michael Auerbach, MD, FACP, Clinical Professor of Medicine Georgetown University School of Medicine. Topics include oral versus IV iron therapy, safety of IV iron, ferritin cutoffs, and how to diagnosis/ treat iron deficiency in patients with chronic inflammation, chronic kidney disease, pregnancy, heart failure, and more! Take our Self Assessment Test Here.

Images by Beth Garbitelli; Written and produced by Justin Berk, MD and Matthew Watto, MD.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro
• 01:27 Listener feedback
• 02:35 Guest bio
• 04:49 Basics of diagnosing iron deficiency, ferritin, soluble transferrin receptor, a new definition
• 07:09 Getting to know our guest
• 08:27 Book recommendations
• 09:33 Brief history of iron deficiency and IV iron
• 15:20 Iron deficiency from menorrhagia
• 19:55 IV iron cures symptoms of iron deficiency, pica immediately
• 20:40 Iron and neurologic symptoms, restless leg syndrome
• 23:30 Iron restricted erythropoiesis, anemia of chronic inflammation
• 26:02 Overview of iron absorption
• 28:35 Iron deficiency without anemia, treatment
• 33:52 Time to improvement with iron therapy
• 34:45 Indications for IV iron
• 38:09 Comparing the oral iron formulations
• 40:05 Iron deficiency and pregnancy
• 42:54 Diagnosis of iron deficiency
• 46:20 Should IV iron be given to patients getting blood transfusion
• 48:40 Is iron safe during active infection?
• 49:17 Iron in congestive heart failure
• 51:50 Questions from social media
• 53:35 Minor infusion reaction from IV iron
• 54:35 Comparison of different IV iron formulations
• 57:35 Take home points
• 60:35 Outro

Tags: iv, iron, ferrous, sulfate, ferric, sucrose, dextran, anemia, deficiency, oral, dosing, fatigue, pregnancy, ckd, heart, failure, chf, bleed, blood, loss, ferritin, transferrin, erythropoiesis, esa, transfusion, reaction, infusion, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Get the latest on valvular heart disease: TAVR vs SAVR, choice of valve type, rheumatic heart disease, antibiotic prophylaxis for endocarditis, who needs an echocardiogram, and anticoagulation goals with tips from cardiologist, Dr Eli Gelfand, Section Chief of General Cardiology at Beth Israel Deaconess Medical Center in Boston and an Assistant Professor of Medicine at Harvard Medical School. Correspondent Dr Kate Grant joins us for this conversation w/Dr Gelfand about his common sense approach to the evaluation and management of valvular heart disease.

Written by Kate Grate, MD and Matthew Watto, MD.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Disclaimer
• 00:35 Intro
• 02:55 Guest bio
• 04:15 Getting to know our guest
• 12:18 Picks of the week
• 17:07 Clinical case of aortic stenosis
• 18:00 Types of valve procedures available and initial workup for valvular disease
• 26:11 Counseling patients about a heart murmur
• 29:33 Symptoms in valvular heart disease
• 31:07 Who needs an echo?
• 32:36 Who needs a referral?
• 34:40 Frequency of echocardiogram
• 36:25 Medications for valvular heart disease
• 39:12 Diuretics and aortic stenosis
• 40:40 Medication for mitral stenosis and anticoagulants in valvular heart disease
• 43:31 INR goals and use of ASA by valve type and position
• 45:23 Endocarditis prophylaxis
• 48:50 Rheumatic heart disease
• 51:55 Valvulitis and a quick history lesson
• 53:50 Transaortic valve replacement
• 57:58 Multidisciplinary teams and how to determine if valve is causing symptoms
• 62:14 Take home points
• 63:47 Closing thoughts from The Curbsiders
• 66:15 Outro

Tags: valve, heart, disease, valvular, cardiomyopathy, failure, systolic, murmur, aortic, mitral, tricuspid, surgery, tavr, diuretic, rheumatic, stenosis, regurgitation, echo, echocardiogram, repair, replacement, inr, anticoagulation, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Challenge your beliefs on the efficacy of pervasive treatments used in dementia with expert Eric Widera, MD, Professor and clinician-educator in the Division of Geriatrics at the University of California-San Francisco. We explore the use of cholinesterase inhibitors, antipsychotics for behavior disturbances, feeding tubes, medications and supplements used for weight gain (inspired by Choosing Wisely and the American Geriatric Society’s “Ten Things Clinicians and Patients Should Question”). Plus, we introduce our new correspondent, Dr. Leah Witt, Geriatrics Fellow at UCSF.

Written and produced by: Jordana Kozupsky, NP, Nora Taranto, MS3, Leah Witt, MD; Edited by: Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Self Assessment Questions Take the quiz now! 

Time Stamps

• 00:00 Disclaimer
• 00:37 Guys set up the show
• 02:00 Dr Widera’s bio
• 03:15 Getting to know our guests
• 13:10 Picks of the week
• 16:40 Clinical case: new diagnosis of dementia
• 17:40 Discussing dementia with patients and caregivers
• 23:42 Cholinesterase inhibitors
• 27:35 Stopping cholinesterase inhibitors
• 33:35 Follow up to therapy
• 36:05 Dealing with behavior disturbances
• 39:15 DICE approach
• 44:17 Risks of antipsychotic medications
• 48:00 Use of benzos or sedative hypnotics
• 49:45 Melatonin for delirium or sleep
• 52:00 Mirtazapine
• 53:54 Clinical case: patient with dementia not eating
• 54:40 Feeding tubes
• 59:40 Dysphagia and NPO orders
• 62:04 Misinformation on malnutrition and girth creep
• 65:10 Thickened liquid challenge
• 70:25 Appetite stimulants
• 72:38 Megestrol
• 73:54 Take home points from Dr Widera
• 79:17 Outro

Tags: dementia, donepezil, cholinesterase, inhibitor, antipsychotic, behavior, disturbance, agitation, benzodiazepine, supplement, feeding, tube, restraints, thickened, liquids, geriatric, choosing, wisely, american, society, ags, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Boost treatment efficacy and amplify the “doctor as a placebo” phenomenon with tips from placebo expert (and ex-cartoonist), Mark W. Green, MD, Director of Headache/Pain Medicine and Professor of Neurology, Anesthesiology, and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai. Topics include: What’s that pesky sugar pill actually doing to us? Why do we get a boost from taking medicines that have no active compounds within them? How does placebo work? How can it be leveraged? What does it mean for study design/blinding? And what’s with its pesky dark twin--the nocebo effect? “Enjoy this, our only placebo-controlled episode”  (Thanks, Stuart!).

Written and produced by: Molly Heublein, MD and Nora Taranto MS3; Edited by: Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 00:00 Disclaimer
• 00:37 Intro banter
• 01:30 Picks of the week
• 08:02 Getting to know our guest
• 14:00 Clinical case of pain
• 15:08 Placebo hierarchy
• 17:19 Non-inferiority studies
• 18:20 Clinical trials, placebo, eligibility creep and regression to the mean
• 22:04 Nocebo response
• 27:05 Physiologic response to placebo
• 29:13 Placebo amplification
• 30:18 Caffeine experient
• Dr Green reports no relevant financial disclosures
• 32:47 How to counsel patients interested in alternative or ineffective therapy
• 34:22 Surgery and placebo; sham surgery
• 37:15 Open-label placebo and genetic response to placebo
• 42:04 Blinding in placebo controlled trials may be ineffective
• 43:53 Script for counseling patients on alternative therapy
• 45:51 Take home points
• 47:56 The Curbsiders recap and lessons learned
• 52:52 Outro 

Tags: placebo, nocebo, study design, dopamine, opioids, COMT, pain relief, therapeutic relationship, research protocol, randomized controlled study, non-inferiority, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Pulmonary hypertension deconstructed with clinical pearls from cardiologist, John J. Ryan MD, FACC, FAHA, director of University of Utah Pulmonary Hypertension Center. We discuss classification, diagnosis/differentiation, initial workup, additional testing, echo findings, how to counsel patients with pulmonary hypertension, and why cows never get ankle edema!

Written and produced by: Jordana Kozupsky, NP and Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps:

• 00:00 Disclaimer
• 01:30 Introducing our new Correspondent Jordy
• 03:05 Listener feedback
• 04:40 Guest bio
• 06:25 Getting to know Dr Ryan
• 09:33 Picks of the week
• 15:20 Clinical case
• 16:35 How to explain pulmonary hypertension to a patient
• 18:12 Groupings of pulmonary HTN
• 21:20 Taking a history. Ask these questions.
• 23:30 Physical exam
• 25:45 Initial testing
• 27:40 Overnight pulse oximetry
• 29:00 Echo findings in pulmonary HTN
• 31:30 Transpulmonary gradient
• 33:33 What is a normal pulmonary artery pressure
• 35:15 Accuracy of PA pressure estimate by echo
• 39:04 Mechanism of shortness of breath in PH
• 40:10 Should you hold PAH meds in a hypotensive patient?
• 41:55 Therapy for PH and follow up
• 46:28 Who to refer
• 47:40 PAH risk factors
• 52:09 Mortality in PH
• 58:22 Take Home Points
• 60:24 Outro

Tags: pulmonary, arterial, hypertension, group, classification, prognosis, pressure, blood, diagnosis, treatment, pay, ph, echocardiogram, ekg, hypoxic, chronic, lung, disease, heart, left, right, failure, chf, pressure, mean, diuretic, HFpEF, cteph, embolism, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Differentiate, diagnose, and treat the various forms of dermatitis and stop the ‘itch that rashes’ with this in-depth, myth-busting episode of “The Dermsiders” with Dr. Kalman Watsky Clinical Professor of Dermatology at Yale Medical School. Topics include: how to differentiate between and diagnosis various forms of dermatitis, topical therapies, common pitfalls, patch testing, and more! Special thanks to Bryan Brown and Beth Garbitelli who wrote and produced this episode and the show notes!

• Written by: Bryan Brown, MD and Beth Garbitelli
• Edited by: Matthew Watto, MD
• Infographics by: Bryan Brown, MD
• Cover image by: Beth Garbitelli

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Hook
• 00:24 Disclaimer
• 02:32 Picks of the week
• 03:33 Guest bio and intro to the topic
• 05:01 Getting to know our guest
• 10:24 Clinical case of dermatitis
• 11:00 Atopic dermatitis and eczema: definition and background
• 16:21 Counseling patients w/atopic dermatitis on choice of soap
• 19:46 Mimics of atopic dermatitis
• 25:16 Seborrheic dermatitis
• 26:46 Dyshidrotic eczema
• 28:35 Behavior modification for atopic dermatitis
• 32:21 Wet pajamas
• 34:34 Bleach baths
• 36:52 Contact dermatitis
• 41:29 Patch testing
• 45:58 Back to our case, making the diagnosis
• 47:44 Topical steroids
• 51:43 Skin atrophy from steroids
• 55:45 Calcineurin inhibitors as steroid sparing agents
• 59:30 How to handle chronic need for topical steroids
• 65:24 Questions from Facebook
• 69:04 Take home points
• 72:21 Outro

Tags: eczema, dermatology, dermatologist, skin lesion, atopic, contact, allergic, irritant, steroid, topical, therapy, atrophy, dermatitis, rash, skin, patch, testing, calcineurin, inhibitor, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

It's a potpourri of Infectious Diseases with tips from expert, Dr Paul Sax, MD, Clinical Director of the Division of Infectious Diseases at Brigham and Women's Hospital, and Professor of Medicine at Harvard Medical School. We discuss the man flu, the flu vaccine, travel medicine, malaria, lyme disease, post lyme syndrome, chronic lyme, shingles, cellulitis, abscesses, antibiotics, c diff, antibiotic associated diarrhea, the dangers of fluoroquinolones, why doxycycline is awesome, and more! Told you it was a potpourri. Dr Shreya Trivedi joins Matt and Paul as guest host.

• Show Notes, MCQ by Shreya Trivedi, MD
• Edited by Matthew Watto, MD
• Infographics and cover image by Matthew Watto, MD

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps:

• 00:00 Announcement
• 01:38 Intro
• 03:46 Picks of the Week
• 06:47 Guest bio
• 08:47 Getting to know our guest
• 15:40 Flu vaccination
• 19:54 Barriers to the flu vaccine
• 23:34 Can you give the flu vaccine to an ill patient
• 24:14 Man flu
• 26:27 Travel Medicine
• 30:35 Tick bites
• 33:49 Lyme serologies
• 35:38 Lyme prophylaxis
• 37:37 Chronic lyme disease and post lyme syndrome
• 38:55 Penicillin and antibiotic allergies
• 41:48 Fluoroquinolones and adverse reactions
• 45:24 Should antibiotics be given after an I&D of an abscess 
• 49:34 Antibiotic associated diarrhea, C diff
• 52:10 Probiotics, stool transplantation, and C diff
• 54:50 Shingles, recurrent zoster, complications, and the new subunit vaccine
• 61:45 Using salad tongs at a buffet
• 63:04 Take home points
• 64:26 Outro

Tags: 

ID, infectious, diseases, disease, flu, influenza, lyme, doxycycline, cdiff, antibiotics, infection, cellulitis, abscess, vaccine, zoster, shingles, malaria, travel, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Ease the tension around blood pressure goals in older adults and get inside the hypertension guidelines released by the ACP and ACC/AHA in 2017 with the sagacity of Dr. Mary Ann Forciea, MD, MACP, Professor of Medicine at University of Pennsylvania. We cover: how to properly measure blood pressure, how to diagnose hypertension, blood pressure targets, why BP goals differ by society, how to guidelines are written and how to interpret them with a critical eye, plus a hot take on the 2017 ACC/AHA guidelines. Dr. Shreya Trivedi joins as cohost. Special thanks to Hannah Abrams for her wonderful infographics and to Dr Trivedi for compiling our show notes.

Time Stamps

• 00:00 The setup
• 02:15 Disclaimer
• 03:32 Picks of the Week
• 08:13 Getting to know Dr Forciea
• 13:35 Broad overview and a clinical case of geriatric hypertension
• 14:45 Brief history on BP targets
• 18:05 How do you measure a blood pressure? What type of monitors are available?
• 22:13 How to standardize BP in the office?
• 23:55  Ambulatory BP monitoring
• 24:55 Home blood pressure monitoring
• 26:11 Standing blood pressure readings and orthostatic hypotension
• 27:53 How guidelines are written
• 30:51 Evaluating evidence quality and strength of recommendation
• 32:35 Timeline and process for guideline generation
• 34:27 How to read guidelines with a “critical eye”
• 36:15 Return to our case of uncontrolled hypertension
• 38:25 Blood pressure targets from ACP guidelines and BP management in frail older adults
• 40:33 Counsel patients on BP targets   
• 42:25 Low diastolic blood pressure
• 45:35 SPRINT and the ACP BP guidelines
• 48:58 Take home points from Dr Forciea
• 50:07 HTN targets and pay for performance in clinical practice
• 51:45 Curbsiders recap the ACP guidelines
• 53:45 Matt and Paul recap the AHA guidelines
• 54:47 AHA definitions of hypertension
• 56:15 Diagnosing hypertension and how to measure a blood pressure
• 60:35 Choosing a blood pressure monitor and HBPM
• 62:29 Blood pressure goals in ACC guidelines
• 66:08 Non-pharmacologic measures
• 69:15 Will we follow these new strict targets?
• 72:45 Outro

Tags:hypertension, blood, pressure, monitor, cuff, heart, aha, acc, act, stroke, cardiac, cardiovascular, event, guidelines, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Conquer community acquired pneumonia and avoid misdiagnosis with tips from Dr. Robert Centor, Professor Emeritus University of Alabama and newly appointed Chair of Medicine at Kashlak Memorial Hospital. We discuss diagnosis, misdiagnosis, procalcitonin, steroids for severe pneumonia, pneumonia severity index versus CURB-65, and how to determine antibiotic choice and duration. Special thanks to Correspondents Neela Bhajandas (cohost), Justin Berk and Bryan Brown who all contributed several articles, resources, and questions to prep for this show. Cover image by Dr Kate Grant paintscientific.com.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro
• 02:38 Brief bio for Dr Centor
• 04:22 Picks of the week with Dr Centor
• 11:27 Clinical case of suspected pneumonia
• 12:30 Brief history of community acquired pneumonia
• 14:40 Misdiagnosis rates are high
• 16:18 Defining diagnostic criteria for pneumonia
• 18:50 Chest x rays and pneumonia
• 22:18 Illness scripts teaching about pneumonia
• 23:41 Ubiquitous misunderstanding of pneumonia definition
• 25:26 History and physical exam tips from Dr Centor
• 27:19 Further testing for pneumonia, PSI, CURB-65
• 32:50 Procalcitonin discussed
• 38:10 Antibiotic choice discussed with Dr Bhajandas
• 41:15 Safety considerations for various antibiotics
• 43:38 Use of high dose amoxicillin
• 44:45 Dr Centor’s antibiotic preferences, and some thoughts on blood and sputum cultures
• 46:55 Dangers of fluoroquinolones
• 48:25 Antibiotic duration
• 51:40 HCAP is no longer a thing and how to assess risk for drug resistant organisms
• 55:42 Corticosteroids for pneumonia
• 60:25 Inpatient antibiotic choices
• 62:00 Dr Centor’s take home points
• 62:45 Dr Centor becomes Chair of Kashlak Memorial
• 65:38 Outro

Tags: pneumonia, community, acquired, cap, antibiotic, duration, diagnosis, misdiagnosis, strep, cough, procalcitonin, steroids, fluoroquinolones, azithromycin, drug, resistant, mdro, illness, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Join us for this recap of the key clinical pearls and favorite fan voted episodes from 2017 including: lipids, asthma, diuretics, hyponatremia, CKD, vertigo, and dizziness. Plus, Picks of the Year, exciting announcements for 2018, and Paul reveals that he has a wife! Matt, and Paul are joined by Curbsiders Correspondent, Dr. Chris Chiu, who wrote and produced this episode. Stuart was out with the Man Flu. My apologies to Dr. Bryan Brown whose name I forgot to shout-out when listing our Correspondents. Thanks to Kate Grant for her beautiful cover image.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps 

• 00:00 Intro
• 01:18 Getting to know Chris Chiu introduction
• 03:07 Picks of the week and
• 06:10 Picks of the year and discussion of vancomycin and pip-tazo causing AKI
• 11:41 Recap of Scott Weingart and EM vs IM episode
• 17:45 Discussion of Lipids, PCSK9, CAC, CCTA
• 27:10 Asthma pearls recapped
• 32:43 Dizziness and vertigo recapped
• 38:40 Diuretics, diuretic resistance, and secondary hypertension diagnosis and treatment
• 44:35 Diuretic dosing
• 46:25 Hyponatremia, volume status, solute loads and SIADH
• 50:08 CKD, when to refer, and an argument about low protein diets
• 54:25 Matt, Paul, and Chris reflect on important lessons learned from 2017
• 59:32 Listener questions and comments
• 63:35 Wrap-up, and shout outs
• 66:22 Announcements for 2018
• 67:25 Outro

Tags: hyponatremia, salt, kidney, ckd, asthma, vancomycin, zosyn, injury, weingart, emcrit, emergency, lipids, pcsk9, statin, dizziness, vertigo, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Combat opioid use disorder and the opioid epidemic as we review common clinical scenarios with addiction medicine specialists, Dr. Stefan Kertesz, University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton,Virginia. We need all hands on deck, and that means you! Learn the basics of opioid use disorder treatment as Dr. Manhapra gives us the scoop on “bup, bup, bup” (buphrenophine), and Dr. Kertesz primes us on opioid related health care policy and reminds us that “We can all do something about the opioid crisis”. Plus, Stuart and Paul express some concerns about how to approach these patients. Do not miss this episode filled with clinical pearls, policy, and joy! Special thanks to writers and producers, Dr. Carolyn Chan and Elena Gibson (MD Candidate, MS4), for their hard work on both of our addiction medicine episodes.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro
• 01:35 Guest Bios
• 03:10 Picks of the week
• 06:22 Case from Kashlak Memorial
• 07:20 Controversy: Is opioid addiction a real disease?
• 10:16: Vietnam Heroin Study (4)
• 12:52 Counseling patients on treatment options for opioid use disorder
• 17:32 Detox and initiation of medical treatment
• 18:50 Psychosocial needs and treatment (5)
• 20:50 How effective is Narcotic Anonymous?
• 21:36 80/20 rule
• 25:50 Inpatient vs outpatient treatment, complex discharge planning
• 27:03 Shared decision making for treatment options
• 31:50 Medical treatment is strongly recommend for OUD
• 32:17 Viewpoint: harms reduction in residential programs with polysubstance use
• 32:29 Taper, abstinence, and long-term treatment with buprenorphine
• 34:50 How to prescribe buprenorphine - Take the leap!
• 39:30 Medical education and the opioid epidemic
• 42:02 1980 NEJM article (6)
• 43:00 Complex persistent dependence patients (7)
• 46:40 Post-op pain and risk of addiction
• 51:34 Approach to increasing pain medications
• 54:50 Health Policy Intro
• 54:59 Opioid thresholds for patients and policy
• 61:39 Medicaid expansion and opioid epidemic (10)
• 66:25 Take home points
• 69:50 Round Table
• 73:56 Outro

Tags: opioid, use, abuse, addiction, disorder, dependence, buprenorphine, suboxone, naloxone, methadone, taper, abstinence, heroin, fentanyl, drug, substance, overdose, chronic, pain, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, policy, resident, student

Take the pain out of pain management with clinical pearls from addiction medicine specialists Dr. Stefan Kertesz at the University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton,Virginia. They walk us through an approach to pain management in the recovered addict, discuss treatment options for opioid use disorders, plus hot tips on how to interpret guidelines surrounding opioids, and more! What are you waiting for? Hit the play button! Special thanks to Elena Gibson and Carolyn Chan for writing and producing this show.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro
• 01:58 Host picks of the week
• 04:10: Intro to the episode
• 04:35: Guest Bios
• 12:32: Case from Kashlak Memorial
• 13:40 Define substance dependence, substance abuse, hazardous use
• 17:42 Where to go next conversation about pain control
• 17:54: Assessing risk of relapse
• 19:35 Screening Tools
• 20:10 Risk factors for developing OUD when initiating opioids.
• 25:10: CDC Guidelines length of prescription and risk of substance use disorder (7)
• 27:00: Defining optimal length of opioid after common surgical procedures  (6)
• 30:30: Long term receipt of opiates and addiction
• 33:50: OUD treatment options
• 37:30: Duration of buprenorphine/naloxone treatment, tapering risks (8)
• 38:50: POATs: Prescription opioids (9)
• 40:05 Social support and mental health services for addiction management
• 41:10 Risk of abstinence and adverse outcomes
• 42:35 Protracted withdrawal
• 43:35: Editorial BMJ Golden Month of Opioid use disorder (10)
• 44:00 Overdose risk in patients on long term opioids
• 44:40 Op-Ed on the Hill (11)
• 45:40 Example of protracted withdrawal syndrome
• 47:40 Reducing Harms: Naloxone, who to prescribe to?
• 50:30 Take home points
• 53:40 Outro

Tags: opioid, use, abuse, addiction, disorder, dependence, buprenorphine, suboxone, naloxone, methadone, taper, abstinence, heroin, fentanyl, drug, substance, overdose, chronic, pain, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Trans patients need excellent primary care and you can provide it with expert tips from endocrinologists, Dr Vin Tangpricha, Professor of Medicine at Emory University School of Medicine, and Dr Jeffrey Colburn, Assistant Professor of Medicine at Uniformed Services University. Learn practical tips in caring for transgender patients including: defining terms like gender dysphoria, gender nonconformity, transgender; use of pronouns; patient counseling; fertility concerns; initiating and monitoring hormonal therapy; surgical options; and how to help trans patients navigate the complexities of gender affirming therapy.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro and disclaimer
• 01:00 Guest bios
• 03:27 Getting to know our guest
• 08:00 Clinical case of a trans female
• 09:00 Defining terms and discussion of gender
• 14:15 What’s the difference between transgender and transexual?
• 16:05 How to handle mistakes in use of pronouns
• 17:12 How to set up a welcome practice environment
• 19:03 Maintaining confidentiality
• 20:37 Back to the case: What needs to be done before starting hormone therapy?
• 25:20 Evaluating for comorbidities, mental health issues and social risk factors
• 27:26 Is gender dysphoria driven by biology?
• 27:54 Evidence for hormone therapy and surgery as treatment for gender dysphoria
• 29:00 Cost and availability of medical and surgery therapy
• 34:00 Initial history and laboratory evaluation prior to hormone therapy
• 36:00 Choice of hormonal agent and route of administration
• 37:38 Fertility in trans women and men
• 40:30 When to expect body changes after starting therapy
• 43:00 Dr Tangpricha’s take home points
• 45:25 Monitoring of trans female on hormone therapy
• 46:57 Therapy and Monitoring of trans male on hormone therapy
• 49:56 Surgical therapy for MtF transition
• 52:33 Surgical therapy for FtM transition
• 55:50 Mental health clearance prior to surgery
• 57:54 Dr Colburn’s take home points
• 60:16 Outro

Tags: gender, sex, identity, role, trans, transgender, hormone, therapy, surgery, nonconformity, dysphoria, transition, MtF, FtM, lgbt, diversity, wpath, fertility, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Knock the wind out of asthma with tips from Dr Denitza Blagev, a pulmonologist and intensivist who currently serves as Director for the Schmidt Chest Clinic at Intermountain Medical Center in Murray, Utah. We simplify the approach to diagnosis, spirometry, patient counseling, choice of agent, stepwise therapy, and de-escalation...plus, a little myth busting. Special thanks to Dr Cyrus Askin for writing and producing this episode and to Dr Bryan Brown for his wonderful infographics.

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 00:00 Disclaimer
• 00:32 Intro
• 01:44 Picks of the week
• 04:38 Guest bio
• 06:20 Getting to know our guest
• 11:50 Clinical case and approach to the patient with dyspnea
• 16:38 How to explain asthma to a patient
• 17:22 Are PFTs needed for diagnosis and management of asthma?
• 18:44 Methacholine challenge and who needs one
• 21:15 Is imaging needed?
• 22:09 Typical PFT patterns in asthma
• 24:23 Utility and use of peak expiratory flows
• 25:45 Cough variant asthma
• 26:34 Physical exam in patient with asthma
• 27:45 Lab workup
• 29:07 Initial treatment and inhaler teaching
• 33:10 Stepwise therapy for asthma
• 37:27 De-escalation of therapy
• 39:18 Levalbuterol versus albuterol
• 40:20 Asthma action plans
• 43:06 Who needs a sputum sample
• 45:25 How to treat asthma exacerbations
• 48:05 Asthma therapy for hospitalized patients
• 51:10 Azithromycin and asthma
• 53:40 Who needs a referral
• 55:24 Are beta blockers safe in asthma?
• 56:08 Anticholinergic therapy and asthma
• 57:26 Take home points
• 58:58 Paul tells a story about asthma
• 59:55 Outro 

Tags: asthma, inhaler, teaching, eosinophilia, albuterol, cough, variant, methacholine, spirometry, xray, pft, peak, flow, fev1, sputum, step, laba, lama, beta, agonist, azithromycin, symptoms, steroids, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Dr Kevin Pho, founder KevinMD.com “Social Media’s Leading Physician Voice" schools Matt, Paul and Stuart on a potpourri of topics including physician advocacy, the dangers and benefits of social media, the pros and cons of electronic health records, health policy, health advocacy and lastly primary care and the integration of advanced practice providers/clinicians. Special thanks to Dr Chris Chiu who helped produce the show and write our show notes.

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps:

• 00:00 Intro
• 00:54 Picks of the week
• 06:58 Getting to know our guest
• 10:30 Why physicians need to understand health policy
• 11:21 Best advice Dr Poh has received in his career and why variety is important to avoid burnout
• 13:45 Advice to young physicians about to start using social media
• 16:40 Why are physicians afraid of social media
• 18:54 Risks of social media
• 21:20 Discussion of “Twitter bates” aka debates
• 23:20 Physician advocacy and social media
• 26:18 The next big health care debate...is it a right?
• 31:03 Why electronic health records are so painful to use?
• 34:49 How can charting be worked into clinic workflow?
• 37:50 Conspiracy theories on EHRs
• 39:11 Advanced practice providers/clinicians
• 46:40 Primary care shortage
• 50:16 Growth of medical administrators and how to take back control as physicians
• 52:38 Advice on how to break into medical writing
• 54:08 Paul ends the show with some wisdom and steals the show
• 55:59 Outro 

Tags: kevinmd, advocacy, policy, health, care, ehr, chart, advanced, practice, clinician, physician, meded, foamed, social, media, twitter, kevin, pho, nurse, practitioner, medicine, internal, family, primary, education, internist, hospitalist

Making all your nephrology dreams come true with part 2 of our interview with  @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Flush away your bad prescribing habits when it comes to nephrotoxic drugs in this fast paced run down of the medications which must stay on or off Santa’s naughty-list, backed up with a sack full of memorable research studies. Special thanks to Annie Medina, Justin Berk and Kate Grant for writing/producing this show and to physician artist, Kate Grant for her lovely/hilarious artwork (more at paintscientific.com).

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro
• 03:00 Which medications should we exercise caution over in CKD?
• 03:31 Bactrim (Trimethoprim+Sulfamethoxazole)
• 07:00 NSAIDS
• 08:29 NSAIDS and the ‘Precision’ Trial NEJM 2016 looking at cardiovascular safety
• 12:50 The Male Physician Study JAMA 2001
• 13:50 Discussion about Nurses Health Study and use of analgesia, and CKD
• 15:15 Acute Interstitial Nephritis, Beta Lactam Antibiotics, and the risk of Acute kidney injury +/- CKD with Proton Pump Inhibitors
• 18:20 Advice for co-prescribing NSAIDS,ACE inhibitors and diuretics
• 20:39 Creatinine levels and ACE/ARB prescribing. How High can you go?
• 24:55 Facebook question from listener: measures to reduce proteinuria in hypertensive patients
• 27:20 Empagliflozin and renal protection in diabetic patients
• 32:00 Contrast Induced Nephropathy, the AMACING trial 2016.
• 38:00 Take Home Points
• 39:57 Outro

Tags:  chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, medications, pharmacology, bactrim, nsaids, ace-i, contrast, metformin, empagliflozin, nephropathy, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Steady your hand and annihilate tremor with tips from Neurologist, and Movement Disorder specialist, Andres Deik, MD, Assistant Professor of Clinical Neurology at Kashlak Memorial Hospital (we can’t tell you where he really works: ) We teach you to differentiate benign causes of tremor from Parkinson’s disease with simple history and physical exam skills, plus nonpharmacologic and pharmacologic therapies for tremor. Special thanks to Beth Garbitelli and Chris Thrash who wrote and produced this episode and the show notes!

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro and disclaimer
• 01:08 Listener feedback - Paul is not fired.
• 02:09 Picks of the week.
• 05:35 Dr. Deik intro
• 07:19 Icebreaker questions
• 12:20 Wikipedia definition
• 13:02 Classifying tremor
• 14:33 Postural tremor vs. reemerging rest tremor
• 15:48 Important history questions
• 17:58 Medications that can induce tremor
• 21:39 Physical exam techniques
• 27:30 Exam characteristics between typical PD tremor and ET
• 28:36 History components to distinguish between PD and ET
• 34:10 Misdiagnosis of Parkinson’s
• 36:54 Imaging workup
• 39:03 Case from Dr Deik
• 41:33 Nonpharmacologic management
• 44:18 Pharmacologic management
• 49:06 Dosing propranolol
• 51:07 Distinguishing between physiologic tremor and pathologic tremor’
• 54:06 Website recommendations
• 55:50 Handwriting
• 59:14 Take home points
• 61:34 Outro

Tags: tremor, essential, postural, neurology, Parkinsons, disease, beta, blockers, primidone, movement, disorders, antidepressants, occupational, therapy, rest, intention, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Take control of chronic kidney disease with tools, and tips from @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Learn which equation is best for eGFR, how to counsel patients about progression/prognosis, how to monitor patients in CKD, and who needs a referral to Nephrology. Special thanks to Annie Medina, and Justin Berk for writing/producing this show and to physician-artist, Kate Grant for her lovely and hilarious artwork (more at paintscientific.com). 

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

• 00:00 Intro
• 03:13 Pick of the weeks
• 08:49 Clinical Case
• 09:36 How to explain CKD to patients
• 12:16 Loss of GFR with age
• 13:22 Which equation should be used to estimate GFR
• 18:05 Creatinine clearance from 24 hour urine collection
• 22:25 Initial workup upon diagnosis of CKD
• 25:40 Interpreting tests for proteinuria
• 26:52 Staging and prognosis in CKD
• 32:00 Completing the initial workup for CKD
• 33:52 Who needs a referral to nephrology?
• 35:53 What labs to check in CKD and a discussion of secondary hyperparathyroidism
• 40:32 Take home points
• 42:30 Outro

Tags: chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, prognosis, monitoring, iron, pth, proteinuria, hypertension, nephropathy, diabetes, albumin, protein, anemia, hyperparathyroidism, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Hiding from Hep C? Dive in with experts Dr. Gina Simoncini, MD, MPH Associate Professor of Clinical Medicine at Temple University Hospital, & Dr. David Koren, PharmD, BCPS, AAHIVP,  board-certified pharmacotherapy specialist and infectious diseases clinical pharmacist at Temple University Hospital. They walk us through a simplified approach on whom to screen, how to start antiviral therapy, what to follow up on, and how to navigate insurance waters along the way. Special thanks to Sarah Roberts and Jordana Kozupsky who wrote and produced this episode and the show notes!

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

• 00:00 Intro
• 01:00 Guest bios
• 03:00 Getting to know our guests
• 05:35 Picks of the week
• 10:05 Clinical case
• 10:54 Diagnosing HCV
• 12:00 ASCEND study
• 13:14 Restrictions on HCV treatment
• 15:17 Ordering and interpreting pre-treatment tests
• 19:30 Prescribing medication
• 22:00 Genotyping and drug resistance
• 24:10 Patient counseling
• 25:49 Understanding drug classes
• 27:33 Drug interactions
• 30:06 Multidisciplinary approach to treatment
• 33:01 Follow-up
• 36:47 Reinfection/cure rates
• 39:35 Patient counseling revisited
• 41:25 Side effects of treatment
• 42:53 Screening
• 44:02 Take home points

Tags: hepatitis, virus, hcv, direct-acting, antiviral, therapy, management, primary, care, liver, ultrasound, fibrosis, cirrhosis, side, effects, monitoring, hcc, hiv, infectious, disease, assistant, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Fighting with Emergency Medicine colleagues is stupid. Learn how EM doctors think and avoid the petty infighting with tips from Dr. Scott Weingart, MD FCCM FUCEM DipHTFU, host of the EMCrit podcast, Clinical Associate Professor and Chief, Division of Emergency Critical Care at Stony Brook Hospital, NY. We discuss decision making, how to avoid anchoring bias, the devil of the gaps, why the elderly always get admitted, how to build relationships with the ED, and Scott’s pet peeves.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

00:00 Intro

01:10 Picks of the week

05:28 Guest bio

07:00 Getting to know our guest

12:00 Do EM and IM docs hate each other?

14:04 Where conflicts arise.

17:05 System 1 versus system 2 thinking

20:19 When the patient doesn’t match the story

23:55 Why does every 85 year old get admitted?

26:05 Transitions of care: form ED to medical ward

32:08 Is face-to-face signoff only needed for sick patients?

36:28 The devil in the gaps

41:03 Scott’s beer recommendation

42:17 BP cutoff for discharge home

43:44 Scott’s biggest pet peeve with primary care

45:04 How to make friends and collaborate with your EM colleagues

47:14 Take home points

50:35 Outro

Tags: emergency, department, room, em, ed, im, conflict, devil, gaps, post-test, probability, illness, serious, system, one, bias, heuristic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Get schooled on medical homes, payer reform, and what the future might look like for primary care with Dr. Sue Bornstein, MD, FACP and Executive Director of the Texas Medical Home Initiative and Chair of the Health and Public Policy Committee at the ACP.

Dr Alex Lane of Cooper University Hospital joins Matt as cohost!

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

00:00 Intro

02:42 Guest CV and background

04:42 Getting to know our guest

10:40 Helpful resources for learning health policy

12:10 Who are the major players/influencers in health care and how do their interests align

15:02 Defining “medical home”

18:45 Where did the idea for a “medical home” originate

22:33 How does medical home affect cost

29:45 Payer reform and the quality payment program (QPP)

33:06 Recap and defining terms

37:18 How will the QPP be implemented?

41:04 Repeal and replace

43:37 Cuts in funding for safety net hospitals that care for the poorest, sickest patients

46:59 Take home points

48:55 Outro

Tags: medicare, medicaid, health, care, policy, spending, quality, improvement, advanced, payment, macra, mips, qpp, apm, medical, home, pcmh, affairs, super, utilizer, texas, physician, doctor, assistant, nurse, practitioner, foamed, meded

Expand your consciousness around medical cannabis (aka marijuana) with expert Dr Donald Abrams, Chief of the Hematology-Oncology Division at San Francisco General Hospital and a Professor of Clinical Medicine at the University of California San Francisco. We explain the cannabinoid system, THC, CBD aka cannabidiol, limitations surrounding cannabis research, current and future medical uses for medical cannabis (marijuana), and potential conditions it may benefit. We take a deep dive on the potential harms of medical cannabis and how to counsel patients on safe use. Plus, the return past guest and new correspondent, Dr Molly Heublein, Assistant Professor of Medicine from UCSF.

Thanks to Dr Molly Heublein for writing and producing this episode and it’s show notes!

Full show notes available at http://thecurbsiders.com/podcast

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.

Clinical case from Kashlak Memorial:  MM is a 62 yo woman with a history of osteoarthritis and breast cancer, now on an aromatase inhibitor. She struggles with aching and stiffness in her hands, shoulders, knees, and hips. A friend suggested she try medical marijuana. She wants her provider’s opinion on if this is safe and effective.

Time Stamps

00:00 Intro

01:30 Picks of the week

03:40 Guest bio

05:11 Getting to know our guest

11:03 Clinical case

11:40 Limitations for cannabis research

12:59 Discussion of THC and cannabidiol

14:50 Smoking versus ingesting cannabis products

16:40 Recap of cannabinoid mechanism of action

18:30 Cannabis and cannabinoid products available

20:20 Synthetic THC (dronabinol)

21:46 How “recommending” cannabis and dispensaries work

25:46 Conditions that respond to medical cannabis

29:15 Potential harms of medical cannabis

34:51 Future directions of cannabinoid medicine research

37:24 Cannabis induced hyperemesis syndrome

39:00 Possible lung cancer risk

40:12 Take home points

42:54 The Curbsiders recap and share their views on the medical cannabis controversy

49:40 Outro

Tags: marijuana, medical, cannabis, weed, pot, oil, budtender, law, psychoactive, thc, cbd, cannabinoids, endocannabinoid, system, receptor, substance, harm, adverse, safety, pain, nausea, emesis

Remedy your ignorance as we review some basics of health care policy with Dr. Fatima Syed, Chair of the Council of Residents and Fellows for the American College of Physicians. Dr. Syed is early career physician whose work is already affecting health policy at a national level. You can do it too and we’ll teach you where to start along with defining basic, but poorly understood concepts like The Affordable Care Act, universal health care, single payer health care, MACRA, MIPS, and how “quality” is really measured. Don’t miss this part one in our health care policy for beginners series.

Full show notes available at http://thecurbsiders.com/podcast

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. 

Time Stamps

00:00 Intro

03:20 Getting to know our guest

07:23 How to get involved in a professional organization

09:37 Resources to learn health policy

14:06 The Affordable Care Act and ObamaCare

17:56 What is MACRA, MIPS and how do they affect physicians?

23:09 Nationalized health care in the US versus other countries

25:33 Universal and “single payer” health care defined

27:00 How is quality health care defined? Why is the US rated so poorly?

32:53 Recap and summary of what we’ve learned

34:09 Dr. Syed’s take home points

35:36 Outro

Tags: policy, healthcare, macra, mips, aca, affordable, care, act, health, acp, advocacy, quality, payments, reimbursement, kaiser, commonwealth, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Keep your cool in the face of inflammation, and make the path to vasculitis diagnosis less tortuous with Dr. Rebecca Sharim, Rheumatologist and Assistant Professor of Medicine at Temple University. In this episode, we go with the flow from large vessel to small vessel vasculitides, and then learn how to make the diagnosis and management of Giant Cell Arteritis (GCA) and polymyalgia rheumatica (PMR) less of a headache. Correspondent, Dr. Bryan Brown cohosts! 

Special thanks to Dr. Bryan Brown for writing our show notes, and creating figures for our handouts.

Full show notes available at http://thecurbsiders.com/podcast

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.

Case from Kashlak Memorial:  A 75 year-old woman with a PMHx of hypertension presents to the ED with three days of worsening left sided headache, now with left sided vision loss during a Norwegian folk festival. On review of systems, she also endorses a week of soreness of her shoulders and hips. This has never happened to her before.

Time Stamps

00:00 Intro

03:07 Picks of the week

09:13 Getting to know our guest

15:00 Clinical case of vasculitis

15:59 Defining and classifying vasculitis

20:55 Workup for suspected vasculitis

23:17 How to explain GCA to a patient

25:08 Typical symptoms of vasculitis

28:00 Chewing gum test

29:34 Interpreting ESR

32:54 Basic exam and lab workup for vasculitis

35:23 Headache and suspicion for GCA/temporal arteritis

38:10 Is a temporal artery biopsy still mandatory?

39:20 Polymyalgia rheumatica

40:59 Steps to take when GCA/temporal arteritis suspected in clinic

43:55 PCP prophylaxis with high dose steroids

46:30 DMARDs and steroid sparing agents

48:12 Imaging studies to aid in diagnosis of GCA

50:50 Complications of long term steroid therapy

52:31 Take home points

53:26 Outro

Tags: giant, cell, arteritis, gca, vasculitis, steroids, temporal, biopsy, artery, esr, pmr, polymyalgia, rheumatica, vessel, headache, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

How to individualize learning for yourself, and your learners with tips from Dr. Philip A. Masters, editor-in-chief of MKSAP and IM Essentials, Vice President of Membership/International Programs at the American College of Physicians (ACP) and an Adjunct Professor of Medicine at the University of Pennsylvania School of Medicine. Dr. Masters schools us on work life balance, how to recognize and diagnose struggling learners, what resources to use, teaching exercises, and how to generate a study plan.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

00:00 Intro

01:50 Listener feedback

04:18 Announcements

04:58 Picks of the Week

10:37 Guest bio and credentials

12:36 Getting to know our guest

18:05 Wellness and work life balance

22:55 How medical education has changed

28:55 Choosing resources as a learner

38:00 Case of a struggling learner

41:50 Learners with knowledge deficits and the role of the clinician (non-professional educator)

47:56 Resources to improve your skills as a medical educator

51:01 Take home points 

Tags: study, resources, MKSAP, acp, learner, educator, academic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, primary, physician, resident, student

Solidify your approach to back pain and sciatica with Dr. Chris Miles, Assistant Professor, Family & Community Medicine and Associate Director, Sports Medicine program, Wake Forest Baptist Medical Center. He schools us on red/yellow flags, physical exam maneuvers, when to order imaging, and practical tools and tips for evidence-based management! Correspondent Dr. Shreya Trivedi cohosts!

Full show notes available at http://thecurbsiders.com/podcast

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.

Case from Kashlak Memorial: 53 yo M construction worker with a BMI of 29 and PMhx of DM2, HTN, depression presenting with right low back pain. He can't remember any trauma or injury. Denies radiation, no bowel or bladder dysfunction, saddle anesthesia, weakness

Case from Kashlak Memorial: 48 yo F nurse who has had intermittent back pain for years presented with acute flare after helping lift a patient. The pain similar to previous episodes but more severe and also radiates to her left foot. She has tried naproxen and exercises/mindful stress reduction for months without improvement. It is unbearable for her to work.

Time Stamps

00:00 Intro

02:14 Listener feedback

03:44 Announcements

05:14 Picks of the week

08:20 Millenial learners

10:40 Topic intro and guest bio

12:06 Getting to know our guest

17:30 Clinical case of back pain

20:18 How to hand sensory deficits

21:51 Red and yellow flag symptoms

25:44 How to approach patient with yellow flag symptoms

28:00 Physical exam for back pain

30:00 Special testing: Trendelenburg, Slump test, and Straight leg raise

35:48 Classifying types of back pain and a quick recap of teaching points so far

39:28 How to manage patient expectations

40:42 Treatment of non-radicular back pain

46:33 Home exercises and YouTube training

49:31 When to follow up after initial treatment trial

51:35 The patient with severe acute pain

53:33 Some pearls on muscle relaxants

55:22 Clinical case and how to treat radicular pain

59:40 Invasive treatment of back pain

65:04 Back pain treatments that don’t work

66:06 Take home points

67:34 Outro

Tags: back, pain, radicular, radiculopathy, sciatica, lumbar, disk, herniated, facet, arthritis, spine, muscle, relaxant, tramadol, nsaids, exam, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Summary:

Get a-HEAD of concussions (aka traumatic brain injuries) with tools, tips, and tricks from The Concussion Guy, Dr. Evan Ratner, Medical Director of Gridiron Heroes. Learn to recognize concussions/traumatic brain injury, what questions to ask, physical exam maneuvers, and how to counsel patients and families on safe return-to-learn/play.

Full show notes available at http://thecurbsiders.com/podcast

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.

Case from Kashlak Memorial: 29F with no significant PMH presents to primary care office less than 24 hours after she accidentally struck her head on the metal of her car door. She experienced temporary altered consciousness lasting about one hour along with a headache. No nausea, vomiting, speech, or vision changes. She rested at home last night, but didn’t feel up to reading, or watching TV. She drove herself to your office today.

Time Stamps

00:00 Intro

02:33 Listener feedback

05:35 Picks of the week

12:15 Getting to know our guest

19:41 Defining and classifying concussion

23:00 What questions to ask your patient

26:34 Physical exam for patient with concussion

28:50 Use of neurocognitive testing in concussion

30:45 Specifics of testing eye movements and balance

35:00 Who needs imaging?

41:51 Recap of what we’ve learned so far

43:40 Can you let someone with a concussion go to sleep?

47:08 Return-to-learn protocol

50:30 Return-to-play protocol

52:30 Post-concussive syndrome

53:55 Medications for post-concussive symptoms

58:58 Second impact syndrome

64:40 Counseling the patient with multiple concussions

67:08 Take home points

69:09 The Curbsiders recap their favorite teaching points

71:30 Outro

Tags: concussion, post, concussive, syndrome, tbi, traumatic, brain, injury, return, play, school, cognitive, rest, treatment, diagnosis, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Improve your prescribing practices with tips from The Curbsiders as Matt, Stuart and Paul “Pwilliams” discuss safe prescribing in frail, older adults with diabetes, chronic kidney disease, hypertension, and/or dementia in this part two episode on polypharmacy and deprescribing.

Full show notes available at http://thecurbsiders.com/podcast

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.

Tags: polypharmacy, deprescribing, prescribing, cascade, pharmacist, drug, therapy, medications, side, effects, adverse, reaction, beers, criteria, interaction, disease, anticholinergic, diabetes, hypertension, kidney, chronic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Avoid common pitfalls, recognize prescribing cascades, and deprescribe like a champ with tips from Clinical Pharmacist, Dr. Sean M. Jeffery, Clinical Professor of Pharmacy at the University of Connecticut School of Pharmacy, and Chair of the Polypharmacy Special Interest Group for the American Geriatrics society. We discuss how to create better medication lists, tools and tips for deprescribing, how to counsel patients on polypharmacy, and safe use of medication in the elderly.

Special thanks to the American Geriatrics Society for setting up this interview.

Full show notes available at http://thecurbsiders.com/podcast

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.

Time Stamps

00:00 Intro

01:12 Listener feedback

01:56 Picks of the week

06:28 Topic intro and guest bio

07:49 Getting to know our guest

13:05 Defining polypharmacy and related terms

16:30 Clinical Case of polypharmacy

20:34 Making better medication lists

25:01 Clinical Case from Kashlak Memorial

28:40 Beers Criteria

35:41 Statins in frail, elderly patients

38:00 Treating insomnia in the elderly

44:15 Dosing of meds in patients with CKD

45:50 Tool for analysis of drug-drug interactions

48:10 Take home points from Dr. Jeffery

50:00 Outro

Tags: polypharmacy, deprescribing, prescribing, cascade, pharmacist, drug, therapy, medications, side, effects, adverse, reaction, beers, criteria, interaction, disease, anticholinergic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Enhance your skills in the identification and management of eating disorders with clinical pearls from Dr. Rosalind Kaplan, Clinical Associate Professor of Medicine at Thomas Jefferson University and a Primary Care Physician in Jefferson Women's Primary Care. We learn who to screen for eating disorders, what questions to ask, criteria for diagnosis, common complications, and how to manage them. This is a must listen if you’re like us and don’t know much about eating disorders specified and not otherwise specified.

Full show notes available at http://thecurbsiders.com/podcast

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.

Case from Kashlak Memorial Hospital: 24yo F medical student with history of anxiety, weight loss, and restricting food senior year of high school. She regained weight with psychotherapy. Now she is a medical student who is over exercising, and abusing laxatives. She passes out one day after class and is referred to you at Kashlak.

Time Stamps:

00:00 Intro

01:19 Listener feedback

02:43 Picks of the week

06:50 Topic intro and guest bio

09:10 Getting to know our guest

15:18 Clinical case 

20:15 Broad overview of eating disorders

26:40 Eating disorder not otherwise specified

29:19 Underreporting and under diagnosis in men

30:25 Who to screen and how to do it

34:33 Questionnaires: SCOFF, ESP, and Binge Eating Disorder Inventory

38:42 Initial lab workup for eating disorders

42:38 Bone density screening, treatment

45:41 Back to the case: Initial patient counseling 

49:22 Medical therapy

52:20 Can we use bupropion?

54:02 What’s the role for primary care?

58:14 Hyponatremia in eating disorders

60:34 Complications of purging

66:25 How to be an ally for your patient

69:12 Treatment for binge eating

72:51 Take home points

74:30 Outro

Tags: anorexia, nervosa, bulimia, eating, disorder, weight, loss, binge, binging, purge, electrolytes, not, otherwise, specified, ideal, body, image, treatment, screening, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Don’t miss life threatening upper respiratory infections, and stop underusing antibiotics with tools and tips from our wonderful guests: Dr. Robert Centor, Professor of Medicine at University of Alabama, known for developing the Centor Criteria for pharyngitis, and his excellent blog and Twitter feed @medrants; and Dr. Alexandra Lane, Assistant Professor of Medicine, and Director of the Resident Clinic at Cooper University Hospital. We cover red flag signs in upper respiratory tract infections, diagnostic testing, physical exam maneuvers, antibiotic therapy, and symptom management. Plus, we’ll teach you have to counsel patients about upper respiratory infections and recommend some great learning resources.

Full show notes available at http://thecurbsiders.com/podcast

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Case from Kashlak Memorial Hospital: 39 yo F with obesity, HTN, fibromyalgia who presents with 3 days of chills, subjective fevers, sinus pressure/congestion, post-nasal drip, and cough with some green/yellow mucus. She says, “I get this every year and it only goes away with antibiotics. They usually give me a z-pack”.

Tags: upper, respiratory, infections, cough, cold, nasal, pharyngitis, bronchitis, rhinosinusitis, sinusitis, decongestant, spray, symptoms, management, pneumonia, pertussis, influenza, antibiotics, overuse, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Get control of urinary incontinence with tips from Internist and Women’s Health Specialist, Dr. Molly Heublein, Assistant Clinical Professor of Medicine at UCSF. This is a must listen if you’re still uncomfortable managing urinary incontinence. We learn nonpharmacologic strategies like pelvic floor muscle therapy, bladder training, timed voiding, foods to avoid, and run through the available medical therapies, their efficacy and side effects. Plus, a brief review of next line therapies like percutaneous tibial nerve stimulation, and botox injections for overactive bladder.

Full show notes available at http://thecurbsiders.com/podcast

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Case: 79 yo F with at least 10 years of urinary urgency with occasional loss of small amounts of urine and rare full bladder emptying. She drinks 1 cup of coffee every morning and about 2-3 glasses of water per day. She tries to minimize liquids due to her incontinence. She has HTN and takes HCTZ. Has been on oxybutynin for 10 years and wants to try something else.

Time Stamps

00:00 Intro

01:06 Listener feedback

02:43 Announcements

03:43 Picks of the week

09:07 Getting to know our guest

14:27 Case of urinary incontinence (UI)

15:30 Epidemiology of UI

16:34 Screening for UI

17:30 The 3IQ Questionnaire

18:44 Additional testing in UI

21:23 Classifying UI

24:00 Nonpharmacologic therapy for UI

32:42 Effectiveness of pharmacologic versus nonpharmacologic therapy

34:50 Case continued. Changing medications

37:42 Mirabegron as an alternative to anticholinergics

40:18 More options for stress UI management

41:40 Next line therapies for urge UI, overactive bladder

44:38 Surgery for stress urinary incontinence

45:50 Botox therapy for urge UI, overactive bladder

48:30 Do we need any more fancy diagnostic tests?

50:30 Take home points

55:05 Stuart schools us on urinary incontinence in men and timing of BPH meds

56:40 Outro

Tags: urinary, urine, incontinence, urge, stress, mixed, bladder, training, kegels, pelvic, floor, muscle, therapy, anticholinergic, botox, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Master the anemia algorithm, and take a deep dive on iron deficiency, anemia of chronic kidney disease, anemia of chronic inflammation, causes of macrocytic anemia and more in this discussion with international expert, Dr. David P. Steensma, Senior Physician from Dana Farber Institute, and Associate Professor of Medicine at Harvard Medical School.

Full show notes available at http://thecurbsiders.com/podcast

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Cases from Kashlak Memorial:

• 62 yo M with diabetes and CKD with asymptomatic Hgb 10, MCV 90, and Cr. 1.9?
• 72 yo F with HTN with asymptomatic Hgb of 11, MCV 85 and Cr. 0.6.
• 72 yo F with breast cancer in remission after lumpectomy, adjuvant chemo, and XRT treated 6 years ago presents with fatigue and some dyspnea on exertion. Hgb 9.6, MCV 102.

Time Stamps

00:00 Intro

01:18 Listener feedback

04:05 Announcement: We’re looking for on air correspondents to join The Curbsiders

05:05 Picks of the week

11:12 Getting to know our guest

17:50 Case #1 Normocytic anemia

19:15 Defining anemia (WHO criteria)

21:10 Epidemiology of anemia

23:45 Normocytic anemia

25:55 Erythropoietin for diagnosis and treatment

28:22 Anemia of CKD or chronic inflammation?

31:37 Discussion of ferritin and soluble transferrin receptor

33:47 Case #1 Conclusion

35:45 Hemoglobin targets in CKD

36:53 Case #2 Microcytic anemia

37:43 Correct reticulocyte count and reticulocyte index

40:45 Deciding on dose and route for iron repletion

43:44 Does vitamin C improve iron absorption?

45:27 Case #3 Macrocytic anemia

46:54 Vitamin B12 deficiency

51:54 Medication related B12 deficiency

52:35 Myelodysplastic syndrome

55:00 Side effects of common MDS treatments

56:18 Take home points

57:35 The Curbsiders post game analysis

64:16 Outro

Tags: anemia, hemoglobin, iron, supplementation, B12, vitamin, ferritin, kidney, chronic, inflammation, deficiency, oral, therapy, myelodysplastic, syndrome, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Get cozy with these new drugs for diabetes. Don’t be scared, they won’t bite. On this episode,  we interview Endocrinologist and current president of AACE, Dr. Jonathan D. Leffert, MD, FACP, FACE, ECNU about how to utilize the myriad of new diabetes drugs on the marketplace including SGLT2 inhibitors, DPP4 inhibitors, GLP1 agonists, and new ultra long acting insulins. Plus, we’ll teach you how to choose between agents, common side effects, A1C goals, and the cardiovascular benefits of these newer agents.

Full show notes available at http://thecurbsiders.com/podcast

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Case: Case from Kashlak Memorial Hospital: 49 yo M with HTN, BMI 29, hyperlipidemia, family history of premature CAD (dad age 45yo), and DM2 with A1C increase from 6.4% to 9% while on metformin monotherapy.

Time Stamps

00:00 Intro

04:33 Getting to know our guest

09:50 Clinical case of diabetes

12:40 Latent autoimmune diabetes

15:16 Life expectancy and A1C goal

16:47 Anemia’s effect on A1C

18:40 Back to our case, choice of agent

20:57 Lifestyle changes effect on A1C

22:55 Starting an SGLT2 inhibitor, what to look for

26:45 SGLT2 inhibitor use in patient already on diuretic

27:53 Discussion of CV risk reduction and newer DM meds

33:27 Euglycemic DKA

34:30 Choice of agent GLP1 vs SGLT2

37:10 Use of DPP4 inhibitors

38:55 Back to the case

39:37 Degludec, long acting insulin

41:34 Clinical case conclusion

43:03 Take home points

45:15 Outro

Tags: diabetes, medications, glucose, insulin, oral, therapy, drug, hypoglycemia, a1c, blood, cardiac, risk, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Master this practical approach to reading the medical literature (*No statistics needed!) with expert tips from Dr. Christine Laine, Editor in Chief, Annals of Internal Medicine, and Dr. Darren Taichman, Executive Deputy Editor, Annals of Internal Medicine. They teach us what we should be reading, and detail their thought processes as they appraise an article. Topics covered include: Is 3 minute critical appraisal possible? What’s the deal with P-values? What are common sources of bias? How does the approach differ with clinical trials versus observational studies versus meta-analyses?

*Minimal statistics needed ; )

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

01:13 Listener comment on Entresto

02:50 Picks of the week

09:36 Getting to know our guests

14:00 How to stay up on the medical literature

17:15 Three minute critical appraisal

19:15 Step 1: Assess the outcome being studied

20:50 Statistical versus clinical significance

22:33 Evaluating composite endpoints

24:47 Statistical power

28:58 Evaluating for bias

34:40 Recap of what we’ve learned so far

36:33 Is PICO useful?

39:01 Observational studies and bias

41:09 Evaluating a meta-analysis

46:05 Take home points

50:35 The Curbsiders recap the episode

53:02 Outro

Tags: literature, appraisal, meta, analysis, analyze, critical, read, medical, journal, study, randomized, observational, systematic, review, clinical, trial, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

A simplified approach to dizziness/vertigo with tips from international expert, Dr. David Newman-Toker, Professor of Neurology, Ophthalmology and Otolaryngology at Johns Hopkins University. We learn how to differentiate stroke from other causes of dizziness/vertigo; how to approach the differential diagnosis in dizziness/vertigo; how to perform the Dix-Hallpike test, Epley maneuver, and HINTS exam; plus, who benefits from medical therapy and vestibular rehab.

Special thanks to Dr. Cyrus Askin who found our expert, wrote the questions for this episode, and acted as our cohost.

Full show notes available at http://thecurbsiders.com/podcast

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Case: A 45-year-old man presents to the emergency department because of continuous dizziness, nausea, vomiting and unsteady gait that began 18 hours earlier.

Time Stamps

00:00 Intro

04:16 Getting to know our guest

11:56 Clinical Case

13:13 Why can’t patients describe their dizziness?

15:20 Classifying dizziness

18:35 The 3 vestibular syndrome buckets defined

22:14 Episodic vestibular syndrome differential diagnosis

26:49 Acute vestibular syndrome differential diagnosis

28:08 Chronic vestibular syndrome differential diagnosis

30:15 Challenges of medical history taking

32:10 Approach to the acute vestibular syndrome/HINTS

33:38 How to evaluate nystagmus

38:00 How to perform the head impulse test (aka head thrust)

45:56 How to perform “test of skew” (alternate cover testing)

47:45 Recap of HINTS exam and discussion of MRI

50:50 Signs and symptoms of cerebellar stroke

55:17 Use of Dix-Hallpike for episodic vertigo

57:00 How to perform Dix-Hallpike

59:50 How to perform the Epley maneuver

64:17 What happens when you choose the wrong test

66:10 Continuous versus triggered dizziness, or vertigo

67:40 Meclizine use in BPPV

69:25 How to cure horizontal canal BPPV

71:00 Treatment for vestibular neuritis

72:56 Treatment for Meniere’s disease

74:32 Who benefits from vestibular rehab/exercises

77:23 Dizziness and giddiness

78:15 Take home points

81:06 Outro

Tags: vertigo, dizziness, presyncope, ataxia, stroke, BPPV, Meniere’s, disease, neuritis, vestibular, syndrome, episodic, meclizine, migraine, gait, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Step up your salt game. We deconstruct hyponatremia with expert tips from our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer. Topics include: true versus false hyponatremia, SIADH, tea and toast/beer potomania, safe rates of sodium correction, fluid restriction, salt tablets, IV fluid choice, DDAVP clamps, and more.

Full show notes available at http://thecurbsiders.com/podcast

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Case: 85yo F with anxiety, asthma, HTN (on a CCB), hypothyroidism with TSH of 3 on therapy. Sodium was 128 from previous values 134-137 mg/dL. She is more fatigued than usual.

Time Stamps

00:00 Intro

03:00 Guest interview

06:45 Pick of the week w/Dr. Topf

15:50 Clinical case of hyponatremia

17:18 False hyponatremia normal osmolality

19:04 False hyponatremia high osmolality

20:06 Understanding why osmolality matters

22:58 Workup false hyponatremia

24:15 Recap of discussion so far

25:10 ADH dependent vs independent hyponatremia

26:30 Psychogenic polydipsia

28:45 Renal failure and hyponatremia

29:33 Tea and toast, and Beer Drinker’s potomania

34:42 ADH dependent hyponatremia

37:45 Volume versus osmolality

39:30 Volume status exam

44:44 Additional testing with urine lytes and uric acid

47:00 Treatment for SIADH

52:12 Discussion of the vaptans

57:51 Additional testing in SIADH

62:20 When to admit patient for hyponatremia

63:29 Clinical case of hyponatremia complications

68:26 Fluids and rate of correction

73:06 DDAVP clamp

76:00 Moderate hyponatremia

78:05 Diuretic dosing DOES matter!

81:29 Loop diuretics for SIADH

83:55 Take home points

86:55 Outro

Tags: hyponatremia, salt, sodium, SIADH, ADH, vasopressin, fluids, electrolytes, kidney, nephrology, osmolality, urine, concentration, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Solidify your knowledge of osteoporosis and osteopenia in this discussion with Endocrinologists and osteoporosis guideline authors, Dr. Rachel Pessah-Pollack, and Dr. Dan Hurley from the American Association of Clinical Endocrinologists (AACE). Learn when to start therapy after an acute hip fracture, how to use bone turnover markers to assess fracture risk, more on how to dose calcium and vitamin D, and finally, we discuss the new American College of Physicians (ACP) guidelines and how they differ from the AACE guidelines on osteoporosis.

For a more basic talk on osteoporosis check out episode #18 w/Dr. Pauline Camacho.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

03:00 Picks of the week

07:31 Guest and topic intro

10:25 Rapid fire questions

14:45 Clinical Case and defining osteoporosis

17:00 FRAX score

20:35 Secondary evaluation for cause of bone loss

20:54 Bone turnover markers (telopeptides)

23:17 Alkaline phosphatase

26:30 Calcium and Vit D

29:35 Recap of teaching points so far

31:25 Antiresorptive versus anabolic therapy

32:40 Aromatase inhibitors increase fracture risk

34:28 When to start therapy after fracture

35:44 Mechanism of action recombinant PTH

41:38 Vitamin D assay and dosing

46:53 Calcium intake, and formulations

49:45 Take home points

50:54 Recap and discussion of AACE vs ACP guidelines by The Curbsiders

59:42 Outro

Tags: bone, osteoporosis, anabolic, osteopenia, vitamin D, calcium, fracture, density, AACE, guidelines, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Master the evaluation of acute and chronic chest pain with coronary CT angiography (CCTA). We deconstruct this game changing technology w/experts from the Society for Cardiovascular Computed Tomography (SCCT), Dr. Todd Villines and Dr. Ahmad Slim. We’ve got answers on what to do when a patient with chest pain has a prior CAC score of zero, and/or a CCTA with non-obstructive disease. Plus: how to select, prepare, and counsel patients; how to interpret reports; choosing between myocardial perfusion study and CCTA, and more!

Special thanks to Dr. Emilio Fentanes from SCCT for setting up this interview.

Full show notes available at http://thecurbsiders.com/podcast

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Case: 45 yo F active duty Colonel with chronic chest pain syndrome despite negative conventional stress test and CAC score of zero.

Time Stamps

00:00 Intro

04:00 Rapid fire questions

08:23 Book recommendations

10:14 Defining terms CCTA vs CAC

12:47 Script for counseling patient about CCTA

14:34 Prep for CCTA

16:40 Why is CCTA controversial?

19:37 Patient selection for CCTA both acute and chronic

25:20 Chronic chest pain and CCTA

27:58 CAC and CCTA in high risk occupations

33:25 Clinical case

36:10 Acute chest pain in patient w/CAC score zero

39:18 Acute chest pain in patient w/CAC score zero and previous CCTA w/non-obstructive CAD

41:22 How to read a CCTA report

45:48 CCTA versus conventional testing and risk MI, death

49:18 Use of CCTA in outpatients

52:16 Plaque characteristics and risk ACS

55:51 CCTA w/non-obstructive disease in patients with acute chest pain

58:14 When is myocardial perfusion scanning better?

61:00 Listener question on small vessel disease

62:09 Take home points

65:00 Curbsiders recap

69:33 Outro

Update your management of heart failure (HF) with expert tips from Cardiologist Dr. Eric Adler, Associate Professor of Medicine and Director of Cardiac Transplant and Mechanical Circulatory Support at UC San Diego. We cover how to use BNP, a simple way to examine jugular venous distention, medical therapy for heart failure, the PARADIGM-HF trial, and how to use sacubitril/valsartan (Entresto).

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

04:25 Rapid fire questions

06:00 Palliative care and heart failure

08:40 Book recommendation

10:20 Advice for teachers and learners

12:27 Clinical case of HF

13:38 Classification and staging of HF

17:07 Discussion of BNP

19:35 How to perform neck vein exam for JVD

21:20 BNP for prognosis

23:00 BNP at hospital discharge

26:36 Factors that affect BNP

27:25 Initial patient counseling

32:35 Exercise in HF

34:00 Additional testing at time of diagnosis

36:28 Initial medical therapy

38:30 Discussion of diuretics and dosing

42:50 Aldosterone antagonists

44:30 PARADIGM-HF and entresto

51:27 Medications to avoid in HF

54:14 Digoxin

57:30 Dr. Adler’s take home points

59:11 Stuart questions dosing conventions

60:48 Outro

Tags: arni, assistant, care, diuretics, doctor, education, failure, family, foam, foamed, health, heart, hospitalist, hospital, internal, internist, neprilysin, nurse, management, medicine, medical, physician, practitioner, primary, resident, sacubitril, student

Master the safe and effective use of obesity medications with Endocrinologist, Dr. Karl Nadolsky (co-author of 2016 AACE Obesity guidelines), Director of the Diabetes, Obesity & Metabolic Institute at Walter Reed National Military Medical Center. We get under the hood of each FDA approved obesity medication plus some of our normal hijinks. Check out episode #23 for a more general overview of obesity.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

03:12 Picks of the week

08:44 Rapid fire questions

13:00 Counsel patients about obesity

14:40 Pathophysiology of obesity

18:00 Case

22:46 Phentermine/topiramate (Qsymia)

26:20 Bupropion/naltrexone (Contrave)

29:18 Liraglutide (Saxenda)

34:32 Orlistat (Alli, Xenical)

37:35 Cost issues

40:18 Lifelong medical therapy for obesity

42:44 Dr. Nadolsky’s take home points

44:45 The Curbsiders recap and discuss their experience with obesity medications

52:28 Outro

Tags: assistant, care, doctor, education family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, primary, resident, student, obesity, pharmacotherapy, weight loss, safety, side effects, orlistat, alli, naltrexone, bupropion, contrave, phentermine, topiramate, qsymia, lorcaserin, belviq, FDA

Load up on clinical pearls for your practice in this wide ranging discussion with expert clinician educator, Dr. Jon M. Sweet, Associate Professor of Medicine from Virginia Tech Carilion School of Medicine. Topics include cellulitis, tinea infections, dermatologic emergencies, smoking cessation, heart failure, hormone replacement therapy, iron supplementation, and vocal cord dysfunction. Plus, Stuart gives Paul a new nickname! Special thanks to the Dr. Patrick Alguire and Dr. Darilyn Moyer from the American College of Physicians for setting up this episode.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

02:12 Picks of the week

05:10 Guest intro

07:13 Rapid fire questions

15:25 Tinea infections

18:22 Misdiagnosis of cellulitis

23:53 AGEP (Dermatology)

29:03 DRESS syndrome (Dermatology)

35:28 Smoking cessation

36:55 Back pain, acetaminophen and acupuncture

41:42 Hot flashes and hormone therapy

43:05 Iron supplementation

49:55 Heart failure and sacubitril/valsartan

53:33 Vocal cord dysfunction

56:50 Response from Stuart and Paul

62:20 Outro

Tags: AGEP, ARNI, assistant, back pain, care, cellulitis, cessation, dermatology, DRESS, doctor, education family, foam, foamed, health, heart failure, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, primary, resident, smoking, student, tobacco, vocal cord dysfunction

Diagnose, prevent, and treat diabetic foot ulcers and infections like international expert, Dr. Andrew Boulton, Professor of Medicine at the University of Manchester (England). From how to perform a proper foot exam, to foot care, to ulcers and infections we cover the essentials for your practice.

For full show notes visit http://thecurbsiders.com/podcast

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Tags: assistant, care, diabetes, diabetic, doctor, education, family, foam, foamed, foot, health, hospitalist, hospital, infection, internal, internist, nurse, medicine, medical, physician, practitioner, primary, resident, student, ulcer

Prevent HIV infections with pre-exposure prophylaxis (PrEP), and learn to perform appropriate screening for sexually transmitted infections with tips from expert, Dr. Gina Simoncini, Associate Professor of Medicine at Temple University Hospital. Learn how to implement PrEP in your practice, plus tips on vegetable gardens, fellowships, and where to get the best samosas, in this wide ranging discussion.

Full show notes available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

04:50 Rapid fire questions

16:23 Defining preexposure prophylaxis

18:50 Who benefits from PrEP

21:43 Case discussion

23:45 PrEP during pregnancy, breastfeeding

24:45 Baseline testing and STI screening before PrEP use

28:15 Counseling on adherence, side effects

31:25 Adverse effects of PrEP

34:00 Monitoring patients on PrEP

36:46 Collaborative practice

37:30 Discussion of high risk behaviors on PrEP

39:30 Does PrEP promote viral resistance?

41:51 Insurance reimbursement for PrEP

42:50 Take home points

44:24 Outro

Tags: assistant, care, doctor, education, emtricitabine, family, foam, foamed, health, HIV, hospitalist, hospital, infection, internal, internist, nurse, meded, medicine, medical, physician, practitioner, primary, prophylaxis, resident, sti, student, tenofovir

Learn “weird” endocrine stuff! How to approach vague complaints like fatigue and weight gain. Reverse T3 syndrome, Wilson’s T3 syndrome, and adrenal fatigue; Do they exist? Learn how to help the challenging patient who is convinced they have an endocrine disorder in this discussion recorded live from AACE 2017 with Dr. Michael T. McDermott, Professor of Medicine, University of Colorado Denver School of Medicine.

For full show notes visit http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

05:36 Guest intro

07:50 Definition of “pseudo” endocrine

10:02 Case introduction

13:39 “Reverse T3 Syndrome”, the thyroid and fatigue

20:45 Growth hormone

25:10 Fatigue, and where to start

33:00 Adrenal fatigue

38:00 Lab testing

39:34 Take home points

42:12 Stuart on the thyroid and reverse T3

45:30 Paul’s approach to multisystem complaints

51:12 Outro

Tags: adrenal, assistant, care, doctor, education, endocrine, family, fatigue, foam, foamed, growth, health, hormone, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, primary, resident, student, thyroid, t3

Expert tips on the diagnosis and management of secondary hypertension in this conversation with Dr. Richard Auchus MD, PhD, Professor of Pharmacology and Internal Medicine & Director of the Diabetes, Endocrinology, & Metabolism Fellowship Program at the University of Michigan. Topics include: primary hyperaldosteronism, use of spironolactone, Cushing’s syndrome, pheochromocytoma, and which tests to utilize.

Full show notes available at http://thecurbsiders.com/podcast

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Tags: assistant, care, cushing's, doctor, education, endocrine, family, foam, foamed, health, hospitalist, hospital, hypertension, internal, internist, nurse, medicine, medical, pheochromocytoma, physician, practitioner, primary, resident, resistant, spironolactone, student

Recognize and manage end of life symptoms with competence and confidence. In this extensive discussion with Dr. Brooke Worster, Assistant Professor of Medicine at Sydney Kimmel Medical College and Medical Director, of the Palliative Care Service at Thomas Jefferson University Hospitals we discuss scripts for having difficult conversations, managing patient/family expectations, what comes in the hospice “E” kit, terminal delirium, the “death rattle”, air hunger, and more.

Full show notes available at http://thecurbsiders.com

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Time Stamps

00:00 Intro

03:10 Rapid fire questions

08:33 Defining hospice and palliative care

11:28 Case discussion

21:28 Gunderson, MI and Respecting Choices

24:25 How to counsel patients about home hospice?

37:10 Hospice “E” kit and how to use it

42:09 Air hunger, terminal delirium, death rattle, and Cheyne Stokes breathing

52:48 What is the PCM’s role while patient is on hospice?

58:19 Cancer survivorship and palliative care

60:33 Take home points

62:20 Outro

Tags: assistant, care, doctor, end, education, family, foam, foamed, health, hospice, hospitalist, hospital, internal, internist, life, nurse, medicine, medical, palliative, physician, practitioner, primary, resident, student, symptom

Learn the latest in lipid lowering therapy in this extensive discussion with Dr. Paul S. Jellinger, MD, MACE, Professor of Medicine at the University of Miami and Chair of the writing committee for the American Association of Clinical Endocrinologists (AACE) 2017 Guidelines for the Management of Dyslipidemia and Prevention of Cardiovascular Disease (CVD). Topics include ezetimibe, PCSK9, FOURIER trial, statin myopathy, CoQ10, fish oil, fibrates and more. For a more basic discussion of dyslipidemia check out episode #10.

Full show notes are available at http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

03:10 Rapid fire questions

08:15 Dyslipidemia defined

10:26 Classifying dyslipidemia

13:21 Diagnosing Familial Hypercholesterolemia

17:48 A difficult lipid case discussed

22:40 Lp (a), Apo B and LDL particle concentration

28:40 What labs to order

31:31 ACC/AHA versus other risk scores

38:21 IMPROVE-IT

41:35 Non-statin medications discussed

45:05 Hypertriglyceridemia fibrates and fish oil

48:25 How often to check the lipid panel

49:58 Statin Myopathy and CoQ10

54:17 FOURIER, PCSK9 and very low LDLs

59:43 Extreme risk category discussed

62:34 Is plaque regression possible?

64:12 Take home points

67:08 Outro

Tags: assistant, care, cholesterol, doctor, education family, fish oil, foam, foamed, health, hospitalist, hospital, internal, internist, ldl, lipid, medicine, medical, myopathy, nurse, pcsk9, physician, practitioner, primary, statin, resident, student

A recap and highlights from ACP 2017, Internal Medicine's largest national conference, with Dr. Alan Dow MD, MSHA, FACP, Professor of Medicine from Virginia Commonwealth University. We discuss iron supplementations, shellfish allergies and IV contrast, proton pump inhibitors, and more!

For full show notes visit http://thecurbsiders.com/podcast.

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Tags: acp, allergy, assistant, care, contrast, doctor, education, family, foam, foamed, health, hepcidin, hospitalist, hospital, internal, internist, iron, nurse, medicine, medical, physician, ppi, practitioner, primary, resident, shellfish, student

Master the management of major depressive disorder (MDD) with clinical pearls from Dr. Marius Marcel Commodore, Associate Professor of Clinical Medicine and Psychiatry from Temple University Hospital. We cover diagnosis, patient counseling, choice of agent, dose titration, augmentation...and DJ names?

For full show notes visit http://thecurbsiders.com/podcast

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Time Stamps

00:00 Intro

02:08 Rapid fire questions

11:04 Initial diagnosis and screening

13:06 Tools for diagnosis discussed

17:07 Shared decision making in choice of agent

19:40 Monitoring and follow up

21:51 Choice and comparison of agents

27:38 Augmentation and the STAR-D study

31:03 Quick recap

33:52 Cognitive behavior therapy

40:58 Medication titration and duration of therapy

45:18 Bipolar disorder screening

47:38 Screening for suicidality

49:58 Difficulty getting patients into specialty care

53:38 Mood disorders in health care providers

58:31 Listener Questions

60:48 Take home points

64:10 Outro

Tags: antidepressant, assistant, care, depression, doctor, education family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, mood, physician, practitioner, primary, psychiatry, ssri, snri, resident, student

An approach to super utilizers, and difficult patients with Dr. Alex Lane, Assistant Professor of Medicine at Cooper University Hospital. In this wide ranging discussion we cover books, learning, super utilizers, hot spotting, and how to approach difficult patients.

For full show notes visit http://thecurbsiders.com/podcast

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Time Stamps

00:00 Intro

02:04 Getting to know you

06:12 Best advice

07:13 Alex’s tips on keep up with EBM

11:22 Something about Alex we won’t forget

13:06 Listener Mail

15:00 Super Utilizers defined

17:00 Hot spotting defined

24:55 ACE score discussed

30:15 Team based approach to care

33:16 Getting involved in your community

36:18 Outro

Tags: assistant, care, difficult, doctor, education family, foam, foamed, health, hot, hospitalist, hospital, internal, internist, nurse, medicine, medical, patient, physician, practitioner, primary, resident, spotting, student, super, utilizer

Dominate the diagnosis and management of dementia with tips from international expert Dr. Stephen Dekosky, Professor of Neurology, and deputy director of the McKnight Brain Institute at the University of Florida. Filled with clinical pearls, we cover everything from basic testing to advanced imaging modalities, as well as current and future therapies for dementia. This episode is a must listen. Big thanks to the American Academy of Neurology for setting up this interview.

Full show notes are available at http://thecurbsiders.com/podcast

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

00:00 Intro

02:20 Rapid fire questions

04:40 Defining dementia

08:40 Choosing a clinical test for dementia

17:20 Diagnostic labs

19:00 Genetic and CSF testing

25:46 Advanced brain imaging

28:18 Preclinical Alzheimer’s disease (AD)

32:17 Routine CNS imaging

36:18 Initiating medical therapy

39:35 Differentiating MCI and dementia

41:45 Vascular Dementia

44:10 CSF testing for AD

45:15 Vitamins, supplements, and foods as treatment or prevention

50:56 Mental exercise for AD prevention

52:36 Anticholinergic, benzos and dementia

54:46 Future directions

57:55 Outro

Tags: Alzheimers, assistant, care, education, dementia, disease, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, neurology, nurse, medicine, medical, mri, pet, primary, physician, resident, student, vascular

Dominate syncope with tools, tips, and tricks from The Curbsiders. No guest on this episode, just doctors Watto, Brigham, and Williams deconstructing the frustrating topic of syncope to provide listeners with some shiny clinical pearls and practice changing knowledge.

For full show notes visit http://thecurbsiders.com/podcast

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Tags: assistant, cardiology, care, doctor, education, epilepsy, family, foam, foamed, guideline, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, presyncope, primary, resident, student, syncope

Dominate leg cramps, diuretic therapy, and resistant hypertension. Our guest, Dr. Joel Topf, is a clinical nephrologist, pioneer in the use of social media for medical education, and Assistant Clinical Professor at Oakland University William Beaumont School of Medicine, best known for his blog, Precious Bodily Fluids, and hilarious/informative Twitter feed @kidney_boy. We start with basic renal physiology and build up to the treatment of resistant hypertension.

For full show notes visit http://thecurbsiders.com/podcast.

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Tags: assistant, care, diuretics, doctor, education family, foam, foamed, health, hospitalist, hospital, hypertension, internal, internist, nephrology, nurse, media, medicine, medical, physician, physiology, practitioner, primary, social, renal, resident, resistant, student

Dominate the treatment of menopause with tips from expert, Dr. Amy Tremper, Assistant Professor of Obstetrics and Gynecology at the University of Michigan Medical School. We discuss hormone replacement therapy, the Women’s Health Initiative, bio-identical hormones...and game shows?!

For full show notes visit http://thecurbsiders.com/podcast.

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: assistant, care, doctor, education family, foam, foamed, health, hormone, hospitalist, hospital, hot flashes, internal, internist, nurse, medicine, medical, menopause, physician, practitioner, primary, replacement, resident, student, therapy

Stop the madness! Diagnose and treat neuropathy like expert guest, Dr. Grace Kimbaris, Assistant Professor of Clinical Neurology from University of Pennsylvania. We cover the basics along with some random pearls on fluoroquinolones, small fiber neuropathy, alpha lipoic acid, and more! 

For full show notes visit http://thecurbsiders.com/podcast. 

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medical, medicine, nerve, neuropathy, primary, physician, resident, student

Individualize cardiovascular risk, and optimize risk reduction using cardiac CT with coronary artery calcium (CAC) scoring. Our expert guests from The Society for Cardiovascular Computed Tomography (SCCT), Dr. Harvey Hecht, Professor of Medicine from Mount Sinai, and Dr. Matthew Budoff, Professor of Medicine from UCLA, school us on the use of this powerful tool. Special thanks to Dr. Emilio Fentanes from the SCCT for setting up this interview.

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Get full show notes at http://thecurbsiders.com/category/podcast

Tags/keywords: artery, assistant, cac, calcium, care, cardiovascular, coronary, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Diagnose and treat irritable bowel syndrome (IBS) like master clinician, Dr. Brooks Cash of the American College of Gastroenterology. This condition frustrates clinicians and patients alike, but we’ll give you the tools to conquer IBS. Now with our theme song included!

Recommend a guest or topic and give feedback at thecurbsiders@gmail.com  

Get full show notes at http://thecurbsiders.com/category/podcast

Tags: assistant, bowel, care, doctor, education, family, foam, foamed, gastroenterology, health, hospitalist, hospital, internal, internist, irritable, nurse, medicine, medical, primary, physician, resident, student, syndrome

Anticipate, and dominate the side effects of radiation therapy. On this episode we interview Dr. John J. Cuaron, Radiation Oncologist from Memorial Sloan Kettering Cancer Center in New York to better understand, “What’s the deal with radiation oncology?”.

Recommend a guest or topic and give feedback at thecurbsiders@gmail.com  

Get full show notes at http://thecurbsiders.com/category/podcast

Tags: assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student 

Master the management of hyperglycemia, DKA, and learn to avoid common pitfalls. This episode is packed with clinical pearls from repeat guest, Endocrinologist, Dr. Jeffrey Colburn.

Recommend a guest or topic and give feedback at thecurbsiders@gmail.com  

Get full show notes at http://thecurbsiders.com/category/podcast

Tags: assistant, care, diabetes, dka, doctor, endocrinology, family, health, hospitalist, hospital, hyperglycemia, internal, internist, ketoacidosis, nurse, medicine, medical, primary, physician, student, resident

Summary:

More tools, tips, and tricks so you can master obesity in clinic. On this first roundtable episode, The Curbsiders give their take on the management of obesity, and offer their own practice changing tips. Also, Paul announces his goal to watch 365 movies in 365 days, and the guys give more great book, movie, and TV recommendations.

Got feedback? Email thecurbsiders@gmail.com  

Picks of the week

1. Matt’s pick - Never Eat Alone by Keith Ferrazzi
2. Paul’s pick - Sing Street (film)
3. Stuart’s pick - Lemony Snicket's: A series of unfortunate events

Clinical pearls (from Recap and response OR Brief topic review)

1. Obesity is a DISEASE. Not a lifestyle choice.
2. Percent weight loss by intervention
   • Diet and lifestyle 5-10%
   • Medications >10%
   • Bariatric surgery >30%
3. Utilize specialist referral to gain resources e.g. dietician, and psychologist through bariatric surgery referral
4. Put faith in your patients ability to change and they will hold themselves accountable

Coding tips

1. If BMI >35 then code “morbid obesity” to increase medical decision making
2. Code “BMI” in addition “Morbid obesity”
3. Be sure to code comorbid conditions e.g. hypertension, diabetes, hyperlipidemia, OSA

Time Stamps

00:00 Intro

01:29 Picks of the week

06:07 Recap and responses to our obesity interview with Dr. Garvey

08:55 Mechanisms of obesity

10:15 Discussion of relapse rates, weight gain

11:23 Percent weight loss per therapy

14:35 Treating obesity on a budget

18:51 Coding tips

20:43 Diet, lifestyle counseling and how to leverage resources

26:38 Closing remarks

28:40 Outro

Disclosures:

The Curbsiders report no relevant financial disclosures, but as always hope to have lots of them in the future.

Links from the show:

1. Tomlinson, S et al. Mechanisms, Pathophysiology, and Management of Obesity. NEJM 2016; 376(3) http://www.nejm.org/doi/full/10.1056/NEJMra1514009
2. E&M University website http://emuniversity.com
3. ICD10Data.com http://www.icd10data.com
4. Matt’s pick - Never Eat Alone by Keith Ferrazzi
5. Paul’s pick - Sing Street (film)
6. Stuart’s pick - Lemony Snicket's: A series of unfortunate events

Tags: care, doctor, family, health, hospitalist, hospital, internal, internist, medicine, medical, obesity, primary, physician, student, resident

Obesity is of epidemic proportions in the United States and, unfortunately, many physicians are ill-equipped to tackle this disease.  In this episode, we talk with Dr. Timothy Garvey, MD, FACE, one of the world’s leading experts in obesity research.  We asked the American Association of Clinical Endocrinology to recommend an obesity expert and they gave us the best!

Got feedback? Email thecurbsiders@gmail.com 

Clinical Pearls:

1. Obesity is a DISEASE. Not a lifestyle choice!
2. Obesity is known to be associated with many of the most common preventable diseases and, thus, should be an important component of any treatment program.
3. BMI goals differ between ethnic groups (for example, east Asians developing heart disease with a BMI greater than 23).
4. Weight loss treatment should focus on the disease burden and not on body image.
5. While diet and exercise are independently important, failure to address the underlying sedentary lifestyle will likely prove fruitless.  The American College of Sports Medicine recommends avoiding any sedentary activity greater than 90 minutes at a time and at least 150 minutes of moderate activity weekly.
6. Always ask permission before talking about weight loss; otherwise, you might negatively impact the physician-patient relationship.
7. In order to prevent weight-related complications, aim for approximately 10% weight loss.
8. Weight regain is a REAL problem that should be anticipated (decreased BMR, hormonal implications, and many other issues); weight loss medications help to fight against these pathophysiological mechanisms.
9. Weight loss medications (Orlistat [inhibits fat absorption], Lorcaserine [5HT2C agonist, blunts appetite], Liraglutide [GLP1-RA] at higher dosages [3mg/day], Phentermine/Topiramate [“...most effective…”], Naltrexone/Bupropion) are under-utilized across the board, but before using these medications, the physicians should understand how to use these medications and consider them as part of a weight loss treatment plan that includes lifestyle modifications (i.e. dietary assessment and exercise “prescription”).
10. Liraglutide, Phentermine/Topiramate, and Naltrexone/Bupropion are the most effective medications.
11. If the patient does not lose at least 5% of their weight by three months, stop that specific medication and consider trying another medication.
12. Follow-up with your weight loss patients frequently over the telephone (2 weeks after starting a medication) and in the office (at least monthly).
13. Minimal data supports using weight loss medications in the elderly (>70 years of age)

Dr. Garvey’s “Take-Home” Points:

1. Obesity is a DISEASE not a lifestyle choice!
2. Don’t be afraid to use weight loss medications!
3. Weight loss should be a tool to improve HEALTH, not appearance.

Disclosures:

Dr. Garvey reports several financial disclosures for this talk:

1. Scientific Advisory Board:  Novo Nordisk, Eisai, Janssen, Vivus, Liposcience, Takeda, Astra Zeneca, Alexion, Merck
2. Research Funding (university administered):  Merck, Astra Zeneca, Weight Watchers, Eisai, Sanofi, Pfizer, Novo Nordisk, Lexicon, Elcelyx
3. Stock Ownership (publicly traded):  Eli Lilly, Pfizer, Novartis, Merck, Isis, Bristol-Myers-Squibb, Affymetrix

Learning objectives:

By the end of this podcast listeners will be able to:

1. Understand the impact obesity has on overall health and disease burden.
2. Identify the weight loss medications and which might be appropriate for your patient(s).
3. Have a general understanding of the impact that each individual treatment modality (lifestyle modification, medications, and surgery) has on weight loss.

Links from the show:

1. Dr. Timothy Garvey’s bio (UAB):  https://www.uab.edu/medicine/diabetes/faculty/faculty-bios/111-w-timothy-garvey
2. Dr. Timothy Garvey’s app recommendation, “Lose It,” available from https://www.loseit.com/.
3. Dr. Timothy Garvey’s book recommendation:  “House of God” available https://www.amazon.com/House-God-Samuel-Shem/dp/0425238091/ref=sr_1_1?ie=UTF8&qid=1484443555&sr=8-1&keywords=House+of+God.
4. AACE 2016 Obesity Guidelines:  https://www.aace.com/files/final-appendix.pdf
5. AACE Obesity Treatment Algorithm (highly recommended):  https://www.aace.com/files/guidelines/ObesityAlgorithm.pdf
6. Naltrexone/Bupropion SR for Weight Loss:  Method-of-use study of naltrexone sustained release (SR)/bupropion SR on body weight in individuals with obesity.  Obesity (Silver Spring). 2016 Dec 27. doi: 10.1002/oby.21726.
7. Phentermine/Topiramine for Weight Loss (Review Article):  Combination phentermine and topiramate extended release in the management of obesity.  Expert Opin Pharmacother. 2015 Jun;16(8):1263-74. doi: 10.1517/14656566.2015.1041505.

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview national and international experts to bring you clinical pearls and practice changing knowledge. Doctors Matthew Watto, Stuart Brigham, and Paul Williams deliver some knowledge food for your brain hole.

Comments or questions? Email thecurbsiders@gmail.com

Summary:

Consolidate your knowledge and reinforce the learning you’ve done with us in 2016. Enjoy this holiday helping of knowledge food for your brain hole. The guys offer their best of recommendations for 2016 and recap key teaching points from the past year so you have the tools to dominate 2017.

Recommend a guest or topic and give feedback at thecurbsiders@gmail.com  

Clinical Pearls:

SPRINT trial debate

1. Bias effects results seen in this trial. e.g. stopped early
2. Blood pressure (BP) control may have been overestimated based on how BP was measured leading to increased CV events (Stuart’s view).
3. BP measurements in trial likely reflected out of office BP so results are useful (Paul’s view).
4. Lower BP is probably safe, even in the elderly so be reluctant to back off on meds.

HTN Urgency

1. Verify BP reading and measurement technique
2. Evaluate for pain, anxiety, volume overload, nonadherence, or noncompliance
3. Treat high BP with long term goals in mind (i.e. go up on chronic/long-acting meds)

Anticoagulation

1. Avoid warfarin in patients with gastric bypass or Crohn’s with ileitis.
2. Use SPARC tool to visually demonstrate risks and benefits of anticoagulation in Afib.
3. Physicians commonly underestimate benefit of anticoagulation in older sicker patients and overestimate risk of bleeding.

Fibromyalgia and chronic pain

1. Recognize the constellation of fatigue, memory problems, sleep disturbance, and multifocal pain as fibromyalgia.
2. Use the 2011 American College of Rheumatology criteria for diagnosis. No tender point exam required!
3. Nonpharmacologic therapies and education are most effective (see video links below).
4. Chronic painful conditions like rheumatoid arthritis, or lupus can lead to fibromyalgia.

Functional Medicine

1. At least 80% of your food should be whole foods.
2. Use the Dirty Dozen and Clean 15 to guide organic food choices.
3. Knowledge of pathophysiology and biochemistry can be used to treat disease e.g. treating small intestinal bacterial overgrowth can fix iron deficiency and indirectly treat iron deficiency.

Lipids

1. Lowering LDL is key. Some statin is better than none, so consider intermittent dosing (three times weekly) of atorvastatin or rosuvastatin.
2. Statins have a 20 year safety record, are cheap, and will remain king for now.
3. Check baseline LDL and monitor percent decrease on statin therapy to ensure desired effect (e.g. 50% drop in LDL for patient requiring high intensity).
4. Withdrawal of statins at end of life is warranted and safe.

Insomnia

1. Nonpharmacologic therapy is as good or better than pharmacologic therapy.
2. Benefits of nonpharmacologic therapy persist 1-2 years after discontinuation.
3. Identify problem with sleep initiation versus maintenance, or both, then choose agent.
4. Use long taper of sleep agent (several months) along with CBT for nightly problems with sleep.
5. Intermittent dosing of sleep agent okay if only intermittent sleep trouble.

Osteoporosis

1. If secondary hyperparathyroidism present, then target normal PTH not just a Vit D level 30-50 ng/ml.
2. After hip fracture, first normalize Vit D and/or PTH, then treat with bone conserving agent.
3. Drug holiday stops when bone density falls, fracture occurs, or risk increases (e.g. steroid use).
4. Patients may require multiple courses of bisphosphonates or other bone conserving drugs.

In-flight emergencies

1. Know contents of standard medical kit include:
2. Be prepared to improvise.

Lessons learned

1. Failure is essential to learning and improving.
2. Don’t fall victim to “fear of being left out”. Saying “No” protects you from being spread thin.
3. Overcome the “curse of knowledge” by teaching the basics and gearing lesson to level of learner.

Disclosures:

The Curbsiders report no relevant financial disclosures, but hope to have a long list of them in the future.

Time Stamps

00:00 Intro

02:54 Best of 2016 Articles

07:45 Best of 2016 Book recommendations

12:44 Best of 2016 Apps

15:49 SPRINT trial

24:34 Hypertensive urgency

27:05 Anticoagulation

33:00 Fibromyalgia and chronic pain

38:38 Functional Medicine

42:05 Lipids

48:09 Insomnia

52:13 Osteoporosis

56:29 In-flight emergencies

59:09 Lessons learned in 2016

1:03:45 Outro

Links from the show:

Articles

1. Blood pressure as a risk factor for headache and migraine: a prospective population-based study.  Eur J Neurol. 2015 Jan;22(1):156-62, e10-1. doi: 10.1111/ene.12547. Epub 2014 Aug 25.
2. Imbalanced insulin action in chronic overnutrition: Clinical harm, molecular mechanisms, and a way forward. Atherosclerosis. 2016 Apr;247:225-82
3. Sniffing out significant “Pee values”: genome wide association study of asparagus anosmia http://www.bmj.com/content/355/bmj.i6071

Books

1. How Doctors Think by Jerome Groupman
2. Multipliers: How the Best Leaders Make Everyone Smarter by Liz Wiseman:
3. Spook Country by William Gibson
4. Carter Beats the Devil by Glen David Gold
5. Evidence Based Physical Diagnosis by Steven McGee

Apps

1. Download Google Drive
2. UptoDate
3. My Fitness Pal
4. Map My Run

Other links

1. SPARC Tool for anticoagulation in atrial fibrillation
2. Warfarin use in heart failure patients may have a mortality benefit
3. Fibroguide.com
4. Chronic Pain is it all in their head
5. Five minute video on Chronic Pain from Australia (not the VA!)
6. EWG.org (environmental work group) - gives the Dirty Dozen and the Clean 15

Summary:

Advance your career and expertly navigate the job hunt with guidance from Dr. Alia Chisty of Temple University Hospital.  Highlights include Dr. Chisty offering up her personal email address for mentorship and Dr. Watto announcing our first contest. This episode is full of wisdom to enhance your career whether you're gainfully employed or looking for your first job.

Clinical Pearls:

1. Meet with your mentors at the start of the process. They can:
2. 1. Help clarify your goals
   2. Activate your network
3. Look for jobs 9 months in advance.
4. An ideal job: incorporates your interests, skills, and values.
5. Leverage your network (friends, mentors, program director) to identify available opportunities
6. Email your cover letter (typically an email) and CV to the division chair or section chief
   1. Craft your elevator pitch.
   2. Do your homework.
   3. Explain how you will add value.
7. When interviewing:
8. Give yourself credit! Highlight experiences in your CV (e.g. conference attendance, lectures given, etc.)
9. Have someone review and proofread your CV.
10. If an employer makes a promise, then have it included in your contract. Don’t just take their word!
11. Have a lawyer review your contract.

Goal: Listeners will learn to craft a systematized approach to finding their perfect job.

Learning objectives:

By the end of this podcast listeners will:

1. Recognize timeline for applications and finding or switching jobs.
2. Design an effective CV and cover letter.
3. Recognize the importance and utility of mentors in the application process

Disclosures:

Dr. Chisty reports no relevant financial disclosures.

Time Stamps

0:20 Intro

03:40 Rapid fire questions

07:10 When to start looking for jobs

09:22 How to narrow your focus

11:33 Too many choices may be worse

13:05 Asking yourself the right questions

14:40 Quick recap of what we’ve learned

15:20 Who to contact, and what to send

19:30 Recruiters

22:25 How to prepare for your interview

26:05 Ramit Sethi on finding your dream job and negotiating your salary

27:36 Where to look for jobs (including social media)

31:10 Discussion of social media

33:18 What to include in your CV

35:25 Our first contest (send us your CV!)

36:30 So you’ve been offered a job (s)

38:38 Take home points

40:15 Outro

Links from the show:

1. NEJM career center: http://www.nejmcareercenter.org/jobs/internal-medicine/
2. JAMA career source: http://www.jamacareercenter.com/resources_overview.cfm
3. Zerzan, J.T. et al.  2009.  Making the most of mentors: a guide for mentees.  Academic Medicine 84: 140-144. https://www.ncbi.nlm.nih.gov/pubmed/19116494
4. Ramit Sethi on finding your dream job http://www.iwillteachyoutoberich.com/find-your-dream-job/
5. Ramit Sethi on negotiating your salary http://www.iwillteachyoutoberich.com/blog/salary-negotiation/
6. Pride and Prejudice by Jane Austen
7. Harry Potter and the Goblet of Fire by JK Rowling
8. NEJM Journal Watch http://www.jwatch.org
9. AHRQ ePSS app  https://itunes.apple.com/us/app/ahrq-epss/id311852560?mt=8

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Summary:

On this episode we’ll teach you to dominate hypertensive urgency and severe hypertension (HTN) in the clinic, the ER, or on the hospital wards. The Curbsiders offer you this delicious serving of knowledge food so you can manage high blood pressure (BP) without making the same egregious errors that we made during our more formative years.

Of note, The Curbsiders are guestless for this episode. Guestless? Is that a word? Our guest for this episode was supposed to be Dr. Wallace Johnson, a Cardiologist, and expert on HTN from the University of Maryland. He did a fantastic job, but, unfortunately, technical difficulties caused us to lose any useable audio. Our sincerest gratitude and deepest apologies to Dr. Johnson. Nevertheless, we pressed on and used one of our own, the illustrious Dr. Paul Williams, as our expert guest.

Clinical Pearls:

1. Hypertensive crisis is divided into hypertensive emergency and hypertensive urgency.
2. • “Emergency” needs IV therapy NOW
   • “Urgency” needs increased oral therapy over next 24-72 hours
3. History, physical exam, and familiarity with the patient are key for triage (e.g. verify BP readings, assess compliance, etc.)
4. Severe HTN and hypertensive urgency can often be treated in the outpatient setting
5. IV agents are not indicated outside of true hypertensive emergency (i.e. objective end organ damage)
6. We recommend increasing dose or frequency of existing BP meds as 1st line (better long-term solution)
7. Intermittent dosing of oral labetalol, clonidine, and captopril can be considered as 2nd line (short-term solution)
8. Rule out uncontrolled pain, volume overload, alcohol withdrawal, illicit drug, and missed medications as cause of severe HTN
9. Evidence from observational studies suggests that headaches are NOT caused by HTN
10. Untreated severe HTN was historically fatal in months to years prior to development of antihypertensives

Goal: Listeners will become proficient in the appraisal of severe hypertension/ hypertensive urgency and employ safe and practical management strategies.

Learning objectives:

By the end of this podcast listeners will:

1. Confidently triage patients with severe hypertension and provide appropriate disposition in a variety of settings
2. Employ a safe and common sense approach to the treatment of severe hypertension in the clinic, the ER, or on the wards
3. Be familiar with pharmacologic management of severe hypertension in a variety of settings
4. Recognize the common causes of severe blood pressure elevation in the inpatient setting
5. Counsel patients on the relationship of severe hypertension and headache
6. Recall the natural history of untreated severe hypertension

Disclosures:

The Curbsiders report no relevant financial disclosures, but hope to become successful enough to display an absurd list of disclosures in the future.

Time Stamps

0:00 Hook

0:26 Intro

1:38 Rapid fire questions

03:45 Triage of patient with severe HTN

05:05 Case example HTN in office

07:05 Does HTN cause a headache?

08:30 Workup of severe HTN in the office

10:20 Stuart discusses HTN and headaches

11:30 In office treatment of blood pressure

14:28 Recap

15:50 Stuart discuss HTN emergency at normal BP

17:00 Acute treatment of HTN in ER

18:10 Approach to the inpatient with HTN

20:50 Choice of agent for inpatient HTN

23:23 Italian study of HTN crisis in the ER

24:20 Outcomes in asymptomatic patients with severe HTN

26:15 Sleep apnea and HTN

27:10 Natural history of untreated severe HTN

29:10 Take home points

30:50 Outro

Links from the show:

1. Blood Meridian by Cormack McCarthy
2. Horton Hears a Who by Dr. Seuss
3. ASCVD risk calculator http://tools.acc.org/ASCVD-Risk-Estimator/
4. Epocrates. Download it here
5. Dr. Johnson’s excellent review article on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/23102030
6. Another great review with tables on oral drug therapy and dosing for hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/18710665
7. Fascinating article from 1928 on The Syndrome of Malignant Hypertension* http://archinte.jamanetwork.com/article.aspx?articleid=535650
8. Observational study from Italy characterizing symptoms and outcomes in hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/8591878
9. JNC 7 recommendations for hypertensive crisis: See page 54 of this PDF for details http://www.nhlbi.nih.gov/files/docs/guidelines/express.pdf
10. Most recent review we could find on hypertensive crisis https://www.ncbi.nlm.nih.gov/pubmed/25575271
11. Migraine and subsequent risk of stroke in the Physicians' Health Study. https://www.ncbi.nlm.nih.gov/pubmed/7848119
12. Blood pressure as a risk factor for headache and migraine: a prospective population-based study. https://www.ncbi.nlm.nih.gov/pubmed/25155744
13. Blood pressure and risk of headache: a prospective study of 22,685 adults in Norway. https://www.ncbi.nlm.nih.gov/pubmed/11909904

Summary:

Does the thought of responding to an in-flight emergency ruin your air travel? Then tune in because on this episode, Angelica Zen, MD, Chief Resident of Internal Medicine at UCLA, recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane.  

Clinical Pearls:

1. Stay Calm!  If you freak out, so will everyone else.
2. Think outside the box and be prepared to improvise from available resources. (e.g. ask another passenger for a glucometer)
3. Standard medical kit contains - manual BP cuff, stethoscope (cheap), gloves, oropharyngeal airways, CPR masks, bag-valve masks, IV set, 500 ml saline, needles, syringes, analgesic tabs, antihistamine (tabs or injection), aspirin, atropine, inhaler (bronchodilator), Dextrose 50%, Epi (1:1000 and 1:10000), IV lidocaine, nitroglycerin tabs, supplemental oxygen.
4. Don’t forget to utilize the ground medical team!
5. Legal repercussions very unlikely unless there is “gross neglect” or “intentional harm”. DON’T treat patients if YOU’VE BEEN DRINKING!
6. Common emergencies in order of decreasing frequency - syncope and presyncope, dyspnea, acute coronary syndrome, altered mental status, psychiatric emergencies, stroke, cardiac arrest

Goal: Listeners will understand their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane.

Learning objectives:

By the end of this podcast listeners will:

1. Be familiar with the contents of the standard medical kit
2. Think outside the box to identify, improvise and utilize available resources for patient care
3. Recognize the medical legal consequences of providing emergency medical care on a plane
4. Confidently evaluate and manage common in-flight emergencies using the available resources

Disclosures:

Dr. Zen reports no relevant financial disclosures.

Time Stamps

00:26 Intro

02:06 Start of Interview

03:02 Rapid Fire Questions

07:08 Dr. Zen tells her story

17:27 Monitoring your patient in-flight

18:05 Contents of the standard in-flight medical kit

20:10 What Dr. Zen would have done differently

21:05 How to use available resources in-flight

22:20 Medical legal implications

26:07 How to respond to common in-flight emergencies and how to respond

27:35 Syncope and presyncope

29:52 Hypoxia altitude simulation test (HAST)

31:15 Altered mental status

31:52 Anaphylaxis

33:19 Stroke and acute coronary syndrome

34:51 Dr. Zen’s take home points

36:40 Outro

Links from the show:

1. Baby delivered in-flight by Angelica Zen, MD http://newsroom.ucla.edu/stories/
2. Pharmacy article detailing supplies in standard medical kit on plane http://www.ashp.org/menu/News/PharmacyNews/NewsArticle
3. Great review article on In-Flight Emergencies. Nable JV, Tupe CL, Gehle BD, Brady WJ.  In-Flight Medical Emergencies during Commercial Travel. N Engl J Med. 2015 Sep 3;373(10):939-45. doi: 10.1056/NEJMra1409213.
4. Article on the hypoxia (or high) altitude simulation test (HAST) https://www.ncbi.nlm.nih.gov/pubmed/18398121
5. Interesting article: Passenger safely defibrillated 21 times during International Flight. Harve H1, Hämäläinen O, Kurola J, Silfvast T. AED use in a passenger during a long-haul flight: repeated defibrillation with a successful outcome. Aviat Space Environ Med. 2009 Apr;80(4):405-8.
6. How Doctors Think by Jerome Groupman: Amazon.com link
7. NEJM Physicians First Watch http://www.jwatch.org/medical-news

Summary:

On this episode, we got served! Endocrinologist, Dr. Pauline Camacho, current president of AACE and Professor of Medicine at Loyola University Chicago makes it rain clinical pearls as she schools us on the use of calcium, Vitamin D, bisphosphonate therapy and drug holidays. This is a must listen for anyone treating osteoporosis. Make sure to check out the new 2016 AACE guidelines, which include infographics for patients and their easy to use algorithm.

Clinical Pearls:

Vitamin D

1. Vitamin D for postmenopausal osteoporosis prevention (women ≥ 50 yo)
2. 1. Optimum Vit D level between 30-50 ng/ml recommend
   2. Check PTH if Vit D is very low
   3. If secondary hyperparathyroidism then treat until PTH normalizes
   4. Usual dose is Vit D2 or D3 1000 to 2000 IU daily
   1. Weekly dosing may be required for loading
   2. Vit D3 preferred if malabsorption (e.g. post gastric bypass)
3. Vitamin D2 or D3 50,000 IU dosed monthly or biweekly is probably safe despite trials suggesting increased falls^2-3

Calcium

1. Calcium recommended total daily intake through diet +/- supplements
2. 1. postmenopausal women 1200 mg daily
   2. Men 1000 mg
3. Calcium citrate has better absorption, especially in the elderly or those on PPI

Osteoporosis and drug therapy

1. AACE’s four criteria for diagnosis osteoporosis
   1. T-score –2.5 or below in the lumbar spine, femoral neck, total, and/or 33% (one-third) radius
   2. Low-trauma spine or hip fracture (regardless of BMD)
   3. Osteopenia or low bone mass (T-score between –1 and –2.5) with a fragility fracture of proximal humerus, pelvis, or possibly distal forearm
   4. Low bone mass or osteopenia and high FRAX® fracture probability based on country-speci c thresholds
2. Bisphosphonate therapy
   1. Treat for 5-10 years with oral or 3-6 years with IV bisphosphonates
   2. High fracture risk: elderly patients or those with hx of fracture then consider IV agents 1st line (zoledronic acid, denosumab, teriparatide)
3. Therapy is successful if:
   1. Stable bone mineral density (BMD)
   2. Increasing BMD
   3. Diminishing levels bone turnover markers (e.g. N-terminal and C-terminal cross-linked telopeptides)⁴
4. Therapy is a failure if:
   1. Significant or progressive loss of BMD (using a reliable machine)
   2. Fracture occurs
5. Drug holiday may last several years, but ends if:
   1. Fracture occurs
   2. BMD declines significantly
   3. Rising bone turnover markers (telopeptides)
6. After drug holiday the clock resets. Meaning patient may start another full treatment course with bisphosphonate, denosumab or teriparatide
7. After a hip fracture
   1. Check Vit D level and replete
   2. Start bisphosphonate once Vit D level corrected (usually takes 2-3 months)
8. Routine testing of BMD is recommended for men >70 yo
   1. If you can get it covered!

Disclosures:

Dr. Camacho did not report any relevant financial disclosures.

By the end of this podcast listeners will be able to:

1. Make recommendations for daily intake of vitamin D, recognize appropriate levels, and treat secondary hyperparathyroidism
2. Ensure adequate calcium intake through diet and/or supplementation and counsel patients on risks and benefits
3. Select appropriate bone preserving therapy, treatment course, and learn to monitor for treatment failure
4. Identify appropriate timing of drug holidays and reinitiation of drug therapy 

Links from the show:

1. Hot off the press! 2016 AACE Guidelines for postmenopausal osteoporosis https://www.aace.com/files/final-appendix-sept-7.pdf
2. Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline RCT JAMA Int Med Jan 2016
3. Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women JAMA 2010
4. Eastell R et al. Bone turnover markers and bone mineral density response with risedronate therapy: relationship with fracture risk and patient adherence. J Bone Miner Res. 2011 Jul;26(7):1662-9. doi: 10.1002/jbmr.342. 

Further recommended reading:

1. Calcium intake and bone mineral density: systematic review and meta-analysis
2. Calcium intake and risk of fracture: systematic review
3. Dr. Camacho responds to reader response about physiologic norm for Vit D level http://ajcn.nutrition.org/content/101/2/413.2.full.pdf
4. Dr. Camacho’s review article on prediction of fracture risk from Jul 2015 https://www.ncbi.nlm.nih.gov/pubmed/26236988
5. Differing Vit D levels by latitude challenge idea of a physiologic norm https://www.ncbi.nlm.nih.gov/pubmed/25008852
6. VITAL Study for Vit D and Omega 3 fatty acids for prevention of cancer, heart attack and stroke http://www.vitalstudy.org

Summary:

Dr. Robert Centor’s Knowledge Food, Part 2!  On this episode of The Curbsiders, we continue our discussion with the legendary Dr. Centor, focusing on pharyngitis and the highly entertaining origin of the Centor Criteria.  Not only do we learn how to dominate pharyngitis, but we also uncover one of Dr. Watto’s knowledge deficits - Lemierre’s Syndrome.  (He owes us a two minute talk on Lemierre’s Syndrome in case you’re wondering. I know I am.)

Clinical Pearls:

1. Admit your own limitations!  Many overestimate their skills as a clinical educator.
   1. Preadolescents get streptococcal pharyngitis (...or it’s nothing).
   2. Adolescents are much more complicated with streptococcus, EBV, CMV, acute HIV, fusobacterium, and multiple other causes.
2. Important: Separate the causes of pharyngitis in preadolescents and adolescents.
   1. General rule: Sore throats should not cause rigors; if present then admit patient, obtain blood cultures, and start antibiotics.
3. Do NOT miss a peritonsillar abscess or Lemierre’s Syndrome in acute pharyngitis.
4. Pharyngitis improves within three to five days.  Failure to improve should prompt a more thorough investigation.
5. Lemierre’s Syndrome (1 in 70,000 untreated pharyngitis patients) is septic thrombophlebitis of the internal jugular vein.  The treatment is IV antibiotics and NOT anticoagulation.  
6. Dr. Centor and the IDSA recommends Amoxicillin once daily and, if penicillin allergic, Clindamycin.  The most recent IDSA update recommends a 10-day course of Amoxicillin (50mg/kg up to 1000mg once daily).

Dr. Centor’s “Take-Home” Points:

1. Adolescents tend to have more complicated pharyngitis
2. Pharyngitis and rigors?  Admit, obtain cultures, and start antibiotics.
3. Sore throats don’t get worse and, if they do, you need to rethink the case

Disclosures:

Dr. Centor reports no relevant financial disclosures for this topic.

Learning objectives:

By the end of this podcast listeners will be able to:

1. Identify the limitations of the Centor Criteria in regards to (a) preadolescents and (b) adolescents, taking special precautions in the adolescent population
2. Understand which acute pharyngitis patients require a more thorough investigation
3. Be able to identify Amoxicillin as the treatment of choice for acute bacterial pharyngitis with Clindamycin as the second-line antibiotics choice.

Links from the show:

1. Check our Dr. Centor’s wonderful blog, at http://www.medrants.com or on twitter https://twitter.com/medrants
2. Centor’s Criteria (MDCalc) -- http://www.mdcalc.com/modified-centor-score-for-strep-pharyngitis/
3. IDSA Guidelines on Diagnosis and Management of Group A Streptococcus Pharyngitis - http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full.pdf+html
4. Original article using the Centor score for pharyngitis https://www.ncbi.nlm.nih.gov/pubmed/6763125?dopt=abstract
5. Dr. Centor’s article on fusobacterium Centor RM, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015 Feb 17;162(4):241-7. doi: 10.7326/M14-1305.

Summary:

Dr. Robert Centor’s Knowledge Food, Part 1.  This Halloween, the “Curse of Knowledge” is REAL!  So you think you can teach? This master clinician educator, known for “Centor’s Criteria,” schools us the most common errors made by medical educators and how to improve learner retention.  While we only scratch the surface, Season 1’s arguably penultimate episode should NOT be missed.  After all, how else are you going to learn about Pretty Pimpin’?  Stay tuned for Part Duex when we briefly review Pharyngitis and Dr. Watto finally learns about Lemierre’s Syndrome!  As always, you’re welcome.

Clinical Pearls:

1. Don’t fall victim to the “Curse of Knowledge!”  Remember that your students/residents do not know what you know!
2. Effective rounding should include a healthy mixture of both table-top and bedside rounds.
3. Feedback should be specific, timely (even immediate!), and focused on improvement.  
4. Allow the learner to self-evaluate before providing specific feedback and invite all members of the team to provide collaborative feedback.
5. Always remember that feedback should be positive as well as constructive.
6. There are multiple courses available to further your own skills as a medical educator
7. The physician-educator should embody the “servant leader” and prioritize medical education (the “service” you are providing).
8. Consider blogging to improve your own writing!

Dr. Centor’s “Take-Home” Points:

1. The “Curse of Knowledge” is real -- never assume the basics are known.
2. The attending physician should embody service before self.
3. Dr. Centor’s playlist -- Matt Duncan, Lawrence, Saint Paul and the Broken Bones, Houndmouth, Kurt Vile

Disclosures:

Dr. Centor reports no relevant financial disclosures for this topic.

Learning objectives:

By the end of this podcast listeners will be able to:

1. Understand the basics concepts that underscore effective feedback (specific, timely, and collaborative)
2. Identify the tenants that underscore effective rounding
3. Re-evaluate your own teaching style and consider training seminars to improve your skills as a medical educator

Links from the show:

1. Dr. Centor’s Blog -- http://www.medrants.com/
2. Dr. Bradley Sharpe’s profile -- http://profiles.ucsf.edu/bradley.sharpe
3. Stanford Faculty Development Course -- http://sfdc.stanford.edu/
4. UCSF Workshop - “Developing Skills in the Art of Effective Feedback” -- http://meded.ucsf.edu/radme/developing-skills-art-effective-feedback
5. Ten Tips for Receiving Feedback -- http://med-ed-online.net/index.php/meo/article/view/25141
6. Who should take statins? -- https://www.washingtonpost.com/news/to-your-health/wp/2016/10/04/who-should-take-statins-a-vicious-debate-over-cholesterol-drugs-side-effects/?postshare=1551475707596812&tid=ss_tw
7. Kurt Vile - “Pretty Pimpin” -- https://www.youtube.com/watch?v=659pppwniXA
8. 7 Habits of Highly Effective People by Stephen Covey
9. Made to Stick: Why Some Ideas Survive and Others Die by Chip and Dan Heath

Summary:

Stop feeling helpless in the face of vague complaints like fatigue, digestive problems, mood swings, inability to lose weight, etc. Learn to treat any chronic disease without writing more prescriptions. Heal yourself and your patients with the power of food. Join us for the return of Functional Medicine physician, Dr. Yousef Elyaman, as he schools us on elimination diets, phytonutrients, liver detoxification, going “paleo” and more. This is a deluxe episode so we’ve included a time key below. You’re welcome.

Clinical Pearls:

1. Use the 80:20 rule. Try to make 80% of your food paleolithic (unprocessed).
2. Eliminate the chemicals when possible (processed foods, plastics, cleaning products, cosmetics, etc.)
3. Workarounds for your budget: home garden and/or frozen foods.
4. Preserve phytonutrients - Avoid microwaves. Lightly saute or eat veggies raw.
5. Try an elimination diet for one month then reintroduce foods one at a time.
6. Assess patient readiness and prescribe diet that fits their degree of commitment.
7. Basic lab panel to consider: Check homocysteine, zinc, 25OH Vit D, B12, RBC folate, RBC magnesium (use diagnosis of fatigue).
8. More specialized labs: 
   1. SpectraCell - Micronutrient panel.
   2. NutraEval Plasma by Genova Diagnostics.
   3. Check for MTHR mutation (if off then patient needs methylfolate).

Dr. E's Four steps to healing with food

1. Ensure a nutritionally dense diet.
2. Remove bothersome foods.
3. Replace deficiencies.
4. Rebalance the system.

Disclosures:

Dr. Elyaman reports no relevant financial disclosures for this topic.

Learning objectives:

By the end of this podcast listeners will be able to:

1. Appraise the quality of a patient’s diet and identify potential sources of intolerance/food sensitivity
2. Counsel patients on sustainable dietary changes to remove potentially bothersome foods and chemicals
3. Perform a basic laboratory evaluation to identify deficiencies
4. Identify resources for patients and providers to facilitate education and adherence

Show breakdown

0:00 Intro.

02:30 Welcome Dr. Elyaman.

03:15 Stuart bums everyone out with a current event.

04:30 Functional Medicine defined.

07:10 Logistics of educating patients on dietary changes.

11:15 Four steps to healing with food.

15:00 Use food to treat chronic disease.

16:45 Fats and a nutritionally dense diet.

20:00 Alzheimer’s and food.

23:45 Phytonutrients.

27:45 Eating on a budget.

33:40 Genetically modified foods, lectins and autoimmune disease.

40:30 Elimination diets.

46:00 Multiple sclerosis, Milk and casein.

50:00 Autism’s interplay with diet, genes, folate metabolism.

53:00 How to boost liver detoxification.

56:00 The Wahl’s protocol for multiple sclerosis.

58:30 Paleo diet.

1:00:00 Patient adherence.

1:07:35 Testing for and repleting vitamin deficiencies.

1:11:15 Fast food salad and inflammatory markers (Stuart derails the show again).

1:14:30 Dr. E’s Take home points.

Links from the show:

1. The Institute of Functional Medicine's Elimination Diet Plan
2. Stanford FODMAP Diet Handout
3. Visit Dr. E's website for Absolute Health
4. Institute of Functional Medicine website - https://www.functionalmedicine.org
5. Learn the basics - Intro To Functional Medicine by Dr. David Jones and Sheila Quinn
6. MSQ questionnaire from Dr. Hyman's website - assess medical symptoms and toxicity
7. DASS 21 questionnaire - for anxiety, depression, stress
8. A study of macronutrient type on ApoE levels in ApoE2, E3, E4 genotypes
9. Video on the “10 Americans” study by the Environmental Working Group - chemicals in cord blood https://youtu.be/0-kc3AIM_LU
10. EWG.org (environmental work group) - gives the Dirty Dozen and the Clean 15
11. Gluten free diet removes anti islet cell Ab in a child https://www.ncbi.nlm.nih.gov/pubmed/12434905
12. Dr. Terry Wahls TED Talk - Diet for Multiple Sclerosis (the Wahls protocol)
13. The Paleo Diet book can be purchased here
14. Handful of nuts per day lowers mortality in both of these studies https://www.ncbi.nlm.nih.gov/pubmed/25833976 and https://www.ncbi.nlm.nih.gov/pubmed/26548503
15. 23 and Me genetic testing
16. SpectraCell - Micronutrient panel
17. NutraEval Plasma by Genova Diagnostics
18. Stuart’s Omron blood pressure cuff

Learn to treat non cancer pain in the elderly. Managing persistent pain in the elderly can be...painful. On this episode Matt and Paul interview Dr. Marissa Galicia-Castillo, a Professor of Geriatrics from Eastern Virginia Medical School board certified in Internal Medicine, Geriatrics, Hospice/Palliative Medicine. Are we being too stingy with opioid prescriptions? How do you assess and treat pain in patients with advanced dementia? We’ve got your answers.

Clinical Pearls:

1. Persistent pain in the elderly is underrecognized and undertreated
2. Nonpharmacologic therapy is still first line (get off the couch!)
3. Scheduled acetaminophen is a valid first line
4. Consider low dose oxycodone IR as a second line (assuming NSAIDS contraindicated)
5. Diversion of medication by family members is a concern and may cause treatment failure
6. Opiates can be a great tool. Don’t be afraid to use them with careful patient selection.
7. Follow quality of life and functional status as your end points for pain control.
8. Pain in cognitively impaired may present as behavior problems. Treat the pain and treat the behavior.

Disclosures:

Dr. Galicia-Castillo reports no relevant financial disclosures.

Learning objectives:

By the end of this podcast listeners will be able to:

1. Recognize that pain in the elderly is often underrecognized and undertreated.
2. Recognize the signs and symptoms of pain in patients with cognitive impairment.
3. Utilize opiates safely and effectively for the management of noncancer pain in the elderly
4. Formulate a basic therapeutic approach to noncancer pain utilizing nonpharmacologic and pharmacologic therapy 

Links from the show:

1. Dr. Galicia-Castillo’s article on use of opioids for persistent noncancer pain in older adults

http://www.ccjm.org/current-issue/issue-single-view/opioids-for-persistent-pain-in-older-adults/a136ddc8a922abd74237073a1ab89d4f.html

2. CDC guidelines on prescribing opioids for chronic pain (#8 discusses criteria for naloxone prescribing)

https://www.cdc.gov/drugoverdose/pdf/guidelines_factsheet-a.pdf

3. World Health Organization Pain Ladder

http://www.geriatricpain.org/Content/Management/Interventions/Documents/WHO%20ladder.pdf

4. Observational study of Naloxone administration along with opiate prescriptions (NEJM Journal Watch 2016).

http://www.jwatch.org/na41676/2016/07/19/should-naloxone-be-prescribed-patients-taking-opioids

5. Effect size seen with opiates and tramadol were small in this review, but adverse event rates were high. This is why a trial with monitoring of functional  status is recommended.

http://www.ncbi.nlm.nih.gov/pubmed/21472151

6. A RCT looking at Tramadol for knee osteoarthritis with underwhelming results.

http://www.ncbi.nlm.nih.gov/pubmed/20215961

7. EULAR 2016 guidelines for treatment of fibromyalgia

http://ard.bmj.com/content/early/2016/07/04/annrheumdis-2016-209724.abstract

8. Dr. Clauw’s YouTube Video

Chronic Pain: Is it all in their head?

9. Dr. Clauw’s University of Michigan website for patient self education on fibromyalgia

Fibroguide.com

Summary:

Fifty four percent of physicians report at least one symptom of burnout. On this episode Dr. Philip Kroth an Internist and Chief of Clinical Informatics from the University of New Mexico schools us on how electronic health records (EHR) relate to burnout and tips to promote physician wellness. Miss this episode and you might get burned...out. I refuse to apologize for that pun. Enjoy!

Clinical Pearls:

*Check out the article by Shanafelt below to view breakdown of burnout by specialty.

*24/7 access to EHRs is a double-edged sword. You have to protect your own time.

*Turn off email alerts.

*Limit your screen time when off the clock. Kids are only allowed 1 hour per day!

*Take the EHR training and become a MASTER.

*Keep in mind these four domains related to burnout and try to mitigate your risk.

1. Health information technology and documentation burden
2. Stress versus control and support. You need to balance the “seesaw”
3. Health policy and regulation (e.g. ACOs, MACRA)
4. Physician culture of endurance (e.g. giving yourself an IV when sick instead of going home)

Disclosures:

None reported.

Links from the Show:

1. Article by Shanafelt finding burnout in 54 percent of physicians.

Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014 Shanafelt, Tait D. et al. Mayo Clinic Proceedings , Volume 90 , Issue 12 , 1600 - 1613

2. Turnover of primary care doctors cost about $250,000 in 1991!

Buchbinder, SB et al. Estimates of Costs of Primary Care Physician Turnover. Am J Manag Care. 1999 Nov;5(11):1431-8.

3. Maslach Burnout Inventory

http://www.mindgarden.com/117-maslach-burnout-inventory

4. Volkswagen stops sending emails in the evening.

http://www.bbc.com/news/technology-16314901

Do complaints of insomnia stress you out? Well, never fear. In this episode our guest is Dr. Karl Doghramji, Professor of Psychiatry, Neurology and Medicine and the Medical Director of the Sleep Disorders Center at Thomas Jefferson University Hospital in Philadelphia. With his help we deconstruct the “dread pirate” insomnia (as I call it) so you can dominate it in your daily practice.

Disclosures:

Dr. Doghramji reports recent relationships with Merck (stock) and consulting work for Merck, Xenoport, Jazz, Inspire, Teva and Pfizer. He has a current research grant from Inspire.

Clinical Pearls:

*Pathophysiology: Likely biological, neurobehavioral and psychological hyperarousal. Possible genetic component.

*Depression, anxiety or PTSD may be their primary disorder. Many insomniacs unaware of their depression. Need a high index of suspicion.

*Sleep apnea is probably cause in 10-20% of patients who present with insomnia.

*GERD can present with insomnia and night time awakenings as its primary symptom.

*CBT works as well as pharmacotherapy and has lasting potential even 1-2 years after discontinuation of therapy.

*High yield nonpharmacologic therapy: Get up at the same time every morning. Don’t sleep in, even if bedtime or sleep onset was delayed.

*Melatonin: It’s effect depends on time administered (see below). It’s not as safe as you think (insulin resistance, low sperm count)

1. Administer very low dose (under 3 mg) four to five hours prior to bed for delayed sleep phase (usually occurs in teens).

2. Administer higher dose (3-5 mg) one hour before bed for sleep initiation (adults with fragmented sleep).

*Agents for sleep initiation: zaleplon, zolpidem, ramelteon

*Agents for sleep maintenance: zolpidem ER, eszopiclone, doxepin (low dose of 3mg or 6mg), gabapentin (off label)

*Suvorexant (orexin antagonist) treats both sleep initiation and maintenance: Start 10 mg and go up 5 mg every few weeks to max 20 mg daily. Orexins are deficient in narcolepsy. Orexins seem to mediate a switch system between arousal and sleepiness.

*Doxepin, gabapentin and ramelteon have very lose risk for abuse. 

*Off-label use of diphenhydramine for sleep is not recommended ("dirty drug"). Trazodone and mirtazapine also have uncertain benefit.

*Mirtazapine 7.5 mg is the dose for insomnia (more sedating). Lower dose favors histamine receptor.

Links from the Show:

1. This is one possible site for online CBT

https://www.sleepio.com as referenced in this study

2. Melatonin associated with impaired glucose tolerance

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173928/

3. American Academy of Sleep Medicine

4. This site below has easy to understand information on sleep related disorders and links to videos explaining sleep hygiene. You can also download sleep logs, get info.

SleepEducation.org Website

5. Review on use of mindfulness and meditation for insomnia.

http://www.ncbi.nlm.nih.gov/pubmed/26390335

Summary:

In this episode our guest is Dr. Robert Dickson a Pulmonologist from the University of Michigan who studies the respiratory microbiome. We discuss how the lung microbiome differs in health, chronic illness and acute disease states like pneumonia, sepsis and ARDS. The lung microbiome has the ability to predict frequency of exacerbations and even severity and progression of certain lung diseases. We’ll explore all of this plus Dr. Dickson’s new paper published last month in Nature Microbiology, which had the surprise of finding gut bacteria in the lungs during critical illness. Please enjoy this wide ranging discussion

Disclosures:

Dr. Dickson did not report any disclosures.

Clinical Pearls

1. The lungs are constantly bombarded by microbes and the largest host to microbe interface in the body where bacteria come within millimeters of the blood stream.

2. The lung microbiome is altered in both acute and chronic diseases

3. The lung microbiome is altered by antibiotics, corticosteroids, PPIs and probably lots of other things we are just beginning to discover.

Links from the Show:

Dr. Dickson’s latest article reporting gut bacteria in the lungs during critical illnesses.

Dickson, R et al. Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome. Nature Microbiology 1, Article number: 16113 (2016). doi:10.1038/nmicrobiol.2016.113

A link to Dr. Dickson’s podcast discussing the role of microbiome and the care and treatment of critically ill patients.

The role of microbiome: The Lancet Respiratory Medicine: January 2016

Dr. Dickson’s recent publication in The Lancet.

Robert Dickson. The microbiome and critical illness. The Lancet. Published Online: 11 December 2015. DOI: http://dx.doi.org/10.1016/S2213-2600(15)00427-0

Five clinical pearls on the Pulmonary microbiome

Robert P. Dickson and Gary B. Huffnagle. The Lung Microbiome: New Principles for Respiratory Bacteriology in Health and Disease. PLoS Pathog. 2015 Jul; 11(7): e1004923. Published online 2015 Jul 9. doi:  10.1371/journal.ppat.1004923 PMCID: PMC4497592

A comprehensive review of the Pulmonary Microbiome field

Dickson, RJ et al. The Microbiome and the Respiratory Tract. Annu Rev Physiol. 2016;78:481-504. doi: 10.1146/annurev-physiol-021115-105238. Epub 2015 Nov 2.

Summary:

In this episode our guest is Master Lipidologist, Dr. Peter Howard Jones from Baylor College of Medicine and the National Lipid Association. My guest host is Dr. Paul Williams, Clinician Educator extraordinaire from Philadelphia. We explore everything you’ll ever want to know about cholesterol and lipids. Are statins still king when it comes to cholesterol lowering? Should we be rushing to use PCSK9 inhibitors? Should we throw away older drugs like fibrates? Are nonpharmacologic therapies like niacin and fish oil worthwhile? Join us for this extensive conversation.

Disclosures:

Dr. Jones is the Chief Science Officer at the National Lipid Association. He has served as a scientific advisor to Merck, Amgen and Sanofi.

Learning objectives:

1. Identify each individual's risk for cardiovascular disease and counsel them on benefits of therapy.

2. Learn to lower atherogenic lipids by any means necessary and understand the effects of the common lipid lowering drugs

3. Effectively counsel patients on benefits of lipid lowering drugs to promote patient buy in and adherence.

Clinical Pearls

1. Omega 3 fatty acids at 1,000 mg daily or more is useful for prevention of sudden death in post ACS patients.

2. Omega 3 fatty acids at dose of 4,000 mg per day is needed to lower triglycerides. Indicated if TG remain above 500 on first line therapy.

3. Hypertriglyceridemia with level above 500 on optimal statin dose, then consider addition of fibrate and/or omega-3 fatty acids. Uncertain clinical benefit in patient with moderate elevation (200-300) of triglycerides.

4. Statin intolerance can be overcome in most patients using the following methods:

a. Same statin at lower dose

b. Different statin

c. Use of rosuvastatin or atorvastatin 3 times weekly

5. Statins are safe to take for at least 20 years and probably longer (this data is still being collected, but will be available in the future)

6. Withdrawal of statins at the end of life is not harmful and may be beneficial.

Links from the Show:

Studies that used fibrates for preventions of CV events:

Helsinki Heart Study for primary prevention NEJM 1987

VA HIT Study for secondary prevention NEJM 1999

Withdrawal of statins at the end of life

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4618294/

Expert Consensus on use of Non-Statin Drugs

http://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/30/11/58/2016-acc-expert-consensus-decision-pathway-on-the-role-of-nonstatin

National Lipid Association recommendations for patient-centered management of dyslipidemia

https://www.lipid.org/sites/default/files/Recommendations-Part-1.pdf

Recommended websites

National Lipid Association

The Heart.org (Medscape)

Journal of Clinical Lipidology

Treat C. diff, choose the correct antibiotic regimen, and identify who needs fecal transplant as we “curbside” Gastroenterologist, Dr. Adam Ehrlich from Temple University Hospital. On the show, we cover the ins-and-outs of procuring, preparing and performing transplants as well as future directions in this burgeoning field e.g. IBD, obesity, metabolic syndrome and more.

Take Home Points:

1. Clostridium difficile infection is the only indication for which FMT is allowed by the FDA without special authorization
2. FMT is VERY effective in these C difficile patients compared to standard of care (approximately 90% cure vs 30%)
3. We are just beginning to understand the role of the microbiome in human health, and I anticipate many changes in the years ahead where modifying the microbiome will be used to help treat a number of diseases.

 Links from the Show:

Recommended reading...

NEJM Journal Watch for Gastroenterology - register here

Review on novel uses for fecal transplantation

Rossen NG, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. World J Gastroenterol. 2015 May 7;21(17):5359-71. doi: 10.3748/wjg.v21.i17.5359.

Randomized controlled trial of fresh vs frozen fecal transplantation

Fresh vs Frozen Fecal Microbiota Transplant for C diff Recurrent C difficile infection. JAMA 2016

Review on mechanisms for gut microbiota on metabolic syndromes

Qian LL, et al. Effect of the Gut Microbiota on Obesity and Its Underlying Mechanisms: an Update. Biomed Environ Sci. 2015 Nov;28(11):839-47. doi: 10.3967/bes2015.117.

In this episode Dr. Yousef Elyaman from the Institute of Functional Medicine schools us on how the biochemistry and pathophysiology we’ve forgotten from medical school can be used to cure illness. FODMAP diet and Antibiotics to cure restless legs syndrome? Melatonin to treat gastroesophageal reflux disease?  This is just a little taste of the knowledge food served up on this introduction to Functional Medicine.

This episode, part 2 of our last episode, is a must listen if you’ve ever felt helpless in the face of fibromyalgia and chronic pain. Keep listening for part 2 of our “curbside” with expert clinician and prominent researcher Dr. Daniel Clauw, from the University of Michigan’s Chronic Pain and Fatigue Research Center. The show is chock full of clinical pearls for the mastery of chronic pain syndromes.

This episode, part 1 of 2, is a must listen if you’ve ever felt helpless in the face of fibromyalgia and chronic pain. Listen as we “curbside” expert clinician and prominent researcher Dr. Daniel Clauw, from the University of Michigan’s Chronic Pain and Fatigue Research Center. The show is chock full of clinical pearls for the mastery of chronic pain syndromes.

In this episode we “curbside” SoCal Cardiologist, Dr. Neel Patel. If you’re like us and confused by the smorgasbord of cardiac imaging and stress testing then this show is a must listen. Whether you’re in the clinic or on call for Internal Medicine, Dr. Patel has your answers on coronary artery calcium scoring, coronary CT scans and all types of stress testing.  

If headache patients strike fear in your heart, then this is the episode for you. In this episode The Curbsiders interview Internist and Headache Specialist Dr. Glen D. Solomon to deconstruct the topics of migraine and chronic tension type headaches. Dr. Solomon is currently a Professor and Chair of the Department of Internal Medicine at Wright State University and a former director of the Headache Medicine Fellowship at the Cleveland Clinic. Join them as they discuss the approach to diagnosis and management of chronic headaches. 

In this part 1 of 2 episode on the non-Vitamin K oral anticoagulants, The Curbsiders discuss these novel medications and other changes associated with the updated 2016 CHEST guidelines for anticoagulation. 

In this interview, Matt speaks with Dr. Paul Williams about the SPRINT Trial of Intensive blood pressure control and how it is likely to change clinical practice. Tony and Stuart discuss their own take-home points from the trial. Discussion of ARBs you've never heard of and the holy grail of blood pressure cuffs ensues.

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